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Sunday, October 7, 2012

Fat Englanders ~ 200 years ago

(Apologies for non-publication of some recent blogs but China still poses Internet challenges)

William Wadd, born in London in 1776. He was from a medical family and he followed in that tradition, becoming a Member of the Royal College of Surgeons of England in 1801. After a distinguished career in medicine, he was appointed one of the Surgeons Extraordinary to King George IV in 1820. Wadd wrote notes on his favourite topic, obesity and although he always proposed to tidy them up for into a book, they were in fact published in unedited form in1816. His book (still available on Amazon) bore the lengthy title: ”Cursory Remarks on Corpulence, Or, Obesity Considered As A Disease: With a Critical Examination Of Ancient And Modern Opinions, Relative To Its Causes and Cure.”  What is singularly important about this book is its comments on obesity and its prevalence, its perceived causes and consequences and on its social context all at the turn of the 18th century. For those of us interested in obesity all of 2 plus centuries later it is worthwhile reflecting on some of the comments of Dr Wadd.

Epidemiology: Of the general epidemiology of obesity prevailing at the time he writes: ”If the increase of wealth and the refinement of modern times, have tended to banish plague and pestilence from our cities, they have probably introduced the whole train of nervous disorders, and increased frequency of corpulence”.  He goes on to argue that: ”It has been conjectures by some that for one fat person in France or Spain, there are an hundred in England.” These comments on the widespread prevalence of obesity 300 years ago is in direct conflict with a key assumption of Robert Kessler in his popular bestseller “An end of overeating” is that obesity is more or less a recent phenomenon…. A measure of opulence that surprises one at first but on reflection should not surprise us at all is the advent of chimneys. Wadd cheekily ponders the adornment of houses with chimneys but speculates that there is no associated record “…of the front of a house or the windows being taken away to let out, to an untimely grave, some unfortunate victim, too ponderous to be brought down the staircase”!

Genetics: “The predisposition to corpulency varies in different persons. In some it exists to such an extent, that a considerable secretion of fat will take place not withstanding strict attention to the habits of life and undeviating moderation in the gratification of appetite. Such a predisposition is often hereditary”. It is interesting to note that 300 years ago there was recognition that obesity had a genetic dimension, which modern research shows to be of the order of 75% in terms of heredity but which is still so hard to stomach for the high priests of health eating.

Social class and the obesogenic lifestyle: “Yet even such dispositions [hereditary] seem to require certain exciting causes to bring them to action. Of these, a free indulgence of the table is principal. For it must be admitted that the lower orders of society, the poor and the laborious are seldom thus encumbered and it is only among those who have the means of obtaining the comforts of life, without labour, that excessive corpulency is met with. You may see an army of forty thousand foot soldiers without a fat man. And I affirm, that by plenty, and rest, twenty of the forty shall grow fat.”

Comments on causes: ”The article of drink requires the utmost of attention. Corpulent persons generally indulge to excess; if this be allowed every endeavour to reduce them will be in vain”. Boo-hoo for the boozers! On sugar he wrote: ”Negroes in the West Indies get fat at the sugar season” and he also commented: “The following case, which occurred in my knowledge, seems to prove how readily the saccharine particles of vegetables contribute greatly to increase bulk”. He then goes to describe a case history of a brewer who got fat, not on the alcohol but on the “sweet wort” from which it was brewed.

Treatments: He describes very many treatments from vegetarianism (the most popular), the consumption of vinegar or soap, salivation, perspiration, exercise or bandaging. He concludes: ”These are the principal articles that have been resorted to in the treatment of this disease; and the person who depends solely on the benefit to be derived from the use of any of them, will find himself grievously disappointed”.

“How can a magic box of pills,
Syrup, or vegetable juice,
Eradicate at once those ills,
Which years of luxury produce”

200 hundred plus years and nothing much has changed!!

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