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ORIGINAL ARTICLES [JULY 28, 1956
INTAKE IN RELATION even even when when given given free free choice choice of of food food (fig. (fig. 1). 1). ThisThis
CALORIE TO observation observation has has been been made made before before (Newburgh (Newburgh 1942),1942),
BODY-WEIGHT CHANGES IN THE OBESE and and therefore therefore a a period period of of stabilisation stabilisation was was arrangedarranged
A. KEKWICK to to precede precede our our studies.studies.
M.B. F.R.C.P. After After that that periodperiod
M.A., Camb., their their daily daily weightweight
PROFESSOR OF MEDICINE IN THE UNIVERSITY OF LONDON became became stable,stable,
relatively relatively
G. L. S. PAWAN and and at at this this point point allall
B.Sc. Lond. were were placed placed on on one one oror
other other of of three three series series ofof
RESEARCH
BIOCHEMIST diets diets prepared prepared by by MissMiss
From the Medicine, The Middlesex Hospital, Wilkinson Wilkinson chiefchief
Department of London Hughes, Hughes,
dietitian dietitian to to the the Middle-Middle-
MANY MANY different different types types of of diet diet have have been been successfullysuccessfully sex sex Hospital. Hospital. TheseThese
used used to to reduce reduce weight weight in in those those considered considered obese. obese. TheThe diets diets were were drawn drawn upup
principle principle on on which which most most of of them them are are constructed constructed is is toto from from the the tables tables ofof
theoreticaltheoretical McCance McCance and and Widdow-Widdow-
effect effect a a reduction reduction of of calorie calorie the the
intake intake below below and and in in
son son
(1946), (1946), everyevery full full diet diet
I-Loss I-Loss of of on on soonsoon
calorie calorie needs needs of of the the with with these these Fig. Fig. weight weight
body. body. Experience Experience patientspatients case case ofof admission admission to to
has has suggested, suggested, however, however, that that this this conception conception may may bebe aliquot aliquot samples samples after after hospital.hospital.
too too a a all all the the diets diets werewere
of of them them state state that that
rigid. rigid. Many Many very very slight slight departuredeparture The The
turmixed turmixed and and results results within within
from from the the which which can can analysed.analysed. agreed agreed 10%10%
strict strict diet diet affect affect calorie calorie
hardly hardly intake,intake, in in the the tables.tables.
results results a a with with those those
in in them them to to lose lose for for time. time.
it it is is failing failing weight weight ThoughThough
realised realised that that evidence evidence from from such such is is notori-notori-
patients patients Diets Diets Series Series 11
to to of of
inaccurate inaccurate their their to to this this
ously ously owing owing approach approach particularparticular In In the the first first series series the the of of carbo-carbo-
it it is is too too constant constant a a proportions proportions protein, protein,
belief belief to to
condition, condition, them them bebe the the
discarded.discarded. among among hydrate, hydrate, and and fat fat were were kept kept constant constant and and intake intake ofof
entirely entirely calories calories was was varied. varied. In In all all of of them them protein protein suppliedsupplied
Furthermore, Furthermore, most most of of the the diets diets in in common common use use notnot about about 20%, 20%, fat fat 33%, 33%, and and carbohydrate carbohydrate 47% 47% of of thethe
aa
The The in in the the diet diet determined determined and and
only only restrict restrict the the intake intake of of calories calories but but also also radicallyradically calories. calories. water water was was
alter alter the the proportions proportions provided provided by by protein, protein, fat, fat, andand supplement supplement of of water water given given to to each each patient patient to to makemake
3000 3000 ml. ml. The The same same was was withwith
carbohydrate. carbohydrate. In In this this country country a a healthy healthy sedentarysedentary sodium sodium per per day. day. procedure procedure adopted adopted ForFor
be be to to 2200 2200 chloride, chloride, which which totalled totalled 10 10 g. g. per per day. day.
