Contraindications and Therapeutic Results of Fasting in Obese Patients*

Abstract

Results and hazards attending intermittent total fasts of 10 days to two weeks are illustrated from an experience with approximately 900 intractably obese patients in the past three years. Our study was instigated by the results which Bloom' obtained in his modification of this ancient therapeutic measure. Liquids, free of nutritional value, are allowed ad libitum and supplementary vitamins are prescribed. If no contraindication is detected, the fast is begun on the second day of hospitalization.An abrupt decrease in weight ensues varying from 2 to 10 pounds in the first 24 hours. The heavier the patient the greater is the reduction. About 25 per cent of that lost in two weeks is regained in two to four days after resumption of a low caloric diet, e.g. 1100 calories. This gain in weight is attributable to water retention that ensues with resumption of food, notably carbohydrate and salt. A gradual decrease in weight follows in response to the reduced caloric intake-1 100-1900 calories, a gradual increase in physical exercise and to interspersed single days of fasting once per week initially and with longer intervals intervening as the need for them decreases.This therapy is effective and is clinically acceptable for patients with obesity that has been refractory to conventional methods of redu~tion.',~ Anorexia is the rule throughout the fast though some patients are hungry for the first day. The reduction in weight has a salutary effect on the mild diabetes that was present in 51 per cent of our series, 38 per cent being newly discovered cases. Favorable effects were especially noted in cases of hypertension, impaired pulmonary function, chronic cardio-vascular disease and psoriasis.Several preventable hazards have been encountered with the total fast regimen as we have employed it.Cardiac disorders. Three adult male patients developed atrial flutter during the fast. In each this abnormality followed a breach of the rule that physical exercise be kept a t a minimum.Illustrative Case: W.K., a male aged 62 years, had a history of having had attacks of supraventricular arrythmias for 25 years. An attack on the fourth day of the fast followed a six mile walk-part of a daily routine advised by his cardiologist prior to the fast during which this exercise was continued surreptitiously. A normal cardiac rhythm followed resumption of a 1500 calorie diet,

Long‐term weight loss and weight‐loss maintenance strategies

“…Total starvation was a treatment modality during the last century up to the 1960s (17,18), before it was realized that weight‐loss maintenance rather than weight loss only was the crucial issue. With ketonaemia developing possibly curbing hunger, it was not very difficult for patients to lose weight in specialized units, being supplied only with fluids, electrolytes, minerals, vitamins and other essential trace elements.…”

Initial- und Spätergebnisse der Diätbehandlung bei Fettsucht

“…Auch durch Kuren mit i000 Kalorien Mischdiät lassen sich erhebliche Gewichtsverluste erreichen. So steht der stärksten in unserem allerdings wesentlich größeren Kollektiv erzielten Gewichtsabnahme von79,8 kg ein Maximalwert von44,2. kg ge- genüber, den …”

“…Fastenkuren erscheinen uns vor allem dann angezeigt, wenn in Einzelfällen eine schnelle Gewichtsabnahme erforderlich ist und wenn während des stationären Aufenthaltes eine intensive diätetische Aufklärung und Schulung stattfindet (z, 8). Diese Schulung ist besonders wichtig für die Langzeitergebnisse, und ohne sie lassen sich auch gute Initialerfolge in der Regel schon nach Jahresfrist nicht mehr nachweisen.…”