Obesity as a medical epidemic is a rather recent phenomenon. But obesity has long been recognized as a condition requiring medical management.
Indeed, according to the French historian and sociologist George Vigarello (“The Metamorphoses of Fat”), the first appearance of the word obesity in a dictionary (the 1701 revision of Antoine Furetiere’s “Dictionnaire Universel”) is accompanied by this definition: “Medical term. State of a person carrying too much fat or flesh.”
In the 18th century, says Vigarello, many European doctors began to systematically document cases in which they believed obesity to be a contributor to death. By the end of the 19th century, obesity was fully recognized as a condition that required serious medical attention, and many doctors developed personalized weight-loss “treatments” for their obese patients.
One such patient was William Howard Taft, the 27th president of the United States (1909-1913) and tenth chief justice of the United States (1921-1930). In 1905, while serving as secretary of war under President Theodore Roosevelt, the corpulent Taft hired a British physician and diet expert, Dr. Nathaniel E. Yorke-Davies, to treat him for obesity.
Deborah Levine, a medical historian at Providence College in Rhode Island, recently published a fascinating article about the correspondence between these two men in the Annals of Internal Medicine. As she notes, the letters not only offer “a unique opportunity to examine in detail the history of the obesity experience in the United States,” but they also shed light “on the almost-timeless challenges of creating and maintaining long-term treatment courses for conditions like obesity.”
Similarities with today
Taft wrote to Yorke-Davies because he was experiencing several uncomfortable symptoms that he attributed to his weight, including heartburn, indigestion, fatigue and restless sleep. At the time, the 6-foot-2-inch tall Taft weighed 314 pounds.
Yorke-Davies prescribed a dietary regimen that sounds quite similar in many ways to the “Mediterranean diet” that was developed a half-century alter. It emphasized lean meant, lots of vegetables and a reduction in sugar. Writes Levine:
The Yorke-Davies’ reducing diet for Taft mandated that at 8 a.m. each day, a tumbler of hot water with lemon was to be sipped slowly. Then at 9 a.m., breakfast was unsweetened tea or coffee, “two or three Gluten biscuits,” and 6 ounces of lean grilled meat. Lunch was at 12:30 p.m., containing 4 ounces of lean meat, 4 ounces of cooked green vegetables without butter, 3 ounces of baked or stewed unsweetened fruit, 1 gluten biscuit, and 1 of the recommended “sugarless” wines.
An afternoon cup of tea, coffee, or beef tea without milk or sugar was advised. Dinner, eaten between 7 p.m. and 8 p.m., was to consist of clear soup, 4 ounces of fish, 5 ounces of meat, 8 ounces of salads, and condiments that could be used for variation.
Taft also exercised every day — usually horseback riding. He sent Yorke-Davies frequent and detailed accounts of both his diet and exercise activities, along with information about his bowel movements and weight.
Each morning, Taft climbed onto a scale and dutifully wrote down how much he weighed under a notebook heading call “My weight stripped.” Although, as Levine found out by comparing the notebook entries to the ones mailed to Yorke-Davies, the future president often altered the numbers to make it look as if he were losing weight faster.
‘I feel in excellent condition’
Between December 1905 and April 1906, Taft’s weight dropped to 255 pounds, a loss of 59 pounds. He was very pleased with these results.
“I feel in excellent condition,” he wrote to Yorke-Davies. “I used to suffer from acidity of stomach, and I suppose that was due to overloading it. Since I have undertaken this diet I have not suffered from it at all.”
To his brother, Taft wrote that “everybody says that I am looking very well, which indicates I suppose that I have a good color.”
But he also confided to his brother that he was “pretty continuously hungry.”
After shedding the 59 pounds, Taft, with Yorke-Davies’ approval, decided to go on a maintenance diet — one he hoped would help him keep the weight from coming back. But, as happens with most dieters, the pounds gradually returned. By his presidential inauguration day in January 1909, Taft weighed 354 pounds.
A subject of ridicule
Taft’s weight was — and remained so for the rest of his life — “the subject of jokes, editorial cartoons, and newspaper articles,” says Levine. During his presidency, a humiliating rumor circulated that his large body had become stuck in a White House bathtub.
Taft undertook another weight-loss effort in 1913, under the guidance of a different physician (although he also still stayed in touch with Yorke-Davies). That time he dropped 70 pounds. But his struggle with his weight wasn’t over, for it continued to fluctuate until his death from heart failure in 1930 at the age of 73.
Taft reportedly weighed 280 pounds at his death, but he had been in a coma for several weeks, which would have caused a significant drop in his weight.
A symbol of changing attitudes
The exchange of letters between Taft and Yorke-Davies “showcases the important challenges that continue to surface in management of chronic conditions, such as obesity,” says Levine. “Like so many obesity patients, Taft was at times unreliable, exaggerating his progress and not adhering to the prescribed regimen.”
He also became one of the first celebrity “experts” on weight-loss diets, at least in the United States. The press regularly asked him for his opinions on the latest diet fads and trends. “For the general public at the time,” writes Levine, “Taft became symbolic of the medical management and struggles associated with sustaining long-term weight loss.”
Taft’s weight and the attention it got from the public at the time also marked “the culmination of an important change in professional and popular Americans’ perception of and behavior toward diet and weight management,” she adds. “Discourse on diet, nutrition, and obesity in the United States had increased dramatically over the course of the 19th century. Some level of continued concern about extreme fatness or extreme thinness has persisted throughout history, but by the beginning of the 20th century, a person’s weight and approach to diet was explicitly recast as an outward indicator of the health, vitality, self-control, and discipline required to succeed and lead in the modern United States of America.”
Unfortunately, Levine’ article is behind a paywall.
Diets simply don’t work. Full stop.
Even if someone gets a benefit from a diet it’s only temporary until the body adapts to the new regimen or, more likely, the client falls off of wagon because they’re tired of being deprived of meat, bread, ice cream, or whatever it is the diet says they’re not supposed to have.
I know everyone’s looking for the magic trick or little yellow pill that will help them maintain a balanced weight, but it really comes down to two things: calories in and calories out. To hit that most people just have to eat sensibly and get a little exercise. There’s no need to get fancy by starving yourself, eliminate certain foods, or run a marathon every day just to shed a couple of pounds. Eat real food–not processed items–and mostly plants, as Michael Pollan says. Just eat items your great grandparents would recognize and take the time to cook it yourself. That way you can control the quantity and quality of your food intake. Most processed foods are loaded with salt, fat, and sugar, the very items that were in short supply back when we lived in caves.
If you don’t have time for exercise, build it into your daily commute by walking or biking into work. Even if you live 50 miles from work most people can still fit it into their schedule by simply driving most of the way to work and walking the rest. Drive in 49 ½ miles and walk the other half mile. Or park a block away from work if a half mile it too far and work your way up to it, gradually adding more distance as your body allows.
When it comes to food intake and exercise we are our own worst enemies. Unfortunately food manufacturers are more than happy to take advantage of our evolutionary weaknesses and design foods that are oh so tempting. Of course that’s simply another reason to stay away from them in my opinion. The techniques and products are out there for improving ourselves, but we have to kick our own rears and create our own motivation. Nobody’s going to do it for us.