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Some Weighty Thoughts on Dieting and Epidemics

I n July 2004, the then-American Health and Human Services Secretary Tommy G. Thompson announced that Medicare was abandoning a long-held policy that said obesity was not a disease, opening the way for the Government to pay for a whole range of possible treatments. Soon after Thompson's decision, a cartoon by Dick Locher of Tribune Media Services appeared. A portly little boy having read the newspaper with the headline "Obesity Now Considered a Disease" announces into the telephone, "Hello, Principal's office? This is Tommy Frobish ... I won't be in school today, I got a disease."

We know what type of disease Tommy Frobish had. As early as 1987, the media began to evoke the specter of a forthcoming epidemic of obesity: "Childhood obesity is epidemic in the United States," stated Dr. William H. Dietz Jr. of New England Medical Center. The World Health Organization declared obesity the new "global epidemic" in 1998. By 2004, headlines such as "Obesity Epidemic Raises Risk of Children Developing Diabetes" grabbed (and continue to grab) the attention of readers. Scientists at the American Association for the Advancement of Science annual meeting in February 2002 had already warned the Government that obesity was now a "global epidemic"—no longer confined to Western, industrialized societies. This reflected a growing consensus in the 1990s that obesity (not smoking) was going to be the major public health issue of the new millennium.

Parallel to the seemingly unstoppable spread of this new epidemic was the development of new, radical cures: Would it be surgical (stomach stapling), genetic (the "ob [esity]-gene") or would it be the old, tried and true "cure" of dieting? In the twenty-first century, dieting has come to mean the control of the intake of nutrients and the use of parallel interventions such as exercise, psycho logical therapy, surgery, or pharmaceuticals to control (increase or decrease) body weight, strength, health, and/ or shape. From the mid-nineteenth century to today, medical specialists and lay practitioners have tried to claim too fat or too thin people (however defined) as their patients. Fat and thinness is truly in the eye of the beholder. Each age, culture, and tradition defines unacceptable weight for itself: Yet, all do have a point beyond which excess or inadequate weight is unacceptable—unhealthy, ugly, or corrupt. Today, we call this "morbid obesity or anorexia," and both are always seen as an issue of health. Thus, dieting today may also limit the intake of foods, such as salt or transfats, that are labeled unhealthy.

Yet health, as we well know, is a code word for a positive range of qualities that any given society wishes to see in its citizens: From beauty to loyalty to responsibility to fecundity (and the list marches on). Thus, today, the very opposite illness, anorexia nervosa, it would seem, has become what George Devereux in the 1950s called a prescribed template for mental illness: "Don't go crazy, but if you do, do it this way." Obesity has precisely the opposite quality. The morbidly obese do not figure in society as a socially acceptable form of mental illness in any way. The asymmetry between today's image of obesity and of anorexia points to the complex meanings given to weight and body shape over history. All of these impact and are impacted by the culture of diet and dieting in which individuals find themselves.

From the 1860s, it was the diet culture that dominated the market even as biomedical science developed tools to understand the biochemical nature of metabolism, endrocrinological imbalance, and, more recently, genetics. Dieting was the tool of the physician, but it was also the means by which lay practitioners of the modern "health culture" were able to claim the too fat and the very thin as their clients. Dieting, or (more recently) "lifestyle change," became a way to halt the obesity epidemic, to intervene to improve the private life of the individual and, thus, the health of the nation.

These two qualities were regularly linked. Whether through claims that morbid obesity impacted on the health of the mother and child and thus weakened the state or whether the fat man and the thin man could not fulfill their civic and military duty and became a drain on the state, the obese, from at least mid-nineteenth century, were seen as a danger to themselves as well as others. When it was clear that too many men had failed the draft physical in World War II because of malnutrition, Harry S Truman created the school lunch program in 1946, which stood accused in the 1990s of being one of the causes of obesity. The general stigma associated with a potentially unhealthy body that stood out because of its size made it imperative that the fat and the thin seek or be forced to treatment. Thus, there were financial incentives to seek this group out and rehabilitate them. Too fat and too skinny people could be made productive and healthy people through the interventions of medical professionals but also lay specialists. In France, the modern food culture, without its sauces and exotic ingredients, was created in the 1820s by Jean Anthelme Brillat-Savarin, whose The Physiology of Taste or, Meditations on Transcendental Gastronomy was a fat man's confession about how he tried to lose weight. It was a self-help book that created the French cult of modern food. "Obesity," as Brillat-Savarin states, "is not actually a disease, it is at least a most unpleasant state of ill health, and one into which we almost always fall because of our own fault." It was a change in the way one ate that could control one's weight.

