Fat in the Fifties: America's First Obesity Crisis by Nicholas Rasmussen (review)

Declared an epidemic by the World Health Organization in 1999, obesity is still a hot topic for historians seeking to connect present-day concerns about weight to the past. Fat in the Fifties: America's First Obesity Crisis, from established medical historian Nicholas Rasmussen, explores this terrain through the lens of public health, insurance, and epidemiological debates about obesity in the immediate postwar era. Rasmussen argues that responses to obesity cannot be explained biologically: Americans have gotten heavier over the course of the twentieth century, while medical interest has waxed and waned. Unlike many recent books published on this topic, Fat in the Fifties accepts the idea that there is an obesity crisis. The author does not engage in debates about the moral, gendered and racialized dimensions of medical knowledge. Instead, the book focuses on the power dynamics of American medical care.

America's first obesity crisis was fuelled by insurance industry data indicating that heart disease was rapidly on the rise. By the 1920s, heart disease rivalled tuberculosis in terms of its fiscal impact on the industry. Data collected from millions of insurance subscribers showed that mortality rates increased with the degree to which subjects were overweight and were more pronounced in men over 45. This information sparked the interest of medical professionals, who became convinced that "heart disease posed a major threat to Americans' health and economic productivity" (21).Physicians mobilized and in 1948 the "National Heart Act" passed, providing robust funding for the National Heart Institute and a "growing biomedical research umbrella" that sounded the alarm about obesity (56).

Whereas in the 1920s physicians had treated obesity as a glandular disorder, by the 1950s the consensus was that it was rooted in psychological problems. Rasmussen points to the influence of a postwar desire for normalcy and the work of psychologist Hilde Bruch to explain this shift. Bruch's influential work, which blamed obesity on overindulgent and overprotective mothers who failed to instill self-control in childhood, fitted particularly "well with the established popular stigma that fatness was a moral failing and a character flaw" (40). What resulted was a "diet pill bonanza" (41). Physicians treated depression and obesity as interrelated illnesses. In ads for diet pills, overeaters were alternately treated as addicts or patients with a serious mental illness.

Fat in the Fifties covers similar thematic ground as recent publications about Canada by Wendy Mitchinson and Deborah McPhail, but the framing of the issue in this text is altogether different.¹ Rasmussen does not explore how gender stereotypes and racism shaped the treatment of people deemed obese. For example, the lack of insurance industry data on Black Americans, women, and the working classes is not explored. Nor is the medicalization of obesity or medical and social-scientific evidence that challenges the idea of an obesity epidemic. The use of "fat" in the title of the book does not signal, as is usually the case, a critical analysis of obesity itself.

Rasmussen's real focus is the macro-politics of American health care. Obesity is a lens through which he analyzes the battle between physicians and epidemiologists to understand and gain funding to treat heart disease. What was done about obesity/heart disease serves as an object lesson for American approaches to health more generally. A younger generation of physicians wanted a public screening program and socialized medicine to support a nationwide response to heart disease. Established physicians who controlled the American Medical Association feared this response would infringe on their clinical decision-making. A pamphlet circulated by the AMA at the time linked socialized medicine with socialism. The campaign succeeded, and public health advocates could not gain funding for screening and heart disease prevention. Health promotion became the go-to strategy for heart disease, and responsibility for treatment was off-loaded onto individuals. Public health offices offered free weight-loss groups, but any organized response was abandoned.

Physicians and lobby groups are to blame...