Dietetics for Nurses

Rules and Regulations.—The following directions and menus are given to be used when a reduction in weight is necessary. Care must be taken not to allow large amounts of even the non-fat-forming foods in the dietary, since under certain conditions the body will manufacture adipose tissue of any surplus organic material ingested. Breakfast must be limited as demonstrated in the tabulated diet sheet.

Keeping the Weight Down.—After the individual has been reduced to approximately the desired weight the diet may be made a trifle more liberal, keeping in mind, however, that moderation is the keynote in the obesity régime and will have to be practised to a certain extent always. It is wise to continue the dry meals and to limit the amount of butter, cream, and other “fatty foods,” to a certain extent. Pork, with the exception of crisp bacon several times a week at breakfast, had best be avoided, and alcoholic beverages should be omitted entirely except when prescribed by the physician. The outdoor exercise should be continued and only the amount of sleep requisite to health indulged in. If the individual will faithfully carry out these directions, there is no reason why the weight should continue to be a burden. It must be remembered that it is never safe to diet indiscriminately and without the advice of a physician, since much harm may come of so doing.

Value of Massage.—Massage is an advisable accompaniment to an obesity diet and will help to prevent a sagging of the tissues which have been deprived of the supporting fat. The tissues of the face, neck, and breast are especially apt to wrinkle unless given the exercise and stimulation from massage. Cold baths are likewise advisable, since they stimulate the body to burn up the fat.

OBESITY MENUS

EMACIATION

Emaciation as a rule is a symptom of an abnormal condition rather than a disease in itself. Certain individuals are said to be “constitutionally thin” and upon investigation it is often found that this thinness extends back in many cases for generations, many members of a family being thin no matter what measures are taken to overcome the condition. However, constitutional emaciation is not so prevalent as constitutional obesity and, as has already been stated, is more often a symptom of some metabolic disturbance or pathological condition.

Causes of Emaciation.—Errors in diet—insufficient or improper food—are accountable for most of the cases seen in infants and children. Over-exercise, that is, when the amount of exercise taken is not commensurate with the intake of food, is accountable for other cases. This type of emaciation is found especially in growing children.

Disease as a Cause.—Wasting diseases, such as tuberculosis and anemia, bring about a loss of weight, while in fevers in general and typhoid fever especially not only the febrile condition hastens the metabolic processes but also the activities of the bacteria act together and break down the tissues of the body, causing a falling off from the normal body weight. Loss of sleep, unhygienic or unsanitary surroundings, and capricious appetites probably cause some of the cases of excessive thinness.

Thinness in Children.—Parents are to blame for much of the thinness seen in children, especially the nervous high-strung children whose energies outweigh their desire for food or, as is more often the case, their willingness to eat the proper foods. It is a mistaken kindness to cater to the whims and fancies of a child’s appetite, and much harm is wrought by allowing the “trash” to overbalance the necessary building or repair food in the dietary. Not that sugar is not necessary, for it is particularly so at the age when the metabolic processes are faster than later in life, but it must be remembered that the body is being built up both in height and breadth.

The Need for Building Foods.—The skeleton and the muscular tissues cannot be constructed from sugar, hence the diet which consists chiefly of this food constituent is unbalanced and will sooner or later bring about disturbances which are very apt to result in emaciation. The causes of emaciation may be summarized as follows:

(1) Those cases which are due to pathological conditions such as tuberculosis, anemia, typhoid fever, etc.;

(2) Those induced by errors in diet and bad habits such as insufficient or improper food, loss of sleep, over-exercise, lack of ventilation in the sleeping apartment, which destroys the appetite;

(3) Malformation or deformities of mouth, throat, or stomach which make it impossible for the individual to partake of sufficient food to cover the needs of the body;

(4) Heredity (“constitutional thinness”).

Regulating the Diet.—As has been stated in a former chapter, any persistent loss of weight or failure to gain on the part of an infant whose chief business in life should be to grow, should be given immediate and careful attention. As a rule the diet is to blame; it is either improperly balanced, insufficient in amount, or poorly prepared, any of which might readily cause a disturbance to the delicate apparatus of the child.

