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 607

Chapter 9 – Weight Management: Overweight, Obesity, and Underweight

An. Page(s)/difficulty K = knowledge-level, A = application level

Multiple Choice

Questions for Section 9.1 Overweight and Obesity

d 271(K) 01. According to body mass index values, what fraction of the U.S. adult population is
considered overweight or obese?
a. 1/10
b. 1/6
c. 1/3
d. 2/3

b 271(K) 02. According to body mass index figures, what percentage of people aged 2-19 years are
overweight or obese?
a. 12
b. 33
c. 48
d. 68

b 272(K) 03. Which of the following describes a trend of worldwide obesity?

a. Nowadays, obesity is not seen in developing countries
b. Prevalence of obesity has leveled out in the last few years
c. The cut-off figure of the BMI for obesity varies from country to country
d. The obesity in other countries does not seem to increase risks for chronic diseases

b 272(A) 04. What is the classification of a person who is 6 feet 4 inches tall and 202 lbs?
a. Underweight
b. Healthy weight
c. Overweight
d. Obese

b 272(K) 05. Which of the following is a characteristic of fat cell development?

a. The amount of fat in the body is substantially determined by the size of the fat cells
b. More and larger fat cells are found in obese people compared with healthy-weight
persons
c. Fat cell number increases most readily during early adulthood, when energy
expenditure declines
d. Fat cells may enlarge but not increase in number upon reaching the age of 50 in
males and reaching menopause in women

a 272(K) 06. All of the following describe the behavior of fat cells except
a. the number decreases when fat is lost from the body.
b. the size is larger in obese people than in normal-weight people.
c. the storage capacity for fat depends on both cell number and cell size.
d. the number increases several-fold during the growth years and tapers off when adult
status is reached.

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a 272(A) 07. Tom was overweight when he was 13. During puberty he continued to gain weight
steadily until at age 23, when he decided to lose weight. Tom successfully lost 50 pounds.
Which of the following most likely happened to Tom’s fat cells?
a. They shrank in size but did not decrease in number
b. They melted away when he burned all the excess fat
c. They decreased in number but did not decrease in size
d. They changed very little since fat cells shrink only with a weight loss greater than
100 pounds

d 272(A) 08. In the quest for achieving desirable body weight, adults have control over all of the
following except
a. diet.
b. behavior.
c. physical activity.
d. adipocyte number.

c 272-273(K) 09. What is the rationale for the fat cell theory of obesity?
a. Fat cell number increases dramatically after puberty
b. Fat cell number in an adult can decrease only by fasting
c. Fat cell number increases most readily in late childhood and early puberty
d. Weight gain from overeating in adults takes place primarily by increasing the
number of fat cells

b 272-273(K) 10. Which of the following is known to promote fat storage in adipocytes?
a. Glucagon
b. Lipoprotein lipase
c. Cellulite synthetase
d. Lipoprotein synthetase

b 272-273(A) 11. The most likely explanation for why women readily store fat around the hips whereas
men readily store fat around the abdomen is gender differences in
a. blood insulin levels.
b. the activity of lipoprotein lipase.
c. circulating lipid transport proteins.
d. the activity of lipoprotein synthetase.

a 272-273(K) 12. All of the following are features of fat cell metabolism in men and women except
a. the rate of fat breakdown is higher in women than in men.
b. fat storage in adipose as well as muscle tissue is regulated by sex-specific hormones.
c. lipoprotein lipase enzyme activity is regulated by a gene that responds to weight loss.
d. fat storage in men develops primarily across the abdomen whereas in women it is
found chiefly around the hips and thighs.

c 272-273(K) 13. Which of the following is a feature of the lipoprotein lipase enzyme?
a. Its activity decreases after weight loss but then rebounds quickly after resuming
normal food intake
b. Its activity can always increase but cannot decrease and is, in part, controlled by the
ratchet effect of metabolism
c. Its activities in men and women are sex-related and explain the differences in major
fat storage regions of the body
d. Its low activity in obese people explains, in part, the inability to mobilize storage fat
for energy when following an energy-restricted diet

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b 273(K) 14. Obesity resulting from an increase in the size of fat cells is termed
a. hyperplastic obesity.
b. hypertrophic obesity.
c. idiopenthic leptinemia.
d. anaplastic hypometabolism.

a 273(K) 15. Adverse effects on organs such as the liver from the presence of excess body fat is known
as
a. lipotoxicity.
b. hyperplastic lipase.
c. set point susceptibility.
d. hyper-responsive ghrelin.

d 273(K) 16. Hyperplastic obesity is related to a(n)

a. increase in fat absorption.
b. decrease in ketone formation.
c. increase in the size of fat cells.
d. increase in the number of fat cells.

a 273(K) 17. Obesity resulting from an increase in the number of fat cells is termed
a. hyperplastic obesity.
b. hypertrophic obesity.
c. idiopenthic leptinemia.
d. anaplastic hypometabolism.

d 273(K) 18. Which of the following defines the body’s set point?
a. Minimum weight of a person
b. Maximum weight of a person
c. Point at which a person’s weight plateaus before dropping again quickly
d. Point above which the body tends to lose weight and below which it tends to gain
weight

Questions for Section 9.2 Causes of Overweight and Obesity

b 273(K) 19. What is Prader-Willi syndrome?

a. Altered receptor activity for leptin
b. A genetic disorder resulting in obesity
c. Fat accumulation in the liver of gastric bypass patients
d. A failure to adapt to alternating periods of excess and inadequate energy intake

d 273-274(K) 20. Which of the following is a feature of weight gain and genetics?
a. Obese people can change their genome but not their epigenome
b. Even mild exercise can minimize the genetic influence on weight gain
c. Genetics is the overwhelming factor that determines a person’s risk for weight gain
d. Identical twins are twice as likely to weigh the same compared with fraternal twins

d 274(K) 21. On which organ or tissue does leptin primarily act?

