OBESITY 1  2  3  4  endnotes >>
Roberta J. Park

INTRODUCTION

“This was one of the few occasions when obesity was treated as worthy of an international meeting in its own right.”¹ These words appear in the preface to the Proceedings of the First International Congress on Obesity, which took place at London’s Royal College of Physicians in October 1974. Since then the number of international conferences, forums, and other gatherings that focus upon obesity and the need for populations to engage in more physical activity has become extensive.² So has the growth of organizations and reports that deal with such matters.

More astounding has been the number of articles that have appeared in the International Journal of Epidemiology, Journal of Pediatrics, and scores of other scientific and clinical publications. The International Journal of Obesity and Related Metabolic Disorders began publication in 1977. Obesity Reviews, the official journal of the International Association for the Study of Obesity, was initiated in 2000.

That same year Human Kinetics published Physical Activity and Obesity, a 400-page book in which thirty-five experts in fields ranging from medicine, biology, and nutrition to psychology, physical activity sciences, and more examined what now often is referred to as “The Obesity Epidemic.”³ In the opening chapter the book’s editor Claude Bouchard observed: “Obesity and a physically inactive lifestyle are two of the most prevalent risk factors for chronic diseases in the Western world.”⁴

Although it is now known that heredity, certain neurological disturbances (e. g. damage to the hypothalamus), and other disorders (e. g. Cushing’s syndrome)⁵ may contribute to obesity, it is generally agreed that improper diet and lack of exercise are the major causes. For well over two thousand years, physicians, philosophers, and others have acknowledged this as a fact.

Coming to some agreement regarding physical activity has been much easier to achieve than have matters concerning what constitutes a proper diet. Soil conditions and weather have had a major impact upon what was eaten in different parts of the world. Cultural, religious, and philosophical beliefs still do. Social status and economic wealth certainly have been factors. Until quite recently it was malnutrition - not overeating - that affected large numbers of a population. This problem still exists in some parts of the world.

Among the Greeks of Antiquity, fruit, vegetables, wheat, olive oil, and fish---the so-called “Mediterranean Diet”--- provided the major nutrients. During the Middle Ages the rich in England typically ate white bread, large quantities of meat, suet, and other concentrated sources of animal. Standard vegetables were onions, leeks, and cabbage. Tomatoes were thought to be poisonous; and fruit, if eaten at all, was usually cooked. The vast majority of the population, who worked long hours at arduous tasks, relied upon bread made from rye or barley, some cheese (if they were lucky), and very occasionally a bit of meat or poultry.⁶ The potato, brought to Europe from South America during the sixteenth century, subsequently became a major food source for the poor, especially in Ireland where the “Potato Famine” wiped out more than twenty percent of the population between 1845 and 1852. Among the many things that led to changes in the American diet in the half century between1880 and 1930 were the emergence of giant food processing companies, the discovery of vitamins, and a preference for the slender (even anorexic) “flapper” that during the 1920s replaced the full-figured ideal woman of the 1890s.⁷

Ideals regarding bodily size and shape have been influenced by cultural beliefs far more than often is realized. A comparison of the muscle-absent male body in Hua Shou’s Shisijing fahui (1341) and the intensely muscular male in Andreas Vesalius’s De Humani Corporis Fabrica (1543) offers a striking example.⁸ It is thought that statuettes depicting obese females in ancient Mediterranean cultures celebrated fertility. Whereas depictions of portly men were by no means uncommon in Georgian England (1714-1830), by the late 1800s it was the icon of the muscular athletic-looking male that was rapidly gaining ascendency.

The English language is, in fact, replete with words that refer to excess bodily weight. These include, but are by no means limited to: plump, portly, substantial, and corpulent (from the Latin word corpus).⁹ “Obesity” (from the Latin obesus) entered the English language in the mid-1600s. Vestiges of the Greco-Roman world continue to surround us. Given the health problems that we face today, two of the most significant would seem to be matters relating to diet and exercise.