person person may may supposed supposed consume consume some some caloriescalories periods periods of of 7-9 7-9 days days the the patients patients were were kept kept on on eithereither
made made of of about about 70 70 of of 60 60 of of andand
daily, daily, up up g. g. protein, protein, g. g. fat, fat, 2000 2000 1500 1500 1000 1000 or or 500 500 caloriescalories
350 350 of of of of thethe calories, calories, calories, calories, calories, calories,
g. g. carbohydrate : carbohydrate : protein protein supplies supplies 12% 12% per per 2). 2). Six Six were were studied studied in in this this
fat fat and and On On mostmost day day (fig. (fig. patients patients way,way,
each each each each 7-9 7-9
calories, calories, 24%, 24%, carbohydrate carbohydrate 64%. 64%. patient patient diet diet for for and and a a definitedefinite
having having days, days,
the the and and relation relation was was found found to to exist exist between between the the ofof
reducing reducing diets, diets, however, however, carbohydrate carbohydrate fat fat willwill deficiency deficiency
and and
while while the the remains remains the the calories calories the the amount amount of of lost.lost.
be be restricted restricted protein protein about about same ;same ; weight weight
1000 1000
and and in in a a diet diet calories calories may may
yielding yielding protein protein provideprovide Diets Diets Series Series 22
fat fat and and of of
30%, 30%, 37%, 37%, carbohydrate carbohydrate 33%.33%. The The final final that that the the amount amount
proof proof of of lost lost
Finally, Finally, Lyon Lyon and and Dunlop Dunlop (1932) (1932) observed observed thatthat on on the the of of weight weight be be dependsdepends
isocaloric isocaloric diets diets lost lost moremore directly directly deficiency deficiency calories calories should should adducedadduced
patients patients on on reducing reducing weight weight a a constant constant loss loss of of in in each each
when when the the of of the the calories calories waswas by by observing observing weight weight patientpatient
rapidly rapidly largest largest proportion proportion whose whose calorie calorie intake intake is is constant constant regardless regardless of the of the typetype
food food the the diet.diet.
supplied supplied by by fat fat than than when when it it was was supplied supplied by by carbo-carbo- of of making making up up
hydrate. hydrate. Anderson Anderson (1944) (1944) attributed attributed these these findings findings toto Fourteen Fourteen patients patients were were put put on on diets diets in in which which thethe
1000 1000
calorie calorie intake intake was was constant constant a a and and
the the different different amounts amounts of of salt salt (causing (causing water water retention)retention) kept kept at at day day 90 %90 %
in in the the diets diets used used by by these these workers. workers. More More recently,recently, of of it it was was provided provided in in turn turn by by carbohydrate, carbohydrate, fat, fat, oror
has has recommended recommended dietsdiets protein. protein. Measured Measured amounts amounts of of water water and and of of sodiumsodium
(1951, (1951, 1954) 1954) high-fat high-fat
Pennington Pennington chloride chloride were were added added to to each each diet diet to to make make anan
in in It It therefore therefore seemed seemed again again up up
the the treatment treatment of of obesity. obesity. impor-impor- 3000 3000 ml. ml. water water and and 10 10 of of sodium sodium
tant tant to to establish establish which which factor factor has has the the effect-effect- intake intake of of of of 6. 6. chloridechloride
of of
different different were were the the rates rates
greater greater per per (fig. (fig. 2). 2). So So weight-lossweight-loss
restriction restriction of of or or alteration alteration in in the the ofof day day diets diets that that the the of of the the dietdiet
calories, calories, proportions proportions on on these these isocaloric isocaloric composition composition
fat, fat, and and in in thethe
protein, protein, carbohydrate carbohydrate
diet.diet.
and and
Materials Materials MethodsMethods
The The for for our our
selected selected
subjects subjects studystudy
were were definitely definitely obese. obese. It It has has beenbeen
debated debated whether whether an an increase increase ofof
weight weight above above that that laid laid down down inin
normal normal height-weight height-weight charts charts is is aa
satisfactory satisfactory criterion criterion of of obesity, obesity, andand
other other
definitions definitions have have been been
but but all all suggested ;suggested ;
the the persons persons chosen chosen for for thethe
present present were were
investigation investigation manifestlymanifestly
obese, obese, and and this this description description couldcould
not not have have been been questioned questioned either either byby
skilled skilled or or by by lay lay observers. observers. All All hadhad
weights weights more more than than 35% 35% above above thethe
standard standard for for
weight weight height height accordingaccording
tables tables
to to the the the the Metro-Metro-
compiled compiled by by
Life Life Insurance Insurance (1942,(1942,
politan politan Company Company
1943).1943).
to to andand
All All were were admitted admitted hospital hospital
of of exer.exer.
allowed allowed a a moderate moderate amount amount
ward. ward. the the first first fewfew
the the
cise cise in in During During
lost lost of of diets diets of of series series I I and and
after after admission admission Fig. Fig. 2-Composition 2-Composition 2.2.
