Fat History: Bodies and Beauty in the Modern West 9780814771020

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Fat History

Fat Historgr Bodies and Beauty in the Modern West With a Ne w Prefac e

PETER N . STEARN S

n

NEW YORK UNIVERSIT Y PRES S New York and Londo n

NEW YORK UNIVERSITY PRESS New York and Londo n Copyright © 1997 , 2002 by New York Universit y All Rights Reserved Library of Congress Cataloging-in-Publicatio n Dat a Stearns, Peter N . Fat history : bodies and beaut y i n the moder n Wes t / Peter N . Stearns, p. cm . Includes bibliographical reference s an d index . Contents: The turnin g point—The medica l pat h : physicians and faddists —Fat as a tum-of-the-century target : why?—Th e misogynist phase : 1920S-1960S — Stepping up the pac e : old motives, new methods —Fat city : American weigh t gains i n the twentieth century—Th e evolutio n o f weight control i n Franc e — The Frenc h regime—Atlanti c crisscross : the Franco-America n contrasts —Conclusion : the fat's i n the fire. ISBN 0-8147-9824-1 (pbk. : alk. paper). 1. Weigh t loss —United State s —History. 2 . Weigh t loss —France — History. 3 . Bod y image — United State s — History. 4 . Bod y image — France — History. 5 . Fat—Socia l aspect s —United State s —History. 6. Fat—Socia l aspect s —France —History. I . Title . RM222.2.S755 199 7 613.2*509 — dc2i 96-4587 8 CIP New York University Press books are printed o n acid-free paper , and thei r binding materials are chose n fo r strengt h an d durability . Manufactured i n the Unite d State s of America 10 9 8 7 6 5 4 3

CONTENTS All illustrations appear as a group following p. 134 New Preface | vi i Preface | xvii i Acknowledgments | xx v

PART I • American Fa t 1 Th 2 Th 3 Fa

e Turnin g Poin t | 3 e Medica l Path : Physician s an d Faddist s | 2 5 t as a Turn-of-the-Century Target : Why? | 4 8

PART II • Intensification o f the Culture , 1920-1990S: Expiation an d It s Limits 4 Th e Misogynis t Phase: 1920S-1960S | 7 1 5 Steppin g u p th e Pace : Old Motives , New Methods | 9 8 6 Fa t City : American Weight Gain s i n th e Twentieth Centur y | 12 7

PART III • The Frenc h Regim e 7 Th e Evolutio n o f Weight Contro l i n Franc e | 15 3 8 Th e Frenc h Regim e | 18 7 9 Atlanti c Crisscross : The Franco-America n Contrast s | 21 7 10 Conclusion : Th e Fat' s i n the Fir e | 24 7 Notes I 261 Index I 289 v

NEW PREFAC E Research fo r thi s boo k wa s complete d i n th e mid-1990s , an d th e book itsel f ha s bee n circulatin g fo r si x years. I n takin g th e oppor tunity to add some comments for this edition, a welcome occasion , there ar e tw o obviou s targets . First , ha s th e book' s receptio n pro voked an y particular concerns ? And second, mor e important : Hav e there bee n significan t ne w trend s sinc e th e 1990s ? Ho w d o th e book's findings stan d u p i n ligh t o f th e additio n o f a bi t mor e contemporary history ?

The Book's Reception The boo k has , o n th e whole , fare d well . Sale s hav e bee n steady , and th e boo k als o ha s bee n cite d i n a persisten t strea m o f medi a discussions, including radi o and televisio n show s about weight and diet trends. Fat History is not the onl y historical treatmen t o f these issues, but i t has becom e accepte d a s a standard. An d interes t an d concern abou t weight , health , an d th e pressure s an d opportunitie s of appearanc e maintai n a n appetit e fo r insight s tha t th e historica l perspective readil y provides. Adding a comparative approac h t o the history help s a s well, offerin g som e challengin g vantag e point s o n how an d wh y Americans thin k an d behav e a s the y d o (a s wel l a s why the Frenc h thin k an d behav e as they do). Reviews o f th e boo k hav e bee n largel y laudatory . Th e on e par tially critica l commen t tha t struc k hom e wa s a lamen t tha t th e book di d no t g o far enoug h i n providin g suppor t an d guidanc e fo r vi 1

viii | New Preface people wh o suffere d mos t fro m th e intens e pressure s o f th e con temporary bod y image . Th e histor y o f dietin g an d weigh t con sciousness, i n bot h Franc e an d th e Unite d States , certainl y help s explain ho w trouble d peopl e coul d seiz e o n demandin g standard s as a reaso n t o rejec t norma l eating , throug h anorexi a nervos a o r bulimia. I t doe s no t howeve r focu s o n a condemnatio n o f thes e standards, no r doe s i t tel l thos e sufferin g fro m o r dealin g wit h eating disorders what to do. I sympathize d wit h th e criticis m —and certainl y wit h th e pai n eating disorder s ca n caus e —but ultimatel y I thought i t was somewhat of f the mark . First—an d her e I may be vulnerable —I do no t think th e historica l recor d necessaril y warrant s a condemnator y approach. I t i s certainly tru e tha t th e emergenc e o f weight contro l standards ha s pu t pressur e o n people . Thi s ha s undoubtedl y en couraged eatin g disorder s (thoug h th e bes t history o f modern ano rexia, by Joan Jacobs Blumberg , suggest s the patter n began , chron ologically, befor e th e moder n die t cultur e an d therefor e ha s mor e complex roots) . I t ha s als o encouraged , particularly i n th e Unite d States, widespread dissatisfactio n wit h one's own body, which I find both od d an d troubling . A t the sam e time , moder n historica l con ditions hav e als o encourage d weigh t gains , thank s t o mor e seden tary jobs , less walking, an d th e unprecedente d abundanc e o f food . Considerable weigh t gai n ha s occurre d eve n wit h th e existenc e o f highly touted slendernes s standards . Some of these weight gains, in turn, hav e probabl y bee n harmfu l t o healt h an d qualit y o f life . Here, the real question i s not a criticism of the pressure slenderness standards appl y (howeve r harmfu l thi s pressur e i s t o a minority) , but a discussion o f whether th e standards , or something lik e them , should b e revisite d towar d greate r effectiveness . Maybe , given contemporary eatin g opportunities , we' d b e wors e of f withou t them . It's a complicate d situation , an d th e book' s lac k o f crusadin g zea l reflects th e complexity . And ther e i s a further point . Thi s i s a work o f history—deliber ately applie d t o a topi c o f pressin g contemporar y concern . A s a historian deepl y intereste d i n th e relationshi p o f th e pas t t o th e present, I thin k it' s m y jo b t o analyz e trend s i n a wa y tha t ca n promote understandin g —in thi s case , o f ho w contemporar y die t

New Preface | i x pressures an d weigh t pattern s hav e emerge d fro m development s over th e pas t on e hundre d an d twent y years , an d wha t cause s fo r these development s stan d out . I do no t thin k it' s m y job , directly , to ad d explici t recommendation s abou t ho w thi s understandin g should b e used . I sincerely hop e tha t a historical perspectiv e help s readers ste p ou t o f a purely contemporar y box , t o thin k abou t th e factors that have accumulated t o shape their thinking and behavior . They ma y wel l decide , a s a result , t o chang e attitude s a bit—t o ease up, perhaps, on a slavish adherenc e t o diet goals, to recogniz e the manipulatio n involve d i n presentin g endles s image s o f de manding slenderness . Bu t the y migh t also , afte r som e thought , accept th e historica l vantag e poin t but decid e no t to change a t all. I truly believe tha t historical understandin g i s useful eve n i f it does not lea d t o a n explici t self-hel p message . I' m mor e intereste d i n encouraging thoughtfulnes s tha n i n tellin g peopl e wha t t o do. We have to o man y expert s eage r t o sel l advice , to o fe w intereste d i n helping u s t o gai n perspective . Bu t th e tensio n betwee n offerin g historical analysi s an d movin g t o explici t recommendation s abou t current behavio r i s real, and som e reader s migh t prefe r a differen t balance. A t th e least , th e criticis m helpe d m e articulat e m y ow n thinking o n th e subject . For m e personally , th e histor y o f die t consciousnes s ha s sug gested slightl y mor e skepticis m abou t extrem e appearanc e de mands an d healt h claims , providin g a bi t mor e self-toleranc e an d additional source s of amusement about the foibles o f contemporary life. Bu t i t has not convinced m e t o stop worrying at least a little. I di d writ e th e boo k a s part o f a continue d fascinatio n wit h th e subject o f self-contro l an d self-scrutin y i n America n life . I n m y judgment, moder n American s hav e develope d a demanding se t of personal standards , eve n whil e believin g tha t their societ y i s dominated b y unbridled hedonism . Die t goals, and a sense of dissatisfaction wit h one' s ow n body , for m par t o f a large r pattern , al l th e more insidiou s i n tha t w e ar e largel y unawar e o f th e pressure s involved. I d o believ e tha t i t i s i n ou r interest , individuall y an d politically, t o gai n bette r awarenes s o f this aspec t o f contemporar y reality. We ar e needlessl y vulnerable t o claim s tha t we (o r at least, those aroun d us ) lac k character , tha t w e hav e becom e endlessl y

x I New Preface

self-indulgent, despit e th e fac t tha t w e hav e internalize d a consid erable arra y o f self-regulator y criteri a i n wha t is , still , a rathe r moralistic society . Self-blam e ca n als o be a contemporary proble m in tha t i t distract s u s fro m politica l an d socia l factor s tha t meri t more concerte d attention . Here , I do conten d tha t ther e i s a defi nite messag e i n contemporar y history . But i t i s als o tru e tha t whil e diet-consciousnes s promote s som e arguably undesirabl e self-preoccupation , a s agains t broade r politi cal concerns , our standards are looser i n practice than i n principle. The ga p betwee n professio n an d realit y i s greate r tha n i n som e other area s o f contemporary America n moralism , suc h a s smoking or germ-fighting. An d th e equatio n ma y have been changin g a bit, which lead s to the nex t challenge o f updating m y comments .

The Pendulum One o f the distinctiv e features o f the book i s its treatment o f actual trends i n weight , i n th e Unite d State s an d France , alon g wit h th e attention t o the developmen t an d promotion o f diet standards. The object, obviously , was to juxtapos e ideal s an d realities , and th e ga p in th e Unite d State s was an importan t finding. But si x years ago , interes t i n th e standard s themselve s ra n high . Concern abou t th e unrealisti c pressures , particularl y o n wome n and girls, helped th e book fit into an active discourse. This concern persists, an d I stil l ge t inquirie s abou t ho w histor y ca n hel p u s understand ho w th e fashio n industr y an d th e medica l professio n combine, howeve r innocently , t o mak e wome n thin k il l o f them selves and , i n extremis , actuall y t o becom e il l throug h disorder s incurred i n a tragic effort t o achieve ideal slenderness. A fascinating issue o f the journa l Social Forces, i n 1999 , contained a number o f articles contendin g tha t ou r die t cultur e continue s t o lea d peopl e astray and actuall y worsens health throug h oscillations , urging that fitness, not fatness , i s th e crucia l point . An d indeed , despit e dir e medical warnings , weigh t gain s hav e no t a s yet actuall y generate d deteriorations i n mortalit y (thoug h arguabl y the y hav e constraine d

New Preface | x i further progress , and thei r impac t i s limited partl y because o f new medicines agains t hypertension an d diabetes) . On th e whole , however , interest s hav e shifted , an d th e par t o f the boo k tha t deal s with actua l weigh t trends an d th e growin g gulf between recommendation s an d rea l America n bodie s no w elicit s the mor e frequen t commentary . Thre e things , clearly , hav e hap pened t o shift th e balanc e o f concern a t least for th e moment . First, keepers o f the flame lon g involve d wit h promotin g weigh t control hav e intensifie d thei r efforts . Healt h an d insuranc e experts, in particular , continu e thei r well-meanin g campaign . Thi s par t of the formula , discusse d i n the book , persists with a vengeance. Second, feminis t analysis , thoug h stil l relevant , ha s recede d i n vigor. A n importan t sourc e o f attentio n t o th e manipulativ e an d even destructiv e qualitie s o f die t standard s ha s partiall y los t it s voice. Scholarl y attentio n persists , as noted above , but the visibility of cautionary comment s ha s diminished . And third, American weigh t gains continue, providing substance for th e growin g literatur e o n mountin g obesit y rates . There i s new reality behin d th e shif t i n interes t fro m th e die t standard s them selves, to the failur e t o live up t o the standards . Janus-faced, th e boo k i s relevan t t o bot h set s o f interests . How ever, i n offerin g a n update , th e chang e i n opinio n climat e offer s inescapable guidance . W e nee d t o tal k particularly abou t rea l weight an d th e rol e o f standard s i n a n increasingl y corpulen t America. There ar e tw o key questions , beyon d briefl y outlinin g th e mos t recent trends . First , doe s th e historica l an d comparativ e analysi s the boo k offer s stil l appl y i n explainin g Franco-America n differ ences an d thei r root s i n th e past ? An d th e answe r is , yes , whic h means i n m y self-intereste d opinio n tha t thi s boo k i s stil l wort h reading for th e no w as well a s for th e then. Second , ar e there signs that the American die t culture , develope d ove r a century, i s breaking u p i n favo r o f a ne w paradigm ? An d her e th e answe r is , no t proven; a lot of continuity remains , for certain , bu t ther e ar e som e straws in th e wind (a s there alway s are) pointin g towar d change .

xii | New Preface

Fatter History and Its Causes In the late 1990s and early 2000s, Americans, on average, continued the rapi d weigh t gain s tha t ha d begu n t o develo p fro m th e mid 1980s onwar d (an d whic h ar e discusse d i n chapte r 6 , particularly on pag e 133) . Th e ide a o f a significan t brea k fro m th e previou s decades o f noticeable bu t mor e moderat e averag e weight increase s becomes inescapable , a s thi s ne w perio d no w extend s fo r almos t two ful l decades . And thi s als o mean s tha t th e cause s o f this mos t recent se t o f trends , briefl y discusse d i n chapte r 6 an d the n late r comparatively, requir e furthe r expansion . By 2002, the average American gaine d abou t 20 pounds betwee n his or her twenties and hi s and he r fifties; this was twice the rate in the 1970s . Th e percentag e o f obes e an d overweigh t ros e t o 6 2 percent, u p fro m 4 8 percen t i n 198 0 accordin g t o th e Surgeo n General's scathin g calculation . Straigh t obesit y rate s ha d almos t doubled i n the sam e span . Three factors , operatin g particularly vigorousl y i n th e Unite d States throughout th e twentiet h century , certainl y acquir e growin g salience i n this current period. First , the commercial food industry , and particularl y thos e devote d t o snacks , gain s a growing hold . I n a sense , foo d consumerism , lon g a t wa r wit h dietin g fro m th e alternating pages of early-twentieth-century women's magazines onward, wins. Americans begin to find it difficult t o locate themselves at an y distanc e fro m a snac k supply . Ther e i s evidenc e als o tha t the siz e o f restauran t portion s ha s increase d a s a relativel y chea p way t o entic e customers . Second , th e specia l cas e o f childre n becomes eve n mor e significant, a s childhood overweigh t expande d rapidly. (Som e estimate s hel d tha t th e percentag e o f overweigh t children ha d triple d i n twenty years.) Though warning s about children's weigh t gain s begi n t o becom e commo n fro m th e 1970 s onward, a s note d i n th e book , the y simpl y hav e no t matche d parental sens e tha t children' s eatin g should b e indulge d o r at least cannot b e regulated . Worrie s abou t eatin g disorder s contribut e here a s well; at least the darling s ar e no t anorectic . Childre n wer e also affecte d b y an expansio n o f video game s an d compute r inter ests tha t ofte n cu t int o physica l activity . An d third , o f course , th e

New Preface | xii i minority populatio n continue s t o expand , an d wit h i t th e group s that neve r bough t int o th e ide a o f American slenderness . Obesit y increases were particularly marked amon g blacks and Hispanics . In other words , cause s o f American departure s fro m die t ideals , dis cussed mor e full y i n th e chapter s tha t follow , continue d t o prevai l with acceleratin g impact . But new factors adde d in , supplementing the prior inducements . These ne w factor s ar e essentia l i n explainin g th e dramati c depar ture fro m approve d standard s an d prio r behavio r alike . The cam paign agains t smokin g mus t b e considered . I t kicked i n durin g th e 1980s an d dre w fa r mor e zealou s respons e tha n dietin g ha d achieved. Forme r smoker s ofte n at e more ; an d American s prou d of thei r nicotin e self-contro l migh t eas e u p o n thei r eatin g con science. Formal , home-cooke d dinner s decline d a s wive s worke d more and olde r children wen t their separate ways. Fast food restau rants an d supermarke t prepare d meal s wer e th e beneficiaries . Given well-established American tradition s of hasty and fairly heedless eating, another finding explore d extensivel y in Fat History, this new pattern unquestionabl y furthere d weigh t gains. Finally, Americans fro m th e mid-1980 s onwar d bega n workin g longe r hour s t o maintain income s ami d growin g inequalit y an d t o mee t th e demands of profit-hungry superiors . More work and, often, les s leisure easily create d greate r relianc e o n snack s a s a sourc e o f comfort , often consume d i n brie f break s o r o n th e jo b itself . Mor e wor k could als o mea n les s parenta l tim e t o supervis e children' s eatin g habits an d mor e eagernes s t o tolerat e foo d reward s tha t coul d relieve a sens e o f guil t abou t th e lac k o f opportunit y fo r mor e elaborate share d leisure . Thi s facto r ease d i n th e lat e 1990s , wit h increased contac t hour s betwee n parent s an d grad e schoo l chil dren, bu t i t wa s no t entirel y erased . A natio n unde r increasin g stress used foo d a s solace. Causation ca n b e elusive , an d o f cours e i t shoul d b e debated . The ne w factors combine d wit h th e longer-establishe d vulnerabili ties i n America n eatin g behavior . Ther e i s n o contradictio n wit h the analysis developed i n Fat History, simply the need t o recognize some additional promptings .

xiv | New Preface

France Revisited Comparison continue s t o hel p i n sortin g ou t th e ke y component s in th e change s an d continuitie s o f recen t behavior . Fat History argues tha t American s lon g ha d mor e troubl e tha n th e Frenc h i n living up t o contemporar y slendernes s standard s becaus e o f several durable difference s i n eatin g habits and eatin g goals, compounde d by a greate r America n reluctanc e t o disciplin e childre n i n thi s regard. These difference s continu e t o affect behavior . But i t i s true tha t the internationa l comparativ e pictur e becam e more complicate d b y the mi d 1990s . Increases in obesity rates were noted i n man y countries , includin g eve n Chin a an d India , wher e the growt h o f a n urba n middl e clas s introduce d importan t ne w factors. These internationa l trend s highlighted th e role of new food availability an d foo d consumerism ; th e globalizatio n o f certai n food outlet s an d habits , includin g fas t foods ; an d th e sprea d o f more sedentar y lifestyles , affectin g childre n (vide o game s an d th e internet) a s wel l a s adults . Ther e wa s som e globa l convergenc e around pattern s tha t initiall y ha d bee n particularly visibl e i n th e United States . France participated , an d a ne w sens e o f a nationa l proble m developed. Th e averag e Frenc h perso n gaine d 1 percen t i n weigh t between 199 7 an d 2000 . Obesit y rate s increase d b y 1 7 percent, t o 9.6 percen t o f th e tota l population . Obesit y amon g childre n wa s particularly troubling , a s rates increase d b y 50 to 100 percent, t o 13 percent o f the total . French commitmen t t o disciplining children' s eating wa s clearl y relaxin g i n practice , o r a t leas t wa s inadequat e against ne w pressures . A s before , th e les s educate d particularl y suffered, thei r habit s reflectin g economi c distress , includin g risin g unemployment, combine d wit h ne w eating patterns. These change s wer e significant , an d perhap s the y predicte d a future i n whic h Franc e an d th e Unite d State s woul d converg e i n corpulent consumerism . Bu t ke y difference s remained , an d no t only because the French ha d been thinner before th e current craze took hold . Change s i n averag e weigh t an d i n obesit y percentage s (including children ) wer e mor e modest tha n i n th e Unite d States . In anothe r interestin g contras t reflectin g gendere d aesthetics ,

New Preface | x v French wome n continue d t o kee p thei r weigh t down , changin g much les s than men . An d eve n a s they warned abou t a new problem, th e Frenc h persiste d i n cautionin g agains t moralis m i n response. But th e critica l differenc e wa s behavioral . A t a roug h approxi mation: th e ne w patter n o f Frenc h weigh t gai n bega n a decad e after th e American intensificatio n an d the n (lat e 1990s ) proceede d at about 5 0 to 60 percent o f the simultaneou s American rate . The ne w comparisons suggested the need for additional nuance s in explanation. The impac t of food affluence , hurrie d eatin g habits, shifts i n women' s rol e i n mea l preparation , an d increasingl y sed entary childre n no w sprea d beyon d th e Unite d States . Bu t causa tion als o underscores continuin g differences . Alon g with the differ entials explore d i n chapter s 8 an d 9 , som e o f th e factor s tha t spurred additiona l America n chang e operate d differentl y i n France. Thus th e American anti-smokin g crusad e ha d onl y modes t ech oes in France , which i n turn reduce d on e o f the source s o f weight gains. Mor e important , an d trul y striking , wa s th e growin g wor k gap. A s Americans worke d mor e —by 2002 , recordin g th e longes t average hour s i n th e industria l world , wit h o n averag e th e shortes t vacations —the Frenc h tende d t o mov e dow n towar d a 35-hou r work week. There wa s simply less need fo r compensatory snacking , more interes t i n elaboratin g other form s o f leisure an d relaxation . The mai n poin t i s clear . Tw o countrie s tha t share d man y cul tural features , includin g a commitmen t t o slenderness , ha d lon g varied i n eatin g goal s an d habits , an d severa l factor s no w main tained considerabl e variance . Th e comparativ e analysi s explore d more full y i n th e ensuin g chapter s provide s th e contex t fo r eve n more contemporar y understanding . Again , cultura l difference s must b e balance d agains t ne w parallel s i n weigh t trends . Bu t the y remained grea t enoug h tha t withou t to o muc h hypocrisy , th e French coul d stil l tak e nationa l prid e i n thei r bodies , a s the y preened agains t thei r transatlanti c cousins . As the Nouvel Observateur put i t none to o subtly i n 2000, "America i s nothing mor e tha n an immens e eatin g machine/ '

xvi | New Preface

Cultures and Prospects And ther e i s a final comparativ e point . Par t o f th e Franco American juxtaposition s i n Fat History distinguishe s betwee n th e French aesthetic-healt h approach , an d th e America n moralistic health combination . Evidenc e suggest s tha t th e Frenc h approac h continues t o wor k better , whateve r it s greate r shallownes s i n prin ciple. T o b e sure , th e Frenc h hav e adde d a ne w leve l o f concer n about weigh t gains , appendin g t o olde r healt h an d beaut y argu ments a warnin g abou t no t fallin g int o th e America n patter n o f obesity. I n th e Unite d States , a greate r moralis m persists , an d i t remains possibl e —a poin t discusse d late r i n th e boo k —that thi s moralism i s actually counterproductive , i n settin g goal s tha t ar e to o high, wit h additiona l eatin g spurre d b y failure . But i s the moralisti c cultur e itsel f cracking , addin g t o th e behav ioral change ? Ar e American s no t onl y eatin g more , bu t gettin g comfortable wit h thei r large r bodies ? Evidenc e i s contradictory . Some fashio n model s ar e no w fuller-figured . Som e televisio n show s feature paunch y actors , thoug h mainl y whe n working-clas s o r eth nic setting s ar e mean t t o b e conveye d —so her e th e signal s ar e no t entirely clear . Goin g agains t this , however , i s Bett y Crocker , lon g a pastr y symbol , wa s altere d towar d greate r slendernes s i n 2000 . The bar e midrif f loo k fo r youn g wome n put s a ne w premiu m o n thinness. Die t advic e an d book s stil l wi n wid e attention , whil e pledges o f weight los s still to p th e chart s fo r Ne w Year's resolutions . The heroi c dieter , capabl e o f castin g of f a hundre d pound s o r more, a stapl e o f women' s magazine s a half-centur y ago , ha s re turned i n advertisement s fo r a sandwic h chain . A leading col a (14 0 calories pe r bottle ) use s a tight-bellie d teenag e se x kitte n a s it s a d symbol. And th e spat e o f attacks o n America n obesit y itsel f suggest s the continue d momentu m agains t weight , wit h abundan t asper sions o n lac k o f willpowe r an d character-erodin g deficiencie s i n exercise. Th e cultur e buil t u p fo r mor e tha n a centur y stil l ha s legs, thoug h o f cours e i t migh t someda y yiel d mor e full y t o altere d behavior. Weight an d dietin g stil l exercis e thei r fascination , whic h i s wh y the analysi s i n Fat History warrant s attention . Th e ne w twists ,

New Preface \ xvi i particularly i n American weigh t gain s an d som e ne w Frenc h con cerns, ad d t o th e nee d t o asses s th e cause s o f th e gap s betwee n ideals an d reality—an d als o rais e question s abou t th e results . Are we eve n les s enamore d o f our ow n bodie s tha n w e were a decad e ago? Th e answe r is , quite probabl y yes . I s ou r ne w behavio r dan gerous t o ou r health ? Th e dominan t answe r is , yes, though ther e are dissentin g voices . Wha t kind s o f change s shoul d w e conside r for alterin g behavior, o r reducing self-distaste , o r both? The answe r is complex, but i t can emerg e onl y from considerin g ou r history .