Diet and Habits.—In adults, the diet and habits of life are in many cases to blame for the excessive thinness seen in many individuals. If the trouble can be traced to some abnormal condition, it can only be removed by relieving or checking the disease which induced it. The older methods of treating typhoid fever, for example, did nothing to prevent the progressive emaciation which was the result not only of the accelerated metabolism from the fever but also from the invasion of the intestinal tract by the specific bacteria which brought about a like result. In tuberculosis a similar breaking down of the tissues occurs, as is likewise the case in anemia and other diseases in which the functions of the blood-making organs are interfered with. Any of the above diseases may cause emaciation, and the treatment in most of the cases resolves itself in removing the cause as far as possible and in adjusting the diet.

Selection of Food.—The dietetic treatment for emaciation is practically the only one which will materially change the weight of the individual, since by food alone is the body built. Certain foods are more capable of being readily converted into adipose tissue than others, and these must have a prominent place in the dietary.

Rules and Regulations.—In obesity it was found that it was necessary to curtail the sleep and rest, increase the amount of exercise and decrease the amount of food. In emaciation practically an opposite régime is adopted. The patient is urged to eat plenteously, drink copiously of water and nutrient beverages, soup, etc., avoid worry and excitement, over-exertion and indigestion, to take one or two naps every day, to retire early, to avoid hot baths and take a warm cleansing bath followed by a cold shower or sponge bath. Exercise must be of a mild character; the patient must be warned against becoming exhausted, since this condition precludes a gain in weight.

Dietetic Treatment.—The meals must be carefully selected, well prepared and daintily served, that all of the psychical benefits from such efforts may be attained. A nutrient beverage such as cream, egg, and vichy, reënforced fruit beverages, malted milk, with egg and chocolate, cereal and milk gruels, etc., may be given between breakfast and lunch, lunch and dinner and before retiring. The meals must consist of the simplest foods that the digestion may not be overtaxed by the quantity ingested.

Allowable Foods.—The following foods may be used in the treatment of emaciation: All dairy products, milk, cream, butter and cheese, eggs cooked in various ways, soups of all kinds, meats in moderation, vegetables, especially potatoes, olive oil, and the various salad oils, cereals, tapioca, macaroni, spaghetti, noodles, rice, bread of every description, fruit including bananas, grapes, dates, raisins, prunes, etc., ice creams, farinaceous puddings, sauces, except those containing vinegar, grape juice and other fruit juices sweetened with sugar, cocoa and chocolate, malted milk and proprietary infant foods, honey, molasses and sirups, cakes, cookies and pastry in moderation. It is advisable to make milk the chief fluid food; to this is added cream, malted milk, lactose, eggs, and other reënforcing agents.

Milk Cure.—Certain physicians advise milk alone, giving from one to two gallons a day for three weeks or longer. Many individuals complain that “milk makes them bilious” but, as a rule, this is because the amount taken is small and the solids insufficient to lend the necessary bulk to the feces, consequently the peristaltic action becomes sluggish and the passage of the food mass delayed in the intestinal tract, furnishing a medium for bacterial growth and activity. When larger quantities are ingested such is not the case and the fluid so high in nutrient qualities is utilized by the body for the building up of the depleted tissues. When the emaciation is the result of disease the diet is necessarily adjusted to meet the condition. At times it is most difficult to overcome the anemia and accompanying emaciation on account of the disease precluding the giving of the foods especially designed by nature to produce flesh. This is especially the case in the progressive emaciation in diabetes. However, in this case the Allen starvation treatment, with the reëducation of the organs to a toleration for carbohydrates, has gone far toward overcoming this distressing condition.

Readjusting the Habits.—When the loss of weight is found to be the result of close application to work, lack of fresh air and sleep, or from errors in diet, a change of climate and occupation should be made, together with a readjustment of the daily habits, such as substituting a cool bath for the regular hot one, and sleeping out of doors or on a sleeping porch instead of in a poorly ventilated bedroom.

The patient must be urged to eat, regardless of appetite, for in this way only can the body weight be increased. The dietary must be made up largely of the fat-forming foods, but not to such an extent as to upset the nitrogen equilibrium.

The following diet sheet is given to be used as a guide in the treatment of emaciation. Other foods of a similar composition and fuel value may be substituted for those given here, to vary the diet.

