Doctors from all over Europe have been meeting this week at the 11th Congress of Obesity at Vienna’s historical imperial palace, the Hofburg. Wherever the doctors have been educated, they will be united in their belief in what constitutes a size, shape and weight that is most likely to reduce the incidence of obesity and the variety of serious diseases that may stem from it.
The doctors will have had plenty of opportunity to study the approach to diet that may lead to this trouble. In fashionable hotels and health clubs, the overweight can be seen struggling across a width of the pool before rewarding their exertions with delicious cakes and cream.
However determinedly doctors may agree on what constitutes obesity and a desirable figure, the rest of the population is swayed by fashion. Every age, and every country, has a different concept of the ideal feminine figure. Doctors are not swayed by trends in the definition of beauty, but their opinion is based on the likelihood of their patient remaining healthy. Fortunately the ideal medical figure has also been the ideal figure in many cultures.
If people want to look at a medically acceptable figure that is also aesthetically pleasing, they couldn’t do better than pay a visit to the Marlborough Fine Art Gallery in the West End of London and look at the sculpture of Aristide Maillol.
Maillol, a contemporary and friend of Matisse, Bonnard and Picasso, was of Catalan working-class stock and was therefore descended from peasant farmers and smugglers. He began life as a painter and only later became a fashionable sculptor. Even when rich, affluent and a friend of the great and good, Maillol always revered the curvaceous, short and thick-limbed figures that reflected the type of women with whom he had grown up in southwest France.
Maillol never changed his belief in what constituted a beautiful woman -an image of beauty that also inspired many of his contemporaries, including Picasso. The ideal build of a Maillol model is very different from that embodied in the spare elegance of Twiggy, or in the promise of pneumatic bliss displayed by an overweight Rubens beauty. Maillol’s sculpture achieves a balance between Twiggy and Rubens, just the same balance which the doctors in Vienna this week hope that their patients will achieve.
The crucial measurement of plumpness in the surgery is the BMI. This mysterious statistic is arrived at by dividing the weight in kilograms by the patient’s height in meters squared. For those whose mathematics is rusty, or who, in any case, still think in pounds, stones, feet and inches the normal range of the BMI is 18.5 to 24.9.
Doctors think of a patient as being overweight if their BMI is 25 to 29.9, and of being obese if they are over 30. Obesity is divided into three sub groups: moderate, severe and very severe.
Maillol’s women were sensual and rounded without being fat. Doctors are not only concerned with the BMI, but also in the way in which someone carries their weight. Just as someone’s liability to disease is dependent on their BMI – their body mass – so does the actual distribution of their fat affect the likelihood of their developing the diseases of obesity.
If the excess fat is carried centrally -a polite way of saying that the superfluous fat is mainly around the tummy -they are more likely to suffer disease than if their weight pads the limbs. Hip measurements should be greater than abdominal girth, as being pear-shaped is less dangerous than being apple-shaped.
None of Maillol’s models could be described as being apple-shaped, and if appearance was the only consideration they should all have made old age. Dina Vierney, his favorite model and, it is widely thought, his ideal woman, was at the opening of the exhibition. Now in her eighties and having survived incarceration as a Resistance worker, she is sprightly, intellectually alert and witty. A good recommendation for the ideal Maillol or medical figure.
The standard means of controlling weight is by following a regimen based on increasing exercise and decreasing calorie intake. It is said that 60 per cent of the art of weight reduction is to so change lifestyle and a patient’s approach to food that they are able to cut their intake without suffering; the remaining 40 per cent of the weight-reduction program is achieved by maintaining a regular exercise schedule.
Diet pills as an aid to weight loss have become very unfashionable. The traditional amphetamine, or amphetamine-type medication, induced addiction in many people -and in a few people severe depression, paranoia and such physical symptoms as a racing heart and raised blood pressure. The next wave of slimming pills had an even more sinister reputation. They didn’t cause such severe addiction problems, but they could induce a potentially fatal pulmonary hypertension, together with other cardiovascular problems.
Xenical has achieved some success; it reduces the absorption of fat from the gut, and it is excessive fat that is responsible for much obesity. Unfortunately Xenical can have some rather unpleasant, inconvenient, but not dangerous, side-effects brought on by the excretion of large amounts of fat.
One of the innovations raised in Vienna has been a totally different approach to diet pills. For some years it has been known that one group of drugs usually prescribed as antidepressants has a side-effect. They reduce appetite by acting centrally on the brain.
Consequently, people feel satisfied with smaller portions of food than they have been hitherto. It becomes no hardship to eat less when controlling their appetite, and as they eat less they lose weight. This side-effect of 5HT and nor-adrenalin reuptake inhibitors has now been utilized in the preparation of a compound, Reductil (sibutramine). In these pills the antidepressant action is absent, or at worst minimal, but their potential to reduce appetite, and the feeling of satisfaction derived by a smaller meal, is enhanced.
When taking Reductil patients are unaware of any change of mood, or even of attitude, but amaze themselves to find that they are losing weight regularly. The average patient’s appetite is reduced by 20 per cent. If Reductil is combined with 30 minutes of brisk, but not violent, exercise a day, people could hope to lose up to a couple of pounds a week.
A new approach to diet and lifestyle, Reductil and a daily brisk walk will help the overweight to shield themselves from the specter of coronary heart disease (obesity is a more important factor than smoking and hypertension), type 2 diabetes, raised blood pressure, gall bladder disease and some forms of cancer. And they may acquire the figure of a Maillol model.