PREFACE Over th e pas t century , a majo r additio n ha s occurre d i n Wester n standards o f beauty an d morality : th e nee d t o sta y thin, o r a t leas t to profes s a desir e t o becom e thin . Th e result s ar e wide-ranging , from a desperat e ques t fo r slimme r oper a star s t o a hug e ne w commercial literatur e an d produc t lin e designe d t o ai d i n th e slimming. Representation s o f succes s change : i n 189 0 success was embodied i n corpulence , failur e i n emaciation ; b y 1900 they were drawing even ; an d no w succes s i s thin . Eve n illnes s changes : nineteenth-century anorexic s complaine d tha t eatin g hur t them , and neithe r the y no r thei r doctor s focuse d o n thinness ; twentieth century anorexics talk about feeling fat and full, and everyone notes their extrem e o f slenderness . Mos t importan t — for th e histor y o f extremes suc h a s anorexi a ha s bee n studie d mor e tha n th e evolu tion o f everyday anxieties and constraints — the list of things people worry about and th e ways they evaluate (an d ofte n scorn ) their own bodies hav e shifte d dramaticall y i n moder n times . Intens e belief s in th e disgustin g inferiorit y o f fa t joi n mor e traditional revulsion s against sexua l deviation s o r uncontrolle d drunkenness . Failur e t o live u p t o th e new , standardize d bod y imag e entail s a t leas t a n appalling ugliness , at most a fundamentally flawed character . But corpulenc e i s a differen t targe t fro m som e o f th e mor e traditional taboo s in that it is so visible, particularly in an age where praise fo r slendernes s i s highlighted b y increasingly revealin g fash ions. Thi s i s on e o f th e reason s tha t th e moder n struggl e agains t fat, i n additio n t o bein g ne w an d pervasive , cut s s o deepl y int o many people' s lives . On e ca n concea l t o som e exten t a n inabilit y xvi 11

Preface | xi x

to liv e u p t o society' s emotiona l standard s an d eve n sexua l demands, but fa t canno t hide . Similarly , successfu l battle s agains t fat can b e differen t fro m struggle s agains t othe r obsession s suc h a s smoking o r drinking , i n tha t peopl e hav e t o eat ; complet e absti nence i s impossible , s o the y mus t wor k ou t som e kin d o f mor e subtle self-restraint . This stud y trace s a majo r ne w moder n cod e a s i t forme d an d had it s first effects . T o b e sure , th e cod e buil t o n som e olde r elements, suc h a s preachment s o f moderatio n an d th e Christia n attack on gluttony as sin. But the full moder n code , and the notio n that eve n moderat e fa t wa s someho w disgraceful , wer e genuinel y novel whe n contemporar y slendernes s standard s bega n t o emerg e in th e 1890s . A full centur y constitutes a fairl y shor t tim e fo r th e institution o f suc h dramati c persona l standards , s o i t i s hardl y surprising tha t thi s i s als o a histor y o f hesitation s an d failures . Indeed, the new culture i s still contested, particularly in the Unite d States but even to an extent in Europe. Various organizations argue that fat i s or should b e beautiful, tha t fat peopl e mus t be protecte d against cultura l discrimination . Face d wit h evidenc e tha t th e United State s i s no t livin g u p t o Frenc h level s o f thinness , a commentator urge s that we revalue fat itself, to see in it an emble m of stability , o f "lovin g ponderation, " remindin g u s quit e correctl y that "i n othe r ages , fat wa s beautiful." Differen t socia l group s and , in th e Unite d States , important racia l culture s disput e th e middle class norms . I t i s particularl y usefu l t o undertak e a histor y o f th e origins an d evolutio n o f a cultur e whe n it s tentativenes s an d une venness ca n als o be noted. 1 Dieting, weigh t consciousnes s an d widesprea d hostilit y t o obe sity form on e o f the fundamenta l theme s i n moder n lif e i n coun tries lik e th e Unite d State s an d France . American women' s maga zines featur e a n averag e o f on e dietin g articl e pe r issue , makin g the subjec t on e o f th e ubiquitou s staple s o f thi s genre . A nea r majority o f America n adult s die t o r profes s t o b e abou t t o diet . Under th e spu r o f dramati c ne w bod y standards , th e Frenc h o n average hav e los t weigh t ove r th e pas t quarte r century . Ye t fe w studies ar e availabl e o f thi s widesprea d phenomenon . Th e onl y substantial analysi s derive s fro m perceptiv e feminis t complaint s

xx I Preface

about th e specia l imposition s o f dietin g standard s o n women , bu t while this provides a legitimate angl e of vision i t is unduly narrow. 2 When an d wh y di d seriou s dietin g concer n begin ? (Interestingly , some feminis t studie s mistak e th e basi c chronolog y whil e missin g the whol e first phase o f the moder n trend ; thi s help s explai n why , despite muc h perceptiv e analysis , th e studie s skim p o n th e expla nation b y assuming a singular plo t against women.) Was the American patter n o f dieting th e onl y on e availabl e t o increasingl y prosperous industria l societies ? An d why , give n th e tremendou s attention devote d t o dieting , hav e American s encountere d suc h mixed succes s i n weigh t control ? Decade s o f warrin g agains t fa t have lef t us , on average , fatter tha n w e used t o be ; here i s another target for som e seriou s thinking abou t a surprisingly meat y topic. This book seeks to explore, through histor y and comparison , th e meaning o f fat an d antifa t i n moder n Wester n society , an d partic ularly the Unite d State s and France . These tw o countries share the Western die t impulse s o f the pas t century, but they represent quit e different pole s within th e commo n trajectory . I try to capture som e of th e char m o f th e topi c i n th e man y amusin g program s an d devices tha t hav e compete d fo r attentio n i n a weight-consciou s century (dietin g i s not usually fun, bu t i t can certainl y be funny). I will eve n mor e consistentl y see k t o understand , usin g a pervasiv e but seemingl y humdru m topi c t o explor e som e surprisingl y com plex feature s o f modern life . Fightin g fa t goe s beyond fashio n an d even health . B y delvin g int o th e large r meanings , w e ca n bette r understand wh y man y moder n peopl e worr y a s the y d o an d eve n why such a gap may exist between sli m ideal s and bulging realities. The stud y derive s fro m severa l relate d premises . Firs t an d mos t obvious, anxiet y abou t weigh t i s s o importan t i n contemporar y Western societ y that historical perspectiv e i s a vital part of our selfunderstanding. Concer n abou t weigh t an d dietin g i s not timeless ; its origins ar e moder n an d ca n b e quit e precisel y traced . I t is also, at least in the form i t took, not inevitable. Forces in the past created a nee d fo r chang e an d forme d a cultur e stil l ver y muc h i n opera tion today . A large segment , possibl y a majority , o f contemporar y American adult s ar e concerne d abou t thei r weight , man y o f the m checking i t regularly , som e o f the m actuall y doin g somethin g

Preface | xx i

about it. Any phenomenon thi s widespread deserve s historical treatment a s something mor e tha n a n antiquaria n featur e o f the recen t past. Further , a serious history of fat and dietin g i s inextricably tied to suc h establishe d historica l topic s a s gender , fashion , an d bod y imagery. There are , t o b e sure , a fe w existin g historica l efforts , fewer , however, tha n th e importanc e o f th e subjec t warrants . I wil l us e prior histories gratefully, bu t while some of them offe r usefu l detai l on th e emergenc e o f specifi c weight-watchin g organization s o r sequences o f die t recipes , thei r analytica l hef t i s inadequate. 3 I n the cas e of France, there i s no explicit history at all, though studie s of fashion , appearances , an d medica l treatment s o f obesit y ar e helpful.4 Yet a comparativ e focu s doe s fa r mor e the n fill som e unneces sary gaps i n tw o nations ' histories . I t illumine s crucia l distinction s in method s an d meaning s withi n a commo n moder n process . While man y aspect s o f American an d Frenc h dietin g ar e simila r because o f shared causation , crucia l differences , rangin g from tim ing to larger cultura l purposes , developed i n th e twentiet h centur y as well . A t first blush , th e Frenc h see m t o die t mor e straightfor wardly — that is , t o contro l thei r weigh t withou t large r symboli c baggage — than American s d o an d d o s o mor e successfully . The y also snack less and ea t more moderat e portion s i n meal s of a more standard size. 5 S o ther e i s a challengin g comparativ e differenc e here, wit h Franc e an d th e Unite d State s a t opposit e end s o f th e modern spectrum . Onl y throug h a rather wide-rangin g histor y ca n we grasp how two different version s of a modern standar d emerged , and wh y Americans canno t readil y imitat e th e Frenc h eve n whe n they recogniz e that , i n weigh t contro l an d aestheti c self-esteem , the Frenc h hav e surpassed them. 6 At first glance, the relativ e Frenc h succes s ma y seem counterin tuitive, a s man y enviou s America n traveler s hav e noted . Frenc h preoccupation wit h foo d migh t leav e the m more , no t less vulnerable, to the perils of obesity. The Frenc h ar e both mor e slender an d more foo d consciou s tha n thei r muc h mor e diet-pron e bu t fatte r transatlantic counterparts . Bot h societie s hav e see n som e basi c changes i n bod y perception s ove r th e pas t centur y a s par t o f a

xxii | Preface common Wester n experienc e wit h prosperit y (contrasting , fo r ex ample, with patterns in Russia, where explicit dieting is not a social norm). Whil e th e rol e o f fa t an d slendernes s i n man y culture s raises fascinatin g comparativ e issue s — including case s wher e brides ar e deliberatel y fattene d t o increas e thei r desirabilit y — France an d th e Unite d States , sharing key basic trends, offer mor e precise comparativ e target s an d mor e revealin g juxtaposition s to ward explainin g wha t th e moder n mani a i s all about . Fo r th e tw o peoples7 definitio n an d implementatio n o f change diverg e consid erably; even th e amusin g aspect s vary, with th e Frenc h mor e ope n to self-parod y abou t foo d an d American s mor e susceptibl e t o bi zarre routines o f self-denial . Furthermore, th e tw o countrie s hav e lon g bee n fascinate d wit h each other' s eatin g and wit h eac h other' s bodies. American interes t dates t o th e nineteent h century , whe n Franc e cam e t o symboliz e fashion an d stylis h restauran t dining . Thi s ha s continue d eve n a s American powe r ha s increased ; Frenc h movi e star s lik e Brigitt e Bardot in the 1950s have recurrently symbolized the latest in bodies or bodil y display . Wit h greate r knowledg e ha s com e complexity ; impatience wit h Frenc h penchant s fo r leisurel y dinin g ( a costl y impatience i n th e cas e o f the restauran t misplannin g a t the Euro Disney, wher e i t wa s assume d tha t th e Frenc h woul d snac k a s quickly an d ofte n a s Americans) combine s wit h enviou s apprecia tion o f French foods . Frenc h focu s o n American lifestyle s i s admittedly mor e recent . Fro m 190 0 onward, th e Unite d State s was seen as a sourc e o f importan t advance s i n die t product s an d methods ; this attachmen t intensifie d i n th e 1950 s as American cultura l pres ence becam e overwhelming . America n models , widel y discusse d as well a s photographed, surpas s Frenc h star s a s pervasive source s of body imagery . At the sam e time , diet method s constitut e on e of those area s wher e th e Frenc h hav e pride d themselve s o n resistin g American errors . And a morbid fascinatio n wit h America n obesit y has complicate d th e exchang e a s well; films like LAmerique Insolite (Unaccustomed America) (i960 ) dwel t vividl y o n overweigh t Americans and o n their fast, voluminous food consumptio n a s they chowed dow n i n diner s an d a t picnics, a theme take n u p agai n i n UAmerique Interdite (Forbidden America) (1982) . The transatlanti c

Preface \

xxii i

fascination nourishe s fa t histor y i n bot h countries , an d bot h guide s and sustain s a comparison . Finally, an d her e bot h countrie s participate , Wester n worrie s about weigh t an d effort s t o contro l eatin g represen t a fascinatin g modern constrain t i n a perio d whe n liberatio n an d individualit y are ofte n see n a s hallmark s o f a rebellio n agains t Victoria n restric tions. I n fact , twentieth-centur y peopl e unquestionabl y limi t thei r eating o r bemoa n thei r inabilit y t o d o s o fa r mor e tha n thei r ancestors did . Par t o f thi s chang e result s fro m mor e sedentar y occupations an d entertainment , mor e abundan t food , an d laborsav ing device s suc h a s automobiles . Bu t par t o f th e change , an d certainly th e exten t o f th e concern , g o beyon d simpl e reaction s t o modern artifacts . I n fact , eatin g restriction s ar e no t th e onl y con straints twentieth-centur y peopl e plac e o n themselves , eve n a s the y partially emancipat e behavior s i n othe r areas . A t th e sam e time , new constraint s continu e a n olde r campaig n t o disciplin e th e body , which ha s lon g bee n see n a s a vita l curren t i n Wester n manner s and definition s o f respectability . Understandin g th e meaning s o f and reason s fo r th e ris e o f ou r ne w disgus t ove r fa t clearl y serve s t o add t o ou r gras p o f th e comple x evolutio n o f contemporar y value s and th e pattern s o f dail y life . By 199 4 over 4 0 millio n American s wer e involve d i n forma l die t programs, wit h 4 5 percen t o f th e populatio n claimin g diete r statu s of som e sort , whil e betwee n 1 2 an d 4 0 percen t o f th e Frenc h professed t o b e dieting . Die t product s wer e gainin g a n eve r increas ing plac e o n th e foo d shelves . Awarenes s an d concer n abou t fa t form on e o f th e leadin g cultura l symbol s o f th e late r twentiet h century. Determinin g ho w thi s curren t began , wha t factor s hav e sustained it , an d wha t i t mean s t o peopl e i n advance d industria l societies get s a t on e o f th e staple s o f contemporar y life , wher e professed ideal s an d individua l behavio r ca n clas h i n revealin g ways. Some conservativ e purist s worr y abou t th e proliferatio n o f histor ical topic s tha t tak e u s farther an d farthe r afiel d fro m understandin g the staple s o f histor y lik e powe r relationships , th e activitie s o f th e state, an d th e rol e o f grea t ideas . I t i s tru e tha t th e developmen t o f new bod y imager y an d ne w anxietie s d o no t hav e muc h t o d o wit h

xxiv | Preface

political phenomen a narrowl y construed . Lik e al l socia l conven tions an d regulations , however , bod y imager y i s relate d t o power , in this case i n the increasin g nee d o f the powerful t o regulate their fat as a demonstration o f successful self-contro l an d i n the commo n scorn fo r individual s an d lower-clas s group s wh o fai l t o measur e up. And while not directly deriving from an y particular Grea t Idea, hostility t o fa t i s part o f larger cultura l shift s involvin g doctor s an d science, artisti c standards , religiou s uncertainties , and , quit e strik ingly, an effor t t o establis h a backhanded kin d o f ethical cod e i n a period o f rapidl y changin g values . The y ar e no t grea t ideas , t o b e sure, an d indee d includ e a goo d bi t o f outrigh t hoku m i n a field pervaded b y faddist s an d exploiters , bu t idea s tha t cam e t o for m part of the moder n mentalit y nevertheless . And here , ultimately , i s th e mai n point . I bega n thi s stud y interested i n dietin g a s a widespread huma n phenomeno n an d a s an exampl e o f ho w moder n peopl e regulat e themselve s o r ar e regulated, eve n whil e professin g grea t persona l freedom . I t turn s out, however, that explaining attitude s toward fat and th e successes and failure s o f a culture o f restraint involve s probing various othe r aspects of modern life . I needed t o explore basic responses to food , not surprisingly , an d her e Frenc h an d America n difference s loo m large; eatin g habit s ar e cultura l products , deepl y roote d i n socia l structures an d system s o f values. 7 Also, mora l response s t o a hig h consumption societ y an d a nee d t o compensat e fo r th e peril s o f indulgence figure in . Value s associate d wit h childre n an d famil y play a role, helping t o explain , fo r example , th e American tensio n between feedin g frenzie s an d die t ideals . Eve n politic s prov e rele vant, a s American s commi t t o dietin g (i n compariso n wit h th e French) i n part because o f the meagernes s o f their political expression. Weigh t consciousness , lik e an y seemingl y prosai c topi c tha t engages dee p popula r concern , provide s a surprisingl y wid e win dow on what moder n peopl e ar e like and wh y they vary.

ACKNOWLEDGMENTS Acknowledgments an d a persona l note : socia l historian s wh o dea l with wha t th e Frenc h cal l th e intimat e sid e o f th e pas t fac e no t only th e challeng e o f demonstratin g significanc e bu t als o th e ne cessity o f acknowledgin g persona l participation . Th e studen t o f diplomatic alliance s o r crucia l pas t election s ma y need t o offer n o disclaimers o f involvement , bu t topic s suc h a s gende r o r emotio n or bod y idea l inevitabl y includ e th e researche r a s participant. Sev eral o f th e fe w historie s an d cultura l studie s o f dietin g alread y available emanat e fro m individual s admittedl y hostil e t o th e mod ern weight regime, seeking liberation fro m it s standards and greate r tolerance fo r individual s (ofte n includin g themselves ) o f more varied body type. I have no such specifi c stake , but I am involved with the topi c a s a recurrent , sometime s partl y successfu l bu t neve r triumphant dieter , awar e sinc e boyhoo d tha t m y form fel l shor t of the contemporar y idea l (which I unquestionabl y shared) . I com e to this topic neithe r wit h th e superiorit y o f slenderness achieve d o r the confidenc e o f fatness defiant . Whethe r thi s involvement color s my treatment I cannot presume to say, but it unquestionably make s my travails par t o f my own history . While m y appreciation fo r th e topic stemmed fro m m y wider interest in the constraints of modern life, i t has surely been enhance d b y my participation i n some of its ambiguities. I have benefited fro m lot s of advice and assistance , and n o small amount o f solid researc h help . M y thanks t o m y colleagues i n th e Center fo r Cultura l Analysi s a t Carnegi e Mello n Universit y fo r various suggestions ; I' m particularl y indebte d t o Andre w Barnes , xxv

xxvi | Acknowledgments Michael West , Barbar a Freed , Stev e Schlossman , Judit h Modell , and Keny a Dworki n y Mendez. Mar y Lo u Robert s wa s exception ally generous in guiding me to French materials . Susan B. Whitney added valuabl e suggestion s o n France . Norale e Franke l helpe d with material s a s well , an d Jil l Field s an d Joh n Komlo s offere d a number o f usefu l suggestions . Librarian s a t th e Carnegi e Mello n University Library , Allianc e Frangais e o f Pittsburgh , th e Muse e Social, the Bibliothequ e Marguerit e Durand , an d othe r center s i n Paris wer e uniforml y helpful . Specia l thank s t o Mme . Geneviev e Morley o f th e Bibliothequ e historiqu e d e l a Vill e d e Paris . Re search assistants , providin g idea s a s wel l a s data , include d Lies l Miller, To m Buchanan , Jaso n Andracki , Dere k Davison , Kerr i Ullacci, an d Sun g H o Lee . Nik o Pfun d an d Christin e Won g a t NYU Pres s supplie d a variet y o f goo d idea s an d assistance . A s always F m gratefu l t o m y famil y fo r interes t an d support , Caro l Stearns wa s a model i n man y way s and Debora h Stearn s offere d a number o f goo d ideas . Thank s als o t o Kare n Calla s fo r assistanc e with thi s manuscript. Bo n appeti t to all.