THE CLASSICAL WORLD

Near the end of the sixth century B.C.E. the Greek philosopher Alcmaeon of Croton had declared that “excess and deficiency of nourishment” are detrimental to health. Hippocrates (ca. 460-370 B.C.) believed that health consisted of balancing the body’s four humors: blood,¹⁰ black bile,¹¹ yellow bile,¹² and phlegm.¹³ Obesity was thought to be caused by a surplus of the humors. Treatment included bathing, sweating, proper diet, and appropriate exercise¹⁴ (It would be another eighteen centuries before William Harvey asserted that the blood circulated through the body by means of arteries and veins.).

Many physicians and others followed the Hippocratic tradition. Among the more noted were the philosophers Plato and Aristotle. In both The Laws and The Republic Plato set forth his beliefs regarding diet and exercise, which should be undertaken for health and proper development not for athletic proficiency.¹⁵ In Book Eight of Politics, written about 350 B.C.E., Aristotle declared: “It is an admitted principle that gymnastic exercises should be employed in education, and for children they should be of a lighter kind . . . lest the body be impaired.”¹⁶

A Greek by birth, Claudius Galen became the most famous physician of the Roman Empire. He believed that when food was digested it was converted to blood. The more food one consumes, he wrote, the “more blood is produced and the more obese the person becomes.” His influential work On the Power of Foods was written around 180 A. D. In De Victu Attenuante (On the Slimming Diet) Galen advocated such things as onions, garlic, leeks, celery, parsley, radishes, beet root, rock fish, and meats from wild animals that lived in the mountains not in valleys. Exercises with “the small sphere,” swimming, and such things as rapid running also were needed to counter obesity.¹⁷ Although Galen had been appointed a physician to gladiators, he was a severe critic of their practices, stating: “Neglecting the old rule of health which prescribes moderation in all things, they spend their lives in over-exercising, in over-eating, and over-sleeping.”¹⁸ His writings would have a major impact upon Western thought for nearly fifteen centuries.

FROM ANDREAS VESALIUS TO GEORGE CHEYNE

Because Roman, like Greek, law prohibited dissecting human corpses, Galen had performed his experiments upon animals. This resulted in a number of incorrect assumptions about human anatomy. These began to be overturned when the Flemish physician Andreas Vesalius undertook human dissections, publishing De Humani Corporis Fabrica in 1543. The “Scientific Revolution” of the sixteenth and seventieth centuries (greatly influenced by individuals like Galileo, Descartes, and Newton), especially Harvey’s discovery that blood circulated throughout the body and was vivified by the lungs, opened the way for major discoveries in physiology.

During the eighteenth century matters relating to diet and exercise often comprised a significant part of the many treatises dealing with health that appeared. In 1705 Francis Fuller, a disciple of the noted English physician Thomas Sydenham, published Medicina Gymnastica. One of the century’s most popular books on health practices, it gave considerable attention to moderate exercise but denounced the violent practices of athletes. In 1702 Scottish-born physician George Cheyne (1671-1743) had opened a medical practice at Bath, where his clients included a number of the aristocracy who went there to enjoy the natural mineral springs and engage in a variety of therapeutic treatments. (They also spent considerable time eating, drinking, and reveling.) While still a young man Cheyne had become extremely corpulent---some say that his weight reached 448 lbs. Using a diet of milk, vegetables, and water as well as active exercise, he greatly reduced his weight and his health was restored.

An Essay on Health and Long Life (1723), which gives considerable attention proper diet and exercise, was one of the more popular books that Cheyne wrote. By 1754 it had gone to nine editions and had been translated into French (1725), Latin (1726), and German (1744). The following words, repeated often throughout history, open chapter I: “‘tis easier to preserve health than to recover it, and to prevent diseases than to cure them.”¹⁹ The opening message of chapter II is: “To preserve health, the quantity, the quality and nature of our food . . . must be proportioned to the strength of our digestion.”²⁰ The benefits of exercise are set forth in chapter IV.²¹

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