OBESITY
PIIS0140673605666056.pdf (application/pdf Object)
Richard Barnett
Obesity
When does “large” become “obese”? Or, at what point does an acceptable variation in body form become a pathological condition? And how does an individual’s lifestyle become subject to public and medical scrutiny?
In discussing obesity historians have tended to contrast the preindustrial physical ideal, in which plumpness signified health and prosperity, with the modern western archetype. But despite the shifting nature of body image, most cultures seem to have drawn a distinction between the pleasantly rounded and the morbidly fat, and have looked to medical practitioners for answers. Obesity (from the Latin obesus, one who has become plump through eating) first appears in a medical context in Thomas Venner’s Via Recta (1620). For Venner obesity was an occupational hazard of the enteel classes.
An afflicted individual could restore their physique by paying attention to the Hippocratic concept of regimen: balancing diet, sleep, and other factors to create and maintain health. In the 18th and 19th centuries, writers favoured the term “corpulence” and the pressure remained on individuals to treat themselves. This was exemplified by William Banting’s pamphlet A Letter On Corpulence Addressed To The Public (1863); his book sold in thousands and “banting” became a verb.
In the early 20th century, some diseases, such as heart disease, stroke, and diabetes, were found to be associated with obesity. Obesity now became a disease that required medical involvement. In 1959, the Metropolitan Life Insurance Company made the first attempt to define an ideal weight, and hence to create medical criteria for intervention in obesity. Their approach was criticised for failing to take socioeconomic factors into account, and in the 1960s a body-mass index (BMI) over 30 was proposed as a more “scientific” measure of obesity. In Latin obesus has another meaning: “coarse” or
“vulgar”. Obesity still carries this sense of moral judgment: it implies a lack of self-control and self-respect.
The rate of adult obesity has been cited at around 15% in the UK and over 30% in the USA and western countries’ obsession with “eating disorders” has led to a monstrous obesity industry. Diets, drugs, and stomach surgery have given way to that quintessentially postmodern medical quest: the obesity gene. Fat, it seems, is not only a feminist issue, but an ethical one too.
Richard Barnett
Wellcome Trust Centre for the History of Medicine
ucgarba@ucl.ac.uk
Perspectives
the Lancet 2005; 366:204
DOI:10.1016/S0140-6736(05)66907-3
Obesity: 1000 years ago
Rabie E Abdel-Halim
I enjoyed Richard Barnett's Historical Keywords piece on obesity (May 28, p 1843).1 More clarification is needed regarding his statement that “obesity first appears in a medical context in Thomas Venner's Via Recta (1620)”.
In Europe during those dark ages, the great era of Greco-Roman medicine came to an end and no progress in medical science was made until the Renaissance.2 However, during the same period in the East, coinciding with the spread of Islam, the study of medicine and other branches of science were revived.2 Under this influence, Mohamed ibn Zakaria Al-Razi (Rhazes, 841–926) critically assessed, in his book Al-Hawi Fit-Tibb (An Encyclopaedia of Medicine), all the available knowledge on obesity at that time.3 In the light of his own experience and practice, he discussed the opinions of scholars who preceded him, such as Hippocrates, Rufus of Ephesus, Galen, Oribasius, and Paul of Aegina, highlighting the points on which he had a different view, particularly in relation to the management of excessive obesity. Galen, for example, believed that prolonged thinking and mental activity would slim the obese, but Al-Razi stated that “prolonged thinking that leads to sadness slims; otherwise prolonged thinking does not slim”.3
Al-Razi documented his discussion using clinical case reports of the patients with excessive obesity he successfully treated, describing in detail the treatments he used, including diet, drugs, exercises, massage, hydrotherapy, and lifestyle changes.