•I • American Fa t

1

The Turnin g Poin t

Between 189 0 an d 1910 , middle-clas s Americ a bega n it s ongoin g battle agains t bod y fat . Neve r previousl y a n ite m o f systemati c public concern , dietin g o r guil t abou t no t dietin g becam e a n increasing stapl e o f privat e life , alon g wit h a surprisingl y stron g current of disgust directed agains t people labeled obese . In contras t to patterns in the nineteenth century , when body styles, particularly but not exclusively for women, shifte d faddishl y ever y few decades, the growing passion fo r slimnes s se t a framework tha t would las t at least a century. T o be sure , the slimnes s ideal s would b e occasion ally modified i n th e twentiet h centur y — women's breast s an d hip s were variabl e t o a degre e — but o n th e whol e the y no t onl y per sisted bu t intensified . Th e initia l crusad e agains t fat , shapin g u p around 1900 , woul d see m tam e b y late r twentieth-centur y stan dards, but i t set the fundamental culture . Historians hav e known abou t th e tur n awa y from plumpnes s fo r some time , thoug h nonhistorica l commentar y ofte n misse s th e point by confusing th e intensificatio n o f dieting after Worl d War II with th e rea l origin s o f the phenomenon . Th e on e goo d histor y of dieting identifie s th e turn-of-the-centur y change. 1 S o d o severa l studies o f women's fashio n history. 2 S o does the excitin g historica l work on th e nineteenth-centur y origin s o f modern eatin g disorder s (about whic h w e ma y know more tha n w e know abou t change s i n normal eatin g pattern s i n th e sam e period). 3 Researc h o f this sor t not onl y mus t b e acknowledge d bu t als o ca n b e utilize d t o craf t a fuller accoun t o f this quie t shif t i n America n worries . Fo r existin g treatments fall short of a completely adequate account of the transi3

4|

The Turning Point

tion i n severa l respects . Eve n Hille l Schwartz , th e pionee r i n exploring th e America n socia l histor y o f dieting , oddl y slight s th e initial tur n t o slimness i n his haste t o get into th e cras s commercia l exploitations o f th e ne w standard s i n th e late r twentiet h century . The resul t is , first, a n incomplet e gras p o f the rang e o f attack s o n fat tha t bega n t o emerg e aroun d 1900 , no t onl y i n fashio n o r i n specific slimmin g device s bu t i n divers e publi c commen t a s well . A fulle r histor y wil l admittedl y confir m existin g understandin g o f the chronolog y involved , bu t wil l ad d scop e an d significanc e t o what wa s more tha n a cosmetic shift . Secon d an d mor e important , existing account s d o no t reall y explai n th e shift itself . Causatio n i s lightly passe d ove r wit h remark s abou t th e triump h o f the ideal s o f athleticism fo r wome n (whic h i s rathe r a manifestatio n o f th e new trend s tha n a ful l explanation ) o r wit h assumption s abou t commercial manipulations . Finally , becaus e causatio n i s not thor oughly understood , th e dimension s o f the chang e itsel f hav e bee n oddly downplayed . Thi s contributes , i n turn , t o the general neglec t of dietin g b y othe r socia l historian s dealin g wit h dee p cultura l change i n th e earl y twentiet h century , a neglec t tha t ha s limite d the scop e o f otherwis e excitin g findings whil e trivializin g die t his tory itself . The fac t i s tha t th e adven t o f systemati c concer n abou t dietin g was a n importan t chang e i n middle-clas s life , particularl y fo r women bu t acros s th e gende r divid e a s well. Th e paucit y o f socialhistorical treatmen t i s surprising. Tracin g wha t wa s to become suc h an abiding , dail y preoccupatio n o f million s o f America n peopl e adds t o our understandin g o f the changing experienc e o f life i n the twentieth century . Ther e i s ever y reaso n t o explor e thi s phenome non a s par t o f interpretin g significan t socia l change . Further , th e growing attac k o n fa t impose d decisiv e ne w constraint s o n Ameri can lif e i n a perio d when , i n man y respects , increasin g latitud e and informalit y wer e gainin g ground . Ultimatel y th e histor y o f dieting mus t b e brough t int o conjunctio n wit h othe r area s wher e constraint wa s bein g reconsidere d — emotion, sexuality , postur e and dress , propriet y o f language , cleanlines s — for a fulle r pictur e of th e dynamic s o f middle-clas s lif e ove r th e pas t hundre d years . Not surprisingly , th e history o f dieting remind s u s of the nee d t o go

The Turning Point | 5 beyond simpl e generalization s abou t Victoria n rigiditie s yieldin g (for bette r or worse) to tolerant permissiveness an d individuality . I n areas like the body , Americans impose d o n themselve s som e nove l and demandin g strictures . A focused exploratio n o f ho w thi s pro cess go t starte d i s a n essentia l first step . T o b e sure , a n inquir y into dietin g pulls awa y from conventiona l historica l topics , at least initially. Dietin g ha s littl e directl y t o d o wit h politics , bu t afte r William Howar d Taft , slimnes s di d affec t politic s i n th e ne w con straints placed o n the bodily desiderata o f political candidates . New topics i n social histor y often tur n ou t to have broader implications , and amplifyin g th e historica l analysi s o f a widesprea d preoccupa tion, justifiabl e i n term s o f th e pervasivenes s o f th e phenomeno n itself, will suggest a number o f larger insights. This sectio n trace s th e adven t o f what would becom e a durabl e American die t craze, first by recapitulating relevant earlier developments i n th e nineteent h century , bot h thos e tha t foreshadowe d dieting an d thos e tha t th e ne w attac k o n fa t ha d t o counter . Th e range of manifestations ar e charted next , again confirmin g familia r chronology bu t i n mor e systemati c fashion . The n causatio n i s addressed, t o repai r a rea l analytica l void . Fro m thi s th e analysi s can b e extende d t o asses s wha t th e chang e meant . Th e factor s i n the growin g hostilit y t o fa t provid e insigh t beyon d explanation . More than justificatio n fo r a subsequent century of anxious dieting, they entaile d som e necessar y compensatio n fo r othe r develop ments i n America n lif e (beyon d abundan t food ) i n whic h th e worry was perhaps a s essential a s the weight .

Before the Fat Focus Thinness ha s lon g bee n a n availabl e idea l i n Wester n culture . Western societ y produce d n o systemati c encouragemen t o f force feeding, which som e cultures introduce d t o create ideal plumpnes s in brides. Greek wisdom preached moderatio n ( a notion Benjami n Franklin woul d reproduc e i n Poor Richard's Almanac i n urgin g reason ove r appetite) , bu t Christia n revulsio n agains t appetit e wa s even more relevant. Though th e Bible largely ignores fat or equates

6 | The Turning Point it approvingl y wit h prosperit y — the fa t o f th e lan d — there ar e a few disparagin g references . Th e image s o f saint s wer e typicall y slender. Fastin g wa s a virtu e tha t coul d b e carrie d t o extreme s b y aspiring religiou s i n th e Middl e Ages. 4 Th e Purita n versio n o f Protestantism maintaine d this . Th e Englis h Purita n Thoma s Wright i n 163 0 define d th e si n o f gluttons , wh o "think , talk , an d earnestly procur e t o have grea t cheer , daint y dishes ; they ea t mor e than natur e requires ; a t th e tabl e the y wil l hav e th e best ; an d i n fine, the eas y rule t o perceive them , i s to note thei r car e & anxiety to far e daintily , t o feast often , an d therei n t o deligh t much." 5 Th e few historian s wh o hav e tackle d th e subjec t o f dietin g heretofor e have properl y note d tha t i t buil t o n long-standin g belief s an d im ages that associated restrain t i n eating with holiness . Christian-derived concer n abou t th e contro l o f eatin g a s a means o f combating si n help s explai n wh y food woul d b e selecte d as a targe t o f constrain t i n a societ y otherwis e increasingl y indul gent. Norther n Christia n societies , fo r example , ha d establishe d the practic e o f deprivin g childre n o f foo d a s a punishment , lon g before systemati c dietin g o r eatin g restrain t emerge d a s goals . French peasant s use d thi s punishmen t int o th e twentiet h century . Americans certainl y coul d stres s th e plo y i n th e nineteent h cen tury; i n a famou s instance , th e presiden t o f Brow n Universit y (proud o f his ability to avoid physical violence) deprive d a stubborn young so n o f food fo r thirty-si x hour s unti l th e bo y bowed hi s will to hi s father . Man y othe r culture s — including Christia n Hispan ics — view this us e o f food a s a weapon agains t childre n a s appalling. B y th e sam e token , th e privilegin g o f foo d a s a metho d o f control se t a relevant framewor k fo r th e cultur e o f dieting tha t ha s emerged ove r th e pas t century , thoug h th e cultur e b y itsel f i t di d not create this framework. 6 Concern wit h dietin g too k o n ne w dimension s i n th e lat e eigh teenth an d earl y nineteent h centuries . I t was at this poin t tha t th e word "diet " began it s evolution fro m it s initial meanin g i n English , of a regime n specifyin g certai n type s o f food t o remed y illness , to its modern usag e o f losing weight. 7 Romanticis m brough t ideal s of slender, etherea l beauty , thoug h th e sam e Byro n who praise d diet ing als o volubly like d voluptuousnes s i n hi s women . I n th e 1830s ,

The Turning Point | 7 high fashio n i n Ne w Yor k briefl y stresse d a willow y look , wit h a hint o f frailty , a s standard s o f appearanc e bega n t o b e mor e im portant fo r respectabl e women . Harrie t Beeche r Stow e raile d against th e slendernes s imager y o f Godey's Lady's Book, th e first popular woman' s magazine , bemoanin g th e hostilit y t o "opulenc e of physica l proportions." 8 Som e wome n bega n accordingl y t o ea t more sparingl y o r t o corse t themselves , an d a n idea l o f a slende r waist (thoug h wit h greate r roundnes s abov e an d below ) persiste d for youn g women . Unprecedente d report s an d apparentl y a risin g incidence o f anorexi a nervos a soo n afte r th e mid-nineteent h cen tury suggest s tha t thinnes s wa s gainin g enoug h ne w attentio n t o motivate a durabl e for m o f femal e deviance , thoug h i t wa s th e process o f eating , no t bod y shape , tha t ensnare d anorexic s a t thi s point.9 Fashio n change s i n th e late r 1850s , thoug h short-lived , emphasized mor e natura l clothin g fo r wome n wit h fewe r artificia l restraints, whic h coul d combin e wit h earlie r hope s fo r thin-waist edness t o creat e ne w interes t i n lightness. Insistenc e o n secludin g pregnant wome n i n th e interest s o f respectability, thoug h inspire d not b y foo d concern s bu t b y Victorian sexuality , migh t als o hav e promoted a quest for slenderness particularly among women. Mor e intense etiquett e standard s focuse d heavil y o n eatin g habit s i n th e middle an d uppe r classes , emphasizin g prope r implement s alon g with avoidin g slurpin g an d gorging , ye t anothe r se t o f constraint s that applied t o food. 10 During th e mid-nineteent h centur y also , ne w nutritio n crusad ers bega n t o wi n publi c attention . Growin g concer n abou t th e body an d wha t wen t int o i t paralleled th e growt h o f new form s o f food processin g and a new if nervous commitment to a commercial market economy. At least in England, this derived from eighteenth century medica l concer n abou t th e effect s o f overeatin g o n th e liver an d kidneys ; her e to o diagnose s linke d disease s t o th e mor e general increas e i n th e consumptio n o f goods. Fo r the nineteenth century Unite d States , Stephe n Nissenbau m ha s show n ho w cru saders lik e Sylveste r Graha m urge d pur e food , includin g avoidin g fats an d commercia l bake d goods , i n a combinatio n o f healt h faddism an d mora l revulsio n agains t th e excesse s o f a market soci ety. Thi s linkag e wa s crucia l i n th e late r developmen t o f moder n

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The Turning Point

dieting standards. Graham pushe d vegetarianis m alon g with sexua l restraint i n a crusad e agains t overstimulation . Warning s agains t gluttony accompanie d thi s message , thoug h the y wer e no t th e central point . Graham' s messag e o f simple foods, temperance, an d chastity wa s widely disseminate d i n th e 1840s , winning man y con verts, particularly amon g young , urba n men . Othe r popula r fad s picked u p a t leas t par t o f th e sam e message . Wate r cures , widel y followed b y wealth y women , adde d attentio n t o carefu l an d re strained nutrition , though agai n more in terms of the types of foods selected tha n throug h an y particular focu s o n weight. 11 Clearly, a substantial preceden t existe d fo r a crusade agains t fat , which help s explai n th e ne w movemen t tha t develope d b y th e 1890s. But it is crucial t o remember tha t this precedent i n no sense created moder n dieting . Specifi c dietin g effort s wer e no t reporte d in th e Unite d States , a fe w brie f flurries i n th e 1830 s aside . Th e word itself continued t o refer t o a general nutritiona l regimen , only adding th e weigh t los s interes t ver y gradually . Thi s i s wh y fa d terms — like th e Englis h impor t "bantingism " o r th e American "fletcherism" — remained usefu l unti l abou t 1910 , whe n die t a s verb an d nou n gaine d it s specifi c moder n meaning . Religiousl y inspired fastin g seem s t o hav e decline d markedl y i n th e Unite d States (an d England ) durin g th e nineteent h century , a shif t o f particular significanc e fo r women. Ne w reports of anorexia nervos a may indee d hav e reflecte d th e declin e o f thi s mor e traditiona l outlet fo r certai n personalit y types . Fo r middle-clas s American s generally, interes t i n pur e nutritio n vastl y exceede d an y specifi c concern abou t weight control. Most important , plumpnes s remaine d quit e fashionable , partic ularly after th e 1830s. Western art had lon g touted ful l figures — the work of Rubens i s the most famous cas e in point — and nineteenth century ar t o n th e whol e maintaine d thi s traditio n o f beauty. Ma ture wome n wer e suppose d t o b e fat . Elizabet h Cad y Stanto n wa s praised fo r her rotun d feature s — "plump a s a partridge" — because they wer e linke d t o successfu l motherhood. 12 Weigh t wa s see n a s natural afte r frequen t pregnancie s durin g whic h wome n wer e urged t o eat heartily. Leannes s migh t be a virtue i n the young, bu t it was a positive vice in the mature. Susa n B. Anthony, accordingly,

The Turning Point | 9 was criticize d fo r he r gauntness . Wome n o n stag e wer e suppose d to b e voluptuous , an d i f the y use d corsets , i t wa s t o accen t thei r roundness. Betwee n th e 1860 s an d th e 1880s , rotundit y gaine d ground fo r me n a s well a s women. Europea n dres s style s empha sized th e "semblanc e o f embonpoint/ ' a s a Britis h observe r note d among wome n i n Bosto n i n 1859 . Portrait painter s stresse d buxo m qualities. Doctor s urge d th e importanc e o f soli d weigh t i n thei r growing campaign agains t nervousness. 13 S . Weir Mitchell demon strated ho w skinn y form s correlate d wit h discontented , nervou s personalities. Actresse s a t al l level s o f th e stag e illustrate d an d promoted fashionabl e plumpness , addin g bustle s t o a corsetin g designed t o stres s ampl e bosom s an d derrieres . Costume , indeed , intended rathe r to rearrange fa t than minimiz e it , while newspape r advertisements feature d nostrum s designe d t o hel p weigh t gai n long befor e thei r column s opene d u p t o die t products . A decen t belly o n a ma n denote d prosperit y an d sensibl e goo d health . A s Mitchell noted , " A fa t ban k accoun t tend s t o mak e a fa t man" ; "[p]lumpness, roundness , siz e . . . are rightl y believe d t o indicat e well-balanced health." 14 When eve n John L . Sulliva n got stout, h e could stil l b e hel d u p a s a symbo l o f masculin e strengt h an d implicit sexuality , i n contras t t o skinny , effet e dandies . " A littl e paunch abov e th e bel t wa s somethin g t o b e prou d of." 15 Eve n a s some interes t i n dietin g emerge d i n Europ e ami d medica l advic e concerning moderation , American s persiste d i n maintainin g thei r full-figure standard s throug h th e 1880 s an d beyond . Th e Britis h Lillie Langtry , fo r example , wa s faulte d fo r lackin g "roundnes s o f limb" becaus e o f to o muc h exercise . A s on e fashionabl e woma n later note d o f th e er a (usin g a ter m tha t onl y late r entere d th e popular vocabulary) , "N o on e counte d calories." 16 Tourin g Euro pean actresse s wh o ha d begu n t o contro l thei r weigh t throug h dieting wer e greete d wit h som e aestheti c skepticism . Individua l Americans ma y hav e dieted , bu t ther e wa s n o publicit y an d n o general cultura l support . Interes t i n exercis e di d begi n t o increas e for bot h me n an d women , bu t i t wa s no t initiall y associate d wit h slenderness.17 Dominant America n foo d habit s certainl y supporte d th e aes thetic an d medica l approva l o f corpulence. We return t o American

io I The Turning Point food tradition s mor e full y late r a s part of a more elaborat e analysis , but certai n nineteenth-centur y patterns can b e quickly established . Everyone who commented o n American eatin g during the centur y noted it s abundance. American foods , from strawberrie s to salmon, were bigger than thei r Europea n counterparts , and th e sheer quan tity of offerings followe d suit . This was a land o f plenty, an d meal s demonstrated thi s directly, while Americans may have gained som e cultural stak e i n usin g foo d t o prov e thei r national , a s wel l a s personal, material success . Upper-class meals (like those i n Britain , but unlike the French ) featured a n amazing array of heavy courses, a pattern tha t extende d int o the twentiet h century . Cookbook s an d women's magazine s emphasize d bake d good s wit h vas t quantitie s of dough. Eve n th e fastidious Ralp h Waldo Emerso n corresponde d on the issue of eating pie, ultimately concluding that the pastry was fine i f consumed fo r breakfast , a s a preparation fo r th e exertion s of the day . Godey's began a regula r cake s featur e i n th e 1870 s tha t seems i n retrospec t absolutel y overwhelming . Apparently , wome n best demonstrated cookin g prowess through thi s sweet, high-caloric offering. A singl e issu e o f thi s popula r magazin e migh t contai n recipes fo r ric e cake , sponge cake , Dunde e cake , and Scotc h mar malade cake , or butter pudding, Alderley pudding, ginger pudding , German fritters , Sall y Lunn , sod a scones , carame l custards , appl e souffle, an d Italia n ric e pudding . Th e lis t seeme d endless . Americans were also known fo r thei r rapi d eating , as if maximal stuffing , not savorin g quality , wer e th e principa l goal . Actual eatin g habit s and recommende d standard s ampl y supporte d th e approva l o f a certain girt h i n bot h mal e an d femal e bodies ; i t would hav e bee n difficult t o maintain a really ethereal ideal. 18 In sum , importan t change s ha d t o occur t o generate th e kind of concern wit h weigh t contro l an d reductio n tha t starte d t o appea r only in the 1890s. The concer n no t only reversed a generation-long plumpness fad . I t di d s o wit h extraordinar y durabilit y an d wit h a crusading zea l tha t woul d ultimatel y mar k i t a s fa r mor e tha n surface fashion . Signs o f change bega n t o emerg e fro m severa l direction s i n th e 1890s a s th e Unite d States , afte r havin g clun g t o it s custom s o f plenty an d th e corpora l results , turne d t o a concer n abou t fa t a

The Turning Point | 1 1 decade o r so after a new sense o f style had emerge d i n Franc e an d other part s o f Western Europe . John L . Sullivan' s unexpecte d box ing defea t i n 1892 , at th e hand s o f a muc h trimme r "Gentlema n Jim" Corbett , triggere d widesprea d comment s abou t th e impor tance of slim efficiency ove r the kind o f ill-discipline that a paunch suggested — an importan t reminde r tha t th e emergenc e o f a ne w hostility to fat was not directly solely at women. Overall, th e revisio n o f bod y imager y an d th e growin g disgus t directed agains t corpulence wer e concentrated i n three sites where the moder n America n interes t i n dietin g first developed consisten t expression: shift s i n fashio n fo r wome n an d me n alike , a hos t o f new fat-contro l devices , an d th e ris e o f publi c commen t o n fat . There was no carefully orchestrate d genera l strategy and, as we will see, n o dominan t hortator y expertise ; rather , thes e followe d th e new publi c passion , thoug h the y woul d late r sustai n an d mor e fully shap e this passion.