a. Pancreas
b. Intestines
c. Adipocytes
d. Hypothalamus

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a 274-275(K) 22. Which of the following is known to cause a reduction in fat cell number in mice?
a. Injection of leptin
b. Supplements of ghrelin
c. Long-term resistance exercise
d. Consumption of high-protein diets

c 274-276(K) 23. What are the observed effects of sleep deprivation on leptin and ghrelin?
a. Leptin and ghrelin both increase
b. Leptin and ghrelin both decrease
c. Leptin decreases while ghrelin increases
d. Leptin increases while ghrelin decreases

b 274-275 (A) 24. As a new assistant in a weight-loss research laboratory, you are given a tour of the mouse
laboratory. Why is the leptin-deficient mouse much larger than its leptin-sufficient
counterpart?
a. Leptin deficiency causes lower levels of ghrelin
b. Leptin deficiency enhances appetite and decreases energy expenditure
c. Leptin deficiency causes psychological depression, which leads to increased food
intake
d. Leptin deficiency reduces the desire to do physical activity, resulting in more excess
energy available for fat storage

c 274-275 (K) 25. Which of the following describes a relationship between leptin and energy balance?
a. Fat cell sensitivity to leptin is higher in obese people
b. A deficiency of leptin is characteristic of all obese people
c. Blood levels of leptin usually correlate directly with body fat
d. Major functions of leptin include an increase in hunger and a decrease in metabolic
rate

b 274-275(K) 26. Which of the following is a feature of leptin?

a. It is an enzyme
b. It is a satiety signal
c. It is usually deficient in obese people
d. It is secreted by the brain and acts on fat cells

b 275(K) 27. Which of the following is a feature of ghrelin?

a. It is a metabolic antagonist of leptin
b. It stimulates appetite and energy storage
c. The blood level in the fasting state correlates directly with body weight
d. It is released in high amounts from adipocytes during periods of excess energy intake

a 275(K) 28. Why is weight loss, in part, more successful with exercise and also after bypass surgery?
a. Ghrelin levels are relatively low
b. Adiponectin levels are relatively high
c. PYY release from the hypothalamus is suppressed
d. Leptin release from subcutaneous fat stores is enhanced

d 275(K) 29. Which of the following is not a feature of adiponectin?

a. It inhibits inflammation
b. It is secreted from adipose tissue
c. It protects against type 2 diabetes
d. It is higher in obese people compared with lean people

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d 275-276(K) 30. Which of the following is a feature of ghrelin?
a. High blood levels are found in obese people
b. Its major role in the body is in suppressing appetite
c. It is secreted by adipocytes and promotes negative energy balance
d. Its blood concentration is very high in people with anorexia nervosa

c 276(K) 31. Which of the following is not a satiating hormone?

a. PYY
b. Leptin
c. Ghrelin
d. Cholecystokinin

d 276(K) 32. All of the following are hormones that promote satiety except
a. PYY.
b. CCK.
c. leptin.
d. ghrelin.

c 276(K) 33. What serves as the body’s chief storage site for lipids?
a. Yellow fat
b. Brown adipose tissue
c. White adipose tissue
d. High-density lipoproteins

a 276-277(K) 34. What is the significance of the uncoupling proteins in adipose tissue?
a. Increased loss of body heat
b. Reduction of fat cell number
c. Lowering of basal metabolism
d. Proliferation of fat cell number

c 276-277(A) 35. Kirima is a Native Eskimo who lives in one of the coldest regions in the world. What
type of adipose tissue is most effective at helping her to maintain warm body
temperatures during the coldest parts of the year?
a. Black
b. White
c. Brown
d. Yellow

a 276-277(K) 36. Which of the following is a characteristic of the body’s major types of adipose tissue?
a. Very little brown fat is found in adults whereas more is seen in infants
b. White adipose is especially important in infants as a moderator of temperature
extremes
c. The uncoupled reactions in brown and white adipose are the result of LPL-induced
hydrolysis of ATP
d. Among the three types of adipose, namely, white, yellow, and brown, the white
adipocytes account for the greatest amount of heat expenditure

d 277(K) 37. What is the chief factor that determines a person’s susceptibility to obesity?
a. Heredity only
b. Environment only
c. Fat content of diet
d. Heredity and environment

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a 277(K) 38. Which of the following is the best evidence that environment must play a role in obesity?
a. The rate of obesity has been rising while the gene pool has remained relatively
constant
b. The recognition that identical twins reared apart have body weights similar to their
biological parents
c. The development of precise body composition methodologies that define adipose
storage sites based on gender
d. The discovery of uncoupling proteins that explain the variations in energy
metabolism among lean and overweight people

c 277(K) 39. All of the following are characteristics of food portion sizes except
a. they are both high in fat and large in size at restaurants.
b. they have increased in general and this change parallels the increasing prevalence of
obesity.
c. reducing portion size has a bigger impact than reducing energy density as a means of
lowering total energy intake.
d. they have increased most notably at fast-food restaurants compared with
conventional eating establishments.

c 278(K) 40. Compared with non-obese people, obese people have a lower
a. basal metabolic rate.
b. thermic effect of food.
c physical activity level.
d. metabolic response to exercise.

b 278(K) 41. Which of the following is a feature of physical inactivity and energy balance?
a. There is a strong genetic component to reduced physical activity of overweight
people
b. Differences in the time obese and lean people spend lying, sitting, standing, and
moving account for about 350 kcalories per day
c. Although watching television correlates with weight gain, playing video games does
not, presumably due to the heightened excitement engendered by action games
d. Extraordinarily inactive people who lower their food intakes below that of their lean
counterparts activate brown adipose tissue uncoupling proteins that stimulate
hyperthermic weight loss

c 278(K) 42. Television watching contributes to obesity for all of the following reasons except
a. it promotes inactivity.
b. it promotes between-meal snacking.
c. it replaces time that could be spent eating.
d. it gives high exposure to energy-dense foods featured in the commercial
advertisements.

b 278(K) 43. To help prevent body fat gain, the DRI suggests daily, moderately intense, physical
activities totaling
a. 20 minutes.
b. 60 minutes.
c. 1½ hours.
d. 3 hours.