days days they they weightweight
6935
156
whole whole could could or or
maintain maintain on on 2000 2000 calories calories butbut
in in gain gain weight weight
except except one one instance, instance, lost lost weight weight consistently consistently on on aa
2600 2600 calorie calorie intake.intake.
daily daily
these these the the were were
During During periods periods patients patients weighed weighed dailydaily
and and in in some some of of them them balance balance were were carried carried out out inin
studies studies
respect respect of of water, water, nitrogen, nitrogen, fat, fat, sodium, sodium, chloride, chloride, andand
potassium. potassium. Total Total body-water body-water and and the the basal basal metabolicmetabolic
rate rate were were estimated estimated or or at at the the end end of of thethe
(B.M.R.) (B.M.R.) weekly weekly for for thesethese
period period on on each each diet. diet. The The methods methods employed employed
estimations estimations have have already already been been listed listed (Kekwick (Kekwick andand
Pawan Pawan
1953).1953).
In In such such a a study study the the difficulties difficulties are are formidable. formidable. TheThe
first first and and main main hazard hazard was was that that of of these these patientspatients
many many
had had inadequate inadequate personalities. personalities. At At worst worst they they wouldwould
cheat cheat and and food food from from from from
lie, lie, obtaining obtaining visitors, visitors, trolleystrolleys
touring touring the the wards, wards, and and from from neighbouring neighbouring patients.patients.
almost almost isolation.) isolation.) At At best best
(Some (Some complete complete theythey
required required a a the the diet diet so so
but but few few found found thatthat
cooperated cooperated fully fully trying trying
of of their their meals. meals. When When
could could not not eat eat the the whole whole thisthis
they they the the was was and and the the
in in 6 6 of of happened happened rejected rejected part part weighed, weighed, equiva-equiva-
Fig. Fig. 3-Daily 3-Daily changes changes of of weight weight patients patients (means (means 7-9 7-9 days days onon lent lent calories calories and and foodstuffs foodstuffs were were added added to to a a meal meal
each each laterlater
diet).diet). in in the the The The results results we we are are selected, selected, a a con-con-
day. day. report report in in
appeared appeared to to outweigh outweigh in in importance importance the the intake intake ofof siderable siderable number number of of known known failures failures discipline discipline beingbeing
calories.calories. discarded.discarded.
Diets Diets Series Series 33 Another Another factor factor of of importance importance which which could could not not bebe
of of eliminated eliminated was was that that many many patients patients were were women, women, inin
a a
In In order order to to confirm confirm this this third third series series of of
point point patientspatients the the of of water water
was was studied studied who who were were put put on on to to 2000-calorie 2000-calorie diets diets ofof whom whom retention retention and and the the losses losses associatedassociated
with with the the menstrual menstrual affected affected the the daily daily andand
normal normal to to show show that that their their could could bebe cycle cycle weight weight
proportions proportions weight weight the the estimation estimation total total were were
in in of of body-water. body-water. W’e W’e surprisedsurprised
maintained maintained while while at at this this level level and and then then
hospital hospital placedplaced to to find find how how such such factors factors could could in in
on on high-fat, high-fat, high-protein high-protein diets diets providing providing 2600 2600 caloriescalories great great be, be, amounting amounting oneone
It It 3 3
per per day. day. was was demonstrated demonstrated that that these these on on thethe woman woman to to the the retention retention of of more more than than litres litres of of water.water.
patients patients
Fig. Fig. 4-Loss 4-Loss of of in in 3 3 patients patients on on diets diets of of series series I I given given inin
weight weight
different different order.order. of of 3 3 on on diets of diets of I.I.
Fig. Fig. 5-Nitrogen-balances 5-Nitrogen-balances patients patients series series
157
" " constant constant
remained remained
cliroinogen cliroinogen approximately approximately regardlessregardless
that that
of of the the intake intake there there waswas
of of suggests suggests
nitrogen-which nitrogen-which of of
breakdown breakdown
no no in in the the
significant significant alteration alteration endogenousendogenous
protein protein on on the the different different diets. diets. Any Any minor minor deviationsdeviations
from from equilibrium equilibrium were were quite quite insufficient insufficient to to account, account, inin
of of
terms terms for for the the lost.lost.
