Contents List of colour illustrations Foreword Picture credits 1 Introduction 2 Obesity and the obese 3 Fat folk on show 4 A brief history of food and drink 5 Addressing obesity - diet 6 Addressing obesity - physical exercise 7 Addressing obesity - drug treatments 8 Gluttony 9 Sloth 10 Heavenly bodies 11 Obesity on the page 12 Popular images of obesity 13 Fat on film Epilogue. The dance of death Notes Select bibliography Index Colour section (see over for details) opposite page
David Haslam is Chairman and Clinical Director of the National Obesity Forum, and medical doctor. He is Visiting Lecturer at Chester University and Visiting Fellow at the Postgraduate Medical School of Herts & Beds. Fiona Haslam worked for many years in medical practice and in 1986, while still working she began her research into medicine and art, which resulted in the award of a doctorate from the University of St Andrews. She has written a number of articles on medicine and art and is the author of From Hogarth to Rowlandson: Medicine in Art in Eighteenth Century Britain (Liverpool University Press, 1996)
In Fat, Gluttony and Sloth: Obesity in Literature, Art and Medicine, David Haslam and Fiona Haslam offer a timely historical survey of cultural perceptions of obesity. A guiding concept of their book is that "there is not an aspect of obesity today that does not have a relevant backdrop in history" (7). The text is grounded in British culture, with some focus on Europe as a whole and America. A recurrent question is, do gluttony and sloth contribute to the current obesity epidemic? By analyzing cultural responses to dietary excess and obesity as represented in medical discourse, art, literature, popular culture, and film, David and Fiona Haslam show how overindulgence and illness have always been associated with disease and premature death. Obesity frequently results in diabetes, cancer, high cholesterol, stroke, heart disease, sleep apnea, and depression. Currently, the Haslams state, obesity is responsible for 30,000 deaths in the UK and 300,000 in the United States annually (15). The Haslams expertly weave knowledge of the past with the practices of the present. For example, they point out, just as doctors recognize today, Hippocrates argued that a proper diet and lifestyle can restore health. The ancients also recognized diabetes, then as unquenchable thirst and resultant excessive urination. The Haslams argue that intemperance, imbalance, and illness have always been inseparable in medical discourse, art, literature, popular culture, and later, film. In their book, the Haslams explore diet, exercise, drug therapy, and surgery as solutions to the obesity epidemic as well as the cultural connections between overindulgence and illness as seen through the veil of religion and morality. Over the ages, excessive alcohol consumption and overeating have been linked to illness and immoral behavior. However, drinking alcohol in moderation was viewed as salubrious (67). The Haslams expertly present the inherent cultural complexities that inform societal responses to illness and obesity. They point out, for example, that currently there are many drug therapies available to the public to control obesity and its resultant disorders, but because of the bogus and sometimes deadly nostrums offered in previous centuries, such as mercury and arsenic, practitioners and patients alike are now reluctant to embrace modern drugs, such as lipase inhibitors. Additionally, in Chapters 8 and 9, the Haslams show how, while, on the one hand, gluttony and sloth are sometimes numbered among the seven deadly sins, on the other hand, in some societies, corpulence, frequently the result of gluttony and sloth, was associated with wealth and social standing and thinness with poverty and illness. The Haslams note that the connection between overindulgence and obesity was not consistently made in early eras. In their discussion of art, the Haslams show the changing perceptions of beauty in relation to body size. Sixteenth- and seventeenth-century artists such as Rubens and Renoir celebrated the sensuality of plumpness while Christian artwork emphasized the skeletal slenderness of the ascetics. The classical model of beauty, da Vinci's "Vitruvian Man," captures the beauty of measured proportion, of being neither too thin, nor too large, a physical representation of the beauty of balance, moderation, and health. The Haslams argue that being overweight was attractive in the sixteenth and seventeenth centuries while contemporary models of beauty favor the slim. In their discussion of film, literature, and popular culture, the authors show how the overweight are frequently parodied, mocked, and humiliated. During the late nineteenth and early twentieth centuries, for example, the overweight were displayed in freak shows and circuses. Discrimination against fat people was and still is socially acceptable. Given that most of the populations of Britain and America are currently overweight, it would seem that models of beauty would change to fit the current corporeal realities, but this, for the most part, has not been the case. There are exceptions. The Haslams discuss movies like Shallow Hal to emphasize that size does not dictate character nor control physical attraction. What is made clear in their book is that discrimination against "fat people" is, unfortunately, socially acceptable. Remarkable in both range and