Fashion Conflicting signal s emerge d fro m th e worl d o f fashion a s the con cern about fat began to emerge in the 1890s, which i s not surprising given it s previous deligh t i n plumpness . Upper-clas s wome n wer e still tryin g t o pa d thei r clothe s i n 189 5 t o loo k mor e substantia l than the y were. Lillian Russell , a leading stag e figure, maintaine d the association betwee n heft an d beauty well past 1900; as Clarence Day noted , "Ther e wa s nothin g wraithlik e abou t Lillian Russell/ ' But a Britis h die t boo k initiall y writte n i n 186 3 began t o acquir e new popularity , goin g throug h twelv e edition s b y 1902 . Willia m Banting describe d hi s battle agains t obesity , i n whic h limitin g starches an d sugar s allowe d hi m t o dro p thirty-fiv e pounds . I t was the popularity of his emphasis on nutrition alon g with exercis e that caused dietin g to be called "bantering " or "bantingism" fo r a short time. Britis h influenc e als o emerge d throug h th e popularit y o f fashionably slende r aristocrat s an d theate r stars . On th e eas t coast , portraits o f wome n b y Sargen t stresse d "pliant , willow y grace " a s early as the 1870s. 19

12 | The Turning Point By 1900, with som e recurren t exception s fo r voluptuousnes s i n theatrical women , the imag e of slenderness ha d largely triumphed . The ongoin g impac t o f athleticis m fo r women , a ne w concer n about the sexualit y of theatrical wome n (an d thei r voluptuousness ) related t o th e widel y publicize d antipornograph y crusade s o f Anthony Comstock , an d ne w medica l idea s tha t contradicte d th e association of moderate fat with good health all seemed to combine to produce a new fashion trend . Calisthenic s group s spread amon g New York' s fashionabl e uppe r class , an d thes e wer e enhance d i n the 1890 s b y th e ne w bicycl e craze . Shirt-wais t blouse s similarl y emphasized natural , moderate curves . Audiences began t o laugh a t hefty choru s girls , whic h increase d interes t i n slendernes s amon g trend setters . The extremel y thi n Sara h Bernhardt , hel d t o be ugly in he r firs t America n visit , wa s haile d fo r he r beaut y i n 1900 . Shortly thereafte r Georg e Ad e wrot e hi s popula r musica l comed y The Slim Princess fo r Elsi e James, celebrating th e en d o f the beef y Amazonian showgirl . B y 189 9 the Denver Post reported tha t Ne w York societ y leader s ha d discovere d tha t th e secre t o f youth la y i n watching one's diet. Pornographic imager y shifted i n precisely the same directions as high fashion . I n th e mid-nineteent h century , wome n i n porno graphic storie s an d picture s coul d com e i n al l shape s — fat, saggy , lean, bouncy and so on. But by the 1890s, along with other change s in pornography includin g a new preference fo r Anglo-Saxons, slenderness predominated . "Wha t perfectio n o f form ; firm bust ; tin y waist; swellin g hips ; massiv e spherica l posteriors ; we e fee t an d hands." "Lucia was just a little above the middle height for girls . . . she was full [i n her bosom ] withou t being too plump. . . . She ha d a wais t naturall y small. " Moderatio n i n figur e becam e a strikingl y uniform requirement , wit h flexibility only for the buttocks. 20 The mainstrea m image , of course, was most important. Betwee n 1895 an d 1914 , Life magazin e an d othe r outlet s feature d th e sketches o f th e Gibso n Girl , wh o becam e a symbo l o f th e newl y fashionable body . Conceived b y Charles Davis Gibson, the Gibso n girl wa s tall , wit h lon g arm s an d leg s an d a definit e ai r o f athleticism. He r boso m an d hip s remaine d noticeable , bu t sh e wa s a distinctly thinne r figure overal l tha n an y widely publicized femal e image i n th e Unite d State s sinc e th e 1830s , and th e durabl e popu -

The Turning Point | 1 3 larity of the sketch serie s literally knew no prior precedent. Slende r women wer e in vogue to stay. 21 A crucial locu s of the new concern abou t fat in women's fashio n involved th e corset . Fro m th e 1870 s onward, a new aestheti c fash ion ha d attacke d th e wearin g o f corsets i n favo r o f a more natura l look. Feminist s als o belabore d th e constraint s o f corsets . Dresses , however, remaine d quit e loose , s o the resul t di d no t requir e slim ness; further, th e ne w style was not initiall y widely popular beyon d the most fashionable uppe r class. By the 1890s, however, the uncor seted bod y becam e increasingl y stylis h amon g middle-clas s women, alon g wit h somewha t tighte r clothin g tha t no w encour aged greate r slenderness . Actua l corsetles s dresse s arrive d onl y i n 1908, fro m a Frenc h designer , an d th e debat e ove r foundatio n garments continued int o the 1920s, with a lingerie makers' counter attack abou t the evil s of corsetlessness i n 1921 . (New invocation s of slenderness coul d requir e mor e rathe r tha n les s corseting , a s was indeed th e cas e for some time.) At the high fashio n level , however, the battle was essentially over by 1914. By this point magazines lik e Vogue had conceded , somewha t reluctantly , tha t "th e mod e o f the corsetless figure i s a n establishe d one, " whil e a late r articl e la mented moder n woman' s "absurd willingnes s to support her figure without externa l aid/ 7 More subtl y tha n th e grea t corse t controversy , growin g utiliza tion o f standardized dres s sizes for ready-to-wea r women' s clothin g may hav e encourage d greate r attentio n t o slenderness . Ready-to wear clothe s ha d advance d i n th e middle-clas s marke t i n th e United State s sinc e th e 1870s , but the y wer e lon g ill-fitting . Afte r 1900 sizing improved . Thi s automaticall y dre w greater attentio n t o oddly shaped bodies. Standardization wa s not inherently supportiv e of thinness , bu t i n a contex t i n whic h fa t wa s bein g attacke d fo r other reasons , th e adven t o f dres s size s (an d th e somewha t publi c store settings i n whic h dresse s were trie d on ) undoubtedl y encour aged weigh t consciousness . Thi s pressur e continue d throughou t the first half of the century , with extrem e size s increasingly hard t o find. Middle-clas s men , wh o accepte d ready-to-wea r clothin g late r and use d tailor s fo r suit s throug h th e 1930s , would fac e a simila r situation i n the ready-to-wear marke t by the 1950s. 22 The ris e o f the ne w fashio n standard , includin g it s initial tenta -

14 | The Turning Point tiveness, showe d clearl y i n th e leadin g periodica l addresse d t o women aroun d th e tur n o f the century , the Ladies Homes Journal Predictably, th e first year s o f th e magazin e i n th e 1880s , thoug h heavily focuse d o n issue s o f style , reflecte d n o concer n abou t weight problems . Corse t advertisement s migh t sugges t som e inter est, a t leas t abou t allocatin g fa t attractively ; bu t eve n i n explici t articles suc h a s a "Lette r t o Homel y Girls, " weigh t issue s di d no t surface. A n inquir y abou t weigh t appeare d i n a catchal l advic e column i n 1891 : "Fanny M. " wa s tol d tha t th e plaines t foo d wa s usually th e mos t damaging ; wate r an d brea d wer e bot h hel d t o be fattening, "particularl y water" ; potatoe s an d al l starch y vegetable s should b e avoided , bu t mea t wa s fine — clearly, som e o f th e ne w nutritional advice , such as Banting's, was circulating — exercise was vital and , i n a them e tha t wa s t o b e a fundamenta l par t o f th e looming crusade , "jus t remembe r tha t lazines s an d fa t g o hand i n hand."23 Bu t thi s initia l column , thoug h interestin g i n reflectin g reader concer n an d a fe w importan t beliefs , di d no t heral d a n imminent crusade . Mos t fashio n discussio n i n th e Journal's page s focused o n quit e differen t issues , suc h a s dres s length s o r ski n conditions. Attentio n t o overl y thi n wome n persisted ; wit h th e ongoing concern abou t excessive nervousness and frailty, to o muc h activity an d to o littl e slee p demande d a fattenin g diet , fo r i n it s absence "goo d tissue s canno t b e buil t up. " The Journal continued to respon d t o letter s fro m "thi n girls " int o th e twentiet h century , sometimes implyin g tha t girldo m wa s abou t equall y divide d be tween th e too skinny and th e to o fat, with dissatisfactio n wit h one' s shape the only common quality . Nevertheless, in keeping with the larger fashion trends , the pace and detai l o f commen t abou t overweigh t bega n t o ste p u p fro m 1895 onward . A column calle d "Side-Talk s wit h Girls " responded to letter s fro m subscriber s abou t fa t o n a regula r basis . I n 1896 , "Phyllis an d others " wer e urge d t o exercis e an d t o avoi d nap s during th e da y while avoidin g starches, sweets and coffee ; th e goal was "t o reduc e th e flesh, t o whic h yo u object. " I n 189 7 "F . A. B. and others " learne d tha t "extrem e plumpness " coul d b e defeate d by exercise and "courage. " European royalt y was cited for example s of peopl e wh o bega n t o exercis e regularl y whe n stoutnes s threat -

The Turning Point | 1 5 ened. "Constan t wor k wil l . . . d o mor e t o reduc e you r flesh tha n anything else, " though, again , sweet s shoul d b e shunned . "Pu t i n plain word s tha t mean s i f wome n wer e les s laz y the y woul d no t grow s o stout. " A n 189 8 column , mor e diet-focused , suggeste d simply skippin g a mea l daily ; lea n mea t an d grape s wer e recom mended, bu t orange s an d lemon s shoul d no t accompan y a mea t diet. B y 1901 , the Journal periodically carrie d explici t die t advice , though stil l ofte n i n respons e t o reade r letters . Mrs . Rope r i n 1901 again urge d lea n meat , thi s tim e alon g wit h coffe e sippe d slowly , with exercis e i n addition . A regula r colum n o n goo d healt h fo r girls, a subcategory o f the "Prett y Gir l Papers " authored b y Emm a Walker, ofte n talke d abou t ho w t o "los e flesh." A specific lette r i n 1904 asked abou t honey , which wa s rated wholesom e bu t fattenin g when eate n wit h bread , "consequentl y i f yo u ar e ver y stou t yo u should no t ea t it. " Mrs . Walke r eve n mor e summaril y dismisse d candy, "Fo r an y gir l wh o desire s t o retai n a slende r an d gracefu l figure, this i s one o f the first articles o f die t tha t mus t b e cu t off. " Plain ol d housewor k wa s toute d a s excellen t exercis e "fo r th e gir l who is too fat"; lazines s and fa t were again boo n companions , with prosperity n o excuse . Severa l piece s i n 190 5 attacked starche s an d sweets, thoug h wit h concer n fo r digestibilit y a s wel l a s fattiness . "Every fa t gir l who m I kno w i s overfon d o f sweet s an d dainties. " While exercis e remained a staple suggestion, dietitians' recommen dations an d th e ple a t o recogniz e th e shee r amoun t consumed , particularly betwee n meals , gaine d ground . An d th e warning s about fa t intensified , addin g healt h t o beaut y considerations . "Ev ery pound o f fa t tha t i s no t neede d fo r som e purpos e i s a burde n and shoul d b e dispose d o f as soon a s possible." Fat women walke d awkwardly (" I be g o f yo u t o avoi d this" ) bu t als o harme d thei r circulation an d digestiv e systems . Parents , finally, bega n t o b e urged t o contro l thei r children' s eating , particularl y i n th e sweet s category, t o hel p battle th e American proble m o f overeating . " Three squar e meal s a day 7 belong, I presume, to the dieteti c sin s of Americans; i n larg e citie s I se e th e ill-fe d eatin g fou r meal s a day — quite sufficien t fo r a man unde r heav y labor — and thes e ar e mostly indolen t people. " Comment s o f thi s sor t mad e i t clear : a historic cycl e of overindulgence mus t be redressed. 24

i6 | The Turning Point By thi s point , clearly , a n essentiall y moder n approac h t o diet , health, an d beaut y ha d bee n reached . Weigh t contro l wa s vita l except fo r thos e naturall y thin . Dieter s wer e eve n advise d t o plac e themselves unde r thei r physicians ' care . T o b e sure , a n accompa nying, if no longer equal , attention give n t o excessive thinness an d a lingerin g sens e tha t plumpnes s an d goo d humo r wer e paire d marked a transitiona l period . A fe w article s als o conclude d tha t slenderness migh t b e "constitutional, " wit h littl e t o b e done ; th e argument als o occasionall y applie d t o "obesity, " thoug h her e th e common judgmen t insiste d o n it s "curability. " An d th e standard s for a fashionabl e for m wer e somewha t lenient . Describin g a "per fect woman" in a n 189 9 Ladies Home Journal article, Mr. and Mrs . Waxman note d th e nee d t o avoi d angularit y bu t als o th e impor tance o f weigh t i n proportio n t o height . Th e "perfectl y formed " woman wa s betwee n five fee t thre e inche s an d five fee t seven , weighing between 12 5 and 14 0 pounds. Bust should b e twenty-eigh t to thirty-six inches, but hips about six to ten inche s mor e than this , with a waist betwee n twenty-tw o an d twenty-eigh t inche s — hardly the figure demands o f a few decades hence. Most important, whil e the Journal was beginning t o discuss dietin g issue s regularly, i t was not featurin g the m a s a primar y promotiona l lure . Readers , mor e than author s an d editors , seemed t o be callin g fo r attentio n t o th e problems o f fat. Th e slick , commercialize d fa d die t approac h tha t would late r become a staple of women's magazin e sales , was barely on th e horizon , a t least i n th e Ladies Home Journal, whic h pride d itself on som e self-restraint i n advertising. 25 While dietin g concern s emerge d a s a growin g featur e o f wom en's fashions, th e sam e development , thoug h differentl y packaged , began t o occu r o n th e men' s side , a s th e 189 2 critique o f John L . Sullivan's lac k o f self-control ha d alread y suggested . Gende r issue s in th e wa r agains t weigh t wer e t o b e vitall y important , an d the y existed i n the earl y skirmishes aroun d 190 0 without question . Me n may hav e pai d les s attentio n t o die t concerns , an d the y certainl y were not called upo n t o be slender. Bu t a new men's fashion arose , too, as implacably hostil e t o fat i n principle a s the growin g appeal s to femal e restrain t i n eating . Thoug h som e fashio n historie s hav e implied tha t wome n alon e wer e squeeze d b y th e ne w attack s o n fat, i f only because the y alone ha d t o preen fo r courtshi p an d wer e

The Turning Point | 1 7 somehow distinctivel y vulnerable t o manipulation b y mode, men' s standards were thoroughly involve d a s well. The timin g was identical, the us e of shame an d ridicul e a t least as great. The focu s for men centere d o n muscle development rathe r tha n appetite control . It was in the 1890 s that Bernarr Macfadde n bega n to give one-man bodybuildin g shows . Once sickly , Macfadden ha d combined exercis e an d carefu l eatin g int o persona l physica l suc cess an d t o a lifelon g caree r o f rol e modeling . Macfadde n too k over th e exercis e magazin e Physical Culture i n 1899 , boostin g its subscriptio n t o 150,00 0 b y 1906 . Persona l problem s obscure d Macfadden's reputatio n fo r a time , bu t th e magazin e underwen t renewed expansio n i n the 1920s . It appealed particularl y to middleclass me n an d preache d a n arden t messag e centere d aroun d ne w physical standards . Artificia l gimmick s lik e corsetr y wer e attacke d in favo r o f an impassione d focu s o n contro l o f gluttony an d vigor ous exercise . Advertisement s stresse d well-muscle d men , nearl y nude, with large but fat-free bodies . The middle-age d wer e particu larly targeted, with slogans that made i t clear that fat lay at the cor e of unnecessar y aging : "earl y ol d ag e show s a t th e waistline" ; "on e must bu y a ne w youth-givin g belt. " The ne w heroes , successfu l a t work an d demon s wit h th e ladies , wer e th e antithesi s o f "fa t an d bald." Eve n earlie r masculinit y adept s wer e no t exemp t fro m ne w scrutiny. When Theodor e Roosevel t died i n 1919 at the age of sixtytwo, Physical Culture mercilessl y inquired , "Di d Mr . Roosevelt' s extra, weight i n an y wa y lesse n th e lengt h o f hi s life? " Workou t instructions ha d title s suc h a s "The Regeneratio n o f a 'Big Slob / " with campaign s agains t th e "fa t look " an d "youn g hippos. " I n no t only Macfadden's magazine s but others that featured mal e models, male appearanc e gaine d ne w attention an d a good build, centere d around contro l o f weight , becam e centra l t o men' s fashio n stan dards.26

Devices and Gimmicks Along wit h change s i n fashio n an d th e unprecedente d attentio n to exercise , th e growin g interes t i n weigh t contro l showe d i n a n impressive scatterin g o f commercial products , which coul d i n tur n

18 | The Turning Point disseminate th e standard s stil l more widely. Devices to reshape th e body wer e no t novel , o f course . Corset s ha d lon g bee n use d t o accentuate femal e bosom s i n relatio n t o wais t size . Nevertheless , an explici t lin e o f product s directe d towar d slimme r appearanc e showed u p onl y afte r th e slendernes s fashion s ha d alread y gaine d ground. Reasonably precis e chronology , a historian's nicety , i s important to hel p se t th e stag e fo r explanation . Th e fe w existin g historie s o f dieting rel y heavily on th e ide a o f commercial exploitatio n drivin g otherwise intelligen t American s int o frenzie d purchasin g i n th e vain hop e o f sheddin g pounds . W e mus t retur n t o thi s approac h more systematicall y whe n w e tak e u p causation . Th e approac h i s not entirel y wrong, to be sure , but i t applies muc h mor e clearl y to explaining wh y die t campaign s persiste d an d intensifie d i n th e 1920s an d particularly afte r Worl d Wa r I I tha n t o accountin g fo r the onse t o f new objection s t o fat . T o be sure , certai n device s lik e corsets ma y hav e bee n widel y use d fo r artificia l slimnes s eve n before commercia l exploitatio n turne d i n thi s direction ; Macfad den's diatribe s agains t me n wh o relied o n corset s suggest s som e closet battle s agains t fa t befor e commercia l announcement s sur faced. Nevertheless , commercia l effort s di d appear ; the y di d illus trate an d intensif y th e antifa t campaign , spreadin g i t t o sector s beneath th e high-fashio n uppe r class ; an d the y ca n b e roughl y pinpointed i n time. Advertisements fo r product s tha t woul d hel p agains t weigh t be gan t o spread abou t a decade afte r fashio n dictate s ha d suggeste d a new concern . Commerc e i n thi s are a seem s t o hav e imitate d lif e at first, rather tha n th e othe r wa y around . Th e normall y cautiou s Ladies Home Journal carried periodi c notice s — not jus t advertise ments bu t column s — touting a fe w product s a s earl y a s 1900 . "Obesity i s Curable withou t inquir y o r dieting , o r muc h expense, " hailed Mrs . Warren. The magic ? Drink a glass of Kissiengen wate r half a n hou r afte r eac h meal , and the n th e nex t day a similar glass of Vich y water . Th e tw o water s balance d aci d an d alkalin e an d acted directl y o n th e fat , allowin g a los s o f tw o pound s pe r week . Tablets coul d replac e th e water s i f thes e wer e unavailable . Mrs . Warren note d tha t thousand s o f reader s shoul d hai l thi s formul a

The Turning Point | 1 9 "with delight/ ' whic h "ha s bee n thoroughl y teste d an d it s efficac y proved." Along with recurrent corset ads, the Journal also carried notices fo r die t pamphlet s b y 1913 . Susann a Cocroft , o f Chicago , claimed t o hav e helpe d 60,00 0 o f th e "mos t refined , intellectua l women o f America" t o weigh exactl y what they should weigh , a t a cost of only a few minutes a day. She announced, "I have had a wonderful experienc e and I should like to tell you about it." The accompanying pictur e showe d a well-proportione d middle-age d woma n who ma y wel l hav e fough t throug h som e weigh t i n he r time . O f course, Bernarr Macfadden pushe d weight-control sessions as part of his lecture series, and after 1900 a number of physical culture parlors began t o open i n majo r America n citie s like New York, directed a t clerks and other sedentary, middle-class men. 27 But th e mos t interestin g commercia l surg e denotin g th e bur geoning die t craze showe d u p i n dail y newspapers, where advertis ing restrictions were lenien t an d wher e th e taste s of a fairly divers e reading publi c migh t b e mirrored . Th e Pittsburgh Press, a widel y sold mass/middle-clas s pape r i n on e o f America's te n larges t cities, carried literall y no explicit diet-related ad s from it s inception i n th e 1870s unti l afte r 1900 . At this point , however , a mino r advertisin g flurry too k shape . Th e produc t calle d Rengo , fo r example , first surfaced i n 1908 . Its advertisement s note d ho w humiliatin g bein g overweight coul d prov e a t th e hand s o f others ; i t urge d reader s t o use Rengo "now" — "don't wait until you ar e a disgusting fright." A single mont h i n 191 0 saw relevan t notice s almos t ever y othe r day . (Interestingly, th e Reng o compan y als o mad e "reducin g corsets, " apparently hopin g t o cas h i n o n th e slendernes s craz e fro m al l directions.) Rengo , whic h on e migh t purchas e b y mai l o r fro m druggists, wa s directe d towar d wome n an d promise d a weight los s of a pound a day: "Yo u ea t i t like frui t o r cand y an d easil y reduc e your fa t a poun d a day. " Tw o day s later , nea r a corse t a d (L a Grecque Belt ) that promised t o "cure to o prominent abdome n an d hips," whil e warnin g agains t th e "paten t medicin e talk " o f som e corset advertisers , a column-lik e notic e wa s headline d "N o Nee d to b e Fat : Ho w t o Reduc e Fles h Easil y i n Natura l Wa y withou t Drugs." Th e vendo r claime d t o hav e battle d a growin g doubl e chin, enlarging hips, and bust for years. She had tried man y things,

20 | The Turning Point including expensiv e rubbe r garments , t o n o avail . Bu t the n sh e had foun d a "simple , Harmles s metho d tha t quickl y too k of f th e superfluous flesh without leaving any wrinkles o r flabbiness." For a mere te n cents , sh e wa s willin g t o sen d a bo x o f he r remarkabl e discovery, no t otherwis e described , t o anyon e wh o i s "fat, 'sloppy / and overweight. " T o b e sure , tw o column s awa y anothe r magica l product was touted fo r women wh o were too thin an d ru n dow n — again, thi s was a transitional period , i n whic h traditiona l concern s about undernutritio n stil l figured strongly . Bu t th e wa r agains t fa t was gainin g th e uppe r hand . Th e nex t da y (Marc h 6 , 1910) , a notice o n th e editoria l pag e rea d "Fa t i s dangerous. I t i s unsightly, uncomfortable, spoil s th e figure, causin g wrinkles , flabbiness an d loss of vigor. Let me send you m y Proof Treatment absolutel y Free ; you ca n safel y reduc e you r fa t a pound a day." This advertisemen t included befor e an d after photograph s along with testimonials fro m satisfied customers . Another pitch i n the same paper, entitled "Cul tivating Slimness, " urge d tha t "exercisin g o r dietin g ar e to o slow " and Mamol a Prescriptio n Tablet s woul d d o th e tric k a lo t mor e easily.28 A host o f product s an d medi a bega n t o for m th e profit-seekin g caravan afte r 1900 . Lillia n Russel l wa s grantin g newspape r inter views o n diet s b y 1909 , talkin g abou t ho w sh e di d 25 0 roll-over s each mornin g i n a frankl y standof f battl e agains t weight . Thi s presaged th e serie s o f sta r die t advic e t o com e i n subsequen t decades. Chittende n pill s wer e widel y advertised , capitalizin g o n the fam e o f a Yale scientist who studie d calorie s an d urge d weigh t control. Healt h Vibrator s hi t th e marke t i n 1906 . Reducing salon s opened b y 191 4 (i n Chicago ) complet e wit h eve n mor e widel y touted equipmen t (Gardne r Reducin g Machines ) t o trim bod y fat . Public scale s bega n t o sprea d fro m 189 1 onward an d wer e widel y used, thoug h th e publi c recordin g wa s embarrassing ; scale s fo r private homes first hit the marke t i n 1913. 29 And so the grea t commercial sho w had begun . Commercialize d medicine o r pseudomedicine ha d bee n par t o f the ris e o f consum erism i n bot h Europ e an d th e Unite d State s goin g bac k t o th e eighteenth century . Wha t wa s nove l wa s it s applicatio n t o th e fat control issue , wher e it s establishe d technique s o f fantasti c claim s

The Turning Point | 2 1 and sincer e testimonial s wer e no w directe d t o wha t wa s clearl y a growing publi c anxiety . Here , a s wit h fashion , a tren d wa s launched tha t woul d simpl y buil d momentu m i n succeedin g de cades.