Ibn Sina (Avicenna, 980–1037) devoted a section of the 3rd volume of his “Canon in Medicine” to the “drawbacks of excessive obesity”. Ibn Hubal Al-Baghdady (1121–1213) also reported on the predisposition of “hugely obese persons” to fall ill quickly.4 In their management, by heavy exercises on an empty stomach, he stressed the importance of a gradually increasing schedule because an excessively obese person may put himself at risk if he starts abruptly on heavy activities.4
Ibn el Nefis (1207–1288) in his book Al Mujaz Fit-Tibb (The Concise Book of Medicine)5 reported on the association between excessive obesity and cardiovascular and cerebrovascular accidents, and with respiratory and endocrine disorders: “Excessive obesity is a constraint on the human being limiting his freedom of actions and constricting his pneuma (vitality) which may vanish and may also become disordered as air may not be able to reach it. They [excessively obese persons] run the risk of a fatal vessel rupture causing sudden death or bleeding into a body cavity. But bleeding into the brain or the heart will lead to sudden death. And frequently they suffer from dyspnoea or palpitation”. Furthermore, Ibn el Nefis distinguished a special type of excessive obesity in those who are “obese by birth” (congenitally obese). He recognised that “they are usually cool-tempered, slender-vesselled, subfertile, could not endure hunger or thirst, and medicaments hardly reach their organs except with difficulty and after a long time”.5
Further references are available from the author.
I declare that I have no conflict of interest.
References
1. Barnett R. Historical keywords: obesity. Lancet 2005; 365: 1843. Full Text | PDF (57 KB) | CrossRef
2. Cumston CG. An introduction to the history of medicine from the time of Pharaohs to the end of the XVII century. In: Islamic medicine, Dawsons of Pall Mall, London (1968). In: Islamic medicine, Dawsons of Pall Mall, London (1968).
3. Al-Razi MZ. . In: , In: Kitab al-hawi fit-tibb. 6:Osmania Oriental Publications, Hyderabad (1958). In: , In: Kitab al-hawi fit-tibb. 6:Osmania Oriental Publications, Hyderabad (1958).
4. Ibn Hubal AI-Baghdady AA. . In: , In: Kitab aI-mukhtarat fit-tibb. 1:Osmania Oriental Publications, Hyderabad (1942). In: , In: Kitab aI-mukhtarat fit-tibb. 1:Osmania Oriental Publications, Hyderabad (1942).
5. Ibn el Nefis AA. . In: Al-mujaz fit-tibb, Ministry of Religious Endowments, Cairo (1986). In: Al-mujaz fit-tibb, Ministry of Religious Endowments, Cairo (1986).
Affiliations
a Division of Urology, Department of Surgery, King Khalid University Hospital, PO Box 7805, Riyadh 11472, Saudi Arabia
Richard Barnett
Obesity
When does “large” become “obese”? Or, at what point does an acceptable variation in body form become a pathological condition? And how does an individual’s lifestyle become subject to public and medical scrutiny?
In discussing obesity historians have tended to contrast the preindustrial physical ideal, in which plumpness signified health and prosperity, with the modern western archetype. But despite the shifting nature of body image, most cultures seem to have drawn a distinction between the pleasantly rounded and the morbidly fat, and have looked to medical practitioners for answers. Obesity (from the Latin obesus, one who has become plump through eating) first appears in a medical context in Thomas Venner’s Via Recta (1620). For Venner obesity was an occupational hazard of the enteel classes.
An afflicted individual could restore their physique by paying attention to the Hippocratic concept of regimen: balancing diet, sleep, and other factors to create and maintain health. In the 18th and 19th centuries, writers favoured the term “corpulence” and the pressure remained on individuals to treat themselves. This was exemplified by William Banting’s pamphlet A Letter On Corpulence Addressed To The Public (1863); his book sold in thousands and “banting” became a verb.
In the early 20th century, some diseases, such as heart disease, stroke, and diabetes, were found to be associated with obesity. Obesity now became a disease that required medical involvement. In 1959, the Metropolitan Life Insurance Company made the first attempt to define an ideal weight, and hence to create medical criteria for intervention in obesity. Their approach was criticised for failing to take socioeconomic factors into account, and in the 1960s a body-mass index (BMI) over 30 was proposed as a more “scientific” measure of obesity. In Latin obesus has another meaning: “coarse” or
“vulgar”. Obesity still carries this sense of moral judgment: it implies a lack of self-control and self-respect.
The rate of adult obesity has been cited at around 15% in the UK and over 30% in the USA and western countries’ obsession with “eating disorders” has led to a monstrous obesity industry. Diets, drugs, and stomach surgery have given way to that quintessentially postmodern medical quest: the obesity gene. Fat, it seems, is not only a feminist issue, but an ethical one too.