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Questions for Section 9.3 Problems of Overweight and Obesity

d 278(K) 44. At any given time, approximately what percentage of all U.S. adults are attempting to
lose weight?
a. 10
b. 20
c. 40
d. 60

c 279(K) 45. Aggressive treatment should be introduced in obese people if they have which of the
following risk factors?
a. Hypertension only
b. Cigarette smoking only
c. High LDL and low HDL
d. Impaired glucose tolerance only

d 279-280 46. Which of the following is not a characteristic of obese people?

a. Obese people often have feelings of rejection
b. Most obese people do not maintain their weight losses
c. In many cultures, obesity is viewed as a sign of robust health
d. Most weight-loss programs that use state-of-the-art techniques allow for long-term
weight loss

b 280(K) 47. What percentage of people in the United States who use nonprescription weight-loss
products have a normal weight?
a. 5
b. 10
c. 20
d. 35

a 280(K) 48. A popular eating plan that promises quick weight loss is known as a(n)
a. fad diet.
b. discretionary diet.
c. spot reduction program.
d. aggressive bariatric program.

c 281(A) 49. What is the primary reason that laxatives are generally not effective agents for losing
weight?
a. They have little, if any, effect on appetite
b. They have a low binding activity to dietary fat
c. They act on the large intestine rather than the small intestine
d. They often induce abdominal cramping and intestinal gas, thereby encouraging
rejection and noncompliance

c 281(K) 50. What is the principal reason that the FDA has banned the sale of products containing
ephedrine?
a. The costs are prohibitive
b. The products were found to be ineffective for weight loss
c. The products were implicated in several cases of heart attacks and seizures
d. The products were found to contain contaminants that were believed to be
responsible for inducing liver failure

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614
d 281(K) 51. Over-the-counter products labeled as “dieter’s tea” are reported to lead to
a. leptin resistance.
b. ketone poisoning.
c. cravings for protein.
d. nausea and diarrhea.

b 281(K) 52. When consumed in high doses, which of the following is associated with modest weight
loss in people?
a. Chitosan
b. Pyruvate
c. Yohimbine
d. Conjugated linoleic acid

c 282(K) 53. Fraudulent weight reduction literature refers to visually apparent, lumpy forms of body
fat as
a. lipomas.
b. lipidosis.
c. cellulite.
d. hyperphagic deposits.

a 282(K) 54. Which of the following is a feature of weight-loss remedies?

a. Dietary supplements are not necessarily tested for safety or effectiveness
b. Body wraps and creams that have FDA approval are helpful for weight-reduction
regimes
c. Sauna baths may reach temperatures high enough to melt visceral but not
subcutaneous fat stores
d. Hot baths raise the metabolic rate by 5-10% for 1-2 hours and may serve as part of a
general weight-loss program

Questions for Section 9.4 Aggressive Treatments for Obesity

d 282(K) 55. The drug sibutramine reduces appetite by affecting

a. ketone production.
b. insulin to glucagon ratio.
c. leptin sensitivity of fat cells.
d. serotonin utilization in the brain.

a 282(K) 56. Clinically severe obesity is also known as

a. morbid obesity.
b. metabolic syndrome.
c. leptin-resistant obesity.
d. psychological-resistant syndrome.

a 282(K) 57. Bariatrics is a field of medicine that specializes in the treatment of

a. obesity.
b. combating fad diets.
c. severe underweight.
d. anorexia and bulimia.

a 282(K) 50. The prescription drug sibutramine acts by regulating the utilization of
a. serotonin.
b. blood insulin.
c. hormone-sensitive lipase.
d. adipocyte lipoprotein lipase.

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d 282-283(A) 58. Your patient, Mr. Sinclair, has a BMI of 43 and is taking drugs to lose weight. He has
heard that some drugs cause lots of gastrointestinal discomfort and would prefer to take
one that doesn’t give him any of these side effects. Which of the following should be
prescribed for Mr. Sinclair?
a. Olestra
b. Orlistat
c. Serotonin
d. Sibutramine

c 283(K) 59. What is the primary action of orlistat, a weight-loss drug?

a. It reduces taste sensation
b. It inhibits lipoprotein lipase
c. It inhibits pancreatic lipase
d. It alters circulating leptin concentrations

c 283(A) 60. All of the following are factors that meet the conditions for surgical intervention for
weight loss in obese people except
a. BMI of at least 40.
b. presence of psychological problems.
c. ability to tolerate sibutramine, orlistat, or phentermine.
d. failure of diet and exercise to promote acceptable weight loss.

d 283-284(K) 61. All of the following are characteristics of the results of weight-loss surgery except
a. hunger is suppressed.
b. deficiencies of vitamins and minerals are common in the long term.
c. dramatic improvements are seen in blood lipids, diabetes, and blood pressure.
d. medical supervision in the postsurgery period is required only for the first 6-9
months.

Questions for Section 9.5 Weight-Loss Strategies

b 284-285(K) 62. Which of the following describes the research results regarding obese women in weight-
loss programs?
a. They were mostly satisfied with a 15% reduction in weight
b. They initially expected to lose unrealistic amounts of weight
c. They typically lost about 30% more weight than researchers predicted
d. They experienced fewer psychological benefits than expected after losing weight

c 285(K) 63. In a weight reduction regimen, the most realistic time frame for losing 10% of initial
body weight is
a. 6 weeks.
b. 3 months.
c. 6 months.
d. 1 year.

a 285(K) 64. What is a safe rate of weight loss on a long-term basis for most overweight people?
a. 0.5-2 lbs/week
b. 3-4 lbs/week
c. 5% body weight/month
d. 10% body weight/month

b 285-286(K) 65. All of the following are sensible guidelines for diet plans except
a. consume low-fat foods regularly.
b. eat rapidly to avoid prolonged contact with food.
c. adjust energy intake downward as weight loss progresses.
d. include vegetables, fruits, and grains as the mainstay of the diet.

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616
c 286(K) 66. As a general rule, what minimum number of kcalories per day is necessary to ensure
nutritional adequacy in an eating plan for reducing body weight?
a. 500
b. 800
c. 1200
d. 1600

b 287-288(A) 67. Which of the following would be most effective at lowering energy intake in a person on
a weight reduction program?
a. Decrease portion size
b. Select less energy-dense foods
c. Restrict fiber intake as a means to reduce excess water retention
d. Consume a small high-fat snack before each meal to reduce appetite

d 287-289(K) 68. The feeling of satiety from weight-loss diets is best achieved by diets rich in
a. fat.
b. short-chain fats.
c. simple carbohydrates.
d. complex carbohydrates.

d 289-290(A) 69. What is the best approach to weight loss?

a. Avoid foods containing carbohydrates
b. Eliminate all fats from the diet and decrease water intake
c Greatly increase protein intake to prevent body protein loss
d Reduce daily energy intake and increase energy expenditure

b 289-290(A) 70. An important aid in any weight-loss diet program is to

a. decrease water intake.
b. increase physical activity.
c. speed up thyroid activity with metabolic enhancers.
d. develop ketosis by keeping carbohydrate intake as low as possible.

a 290(A) 71. Which of the following describes a connection between physical activity and energy
expenditure?
a. Walking a mile uses about the same energy as running a mile
b. Walking a mile uses about half as much energy as running a mile
c. Exercising the leg muscles is effective at burning away fat primarily around the
thighs and hips
d. Exercising the abdominal muscles is effective at burning away fat primarily around
the abdomen

b 290(A) 72. A person who weighs 150 lbs. and walks at a pace of 3 miles/hr expends about how many
kcalories in that hour?
a. 115
b. 270
c. 410
d. 850

