Obesity historically

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Hi All,

How has obesity been viewed during the centuries? The below letters appeared to

high-light some views.

For definitions, there are:

obese: Excessively fat. Synonym: corpulent. Origin: L. Obesus, fat, partic.

Adj.,

fr. Ob-edo, pp. -esus, to eat away, devour

obesity: An increase in body weight beyond the limitation of skeletal and

physical

requirement, as the result of an excessive accumulation of fat in the body.

Origin:

L. Obesus = fat

obesity-related diseases: Obesity increases the risk of developing a number of

diseases including: type 2 (adult-onset) diabetes high blood pressure

(hypertension); stroke (cerebrovascular accident or cva); heart attack

(myocardial

infarction or mi); heart failure (congestive heart failure); cancer (only

certain

forms such as prostate and colon cancer); gallstones and gall bladder disease

(cholecystitis); gout and gouty arthritis; osteoarthritis (degenerative

arthritis)

of the knees, hips and the lower back; sleep apnea (failure to breath normally

during sleep, lowering blood oxygen); and pickwickian syndrome (obesity, red

face,

underventilation and drowsiness).

Obesity: 1000 years ago • CORRESPONDENCE

Science (5733) 15 July 2005:204

Rabie E Abdel-Halim

I enjoyed Barnett's Historical Keywords piece on obesity (May 28, p

1843).1

More clarification is needed regarding his statement that “obesity first appears

in

a medical context in Venner's Via Recta (1620)”.

In Europe during those dark ages, the great era of Greco-Roman medicine came to

an

end and no progress in medical science was made until the Renaissance.2 However,

during the same period in the East, coinciding with the spread of Islam, the

study

of medicine and other branches of science were revived.2 Under this influence,

Mohamed ibn Zakaria Al-Razi (Rhazes, 841–926) critically assessed, in his book

Al-Hawi Fit-Tibb (An Encyclopaedia of Medicine), all the available knowledge on

obesity at that time.3 In the light of his own experience and practice, he

discussed

the opinions of scholars who preceded him, such as Hippocrates, Rufus of

Ephesus,

Galen, Oribasius, and of Aegina, highlighting the points on which he had a

different view, particularly in relation to the management of excessive obesity.

Galen, for example, believed that prolonged thinking and mental activity would

slim

the obese, but Al-Razi stated that “prolonged thinking that leads to sadness

slims;

otherwise prolonged thinking does not slim”.3

Al-Razi documented his discussion using clinical case reports of the patients

with

excessive obesity he successfully treated, describing in detail the treatments

he

used, including diet, drugs, exercises, massage, hydrotherapy, and lifestyle

changes.

Ibn Sina (Avicenna, 980–1037) devoted a section of the 3rd volume of his “Canon

in

Medicine” to the “drawbacks of excessive obesity”. Ibn Hubal Al-Baghdady

(1121–1213)

also reported on the predisposition of “hugely obese persons” to fall ill

quickly.4

In their management, by heavy exercises on an empty stomach, he stressed the

importance of a gradually increasing schedule because an excessively obese

person

may put himself at risk if he starts abruptly on heavy activities.4

Ibn el Nefis (1207–1288) in his book Al Mujaz Fit-Tibb (The Concise Book of

Medicine)5 reported on the association between excessive obesity and

cardiovascular

and cerebrovascular accidents, and with respiratory and endocrine disorders:

“Excessive obesity is a constraint on the human being limiting his freedom of

actions and constricting his pneuma (vitality) which may vanish and may also

become

disordered as air may not be able to reach it. They [excessively obese persons]

run

the risk of a fatal vessel rupture causing sudden death or bleeding into a body

cavity. But bleeding into the brain or the heart will lead to sudden death. And

frequently they suffer from dyspnoea or palpitation”. Furthermore, Ibn el Nefis

distinguished a special type of excessive obesity in those who are “obese by

birth”

(congenitally obese). He recognised that “they are usually cool-tempered,

slender-vesselled, subfertile, could not endure hunger or thirst, and

medicaments

hardly reach their organs except with difficulty and after a long time”.5

References

1 R Barnett, Historical keywords: obesity,

Lancet 365 (2005) 1843.

SummaryPlus | Full Text + Links | PDF (57 K)

When does “large” become “obese”? Or, at what point does an acceptable variation

in

body form become a pathological condition? And how does an individual's

lifestyle

become subject to public and medical scrutiny? In discussing obesity historians

have

tended to contrast the preindustrial physical ideal, in which plumpness

signified

health and prosperity, with the modern western archetype. But despite the

shifting

nature of body image, most cultures seem to have drawn a distinction between the

pleasantly rounded and the morbidly fat, and have looked to medical

practitioners

for answers.

Obesity (from the Latin obesus, one who has become plump through eating) first

appears in a medical context in Venner's Via Recta (1620). For Venner

obesity

was an occupational hazard of the genteel classes. An afflicted individual could

restore their physique by paying attention to the Hippocratic concept of

regimen:

balancing diet, sleep, and other factors to create and maintain health. In the

18th

and 19th centuries, writers favoured the term “corpulence” and the pressure

remained

on individuals to treat themselves. This was exemplified by Banting's

pamphlet A Letter On Corpulence Addressed To The Public (1863); his book sold in

thousands and “banting” became a verb.

In the early 20th century, some diseases, such as heart disease, stroke, and

diabetes, were found to be associated with obesity. Obesity now became a disease

that required medical involvement. In 1959, the Metropolitan Life Insurance

Company

made the first attempt to define an ideal weight, and hence to create medical

criteria for intervention in obesity. Their approach was criticised for failing

to

take socioeconomic factors into account, and in the 1960s a body-mass index

(BMI)

over 30 was proposed as a more “scientific” measure of obesity.

In Latin obesus has another meaning: “coarse” or “vulgar”. Obesity still carries

this sense of moral judgment: it implies a lack of self-control and

self-respect.

The rate of adult obesity has been cited at around 15% in the UK and over 30% in

the

USA and western countries' obsession with “eating disorders” has led to a

monstrous

obesity industry. Diets, drugs, and stomach surgery have given way to that

quintessentially postmodern medical quest: the obesity gene. Fat, it seems, is

not

only a feminist issue, but an ethical one too.

Al Pater, PhD; email: old542000@...

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