insight, the Haslams' book is lively and entertaining. The idea that is reinforced throughout their book is that self-control is necessary for good health. The "thrifty genotype" allowed early man to survive in periods when food was scarce and favored those individuals who could consume massive amounts of food and then store them as fat in order to survive during lean times (4). Given the easy access most Britons and Americans have to food today, overeating is no longer a mechanism for survival, but rather a recipe for premature death. A timely historical survey of cultural perceptions of obesity. The Haslam volume brings together a wide range of sources, wonderful reproductions, and a basic approach that will give many students pause. Fat, Gluttony and Sloth reflects growing interest in and anxiety about fat in British society, and offers an interesting, if at times frustrating, take on fat and culture from ancient times to the present. Written by a physician and a medical historian, this well-illustrated and clearly written book aims to survey 'the history and perceptions of obesity; it is not intended to engage with critical theory and analysis. ... The intention is to present historical facts and to document historical conceptions and the views and reasoning of important medical figures in order to shed light on modern representations and management of obesity' (p. 8). Obviously directed at a wider audience than academics, it features a foreword by Ian Banks (a physician specializing in men's health and obesity) imploring all who are truly concerned about fat to 'read this book, and laugh a little' (p. viii). The authors' outlook on obesity is clearly laid out in the introduction: from the biomedical perspective that they share, fat 'is a threat to the individual and to society as a whole' (p. 4), and readers are reminded of this throughout the book. Through 12 chapters the authors move back and forth across Western history to present the background to our modern predicament, roaming from the Greeks and Romans to contemporary health concerns, discussing along the way 'freak' shows, quack medicine, ancient and medieval views of gluttony and sloth, and depictions of fat people in art, literature and film. The authors are at their best when they pursue a given issue in some detail and remain within a given time period. For instance, the chapter on dubious drug treatments is quite interesting and informative. Yet elsewhere retrospective diagnoses abound, and much of the specific historical material is described with little or no attempt at contextualization. Some of this is to be expected in a book that covers so much ground, but mounting example upon example across centuries would give many medical historians pause. The result is an almost encyclopaedic hotchpotch of information pertaining to fat in history, medicine and a variety of media. While this may be a boon to readers wishing for a richly illustrated factual overview of fat in history-which the book accomplishes reasonably well-it may be unsatisfying for those seeking a deep or rigorous engagement with the material. Haslam and Haslam make good on their promise not to engage in critique, especially when it comes to the diagnostic categories of biomedicine. While I did not expect to see much engagement with the activist scholarship of 'fat studies', even the recent interventions of Paul Campos and Eric Oliver go unmentioned, despite the fact that they have independently raised serious questions about the 'obesity epidemic' that the authors proclaim. Drug companies, however, are commended for their efforts on behalf of public health. Documenting how ineffective and even dangerous anti-obesity drugs and quack remedies have been in the past, the authors assure us that today's pharmaceuticals seem 'effective and well-tolerated', even though in the minds of doctors and patients they are 'unfairly tainted' by the record of past mistakes and unscrupulous advertising practices (p. 144). The authors do not critically examine the bases of the fat stereotypes that have recurred throughout history, but simply report them as a way of illustrating their longevity. Occasionally they acknowledge that such denigrations of the obese as ugly, stupid and lazy can be damaging to self-esteem and may even inspire the binge-eating that they cite as modern evidence of 'gluttony'. In a way, though, the title of the book prepares the reader for what to expect. The spectres of 'gluttony' and 'sloth' have been repeatedly conjured up in discussions about obesity in the UK, but it is not clear that such moral categories are helpful on descriptive or therapeutic grounds. The same concerns arise when we shift from the religious language of sin to the biomedical model of disease, whether this refers to the obesity 'epidemic' or recent tendencies to describe fat people as not only pathological but as downright 'contagious'. The uncritical use of such loaded terms when describing the past strikes me as problematic, and when applied to the present it oversimplifies a complex situation in a way that can promote stigmatization and self-loathing. While the authors acknowledge this potential, they have decided to exploit these terms nevertheless. Cultural History is a wretched business. It's not a discipline of any kind: not science, not literature, certainly not history. At best, it's a ragbag, well stuffed. Cultural studies simply survey