Fighting Fat: Canada 1920–1980 by Wendy Mitchinson (review)

Possibly the first systematic effort at a history of obesity and/or fatness in Canada, this book may interest historians of modern public health more for its unusual methodological twist than for any information captured and conveyed. I do not refer to Mitchinson's core methodology, better described as fitting with cultural studies than (cultural) history of medicine. The book is divided into eight chapters, each of which covers the 60-year period of interest from the perspective of a particular corpus of literature that consists mainly of Canadian medical journals and popular magazines. Within each of the six chapters focused on an aspect of medicine – nutrition, causes of obesity, therapeutic practice, and so on – the book describes the "discourse" around fatness within that literature, names a few themes (especially relating to stigma), and occasionally identifies a "narrative." But little attention is paid to chronology so that "discourses" from diverse decades are often jumbled together within a chapter, and only very rarely are there observations suggesting possible change in the "narrative" over time. Granted, the period in question has a certain unity, as an age of ascendant science in medicine, during which heart disease had just risen to the fore as the leading cause of death. And discourse analysis methodology requires nothing more than noting semiotic resonances.

This book seems a purist example, avoiding efforts to explain discourse except by reference to discourse itself, and with its methodological abstemiousness (to me, impoverishment), the book may disappoint some readers of this journal. Thus, apart from occasional acknowledgement that controversy existed in the discourse around particular issues, minimal effort is made to probe the expert literature for its underlying reasoning and evidence base, which obviously changed greatly over six decades, or for the clashing schools of thought, subdisciplines, and approaches that can explain controversies, heterogeneity, and change in medicine. The developing methods of epidemiology and, relatedly, the growing influence of statistical reasoning in medical thought between 1920 and 1980 are just one important consideration that might fruitfully have been explored. But perhaps it is just as well that an author so uninterested in science that, for instance, she never lays out the evidence for obesity as a predictor of heart disease (sufficient on the face of it to explain the keen medical interest in fatness), and lists an anabolic steroid among weight-loss drugs, does not attempt deeper analysis.

I mentioned a twist. To me, the strongest chapters are the two carried through with a different style of reasoning – and which have the least to do with medicine. One, on body image, carefully analyzes the clothing, and clothing advertising, presented to men and women and girls and boys by Canada's major catalogue store, Eaton's. Brilliantly, it reconstructs the changing ways of measuring and classifying clothing size for the four consumer groups over time – a story that is quite complex for women and girls (encompassing, for instance, the emergence, mutation, and decline of half-size and "chubby" categories) – and relates these to fashion history and cultural change from the roaring twenties to the late Cold War. Here Mitchinson makes a convincing argument that for men fatness was always less problematic than for women (as many scholars have noted) and that, furthermore, bulk was a social problem that clothing effectively managed so as to assist the male wearer's social function, without the belittling or painful efforts to reshape the body suffered by women. Here too we catch a glimpse of the quality of history the author can write when better steeped in the subject matter, and are given an example that medical historians might fruitfully emulate in relating clothing to the range of bodily experiences also dealt with through doctors. There is also a chapter on the lived experience of fat Canadians, drawn largely from 30 interviews conducted by the author. While not adding much qualitatively new to the scholarly literature on fat stigma, this chapter powerfully communicates the suffering that many have experienced due to...