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O ver the past twenty years, American parents, educators, and health professionals have become increasingly concerned with the prevalence of overweight and obesity among children and adults in the U.S.A. and around the world. Results from the 2003-4 National Health and Nutrition Examination Survey (NHANES) indicate that an estimated 17 percent of children and adolescents aged two to nineteen are overweight (Johnston and Steele 2006: 1; National Center for Health Statistics 2003-4). The numbers for adults are even worse at an estimated 66 percent being overweight or obese. NHANES numbers also indicate that the problem of overweight in the U.S.A. is growing (Ogden et al. 2006).

With obesity numbers on the rise, popular and medical discourse on appropriate interventions and treatment methods for weight control are burgeoning. One increasingly popular treatment for overweight children and adults (who can afford it) is inpatient care at a residential weight-loss camp or facility, commonly known as "fat camps."

While there has certainly been an increase in the number of available camps, centers, clinics, and spas designed to treat overweight in recent years, residential health camps, themselves, are not a recent development. They have their historical roots in the spas, health resorts, and health farms of Europe and the U.S.A. It is likely that

European spa practices originally evolved from Roman baths, which grew out of southern Italian and Greek therapeutic bathing at volcanic springs (Delaine 1996: 236). In England, specifically, interest in hot water mineral spas as sites where health could be restored or promoted date to the sixteenth century (Hembry 1997: 1-2).

By the eighteenth and nineteenth centuries, European spas were popular destinations for members of the growing middle class who searched for disease cures and improved health (Hembry 1997: 2). At this time, newspapers and magazines advertised bathing in and drinking mineral water as a cure for such varied afflictions as scurvy, jaundice, indigestion, nervousness, and scrofula (Hembry 1997: Figure 5). Certainly, weight control and digestive difficulties were not the main focus of resort visitors; however, wealthy members of society did visit spas in search of a remedy for problems of overweight (Hembry 1997: 242). Corpulent individuals were encouraged to bath in and drink mineral water, which was bottled for sale and made available all across the country in the early 1800s (Hembry 1997: 242).

Health resorts were also popular destinations for middle-class leisure and recovery in Germany, France, and the U.S.A. In late-nineteenth and early twentieth-century America, doctors and lay enthusiasts developed health farms and institutions, which catered to patients suffering from infectious diseases and psychological ailments, as well as clients merely interested in "healthful living" (Jones 1967). Institutions, including the Agnes Memorial Sanatorium in Denver and the Battle Creek Sanatorium in Michigan among others, were especially popular destinations for patients seeking relief from tuberculosis (TB) (Jones 1967; Schwarz 1970). By the early twentieth century, the YMCA also established health farms in Denver, Dallas, Philadelphia, and other cities, where young men could recuperate from TB and other diseases; indeed, a nationwide series of "prevento-ria" were established so that urban children could strengthen their lungs in the healthful climate of rural American as a prophylaxis against TB (Anon., A Colorado Health Farm 1902; Anon., News and Notes 1903; Anon., Chicago Health Farm Proposed 1912).

These institutions emerged within the context of a growing medical and social concern about abnormalities in body weight, including the recognition of anorexia as a "wasting disease" apart from other conditions like TB and increasing cultural concern about overweight in children and adults (Brumberg 1988: 182-3 and 214-15).

While medical concerns about the health dangers of overweight can be dated to the early eighteenth century (Albala 2005), discourse about regulating body weight became more pronounced at the turn of the century (Sterns 1997: 27-32). Mothers, specifically, were encouraged to monitor the weight of their children against new standardized weight charts and to take measures to rectify weight problems (Brumberg 1988, 232-35). This context provided the impetus for medical professionals in the U.S.A. and Europe to develop dietary management routines for treating overweight and underweight patients (Brumberg 1988: 154-5; Sterns 1997: 38-47).

Treatments for abnormal body weight frequently included regimented eating and activity schedules designed to promote weight loss or weight gain depending on the patient's specific needs. For example, at Battle Creek, John Harvey Kellogg recommended excluding meat and dairy from one's diet and rigidly limiting caloric intake to one half the previous amount eaten. He espoused the virtues of eating only two meals a day and scheduled these meals at intervals of every six to seven hours. In addition, he prescribed increased activity and sweat baths to offset his dietary program (Schwarz 1970: 41-5). At the London Hospital and elsewhere, similarly regimented eating was used to treat underweight in anorexics. Patients were fed a diet of toast, vegetables, fish, and dairy at two-hour intervals, and their activity was severely restricted (Brumberg 1988: 154-6). This evidence suggests that in the late nineteenth and early twentieth centuries, individuals and families accepted inpatient residential programs as viable methods for treating abnormal body weight. William Howard Taft even spent time at "Professor" Izzy Winters's Health Farm in an attempt to reduce his impressive girth (Clark 1946; Hicks 1945).

