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Obesity in historical perspective
Background
Scholarship across the humanities and social and life sciences has documented a wide variety of historical, sociocultural and medical attitudes to large bodies, including both positive and negative associations. Obesity has never been a stable or unified category.
Objective
The aim of this article is to provide an overview of the historical trajectory of obesity as a disease in a Western context.
Discussion
Discussions about whether obesity should be classified as a disease have been ongoing. Many scholars regard the early Greeks as the first to identify obesity as a disease, and trace changing manifestations of obesity from Classical times through the Middle Ages and Age of Enlightenment to contemporary times. This trajectory of obesity as a disease is contentious, and in light of recent moves to attribute disease status to obesity in Australia, this article outlines the politics and value of classifying obesity as a disease.
In 2018, the Australian Government's final report from the Senate Select Committee inquiry into the obesity epidemic recommended that obesity be recognised as a disease and added to the list of medical conditions eligible for the Chronic Disease Management scheme. 1 Almost a decade earlier, the Weighing it up report (2009) recommended obesity be placed on the Medicare Benefits Schedule as a chronic disease requiring an individual management plan.2
The question of whether to classify obesity as a disease in and of itself or continue to consider it a risk factor for diseases such as type 2 diabetes has been a topic of heated debate for years.3'4 Part of the problem is that 'disease' is a difficult category to define and changes over time and place. To add to the complexity, there are many differing and competing models to explain the causes of obesity:5-7 thrifty genotypes, obesogenic behaviour, obesogenic environments and nutrition transition, as well as biocultural models that examine interactions of genetics, environment, behaviour and culture.8 Even within the medical field, conceptualisations of obesity differ. For example, Chang and Christakis, in their analysis of medical textbooks from the 1920s to 2000, make the observation that although all editions accepted that obesity resulted from an energy imbalance, each edition differed in emphasis, and a model of obesity could change 'quite independently of...