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 617
a 291(K) 73. Which of the following is a feature of the body’s response to engaging in physical
activity?
a. After an intense and vigorous workout, metabolism remains elevated for several
hours
b. Lower body fat is more readily lost from vigorous exercises that work primarily the
hip and leg muscles
c. Blood glucose and fatty acid levels are low immediately after working out, but
thereafter recover on their own
d. After an intense workout, most people immediately feel the urge to eat a large
carbohydrate meal to replace glycogen stores

a 291(A) 74. A typical person who burns 200 kcalories during a 2-mile run would, in the postexercise
period, burn an additional
a. 30 kcalories.
b. 75 kcalories.
c. 150 kcalories.
d. 300 kcalories.

c 291(A) 75. What is the principal reason that appetite is turned off immediately after a person finishes
an intense workout?
a. The feeling of thirst overpowers the desire for food
b. The elevated blood lactate level antagonizes ghrelin
c. Glucose and fatty acids are still abundant in the blood
d. The senses of smell and taste are suppressed for at least one hour

b 291-292(K) 76. Features of the adaptive response to regular physical exercise include all of the following
except
a. it curbs appetite.
b. it stimulates digestive function in the postexercise period.
c. it increases energy expenditure in the postexercise period.
d. it triggers release of lipids from adipocytes from all over the body.

c 292(K) 77. What is the chief reason that health-care professionals advise people to engage only in
low-to-moderate intensity activities for prolonged duration rather than more intense,
shorter routines?
a. Cost is lower
b. Boredom is reduced
c. Compliance is better
d. Monitoring time is diminished

a 292(K) 78. Which of the following is a relation of “spot reducing” to exercise?

a. No exercise can target fat removal from any specific area of the body
b. Upper body fat is mostly unaffected by exercising lower body muscles
c. Lower body fat in women is depleted at a faster rate than abdominal fat
d. Abdominal fat in men is released more readily with anaerobic exercise

b 292(K) 79. Approximately how many kcalories are expended per kilogram body weight when
walking a mile at a moderate pace?
a. 0.1
b. 1
c. 2.5
d. 5

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a 292(K) 80. Approximately how many kcalories per week should be expended in physical activity in
order to maintain a weight loss?
a. 2000
b. 4000
c. 6000
d. 9000

d 293(K) 81. Which of the following does not represent a common environmental influence on eating
behaviors?
a. Eating while viewing television promotes overconsumption
b. Socializing with strangers during a meal often leads to reduced food intake
c. The mere sight of food can signal a person to commence eating, regardless of hunger
d. Being in a pleasant atmosphere often lengthens the time of the meal but not the
amount of food eaten

d 293;285-287(A) 82. All of the following are behavior modifications for losing weight except
a. shopping only when not hungry.
b. eating only in one place and in one room.
c. participating in activities such as television viewing only when not eating.
d. taking smaller portions of food but always eating everything on the plate quickly.

a 293-294(A) 83. To help maximize the long-term success of a person’s weight-loss program, which of the
following personal attitudes should be encouraged in the individual?
a. Strongly believing that weight can be lost
b. Viewing the body realistically as being fat rather than thin
c. Refraining from expressing overconfidence in ability to lose weight
d. Accepting that little or no exercise is a part of the lifestyle of most overweight people

d 293-294(K) 84. All of the following are features of the effect of food accessibility on food intake except
a. keeping food out of sight is an effective way to eat less.
b. people underestimate the amount of a snack eaten when it is a short distance away.
c. people eat more of a snack when it is on their desk than when situated only 6 feet
away.
d. people at home would rather travel to the store to obtain new food than eat the
leftovers.

a 293-294(K) 85. All of the following are associations between the environment and food intake except
a. distractions generally appear to reduce food intake.
b. the greater the number of foods at a meal, the more likely people will overeat.
c. the mere sight or smell of food prompts people to commence eating even if they are
not hungry.
d. small portions of food on large plates lead people to underestimate the amount of
food eaten.

b 294(A) 86. An example of a behavior modification technique for weight control is to

a. feel guilty after you overeat.
b. keep a record of your eating habits.
c. always clean your plate when you eat.
d. have someone watch you to prevent overeating.

c 296(K) 87. Which of the following is a feature of energy metabolism in formerly obese people who
have lost weight?
a. Basal metabolic rates are higher than those during the obese state
b. Energy expenditure is the same as in people who were never obese
c. Energy requirements are lower than expected for their current body weight
d. Energy expenditure is the same per kg body weight compared with the obese state

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 619
b 296(K) 88. Approximately what percentage of overweight people who intentionally lose weight are
able to maintain the weight loss for at least one year?
a. 25
b. 50
c. 75
d. 90

c 296(A) 89. To qualify for successful weight-loss maintenance, a 200-pound person who intentionally
lost 20 lbs must hold the loss for at least
a. 3 months.
b. 6 months.
c. 1 year.
d. 2 years.

c 297(K) 90. Because obesity apparently has many causes, even in an individual, the best approach
seems to be
a. fasting.
b. medicines.
c. prevention.
d. genetic counseling.

Questions for Section 9.6 Underweight

a 298(K) 91. Approximately what percentage of U.S. adults are classified as underweight?
a. 5
b. 10
c. 20
d. 25

b 298(K) 92. The classification of underweight is defined when the BMI first drops below
a. 14.
b. 18.5.
c. 20.
d. 22.5.

a 298(A) 93. Among the following, which is the most important strategy for an underweight person
who wishes to achieve a healthy body weight?
a. A high-kcalorie diet plus regular exercise
b. A high-kcalorie diet and minimal exercise
c. A high-protein diet plus regular exercise
d. Total elimination of alcohol and exercise

c 298-299(A) 94. Of the following, which is not among the recommended strategies for weight gain in an
underweight person?
a. Behavior modification training
b. Increased physical activity, especially strength training
c Forced awakening during the night for supplemental meals and snacks
d. Consumption of regular meals and snacks that provide high-kcalorie foods in small
volumes

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620
c 298-299(A) 95. All of the following are meal-planning strategies for underweight people who desire to
gain weight except
a. they should eat at least 3 healthy meals daily.
b. they should eat meaty appetizers rather than salads.
c. they should refrain from between-meal snacking, especially energy drinks.
d. they should increase the amount of food consumed within the first 20 minutes of a
meal.

