Obesity and the modern lifestyle: what can we learn from history?
Continuing our History & Policy series, Dr Ina Zweiniger-Bargielowska considers if the past can offer any solutions to the dietary crisis we are experiencing today
What is the problem today?
Obesity, a major risk factor for heart disease, diabetes and premature mortality, is a leading public health concern today. National surveys have measured the BMI (Body Mass Index, the ratio of weight to height) periodically since 1980, when the first fully representative survey showed that the majority was of normal weight or underweight (BMI under 25) and six per cent of men and eight per cent of women were obese (BMI above 30).
Subsequently, obesity has increased to 13 per cent and 16 per cent respectively in 1993 and 23 per cent and 25 per cent by 2005. Since the mid-1990s about four men out of 10 and nearly a third of women have been overweight and the proportion of people with normal weight has declined. Female obesity is inversely correlated with social class and income – obesity is highest among low income women in unskilled occupations – whereas socio-economic factors make rather less difference to male weight.
These trends occur in the face of a multi-million pound slimming industry. Health education advice has proved ineffective and tackling obesity is now a key government priority.
Is this new?
This is not unprecedented. In the 1920s the chief medical officer Sir George Newman held “excessive and unsuitable food combined with lack of fresh air and exercise” responsible for sowing the “seeds of degeneration”. He accepted that some persons “no doubt” were “under-fed” in 1931, but argued that many were “over-fed – giving their poor bodies little rest, clogging them with yet more food”.
Doctors took increased interest in obesity and The Lancet noted in 1933 that in “these days of ‘slimming’ there was no more popular subject of discussion among the laity than the reduction in weight”. Such a preoccupation appears incongruous at a time of economic depression, high unemployment, hunger marches and working-class poverty.
Obesity and slimming draw attention to inequality in interwar Britain. Excess weight affected the middle class, the first social group to experience the affluent, sedentary lifestyle often associated with the postwar years.
What evidence do we have about obesity in the interwar years?
There are no statistics of obesity rates, but several 1930s dietary surveys document excess consumption among professionals and high income groups with daily intake of about 3,500 to 3,600 calories per man. This contrasts sharply with only 2,000 to 2,300 calories per day among the low paid and unemployed and was well above the recommended 2,700 calories for sedentary workers.
An abundant middle-class diet frequently resulted in weight-gain and there was a flourishing market for popular weight loss manuals, several of which became best sellers during the interwar years. Anxiety about excess weight was exploited in advertisements of “slimming” foods such as Ryvita crisp bread, remedial products such as Linia Shorts intended to massage away the abdominal “danger curve” and vibratory machines which promised to exercise “All the body without effort” and reduce obesity “without drugs or dieting”.
A stock character was the fat middle-class man who was suffering from ill-health, threatened by premature death and represented as an ugly, ridiculous figure. Obesity was associated with middle age and, according to George Orwell, the middle-class endeavour to maintain a youthful appearance was a recent development and one of “the few authentic class differences… still existing”.
While fat women were mentioned, the typical female slimmer was not necessarily overweight but restricted her diet in order to emulate the new female fashions of the 1920s. Doctors considered this practice harmful and portrayed women’s “thin and scraggy” figures and “haggard, drawn expression” as the very opposite of beauty and a threat to women’s responsibility as “race” mothers.
In 1929 dietary expert WF Christie described the obese as a “deviation from the normal”, but norms and ideals are culturally constructed and change over time. During the interwar years the body beautiful, represented by scantily clad young and slim men and women, was celebrated. Aesthetics were not just a female concern but also mattered to men, and obesity conflicted with the dominant Greek ideal of male beauty.
As another obesity expert Leonard Williams put it, “No man has any right to be really fat; no woman has any right to be really thin”. Thus, the self-indulgent middle-aged man and the vain, emaciated woman were subjected to a moralising discourse that condemned women’s excessive slimming in the pursuit of fashion and castigated obese men’s greed as subverting the idea of masculine self restraint.
