The most frequent case encountered in practical life is the development of obesity in persons who are altogether healthy. The decision whether or not to advise a reduction cure in cases of this character hinges altogether on the degree of corpulency and on a variety of other external circumstances that differ in each instance.

a. Advanced Degrees of Obesity

In deciding whether or not a subject is to be considered excessively obese we must study more the general impression created by the patient, both as regards appearance and state of health, than the incubus of a definite number of kilos of fat. Very advanced degrees of obesity judged from this standpoint are almost without exception fit subjects for a reduction cure. The dangers that may arise if the nutritional disorder is allowed to progress unchecked are great and it is necessary to counteract this tendency. The restrictions of diet to be imposed necessarily vary with the age of the patient. In children and young adults up to the 20th year we should be content to arrest the further progress of obesity and should only at long intervals, that is intermittently, for a period of from four to five weeks, make the attempt to cause a definite loss of fat (so-called intermittent reduction cures). All measures aiming at a reduction of the fat-content of the body are essentially counter-indicated in persons who have been obese all their life or at least for a period of several decades, particularly if they are advanced in years and are approaching old age; here it is necessary to individualize, for it is impossible to say at what age senescence begins; in one subject this period of senile decline may be reached at the age of sixty, in others not until seventy or eighty. At this period of life at all events they begin to feel the effects of excessive obesity more than at earlier periods; as soon as their vital energies begin to fail numerous disturbances become manifest that were never apparent in earlier years when their body was stronger and was capable of carrying the ballast of excessive fat without difficulty. Many of these patients energetically demand to be freed of the unwelcome burden. Unfortunately the correct time for instituting a reduction cure has in the majority of these instances been allowed to elapse and a reduction cure instituted in a subject suffering from beginning senile decay would never more lead to a rejuvenation of the body. In fact, reduction-cures instituted in old persons almost without exception accelerate decay and lead to a more rapid loss of strength and of functional powers.