Richard Barnett
Wellcome Trust Centre for the History of Medicine
ucgarba@ucl.ac.uk
Perspectives
the Lancet 2005; 366:204
DOI:10.1016/S0140-6736(05)66907-3
Obesity: 1000 years ago
Rabie E Abdel-Halim
I enjoyed Richard Barnett's Historical Keywords piece on obesity (May 28, p 1843).1 More clarification is needed regarding his statement that “obesity first appears in a medical context in Thomas Venner's Via Recta (1620)”.
In Europe during those dark ages, the great era of Greco-Roman medicine came to an end and no progress in medical science was made until the Renaissance.2 However, during the same period in the East, coinciding with the spread of Islam, the study of medicine and other branches of science were revived.2 Under this influence, Mohamed ibn Zakaria Al-Razi (Rhazes, 841–926) critically assessed, in his book Al-Hawi Fit-Tibb (An Encyclopaedia of Medicine), all the available knowledge on obesity at that time.3 In the light of his own experience and practice, he discussed the opinions of scholars who preceded him, such as Hippocrates, Rufus of Ephesus, Galen, Oribasius, and Paul of Aegina, highlighting the points on which he had a different view, particularly in relation to the management of excessive obesity. Galen, for example, believed that prolonged thinking and mental activity would slim the obese, but Al-Razi stated that “prolonged thinking that leads to sadness slims; otherwise prolonged thinking does not slim”.3
Al-Razi documented his discussion using clinical case reports of the patients with excessive obesity he successfully treated, describing in detail the treatments he used, including diet, drugs, exercises, massage, hydrotherapy, and lifestyle changes.
Ibn Sina (Avicenna, 980–1037) devoted a section of the 3rd volume of his “Canon in Medicine” to the “drawbacks of excessive obesity”. Ibn Hubal Al-Baghdady (1121–1213) also reported on the predisposition of “hugely obese persons” to fall ill quickly.4 In their management, by heavy exercises on an empty stomach, he stressed the importance of a gradually increasing schedule because an excessively obese person may put himself at risk if he starts abruptly on heavy activities.4
Ibn el Nefis (1207–1288) in his book Al Mujaz Fit-Tibb (The Concise Book of Medicine)5 reported on the association between excessive obesity and cardiovascular and cerebrovascular accidents, and with respiratory and endocrine disorders: “Excessive obesity is a constraint on the human being limiting his freedom of actions and constricting his pneuma (vitality) which may vanish and may also become disordered as air may not be able to reach it. They [excessively obese persons] run the risk of a fatal vessel rupture causing sudden death or bleeding into a body cavity. But bleeding into the brain or the heart will lead to sudden death. And frequently they suffer from dyspnoea or palpitation”. Furthermore, Ibn el Nefis distinguished a special type of excessive obesity in those who are “obese by birth” (congenitally obese). He recognised that “they are usually cool-tempered, slender-vesselled, subfertile, could not endure hunger or thirst, and medicaments hardly reach their organs except with difficulty and after a long time”.5
Further references are available from the author.
I declare that I have no conflict of interest.
References
1. Barnett R. Historical keywords: obesity. Lancet 2005; 365: 1843. Full Text | PDF (57 KB) | CrossRef
2. Cumston CG. An introduction to the history of medicine from the time of Pharaohs to the end of the XVII century. In: Islamic medicine, Dawsons of Pall Mall, London (1968). In: Islamic medicine, Dawsons of Pall Mall, London (1968).
3. Al-Razi MZ. . In: , In: Kitab al-hawi fit-tibb. 6:Osmania Oriental Publications, Hyderabad (1958). In: , In: Kitab al-hawi fit-tibb. 6:Osmania Oriental Publications, Hyderabad (1958).
4. Ibn Hubal AI-Baghdady AA. . In: , In: Kitab aI-mukhtarat fit-tibb. 1:Osmania Oriental Publications, Hyderabad (1942). In: , In: Kitab aI-mukhtarat fit-tibb. 1:Osmania Oriental Publications, Hyderabad (1942).
5. Ibn el Nefis AA. . In: Al-mujaz fit-tibb, Ministry of Religious Endowments, Cairo (1986). In: Al-mujaz fit-tibb, Ministry of Religious Endowments, Cairo (1986).
Affiliations
a Division of Urology, Department of Surgery, King Khalid University Hospital, PO Box 7805, Riyadh 11472, Saudi Arabia
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