c 299(A) 96. Which of the following would not be part of a successful program of weight gain in an
underweight individual?
a. Eat energy-dense foods
b. Drink energy-dense beverages
c. Eat a large number of small meals
d. Engage in regular physical exercise

Questions for Section 9.7 The Latest and Greatest Weight-Loss Diet—Again

d 306(K) 97. Fad diets often produce weight loss, at least initially, because
a. they dictate the correct distribution of energy among the macronutrients.
b. they prevent rapid spikes and declines in one’s blood glucose level.
c. they don’t require people to count kcal, and are thus easier to stick to.
d. they are designed to limit energy intake to around 1200 kcal/day.

b 308(A) 98. Jody is taking a nutrition class, and has been assigned to evaluate a popular diet plan. She
finds a description of a plan for her assignment in a magazine at the grocery store. Which
of the following statements in the magazine would suggest that this plan is an unsound,
fad diet?
a. “Keep fresh fruit or carrot sticks in the fridge at work so you won’t be tempted to
raid the vending machine for a snack.”
b. “Once you complete this 6-month plan, you’ll never have to diet again.”
c. “Starting an aerobic exercise plan may seem daunting, but you can start out with
shorter, easier sessions and then build up to 3 or more hours a week.”
d. “On this plan, you can lose up to 2 pounds per week!”

Matching

F 271 01. Percentage of U.S. adults considered overweight

R 272 02. An enzyme that promotes fat storage
T 273 03. A term that describes an increase in fat cell number in obesity
K 273 04. A theory that the body tends to maintain a certain weight by internal controls
S 273 05. A term that describes an increase in fat cell size in obesity
G 274 06. Hormone that suppresses appetite
I 275 07. Hormone that stimulates appetite
M 275 08. Adipose tissue substance that inhibits inflammation
L 276 09. Type of adipose that primarily stores fat
N 276 10. Type of adipose that primarily produces heat
C 280 11. Percentage of nonprescription weight-loss product users in the United States who are at a
normal weight
O 281 12. Substance in some herbs that may cause heart attacks and seizures
J 282 13. A fraudulent term to describe lumpy fat
Q 282 14. A drug that interferes with serotonin metabolism
H 283 15. Inhibitor of pancreatic lipase
D 283 16. Minimum BMI of a clinically severe obese person
P 284 17. A cosmetic surgical procedure
A 285 18. Safe rate of weight loss, in pounds per week

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 621
E 289 19. Recommended minimum number of minutes per day of moderately intense physical
activity to prevent weight gain
B 298 20. Percentage of U.S. adults classified as underweight

A. 1 H. Orlistat O. Ephedrine
B. 5 I. Ghrelin P. Liposuction
C. 10 J. Cellulite Q. Sibutramine
D. 40 K. Set point R. Lipoprotein lipase
E. 60 L. White fat S. Hypertrophic obesity
F. 66 M. Adiponectin T. Hyperplastic obesity
G. Leptin N. Brown fat

Essay

Page(s)

272-273 01. Discuss differences in fat cell metabolism between males and females.

272-273 02. Explain the role of lipoprotein lipase enzyme in fat cell metabolism.

273 03. Explain the set point theory of weight change.

273-274 04. Discuss the role of genetics in promoting excess weight gain and in discouraging
weight loss.

273-278 05. List the major factors involved in obesity. Which ones can be controlled by dietary
changes or behavior modification?

274-276 06. Discuss the roles of leptin, ghrelin, adiponectin, and PYY in the regulation of food
intake and energy storage.

274-276 07. Discuss the interactive roles of leptin, ghrelin, and PYY in food intake control.

276-277 08. Explain the significance and models of action of uncoupling reactions in energy
metabolism.

276-277 09. Explain the association between ghrelin secretion and sleep.

276-277 10. Contrast the metabolic roles of white adipose tissue and brown adipose tissue.

277 11. In understanding food habits in obese people, what is the importance of the energy-
balance equation over time?

277 12. Discuss the limitations of using diet histories to ascertain eating habits.

277-278 13. Explain the factors involved in the promotion of obesity by high-fat diets and food
portion sizes.

277-278 14. Discuss the role of the restaurant industry in promoting excess food consumption.

278 15. Discuss the various factors related to the role of insufficient physical activity in
energy balance.

278-280 16. List several health risks associated with being underweight and with being
overweight.

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622

279 17. Discuss the recommendations for losing weight in population groups who are either
overweight in good health, obese or overweight with risk factors, or obese or
overweight with a life-threatening condition.

279-280 18. Describe psychological problems encountered by obese people in their attempts to
lose weight.

279-280 19. Outline the cycle of behavior associated with the psychology of weight cycling in
relation to the high failure rate of weight-loss programs.

280 20. What types of information might be found in a weight-loss consumer “bill of rights”?

280-282 21. Explain the attraction of unsound weight-loss procedures and plans to obese people.

280-282 22. Discuss the use of herbal products for weight loss.

280-282 23. List several factors that help identify inappropriate, unsound, and possibly dangerous
commercial weight-loss programs.

282-283 24. Discuss the use of prescription drugs for the treatment of obesity, including modes of
action and adverse side effects.

283-284 25. Describe the approaches for weight loss by surgery. What are the benefits and what
are the adverse side effects of these procedures?

284-289 26. Describe a good weight-reduction diet in relation to energy content, meal size,
carbohydrate and fat levels, and water intake.

284-289 27. Outline the recommendations for a successful weight-loss diet.

285-286 28. What are the findings from studies of people on weight-loss diets who skip meals?

288 29. Discuss ways in which an increase in the water content of the diet plays an important
role in body weight management.

288 30. Explain the role of fiber in assisting weight loss.

288-289;287 31. What are the results of research studies concerning the importance of low-fat diets in
weight-reduction regimes?

289 32. Discuss the importance of carbohydrate selection and of sugar alternatives in a
weight-loss program.

289-292 33. Explain the changes in metabolism consequent to a decrease in energy intake. How
are these changes modified by regular physical exercise?

289-292 33. Describe the benefits of regular physical activity as an aid to weight-loss dieting.

291-292 34. Explain the relationship of physical activity and appetite control.

292 35. Explain what is meant by “spot reducing” and discuss its effectiveness in altering
body fat content.

293 36. Describe the effects of socializing during meal times on quantity of food consumed.

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 623
293 37. Provide an explanation for the higher food consumption of people who eat in the
presence of others.

293-294 38. Discuss the role of environmental influences on food intake.