protein, protein, weight weight
Alternatively Alternatively it it is is unlikely unlikely that that the the patients patients becamebecame
depleted depleted of of carbohydrate carbohydrate reserves. reserves. These These reserves reserves areare
small small and and could could not not account account for for the the amount amount of of weightweight
lost lost (Soskin (Soskin and and Levine Levine 1950).1950).
of of be be ""
Loss Loss the the
weight weight may may result result of of available available
This This term term means means losing " losing " whichwhich
body-water. body-water. total total body-water, body-water,
was was measured measured the the urea-dilution urea-dilution method method of of McCanceMcCance
by by the the
and and Widdowson Widdowson (1951) (1951) with with precautions precautions previouslypreviously
described described Pawan Pawan (1954) (1954) and and is is a a measuremeasure
by by probably probably
of of intracellular intracellular fluid, fluid, extracellular extracellular fluid, fluid, and and
circulatorycirculatory
i i
fluid. fluid. Table Table shows shows for for these these the the initial initial
patients patients body-body-
weights weights and and the the measurements measurements of of the the total total availableavailable
It It will will be be noted noted in in
body-water. body-water. (column (column 3) 3) that that all all thethe
patients patients the the available available water water initially initially represented represented 50-50-
of of the the the the end end of of about about fourfour
52-5% 52-5% body-weight. body-weight. By By
weeks weeks on on the the diets diets the the proportion proportion of of body-water body-water toto
remained remained the the same same
weight weight (50-52%) (50-52%) (column (column 7). 7). DuringDuring
the the the the five five had had lost lost 23.7 23.7
periods periods patients patients
of of intervening intervening (column (column 1-column 1-column and and kg.kg.
body-weight body-weight 5) 5) apparentlyapparently
11.6 11.6 these these
litres litres of of available available
body-water. body-water. During During periodsperiods
of of reduction reduction the the total total available available waswas
weight weight body-water body-water
apparently apparently kept kept in in constant constant relationship relationship with with body-body-
On On these these diets diets about about half half the the lostlost
weight. weight. only only weight weight
could could in in of of
and and 11 11 be be accounted accounted for for terms terms body-water.body-water.
6-lntake 6-lntake of of
Fig. Fig. of of creatinine creatinine
nitrogen nitrogen output output chromo-chromo-
urinary urinary Four Four were were studied studied at at the the and and endend
" " patients patients beginning beginning
of of 3 3 on on diets diets
gen gen patients patients of of series series 1.1. the the week week
of of when when the the loss loss of of was was
weight weight greatest-i.e.,greatest-i.e.,
500 500 11 11
on on calories calories Table Table shows shows that that the the scatterscatter
ResultsResults much much per per day. day.
Diets Diets 11 is is greater, greater, but but this this is is because because in in one one patientpatient
Series Series
of of with with an an asterisk asterisk in in the the the the on on 500500
If If in in the the obese obese is is the the aa (marked (marked table) table) period period
weight-loss weight-loss merely merely result of result of calories calories coincided coincided with with the the retention retention of of body-waterbody-water
in in intake intake a a
calorie calorie below below constant constant
deficiency deficiency requirement,requirement, associated associated with with the the menstrual menstrual cycle. cycle. In In the the four four as as aa
the the
the the effect effect of of these these diets diets should should be be when when loss loss ofof
that, that, the the 12 12 in in
weight weight is is plotted plotted against against the the intake intake of of calories, calories, thethe whole, whole, however, however, total total loss loss was was kg. kg. body-weightbody-weight
resulting resulting graph graph is is a a straight straight line line unless unless obscured obscured byby TABLE TABLE II-LOSS II-LOSS OF OF BODY-WEIGHT BODY-WEIGHT AND AND TOTAL TOTAL BODY-WATERBODY-WATER
IN IN 4 PATIENTS 4 PATIENTS ON ON 7 7 DAYSDAYS
total total body-water body-water (Newburgh (Newburgh 1942). 1942). If If 20002000 500-CALORIE 500-CALORIE DIET DIET FOR FOR
changes in, changes in, 1500 1500 calories calories are are
are are and and
calories calories expended expended only only consumed,consumed,
there there is is a a daily daily deficiency deficiency of of 500 500 calories; calories; and and thisthis
deficiency deficiency represents represents 125 125 g. g. of of carbohydrate carbohydrate or or proteinprotein
If If 1000 1000 are are
55 55 of of fat. fat. calories calories
or or about about g. g. only only consumed,consumed,
there there is is a a daily daily deficiency deficiency of of 1000 1000 calories-250 calories-250 g. g. ofof
3 3
or or or or 110 110 of of fat. fat. illustratesillustrates
protein protein carbohydrate carbohydrate g. g. Fig. Fig. if if thethe
two two theoretical theoretical lines lines showing showing this this relationship relationship
loss loss is is in in terms terms of of carbohydrate carbohydrate and and protein protein on on thethe
. . areare 4 4
one one hand hand or or fat fat on on the the other. other. The The and and litres litres of of available available proportion proportion veryvery
plotted plotted points points body-water-a body-water-a
the the actual actual losses losses seen seen in in these these 4 4 showsshows similar similar to to that that above. above. The The thereforetherefore
patients. patients. Fig. Fig. given given assumption assumption
that, that, in in three three patients, patients, this this loss loss of of weight weight was was inde-inde- is is that, that, over over the the period period of of observation, observation, 33-50% 33-50% of of thethe
of of
the the order order in in which which the the diets diets TheThe these these on on diets diets was was loss loss
were were of of these these ofof
pendent pendent given. given. weight-loss weight-loss patients patients
of of diet diet is is at at the the available available and and the the waswas
type type during during any any period period represented represented toptop body-water body-water remaining remaining 50-67% 50-67%
of of each each as as a a the the in in 2.2.
