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Body weight: A love/hate relationship

Yale Medicine Magazine, Autumn 2023 (Issue 171) Obesity Special Report
by Steve Hamm


VIEWED FROM THE LONG LENS OF HUMAN HISTORY, our relationship with body weight has been capricious at best. From one era to the next, cultural attitudes about portliness have idled for long periods, then shifted into new beliefs. What seems clear is that throughout history, we have held contradictory attitudes about human heft.

As far back as the Stone Age, corpulent people were depicted in ornamental figures. Among them is the well-known endomorphic Venus of Willendorf artifact, dating back some 25,000 years. Were such figures objects of reverence signifying fertility or power? Or something else? We don’t know for sure.

With food scarcity prevailing throughout much of our history, the energy conservation provided by extra body weight was long considered a helpful, much-needed survival tactic. Medieval Christians, however, countered this belief by condemning overindulgence in food and drink as one of the Seven Deadly Sins.

Fast-forward to the 17th century, and the famous Dutch painter Peter Paul Rubens glorified full-figured females in paintings that came to be known as “Rubenesque” masterpieces. Portliness also found its way into literature—remember Shakespeare’s Sir John Falstaff in The Merry Wives of Windsor and Miguel de Cervantes’ Sancho Panza in Don Quixote. By the 19th and early 20th century in the United States, portraits of prosperous industrialists also accentuated their girth as an emblem of wealth and power.

In the world of medicine, attitudes weren’t quite so forgiving. Ancient Greece’s Hippocrates, widely considered the father of Western medicine, warned of the dangers of excess body weight, writing that “it is very injurious to health to take in more food than the constitution will bear, when, at the same time one uses no exercise to carry off this excess.”

Over the next several centuries, a few other physicians echoed similar concerns. One was the English physician Tobias Venner, who proposed regular baths to avoid what he then termed “obesity” in his treatise of 1660. “Wherefore let those that feare obesity…be careful to come often to our Baths: for by the use of them, according as the learned Physician shall direct, they may not only preserve their health, but also keep their bodies from being unseemly corpulent.”

However, well into the 20th century, a good many physicians believed that carrying 20 or more pounds of excess fat was a healthy practice—a reserve of energy that could help ward off illness. It wasn’t until the 1930s and beyond that physicians and the life insurance industry began to formally recognize excess weight as a contributor to diseases such as diabetes and heart disease—and to early mortality.

By the 1960s, the pendulum of public opinion swung even farther. Women wanted to look like Twiggy, the ultra-thin British model. Hence, the weight-loss industry was born even as fast foods became ubiquitous, and ad agencies promoted obesity-causing foods one day and weight-loss products the next. With such societal changes as a backdrop, physicians soon began to employ the body mass index (BMI) to monitor weight gain—but with limited effect. Not long thereafter, various medical organizations stepped forward with unequivocal warnings about the health threats posed by obesity.

This brief history brings us to the present. Excess weight has rightly become a concern for society and the medical profession alike; yet even today, ambivalence about bulk remains—think NFL linemen, for example, and proponents of the body-positive movement. How can we make our way through this labyrinthine issue?

When Naomi Rogers, PhD, professor of the history of medicine, lectures Yale medical students and undergraduates about nutrition and obesity, she strives to sensitize them to the complexity of the issues. “I want them not to see obesity as a poor personal choice for which people should be shamed,” she says. “I want them to understand that there are no easy answers.”

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