The weight loss culture disappeared following the outbreak of the Second World War when policymakers, nutritionists and housewives struggled to eke out meagre rations to maintain civilian health and morale. Doctors lost interest in obesity, no dieting manuals were published between 1940 and the early 1950s and remedial products disappeared from popular advertising during the war and difficult years of postwar reconstruction.
What does history teach us?
The prevalence of obesity is closely associated with the emergence of modern lifestyles in Britain. In 1900 Britain was already the world’s most urbanised and one of the wealthiest countries, with a large service sector, expanding public transport network and thriving mass consumer culture.
Despite high unemployment and economic depression, living standards continued to rise during the interwar years. With falling prices and smaller families, real incomes per capita increased by about a third. Britain’s growing prosperity was not shared equally and substantial sections of the working class continued to suffer from under-nutrition.
In this period, obesity was associated with the comforts of suburban middle-class life, plentiful food and a rapid rise of car ownership. Since the 1950s, the British diet has been characterised by ever more abundant cheap food. In recent decades the traditional three meals at home pattern has been replaced by snacking, junk foods and takeaways, contributing towards weight gain.This has been compounded by a decline in physical activity with expanding car ownership and new forms of home-based entertainment.
After 1939, the introduction of extensive rationing and regulation of food supplies resulted in reductions of sugar, meat and fats as consumption shifted to bread, potatoes and milk. This massive state intervention, which was only possible in the context of total war, amounted to a major turning point in the history of the British diet.
The policy has been described as a revolutionary transformation because it largely eliminated the disparities between the social classes with regard to energy and nutrient intake documented in the 1930s.
Middle-class calorie consumption declined and there is extensive evidence of grumbling about the lean, monotonous diet of the period, while wartime diarists fantasised about generous helpings of meat, bacon and eggs, buttered toast washed down with coffee laced with sugar and cream. Activity levels rose due to longer working hours, increased walking, reduced motoring with petrol rationing and schemes such as Dig for Victory.
This erosion of class differentials in food intake persisted after the end of rationing in 1954 and weight gain was no longer confined to the highest income groups. The episode points towards the limits of personal responsibility with regard to dietary restraint and highlights the significance of a heavily regulated food regime in the 1940s.
In interwar Britain, weight loss manuals did not focus on calorie counting. Many did not even mention calories but prescribed a diet of loosely defined portions. This was not due to a lack of understanding of calorific content of food, but rather a holistic perspective which saw weight loss as part of a wider transformation in lifestyle based on self-discipline and the golden rule of moderation.
Thus, the key to weight loss was the adoption of a comprehensive hygienic regimen which involved moderation in eating and drinking, daily exercise and personal cleanliness. Manuals advised avoiding sugary and fatty foods and recommended consumption of lean meat, boiled fish, fruit and salad.
They also emphasised the importance of thorough mastication and regular bowel movements. Constipation, exemplified by a bloated abdomen, was closely linked with obesity and could be avoided by means of regular habits, abdominal exercises and a high fibre diet. The cultivation of health and beauty was not simply beneficial to the individual, but was represented as a patriotic duty because the British Empire required a nation of fit men and women.
Losing weight is difficult and a Department of Health campaign of 1995 which set a target to reduce obesity rates to the 1980 level by 2005 has failed spectacularly. In October 2007 the Government renewed its ambition to reverse the trend with a strategy that combines the promotion of healthy eating with lifestyle changes such as physical activity goals, resembling the holistic approach of the interwar years.
Three lessons from history
1. The history of consumption and living standards in Britain during the 20th century points towards the close relationship between obesity and modern affluent lifestyles characterised by abundant food and increasingly sedentary habits.
2. Extensive rationing and controls of food reversed these trends during the 1940s. The policy was only possible in the context of war and does not offer a practical solution for the public health problems of the early 21st century.
3. Interwar weight loss manuals did not pay much attention to calorie counting, but rather emphasised a holistic approach to transform lifestyles by adopting healthy habits as the key to successful, permanent weight reduction.
Ina Zweiniger-Bargielowska, Department of History, University of Illinois, Chicago, is author of Austerity in Britain: Rationing, Controls, and Consumption (Oxford, 2000). She is currently writing a book entitled Managing the Body: Beauty, Health and Fitness in Britain, 1880s–1939.