In the Mind: New Perceptions of Fat More interestin g than fashio n o r commercialization o f weight control i s th e growin g belie f tha t fa t wa s bad , a s reporte d i n casua l conversation. Evidenc e fo r a ne w se t o f perception s i s inherentl y scattered, bu t i t accumulates fro m th e 1890 s onward an d i n man y ways seem s t o predat e a ful l commitmen t t o ne w fashion s an d certainly th e publi c opennes s t o commercia l appeals . Idea s ma y have preconditioned style s and advertising , though th e decada l la g in advertising may also reflect th e time taken t o see ideas penetrat e the lowe r reache s o f th e urba n middl e clas s fro m thei r possibl y upper-class progenitors . What wa s happening wa s the creatio n o f a new, quickl y powerfu l stigma , reachin g deepl y int o self-imag e an d reactions t o others alike. Vocabulary bega n t o sugges t ne w concern s abou t fa t b y the las t two decades o f the nineteent h century . "Porky " had, i n fact , com e into use in the 1860s, "butterball" by 1879, "jumbo" in 1880. "Slob," interesting becaus e o f it s particula r applicabilit y t o overweigh t men, mad e it s entr y int o th e Englis h languag e i n th e 1860s , transposing a n Iris h wor d fo r a certain kin d o f gooey mud. Bu t th e word ha d it s debut i n Britai n (wher e a lord mayo r o f London wa s described a s a "fa t slob") , becomin g significantl y use d i n th e United State s onl y durin g th e 1880s . Again, Europea n interes t i n weight contro l precede d American . B y 191 0 th e wor d bega n t o appear i n United State s popular fiction, as in the phrase "yo u great fat slob " i n th e nove l Varmint. Usag e wa s pickin g u p steadil y b y this poin t an d woul d continu e int o th e 1930 s a s "slob " entere d normal vocabular y in the Unite d States . Bernarr Macfadden wa s of course usin g "slob " a s a n epithe t i n hi s bodybuildin g material s before Worl d Wa r I . Th e nee d fo r additiona l word s t o identif y and reprov e fa t thu s date s bac k befor e th e clea r incorporatio n o f

22 | The Turning Point slenderness int o fashion, suggestin g a popular antipath y fo r fat tha t cannot simpl y b e explaine d b y styl e o r commercia l manipula tions.30 Words were soon supplemented b y more elaborate articulations . From Living Age i n 1914 : "Fat i s now regarde d a s a n indiscretion , and almos t a s a crime. " Fro m th e Philadelphia Cook Book, au thored first aroun d 190 0 an d sellin g 152,00 0 copie s b y 1914 : "An excess o f flesh is to b e looke d upo n a s on e o f the mos t objection able form s o f disease. " Edit h Lowry , writin g i n 1920 , claimed tha t as recentl y a s 190 0 a woma n coul d "rol l i n fa t an d gro w ol d i n peace"; a decade late r someone alway s seemed t o be saying, "Why don't yo u reduce? " But new thinking wa s forming b y 1900. Simo n Patten i n 189 7 argued tha t th e wealth y wer e killin g themselve s b y overeating, their physical state , in fact, wors e than tha t of the poor . David Graha m Phillips' s novel , Susan Lenox: Her Fall and Rise, in 1900 describe d th e heroin e a s "sensuous , graceful , slende r —the figure of girlhood i n it s perfection an d o f perfect womanhoo d too. " This is , perhaps unsurprisingly , a translatio n o f ne w fashion s int o moral approbation, though th e equation o f girlish shape with womanhood i s a poin t requirin g furthe r attention . Mor e importan t a t this juncture ar e the lovely Susan's reactions to people more corpu lent tha n she : "I t wa s shee r horro r tha t hel d Susan' s gaze , upo n Violet's incredibl e hip s and thighs, violently obtruded b y the closereefed corset. " The Fa t Man' s Clu b o f Connecticu t wa s founde d i n 1866 , a s approval fo r a certain prosperou s plumpnes s ra n high ; i t closed i n 1903. A 1907 play entitled Nobody Loves a Fat Man accompanie d a growing numbe r o f joke s an d cartoon s directe d agains t th e fa t — men particularly a t first, including Presiden t Taft. I n 191 2 a young, upper-class girl , seein g a portrai t o f th e once-fashionabl e Lillia n Russell, asked with tota l naivete , "Who i s that fat lady?" Somehow, as he r shocke d mothe r realized , a ne w generatio n ha d bee n brought u p no t onl y wit h nove l standard s o f physica l beaut y bu t with a n awarenes s tha t overweight , whe n present , becam e th e first characteristic t o note. 31 Even thos e wh o swa m agains t th e tid e wer e uncomfortabl y aware o f the ne w standard s an d o f thei r ow n deficienc y i n failin g

The Turning Point | 2 3 to rise to the challenge. A pensive contributor's not e in the Atlantic Monthly i n 190 7 suggested th e omnipresence , i f also th e frequen t ineffectiveness, o f th e ne w hostilit y t o fat : A woma n take s ou t a year-old dres s and finds it no longer fits her. Sh e reconcile s hersel f to he r ne w girt h b y evokin g olde r standard s o f appearance ; whe n she lived u p to fashion a few years back, her face wa s pinched, bu t with fat the lines are eradicated an d a greater contentment appears . Nevertheless, she knows what she should do , even thoug h sh e also knows sh e wil l not . Sh e shoul d exercise ; sh e use d t o rid e he r bicycle an d g o t o th e gymnasiu m faithfully . Sh e shoul d retur n t o previous die t habits , eatin g bran , cabbage , an d wate r instea d o f desserts an d cocoa. He r fatigu e an d breathlessnes s resul t fro m he r weight. Fa t i s itsel f "a n ugl y word, " an d euphemism s lik e plum p and stou t are scarcel y mor e acceptable . Maturit y tell s he r tha t sh e no longer ha s to worry about th e matter s that once concerne d her , and sh e ca n accep t reality . Bu t placidit y comes a t a price; she ca n claim som e serenit y bu t mus t admi t tha t i t als o attest s ho w " I a m proved bot h fa t an d old. " Th e ubiquitousnes s o f mor e rigorou s weight standards even for people who continued t o spread with age was one of the important results of the new perceptions of weight.32 Growing concer n abou t weigh t becam e a seriou s literar y topi c a s well. Edit h Wharton' s Undin e Spragg , i n 1913' s The Custom of the Country, contemplate d he r appearance . "Onl y on e fac t disturbe d her: there was a hint of too much fullnes s i n the curves of her nec k and i n th e sprin g o f he r hips . Sh e wa s tal l enoug h t o carr y of f a little extr a weight , bu t excessiv e slimnes s wa s the fashion , an d sh e shuddered a t th e though t tha t sh e migh t som e da y deviat e fro m the perpendicular." 33 World Wa r I provided ne w opportunitie s t o publicize th e attac k on fat , fo r health y eatin g becam e par t o f a patrioti c duty . "An y healthy, norma l individual , wh o i s no w gettin g fa t i s unpatriotic. " Military die t recommendation s mad e i t clea r tha t weigh t contro l was not onl y essentia l t o goo d looks , but wa s a basic ingredien t o f good health, even i n coping with stress. 34 What wa s happenin g betwee n th e 1880 s an d 192 0 was a mora l mobilization agains t fa t amon g respectabl e Americans . Habit s tha t had bee n dismisse d o r eve n praise d wer e no w condemne d — quite

24 I The Turning Point analogously t o th e late r campaig n agains t smoking , wit h simila r ethical overtone s an d effort s t o stigmatiz e thos e wh o coul d no t shape up . Childre n learne d th e ne w rules , whethe r o r no t the y lived b y them . Th e standard s wer e powerfu l enoug h t o justif y interventions agains t others , a s i n th e meddlin g prompting s t o reduce an d th e stead y strea m o f bitte r humo r agains t th e fat . Passion, an d no t jus t fashion , wa s involved . Th e publi c reproo f o f fat seem s t o hav e begu n t o tak e shap e surprisingl y earl y — hence the ne w an d opprobriou s slan g word s i n advanc e o f new die t fad s and ne w products . Abov e all , i t involve d a leve l o f revulsio n an d disgust tha t wen t wel l beyon d stylisti c consideration s — the birt h signs o f th e ne w stigma. 35 T o b e sure , earlie r fashio n period s ha d generated attack s o n th e nonstylish , bu t i n th e decade s o f stylis h plumpness, calling someone "gaunt " for her thinness, while admit tedly unpleasant , hardl y carrie d th e emotiona l loa d o f the turn-of the-century attacks on fat. Play s were not written to attack thinness; neologisms wer e no t invente d t o heighte n scorn . Bot h th e timin g and th e emotiona l charg e o f the publi c perception s o f fa t requir e further explanatio n an d assessment. The perception s did not spring simply from commercia l manipulation . The y als o struck a surprisingly dee p an d intens e chord , an d thi s to o woul d persis t a s i n th e familiar contemporar y prejudice s agains t th e fat . Wh y di d Ameri cans star t carin g s o muc h an d wit h suc h revulsio n agains t thos e who could no t measure u p to the ne w constraints ?

2

The Medica l Path : Physicians an d Faddist s

Doctors an d medica l advic e participated i n th e growin g campaig n against fat righ t along with th e pseudoscientifi c enthusiast s aroun d the tur n o f th e century . Thes e group s an d th e argument s the y adduced helpe d caus e th e ne w concer n abou t overweight , a s w e will see. But doctors collectively also hesitated, reflecting common sense caution s an d mor e traditiona l standards . Ofte n the y seeme d (like th e commercia l vendor s o f die t product s o r th e author s i n women's magazines ) t o be respondin g to public pressur e a t least as much a s they were shaping it . Even th e faddists foun d a n audienc e not onl y throug h thei r abilit y t o appea l t o half-digeste d scientifi c innovations bu t als o throug h publi c eagernes s fo r remedie s t o a newl y discovere d problem . Examinatio n o f th e medica l an d pseudomedical contribution s t o th e ne w perceptio n o f fa t add s some importan t ingredients , ye t confirm s th e nee d t o loo k mor e deeply for the fundamental dynamic s o f the process. To put the cas e simply: health worrie s did not seem to cause th e growing interes t i n weigh t control , amon g othe r thing s becaus e they developed a bit late to serve as prime movers . They promote d and sustaine d i t to som e extent , bu t the y als o too k fro m th e mor e inchoate publi c concer n th e targe t an d som e o f th e moralisti c vocabulary. I n this regard, th e campaig n agains t fat differed greatl y from th e late r attac k o n smoking , despit e simila r mora l overtones , for wit h smoking , medica l evidenc e clearl y se t th e stag e fo r th e later popularization . I n th e cas e o f fat , American s assimilate d a new understandin g tha t overweigh t coul d b e a healt h ris k tha t o n the whol e simpl y substantiate d an d justifie d a belie f tha t ha d 2

5

26 I The Medical Path: Physicians and Faddists already taken root. Popularized medica l concern s about overweight begin t o appear onl y after 1900 . For their part , doctors shaped thei r own discussio n throug h som e o f the popula r prejudices , reflectin g the powe r o f thes e prejudice s whil e extendin g the m further . Th e relationship betwee n American dietin g and medicin e thu s show s a new body ideal extending into the health domain, where the power of th e ne w standard s wa s quickl y demonstrate d b y patient s demanding professional help . Soon, however, medical concern bega n to intensify, solidifyin g th e anxiety about weight still further . In th e lon g run , o f course, th e concer n abou t overweigh t dove tailed bot h wit h growin g attentio n t o healt h i n American societ y and wit h th e dramati c shif t i n diseas e patterns tha t wa s beginnin g to take shape around 1900 . Between 188 0 and 1920 , infant mortalit y declined precipitously. The result was a population i n which death , traditionally a scourg e a t both end s o f the ag e scale , concentrate d among olde r adults . This i n tur n mean t tha t healt h issue s increas ingly focuse d o n degenerativ e disease s rathe r tha n contagion . No t surprisingly, geriatri c medicin e bega n t o emerg e shortl y befor e World Wa r I , highlightin g attentio n t o problem s o f th e hear t an d arteries. Contagiou s disease s afflictin g adult s als o began t o dro p — the grea t influenz a epidemi c o f 191 9 wa s th e las t o f it s kind . Improved publi c sanitatio n joine d wit h sulf a drugs , then penicilli n and a growing array of inoculations, t o attack traditiona l killers . As realization o f degenerative problem s spread, i t meshed readil y with growing attentio n t o prope r weigh t an d nutrition . Bu t whil e a generalized worr y abou t healt h probabl y increase d befor e 1900 , along with th e first largely professional-medical wor k on degenera tive killers, the real surge of interest awaited the 1920s. It was at this point, fo r example , tha t takin g bloo d pressur e becam e a standar d part of medical checkups . Prio r t o this point (an d eve n beyond , i n the cas e o f infants) , popula r diseas e fear s (fo r example , thos e fo cused i n nineteenth-centur y fashio n o n tuberculosis ) woul d prompt renewe d appreciatio n o f plumpness, not the ne w diet standards. It is important t o dissociate th e ultimat e medica l linkage s of the antifat cultur e fro m it s initial underpinnings. 1

The Medical Path: Physicians and Faddists | 2 7

A Gradual Interest Doctors di d no t becom e particularly trouble d abou t weigh t a s a factor i n healt h unti l th e 1890s . There wa s no medica l conversio n preceding th e shif t i n publi c perception . Nutritiona l studie s o f various sort s wer e launche d fro m th e 1830 s onwar d (an d som e tradition wen t bac k eve n further , t o th e Renaissance) , wit h Euro pean researc h wel l i n advanc e o f American largel y becaus e o f th e familiar la g i n American medica l trainin g unti l late r i n th e nine teenth centur y an d partly , perhaps, becaus e American fashio n als o hesitated t o embrac e slendernes s longe r tha n it s Europea n coun terpart. Eve n Europea n work , however , move d towar d a focu s o n weight onl y slowly . A n 185 0 articl e "o n corpulence " i n Britai n refused t o dra w precis e healt h conclusion s o r t o se t any particula r weight standards . I t wa s onl y i n 189 4 that a Germa n doctor , Ma x Rubner, linke d calori c outpu t t o organi c metabolism , wit h n o immediate effec t o n dietetics. Scattered article s on obesity, some of them issue d in the United States , continued t o refrain fro m genera l findings. Even the best American researc h hospital s like Massachusetts Genera l o r th e Ne w Englan d Hospita l fo r Wome n an d Chil dren, despit e unusua l interes t i n scienc e an d i n recor d keeping , did no t systematicall y lis t weight s o r weigh t change s o f patient s until th e lat e 1880s . At th e Ne w Englan d Hospital , ver y irregula r records o f weight s bega n i n 1874 . I n 188 6 form s wer e introduce d with spaces for pulse, temperature, respiratory rate, and weight, but the spac e fo r weigh t (an d thi s on e alone ) wa s ofte n lef t blank . While a first doctor' s scal e wa s produce d i n 1865 , regula r us e o f scales ma y have actuall y lagge d behin d th e introductio n o f public scales in the 1890s. In the long run, weight anxieties linked u p with a moder n fetis h fo r precise , standardize d measurements , applyin g these t o intimat e aspect s o f th e bod y the n expose d t o medica l scrutiny, but i t took a while for this to happen. 2 Medical manual s b y the 1870 s di d includ e discussion s o f nutri tional issues . I t wa s i n th e 1870 s tha t th e wor d calorie , previousl y introduced a s a genera l hea t measurement , bega n t o b e applie d particularly t o th e assessmen t o f th e energ y capacit y i n differen t foods, leadin g t o Rubner' s discovery . Europea n researc h o n carbo -

28 I The Medical Path: Physicians and Faddists hydrates an d fats , an d thei r rol e i n producin g heat , bega n t o ente r American materials , a s di d earlie r Germa n researc h o n proteins . Until wel l afte r 1900 , basic nutritiona l stud y centere d i n Europe , under th e aegi s of researchers lik e Kar l van Noorden , wh o catego rized differen t type s of obesity. 3 The bibliograph y o f American work s o n diet , fat , an d nutritio n tells th e stor y clearly . Whil e a Europea n momentu m bega n t o build b y th e mid-i88os , includin g regula r article s i n Britis h jour nals on obesity and it s treatment by the 1890s, Americans generate d but a handful o f scientific papers , mostly derivative fro m th e transatlantic work , unti l 1900 . No t unti l 189 7 di d an y America n essa y deal wit h th e implication s o f nutritiona l knowledg e fo r medica l practice or for evaluation o f Americans' normal eating habits. From 1903 onward, i n contrast , at least five American article s on feeding , weight reduction , an d kindre d topics , ofte n wit h scientificall y rec ommended diets , appeared i n medical journal s eac h year. 4 Physicians' own recollection s confir m a definite bu t slo w transition. Article s a s lat e a s th e 1930 s routinel y note d ho w America n doctors turne d t o die t consideration s ver y gradually . "Th e olde r members o f the professio n . . . can recal l wit h feeling s o f humilia tion th e lac k o f interest i n th e subjec t o f dietetics durin g th e earl y years o f thei r professiona l life . I n thos e day s dru g therap y hel d the cente r o f th e stag e [i n dealin g wit h disease] , whil e dietar y consideration receive d bu t scan t attention. " Agai n int o th e 1930s , medical article s o n die t typicall y bega n wit h referenc e t o olde r European work , suc h a s that o f the Germa n Fran z Morit z o n th e utility of weight-loss diet s based o n products lik e milk and banana s or the leadership of Carl Voit in providing guidelines for the dietary requirements fo r th e norma l adult. 5 The fac t wa s the American doctors , not scientifically traine d fo r the mos t part , lon g maintaine d traditiona l belief s tha t a certai n amount o f weigh t wa s usefu l i n combattin g th e standar d conta gious disease s an d tha t thinnes s wa s positivel y ill-advised . Ne w information sprea d slowly , an d a s we will see , i t was often greete d with considerabl e skepticism . Accusations o f widespread ignoranc e of proper nutritiona l rule s peppered doctors ' comments abou t their colleagues.6

The Medical Path: Physicians and Faddists | 2 9 Nevertheless, two related factors pushe d fo r change i n American medicine, graduall y makin g weigh t contro l a n increasingl y stan dard concern . First , a s doctor s bega n t o realiz e tha t degenerativ e diseases required th e same kind of attention previously given conta gious disease s —a realizatio n tha t bega n t o b e possibl e aroun d 1900 give n th e reductio n o f infan t mortalit y an d th e increasin g pathological knowledg e abou t th e deca y o f organ s i n late r adult hood—factors suc h a s die t inevitabl y calle d fo r mor e attention . Most of the specific healt h warning s attached t o campaigns agains t fat focuse d o n th e degenerativ e proces s fo r th e heart , arteries , an d the digestiv e organs . Second , th e progres s o f nutritiona l research , from it s Europea n base , provide d increasingl y precis e guideline s for assessin g what health y diet s migh t consis t o f and wha t patient s might be told. The American pionee r i n nutrition researc h was Wilbur Atwater of Wesleyan University . Relyin g on Germa n findings and methods , Atwater wa s convince d tha t American s ha d develope d inefficien t and unhealth y food habit s due to the sheer agricultural abundanc e of th e nation . Healt h — and als o th e live s o f th e poor , wh o over spent o n foo d — could onl y benefi t fro m a scientifi c approac h t o diet. Beginnin g i n th e 1880s , Atwater publishe d a series o f article s on nutrition , som e o f them i n la y outlets, that began t o populariz e ideas o f differen t type s o f foo d constituent s — protein, carbohy drates, an d th e lik e — and th e ver y notio n tha t regulatio n o f die t could improv e health . Muc h o f this research , carrie d o n b y others as well after 1890 , focused no t o n weight contro l bu t o n improvin g food qualit y and eve n quantity for the working class in the interest s of healthie r condition s an d highe r productivity . I t wa s thi s aspec t of Atwater' s wor k tha t first capture d th e attentio n o f th e Depart ment o f Agriculture , whic h bega n t o issu e pamphlet s o n foo d values. Recommendation s fo r dail y calori e intak e (Atwate r sug gested 350 0 pe r day ) wer e ver y high , eve n i n compariso n wit h contemporary Europea n medica l standards . Bu t whil e th e scien tific nutritio n movemen t faile d i n initia l effort s t o affec t working class eatin g habits , i t wa s able , whe n suitabl y adapted , t o addres s middle-class weigh t concern s b y 1900. Russell Chittende n o f Yale, for example , used Atwater's work around th e tur n o f the centur y to