294 39. How do package sizes and serving containers influence food intake?

294-295 40. Explain the role of behavior modification in weight reduction programs.

296-297 41. Discuss public health strategies designed to help people reduce body weight and
prevent a re-gain.

298 42. List circumstances under which some people would benefit from having more body
fat.

298-299 43. Present a sound diet plan for weight gain in the underweight person.

306 44. Provide an appropriate response to each of these two comments: “This new diet
discovery can alter your genetic code for energy metabolism” and “High-protein
diets are brain food.”

306 45. Discuss the role of insulin and the glycemic index in association with fad diets.

307;309 46. Compare and contrast the theory, applicability, and success of the Atkins diet with
that of the Ornish diet.

308 47. List 5 guidelines each for identifying a fad diet and a healthy diet.

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 Author’s Tents. A Camp in Nepal

The Tinker village is perched on a height some distance from the spot where the
two principal sources of the Tinker river join—one coming from the five glaciers
to the east (those described in the previous chapter), the other source
descending precipitously and with great force from the Tinker [119]Glacier higher
up, to the north of the village, and spreading in a N.E. direction.

Tinker itself is a quaint and interesting place. Flying prayers—generally pieces of

white cloth—decorated every roof in the village, and some shrubs were similarly
decorated with hundreds of strips of cloth—red, blue, or white—deposited there
by devotees. Chokdens—piles of stones—were numerous, many of them
constructed of stones each of which was inscribed with the Tibetan prayer—“Om
mani padme hum.”

Farther up the mountain one found curious ancient cave-dwellings, identical with
those I have in a previous work described at Taklakot, in Tibet, the peculiar
composition of the rock permitting the chambers to be hollowed out with
comparative ease. These dwellings are very suitable for that climate, being
relatively warm in winter and cool in summer, besides answering all the
purposes of a fortress when built high up into a cliff. In Tibet itself these cliff-
dwellings are most elaborate, and are connected by means of intricate passages
and galleries going right up to the summit of the high cliff. Outer ways of
communication are also noticeable, in the form of dangerous-looking steps and
sharp and narrow gradients, by which the [120]lodgers can find access to or
escape from their apartments.

Upon the higher Himahlyas, in certain selected points, such as on passes, or

where two trails branch off, or near villages, is generally to be found a gay
exhibition of flying prayers, hundreds of them, suspended from ropes stretched
across upon high poles. Large banners are also frequently to be seen at these
spots. Passing caravans make these favourite halting-places. Both the women
of Tibet and those of neighbouring tribes often select these spots for stretching
their hand-looms and weaving their fabrics.

The Tinker Glacier was a very beautiful sight with its high terraces, and we
followed it for its entire length on our way up to the pass. It was a long and steep
climb, mostly on snow, and as the trail was low down between high mountains to
the S.W. and N.E. the sun did not penetrate for any length of time, so that the
cold was intense. My men were rather heavily laden, and at sunset, owing to our
late start, we had gone but a few miles.

We halted at a Tibetan camping-ground, where there were a number of black

Tibetan tents, their occupants bolting full-speed up the mountain-side as soon as
they saw us. After some coaxing, and [121]promises that we would in no way
harm them, they gradually returned and attended to their business. The women
had erected a great many looms outside the tents, and some jolly, but somewhat
shaggy, females were noisily and busily engaged beating wool previous to
packing; others were spinning it and winding it round long rods; others were
speedily making narrow strips of cloth upon their looms. Upon receiving small
presents they became quite friendly, and gave much information regarding the
war preparations of their countrymen. They said thousands of soldiers were
guarding the pass.

Next morning I went to see for myself, but the Tibetan soldiers had, when I
arrived, already beaten a hasty retreat, leaving nothing more than their
footmarks on the snow. Although I constantly heard of this formidable army, I
never was able to catch it up during my incursions, or establish its exact
position, much less meet it.
Everybody has heard so much of late of Tibetan scenery and travelling that it will
perhaps be more agreeable to the reader if I devote most of the space which
remains at my disposal to the description of some Tibetan customs. It is well
known that Tibet is a high plateau, S.W. Tibet especially, where most of my
exploration extended, averaging [122]heights of from 15,000 to 19,000 feet, so
that people who live in such a climate and such a country are bound to have
peculiarities of their own, and their ways offer many curious problems.

First of all, I will answer some of the most common questions—generally very
stupid—which I am daily being asked by people who try to be clever, about the
Forbidden Land.

“If you say that Tibet is such a high plateau, barren and cold, with no trees and
no agriculture to speak of, how is it that the people live there?”

Well, if people stop to think a little, the same question applies to every country.
Why do negroes live in Central Africa, where it is so hot? Why do people go and
live in Panama, where it is so unhealthy? Why do we live in London, where it is
so foggy and damp? In the case of the Tibetans, as with everybody else in
regard to their native land, they believe that no country in the world can possibly
compare with their own—which, indeed, in a sense, is true. They believe their
land is the most beautiful, the richest, the healthiest on earth, their religion the
only one, their civilisation the highest.
 The Tinker Pass, Nepal-Tibet

The Tibetans, having lived for so many generations at such great altitudes,
suffer a great deal [123]when they travel to lower elevations, and they experience
a feeling of suffocation and heaviness which makes them very ill and frequently
causes their death. This is not so much the case with natives of the Sikkim
district and of Lhassa, which are at a much lower elevation; but I am talking
principally of the natives of S.W. Tibet, few of whom live at an elevation of less
than 15,000 feet.

“Then,” say other wise folks, “if you maintain that next to nothing grows in Tibet,
that the people are not farmers, how do they manage to live?”

The answer is simple. The Tibetans import all their food from India, Nepal,
Cashmere, and China during the summer months, while the snow-passes are
open, and they store it in sufficient quantities to last them all through the winter.
Wheat, rice, tsamba (a kind of oatmeal), ghur (sweet paste), sugar are bartered
in large quantities in exchange for borax, salt, sheep, and yak wool.

Another question that seems to puzzle most people is why polyandry exists
legally in Tibet instead of our marriage customs or polygamy, and in the next
chapter I will endeavour to explain the reason, as well as why women are so
much less numerous than men. [124]
[Contents]
 CHAPTER XII

The first two things that strike an observant traveller on entering a Tibetan
encampment are that the number of children in the population is so small, and
that the majority of Tibetans appear, to European eyes, middle-aged, or even old
and decrepit. The second remark is more easily explained than the first, and
many are the reasons which cause Tibetan men and women to look well on in
years long before they have attained a really advanced age. I have seen a man
with hands and face so wrinkled that he might easily pass for an octogenarian,
yet he was no more than three-and-forty.

