Historicizing "Fat"

The history of fat—reactions to fat and efforts to control fat—offers important insight into the modern experience, including the role of gender. While a good bit is already known, thanks in part to feminist scholarship that emphasizes the burdens placed on women by twentieth-century medical and aesthetic discourse, there is certainly room for additional insight. The two books under review unquestionably present some welcome new material and, in the case of Sabrina Strings, some challenging arguments. While they ultimately may not add much to the fundamental analysis already available, they both deserve attention, but for very different reasons.

Any historical study of the modern concern with obesity faces a fundamental dilemma. The issue is in part medical, and medical definitions and uncertainties play a huge role in the evolution of public perceptions and strategies over the past 150 years. But aesthetics and morality come into play as well, and it is not always easy to determine the extent to which these factors drive medical discourse or even preempt sober medical assessment. At an extreme, particularly in dealing with the disproportionate attention applied to women's weight, it is sometimes argued that a problem is created out of whole cloth, generating medical endorsement for campaigns designed simply to stigmatize and shame.

There is no question that the two books under review take radically different approaches to the historical tension. Wendy Mitchinson's careful treatment, designed to add a Canadian dimension to a story that more frequently focuses on the United States, clearly privileges the medical side of the story, including its undeniable limitations and side effects. For Professor Strings, who offers a sweeping argument about the role of race in the modern history of obesity, medical efforts are simply artifacts of an aesthetic and religious campaign designed to privilege Anglo-Saxon whites; they have no significant independent reality.

The Canadian story offers a number of interesting specifics, flowing from Professor Mitchinson's extensive and meticulous research. Canadian concern about issues of weight began to develop clearly in the 1920s and then simply intensified, particularly after the 1950s—a fairly familiar chronology. While detailed coverage ends around 1980, several chapter conclusions note a further amplification of trends thereafter. Successive chapters deal with nutritional advice (which predated the focus on obesity), explicit medical interest, explanations of obesity (both medical and psychological), and drug and other treatment regimens, including important material on appetite suppressants. The final third of the book ranges into aesthetic issues, including some fascinating evidence on clothing styles and sizes, and the impact of stigma on individuals regarded as obese.

There is no commanding overall argument, but Mitchinson makes careful and sensible presentations. Medical concerns implicitly take precedence, but there is ample recognition that they often included moral judgments that ranged well beyond objective data. Attention to the frequent shifts in criteria and diagnoses, as well as outright debate and uncertainty (for example, on the role of exercise), provides abundant fodder for readers interested in the fallibilities of the medical approach, and the results add important details to the basic modern story.

Mitchinson offers a nuanced treatment of gender issues, again adding to available accounts and offering a useful overall model. There is no question that women were often singled out, in Canada as in the United States, thanks to a mixture of medical, moral, and aesthetic judgments. Nutritionists consistently addressed a female audience assuming women's spousal and maternal responsibility for basic diets. Fashion designers were often harder on women than on men, among other things, normally offering fewer options for overweight women than for their carefully-labeled "stout" male counterparts. A greater number of popularized "before-and-after" stories of heroic weight loss featured women than men, presumably another symptom of disproportionate pressure. But men did come in for attention in the intensifying...