Reviewed by Corinna Treitel (Washington University - St. Louis)
Published on H-German (April, 2010)
Commissioned by Benita Blessing (Oregon State University)
Making Obesity History
In his long and illustrious career, Sander Gilman has taken on many roles: literary analyst, cultural historian, and even public intellectual. In his new book, Fat: A Cultural History of Obesity, he operates as all three. Trained in Germanistik (German studies), he wrote an important study of the novelist and poet Klabund (the nom de plume of Alfred Henschke) in 1971. His scholarly interests broadened in the 1980s to the cultural study of topics as diverse as insanity, psychoanalysis, and Jewish self-hatred. By the 1990s he was pioneering the new field of body history, contributing several important works including The Jew's Body (1991) and Making the Body Beautiful: A Cultural History of Aesthetic Surgery (2001). The book under review here clearly belongs to this third phase, yet also shows Gilman pushing towards a global vision of cultural studies. As a work of history, it is far from convincing. Yet as an essay on the cultural components that make up our current obesity epidemic, it offers an engaging and suggestive reading with which all historians of fat, food, and modern dietary regimes will want to engage.
Fat tackles important questions concerning how, when, where, and by whom obesity came to be seen as an epidemic disease. Strictly speaking, Gilman points out, obesity is not a disease. Rather, it is a "phenomenological category which reflects the visible manifestation of bodily size, which in turn can have multiple (or multifactorial) causes" (p. 18). Obesity itself does not kill, but it may be a tertiary cause of diseases that do: via diabetes, for instance, which can lead to vascular disease. Doctors, news outlets, and public health agencies, of course, speak otherwise. After decades of resistance, for instance, Medicare declared obesity a disease in 2004, thus opening the way for recipients to access a spectrum of treatments from diets to surgery to psychotherapy. "Epidemic" became attached to "obesity" even earlier, and it is now common to hear talk of a global obesity epidemic that stretches from the United States, to the United Kingdom, to Canada and Australia, and then over to China. Obesity, Gilman points out, has been constructed as the major public health threat of the twenty-first century. This does not mean that obesity was simply invented, but it does mean that a real pathological experience--"excess weight"--has been reframed in new terms. Gilman's project is to investigate that reframing.
Perhaps his most interesting claim is that obesity has now become the object of a global "moral panic." "Obesity," he notes in his introduction, "presents itself today in the form of a 'moral panic'--that is, an 'episode, condition, person or group of persons' that has in recent times been 'defined as a threat to societal values and interests'" (p. 9). We see obesity as "a national rather than an individual problem ... not only because of epidemiological evidence, but also because of the meanings now firmly attached to the expansive waistline" (p. 3). Our concern about the social implications of obesity for national health and wealth helps render obesity an epidemic disease. In other words, our anxiety precedes the disease, not vice versa. Gilman develops this intriguing claim in five chapters that tackle different aspects of our present moral panic.
In a first chapter on "epidemic obesity," Gilman argues that obesity became an epidemic before it became a disease and indeed that its framing as an epidemic in the 1980s allowed it to emerge as a disease by the turn of the century. He traces the origins of the term "epidemic obesity" to the 1860s, when American media outlets used it with reference to cattle. But it was only in the 1980s that the term was transferred to humans in the American news media, where doctors and public officials began to warn of a new obesity epidemic that threatened the nation's health, particularly that of children, whose excess weight put them at risk for developing diabetes.
Reframing it this way, Gilman argues, legitimated the quest from the 1990s onwards to locate infectious causes and thus render "infectobesity" a bona fide disease. In 1997, for instance, two U.S. researchers suggested that obesity could be partially caused by Adenovirus-36, which had been isolated from fat Bombay chickens, and that its spread might emulate that of the AIDS (acquired immune deficiency syndrome) virus. Ten years later, in 2007, another group of American researchers reported that obesity might stem from "social" infection. This idea suggested that obese friends or family members influenced individuals to adopt overeating as a behavior, leading to obesity. What motivated this intense search for the infectious causes of obesity during these years? Gilman responds with a discussion of contemporaneous moral panics about SARS (severe acute respiratory syndrome), Avian influenza, and BSE (bovine spongiform encephalitis). In the United States, these diseases of the food chain seemed to originate somewhere else, mostly Asia. Suddenly, this logic suggested, the possibility became plausible that a virus had crossed the species barrier from a fat chicken in Bombay to healthy humans in the United States.
