- Childhood Obesity in America: Biography of an Epidemic by Laura Dawes
Obesity is a critical health problem in the United States. The implications of obesity for physical and mental health start in young childhood and extend throughout adulthood, and obesity is far more prevalent than other significant child morbidity such as asthma or ADHD. Treatments for obesity have had little success, mostly because there are so many causes: genetics, early health history, family factors, culture, socioeconomic status, race/ethnicity, friends’ behaviors, neighborhood layout and opportunities, and school food and physical education policies. Recent research demonstrates the interaction of these factors, many of which are beyond the control of an individual child or family.
The complexity underlying the causes of obesity also presents a challenge to the historian: how to adequately address the medical, political, and popular history of such a complicated phenomenon. Laura Dawes does a remarkable job weaving together these various strands in her history of childhood obesity in the United States. Dawes begins with the late nineteenth century, drawing on a wealth of scientific and lay publications. In chronologically overlapping chapters, Dawes lays out the evolving definitions of obesity, medical and popular treatments, and the recent difficulties in addressing the broader social and structural causes of obesity in the early twenty-first century.
One hundred years ago, obesity among children was relatively uncommon, and a condition to be celebrated. Fat babies won contests, and extremely fat children were interviewed for newspaper stories. By the 1920s, the high rate of infant deaths related to malnutrition had begun to drop, and fear of underweight children being unfit for factory work or military service receded. Extrapolating from data on obese adults, some physicians began to worry that obesity might be a problem for children as well. Physicians and the lay public were fascinated by the discovery of hormones that controlled behavior and body functions, and obese children were often thought to “have a gland problem.” Physicians tried treating obese children with thyroid and other animal gland extracts, but found limited success. In the mid-twentieth century, amphetamines became the medical treatment of choice; by the 1960s, mainstream providers stopped prescribing such medicines due to fears of “drugging children” and the lack of long-term success. Dawes completes the history of failed medical approaches to obesity with a description of the unfulfilled promise of leptin derivatives, despite huge investment by the pharmaceutical industry in the 1990s.
Diet became the mainstay of treatment for obesity in the 1960s. Dawes focuses on dietary advice dispensed by popular writers throughout the twentieth century and by founders of “fat camps” in the 1980s. Dawes describes the wide range of dietary treatments and demonstrates how changing advice reflected ideas about gender and childhood, parent and child responsibility, and broader cultural trends. A chapter on psychoanalysis and behaviorism shows how these mid-twentieth-century psychological schools have enduring influence on the treatment of obesity. [End Page 172]
Dawes ends her book with chapters on the failed attempt to regulate advertising for sugary foods in the 1970s and on recent litigation by families and public health advocates claiming that food and media companies are responsible for causing obesity. Dawes uses these examples to demonstrate some obstacles to making structural changes: well-funded industries and public opinion (obesity is a “matter of person responsibility”) can be aligned against change. Dawes concludes that obesity may be a symptom of modern civilization, but such a high prevalence is not inevitable. We as a society have made choices, and one consequence is the increasing number of obese children starting in the 1970s.
Dawes seems to have read everything published about obesity over the past hundred years, and she organizes the vast material in a coherent and well-written narrative. The book is strongest when Dawes dives into specific topics, such as her observation that pediatrician–psychoanalyst Hilde Bruch’s theory of family causes of obesity is undermined by Brunch’s own field notes. It is not possible to maintain such depth on...