By the 1950s, the practice of visiting health farms had combined with secular and religious summer-camp traditions begun in the late 1800s by Frederick W. Gull and others (American Camp Association 2006). As such, there were many summer camps for children that focused specifically on weight reduction (Sterns 1997: 82, 122). It is interesting that programs for children most inform our perceptions of residential weight-loss camps, despite the fact that the earliest residential treatment programs were designed for people of all ages. Even today, weight-loss camps are available for both adults and children, and new camps are emerging to treat entire families who are overweight. At all of these camps, counselors combine elements of structured activity, controlled diet, and behavior modification to force or facilitate dramatic weight loss over a short period of time (usually between four and eight weeks) (Brandt et al. 1980; Gately et al. 2005).

While summer weight-loss camps have evolved dramatically since their earliest incarnations, the prototypical "fat camps" of the 1950s probably most inform our contemporary conceptions of the environment, activities, and experiences of residential weight-loss programs for children. Specifically, weight-loss camps have been represented in popular media as miserable locations for pathetic social outcasts who need to reform their bodies to socially acceptable proportions. Some of the most recent and well-known parodies of the fat-camp experience appear in the popular television programs The Simpsons (2005) and South Park (2000), as well as in the 1995 film Heavyweights and the MTV documentary Fat Camp (2006). Yet, despite the frequently unsympathetic portrayal of fat camps in pop culture, these weight-reduction camps nevertheless have an important role to play in the efforts of children and their parents to treat obesity.

The role that residential diet camps have to play in the diet wars is evident in the increasing numbers and diversity of camps available. Between 2004 and 2005, there were about a dozen camps devoted strictly to weight loss, and four new camps opened in 2004 alone. Each summer, thousands of children and their parents put their hearts and dollars into this growing industry (Ellin 2005). However, the appeal of weight-loss camps is not confined solely to the Western world. In the context of increasing globalization and consumer culture, the appeal of these residential treatment programs is also evident in the emergence of camps in non-Western countries, such as China and Thailand (Jirapinyo et al. 1995). Camps in the U.S.A., Europe, and elsewhere are also receiving attention from major medical journals, such as the International Journal of Obesity and the European Journal of Pediatrics, and popular media outlets like the BBC, The Oprah Winfrey Show, Dateline, The New York Times, and the LA Times, among others (Ellin 2005; MSNBC 2006; Stein 2006).

Some of the most visible and talked-about sites in the U.S.A. and the U.K. include Camp Shane, which was established in 1968 and claims to be "the oldest weight-loss camp"; Camp La Jolla, a fitness-based camp in California; and Camp Wellspring, which is run by

Healthy Living Academies and has several locations across the U.S.A. and U.K. Typically, residential weight-loss programs or camps like these use physical activity, social support, and controlled diet within a cognitive behavioral framework to affect weight loss in children and adults (Braet et al. 2003). For example, Camp Wellspring, a typical weight-reduction camp, offers seven "state-of-the-science" weight-loss camps, including an adventure camp and a family weight-loss camp, in the U.S.A. and the U.K. (Wellspring Camps 2006).

Like all weight-reduction camps, this program promises campers permanent weight loss through changing eating habits and introducing daily activity, and, like most programs, it stipulates admissions requirements for its students. Children and young adults ages ten and older who want to attend Camp Wellspring "must be at least 20 pounds overweight and have been struggling with their weight for at least one year." However, the camp also admits younger clients ages five to nine to the Family Camp "if they are overweight." In addition to physical requirements of overweight, however, the camp also has "attitude requirements." Its promotional literature explains, "Campers must view Wellspring as an opportunity. Wellspring will not admit campers who are clearly opposed to attending, or who have a history of oppos-itional behavior or violence." This emphasis on the camper's own interest in treatment tacitly recognizes and addresses popular perceptions that children are forcibly committed to "fat camps" by their parents and presents Camp Wellspring, instead, as a place for overweight children who have made the choice to lose weight themselves (Wellspring Camps 2006).

Camp Wellspring's philosophy and program of treatment are also typical of the more recent weight-loss camps in the U.S.A. and U.K. and reflect new medical and scientific knowledge about dieting behavior and effectiveness. Their promotional material argues that "diets don't work" and, instead, introduces students to "foods that have the same flavor profile and feel as the foods that have contributed to weight gain, but that instead are very healthful." Nonetheless, eating at Wellspring, like at other camps, is controlled and restricted. The camp's promotional literature explains that "a typical day of controlled foods will include 1,200 calories, 10 g of fat, 50 g of protein, and 30 g of fiber." Well-spring's caloric goals are somewhat less than the typical weight-loss camp diet, which provides about 1,500 calories a day for overweight children (Ellin 2005); however, nutritional requirements vary widely from program to program (Gately et al. 2000: 1445-6). Like other programs Wellspring is committed to nutritional education and provides culinary training, as well as cognitive-behavioral sessions, which, it argues, will help children to monitor and moderate their eating habits after they leave the program, again, typical of most residential weight-loss camps (Brandt et al. 1980; Gately et al. 2000; Holt et al. 2004).