Flying Prayers and a Mani Wall

The wall is constructed of stones, on each of which is inscribed a prayer. In the foreground a
woman is weaving on one of the small portable looms.

The women manage to preserve their complexion slightly better than the men,
by smearing the cheeks, nose, and forehead with a black ointment. This, to a
certain extent, prevents the skin chapping in the cold, but the winds in Tibet are
so terrific that [125]they are disastrous to any human skin, whether besmeared
with grease or not. Indeed, no one who has not been in Tibet knows what wind
can be. I cannot better describe a gale than by likening it to myriads of knives
thrown at one with great force. It cuts into one through any kind of clothing, and
penetrates to the marrow of one’s bones. The skin, particularly where exposed,
chaps and cracks and becomes a mass of sores, unless the constant precaution
is taken of keeping it well soaked in butter, grease, or vaseline.

Again, the intense glare of the snow-covered landscape and the extraordinary
brilliancy of the atmosphere compel the natives constantly to frown—as may be
noticed in many of the illustrations reproduced in this work—in order to screen
their semi-closed eyes as much as possible from the blinding light. This
everlasting frown, of course, covers the forehead with deep wrinkles and
grooves, while “crow’s feet” in continuation of the outward corners of the eyes
and deep channels at both ends of the lips disfigure the faces of Tibetans at an
early age. Naturally, to a European these wrinkles at once suggest age, whereas
they are merely caused by the inclement weather, and they have been the chief
cause which [126]has led casual observers to describe the population of Tibet as
composed mainly of old people.
 A Tibetan Baby Girl

Another curious fact worth noticing is that, according to theoretical scientists, the
greatly rarefied air of the Tibetan plateau should retard the growth of human
beings, and that therefore a Tibetan should reach the age of puberty later in life
than people living in a corresponding latitude but at lower elevations. This is not
the case at all. Tibetan boys and girls attain a state of maturity at a
comparatively early age. I have often noticed girls of fifteen or sixteen and boys
of eighteen or nineteen fully developed, and it is at these respective ages that
men and women of Tibet frequently marry.

Now let us try to explain why one sees so few children in Tibet. Personally, I
think it is mainly due to the custom of polyandry prevailing in the country, which
is bound to have disastrous effects upon the birth-rate of healthy, strong
children, with deteriorating results upon every generation; and also undoubtedly
the altitudes at which the people live to a great extent limit the increase of
population. The generally unhealthy condition of most Tibetans’ blood also
greatly contributes to the non-fertility of parents. [127]

We have yet another curious fact. To an average of fifteen male children who are
born and live in Tibet, only one female child is healthy enough to survive. There
are various reasons for this, and it would be difficult to discover the primary one;
but in my mind, and from personal observation, I could not help associating that
fact with these two principal causes. First, the food diet of the parents, which
certainly has marked effects on the production of one sex more than another;
secondly, the greater mortality among the weaker female children. Tibetans
always told me that the death-rate in children under the age of two years was
very great in proportion to the number of births.

It is impossible to give exact statistics, but, from constant inquiry from families I
met, I came to the conclusion that an average of three children out of seven
born succumb before the age of five. Of these deaths, the majority would be
female children.

The life of a Tibetan baby is not a merry one at best. He is cherished by his
mother when newly born, and for some days the new-comer affords amusement
to the tent-mates and the members of the tribe. Occasional caresses are
[128]bestowed upon him, but the trials of having a loving mother soon begin. She
will besmear him from head to foot several times daily with yak butter, the
mother realising that by this process the skin of her infant will be made
impervious to cold; and with maternal fondness she will press and force the
butter into every pore of his little body. This done, the baby is left naked in the
sun so that under the heat of its rays his skin may absorb the maximum of
melted butter.
 A Tibetan Girl

His next torture comes in the shape of piercing his poor little ears. The lobes are
rubbed between the first finger and thumb until they become numbed, then with
a long silver or brass pin the hole is made, the fond mother being again the
operator. As care is never taken to disinfect the pin from the accumulation of dirt
upon it, and as that very same pin has for generations been used in the various
capacities of tooth-, nose-, and ear-pick, nail-cleaner, and head- and back-
scratcher, it is not infrequent to find that the ear-piercing operation is
accompanied by inflammation or some nasty sore or other, causing the little
fellow much unnecessary pain. Heavy ear-rings are next inserted, elongating
and disfiguring the little ears, in many instances the [129]lobes actually tearing
down altogether owing to the weight of the ear-ring.

Until a few months old the baby is made to lie in a basket, in which he is carried
about on his mother’s back—that is to say, if the mother is in a comfortable
enough position to own a basket. Otherwise she will carry him on her back,
suspended by his little arms, which she tightly clasps over her shoulders; and as
this mode of transport somewhat lacks comfort, it is rather curious to notice the
intelligence of Tibetan babies in order to feel the least inconvenience possible.
Under similar circumstances the average civilised baby who felt his little arms
almost pulled out of their sockets would very likely cry and scream, helplessly
dangling his legs in order to be again deposited on terra firma. The Tibetan baby
knows better. Guided only by his instincts, he will clasp his mother’s waist with
his little toes, so supple that he can use them almost like fingers. By thus
supporting his own weight upon her hips in the identical position of a monkey
climbing a tree, the tension on his arms is absolutely released and he looks
quite at his ease, even comfortable.

Babies in Tibet, as in other lands, do not lack a temporary charm. They are by
nature good, [130]well-behaved babies; occasionally they are even jolly. The
clothes in which their mothers garb them are not devoid of quaintness,—as can
be judged by some of the illustrations,—and if often size is preferred to style, it
is, as in most countries, for economy’s sake. Sometimes I have seen babies
simply smothered in beads and ornaments, but even the humblest displays a
row of beads round his neck and a charm or two.
 Tibetan Woman of the Commoner Class

Notwithstanding what has been said of the strange marital customs, the average
Tibetan woman is seldom absolutely sterile. This, of course, is mainly due to the
fact that if she survives at all to the age of puberty, it is because she is strong
and healthy; but at best she is never so prolific as her Asiatic sisters or even
European women. In Tibet one rarely finds a woman with more than three living
children. The majority of mothers can only boast of one. Yet, on the other hand,
the Tibetan woman can bear children until a fairly advanced age. I remember
meeting a lady who acknowledged her age—after complicated computation with
the aid of fingers and toes—to be forty. Her skin was so wrinkled and rough that
without maliciousness one could have put her down at fifty-five, but maybe she
spoke the truth[131]—she certainly was not less than what she had stated. She
carried in her arms a baby a few months old.

