Book review

Review by Ursula Arens Writer; Nutrition & Dietetics

Ursula has spent most of her career in industry as a company nutritionist for a food retailer and a pharmaceutical company. She was also a nutrition scientist at the British Nutrition Foundation for seven years. Ursula guides the NHD features agenda as well as contributing features and reviews.

OBESITY: THE BIOGRAPHY

AUTHOR: SANDER L GILMAN PUBLISHER: OXFORD UNIVERSITY PRESS, 2010 ISBN: 978-0-19-955797-4 PRICE: Hardback £12.99

Professor Gilman presents a dazzling tapestry of past and present confusions around our attitudes towards obese people.

The current back-and-forth as to whether the obese suffer physiological or psychological impairment has also long been part of ancient debate, but medical or health aspects underlie more influential cultural veils defining human beauty and attractiveness.

These still strongly arouse our attitudes as demonstrated by the internetexploding current interest in very large female bums (e.g. Kim Kardashian). And the astonishing development of private clinics in London offering very costly and painful buttock lifts and expansions; getting fatter not by the ‘old fashioned’ way of eating lots of chocolate cake, but by having fat surgically implanted!

Professor Sander Gilman has pulled together the definitive review of our cultural confusions of obesity, and beautifully weaves through many examples from literature, historic expert opinion from many different nations, and bizarre debates. It is a complete surprise to me how science may have progressed at a logarithmic rate, but how many current debates exactly mirror discussions of hundreds of years ago. On obesity research we have come so far, but

“The desire for food is itself the Devil present in the body.”

Bishop Augustine (353-430) culturally we have not really moved at all. Within his review, Professor Gilman also pulls together what is in effect the history of Dietetics.

We owe the author huge thanks for pulling the subject together into such a very neat and readable 200-page book. There are also 18 wonderful illustrations of famous fatties including ‘the very large man’ Daniel Lambert and the gawping Victorian drawings of demeaned largebottomed Hottentot women.

What is obese (and what is not) is currently described via BMI cut-offs, or more precisely via percent body fat measures. In the prologue of the book, Professor Gilman describes the development of the long-used and still-used weight charts issued by the American life insurance company Metropolitan Life. In 1942, the MetLife statistician Louis Dublin examined the association between mortality and weight among four million insured Americans. The weight span for optimum longevity was about 30 pounds, so, for clarity, he neatly sectioned each height and gender group into the three sections of light/ medium/heavy frames, although these were difficult to define clinically, and from which the defence of being big boned (for being heavy) originated. The data allowed the development of life insurance risk evaluation, but was also intended as a motivational tool to support people in understanding the benefits of

weight loss to increase their life expectancy. There was much later discussion as to whether these figures should be described as ‘ideal’ or ‘desirable’ body weights, and there was later critique that the MetLife weight tables were biased towards the population of middle class, male, urban and white insured rather than the whole US population.

There is much to say about Fat Joe, who was a character in the Charles Dickens book Pickwick Papers, published in 1837. Fat Joe became a code for many expert theories on obesity produced by endocrinologists and psychoanalysts and geneticists. Professor Gilman describes various case descriptions of obese children, where expert doctors refer to Dickens’ Fat Joe as the basis for discussion. Dickens rejected that Fat Joe’s condition was inherited, and medics came to suggest that the description matched hypothyroidism. Later medics suggested that Fat Joe suffered Froelich’s syndrome, and Fat Joe became the test case of medical debate (obesity from impaired thyroid or pituitary function).

In 1956, Sidney Burwell, a Harvard professor researching obstructive sleep apnoea syndrome, claimed the Dickens character with the creation of the term Pickwickian syndrome. His descriptions of his patients matched many of the traits of Fat Joe described by Dickens, and the current medical term of obesity hypoventilation syndrome (OHS) still bears the Dickensian literature tag. It is difficult to imagine that any fictional character penned today could enjoy as much medical interest and retrospective diagnosis as Dickens’ Fat Joe.

Eating is the daily example of the needs of the body winning over the control of the mind, so many religions also present moral barriers to the practice of overeating. Professor Gilman describes how dietary prohibitions set in the Old Testament (not to consume foods from animals without cloven hooves, or cud chewers, or seafood without fins or scales) defined sinful behaviour; overeating initially was just viewed as the lack of the self-control expected of a real man or a scholar. The slide from poor selfdiscipline to sinful behaviour developed with early Christianity and gluttony was promoted on the list of seven deadly misdemeanours, paired closely to the other sin of sloth.

So, obesity and overeating became viewed as a moral sin, but can humans control this? “Not I,” confesses Bishop Augustine (353-430), who reveals, “…in the midst of these temptations I struggle daily against greed for food and drink. This is not an evil which I can decide… to repudiate and never to embrace again, as I was able to do with fornication.”