Emaciation Diet Sheet

Approximately 5106 calories

Methods of Increasing the Diet.—The above diet furnishes three times as much food as is needed to maintain the body living a sedentary life, or about as much as would be needed to maintain a lumberman at hard outdoor labor in the Maine woods. It would be impossible for an ordinary individual to handle such an abundant diet without making the increase in the diet gradually. This is best done by adding the milk and cream at the end of each meal and a glass of milk between meals and at bedtime, then gradually adding the fattening foods already mentioned until the diet approximates the diet sheet here computed.

SUMMARY

GOUT

Gout is a constitutional disease characterized by an inflammatory condition of the joints.

The Joints are the seat of chalky deposits of uric acid or sodium salts.

Metabolism in gout is disturbed, with a consequent retention instead of elimination of uric acid by the body.

The Blood contains an excess of uric acid which increases greatly during an acute attack.

The Urine in true gout does not contain an excess of uric acid except during an acute attack, whereas in the so-called goutiness there is a constant excess of this acid.

Uric Acid is produced as the result of the metabolism in the human body of the nucleoproteins and in food of the purin bodies.

Alcohol undoubtedly assists in the retention and increases the difficulty of uric acid elimination by the body.

Chief Causes of Gout.—Overeating, excessive alcoholism, and too little exercise, especially in the open air.

Treatment consists in regulating the diet both as to the quantity and type of food eaten; reducing or eliminating the alcohol in the dietary, and increasing the amount of outdoor exercise.

Dietetic Treatment.—The best results are obtained by reducing the size of the meals and avoiding the purin-bearing foods as far as possible. Eggs are purin-free and may be substituted for much of the meat in the diet. In chronic gout it is impossible to eliminate meat entirely from the diet, but the quantity can be materially reduced and that which is eaten may be rendered less harmful if it is boiled instead of roasted or broiled, as in this way much of the purin is dissolved out. Highly spiced and seasoned foods, rich gravies, etc., are apt to cause an acute attack and should be omitted. Excesses of all kinds must be avoided to enable the patient to live a fairly comfortable life, free from frequent painful attacks of gout.

OBESITY

Causes.—Heredity, overeating, unbalanced diet, chronic alcoholism, and disturbed metabolism, as manifested in gout and other pathological conditions.

Cures are more or less of a risk, except when undertaken upon the advice and under the care of a competent physician. As a rule they are too strenuous to be carried out alone and are of no good unless persisted in. Among the best known obesity cures may be mentioned those formulated by Banting, Oertel and Ebstein.

Most physicians have their own methods of treating obesity, but all are based primarily on diet and exercise.

Food is the chief cause of obesity and since some foods are more readily converted into adipose tissue than others, it is necessary to understand the behavior and functions of the various food combinations in the body before it is possible to say which are the offending articles of diet.

Water has no fattening properties of its own. This is proved by a glance at its chemical composition, but as it acts as a distributor and carrier of food to the various parts of the body and since the bulk of all the secretions is composed of water and every tissue in the body stores this fluid, thus adding to the weight, a consideration of the intake of water for obesity patients is most essential.

Appetite requires attention. The majority of obese patients eat more than their energy output calls for, consequently it is necessary to curb the appetite and increase the energy output in order to utilize the material on hand in the form of adipose tissue.

Exercise is absolutely essential in order to force the body to burn up its surplus fat as fuel. The best form of exercise is that which is taken out of doors. The well-worked muscle is heavier than one which is unaccustomed to exercise. The latter is infiltrated with fat and weighs less than muscular tissue, but a muscular body can endure more than one which is covered with adipose tissue.

The Heart of obese patients becomes more or less affected as obesity advances and it becomes absolutely necessary in many cases to get rid of some of the surplus fat in order that the patient may live. This is best accomplished by dietetic treatment.

Circulatory Changes likewise occur as the heart becomes affected, making it necessary to institute some dietary measures at once.

Glycosuria in obese patients suffering from gout is not at all unusual and to relieve this condition the carbohydrates in the diet must be at once reduced.

Dietetic Treatment is most important. It constitutes the only rational method of ridding the body of its surplus fat. To do this it is necessary to regulate the diet both as to quantity and type. Fat-forming foods are those which the body utilizes most easily for the production and storage of fat. Any food, no matter whether it is fat-forming or not, if taken greatly in excess of the needs of the body, will be stored as adipose tissue.