the attitudes to a subject - as it might be foot wear, or nudity, or, here, obesity - as revealed in cultural practices of all kinds from all epochs, from cave art to postcards, Chaucer to freak shows. The prevailing attitude has to be non-judgmental. The only conclusion ever to be drawn from cultural history is there's nowt so queer as folk. David and Fiona Haslam have collaborated here on an illustrated survey of how obesity has been perceived and addressed, mainly in Britain and America, also going back to the classical world but timidly making no reference to more far-flung cultures. They know full well that obesity is no joke, for they set out the crushing facts right at the start. Today's children are heavier than ever before. Life expectancy in the West, after rising for centuries, may in future actually fall as a result of the obesity epidemic. Obesity, the Haslams say, "kills more people in the developed world than terrorism, climate change or war. The current adult population of the UK will lose a cumulative 10,000,000 years of life, enough to take the world back to the Cretaceous era." Yet the Haslams also profess blithe optimism, predicting a fat-free future just around the corner, thanks to scientific advances. "Nutrition science will produce food that tastes sweeter and fattier than ever but which can be eaten in typical American vast quantities without ill effect, as it will contain minimal calories." Yuck. For its part, the pharmaceutical industry will produce effective, safe anti-obesity drugs. Gene manipulation may help. In the meantime, surgery such as the gastric bypass will become routine. "If our genetic evolution were quick enough to keep pace with the evolution of the environment, it would do the same, that is, produce smaller stomachs and shorter bowels, " say the Haslams . And if science can't swing it, perhaps nature can. Suddenly, rather surprisingly, they look forward to fat people facilitating their own extinction. "Not only do obese people die prematurely but obesity increases the chances of infertility, reduced libido and erectile dysfunction, and when two fat individuals form a relationship, the risks multiply." A pretty thought. And why, precisely, are our authors so insistent that we'll all be slim any day now? Because "when obesity has been successfully eradicated, it, like smallpox, will be consigned to the history books, art, literature and other media. Hence the importance of this book in documenting its rise, prior to its fall." You have to admire the effrontery of that. Until that great day, though, there remains a tact and decency problem in surveying past attitudes to obesity. Because although the Haslams want to show that "fatness has not always, not everywhere, been shunned", they achieve the opposite. Though stoutness, fleshiness, corpulence, call it what you want, has been admired, at times and in places where it is not so easy to pile on the pounds, obesity, let alone super-obesity, has rarely been esteemed, even before its medical consequences were fully realised. It has more often been ridiculed and regarded as a freak show. "Obese individuals have always been targets for insensitive comments," the Haslams observe, caringly. Apparently it was the then mayor of London who, in 1860, enjoyed the distinction of first being called a "fat slob". And the great rallying cry "Who ate all the pies?" originated with Chelsea FC's first superstar, back in the 1900s, the goalkeeper William "Fatty" Foulkes, 22 stone, who once cleared the plates of all his team-mates before they got a chance to sit down to dinner themselves. Fatties were once literally put on show as grotesques, we are reminded, with pictures of "Dolly Dimples" and the Peckham Fat Boy, before being taken on a tour of legendary porkers, from Billy Bunter to Mr Toad, the Fat Controller to Elvis Presley. Little is missed, from McGill postcards to Lucian Freud's portraits of Big Sue, from the exploding Mr Creosote in Monty Python to Dudley, Uncle Vernon and Neville Longbottom, so cruelly portrayed in the Harry Potter books. And they certainly are spreading. The Peckham Fat Boy, who weighed 36 stone at the age of 18, was considered to be an extraordinary sight in 1917. These days there's almost one in every street. The ranks of overweight adults and children continue to increase. For the first time in history, overweight persons actually outnumber those who are malnourished. Obesity now kills more men and women in developed nations than war, terrorist attacks, or climate changes. On average, obese individuals forfeit about 9 years of life. The authors of Fat, Gluttony and Sloth: Obesity in Literature, Art and Medicine do not pull any punches: "Fat people will have a role in their own extinction." Fat, Gluttony and Sloth is not a rant about fearing flab. Nor is it simply a call to arms for more drastic tactics in the battle against bulging waistlines. Instead, the book sizes up obesity from all kinds of vantage points-popular culture, history, art, science, and literature. The book presents ample illustrations, including political cartoons, photographs, movie stills, postcards, comic strips, advertisements, and paintings by numerous artists. As might be expected, the bulk of these images display plump, fleshy, and morbidly obese individuals. The tantalizing trivia are not limited to cultural references. For example, how many nongastroenterologists know that