E arly Roman medicine, following the lead of classical Greek medicine, saw obesity as a sign of illness. This was best articulated in the works of the Alexandrian physician Celsus (fl. 30 ce). He argued, however, that the body tended toward fat naturally. Nevertheless, too much weight was a sign of disease. "The obese, many of them, are throttled by acute diseases and difficult breathing; they die often suddenly, which rarely happens in the thinner person" (Celsus 1935: I: 97). In treating extra weight, he suggests tepid saltwater baths, hard exercise, food of an austere kind, and restricted sleep (Paulus Aegineta 1844: I, 81).
More important is the shift in Roman medicine, which takes place in the first century when Galen (129-c. 216 ce) began to rethink the basic categories of Hippocratic medicine. He dismissed mere "empiricism" as per the Hippocratic method and demanded that there be a theoretical underpinning to medical knowledge. While the Hippocratic physicians used foodstuffs to treat the imbalance of the humors, Galen saw the natural world as the very source of the illness from which human beings suffer. The core concept remains the humors; Galen's dictum is that "it is always the case that everything superfluous in the body runs to the weakest site and produces effect in them according to its own nature" (Galen 2003: 45). For Galen what is common in all the diseases is "plethos," an excess of bad blood, blood mixed with "residues," which, if not excreted, would wander about the body, settle in weak parts, and there cause "putrefaction" (Galen 2003: 45).
Yet, it is the external world that provides the source of such residues. It is not the weak will of the phlegmatic individual that leads to polysarkia (too much skin), but the very nature of the food itself. For Galen in his On the
Fat and Lean Mode of Life, the causes of illness lie in those things that are "non-natural," (i.e., not the humors) res contra naturum: aer (light and air), cibus et portus (food and drink), motus et qies (movement and rest), somnux et vigilia (sleeping and waking), exkreta et sekreta (metabolism), and affectus animi (affect). This was an argument that made "nurture" equivalent to "nature." In his De alimentorum facultatibus (On the Nature of Foods) Galen suggests "quick exercise" as a cure for obesity. He provides food, "but not of a very nourishing description," to be consumed only after exercise. He argued that a "sufficiently stout patient [could become] moderately thin in a short time by running and massages" (Paulus Aegineta 1844: I, 81). The cause of obesity lies in the natural products of the world consumed in excess. His work was as much for the educated lay reader as for the medical professional. Galen provides clear guidance about what is good to eat and what is not. His first book deals with "starchy" products of nature and what foods result from them, the second with fruits and vegetables, and the third with animal products. Galen's approach is culinary as well as medical; he suggests how food should be best and most tastefully prepared. His focus is both on treating the ill and preserving the healthy. All foods, according to Galen, are necessary and natural, but, used improperly, they can create illness.
Following Galen, the Alexandrian physician Paul of Aegina in the seventh century saw obesity as a problem only when it is "immoderate." Since "warm temperament renders the body lean," it is this state that should be created in fat people. "Active exercise, an attenuated regimen, medicines of the same class, and mental anxiety bring on the dry temperament, and thereby render the body lean." He also recommends that diuretics and small amounts of food (in proportion to exercise taken and preferably only once a day) should be undertaken (Paulus Aegineta 1844: I, 81).
The Romans incorporated diet as a classical therapy along with exercise to treat obesity. The key to all of the diets suggested was the Greek concept of a moderate reduction of foodstuffs complemented by exercise and some herbal treatments. In general Galenic medicine saw "food as therapy," but it also was concerned with questions of food as preserving health and life.
See also Greek Medicine and Dieting
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