figure figure miniature miniature of of diagram diagram fig. fig. loss loss of of fat.fat.
probably probably
Protein Protein is is not, not, however, however, lost lost during during these these dietarydietary Diets Diets Series Series 22
periods. periods. 5 5 shows shows the the balances balances carried carried outout of of
Fig. Fig. nitrogen nitrogen It It has has been been above above if if of of caloriescalories
on on three three patients patients during during these these periods. periods. It It is is clear clear thatthat argued argued that, that, deficiency deficiency
for for loss loss of of in in
alone alone accounts accounts the the diets diets of of
nitrogen nitrogen output output closely closely follows follows intake ; intake ; the the patientspatients weight weight obese, obese, equalequal
calorie calorie value value should should the the same same loss loss of of inin
remaining remaining in in approximate approximate nitrogenous nitrogenous equilibrium.equilibrium. produce produce weight weight
the the same same no no matter matter what what the the thethe
patient, patient, of of
6 6 shows shows that that the the excretion excretion of of " " composition composition
Fig. Fig. urinary urinary creatininecreatinine diet. diet. do do as as can can be be seen seen in in
Manifestly Manifestly not, not, the the
they they patientspatients
on on diets diets of of series series 2. 2. Fourteen Fourteen were were each each
TABLE TABLE I-CHANGES I-CHANGES patients patients givengiven
IN IN BODY-WEIGHT BODY-WEIGHT AND AND TOTAL TOTAL
BODY-WATERBODY-WATER diets diets all all 1000 1000 calories calories but but
IN IN 5 5 containing containing per per day, day, duringduring
PATIENTS PATIENTS ON ON DIETS DIETS OF OF SERIES SERIES 11 one one period period 90% 90% of of the the calories calories was was given given as as carbo-carbo-
another another
as as another another as as
hydrate, hydrate, during during fat, fat, during during protein,protein,
while while a a fourth fourth a a diet diet of of normal normal waswas
during during proportions proportions
given. given. Fig. Fig. 7 7 shows shows the the daily daily losses losses of of weight weight duringduring
these these periods. periods. It It will will be be seen seen that that weight weight was was lostlost
rapidly rapidly when when 90% 90% of of the the calories calories was was given given as as fat fat oror
but but that that be be
as as protein, protein, weight weight could could maintained maintained duringduring
calories calories
these these brief brief when when of of the the was was asas
periods periods 8 8 90% 90% detailed detailed given given
carbohydrate. carbohydrate. Fig. Fig. shows shows the the weight weight changeschanges
in in
the the order order which which thethe
in in three three to to that that
patients patients illustrate illustrate
diets diets did did
were were not not matter.matter.
given given
158
some-some-
but but
what what widerwider
(column (column 3).3).
It It can can bebe
seen seen inin
that that
anv anv indivi-indivi-
dual dual
the the patientpatient
propor-propor-
tion tion of of
body-body-
water water toto
body-weightbody-weight
remainedremained
surprisinglysurprisingly
constantconstant
tt
throughout throughout
the the
periodperiod
of study.of study.
