Metabolic observations during the treatment of obese patients by periods of total starvation

Ten very obese female patients were treated by periods of total starvation lasting 10 days each. In the interval between these starvation periods, a diet of 600 calories was given. Twenty-one periods were completed, 6 patients went through 3 periods each. The fasting was generally well tolerated; with the appearance of ketone bodies in the urine the feeling of hunger diminished. The average weight loss during total starvation was 447 Gm./day ranging from 290 to 600 Gm. Nitrogen excretion was on the average 4.15 Gm./day (2.6–7.2). There was no significant decrease in BMR neither a lowering of body temperature. During the third starvation period weight loss was less than during the other two, but the BMR did not decrease. There were no changes in serum electrolytes, HCO3-, pH, urea, creatinine or serum proteins. The excretion of 17-OHCS dropped significantly but remained within the normal range. The excretion of 17-KS dropped to subnormal values. Plasma FFA were elevated at the start of the experiment. Generally there was some rise from the first to the seventh day of the starvation periods. In the patients who completed 3 periods the FFA values were lower during the third than during the first period. Serum cholesterol, total fat and phospholipids did not show significant changes. The blood sugar values showed some decrease during starvation which was statistically not significant. The implications of these findings are discussed. We are of the opinion that our patients did not exhibit signs of a disturbance in fat mobilization