St Thomas Aquinas (1225-74) also has little faith in the weakness of the ever-hungry flesh. The human mind seeks delights, but our bodies lead us to the opposite (“…on earth it is excrement and obesity, hereafter it is fire and the worm.”). Aquinas observes that the bleak state of humans is being trapped by their bodies and defined by natural functions - eating and excreting.

Professor Gilman reviews many historical discussions on obesity, but also weaves in themes of debate: the battles between science and morality; the battles between somatic or psychological treatments; the battles between individual or societal solutions. He finishes with a focus on obesity patterns in China and Japan; there are such different developments, and understanding the ‘whys’ of this could help predict and perhaps dampen further obesity booms in other fastdeveloping countries. He concludes the book with thoughtful comments on ‘Globesity’.

This tiny 200-page book covers a huge span of history and philosophy on the subject of Obesity. There cannot be a more relevant topic of thought for dietetic practice, and there cannot be a more delightful guide to thinking-about-it, than this book. A very essential read for all dietitians. Thank you very much Professor Gilman.

We have six copies of Obesity; The Biography by Sander L Gilman to give away in a free prize draw. For your chance to win, please email us at info@networkhealthgroup.co.uk. Closing date for entries is Friday 4th November 2016.

UNIVERSITY OF NOTTINGHAM - SCHOOL OF BIOSCIENCES

Modules for Dietitians and other Healthcare Professionals

• Diabetes I/II (D24D01/D24D02)

12th & 13th January, 15th, 16th, 17th March 2017

• Understanding Behaviour Change (D24UCB )

8th, 9th & 10th February 2017

• Paediatric Nutrition (D24PAN)

9th & 10th March, 4th & 5th May 2017

For further details please contact Susan Lewis via email: Susan.Lewis@nottingham.ac.uk. Alternatively, check out the University website at www.nottingham.ac.uk and click on ‘Study with us’ and then ‘short courses’ which will take you to ‘for practising dietitians’.

The future of healthcare services in Wales - Policy Forum for Wales Keynote Seminar The future of healthcare services in Wales 19th October - Cardiff

www.policyforumforwales.co.uk/forums/index. php?fid=policy_forum_for_wales

Latest insights into nutrition and probiotic research 20th October - BMA House, London

www.hcp.yakult.co.uk/

Multidisciplinary Stroke Educational Programme 2nd November - Conference Centre, Nottingham University Hospital

www.ncore.org.uk

Next steps for policy on obesity - prevention initiatives and the new Government childhood obesity strategy 3rd November - Central London

www.westminsterforumprojects.co.uk

To place a job ad here and on www.dieteticJOBS.co.uk please call 0845 450 2125 (local rate)

dieteticJOBS.co.uk

CLINICAL SCIENCE DIETITIAN - FULL-TIME, PERMANENT - LIVERPOOL We are seeking someone who will thrive in a dynamic, innovative environment, who has excellent communication skills, is flexible, self-motivated and enthusiastic. In return, we offer a competitive remuneration package. Full training will be provided but clinical experience, particularly in metabolic disorders would be a definite advantage. Previous industry experience would also be advantageous but not essential. The successful candidate will implement their clinical and nutritional science knowledge and input to the business including the nutritional design of new products, clinical studies and be instrumental in designing guidelines of product use. This role offers a fantastic opportunity to utilize your clinical knowledge and expertise in an innovative new way. This will be a challenging role, providing opportunities to continue your professional development. Please e-mail your CV tochris.richards@vitaflo.co.uk or post to: Mr Chris Richards, HR advisor, Vitaflo International Ltd, Suite 1.11, South Harrington Building, 182 Sefton Street, Brunswick Business Park, Liverpool L3 4BQ. Salary is negotiable dependent upon experience. Closing Date: 21st October 2016. COMMUNITY EATING DISORDERS SERVICE, (CEDS-CYP & CAMHS) Somerset Partnership NHS Foundation Trust, in collaboration with the Somerset Clinical Commissioning Group (SCCG), is establishing and developing a dedicated team of skilled professionals to work with children and young people presenting with an Eating Disorder, and their families and carers. The service model proposed uses the Maudsley approach as the core intervention. We are looking for enthusiastic senior clinicians to participate in this service from establishment through to ongoing development. The successful candidates would be expected to contribute the design of the service, ensure effective evidence-based and adherent models are implemented, as well as maintain their own caseloads and provide clinical and managerial supervision to the team. As senior clinicians within the service, you’ll bring highly developed knowledge of specialist therapeutic assessment, formulation and intervention skills. You will be able to demonstrate registration with your appropriate governing body. Specific knowledge and expertise in the area of Eating Disorders within this population is a key part of this role. To apply email kerry.allen@ sompar.nhs.uk.Tel: 01823 368368. Closing Date: 31st October 2016.