The origins of our present moral panic about childhood obesity in nineteenth-century Anglophone literature is the topic of chapter 2, with Charles Dickens's Pickwick Papers (1836) as the key text. Most of Dickens's characters were fat, but only one character suffered from pathological fatness: the servant boy Joe, whose blank face, excessive appetite, and corpulent body were the physical expressions of his monumental stupidity, boundless laziness, and moral turpitude. Gilman traces Joe's afterlife in medical literature, where Joe "became a case study of pathology" in which a fat boy always hid a "fat man in waiting" (p. 57). Fat children may have been excoriated in the nineteenth century as weak-willed, but not as diseased. Doctors at the time were more concerned with undernourishment than excess weight, and considered fat babies healthy. This attitude changed in the 1930s and 1940s, when the Viennese clinician Alfred Froehlich described a massively obese and sexually infantile pubescent boy suffering from a pituitary tumor. Soon after, Froehlich's syndrome became a catch-all term for pathological, as opposed to moral, readings of obesity. This development, in turn, allowed doctors to take the Dickensian character Joe in new directions. Joe emerged in twentieth-century medical literature as a paradigm for all cases of pathological childhood obesity, from Hilde Bruch's psychoanalytic approach in Eating Disorders (1973) to Claudio Rabec's hormonal approach in Today's Fat Children (2006).
Nineteenth-century discourses about fat men and races inform our current moral panic about obesity, argues Gilman in chapters 3 and 4. If fat children were not medically pathologized until the mid-twentieth century, the same cannot be said of fat men, who were already suffering social stigma a century or so earlier. From William Banting's autobiographical Letter on Corpulence Addressed to the Public (1863) to the reinvention of Shakespeare's character Falstaff in Guiseppe Verdi's opera of the same name, fat male characters in the nineteenth century sought a cure for their fatness--not because of feelings of ill health, but because social stigmatization made them anxious. Gilman gives a similar reading with regard to the racial dimensions of the story. Nineteenth-century doctors, he reminds us, regularly labeled Jews a "diabetic race." Jews' supposed propensity to overeat, become obese, and develop diabetes reflected doctors' core assumption about the link between fat and "the 'oriental' race" (p. 111). In the 1950s, Hilde Bruch, a German-Jewish physician who had fled Nazi Germany and settled in the United States, pushed aside this racial explanation by positing an alternative psychoanalytic framework that rooted obesity in familial dysfunction, especially bad mothering. But by the 1970s, the familial and racial explanations had merged in discussions about fat in African American communities.
Gilman's final chapters consider the regional dimensions of epidemic obesity, first in the U.S. South (chapter 5) and then in China (chapter 6). Medical researchers who investigate the demography of obesity in the United States today, Gilman charges, perpetuate older models of ethnicity and race. As evidence, he cites articles published in 1998 and 2006 by medical sociologist Kenneth Ferraro, who found Baptists and other Protestants to be the fattest of all Americans; Catholics, Mormons, and other heterodox Christian groups to be in the middle; and Jews and other non-Christians to be the thinnest. This line of research, Gilman claims, "maps historically on to older models of ethnicity, which in the world of the nineteenth and early twentieth century were also models of race" (p. 125).
Gilman also draws these lineages by consulting novels about the South, such as Margaret Mitchell's Gone with the Wind (1936) and John Kennedy Toole's A Confederacy of Dunces (1980). In the first, "black" Irish Catholics become "white" by using their ethnic vigor and sturdy (not fat) bodies to rebuild the South after the Civil War. In A Confederacy, a spectrum of ethnic whites try to become fully white, but sink into obesity and ethnicity instead.