The The twelvetwelve
patients patients inin
whom whom
thesethese
measure-measure-
ments werements were
made made lostlost
51-3 51-3 kg. kg. ofof
Fig. Fig. 7-Daily 7-Daily changes changes of of weight weight of of patients patients on on 1000-calorie 1000-calorie diets diets ofof body-weightbody-weight
5-9 5-9
different different of of on on each each
composition composition (mean (mean days days diet).diet). and 181itresand 181itres
of of avail-avail-
is is the the able able
The The first first and and obvious obvious that that
explanation explanation patientspatients body-body-
or or
either either the the the the fat fat in in the the diets.diets. water water
to to absorb absorb
failed failed protein protein (35%).(35%).
9 9 the the balance balance in in three three andand Table Table vv
Fig. Fig. shows shows nitrogen nitrogen patients patients
demonstrates demonstrates that that nitrogenous nitrogenous equilibriumequilibrium shows shows thethe
approximate approximate
is is maintained. maintained. There There was was retention retention of of nitrogen nitrogen duringduring losses losses ofof
the the periods periods of of large large intake intake of of nitrogen. nitrogen. Fig. Fig. 10 10 showsshows body-weightbody-weight
" " "" and and
that that the the urinary urinary excretion excretion of of creatinine creatinine chromogen chromogen body-body-
was was of of the the intake intake of of It It thereforetherefore water water inin
independent independent nitrogen. nitrogen. therethere
seems seems that that patients patients onon
was was no no lack lack ofof the the
high-high-
ofof and and
absorption absorption fat fat thethe
the the dietarydietary high-proteinhigh-protein
nitrogen, nitrogen, nornor diets. diets. TheThe
any any
large large changechange high-carbo-high-carbo-
in in the the break-break- hydratehydrate
down down of of endoge-endoge- diets diets areare
nous nous excludedexcluded
protein.protein. becausebecause
111 111 showsshows
Table Table changes changes inin
the the fat-balancesfat-balances
in in patientspatients body-weightbody-weight
eight eight thethe and and body-body-
during during water water were were ee
, ,
periods periods on on thethe negligiblenegligible
high-fat high-fat diets.diets. thisthis
; ;
In In view view of of thethe during during
; ; period. Onceperiod. Once
large large percentagepercentage itit
_ _
of of fat fat absorbedabsorbed again again
B B appearsappears
(column (column 3) 3) therethere that, that, of of thethe
reason reason , ,
is is no no toto total total
that that
suppose suppose thethe weightweight
loss loss of of ininl l lost, 41-52%lost, 41-52%
weight weight was was in in thethe
these these ; ;
patientspatients form form ff of of 3 3 on on diets diets ofof
due due ) ) of of Fig. Fig. 9-Nitrogen-balances 9-Nitrogen-balances patients patients
was was toto availableavailable series series 2.2.
ee, J , J
inadequate inadequate body-waterbody-water
absorption.absorption. and and in in the the form form ofof
Measur e m e n Measur e m e n tt the the remaining remaining 48-59% 48-59% probably probably
of of availableavailable body-fat.body-fat.
body-water body-water dis-dis- Diets Diets Series Series 33
the the samesame It It of of that that the the of of the the dietdiet
plays plays seems seems qualitative qualitative composition composition
asas has has a a effect effect on on in in the the obese obese whenwhen
phenomenon phenomenon profound profound weight-loss weight-loss
in in intake intake calories calories is is deficient. deficient. The The
the the first first seriesseries the the of of already already extentextent
of of of of these these that that this this be be
patients patients (table(table changes changes may may an an
The The suggests suggests importantimportant
iv). iv). rangerange factor factor in in the the dietetic dietetic therapy therapy of of obese obese patients. patients. ItIt
of of ofof in in
was was decided decided to to test test this this idea idea another another Five Five
proportions proportions way. way. obeseobese
total total body-body- patients patients were were put put on on a a 2000-calorie 2000-calorie diet diet containing containing aa
and and totaltotal normal normal of of fat, fat, and and
weight weight proportion proportion protein, protein, carbohydrate.carbohydrate.
waswas a a of of 7 7 it it was was
body-water body-water During During period period days days shown shown that that eithereither
of of in in 3 3 on on diets diets ofof they they
Fig. 8-Loss Fig. 8-Loss weight weight patients patients of of orderorder
the the same same maintained maintained their their or or a a little. little. The The
in in order.order. number number ofof
2 2 different different
series series given given weight weight gained gained
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