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A New Approach to Obesity
BY: A.T.W. Simeons, M.D.
Salvator Mundi International Hospital
00152 - Rome
Viale Mura Gianicolensi, 77
FOREWORD
This book discusses a new interpretation of the nature of
obesity, and while it does not advocate yet another fancy
slimming diet it does describe a method of treatment which
has grown out of theoretical considerations based on
clinical observation.
What I have to say is, in essence, the views distilled out
of forty years of grappling with the fundamental
problems of obesity, its causes, its symptoms, and its
very nature. In these many years of specialized work,
thousands of cases have passed through my hands and were
carefully studied. Every new theory, every new method,
every promising lead was considered, experimentally
screened and critically evaluated as soon as it became
known. But invariably the results were disappointing and
lacking in uniformity.
I felt that we were merely nibbling at the fringe of a
great problem, as, indeed, do most serious students of
overweight. We have grown pretty sure that the tendency to
accumulate abnormal fat is a very definite
metabolic disorder, much as is, for instance, diabetes.
Yet the localization and the nature of this disorder
remained a mystery. Every new approach seemed to lead into
a blind alley, and though patients were told that they are
fat because they eat too much, we believed that this is
neither the whole truth nor the last word in the matter.
Refusing to be side-tracked by an all too facile
interpretation of obesity, I have always held that
overeating is the result of the disorder, not its cause,
and that we can make little headway until we can build for
ourselves some sort of theoretical structure with which to
explain the condition. Whether such a structure represents
the truth is not important at this moment. What it must do
is to give us an intellectually satisfying interpretation
of what is happening in the obese body. It must also be
able to withstand the onslaught of all hitherto known
clinical facts and furnish a hard background against which
the results of treatment can be accurately assessed.
To me this requirement seems basic, and it has always been
the center of my interest. In dealing with obese patients
it became a habit to register and order every clinical
experience as if it were an odd looking piece of a jig-saw
puzzle. And then, as in a jig saw puzzle, little clusters
of fragments began to form, though they seemed to fit in
nowhere. As the years passed these clusters grew bigger
and started to amalgamate until, about sixteen years ago,
a complete picture became dimly discernible. This picture
was, and still is, dotted with gaps for which I cannot
find the pieces, but I do now feel that a theoretical
structure is visible as a whole.
With mounting experience, more and more facts seemed to
fit snugly into the new framework, and then, when a
treatment based on such speculations showed consistently
satisfactory results, I was sure that some practical
advance had been made, regardless of whether the
theoretical interpretation of these results is correct or
not.
The clinical results of the new treatment have been
published in scientific journal and these reports have
been generally well received by the profession, but the
very nature of a scientific article does not permit the
full presentation of new theoretical concepts nor is there
room to discuss the finer points of technique and the
reasons for observing them.
During the 16 years that have elapsed since I first
published my findings, I have had many hundreds of
inquiries from research institutes, doctors and patients.
Hitherto I could only refer those interested to my
scientific papers, though I realized that these did not
contain sufficient information to enable doctors to
conduct the new treatment satisfactorily. Those who tried
were obliged to gain their own experience through the many
trials and errors which I have long since overcome.
Doctors from all over the world have come to Italy to
study the method, first hand in my clinic in the Salvator
Mutidi International Hospital in Rome. For some of them
the time they could spare has been too short to get a full
grasp of the technique, and in any case the number of
those whom I have been able to meet personally is small
compared with the many requests for further detailed
information which keep coming in. I have tried to keep up
with these demands by correspondence, but the volume of
this work has become unmanageable and that is one excuse
for writing this book.
In dealing with a disorder in which the patient must take
an active part in the treatment, it is, I believe,
essential that he or she have an understanding of what is
being done and why. Only then can there be intelligent
cooperation between physician and patient. In order to
avoid writing two books, one for the physician and another
for the patient - a prospect which would probably have
resulted in no book at all - I have tried to meet the
requirements of both in a single book. This is a rather
difficult enterprise in which I may not have succeeded.
The expert will grumble about long-windedness while the
lay-reader may occasionally have to look up an
unfamiliar word in the glossary provided for him.
To make the text more readable I shall be unashamedly
authoritative and avoid all the hedging and
tentativeness with which it is customarily to express new
scientific concepts grown out of clinical experience and
not as yet confirmed by clear-cut laboratory experiments.
Thus, when I make what reads like a factual statement, the
professional reader may have to translate into: clinical
experience seems to suggest that such and such an
observation might be tentatively explained by such and
such a working hypothesis, requiring a vast amount of
further research before the hypothesis can be considered a
valid theory. If we can from the outset establish this as
a mutually accepted convention, I hope to avoid being
accused of
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