The American food faddists of the late nineteenth century, who produced "modern" machine-made foods such as "corn flakes," sought to reform the body politic; today we hear their heirs advocate "natural" or "organic" food. Their argument is that unprocessed food is close to nature and, thus, healthier. In 1894, Will Keith Kellogg was trying to improve the vegetarian diet of sanatorium patients when he invented Corn Flakes; one of them, Charles William Post invented Postum cereal beverage in 1895. Two years later, Post developed Grape-Nuts cereal, part of the new health-industrial complex. They followed the lead of those who first canned milk at mid-century;

they saw in the modern manufacture of food the introduction of the principles of hygiene. And they were certainly right—boiled, condensed milk was certainly healthier than milk from tuberculosis-infected cows. Well, if you discounted the lead that leached into the milk in the early containers.

All aimed and aim at healthier, better citizens. And all succeed in making a profit doing it. The cereal manufacturers of the nineteenth century, like Post and Kellogg, moved from fringe-food-fad operations in "Wellville" (read T. Coraghessan Boyle's 1993 novel The Road to Wellville, the title of which is taken from a pamphlet by C. W. Post) to dominate the food market; "organic" food today may well rescue the small farm as it returns much greater profit than "traditional" food. Health and wealth are linked by more than a rhyme.

Dieting aims at both cure and profit. It is, thus, very modern. Certainly, fasting as a religious observance was part and parcel of Western Christianity, beginning with Paul. (It also became part of both rabbinic Judaism and Islam.) But religious fasting is not dieting. It was (and is) a sign of man's relationship to God and to God's complex world. Ironically, this is not much different from the ancient Greeks who saw food (and food reduction) as part of a complex web that spanned human beings and the gods through the humors. Dieting arises in the post-Copernican world when scientists and lay people from the late seventeenth to early nineteenth century began to think of the human body more as a machine and then as a collection of chemical processes. The dieting body is not necessarily an extension of the divine. Here we can evoke Zygmunt Bauman's distinction in his 1998 Globalization: The Human Consequences between "pilgrims" and "tourists." In a real sense, fasters are pilgrims who believe that their world is bounded by God (or the gods) and fasting will bind them to that world. Dieters are tourists in the new economy of the body.

The rise of the modern dieting culture comes to hold powerful metaphoric implications for all bodies, including, as Thomas Hobbes observes in The Leviathan (1651), the body politic. Hobbes observes that (like human beings) "Commonwealths can endure no diet: for seeing their expense is not limited by their own appetite but by external accidents, and the appetites of their neighbours, the public riches cannot be limited by other limits than those which the emergent occasions shall require." Here is perhaps the best sense of the conflict between the desire for food and the difficulty (if not impossibility) of diet. For as the diet industry of the modern era shows, its greatest failure would be the elimination of actual or perceived unhappiness with weight, for with this success would come the end to the dieting industry. For Hobbes, a nation's appetite is actually enhanced by the increase in its consumption of the "commodities of sea and land". The more you have, the more you want; so much for a world limited by self-control.

