=Definition.=—Obesity is essentially a nutritional disease and is an
inconvenient accumulation of adipose tissue in the body, sometimes
impairing the bodily function. With some individuals obesity is a
normal condition. In others it means impaired health, especially poor
elimination.
=Etiology= and =Pathology=.—Heredity, overeating, sedentary habits,
hot, moist climates are predisposing causes. Exciting causes are
especially the eating of fat-making food, excessive use of alcohol
and insufficient exercise. Obesity may follow the menopause or an
infectious disease. Osteopathic lesions are frequently found in
the upper and middle dorsal region. These probably are causes of a
disturbed metabolism. An excessive diet of starches and sugars will
indirectly act as a fat producer. In young people the possibility of
hypopituitarism should be considered. Lesions of the upper cervical, in
these cases, are frequent.
=Pathologically=, adipose tissue is deposited throughout most of
the tissues. Usually the abdomen is encumbered with a large amount.
Passive congestion probably favors the deposition of fat, for in cases
of pendulous abdomen, simply drawing the abdomen in and up and the
patient, through voluntary effort, keeping it up, will frequently cause
absorption of the fat in a few days or weeks. The fat is distributed
underneath the skin, throughout the viscera and about the heart. The
tissues may suffer from fatty infiltration, especially the heart,
arteries and veins; also the liver, kidneys and stomach. There is an
increase of specific gravity of the blood. Edema occurs from passive
congestion, due to weak heart.
=Symptoms.=—The round, fat face, double chin, hanging cheeks, large
waist, the thick, prominent, sometimes pendulous abdomen, and the
bulky extremities form characteristic features. At first obesity
presents no harmful symptoms. Usually the first troublesome symptom
is increased frequency in the breathing, due to a weak and overworked
heart, and to the fact that the motion of the lungs is hampered by
the heavy chest walls, and also by the interference with the descent
of the diaphragm on account of the enlarged liver. Dyspnea, passive
congestion, anemia, poor digestion, uterine disorders, and mental
inactivity are common. There is cardiac hypertrophy; later the heart is
overlaid with fat. The pulse is usually frequent, but may be irregular
and slow.
=Treatment.=—Obesity being a nutritional disease it seems but
reasonable that alterations of the anatomical structures will produce
a change in the proper balance of nutrition. Along osteopathic lines,
derangement of tissues affecting the nerves to the digestive and
lymphatic systems will produce obesity. In the majority of cases
examined have been found disturbances at the sixth and seventh
cervical, fourth and fifth dorsal and from the tenth dorsal to the
second lumbar. Lesions at these points could readily interfere with
the thoracic duct and the receptaculum chyli, as well as with the
processes of digestion, assimilation and elimination. It is claimed
that stimulation of the splanchnic nerves causes dilatation of the
receptaculum chyli. Direct treatment to the abdomen and to areas of
fatty deposit will aid very materially in absorption.
The =dietetic treatment= is essential, the principle being to furnish
less food to oxidize. Restrict fats, sugar and starches and limit the
amount of water. Alcohol should be prohibited. Another important point
in the treatment is exercise, which must be carried out in a systematic
way. Rules can be laid down only in individual cases and should be
governed by the osteopath in charge. The principal effect of general
mechanical treatment is to promote oxidation. Massage and baths are
beneficial. The patient can do much for the abdomen by keeping it in
and up, and walking erect.