Chief Points to be remembered in formulating a diet and instituting an obesity treatment are the necessity for small meals and dry meals, no fluid given at all during the meal except perhaps one or two small cups of coffee per day, without sugar or cream, the avoidance of fat-forming foods, sugars and starches in all forms, milk, cream, butter and oil, potatoes, bananas, fat meats of all descriptions, especially pork, soups of every description and alcoholic or malted beverages. It is necessary to limit the amount of sleep, prohibiting naps during the day, and to increase the amount of outdoor exercise.

Massage is advisable, especially in those patients who are unable, on account of their excessive weight or heart symptoms, to take the requisite amount of exercise necessary for their future welfare. Massage likewise makes the muscles firmer, often preventing the disfiguring sagging of the skin caused by depriving it of its padding of fat.

EMACIATION

Causes.—Errors in diet, overwork, over-exercise, heredity, nervousness, worry, malformation of the mouth, throat, or stomach, heredity and certain pathological conditions, such as typhoid fever, tuberculosis, anemia, dysentery, etc., in which the breaking down of the tissues occurs more rapidly than they can be rebuilt.

Children are often emaciated on account of their unbalanced diet. They receive an insufficient amount of building food to cover their growth and development requirements. Parents are often to blame for allowing the child to overeat of some of the food constituents at the expense of others. Sugar, for example, is very necessary in the diet of a growing active child, but all sugar and very little milk and eggs will lead to an unbalanced diet which may bring about a condition of extreme thinness later on.

In Adults the constant eating of the wrong foods, overworking and persistent worrying, all contribute to the breaking down of the tissues which ends in emaciation.

Weight is an index to health. Any persistent loss of weight on the part of an adult or loss or even failure to gain in a growing child, are indications that all is not right and immediate measures must be taken to locate and relieve the trouble.

Loss of Weight due to pathological conditions can only be relieved by removing the cause, after which the diet may be adjusted to suit the condition.

Dietetic Treatment is practically the only means of combating and overcoming emaciation, since it is by food alone that the body is built.

Fat-forming foods, which in obesity were prohibited, have a prominent place in the diet for emaciation. Padding the nerves and organs with a layer or covering of fat protects them from the jars and shocks incidental to daily life, besides lending grace and contour to the body.

Foods Which Produce Fat are nutrient beverages of all sorts; milk, malted milk and cream are especially valuable; water, because of its particular properties and functions in the body; and fruit beverages, which are made chiefly of water and sugar, are always included in the dietary. Milk and cream, soups and milk gruels, as well as all dishes made with milk or cream, add materially to the fat-forming quality of the diet. Butter, olive and other salad oils, as well as cereals, potatoes, bread and simple desserts are advised. The diet must be bountiful, the meals frequent, and lunches consisting of milk or cream with crackers will hasten the gain in weight.

Rest, preferably lying down, is absolutely essential. A period of relaxation covering from fifteen to thirty minutes should be taken before or after each meal. The body derives the use of the food for the storage of fat which would otherwise be required to cover its energy expenditures.

Sleep is essential to gain, consequently the patient should retire early and take one or two naps during the day.

Baths should be warm, not hot, followed by a cold shower or sponge.

Exercise must be mild in character; over-exertion precludes a gain in weight and exhaustion undermines the forces which make it possible for the body to store fat as adipose tissue.

Nervous Excitement and Worry must be avoided.

Gastro-intestinal Disturbances should be guarded against, since all the pounds gained through months of treatment may be quickly lost during one acute attack of diarrhea or auto-intoxication.

Massage is advised. The kneading and gentle manipulation of the muscles stimulates them to utilize more food material, besides enabling the patient to eat more by reason of an increased appetite.

The Milk Cure has been used extensively in overcoming extreme emaciation. It consists in the taking of large quantities, ranging from one to two gallons per day. It is given every hour or oftener for a period of one month to six weeks.

Reënforcing the Diet with eggs and lactose is often found of great value in increasing the weight quickly, as is the giving of one-third of a glass of cream and two-thirds of a glass of milk after each meal and at bedtime. The whole scheme of putting on pounds resolves itself into the giving of proper food in larger quantities than are ordinarily given, but dividing it up into frequent meals in order not to upset the digestion and do away with the good already accomplished.

PROBLEMS