30 | The Medical Path: Physicians and Faddists formulate recommendation s fo r calori e countin g i n relatio n t o th e energy a n individua l expended . Her e wa s a scientifi c mean s o f developing a patter n o f weigh t control , o r i f necessar y o f weigh t reduction, i n a perio d whe n fashio n a s wel l a s healt h considera tions were beginning t o dictate ne w restraint. 7 Even wit h a researc h base , itsel f conditione d o n a growin g understanding o f th e importanc e o f degenerativ e an d no t simpl y contagious threat s t o health , man y physician s hel d bac k i n th e decade afte r 1900 . On e distractio n wa s a pronounce d interes t i n labeling mos t obesit y glandula r o r hereditary — interesting, mayb e harmful, bu t irremediable . A category o f "exogenou s obesity " ha d been introduce d i n Europe , bu t man y doctor s found i t a relatively modest grouping . "I t canno t b e denie d . . . that ther e i s a certai n percentage o f obesit y case s . . . tha t ma y b e definitel y classe d a s clearly th e resul t o f over-eatin g o r o f sedentar y habits . Eve n i n these, however , i t i s doubtfu l i t th e patient' s fault y habit s ar e th e primary cause or if there may not be some change i n his intracellular chemistr y . . . tha t produce s a n inordinat e appetit e tha t i s beyond th e powe r o f th e wil l t o control. " Dietin g migh t hel p suc h people, accordin g t o this lin e o f reasoning, bu t fo r mos t the newl y popular diet s wer e shee r torture . "Othe r pathologica l factors " ac counted i n trut h fo r mos t obesity , an d the y wer e difficul t i f no t impossible t o manage . "I n almos t ever y fat chil d I have seen , th e trouble ha s bee n du e t o endocrina l disturbance. " Her e again , die t advice wa s though t t o b e o f littl e use . Furthermore , fo r man y doctors, patients of the endogenou s typ e "presented] n o real problem" fo r the y jus t neede d t o b e se t straight ; nothin g mor e shoul d be necessary . Indeed , a s w e wil l see , doctor s int o th e 1930 s ofte n found i t difficul t t o tak e simpl e overweigh t seriousl y a s a medica l problem. Th e constitutionall y obes e wer e muc h mor e fascinatin g in a perio d i n whic h endocrin e researc h wa s advancin g rapidly . These wer e people , i t wa s commonl y reported , wh o at e quit e normally bu t gaine d weigh t eve n so ; something metabolicall y wa s amiss.8 Onl y i n th e 1940 s wa s th e endocrin e approac h t o obesit y definitively downplaye d i n favor o f more general recognitio n o f the eating issues associated wit h obesity . ("Thi s onc e popular diagnosi s is no w realize d t o res t o n ver y slende r foundations.") 9 I n th e

The Medical Path: Physicians and Faddists | 3 1 meantime, th e ide a o f endocrin e factor s o r heredit y na y hav e distracted doctor s fro m presentin g a consisten t fron t concernin g the nee d fo r restrain t i n mor e standar d case s o f overweight ; the y might not, i n fact, hav e been ver y interested . Continued concer n abou t underweigh t patient s migh t hav e combined wit h th e endocrin e o r heredit y argumen t t o produc e considerable skepticis m abou t dieting . " I fee l sur e tha t I hav e several time s see n person s unknowingl y starve d t o deat h unde r such circumstances , chiefl y whil e unde r treatmen t fo r seriou s acute disease. " The ide a o f restrictin g children' s food , i n a perio d when poverty so obviously caused malnutrition, coul d have seemed "always dangerous. " Finally , a s a deterren t t o activ e interventio n against overweight , ther e wa s simpl y th e amoun t o f professiona l dispute abou t what the problem wa s and ho w it should b e tackled . "Another difficult y i n gettin g stric t observanc e t o dietary rule s an d regular exercise , i s th e difference s o f physician s a s t o th e impor tance o f one o r other limitation . Thus doub t comes int o the min d of th e patient , whe n note s ar e compare d wit h a friend , wh o ha s another physician wit h differen t appreciatio n o r outlook." 10 Partly becaus e o f disputes , partl y becaus e o f understandabl e traditionalism i n a n are a wher e medica l concer n wa s quit e new , many popularizin g doctors , an d doubtles s man y physician s i n ac tual practice , continued t o downplay the fa t furor i n the years afte r 1900. Maclay Lyon , a Kansas Cit y doctor , wrot e i n 191 0 about th e folly o f tryin g t o chang e mos t people' s eatin g habits . I f they like d potatoes, le t the m ea t potatoes . Ther e wa s n o idea l die t fo r every one anyway . "Better admi t to the patient: 'Ea t what you want, what seems t o agree ; ea t plenty, tak e goo d car e o f yourself, an d w e will worry alon g wit h th e hop e tha t Natur e wil l ste p i n an d i n som e mysterious wa y brin g yo u ou t o f thi s an d sav e m y baco n b y cov ering u p m y ignorance/ " Possibly, Dr . Lyo n wrote , science woul d come u p wit h cleare r answer s fo r a rational die t i n future , bu t fo r the momen t i n hi s judgmen t mos t advic e abou t cuttin g intak e was arran t nonsense . I n a mor e popularizin g vein , Dr . Wood s Hutchinson downplaye d th e importanc e o f warrin g agains t fa t t o the reader s o f Cosmopolitan i n 1910 . Mos t fa t wa s harmles s an d mainly (9 0 percent ) hereditar y anyway . Exercis e shoul d tak e car e

32 I The Medical Path: Physicians and Faddists of the 1 0 percent tha t was really optional. The proble m wa s mostly mental anyway , involvin g worrie s abou t beaut y o r "excitin g ridi cule/' Propose d remedie s wer e mostl y frauds, an d sometime s posi tively dangerous . Turkis h bath s an d sweat-inducin g rubbe r gar ments strained th e heart or poisoned th e body. A woman unde r 185 pounds ha d nothin g t o worr y about , no r di d a ma n unde r 250 . Excessive obesit y was bad, to be sure, burdening th e bodily organs. But mos t fa t peopl e wer e "vigorous , efficien t an d successfu l indi viduals, wh o lea d happy , health y an d usefu l lives. " S o the y live d two years less — their deaths woul d b e quick , whic h wa s all t o th e good. Th e moral ? exercis e wit h care , die t ver y littl e i f a t all , an d don't make artificial problem s for yourself. 11

Competitive Fads The cautiou s medica l respons e t o th e risin g anxiet y abou t fa t lef t the wa y ope n fo r a ne w serie s o f pseudoscientifi c fads . Man y o f these buil t o n earlie r nutritiona l strategies , bu t the y no w adde d i n weight contro l a s well . Th e fad s helpe d publiciz e th e nee d t o lose weight , jus t a s the y capitalize d o n existin g concern . The y complicated forma l medica l respons e furthe r b y lending a n ai r o f speciousness t o th e whol e die t enterprise . A medical approac h di d develop durin g th e decad e afte r 1900 , an d i t ultimatel y exceede d the faddis t display s i n influencin g publi c belief . Bu t th e faddist s had thei r rol e t o play as well, particularly i n th e transitio n year s at the tur n o f the centur y itself. It was in 1905, for example , that the middle-clas s Germa n immi grant Henr y Lindlah r opene d a clini c i n Chicago , base d o n a European natura l food s regimen . Lindlah r himsel f ha d los t ove r forty pounds i n the 1890s. He became a full-fledged die t enthusiast; his son , traine d a s a doctor , expande d th e clini c i n th e 1920s , developing th e Cataboli c die t whos e popularit y ha s recentl y bee n revived. Treating patients of both genders, but increasingly women, the focus ofte n involve d diabetics . The mos t strikin g entran t t o th e ne w die t sweepstake s wa s on e Horace Fletcher , a n America n wh o als o excelle d i n associatin g

The Medical Path: Physicians and Faddists | 3 3 himself with the growing, if inchoate, science of nutrition. Fletche r himself los t a grea t dea l o f weigh t i n th e lat e 1890s , an d h e has tened t o advertise hi s resultant goo d healt h an d gai n publi c recog nition fro m hi s understandin g o f ho w h e manage d hi s achievement. Writin g widel y i n th e Ladies Home Journal Good Health Magazine, an d othe r outlets , Fletcher advocate d a new and precis e science o f chewing. "Thoroug h mastication, " taking at least twenty careful, individuall y counte d bite s fo r eac h mouthfu l o f food , would eas e the task of a mechanism i n the bac k o f the mout h tha t performed a "filter function " crucia l t o digestion . Filte r o r no , th e main poin t o f "Fletcherized " chewing , a s i t wa s widel y dubbed , was t o mak e sur e tha t n o mor e foo d wa s take n i n tha n wa s absolutely necessar y t o assuag e rea l hunger . Foo d chewe d s o com pletely woul d los e tast e (an d probabl y bor e th e chewer ) suc h tha t artificial appetit e woul d b e eliminated . Fletche r als o appeale d fo r a lowere d consumptio n o f mea t an d protei n generally . Thoug h advocates o f all-meat diet s stil l gaine d som e attention , thi s appea l coincided wit h increasin g nutritiona l argument s i n favo r o f higher vegetable an d carbohydrat e intak e "a t th e expens e o f mor e fatt y foods."12 Fletcher di d no t reall y inven t th e ide a o f slo w chewing . No r were hi s claim s t o bette r health , an d particularl y bette r digestion , through nutritio n novel . I n thi s sense , Fletche r wa s simpl y th e latest i n a lon g lin e o f nineteenth-centur y nutritiona l faddists , though hi s emphasis o n controllin g th e quantit y o f food wa s mor e distinctive. Fletcher' s wealth , a s a retire d businessman , facilitate d his campaign , an d h e wa s als o abl e t o persuad e othe r wealth y o r influential individual s to advocate dieting . John D . Rockefeller, fo r example, thoug h no t a litera l Fletcherite , i n 190 4 publicl y an nounced hi s succes s i n conquerin g a seriou s illnes s b y losin g weight. Fletche r als o contribute d fund s t o a numbe r o f nutritio n laboratories i n Britai n an d th e Unite d States . Docilely , a numbe r of scientist s soo n announce d thei r ow n conversio n t o thoroug h mastication, wit h resultan t cure s fo r headaches , colds , boils , an d other disorders . A widel y publicize d das h u p an d dow n th e 85 4 steps o f th e Washingto n Monumen t i n 190 2 gav e Fletche r ne w American attentio n an d dre w th e interes t o f th e Yal e physiologis t

34 | T/z e Medical Path: Physicians and Faddists Russell Chittenden . Chittende n performe d carefu l measurement s on Fletche r an d conclude d tha t i t wa s possibl e t o maintai n ful l functioning o n fa r les s foo d tha n ha d commonl y bee n imagined . Specifically, Fletche r consume d les s than hal f th e amoun t o f protein a da y than expert s suc h a s Atwater ha d bee n recommending . Chittenden discovere d tha t hi s ow n rheumatis m virtuall y disap peared whe n h e adopte d Fletcher' s plan ; thoug h h e los t fourtee n pounds, h e fel t stronge r tha n ever . Fletcher' s an d Chittenden' s work wa s take n u p b y a uni t o f th e U.S . Army, whic h conducte d an experimen t i n th e Yal e laboratorie s t o prov e tha t excellen t physical fitness was compatible wit h small rations . (While Chitten den prudentl y droppe d Fletcher' s ide a o f a filter in the bac k o f the mouth, h e di d analyz e a packag e o f Fletcher' s stools , which wer e odorless becaus e o f thoroug h chewing , tha t Fletche r ha d maile d him.) 13 Fletcher continue d t o lectur e widel y fo r severa l years , combin ing hi s advocac y wit h tale s o f physica l prowes s i n Asia , chargin g through tropica l jungle s o r bravin g immens e blizzard s i n th e Hi malayas. A host o f American an d Europea n celebritie s subscribe d to Fletcher' s claims , includin g Henr y Jame s (fo r who m Fletcher ism cure d malais e an d restore d serenity ) an d hi s scientis t brothe r William. Indeed , Willia m Jame s urge d Harvar d facult y an d stu dents t o attend a Fletcher tal k i n 1905 . Not onl y Fletche r bu t als o Chittenden an d othe r convert s wrot e regularl y i n bot h Ladies Home Journal and othe r fashionabl e outlet s an d th e prestigiou s Scientific American, lendin g ne w vigo r an d apparen t professional ism to the effor t t o persuade middle-clas s American t o lose weight. Fletcher himsel f saw dieting not simply as a health measure , but as a defense agains t the broader ills of urban life . In this, he forme d a lin k wit h th e olde r nutritiona l tradition , represente d b y earlie r advocates lik e Sylveste r Graham , wh o sa w food choic e a s part o f a wider attac k o n th e peril s o f a moder n economy . Fletcher' s mes sage, however , an d certainl y th e echoe s b y scientists lik e Chitten den, shifte d th e emphasi s mor e heavil y towar d healt h gain s a s the list o f medica l problem s tha t weigh t los s an d reduce d protei n intake coul d tackl e expande d quit e steadily. Fletcherism affecte d virtuall y all fad die t advocates around 1900,

The Medical Path: Physicians and Faddists | 3 5 but i t di d no t gai n complet e monopoly . A s Fletcheris m bega n t o fade (Willia m James parted compan y i n 1908, for example) , Upto n Sinclair parlayed hi s muckraking fame int o an eve n more dramati c appeal for food restraint . Writing in Cosmopolitan and other outlets around 1910 , Sinclai r argue d fo r lon g period s o f tota l abstentio n from eating . Deepl y intereste d i n perfectin g hi s healt h — maintaining the "gloriou s feeling " o f perfect healt h — Sinclair ha d trie d both Christia n Scienc e an d Fletcherism . Mos t people , h e wa s convinced, wer e sick ; h e himsel f ha d suffere d fro m dyspepsia , headaches, and othe r ailments . Doctor s ha d offere d n o solace , bu t Fletcher's wor k ha d turne d hi s attentio n t o hi s standar d middle class eating habits, which were by the same token bad. Fletcheris m had weane d hi m fro m food s lik e frie d chicken , bu t eve n wit h frequent chewin g he still ate too much. Hi s reading of Elie Metch nikofPs wor k (Frenc h researc h tha t warne d o f impur e intestina l organisms) ha d informe d hi m o f th e bacteri a tha t unassimilate d food woul d engende r — six billion fro m on e stin t of desk work an d overeating alone . S o h e faste d completel y fo r severa l days , losin g fifteen pound s an d relyin g o n ra w vegetable s an d fruit s whe n h e did star t eatin g again . H e fel t aler t an d healthy . Mos t Americans , he could no w attest, ate too much: "Superfluous nutrimen t i s taken into th e syste m an d ferments , an d th e bod y i s filled with a greater quantity o f poisonou s matte r tha n th e organ s o f eliminatio n ca n handle." The result : not only digestive problems, but clogged blood vessels, cirrhosis, and apoplexy. 14 Sinclair's appeals for recurren t fastin g wo n widespread approval . Many reader s wrot e t o than k th e autho r fo r a techniqu e tha t re stored thei r healt h a s well . A follow-u p piec e i n Contemporary Review provided attestation s t o th e wonder s o f fasting, wit h claim s of successful period s o f denial lastin g up to twenty-five days. 15 The mos t popula r singl e fa d autho r i n th e die t field wa s Joh n Harvey Kellogg , wh o too k ove r a n olde r nutritiona l sanitariu m in Battl e Creek , Michigan , begu n i n earlie r religious-vegetaria n crusades. Eve n mor e tha n Fletcher , Kellog g achieve d scientifi c status a s a nutritional expert . H e helpe d populariz e Fletcheris m i n 1902, inventin g a "Chewin g Song " fo r hi s patient s t o encourag e their conversion. H e also joined MetchnikofF s attac k o n poisonou s

36 I The Medical Path: Physicians and Faddists intestinal bacteria . Bu t vegetarianis m wa s Kellogg' s grea t crusade , with individualize d diet s o f fruit s an d vegetable s fo r eac h o f hi s patients. While calori e reductio n wa s not th e mai n point , patient s did, i n fact , greatl y curtai l thei r norma l intak e alon g wit h "purify ing" th e product s the y consumed ; calori e conten t wa s carefull y checked. Researc h facilitie s allowe d carefu l monitorin g o f weight, urine, bloo d pressure , an d othe r characteristic s o f each sanitariu m participant. Whil e som e patient s rebelle d agains t th e diet s o f th e "San," most proved willing to undertake massiv e changes i n eatin g habits fo r th e sak e o f bette r health . A British observe r note d wit h astonishment tha t "a n incredibl y smal l numbe r appeare d t o hav e any objection s t o o r b e affecte d i n a deleteriou s manne r b y th e great change." 16 Diet faddists ha d a lasting influence. Physica l educatio n instruc tors could still be known t o preach Fletcheris m a s late as the 1930s. Kellogg an d Chittende n live d lon g lives , continuin g t o writ e o n behalf o f low-protei n diet s an d overal l restraint . Som e medica l doctors directl y joine d th e faddis t parad e a t it s height. A New York doctor toute d "Flavettes " a s a die t table t designe d t o cur b th e appetite, which "ma y be used i n any condition wher e a diminution of an y o f th e foo d intak e i s required, " particularl y thoug h no t exclusively i n case s of obesity. Again, scienc e wa s invoked i n care ful diagnose s o f the content s o f the pill s an d monitorin g o f results with patients , and astoundin g weight losses were reported . Miracu lous improvement s o f blood pressur e an d othe r problem s resulted , and the typical patients gratefully reporte d a n unprecedented "feel ing o f well-being. " Franci s Humphris , o f th e America n Electro Therapeutic Association , advocate d electrica l stimulation , ofte n i n conjunction wit h othe r dietin g techniques . "Ver y stou t people " could los e a s muc h a s fort y pound s a mont h unde r hi s regimen , which successfull y countere d th e overeatin g an d sedentar y habit s characteristic o f middl e age . Humphri s pointe d ou t th e medica l concomitants o f much overweight : a heart and live r often enlarge d and "infiltrate d wit h fat, " smal l lung s and attendan t breathlessness , and advers e change s i n th e bloo d tha t "migh t occu r t o suc h a n extent as to be visible to the nake d eye." 17 The heyda y o f this first round o f extrem e fad s i n die t bega n t o

The Medical Path: Physicians and Faddists | 3 7 draw to a close around 1910 . The popularit y o f bizarre approaches , whether incredibl e feats of chewing or literally unbelievable claim s of fasting , suggest s a publi c eage r fo r quic k fixes t o a suddenl y acute weigh t proble m an d a scientifi c establishmen t no t ye t wel l formed t o respon d t o ne w needs . No t surprisingly , man y doctor s reacted hostilel y to diet faddism, resentin g the competition bu t also quite plausibl y notin g th e healt h risk s involved . Dr . Lyo n blaste d Fletcher (carefull y designate d a s " a layman") an d Sinclair , savin g his bitteres t scor n fo r Chittenden , wh o a s a scientis t shoul d kno w better; th e ide a o f survivin g whil e eatin g hal f a norma l die t o r fasting fo r eigh t o r nin e day s wa s patentl y absurd . A Philadelphi a doctor, Davi d Edsall , blaste d commercia l sponsors , wh o wer e be ginning t o issu e specia l low-fa t foods , complet e wit h unbelievabl e claims o f nutritiona l benefi t an d weight-los s potential . Accordin g to Edsall , the product s "hav e bee n use d wit h a n enormousl y exag gerated ide a o f thei r values , an d hav e don e a correspondin g amount o f harm. " Commercia l exploitatio n mus t b e stoppe d an d with i t the ignoran t credulity o f too many physicians who accepte d any myt h withou t puttin g i t t o th e tes t o f science . Edsal l an d other debunker s insiste d tha t to o man y clinical result s wer e bein g adduced tha t wer e absolutel y impossible . I n th e page s o f the Journal of the American Medical Association, indeed , a traditio n wa s being launched , whic h woul d exten d throug h th e 1930s , o f vehemently an d gleefull y debunkin g on e die t craz e afte r another , call ing o n governmen t prosecutio n an d posta l disbarmen t wheneve r possible.18 But the faddis t phase , i n addition t o launching a host o f milde r and mor e clearl y commercia l produc t lines , helped persuad e bot h doctors an d th e genera l publi c o f the nee d fo r restrain t i n eating , at leas t i n principle . Th e connectio n betwee n weigh t reductio n and bette r healt h seeme d increasingl y clear . Sobe r popularization s by doctor s an d other s coul d distinguis h b y 191 0 between th e silli ness o f claim s b y peopl e lik e Fletche r an d th e kerne l o f seriou s truth abou t a nationa l healt h problem . Adults , s o on e articl e i n McClures noted , wer e no t improvin g thei r health . Th e dro p i n contagious disease s almos t exclusivel y benefite d children . A Yale report was cited claimin g tha t the deat h rat e ove r fifty was actually

38 I The Medical Path: Physicians and Faddists rising. The villain ? Poo r eatin g habits: "Scientists no w believe tha t nearly al l th e evil s o f middl e lif e an d ol d ag e ar e cause d b y unintelligent eating. " The sedentar y life o f the successfu l business man wa s a particula r curse , wit h a disgustin g lis t o f visible symp toms: "th e protuberan t abdomen , th e pendan t cheeks , th e puff y eyes an d th e wrinkle d nec k whic h see m t o hav e becom e th e stigmata o f a prosperou s busines s career. " Fortunately , scienc e could no t onl y identif y th e proble m bu t als o poin t t o a solution , and die t heroe s lik e Fletche r (commende d fo r droppin g fro m 20 7 pounds t o a mere 163 ) deserved rea l credi t fo r thei r contributions . Calories mus t b e counted ; meat , wit h it s excessiv e protein , mus t be cu t back . Chittenden , Kellogg , an d th e whol e scientifi c an d pseudoscientific pane l seeme d t o unit e i n callin g attentio n t o eating restraint as a key to health. 19

Growing Consensus Indeed, i t wa s th e developmen t o f increasingl y standar d medica l commentary o n die t tha t helpe d displac e th e outrigh t faddists , a s doctors loosely assembled a common lin e o f argument fro m abou t 1903 onward . B y 1905 , i n fact , doctor s wer e discussin g issue s o f weight an d reducin g wit h increasin g confidence . Ne w York physician Joh n Wainwrigh t note d tha t ther e wa s stil l n o unanimit y i n the professio n concernin g th e treatmen t o f obesity . Bu t h e haile d the new knowledge that challenged existin g theories of how to treat "corpulency," an d h e calle d fo r mor e practica l wor k i n th e field. References t o Europea n wor k continued . Kar l va n Noorde n wa s cited, thoug h wit h disappointmen t tha t hi s diagnosi s wa s no t matched b y clea r guideline s a s t o ho w "superfluou s flesh ma y b e reduced." Bu t hi s caution s abou t undul y rapi d weigh t loss , hi s recommendations tha t any diet be tailored t o individual situations , and hi s insistenc e tha t som e traditiona l methods , lik e massage , were o f dubiou s valu e wer e regarde d a s important . S o wa s hi s recognition tha t a perio d o f die t "followe d b y eleve n month s o f self-indulgence" wa s "of little benefit." Van Noorden was also given credit for insistin g on the treatment o f obesity in combating several

