The second type of fat is a normal reserve of fuel upon which the body can freely draw when the
nutritional income from the intestinal tract is insufficient to meet the demand. Such normal
reserves are localized all over the body. Fat is a substance which packs the highest caloric value
into the smallest space so that normal reserves of fuel for muscular activity and the maintenance
of body temperature can be most economically stored in this form. Both these types of fat,
structural and reserve, are normal, and even if the body stocks them to capacity this can never be
But there is a third type of fat which is entirely abnormal. It is the accumulation of such fat, and
of such fat only, from which the overweight patient suffers. This abnormal fat is also a potential
reserve of fuel, but unlike the normal reserves it is not available to the body in a nutritional
emergency. It is, so to speak, locked away in a fixed deposit and is not kept in a current account,
as are the normal reserves.
When an obese patient tries to reduce by starving himself, he will first lose his normal fat
reserves. When these are exhausted he begins to burn up structural fat, and only as a last resort
will the body yield its abnormal reserves, though by that time the patient usually feels so weak
and hungry that the diet is abandoned. It is just for this reason that obese patients complain that
when they diet they lose the wrong fat. They feel famished and tired and their face becomes
drawn and haggard, but their belly, hips, thighs and upper arms show little improvement. The fat
they have come to detest stays on and the fat they need to cover their bones gets less and less.
Their skin wrinkles and they look old and miserable. And that is one of the most frustrating and
depressing experiences a human being can have.
Injustice to the Obese
When then obese patients are accused of cheating, gluttony, lack of will power, greed and sexual
complexes, the strong become indignant and decide that modern medicine is a fraud and its
representatives fools, while the weak just give up the struggle in despair. In either case the result
is the same: a further gain in weight, resignation to an abominable fate and the resolution at least
to live tolerably the short span allotted to them - a fig for doctors and insurance companies.
Obese patients only feel physically well as long as they are stationary or gaining weight. They
may feel guilty, owing to the lethargy and indolence always associated with obesity. They may
feel ashamed of what they have been led to believe is a lack of control. They may feel horrified
by the appearance of their nude body and the tightness of their clothes. But they have a primitive
feeling of animal content which turns to misery and suffering as soon as they make a resolute
attempt to reduce. For this there are sound reasons.
In the first place, more caloric energy is required to keep a large body at a certain temperature
than to heat a small body. Secondly the muscular effort of moving a heavy body is greater than
in the case of a light body. The muscular effort consumes calories which must be provided by
food. Thus, all other factors being equal, a fat person requires more food than a lean one. One
might therefore reason that if a fat person eats only the additional food his body requires he
should be able to keep his weight stationary. Yet every physician who has studied obese patients
under rigorously controlled conditions knows that this is not true. Many obese patients actually