Recently the American Medical Association declared obesity to be a disease. The World Health Organisation had warned us in 2001 of the dangers of “globesity”, global obesity. Indeed, sit in any cafe anywhere in Europe (or, especially, in North America) and stare at those walking past: it is clear that all about you are larger and larger men and women.
The walking wounded, damned by their girth to early death and long and expensive medical treatment before that. Nonproductive members of society drawing on our taxes to fund the results of their gluttonous, lazy lifestyle: deep-fried Mars bars and chips followed by a Coca-Cola or 10.
The problem with this rather ominous warning about the end of our slim and healthy civilisation as we know it is that it is only a fragment of the truth, seen through our anxiety about controlling our (and everyone else’s) body. Whether body size or sexual practices, we are constantly monitoring those about us for healthy or unhealthy, for natural or unnatural practices, practices that will damn the rest of us unless we force them to control themselves.
Contrary to the claims of the AMA, obesity is not a disease: it lacks a single cause, single outcome or single treatment. It is not global: individual weight may be spiking in China, as in the United States, but its complex causation and results are very different, and, at least in China, malnutrition remains a greater health problem than overweight. Even in the United States there are concentrations of obesity, using existing epidemiological definitions, such as in the poverty-ridden southeast.
Fat really does have a history, and Georges Vigarello’s book presents its complexity in readable and intelligent form. From medieval struggles with food (remember gluttony is one of the seven deadly sins) to the complex history of the science of fat in the 19th-century age of biology, how fat is understood, what meanings it is given and, perhaps even more centrally, how it is defined evolve and change based on any given society’s need to control the bodies of its members.
It is not merely that obesity is omnipresent as a medical category from the earliest written records of the Greeks and the Egyptians but that it is constantly redefined. The boundary between the healthy and the diseased is in constant negotiation at every level. The healthy Victorian gentlemen that WS Gilbert noted in his Victorian Ballad of the Sugar Broker
. . . had one sorrow – only one –
He was extremely bulky.
A man must be, I beg to state,
Exceptionally fortunate
Who owns his chief
And only grief
Is – being very bulky.
And this poor sugar broker, living in the first modern age of public debate about dieting and fat, is undone by his healthy though bulky body. As Gilbert notes:
I hate to preach – I hate to prate
– I’m no fanatic croaker,
But learn contentment from the fate
Of this East India broker.
He’d everything a man of taste
Could ever want, except a waist;
And discontent
His size anent,
And bootless perseverance blind,
Completely wrecked the peace of mind
Of this East India broker.
The line between contentment and unhappiness for the Victorians is sharply drawn because the man on the Clapham omnibus can’t be fat. He can be stately, portly, even perhaps plump, but fat he cannot be. As the first bestselling guide to dieting, published in the 1860s by William Banting, complained: “No man labouring under obesity can be quite insensible to the sneers and remarks of the cruel and injudicious in public assemblies, public vehicles, or the ordinary street traffic . . . He naturally keeps away as much as possible from places where he is likely to be made the object of the taunts and remarks of others.”
The age of Victoria may well be the moment when our contemporary lines of the healthy, happy, sane thin person and the diseased, weak-willed fat person begin to be drawn. But the reality is that between Dickens’s happy and fat Mr Pickwick and Gilbert’s Sugar Broker lies as wide a difference in the meanings ascribed to bodily size as between the 1980s and 2013.
Each age draws that boundary clearly and as if the boundary existed in lived experience. Thus after the 1980s the very definition of overweight and obese is officially lowered by public-health authorities, so that at one moment the healthy body became an endangered body. Change the definition and more and more people stand at risk for illness because of their body size.
Even contemporary studies of obesity note that being overweight is less of a risk to your total health than “see-saw” dieting. Better to retain the 25lb than to gain and loose them constantly.
The notion of the healthy, overweight person has been lost today, and Vigarello’s account of how this has happened should be required reading not only for all who are pleasantly plump, happily stout, healthily portly but also for the health authorities whose draconian attempt to control the intake of foods, their composition or their distribution is based on not only faulty science but faulty definitions of health.
Can one be too fat? Of course. Can one be too lean and fit? Ask the families of people who die every year from anorexia nervosa or even the relatives of those who collapse running marathons. Take care of yourself, use the Greek notion of moderation in all things to do so, and you may be healthy (if your genes permit)! Or indeed not. There is no simple answer to health, and condemning those whose weight is deemed excessive does not and will not accomplish the goal of a perfect, healthy, productive society.
Sander L Gilman is distinguished professor of the liberal arts and sciences and professor of psychiatry at Emory University, in the US. His Obesity: The Biography was published by Oxford University Press in 2010.
