Medical Use of Dieting

A ccording to the cliché, "You are what you eat." More recently, in the medical field, the phrase has become praxis, and dieting is used to cure and prevent various illnesses. The use of diet has gone much further than the proverbial "an apple a day keeps the doctor away," "eating carrots will improve your vision," or "have some chicken soup to cure . . . everything." In our seemingly rational, enlightened era, science and medicine are generally accepted as unquestionable truths. With the backing of these fields, the dieting industry has gained power, legitimacy, and sustainability. Viewed as a cure for diabetes, heart disease, sleep apnea, and obesity, the medical support of dieting has provided justification for dieters who are seeking health and longevity.

The connection between medicine and dieting has a long history, extending back into the ancient world. The primary focus of the Hippocratic School of Medicine was an emphasis on lifestyle, including diet, nutrition, exercise, and a reliance on calm, moderate living. Plato believed that excessive eating led to illness and that disease should be cured not by drugs, but by food. Samuel Johnson's Dictionary (1799) claimed that "to diet" meant "to feed by the rules of medicine (to eat by the rules of physick); to give food to." In addition, Hillel Schwartz traces the history of dietary regulation of salt intake:

Athletes were the first to be hostile to salt, since it causes water retention and may add pounds to body weight. From this came the association with obesity, Bright's disease and diabetes in the early part of this century and the first suggestions that dieters should watch salt intake. Then came stronger associations with heart disease and high blood pressure, until in 1973 Cosmopolitan's Super Diets & Exercise Guide would claim that most Americans consumed ten to twenty times as much salt as they should.

(Schwartz 1986: 259)

Some of the earliest diets, too, sought to cure ailments through dieting. John Wesley wrote Primitive Physick (1747) with the aim of bringing practical medical advice to those who could not afford to see physicians, and Gaye-lord Hauser used lemons to fight tuberculosis. The trend has continued with contemporary diets like the DASH diet (Dietary Approaches to Stop Hypertension) and the creation of "nutraceuticals," chemically engineered foods that cure diseases.

In addition, diabetes has been treated through diet since antiquity. In ancient India, the classical medical author Susruta described a diabetes-like disease which was understood as the result of the gluttonous overindulgence in rice, flour, and sugar (Papaspyros 1964). In 1796, Dr. John Rollo devised a treatment for diabetics: a low-carbohydrate diet high in fat and protein. In contrast, in the late 1850s, French Dr. Priorry prescribed eating large amounts of sugar to treat diabetes. The French Dr. Bouchardat also had the idea in the 1870s of personalizing diets for his diabetic patients after the glucose levels in their urine decreased following the rationing of food during the Franco-Prussian War. In the late nine teenth century, Catoni, an Italian diabetes specialist, used a lock and key to force his patients to follow their diets. From 1900 to 1915, diets for diabetes included the "oat(meal)-cure," the milk diet, the rice cure, and "potato therapy." In 1914, American Dr. Frederick Allen prescribed low-calorie diets of as little as 450 calories a day to his diabetic patients, believing that less food would reduce the strain on the body since it was believed that a diabetic's body was unable to process food. Again, in 1921, Dr. Elliot P. Joslin linked diabetes to obesity and thought that thin people might be immune to the disease. In contrast, another diet to treat diabetes was based on overfeeding and the belief that excess food could make up for the diabetic body's loss of weight and fluids. Even following the discovery of insulin, treatment was administered along with a reducing diet that "required the weighing of foods" (Schwartz 1986: 173).

Medicalization, or the identification of nonmedical problems as medical ones, is also evidence of medicine's authority. Specific attention to body size increased after a space for weight was introduced to standard forms in 1866, and life-insurance companies eventually began connecting weight with lifespan. Many fad diets, sometimes created by "doctors" with the title yielding legitimacy, also supported the idea that weight loss through a reducing diet would lead to health. However, medical concern about weight emerged only after public anxiety regarding excess weight had already begun. In addition, the growing attention toward degenerative diseases and studies on nutrition contributed to the growing medical attention on weight (Stearns 2002).

The use of diet as a cure was also supported by The China Study, which was able to show the link between nutrition and heart disease, diabetes, and cancer. This 1983 study surveyed the diet, lifestyle, and disease mortality data of 130 villages in sixty-five counties of rural China in hope of finding the causes of some diseases. Their results found that "the richer the diet is in native nutrients provided by plant matter, the greater are the reductions of degenerative diseases and the more beneficial are their biochemical indicators" (Campbell and Chen 1994: 103). This implies that a diet with proper nutrition can reduce or eliminate these diseases, as well as obesity. Yet the problem with such a bold assertion is the nature in which the belief was proven. That is, the collection of such statistics neglects many other factors that may contribute to a decreased prevalence of disease. Other clinical studies that have supported dieting for health are also limited by their methodology; it is impossible to make the control group and dieting group exactly the same.

The promotion of dieting as a medical cure has also been criticized for reinforcing the stigma against fat and for emphasizing weight loss over healthy eating and exercise (Germov and Williams 1996: 103; Campos 2004). In addition, the target audience is unclear such that many people who are encouraged to diet don't need to. The possible negative consequences of dieting, such as nutritional deficiencies and anxiety, are often overlooked, as are the problems associated with being underweight. Paul Campos pointedly asks, "If we were to employ the logic of the anti-fat warriors, does this latter fact mean that Americans should be encouraged to gain weight so as to protect themselves from, among other things, cancer, osteoporosis, and most of the major pulmonary diseases?" (Campos 2004: 25). It has also been suggested that the use of dieting as a cure caused the Food and Drug Administration (FDA) to be more lenient in the regulation of dieting drugs with dangerous side effects, such as "fen-phen" and Redux (Klein 1997). The FDA believed that the effects of obesity outweighed the consequences of taking these drugs. On the other hand, some just do not believe that dieting is a sufficient cure. In a statement by the American Obesity Association (2004), the organization claims that dietary interventions may not be enough, and direct surgical intervention, such as gastric bypass surgery, is sometimes necessary to improve health.

The medical industry's use of dieting as a cure can be seen throughout history, generally for diseases associated with obesity. Although many still claim that they diet for overall health and not necessarily to cure a particular ailment, the evidence backing the health claims of diets is not irrefutable. In addition, society's influence on the medical field, in particular its aversion towards fat, should not be overlooked.

SLG/Dorothy Chyung

See also Bariatric Surgery; China Today; Greek Medicine and Dieting; Hauser; Milk; Noorden; Wesley

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