The Medical Path: Physicians and Faddists | 3 9 diseases, particularl y thos e o f th e hear t bu t als o respirator y prob lems. Lif e insuranc e experienc e wa s als o providin g informatio n about "ho w dangerou s t o lif e obesit y is. " Dr . Wainwrigh t judge d that cures i n sanatoria seeme d desirabl e where th e nee d fo r weigh t reduction wa s particularl y pressing ; whil e warnin g agains t seizin g on novelt y fo r it s ow n sake , h e als o ha d approvin g thing s t o sa y about carefu l chewin g an d electrica l treatments . H e conclude d b y summing u p availabl e knowledg e abou t wha t food s (alon g wit h regular exercise ) wer e recommended , an d wha t shoul d b e shunned, i n diet s directe d agains t weigh t gain . A commonsens e approach wa s beginnin g t o b e possible , alon g wit h a certai n rou tine acceptance o f the standard evaluatio n an d treatment. 20 Medical suppor t fo r slendernes s als o gaine d ground . Anothe r New Yor k physicia n attacke d an y lingerin g ide a tha t lea n peopl e must of necessity be underfed, althoug h h e added som e stereotype s reminiscent o f the transitiona l hesitation s i n fashion : "Th e appear ance of the lean, it is true, may not always conform t o our aestheti c sense, h e ma y b e easil y effecte d [sic] b y heat an d col d an d atmo spheric changes in general, he may also be possessed of an irritabl e nature, bu t notwithstandin g thes e apparen t drawback s an d defi ciencies, h e ma y no t onl y b e hal e an d soun d bu t ma y frequentl y display a degre e o f enduranc e an d energy , no t ofte n me t wit h i n the ove r nourishe d individual. " I n fact , overfeedin g wa s th e rea l issue, as Chittenden ha d show n experimentally . "Th e dietar y stan dards a t presen t i n vogue , especiall y i n th e cities , see m t o b e entirely to o large. " Healt h an d functionin g "ar e th e bette r main tained, th e mor e th e su m o f ingeste d assimilabl e nutrient s i s limited t o th e amoun t absolutel y necessar y t o keep th e bod y i n meta bolic balance." The autho r maintained tha t doctors must help their patients lear n t o coun t calories , tha t table s coul d b e develope d — and th e autho r offere d on e — specifying appropriat e weight s ac cording t o age , height , an d gender . A t ag e thirty , fo r example , a man five feet nin e inche s tal l shoul d weig h 15 4 pounds; a woma n five feet four , 12 4 pounds. Th e tabl e allowe d a ten-poun d weigh t gain fo r me n (nin e pound s fo r women ) durin g one' s thirties , bu t called fo r som e reductio n thereafte r (a t age fifty, a man almos t five feet eight should b e back to about 156 pounds). And doctors should

40 | The Medical Path: Physicians and Faddists refrain fro m encouragin g adult s unde r "normal " weigh t t o gai n unless there was positive indicatio n o f some disease condition. 21 As doctor s bega n t o commen t adversel y o n norma l America n eating habits , s o the y becam e somewha t mor e comfortabl e i n advising overweigh t individuals , no t otherwis e diseased , t o she d some flesh. Granted , muc h obesit y wa s hereditar y o r glandular . But doctor s recognize d tha t mor e case s tha n ha d onc e bee n real ized resulte d purel y an d simpl y fro m overeatin g ("I n th e grea t majority o f cases , th e caus e i s chiefl y overeating") . An d whil e treatment was often difficul t becaus e of patient resistance, it should be attempted : Doctor s shoul d carefull y determin e th e cause s o f obesity an d th e conditio n o f th e hear t an d othe r organs . Patient s should b e weighe d frequentl y — as ofte n a s onc e a week . Alcoho l and starche s shoul d b e cu t fro m th e diet , an d i n recalcitran t case s the frequenc y o f meal s mus t als o b e reduced . Patient s neede d guidance i n learnin g wha t food s wer e bes t advise d fro m a calori c standpoint, thoug h n o on e regime n wa s indicate d fo r overweigh t adults a s a class . Regula r exercise , walkin g o r running , wa s als o essential. Abov e all , doctor s dealin g wit h overweigh t coul d no t simply diagnos e physica l symptoms ; the y mus t "stud y thoroughl y the habits and mod e of life o f the patient" to see what combinatio n of sedentar y occupation s an d poo r eatin g wa s involve d an d ho w radical mus t b e th e redress . I n mos t cases , moderat e exercis e an d exclusion o f hig h calori e food s woul d d o th e trick ; sometime s merely eliminatin g a n extr a sandwic h o r a glas s o f bee r woul d "correct th e evil. " Bu t othe r patients , particularl y wit h a famil y history of obesity, required muc h close r regulation an d supervision ; cutting calori c intak e from th e norma l 300 0 per da y to 2200 would generate a los s o f ove r tw o pound s pe r week . Varie d patien t re sponses mus t als o b e considered . Som e patient s wer e s o distressed by th e los s o f energ y tha t extr a weigh t produce d tha t the y woul d follow doctors ' order s closely . Bu t anothe r group quickl y relapsed , excusing themselve s b y the nuisanc e involve d o r by social o r business pressure s t o ea t heartily . "I n thi s categor y I plac e especiall y young married wome n an d clu b me n o f middle life." But whatever the difficulties , doctor s shoul d act , fo r certai n fact s wer e "no w generally know n an d admitted. " Rule s shoul d b e se t dow n t o pre -

The Medical Path: Physicians and Faddists | 4 1 vent furthe r weigh t gai n an d i f necessar y t o reduc e t o norma l range. Again , standar d nutritiona l advic e wa s no w available , ar guing agains t th e intak e o f to o muc h suga r an d starch . Th e ap proach wa s beginning to sound redundan t (" I am consciou s that in writing this article, I have not said muc h tha t i s new"). But doctors still neede d hel p i n giving "sound , practica l advice " to overweigh t patients; man y wer e stil l embarrasse d b y lac k o f concret e guide lines. Henc e th e justificatio n fo r repeatin g wha t by 1915 seemed t o be "common sens e views." 22 Crucial t o th e growin g acceptanc e o f th e nee d t o dea l wit h weight problems was the commo n recognitio n o f adverse result s of excess. "Accumulation s o f fa t aroun d th e hear t an d intestine s im pede the actions of these organs. The ponderous body is sometimes too heav y fo r th e legs ; lazines s results , leadin g occasionall y t o fatty degeneratio n o f important muscles , including th e heart. " Th e counterindications o f excess fat for diabetes were also widely noted. Doctors added, however, some more general consideration s a s they picked u p message s abou t weigh t ideal s fro m th e cultur e aroun d them. Henc e "[t]h e bodil y weigh t shoul d b e reduce d a s soo n a s there i s a surplus o f fat, whic h i s displeasing t o the ey e or mars th e harmony o f the body. " Or, a s another die t pitch pu t it : "To be thi n is fashionable . Likewise , i f no t carrie d to o far , i t i s conduciv e t o comfort an d longevity." 23 Doctors stil l ha d t o lamen t th e recalcitranc e o f man y patients . One wrot e o f a class o f corpulent person s "wh o ar e ver y stout, ye t are activ e an d otherwis e healthy. " Thes e wer e ver y har d t o dea l with, and ofte n coul d a t best be submitted t o a regimen preventin g the furthe r accumulatio n o f fat . Longing s fo r institutionalizatio n continued t o surface, fo r i t was difficult t o keep patients t o a diet at home given temptations and family pressures ("t o be less strict than the physicia n ha s directed") . Patient s mus t b e determined , an d people i n thei r thirtie s wer e ofte n particularl y disobedient , bu t the healt h imperative s coul d no t b e ignored . Circulator y disease s including stres s on th e hear t mus t be recognized , ideall y by reducing weight "before an y signs of failing compensatio n appear. " Lowered bloo d pressur e wa s a frequen t benefit , an d indicator , o f successful weigh t loss , a s doctor s multiplie d thei r cas e studie s o f th e

42 I The Medical Path: Physicians and Faddists methods an d healt h gain s o f weigh t reductio n i n adults . "I t i s no t necessary t o resor t t o bizarre , frea k diet s i n orde r t o accomplis h a reduction i n weight . . . . Rationa l measures , tha t follo w know n physiologic laws , consistentl y observed , ar e safe r and , i n th e end , more effective. " Th e medica l approach , confiden t i f undramatic , was secure. 24 The elaboratio n an d increasin g routinizatio n o f doctors 7 ap proach t o overweigh t wa s highlighte d b y th e standar d productio n of weigh t an d calori e tables , whic h varie d slightl y accordin g t o which exper t wa s involved , bu t whic h al l recognize d th e nee d fo r reasonably precis e measurement s an d controls . Dict a fro m insur ance companie s supporte d thi s approac h an d undoubtedl y helpe d both doctor s an d th e genera l publi c realiz e th e healt h conse quences o f obesity . A lif e insuranc e examiners ' manua l a s earl y a s 1898 argue d tha t anythin g mor e tha n 2 0 percen t abov e standar d weight table s mus t b e deeme d excessive . B y 191 2 th e Actuaria l Society o f America , thoug h throug h a rathe r flawed study , at tempted conclusivel y t o prov e a n exac t correlatio n betwee n th e amount overweigh t an d th e ris k o f premature mortality . Th e devel opment o f growin g nutritiona l expertise , includin g burgeonin g home economic s claim s an d th e emergenc e o f professiona l dieti tians, o n th e whol e supporte d th e medica l approac h i n arguin g fo r a cautiou s an d scientifi c approac h t o eating . I n 1911 , Henry Sher man, a Columbi a Universit y chemis t involve d i n th e expansio n o f home economics , publishe d a mor e definitiv e statemen t o f die t requirements, an d thi s adde d bot h clarit y an d credibilit y t o th e medical offensiv e agains t fat . Sherman' s book , The Chemistry of Food and Nutrition, avoide d th e faddis t excesse s o f Chittende n b y admitting a highe r amoun t o f dail y protei n whil e als o supportin g the genera l ple a fo r reduce d foo d consumption . Th e boo k rapidl y became th e standar d referenc e i n hom e economic s courses . I n 1914 Sherma n use d hi s prestig e t o urg e tha t American s halv e thei r current consumptio n o f meat. 25 One final sig n o f th e shif t i n medica l opinio n wa s ver y simple . Not onl y had doctor s increasingl y accepte d th e widesprea d hostilit y to fa t an d give n i t ne w medica l justifications . The y ha d als o re versed thei r lat e nineteenth-centur y preference s whe n i t cam e t o

The Medical Path: Physicians and Faddists | 4 3 exercise. Physical activit y remained important , bu t th e crucia l em phasis now rested o n restrain t and goo d sense i n eating . A Chicago doctor pu t th e ne w prioritie s simply , i f unwittingly: "Th e method s at our disposa l fo r reducin g obesit y ar e chiefl y dietetic . Secon d i n importance i s th e regulatio n o f th e muscula r exercise. " Certainl y the earlie r belie f tha t physica l activit y wa s alon e sufficien t fo r health, regardles s o f weight , wa s definitivel y buried. 26 Thi s shif t followed fro m th e ne w experimenta l interes t i n nutritio n and , probably, fro m th e increasin g demand s o f patients eage r fo r direc t attacks o n thei r exces s poundage . I t set the stag e fo r furthe r atten tion t o foo d restrain t fo r peopl e lackin g th e tim e o r inclinatio n t o exercise, and i t gave doctor s a greater rol e (i n guardin g th e weigh t charts an d handin g ou t die t sheets , al l tidil y measure d i n th e bes t scientific-quantitative fashion ) tha n the y migh t hav e ha d i n mor e generalized recommendation s abou t exercise. While physical activity continued t o be urged , th e balanc e o f attention shifte d t o foo d intake unti l lat e in the twentieth century .

Doctors and Causation The evolutio n an d disseminatio n o f medical idea s abou t fa t migh t suggest a broade r patter n o f "medicalization, " b y whic h doctor s seized o n ne w informatio n an d use d i t t o browbea t a n innocen t public int o novel anxieties the treatment of which, not surprisingly, extended physicians ' powe r an d profit . Thi s i s a n interpretatio n that ha s bee n used , ofte n wit h som e exaggeration , concernin g doctors7 inroad s i n sexualit y an d birt h contro l o r eve n aspect s o f mental illness. 27 As doctors saw how monitoring weigh t could giv e them leverag e over a host of lifestyle issues , some surely argued fo r reasons that were no t purely scientific . Certainl y th e nee d t o combat competitio n i n th e die t are a — to labe l mos t o f th e faddist s charlatans an d quack s — built o n a classi c medicalizatio n impuls e to circl e wagon s aroun d professiona l boundaries . An d ther e i s n o question that , i n turnin g t o attack s o n overeating , doctor s bega n after 190 0 t o addres s a middle-clas s clientel e tha t wa s potentiall y much mor e rewardin g tha n th e working-clas s group s t o who m

44 I The Medical Path: Physicians and Faddists earlier nutritiona l advic e ha d bee n directed . I t wa s surel y mor e satisfying an d potentiall y mor e profitabl e t o belabo r middle-clas s excess ( a favorite physicians ' target , a s Victorian sexua l constraint s demonstrated) tha n to continue to worry about the diet deficiencie s of urba n immigrants , th e mor e commo n publi c healt h target s o f the 1890s. 28 Finally, the gle e and, often , th e imprecisio n wit h whic h doctor s tossed aroun d th e wor d obesity , a t leas t i n thei r professiona l an d popular articles , migh t sugges t a characteristi c plo y o f medicaliza tion. T o b e sure , doctor s di d no t rus h t o cal l obesit y a disease , a s opposed t o callin g i t a contributo r t o disease . Bu t th e ter m wa s deliberately extreme , eve n a s i t wa s applie d t o peopl e wh o i n laymen's term s migh t hav e bee n describe d a s stou t o r plump . As body-weight tables developed, obesity gained mor e exact meanings, normally referrin g t o peopl e 2 0 percen t o r mor e abov e desire d weight. I t wa s tru e tha t earlie r i n th e nineteent h centur y obesit y had describe d extrem e conditions ; that i t now migh t b e applie d t o more modes t and standar d problem s o f overweight pointed t o a bit of medical hyperbol e designe d t o increas e professiona l an d publi c alarm. Though popula r us e o f the wor d obes e did , i n fact , remai n more restrained , doctors ' labelin g coul d wel l hav e ha d a n effec t within th e medica l communit y itself . From thi s point on , i n medi cal writin g an d i n muc h popula r comment , extrem e obesit y wa s commonly use d t o illustrat e th e sam e ter m tha t wa s applie d t o people wh o wer e no t drasticall y overweight . Thu s article s o n obe sity frequently detaile d elephantin e 35 0 pounders, implyin g b y the term a intimat e connectio n wit h mor e normal , fa r les s extrem e weight problems . Thi s conflatio n helpe d scar e th e norma l over weight—Fm no t jus t fat , F m obes e —and probabl y encourage d doctors themselves to think i n urgent, hyperbolic terms . On th e whole , however , a medicalization mode l doe s no t work well i n explainin g th e initia l stage s o f th e campaig n agains t fa t and doctors ' growin g involvemen t i n it . Rather , i t applie s t o th e intensification o f effort s fro m 192 0 onward . Medica l view s di d change befor e 1920 , an d thi s wa s importan t i n wha t doctor s di d with thei r patients an d ho w they informed th e genera l public . Th e changes adde d importan t motivation s t o th e growin g concer n

The Medical Path: Physicians and Faddists | 4 5 about weigh t control . I t became harde r an d harde r t o believ e tha t one coul d b e full y health y i f significantly overweigh t Callin g thi s condition obesit y in an appeal fo r treatment confirme d thi s diagnosis and helpe d cal l i t to general attention . Yet doctors move d int o th e die t are a somewha t hesitantly ; wit h some individua l exceptions , they lagged a full decad e behin d fash ion standards . No r i s there muc h evidenc e tha t healt h argument s really spurre d th e initia l die t campaig n (i n contrast , fo r example , to matter s o f sexuality, wher e healt h belief s loome d larg e i n nine teenth-century discussion s o f th e danger s o f youthfu l excess). 29 Rather, the y supplemente d othe r reasoning . Doctor s themselves , in toutin g th e ne w wisdo m abou t thinnes s an d beauty , picke d u p at least as much fro m th e genera l cultur e a s they contribute d t o i t during th e transitio n year s i n medica l discussion s betwee n 189 5 and 1920 .

Indeed, muc h o f the causatio n o f the growin g medica l concer n about weigh t cam e fro m patien t pressure , rathe r tha n th e othe r way around. O f course, nutritional an d actuaria l discoverie s played a role , and th e increase d attentio n t o degenerative disease , particularly cardiovascula r disease , migh t wel l hav e prompte d physician s to reconside r fa t i n an y event . Bu t demand s fro m middle-clas s clientele frequentl y playe d a prominen t role . Thes e report s esca lated afte r 192 0 t o b e sure , bu t patients ' striving s fo r slendernes s clearly bega n t o affect doctors ' thinking soo n afte r 1900 . It was not uncommon, fo r example , for doctors to discuss seeing patients who sought die t advic e simpl y "becaus e i t i s stylis h t o b e thin. " Som e denigrated suc h types, as opposed t o people who suffered physicall y from excessiv e fat , arguin g a lac k o f sympath y fo r suc h patients . More neutrally , a docto r discussin g th e variou s reason s fo r treat ment o f overweight (whic h focuse d ultimatel y o n possible injuries , diabetes, an d circulator y disorders , alon g wit h insuranc e statistic s on mortality ) starte d ou t wit h "persona l appearanc e an d comfort" : "Fashion an d styl e hav e mad e th e publi c 'weigh t conscious / Th e modern desire , particularly of the female o f the species, is slimness. It is undesirable t o require specia l clothes , restrict social and recre ational activitie s an d b e th e targe t o f jokes. " O r mor e simply : "Overweight i s one o f the mos t commo n symptom s fo r whic h th e

46 I The Medical Path: Physicians and Faddists practitioner i s consulted . I t i s looked upo n . . . a s mor e o r les s o f a joke." Given th e pressure s t o see k remed y an d th e availabilit y o f all sorts o f diet s an d drug s tha t migh t caus e seriou s complications , doctors ha d n o choic e bu t t o atten d t o thei r patients ' demands , however marginall y relate d t o basi c health . Or , a s ye t anothe r nutritionist noted , "Overweigh t an d method s o f reducin g hav e be come question s o f importanc e i n professiona l circles , largel y due , no doubt , t o th e fac t tha t the y hav e bee n give n s o muc h attentio n in nonprofessiona l circles . Whethe r thi s attentio n ma y b e attrib uted t o mor e interes t an d intelligenc e i n matter s pertainin g t o health, t o fashion' s decre e o r t o othe r causes , th e fac t remain s tha t discussion o f these subject s ha s bee n widespread. " Th e publi c pres s and advertisin g wer e widel y cite d a s th e basi s fo r patients ' appeal s for medica l help , whic h doctor s mus t the n atten d to , aided b y thei r own knowledg e tha t overeatin g an d overweigh t coul d b e significan t medical problems , fashio n o r no. 3 0 Most important , asid e fro m shee r absorptio n o f publi c concer n about overweight , wa s th e lin k betwee n th e growin g cultura l hostil ity t o fa t an d physicians ' often-expresse d mora l disdai n fo r thei r obese patients . Thi s wa s a hostility , further , tha t steadil y increase d as th e focu s o n hereditar y o r glandula r overweigh t decline d an d a s doctors acquire d mor e experienc e wit h patient s wh o simpl y coul d not stic k t o th e diet s tha t ha d bee n urge d upo n them . Som e medical summarie s shifte d terminology , callin g th e overweigh t tha t resulted "simply " fro m excessiv e eatin g an d inadequat e exercis e "indolence obesity. " Patient s sufferin g fro m thi s shoul d shap e up , and i f they coul d not , a characte r deficienc y wa s clearl y indicated . "Since overweigh t i s essentiall y a n inde x o f wron g living, " though t physicians, a plum p businessma n wa s no t a n inde x o f financial prosperity bu t rathe r a "sig n o f physica l bankruptcy. " O f course , i n many obes e individual s "th e malady " wa s " a characte r defect , a n evidence o f lac k o f self-control. " Thi s wa s th e group , s o on e physi cian argued , wh o followe d on e fa d afte r another , neve r stickin g t o anything. Th e grou p migh t indee d b e lef t t o th e faddists , s o tha t doctors coul d "restric t ou r effort s t o helpin g thos e wh o ca n appreci ate th e importanc e o f adherin g t o dietar y restriction s base d upo n accepted scientifi c principles." 31

The Medical Path: Physicians and Faddists | 4 7 In sum , betwee n 190 0 and th e 1920 s doctors contribute d t o th e growing awarenes s o f overweigh t a s a publi c an d persona l issue . They amplifie d th e reason s fo r concer n an d provide d suppor t fo r careful nutritiona l solutions , based o n growin g attentio n t o degen erative healt h problem s an d th e scientifi c stud y o f foods . A t th e same time , the y joine d i n a campaig n agains t fa t tha t ha d alread y been launched , an d the y responde d t o popula r anxiety , includin g attention-getting faddists , eve n a s they furthe r define d thi s anxiety . In th e process , the y echoe d som e o f th e disgus t tha t th e ne w popular perception s o f fa t ha d involved , anchore d b y a revulsio n against lac k o f self-control . The y mirrored , an d doubtles s encour aged, th e emotiona l o r ethica l sid e o f th e revulsio n agains t over weight. Fa t patient s an d thei r concerns , includin g thei r fashio n concerns, could no t be avoided. They might be helped. They were not, unless they quickly reformed, wel l liked.

3

Fat a s a Turn-of-the-Centur y Target: Why?

What cause d a growing numbe r o f Americans, i n a growing num ber o f fields from fashio n t o medicin e t o bodybuilding , t o pu t fa t in th e fire aroun d 1900 ? The explanatio n fo r a dee p an d durabl e revulsion against excessive weight has not been resolve d in previous work, partl y becaus e i t i s inherentl y complex . Ha d a n interes t i n dieting been a passing fad — like the precedin g approva l o f plumpness, whic h develope d i n th e 1860 s —a brie f referenc e t o th e whimsy o f fashio n migh t suffice . Bu t th e ne w anxietie s abou t weight affecte d America n consciousnes s mor e profoundly , whic h is why they have lasted fo r a full centur y an d stil l burn bright . Th e inquiry into causation wil l not only help to explain the change, but also wil l produc e fulle r understandin g o f what th e chang e wa s all about.