“It is my baby,” she proudly said, screening with her hand the fat offspring to
prevent the “evil eye” of an inquisitive foreigner. “Go away; do not touch him or
he will die.”

I was in a chaffing mood, and chaff in Tibet can never be too personal.

“I do not believe that he can be your baby, for he has a smooth skin and yours is
rough and wrinkled. Were he your child he would have a skin like yours.”

The woman, half-amused, half-astonished, called witnesses to testify that the

baby was really hers, and after assumed reluctance I acknowledged that there
existed some resemblance between mother and son, in the lack of nose.

“Why,” I asked her, “did you not have the child sooner, so that he might now be a
help and comfort to you in your old age?”

She said she had had two other children, but they had died, one when only “a
few moons” old, the other when about four years of age.

With the exception of the few larger towns, Tibet is peopled by small, semi-
nomadic tribes. A [132]large tribe may number a hundred tents, but the average
is from ten to fifty tents. Each tent is inhabited by one family, although
investigation generally brings out the fact that nearly all members of a tribe are
related to one another owing to the constant intermarriage among themselves.

This constant intermarriage also contributes to a great extent to the decadence

of the race generally, and to the diminution of the population with each
generation.
 Tibetan Lady

I had several opportunities of noticing the difference which existed when either
the wife or husband had come from a distant tribe. There were generally more
children to the union, and they were invariably stronger, both physically and
mentally. The Tibetans are well aware of this, and when a tribe is likely to die out
from the causes I have stated, fresh blood is imported into it by the advice of the
Lamas in order to revive it.

I found that the cleverer men I met in the country were generally born from
parents of different tribes, and not infrequently of widely separated social
positions.

In cases of crosses between different races altogether, such as a Tibetan and a

Nepalese, for [133]instance, or a Shoka, or other frontier tribes, the families were
larger; but these semi-foreign marriages are not common, and cannot be given
as a general rule.

Wilful infanticide is seldom practised in Tibet, and cannot be put down as one of
the causes limiting population. It, of course, occasionally occurs, for instance, in
order to suppress an illegitimate child, but the custom is greatly looked down
upon by Tibetans, although no punishment—beyond the contempt of the entire
tribe—would be meted out to the culprits.

The women of Tibet are seldom separated from one or other of their husbands.
When one man goes for some days to take the yaks or sheep to a distant
grazing ground, another fills his place in the tent. Occasionally more than one of
her legal husbands live together happily under the same tent, but usually not
more than one at a time.

As I have fully explained in a previous book, In the Forbidden Land, marriages

are principally family arrangements, where a girl becomes the wife of several
brothers; and, in any case, bachelors are, as a whole, to be greatly
congratulated in Tibet.

Other minor causes there are which tend to [134]limit population, but which
cannot very well be mentioned here. Several diseases of the blood—very
common—decidedly do not improve the race; and possibly all these evils—some
natural, some unnatural—may in time bring about the disappearance of the
Tibetan race from their lofty and sacred land.
 An Old Lady and her Prayer Wheel

[135]
[Contents]
 CHAPTER XIII

Another thing that strikes the traveller in Tibet is the sturdiness of Tibetan
ponies,—long-haired, short, stumpy little brutes, which possess most marvellous
endurance under circumstances which would kill most horses. They live on
whatever grass they can find, which is not much—at best, short semi-dried
blades which take a good deal of looking for before you can see them at all.
Tibet ponies have all the qualities of a goat and antelope combined, and I have
seen them, with a rider on their back, go up gradients where a human being
would have great difficulty to go up on foot.

The dogs of Tibet are not quite so attractive, being either vicious to a degree or
else stupid, lazy, and uninteresting. The common kind is not unlike our sheep-
dog, except that the hair is longer, which in some cases gives them a slight
appearance of collie dogs. They are generally ill-treated and [136]suffering, and
they seem to have no affection for anybody. They possess plenty of intelligence,
especially those trained by shepherds, and they are indeed a great help to their
masters in driving the flock in the right direction and keeping the sheep together.
These sheep-dogs are generally made to carry a broad leather collar with an
immense brass bell.
 Tibetan Dogs

Perhaps, talking of dogs’ affection, I might here give some account of a Tibetan
dog—a friend of mine—that I met on my first expedition into Tibet, while I was
being chased all over the country by the Tibetan army. One night, during a
storm, we were attacked, and I heard a number of voices around my camp. I
only had two men left, and we jumped up to defend ourselves. Stones were
flung at us with slings—an art at which both Tibetan men and women excel.
From their earliest childhood they keep in constant practice at flinging stones,
and in daylight they can hit the mark with great accuracy. Shepherds use them
constantly, and can pick out any sheep in a flock of hundreds. We kept close to
the ground, rifle in hand, a few feet from our tent, to avoid being hit, as evidently
they were aiming at it, it being of a lightish colour. They struck it several times.
With them was a [137]dog barking furiously all the time. Dog and men seemed to
be approaching—at least, by the sounds of their voices, for I could not see them.
This seemed an appropriate time to fire a shot, which would undoubtedly, as
usual, cause a stampede. It did. Only the dog remained, barking and yelping the
whole night, but we were otherwise not troubled in any other way, although, of
course, we kept watch until sunrise, when all we found were numerous fresh
footmarks a few yards from our tent.

The dog ran about a good deal, barking and barking, until we prepared our
breakfast, when he sat himself down upon his hindquarters and watched the
proceedings with keen interest. He seemed very shy, and whenever we tried to
get near him he bolted away with his tail between his legs, howling madly as if
he had been hit by a stone. Dogs in Tibet are so accustomed to have stones
flung at them at every possible opportunity that no doubt in his imagination he
fancied he had been hit by a missile each time we raised our hand to caress
him. Animals are not unlike people in that way.

At last, by offers of tinned meat and the use of the favourite Tibetan term of
endearment, [138]“Chochu, chochu,” the dog became our friend. He seemed
utterly astonished at being caressed, and rubbed himself affectionately against
our legs. He took a particular fancy to Mansing, my faithful man who developed
leprosy, and from that day the dog followed us everywhere. Mansing, who was
suffering considerably, and who took no interest whatever in scientific
observations, photography, surveying, etc., had at last a sympathising friend to
whom he could confide his grievances. The two were inseparable, and