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Monday, April 2, 2012

Sex, obesity and the seven deadly sins

In 2003, The Economist carried a major article on obesity and featured the topic on its front cover, which has become a PowerPoint icon in obesity lectures.  The images imply that throughout time, our ancestors were lean and fit and that obesity is a modern phenomenon, arising from today’s food industry, as witnessed by the use of a McDonalds package in the illustration of modern obese man. ‘Not so’, says Louise Foxcroft in her recent book “Calories and Corsets” which documents the history of obesity and dieting and which forms the basis of this blog.
 The Venus of Berekhat from the Golan Heights is believed to date from 500,000 BC, prior to Homo Sapiens and in the Era of Homo Erectus. Like later figures such as the Hohle Fels Venus from 35,000 BC, females are portrayed as being grossly obese with pendulous breasts and multiple folds of fat. It is of course impossible to say whether these were based on real cases or are merely symbolic of the recognised need of a minimal amount of body fat for female fertility, grossly exaggerated in these cases (see blog of  February 20th 2012).  However, the very fact that folds of fat are depicted implies some existing cases on which to draw inspiration. Hippocrates, Socrates and most notably, Galen, the father of medicine for a millennium, all espoused diet and physical activity as central to health and in all of their writings they titrate their advice on caloric restrictions to the need for physical activity.  Vomiting was also raised to an art form by the Greeks.
The interest in food and obesity of the early Greeks continued on through the era of the Roman Empire and the advent of printing was to reveal just how passionate the world was with diet and obesity. Luigi Cornado (1464-1566) published his book “The art of living long” in 1558 (he was then 94 years old!) in many editions and in many languages. Louise Foxcroft quotes Milton from Paradise Lost: “If thou well observe the rule of ‘Not Too Much’ by temperance taught in thou eat’st what drink’st, seeking from thence due nourishment, not gluttonous delight, till many years over thy head returns”. One could return to the issue that these were concerns for jus a few and that obesity was about as common as murder. However, the writings of the day say otherwise. Cornado wrote that gluttony “kills every great a number as would perish during the time of a most dreadful pestilence, or by the sword or fire of many bloody wars”. This was echoed by the English parliamentarian John Hales who, in the 16 century believed that obesity claimed more lives than the sword or plague. Only after the industrial revolution did we start to collect the relevant statistics on diet and health and by 1908, enough data had been gathered by the New York Life Insurance company to declare that obesity in those aged 35 years or more was seriously disadvantageous from a mortality point of view. The more widespread morbidities of obesity, diabetes and hypertension, would not have been counted at that time. For actuarialists in 1908 to reach this conclusion meant that there were data stretching back some time into the 19th century on height and weight and that obesity was a public health issue over two centuries ago. Independent data from the US military bear this out. Not only has the human race lived with obesity since time immemorial, but we have also lived with the stigmatization of the obese. As Louise Foxcroft writes:” The insults that are often used against fat people........also have ancient roots. The old disease of polysarcia, the pathological condition of too much flesh was thought to indicate a lazy, phlegmatic, stupid person who just could not control themselves”.

This brings us to the moral stance of society on obesity. There are seven deadly sins in certain Christian faiths of which two might be regarded as “cerebral” (Pride and Envy) with five involving what we call today “lifestyle choices”: Gluttony and Greed associated with diet, Sloth associated with a sedentary lifestyle and of course Lust associated with sex. Food was the perfect illustration of the need to balance pleasure and sin and so great was the former and so dire the latter in its consequences that the concept of ascetism evolved with hermits living lives of great self sacrifice effectively, taking total control of their body in terms of food, exercise and sex, so that their body (effectively detached from “them”) could not get on the way of the pursuit of the moral ideal.  Gluttony was by far the most visible of the seven deadly sins and it was gluttony that attracted most attention from those seeking the afterlife. As ever, the organised churches had very profound views on gluttony, none more so than Pope Gregory the Great who managed to define 6 levels of gluttony: “nimis (eating too much), ardenter (eating with unbecoming eagerness), forente (eating wildly), praepropere (not waiting until decent mealtimes), laute (enjoying food that is too expensive) and studiose (being too picky)”.

Now it could be argued that this is all very interesting but that it has nothing to do with the modern epidemic of obesity. “Not so” say I. The high priests of obesity apparently know the cause of this putatively modern epidemic. It is a food chain that is low cost, engineered to pamper our hedonism and convenient to suit our sedentary lifestyle. Once we know the problem, we can now organise the solution, which means policing, taxing, labeling, restricting, banning and whatever. Louise Foxcroft in her book quotes the anthropologist Meyer Fortes: ”It is not so much that food is good but that it is good to forbid”.  If just for a moment, the hierarchy of obesity were to look at this issue historically, then they would see the present issue as one of scale rather than uniqueness.  Just as we have always had sexually transmitted disease, we have simply far more of it today than ever before. By recognising that obesity has always been with us and at a scale of measurable concern for at least two centuries, we would immediately have to accept that simple solutions drawn from societal experience in the last half century will just distort a true vision of the solution. Obesity will be around for centuries to come. Either we tackle this long term from the food chain to the built environment or we just fool ourselves. Careers are built on the latter. Dreams are built on the former.

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