Dieting becomes the means of self-liberation or self-control or self-limitation. It is a process by which the individual claims control over his or her body and thus shows their ability to fulfill their role in society. From the Enlightenment to the present, the healthy body is also the body in control of its own destiny—a basic claim of Enlightenment ideology. The aging philosopher Kant actually wrote a study of diet and self-control in response to the appearance of one of the first modern diet books in the 1790s. His essay on "Overcoming Unpleasant Sensations by Mere Reasoning" (1797) argued that you could, as an old man, rationally control your frequent trips to the toilet at night by radically restricting your liquid intake before bed. A century later, another German philosopher of note, Friedrich Nietzsche, in his Twilight of the Gods (1888), denied any possibility of a conscious control of the body through dieting. Inheritance dominates, and rational claims by diet gurus only provide the illusion of control. By the 1960s, it was not age but gender that seemed to determine the contours of the dieting culture. With the rise of the women's movement in the 1960s, the standard model for the study of the relationship between gender and obesity has obsessively focused on women's bodies. The central theme focused on how patriarchal society (men) abhors fat women and, thus, causes all women to hate their own bodies. In this rhetoric, no woman's body could be slim enough. As Susie Orbach entitled her Fat is a Feminist Issue: How to Lose Weight Permanently without Dieting (1978) thirty years ago, fat is a problem for women! Kim Chernin in her The Obsession: Reflections on the Tyranny of Slen-derness (1981) coined the phrase a "tyranny of slender-ness" to reflect American society's growing preoccupation with thinness and the attendant issues for the fat female body. The view that dieting is a women's issue has dominated the political reaction to the diet culture. But this was an artifact of seeing patriarchy as pro-dieting and feminism as anti-dieting. In the new age of the "obesity epidemic," the politics of dieting has begun to shift.

Mind over body is the key to "lifestyle changes" in the twenty-first century—but now with a twist. You need the social structure to accomplish this because—and now it is Arthur Schopenhauer's turn—fat is also a sign of another disease process: the lack of will. The will becomes that which is healed by the dieting process and enables the rational mind to control the body—or quite the opposite. Certain studies have shown that dieters as a class have lower self-esteem than non-dieters and that they scored much higher on Albert Ellis's "irrational thoughts measure," having radically unrealistic expectations about self-improvement following weight loss. Most truly believe that weight loss will change their lives rather than their belt size.

Today fat is dangerous because it is now globalized. Fat is now (as smoking was) a sign of the deleterious effect of the modern (read: the American) on the body. We have to restore the healthy mind and, thus, heal the unhealthy body. McDonald's weakens the will through advertising: Tsung O. Cheng claimed recently that childhood obesity in China is the result of globalization: "All of the children in China recognize the image of Ronald Macdonald, even though they may not be able to read English." This may certainly be true in the growing urban middle class, but there is a concomitant decrease of body weight among children in the countryside. Is it McDonald's or the one-child policy and economic "liberalization" that is at the root of the "epidemic" in China?

Dieting is modern. Dieting is ancient. Food is therapy. Food is the source of illness. We diet. We can cure ourselves and improve the world. We can live a "hundred years" and be a productive member of society. We know where the weapons of mass destruction are hidden. They are within us, and we can seek to control or even destroy them—with a little help from our friends in the dieting culture.

The present volume is a dictionary of diets and dieting: It is not a handbook to be followed to lose or to gain weight (though it may point to approaches to avoid). It is a cultural history. It points out some of the signposts in a comprehensive history of dieting down to the present. The science it reflects is, for the most part, calibrated on the science of the twenty-first century. Science (including medicine) is part of culture and, like other aspects of cultural history, reflects and shapes the dieting cultures reflected in this encyclopedia. Science, like literature, cinema, popular, mass, and high culture of all kinds, inhabits both its own sphere of reference as well as that of the totality of our culture. You can't escape from science when you are interested in dieting—whether that science is academic or alternative.

This encyclopedia of dieting includes biographies of the famous, the celebrated, the glamorous, of scholars, scientists and the merely very fat or very thin. It tries to provide some insight into the world of dieting in the past as we see it today. And the one thing that we are certain of is that the world of today will quickly become part of the historical record of the history of dieting. It is the product of an unusual collaboration with a group of students at Emory University whose project was to learn this history with me. In the end, I am responsible for the content of the volume as I have edited and rewritten (oftentimes radically) all of the contributions. Of great help in this project was Suzanne Judd, whose work on it continued well into the conclusion of her graduate work in nutrition and public health.

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