At all weight-loss camps, diet is combined with about three to four hours of exercise per day (Ellin 2005). More and more camps are moving toward a recreational sports model of exercise as opposed to the regimented intentional exercise of earlier programs (Holt et al. 2004: 222-3). For example, physical activity at Wellspring's general and adventure camps is provided through "fun" group sports, such as soccer and hiking. This newer model of physical activity reflects general physical-education findings that children are more likely to stick to an exercise routine when they enjoy it and represents a departure from earlier "boot camp" models for weight reduction.

Viewing the promotional literature alone suggests that a residential weight-loss camp just might be the answer for adults and children struggling with overweight and obesity. However, the cost of such programs is substantial. Most summer weight-loss camps cost about 7,500 dollars, which is approximately 1,500 dollars more than regular summer camps for children (Ellin 2005). Admittedly, a portion of these costs may be paid by major health-insurance providers; however, the out-of-pocket cost to families who choose this form of treatment is still substantial. Wellspring, for example, claims that the majority of PPO (Preferred Provider Organization, a common form of U.S. third-party health insurance) insured patients receive reimbursement of as much as 2,000 dollars (HMO [Health Maintenance Organization, a common form of U.S. third-party health insurance] patients are advised that they will not generally receive any reimbursement), but this covers only about a fourth of the total cost of the 8,650-dollar eight-week program (Wellspring Camps 2006). Clearly, the cost of attending a weight-loss camp like Wellspring is still prohibitive for many overweight families and individuals, especially those who are poor or uninsured (Johnston and Steele 2006: 4).

To many, treatment at a residential weight-loss camp may seem extreme. It is costly and requires that the patient be separated from his or her family and friends for a significant period of time. But to some families it may seem like the only choice, especially for obese children, who are generally not good candidates for surgical treatments or medication (Braet et al. 2004: 519). Researchers do agree that most residential weight-loss programs are effective in helping overweight/obese people lose weight in the short-term (Braet et al. 2003; Gately et al. 2000; Gately et al. 2005). However, the efficacy of these programs may be limited because many patients return to their previous eating and exercise behaviors upon leaving the controlled environment of the program (Snethen et al. 2006: 53-4). Factors, such as the duration of the program, the level of structure provided, weight at the time of entering the program, and the involvement/commitment of family members and the patient, contribute to the success or failure of individual participants in residential weight loss (Snethen et al. 2006: 53).

Studies of weight-loss camps also measure the psychological impact of these intervention programs on boys and girls because children "grow up in a climate of anti-fat attitudes and obesity stigmatisation" where they are "particularly vulnerable to body shape dissatisfaction, preoccupation with weight and shape, and low self-esteem" (Walker et al. 2003: 748). These studies show that "participation in a weight-loss camp improved rather than further impaired children's psychological state" (Walker et al. 2003: 752). Specifically, the patients' dissatisfaction with their body shapes also decreased, and self-esteem improved along with athletic competence and physical appearance esteem (Walker et al. 2003). In addition, patients may also have positive responses to peer and staff support and choice of activities at camp (Holt et al. 2004: 227-8).

However, studies have also shown that attending a weight-loss camp can have negative psychological effects on children. For example, residents experience homesickness and dietary concerns while at camp, which result in negative responses to the treatment program (Brandt et al. 1980; Holt et al. 2004). The little ethnographic work that has been done of children's weight-loss camps also suggests that these residential programs may contribute to campers' feelings that they are set apart from the rest of society because they are different or deviant (Millman 1980).

The treatment programs that we, today, call "fat camps" have a long history. From mineral baths to sanitariums and health farms, middle-class consumers have sought the controlled environments of residential retreats in their efforts to lose weight. While popular culture has constructed Fat Camp as a lonely place where the antisocial overeater can be rehabilitated, researchers tend to agree that "use of a structured fun-based skill learning program may provide an alternative method of exercise prescription to help children prolong the effects of ... intervention" (Gately et al. 2000: 1445; Walker et al. 2003). In a time when childhood and adult obesity are on the rise and most obese children will continue to be overweight into adulthood, residential weight-loss camps are providing an evermore appealing, if costly, form of intervention and treatment.

SLG/C. Melissa Anderson

See also Anorexia; Cheyne; China Today; Globalization; Kellogg; Lindlahr; Obesity Epidemic; Socioeconomic Status; Taft

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