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When does “large” become “obese”? In more technical terms, at what point does an acceptable variation in bodyweight become a pathological condition? And how does an individual's lifestyle become subject to public and medical scrutiny? A stroll round any gallery offers a striking insight into these questions. Contemporary stars may prefer the lean, tense lines of a Mario Testino photograph, but well into the Enlightenment European elites favoured the ample, sensuous contours of Peter Lely and Peter Paul Rubens. In their eyes, to be lean was to be underfed and overworked, vulnerable to famine, and easily swayed by political agitators. To be plump was to be comfortable and secure, embodying the life of leisure and pleasure that wealth and power could bring.
Although body ideals have swelled and diminished over the centuries, most cultures in history 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, “portly”) first appeared in a European context in the English physician Tobias Venner's Via Recta ad Vitam Longam (1620). Venner presented obesity as an occupational hazard of the genteel classes, and his treatments drew inspiration from classical notions of the ars vivendi—the art of living. An afflicted individual could restore their physique through the Hippocratic concepts of regimen and the middle way, modifying diet, sleep, and other factors to sculpt a perfectly balanced body, neither skinny nor ponderous.
Writers in the 18th and 19th centuries favoured “corpulence” as a gentler euphemism for the morbidly fat, and recommended that individuals treat themselves rather than resorting to a physician. Lord Byron strove to manage his fluctuating weight by abstaining from meat, drinking vinegar, and fencing in heavy clothes. A generation later, William Banting—undertaker to the Royal Household and for much of his life a very large man indeed—set out a method of dieting intended to appeal to the self-help philosophy of the rising middle classes. Banting's Letter on Corpulence Addressed to the Public (1863) emphasised self-discipline, advising readers to cut out sugar, starch, beer, and fat. His book sold thousands, and “banting” became a verb.
In the early 20th century, a number of chronic diseases—heart disease, stroke, diabetes—were found to be associated with obesity, and both the meaning and the treatment of obesity began to change. This shift was associated with the emergence of national public health systems, the demographic shift from a mainly acute to a largely chronic disease burden, and the growing importance of statistics in understanding disease at the level of populations. In 1959, the Metropolitan Life Insurance Company in New York made the first attempt to define an ideal healthy weight using actuarial tables. In doing so the company created a new definition of obesity, as 20% above this ideal, and determined the point at which their policies would pay for medical treatment. This approach faced criticism for failing to take socioeconomic factors into account, and body-mass index (BMI), named by the American nutritionist Ancel Keys in 1972, has since been adopted as a more precise measure of obesity.
Obesus has another meaning in Latin—coarse or gross. Were we to reach into one of Rubens' portraits and pull its fleshy, self-satisfied subject into the 21st century, they might be reproached for their lack of restraint, ridiculed for disregarding their appearance, or diagnosed as a health risk to themselves, their families, and society. Since World War 2 scholars across the life sciences and social sciences have identified a crisis in body image and obesity, citing the images of physical perfection presented in the mass media, the rise of the global fast food industry, declining rates of manual labour, and growing socioeconomic inequality as factors in the rising BMI of populations in high-income countries. Medical advice on healthy eating has had to compete with a vast and lucrative diet industry and urban landscapes in which cheap empty calories are everywhere. More radical and controversial interventions like bariatric surgery began to gain popularity in the early 1980s. Fat is more than a feminist issue: it cuts across the boundaries of gender, class, and ethnicity, highlighting the tensions between our fetishised individual rights, our growing knowledge of the health risks of obesity, and the coercive demands of pop culture.
Drunken Silenus Supported By Satyrs, c.1620 (oil on canvas), Peter Paul Rubens (1577–1640) (Studio Of)/National Gallery, London, UK/Bridgeman Images