Chapter 6 takes the story to China, where western researchers categorized new obesity problems there as a result of the "pathological 'Occidentalization' of China and the Chinese" (p. 138). Today, Chinese medical officials speak of a looming obesity epidemic in which economic growth and American fast food (especially McDonald's) are the culprits, with China's fat "little emperors" under particular threat. "China, like America," Gilman notes, "is suffering from a new epidemic, but one that documents its modernity; no model of oriental, primitive infectious diseases here. Rather, a claim of 'invasion from the West... Obesity and its treatment may both be understood as parts of a system of modernization, with all the pitfalls recognized and the 'cure' in sight" (p. 163). A short conclusion on the "globesity" epidemic declared by the World Health Organization in 2001 provides an occasion for Gilman to reiterate a major point: our current anxiety about a global obesity epidemic is but "the most recent iteration of an obsession with control of the body and the promise of universal health" that has characterized modernity (p. 164).
What are scholars who want to write obesity's history to make of this bold and wide-ranging book? Fat is certainly suggestive. Gilman succeeds in highlighting some of the key building blocks that make up our current obsession with an "obesity epidemic: its genre (moral panic), its racial and ethnic tags, its roots in changing and culture-bound understandings of "excess weight" stretching back at least to the nineteenth century. He also shows us again how intellectually profitable it can be to juxtapose sources from widely different genres, especially imaginative literature, which did so much to shape the way doctors and scientific researchers speak and think about obesity today.
But as a work of history, Fat is not persuasive. It claims too much on the basis of too little. This problem becomes clear through Gilman's rhetoric and use of sources. Gilman frequently refers to an undefined "we." On the final page, for instance, he observes that, "[m]aybe at the end of the day our desire to control and reform our bodies is what is truly 'modern', and the obesity epidemic is only proof of our desire to undertake this quixotic task of absolute bodily control" (p. 174). Yet, most of the book is about the United States, and the entire book draws almost exclusively on English-language sources, including the chapter on China. Gilman's claim to be speaking for a global community is thus tenuous at best.
A similar problem emerges at the level of secondary sources. Gilman does not engage with the vast literature on this and related topics, although these works appear in his bibliography. Consider, for example, Peter Stearns's 2002 work Fat History: Bodies and Beauty in the Modern West. Stearns's comparison, limited to the United States and France, concludes that twentieth-century moral anxieties about fat in the United States had no parallel in France. Stearns's case, which directly challenges Gilman's universal statements about "our" global obesity epidemic, would have nuanced Fat's generalizations.
Other important works for the American context do not appear at all. Joan Jacob Brumberg's Fasting Girls: A History of Anorexia Nervosa (2000) addresses the other side of gender and obesity with its discussion of fat girls and obese women. Works from non-Anglophone contexts are entirely absent. From the German literature, which Gilman could be expected to engage with, Sabine Merta's Wege und Irrwege zum modernen Schlankheitskult: Diätkost und Körperkultur als Suche nach neuen Lebensstilformen 1880-1930 (2003) or Michael Wildt's Am Beginn der "Konsumgesellschaft": Mangelerfahrung, Lebenshaltung, Wohlstandshoffnung in Westdeutschland in den fünfziger Jahren (1994) offer regionally differentiated readings of obesity, health, hunger, and abundance in the twentieth century. These are serious criticisms, of course, but should in no way discourage readers from picking up this book. Gilman may not have succeeded in making obesity history, but he has certainly pointed out the paths by which others might do so in the future.
If there is additional discussion of this review, you may access it through the network, at: https://networks.h-net.org/h-german.
Corinna Treitel. Review of Gilman, Sander L., Fat: A Cultural History of Obesity.
H-German, H-Net Reviews.
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