human beings generate approximately 1 liter of gas from the digestion of food each day? However, although the reader will encounter delectable scientific terminology such as ghrelin (the hunger hormone), adiponectin, insulin resistance, leptin, and the fat mass and obesity associated (FTO) gene, Fat, Sloth and Gluttony is otherwise rather lean on purely medical content. On the other hand, the book is gorged with historical tidbits. For example, ancient Egyptians, giving new meaning to the expression "food pyramid," reportedly induced vomiting, purged themselves, and fasted multiple times each month to balance caloric intake and maintain health. Saint Francis of Assisi purportedly placed ashes on his food to eliminate any pleasure derived from eating. William the Conqueror may have been too heavy to ride a horse, so in 1086 he began a weight-reducing program consisting solely of alcohol and avoidance of food. Galen, physician to gladiators, "thought that a good doctor should also be a good cook." An extract of the cactus Hoodia gordonii has been used as an appetite suppressant by Xhomani Sans bushmen of the Kalahari desert during lengthy hunting journeys. One of the heaviest men in history tipped the scales at more than 1400 lb; his body mass index was 105, and 13 assistants were required to turn him in bed. Such "super obese" individuals often die in their early 40s, commonly of congestive heart failure. A chapter titled "Fat on Film" reminds readers that some movie stars are indeed larger than life. These Hollywood heavyweights are primarily comedic men: Norvell (Oliver) Hardy, Roscoe "Fatty" Arbuckle, Lou Costello, John Belushi, and John Candy, to name just a few. That icon of animation, the slobbering Homer Simpson, also comes to mind. In their later years, super-sized actors Marlon Brando and Orson Welles filled the screen-literally. Obese characters also play a prominent role in books. Children's literature regularly showcases rotund creatures. Who does not recognize Winnie the Pooh, Jack Sprat's wife, and Tweedledum and Tweedledee? Piggy (a myopic, asthmatic, and overweight boy) in Lord of the Flies and Augustus Gloop in Charlie and the Chocolate Factory are emblematic of juvenile obesity. "Heavenly Bodies" is a welcome chapter that surveys society's changing views of the perfect human figure. At certain times and places, large size was a measure of prosperity and even elevated social status. Yet it is undeniable that overweight individuals are subject to discrimination. The authors acknowledge that fatness "courts pity, contempt and distaste." Like most stereotypes, those of obese persons are rarely flattering; for example, such persons are often typed as weak-willed, lazy, and self-indulgent. Or, as the authors suggest, "[s]ize speaks volumes." Fat, Gluttony and Sloth: Obesity in Literature, Art and Medicine is an entertaining exploration of obesity that is simultaneously empathic, stark, humorous, unsettling, cautionary, and hopeful. Go ahead and take a nibble. There is no need to feel guilty about sampling this tasty book. Fat, Gluttony and Sloth: Obesity in Literature, Art and Medicine is an entertaining exploration of obesity that is simultaneously empathic, stark, humorous, unsettling, cautionary, and hopeful. Go ahead and take a nibble. There is no need to feel guilty about sampling this tasty book. The book is extremely well researched and illustrated throughout and a book which health professionals who have any interest in the causes and management of obesity will enjoy as it explores much more than just medical fields. Don't, however, take my word for it. The proof of the pudding is in the reading. A well-researched guide to obesity throughout the ages. Obesity we are told is an expanding problem with all its attendant health problems. It may even cause a reduction in life expectancy in today's and future generations if it continues to rise. The authors of this book however look back over the ages to discover that physicians have always associated obesity with poor health and premature death - even in Egyptian records written on papyrus dated 1552 BC there were descriptions of diabetes, the chronic disease most closely linked to obesity. The book contains a fascinating look at how obesity being relatively rare in the 18th and 19th centuries prompted stories of 'celebrated gentlemen of extreme corpulence' and also fat folk being put on show as freaks. The chapters that follow explore the history of food and drink, and how man has addressed obesity through the ages by diet, exercise and drugs. The authors state that the cause of super-obesity is almost always overeating and lack of physical exercise, so they then go on to trace gluttony and sloth through the ages. Other chapters look at obesity portrayed in art, literature and film and the change in what is perceived as the ideal body shape through time. It was somewhat apt that I finished reading this book the same week the newspapers were reporting the new technique of breast augmentation in which the fat is removed from an unwanted place in the patient's body and replaced in the breast. The book is extremely well researched and illustrated throughout and a book which health professionals who have any interest in the causes and management of obesity will enjoy as it explores much more than just medical fields. Don't, however, take my word for it. The proof of the pudding is in the reading.