Organizing the Inquiry The adven t of a lasting hostility to fat involve d a number o f factors, and some of the most important ones operated beneath th e surface . Two question s stan d out : wh y th e timing ? an d wh y th e durabilit y and intensity ? After all , a previous disapprova l o f thinness ha d no t led t o constan t preachments . Ther e wa s aestheti c comment , a concern abou t health , bu t n o passionate crusade . The tur n agains t fat wa s anothe r matter , involvin g a n essentiall y mora l condemna tion virtually from th e outset . Part o f th e explanatio n fo r th e campaig n lie s withou t questio n 48

Fat as a Tum-of-the-Century Target: Why? | 4 9 in preceding movements , going back to the imag e of thinness lon g associated wit h sufferin g Christianit y an d saintl y virtue . A repository o f publi c aestheti c memor y wa s reengage d towar d th e en d of th e nineteent h century . Earlie r nutritionis t fad s (lik e Sylveste r Graham's), thoug h no t initiall y directe d explicitl y towar d weigh t control, wer e revise d an d reworked , a s som e o f th e late r faddist s (like Kellogg ) clearl y demonstrated . Increasingly , demandin g mid dle-class etiquett e wa s applie d t o meals , whic h helpe d conditio n the America n publi c t o ne w self-control . Growin g interes t i n ath leticism (fo r bot h me n an d women , thoug h i n separat e categories ) had develope d durin g th e 1860 s an d 1870s . This, too , coul d hav e supported hostilit y t o fat , thoug h thi s wa s no t chronologicall y a n immediate effect . A leading historia n o f women's fashio n doe s cit e the final triump h o f athleticis m a s th e sol e caus e o f th e shif t i n styles, but i n a passing referenc e tha t prove s ultimatel y unsatisfac tory.1 Precedent s se t a stage for redefinin g th e idea l bod y and hel p account fo r wh y food wa s singled ou t for ne w constraints , but the y hardly explai n wh y th e redefinition s occurre d whe n the y di d o r why they took hold an d endured . The nee d t o probe furthe r tha n precedent s ca n b e readil y dem onstrated b y suggesting a hypothetical scenario . I f around th e yea r 2000 America n taste s suddenl y turne d towar d greate r plumpness , excoriating weigh t contro l a s no t onl y a commercia l bu t als o a n aesthetic an d medica l nightmar e ( a shif t tha t migh t certainl y b e welcome t o aging baby boomers), and i f flab remained fashionabl e for man y decades , a n explanatio n tha t merel y cite d preceden t would immediatel y see m unsatisfactory . Despit e nod s to the earlie r aesthetic tradition s o f Raphae l an d Rubens , an d t o th e theatrica l preferences o f th e America n publi c befor e 1890 , analyst s woul d inevitably clai m th e nee d t o find more , t o see k mor e subtl e an d varied factors fo r a cause. The desultor y searc h fo r th e caus e o f th e antifa t crusad e ha s been undeniabl y complicate d b y th e gende r factor . Muc h o f th e identification o f the 1890 s as a turning point for fat has occurred i n the contex t o f women' s fashio n histor y (an d som e o f th e wor k involved i s ver y goo d indeed) . Becaus e Victoria n wome n wer e undeniably pu t upo n b y men i n certai n ways , particularly i n thei r

5 123> 132-33, 136, 194 Albert-Birot, Pierre , 171 allowances, 57 , 145 Almanack des gourmands, 227 Alsace, 192 American Airlines , 116 American Electro-Therapeuti c Association , 36 amphetamines, 105 , 179 anger, 85 , 209 anorexia nervosa , vii , 3 , 7, 8, 50 , 72, 100, 143, 25 2 Anthony, Susan , 9 anti-Americanism, 229 anti-Semitism, 239-4 0 Appalachia, 136 Apple Computer , 115 aristocracy, 166 , 220 army, U.S. , 26, 34, 100, 115 art, 160 , 220-21 artisans, 220, 223, 240 Association Allegr o fortissimo , 216 Atlas, Charles, 75 , 76, 105 Atwater, Wilbur, 29 , 34 Baker, Bettye , 121 Banting, William, 11 , 14, 74, 158

bantingism, 8 , 11 Barbie dolls , 84 Bardot, Brigitte , 180 , 182 Barth, Kay , 101 bathing suits , 87 , 99, 170, 179, 182-83 Bayard, Emile , 161 Bayliss, Jessica, 105 beauty contests , 72 , 218 belts, 99 , 175 Bergman, Ingrid , 180 Bergonnie machine , 161 Bernhardt, Sarah , 12 , 159 bicycles, 12 , 23, 57, 161, 17 5 Binion, Rudolph , 16 0 birth control , 62-63 , $6 , 93, 138, 153, 156 , 160, 191 , 221 , 24 2

blood pressure , 26, 36, 41, 81, 101, 109, 162 boarding houses , 229 body, standardization of , 24 9 books, 107 Bouchard, Charles , 157 , 164 boys. See me n bread, 155 , 161, 171, 181, 203, 213, 22 5 Brillat-Savarin, 164 , 172, 204, 224-25, 227, 228 Britain, 245 "broad," 81 Bruch, Hilde , 117 , 119, 206 bulimia, 104 , 252 Bush, Barbara , 103 businessmen, 54 , 75 butter, 223 Byron (Lord) , 6

289

290 I Index calisthenics, 1 2 calories, 27 , 30 , 36 , 39 , 111 , 124, 154 , 172, 180, 182 , 186 , 21 3 Calvinism, 55 , 243 camps, 82 , 122 Canada, 229 cancer, 101 , 215 candy, 143-44 , 19 7 Catabolic diet , 3 2 Catholicism, 221 , 240, 24 3

corsetry, 7 , 9, 13 , 14, 17, 18, 19, 92, 158-59, 166, 17 5 cosmetics, 88 , 174 Cosmopolitan, 34 , 35, 117 Courbet, Gustave , 183 crackers, 230 creams, 105-6 , 184, 185, 187, 206-7 cubism, 160 , 220 cuisine, 155 , 186, 188, 207, 223 culotte de chewl, 184 , 205

causation, 4-5 , 18 , 43-47, 48 , 68 , 84-89 , 195, 201 , 213, 217-4 6 cellulite, 179 , 184 , 185 , 186 , 20 7 character, 46 , 54 , 60 , 65 , 114 , 117 , 126 , 168 , 202-3, 2 ^5 chefs, 22 3 chewing, 33 , 19 7 chic, 22 0 Child Stud y Association , 7 6 children, 6 , 30 , 31 , 57-58, 63 , 75-78 , 85 , 96-97, 100 , 133 , 137-45, 156 , 162 , 172, 179, 184 , 195-201 , 218-19, 226 , 231 , 248, 258-59 Chittenden pills , 2 0 Chittenden, Russell , 29 , 34 , 36 , 37 , 38 , 163 chocolate, 23 0

death, 26 , 80, 162 Deboux, Gaston , 173 degenerative disease , 26, 45, 101, 16 5 Deneuve, Catherine , 185 Department o f Agriculture, 29 department stores , 57 , 237-38 Depression (1930s) , 143, 193 depression, 147 , 252 Desbonnet gyms , 162 dietetics, 233 disgust, 83 , 171, 183, 205, 232-46 Disney, 8 4 divorce, 58 doctors, 25-44, 53 , 59, 66, 74-75, 79-81 , 101, 105 , 108 , 110 , 111 , 114 , 116 , 120 , 124 , 134, 144 , 157 , 162-64 , 165 , 168 , 171-72 ,

cholesterol, 100 , 102 , 110 , 181-82 , 21 5

177-78, 184 , 189 , 190 , 199 , 202-4 , 219 ,

Christianity, 5-6 , 49 , 54 , 59 , 97 , 15 3

2

Christmas, 5 7 chrome pill , 185 , 20 7 Cinderella, 8 3 class structure , 24 5 Clinton, Bill , 10 3

54-55 dolls, 57 , 89 drinking, 62 , 156, 218 Dubin, Al , 88 Durkheim, Emile , 239 Durville, Gaston , 16 4

C l u b dietetique , 20 9 Club Med , 13 5 clubs, 8 2 coca cola , 18 0 Cocroft, Susanna , 19 , 74 , 10 5 Cocteau, Jean , 22 0 Colette, 22 0

Communist party , 174 , 193 Comstock, Anthony , 12 , 56, 62 consumerism, 54-59 , 67, 71, 87-88, 96, 108, 117, 147-48, 155, 237-44, 2 45 cookbooks, 82 , 99, 105, 233 Corbett, Gentlema n Jim , 11

Ebony, 89-92 , 123 Edsell, David , 3 7 Eisenhower, Dwight , 14 9 Elias, Norbert , 24 9 Emerson, Ralp h Waldo , 10 emotion, 4 , 54 , 78, 85, 118, 141, 203, 206, 214, 251-52 endocrine causes , 30 Enlightenment, 157 , 250 Esquire, 82, 99 Eugenie, empress , 50 , 159 Euro-Disney, xi , 228

Index | exercise, 38 , 40 , 49 , 52-53 , 105 , 107 , 120 , 137, 161 , 162, 169 , 175 , 182 , 185-86 , 198 , 203, 207 , 21 5

29 1

guilt, 63 , 65 , 68 , 71 , 80, 87 , 94 , 109 , 121, 122, 147 , 160 , 195 , 200, 209 , 24 3 gum, 23 1 Guttmacher, Alan , 8 1

face lifts , 18 5 faddists, 17-21 , 25 , 32-40 , 7 9

hair, 8 8

fashion, 3 , 7 , 11-17 , 45> 4^ > 5 1-52> 55 > 5^ >

Hall, G . Stanley , 6 0

74, 79 , 80 , 89 , 99 , 103 , 158 , 165-67 , 168 70, 179 , 181 , 189, 204-5 , 21 9 -2 3> H

2

fast foods , 118 , 217 fasting, 6

Hardy boys , 7 8 Hawaii, 104 , 13 6 heart, 41 , 80, 100 , 109 , 110 , 156 , 162 , 169 , 172, 182 , 215

Fat Man' s C l u b , 2 2

Heckel, Francis , 166 , 20 4

fatigue, 16 9

Hepburn, Audrey , 18 0

feminism, viii-ix , 13 , 72, 73 , 95 , 128 , 158,

Herschberg, A . D. , 20 3

161, 190 , 24 1

Heudebert, 16 1

Femme chez elle, La, 17 5

Hispanic Americans , 132-33 , 136 , 194 , 229

flappers, 73 , 8 7

h o m e economics , 4 2

Flavettes, 3 6

homeopathy, 15 7

flesh, 11 4

homosexuality, 54 , 25 2

Fletcher, Horace , 32-35 , 36 , 37 , 38 , 51 , 54, 61, 74 , 105 , 163 , 20 4

Hoover, Herbert , 10 3 hospitals, 2 7

fletcherism, 8 , 3 3

Humphris, Francis , 3 6

flight attendants , 11 5

Hutchinson, Woods , 31-3 2

foods, 10 , 95 , 114 , 155 , 196, 223-3 6 football, 76 , 78 , 94 , 102 , 17 3

immigrants, 194 , 229 , 234-3 5

foreplay, 9 7

indolence obesity , 4 6

Fraley, Helen , 118 , 119 , 121 , 122, 124

Infant Care, 14 0

Franklin, Benjamin , 5

infant mortality , 26 , 13 9

fundamentalism, 9 7

Institut de Jaegere, 17 8 insurance, 39 , 42 , 80 , 105 , 111 , 115, 179 , 211

Galen, 15 7

International Slimmin g Centers , 18 4

Gautier, Theophile , 15 8 genetics, 25 5

James, Elsie , 1 2

geriatrics, 2 6

James, Henry , 3 4

Gibson, Charles , 1 2

James, William , 34 , 3 5

Gibson Girl , 1 2

Jansenism, 24 3

Gilbert-Dreyfus, 182 , 202 , 203 , 20 7

Jawas, Dr. , 17 5

Gilman, Charlotte , 6 3

jealousy, 85 , 20 9

girdles. See corsetr y

jeans, 18 2

girls. See wome n

Jenny Craig , 72 , 10 8

Godey's Lady's Book, 7 , 1 0

Jews, 162 , 19 4

gourmands, 163 , 164 , 176 , 19 8

Journal of the American Medical Associa-

Gourmet, 23 7

tion, 3 7

gouter, 197 , 19 8 Graham, Sylvester , 7-8 , 34 , 49 , 54 , 60 , 62 , 224, 23 3 Grimod d e l a Reyniere , 22 5

Kellogg, Joh n Harvey , 35-36 , 4 9 Ken doll , 8 4 Kissiengen water , 1 8

292 I Index kleptomania, 57 , 237-3 8

Metchnikoff, Elie , 35 , 16 4

Ku Klu x Klan , 9 3

Metrecal, 10 7

Labbe, M. , 16 4

military (French) , 162 , 17 3

Metropolitan Life , 106 , 111-13 , 129 , 131 , 202 Ladies Home Journal, 14-15 , 16 , 18, 33 , 34 , 75, 88 , 99 , 105 , 109 , 119 , 122 , 124

milk, 196-9 7 Millman, Marcia , 7 3

Lalanne, Jack , 10 7

Miss America , 7 2

Langtry, Lillie , 9

Mississippi, 13 6

"lardass," 10 0

Miss Universe , 21 8

Latin America , 229

Mitchell, S . Weir , 9

laziness, 14 , 15 , 41, 52 , 59-60 , 62 , 66 , 75 ,

models, xi , 90 , 99 , 110 , 121 , 153, 166, 175 ,

83, 107 , 16 7

180

Lears, Jackson , 5 9

Modes et travaux, 193-9 4

leisure, 58-59 , 190 , 22 2

Moll-Weiss, Augusta , 19 8

Lenoir, Dr. , 16 2

morality, 125-26 , 148-49 , 191 , 202-3, 221,

Leroy-Beaulieu, Anatole , 27 9 Lindlahr, Henry , 32 , 7 4 liver, 156 , 172 , 218 longevity, 253-5 4 "love wanted, " 25 1 low-calorie foods , 107 , 135 , 17 9 Lowry, Edith , 2 2

2

37-45

Moritz, Franz , 28 Moron, Jacques , 20 3 Mosher survey , 6 2 Mother's Day , 8 6 motherhood, 63 , 86-87 , 92—93 , 109, 139 , 141, 159 , 167 , 190 , 196 , 198 , 200 , 206 , 22 1

Lyon, Josette , 178 , 182 , 18 5

movies, 75 , 109 , 22 7

Lyon, Maclay , 31 , 37

muscular Christianity , 5 9 music, 88 , 18 0

Mallarme, 22 0 malnutrition, 27 , 76 , 78 , 139-40 , 143 , 229, 2

34

Mamola tablets , 2 0 manners, 7 , 49 , 79 , 224 , 24 9 Marie Claire, 178-79 , 182-83 , 186 , 18 9

Nabisco, 230-3 1 National Associatio n t o Ai d Fa t Americans , 215 neurasthenia, 7 5 New Englan d Hospital , 2 7

Marie-France, 17 8

Nissenbaum, Stephen , 7

marriage, 86-87 , 9 2> 101_2> n o > 121 > 2 ° 6 , 22 1

Nivernais, 15 5

Martineau, Harriet , 22 8

nouvelle cuisine , 181 , 227

mastectomies, 22 2

nudity, 22 2

Mathieu, Albert , 16 3

Nutrasweet, 18 0

Mathieu, Paul , 169 , 17 1

nutrition, 27-29 , 33 , 42-43, 59 , 106 , 158 ,

Matisse, 160 , 171 , 220 matriarchy, 16 7 Mazrui, Ali , 9 2 McC all's, 10 7 Macfadden, Bernarr , 17,18,19 , 21, 51 , 74, 7 6

2

33"34

obesity, xi , 16 , 27 , 28 , 29 , 30-31 , 32 , 38 , 39 , 40, 44 , 75-77 , 90 , 111 , 120, 136 , 141 , 144, 157, 162 , 164 , 182 , 211-14 , 2 5 2

Meadows, Rosalyn , 7 3

obstetricians, 81 , 183

meat, 28 , 33 , 114 , 156 , 197 , 201 , 215, 225, 22 7

Overeaters Anonymous , 108 , 110 , 122 , 210

men, 16-17 , 19, 72 , 75-76 , 85 , 88 , 91 , 92, 96, 98-104 , 162 , 169 , 173 , 189-9 1 Men's Health Magazine, 10 4

pacifier, 19 8 painting, 8 , 1 1

Index | 29 3 Parents' Magazine, 14 4

Rubrier, Max , 2 7

pathology, 15 7

Rush, Benjamin , 157 , 229

Patten, Simon , 22 , 6 1

Russell, Lillian , 11 , 20, 22 , 7 4

peasants, 155 , 196 , 22 6 pediatricians, 141-42 , 19 9

Saint-Cyr, 20 1

Pediatrics, JJ

salons, 17 , 20, 9 7

Perin, Michel , 18 8

Sargent, 1 1

Philadelphia Cook

scales, 20 , 27 , 105 , 149 , 176 , 18 4

Book, 2 2

Phillips, Davi d Graham , 22 , 5 4

Scarsdale diet , 20 7

Physical Culture , 1 7

schools, 143 , 197 , 20 1

pie, 10 , 22 6

Schwartz, Hillel , 4 , 50 , 51 , 127

Pittsburgh Press , 1 9

Scientific American, 3 4

plumpness, 8 , 24 , 26 , 54 , 75 , 153 , 166-67 ,

Second Empire , 159 , 22 0

193, 200 , 22 5

Seneca, 15 7

Pocahantas, 8 4

Seventeen, 107 , 11 9

Poiret, Paul , 15 9

sexism, 7 7

politics, 221 , 243-44, 25 9

sexuality, 4 , 7 , 43 , 45 , 54 , 56 , 62-63 , $3 >

population (French) , 156 , 159 , 221

86-87, 93-94 , 162 , 109-10 , 169 , 22 2

populism, 24 1

Sherman, Henry , 4 2

pornography, 12 , 62 , 22 2

sin, 6 , 64-65 , 122 , 14 7

Post, Emily , 7 9

Sinclair, Upton , 35 , 37 , 5 4

posture, 4

slob, 17 , 21, 50 , 74 , 12 0

power, 8 8

sluts, 8 7

pregnancy, 7 , 8 , 81 , 109, 124 , 18 3

smoking, 24 , 25 , 91 , 117, 213, 214, 244 , 25 7

Presbyterians, 5 4

snacks, x , 135 , 137 , 143-45 , 184 , 156 , 197 ,

Proust, Marcel , 22 0

201, 213 , 228, 230-32 , 257-5 8

psychiatry, 83 , 101 , 118-19, 2 ° 6

soap, 160 , 17 5

psychology, 202 , 206 , 23 8

socialism, 239-4 0

puericulture, 156 , 193 , 196-20 1

speeding, 25 4

Puritanism, 6 , 243 , 24 4

sphygmomanometer, 10 2

Quetelet, A. , 157 , 211-12

sports, 12 , 38 , 40 , 76 , 78 , 94 , 175 , 17 8

race, 89-9 3

starches, 11 4

Spock, Benjamin , 143-4 4 Stanton, Elizabet h Cady , 8 ready-to-wear, 18 , 181

Stowe, Harrie t Beecher , 7

Reconstruction, 9 2

sugar, 161 , 226, 24 6

religion, 5-6 , 49 , 54-56 , 60 , 62 , 65 , 83 , 90 , 107, 109 , 120 , 121 , 147, 240 , 241 , 247, 25 1

Sullivan, Joh n L. , 9 , 11 , 16 sundae, 17 5

Rengo products , 1 9

Superman, 10 2

restaurants, 223 , 227

surgery, 184 , 186 , 207 , 22 2

Rockefeller, Joh n D. , 3 3 rock stars , 10 2

Tart, Willia m Howard , 5 , 22 , 10 3

Rodgers an d Hammerstein , 8 9

tailors, 173-74 , 18 9

Romanticism, 6 , 15 8

tanning, 25 4

Roosevelt, Theodore , 1 7

television, 102 , 145 , 222

Roper, Mrs. , 1 5

temperance, 55 , 6 2

Rubens, Pete r Paul , 8

thyroid pills , 163 , 170 , 172 , 175 , 17 8

294 I Index time (eating) , 217 , 229

Warren, Harry , 8 8

toplessness, 182 , 217

Warren, Mrs. , 15 , 18

toys, 5 7

water cures , 8

Tramar, Countes s de , 166-6 7

Watson, James , 8 6

Tremolieres, Jean , 182 , 190 , 202 , 24 2

weaning, 19 7

triscuits, 16 1

weight, pattern s of , 129-3 4

Trollope, Anthony , 23 0

weight tables , 37 , 42 , 44 , 74 , 99 , 111-13 ,

tuberculosis, 26 , 140 , 156 , 19 6 Turner, Lana , 7 3

129-34, 146 , 157 , 179 , 182 , 202- 3 Weight Watchers , 72 , 107-8 , 180 , 184 , 20 9

Weil belt , 9 9 U-Haul renta l company , 11 5

Weiss, Lillie , 7 3

ugliness, 205 , 210 , 21 6

wellness programs , 11 5

underweight, 76-77 , 111 , 142-43, 199 , 25 3

West Point , 20 1

unemployment, 14 8

West Virginia , 13 6

vacations, 182 , 193 , 222

Wheeler, Elmer , 101- 3

Wharton, Edith , 2 3 van Noorden , Karl , 28 , 38

Wolf, Naomi , 7 3

Veblen, Thorsten , 59 , 24 1

women, 4 , 11-17 , 49-50, 63-64 , 71-97 , 100 ,

vegetarianism, 33 , 36 , 16 4

115, 144 , 155 , 156 , 161 , 166-67, x 68, 177 ,

vibrators, 20 , 7 4

179, 184 , 189-91 , 192 , 198 , 215 , 221, 225,

Vichy water , 1 8

232, 237 , 241-4 2

Victorianism, 5 , 7 , 44 , 57 , 62 , 83 , 85 , 88 ,

work, 58-59 , 92 , 96 , 114-15 , 121 , 217, 248 , 256-57

93-94 Vittel, 16 1 Vogue, 13 , 170 Voit, Carl , 2 8

Worth, Mary , 8 4

Volney, Constantine , 228 , 229

Wright, Thomas , 6

World Wa r I , 23 , 2 6 World Wa r II , 105 , 17 7

Votre beaute, 169 , 17 0 Yoruba, 9 2 Wadsworth, Ruth , 8 0 Walker, E m m a , 1 5

Zeno, Michelle , 7 0

Wallace, Mrs . (plan) , 10 5

Zola, Emile , 159-60 , 190 , 23 8