SYMONDS’ CURIOUS FAT FACT
full allowance for the difference in selection. I am
convinced that the same percentage of overweight is
a more serious matter than if it were underweight.
The excessive weight, whether it be fat or muscle, is
not a storehouse of reserve strength, but it is a burden
which has to be nourished if muscle, and which
markedly interferes with nutrition and function if
fat. This does not apply to the young, those below
25 years of age. Here a moderate degree of overweight
is much more favorable than underweight. In fact, up
to age 25 an overweight not to exceed 110% of the
standard is upon the whole good for the individual. It
seems to indicate a certain hypernutrition and robustness of physique which is favorable to the subsequent
957
life. Underweight among these young people on
the other hand is unfavorable, and in some cases
indicates commencing disease or the tendency thereto. But, when we pass the age of 30, these conditions
are reversed and the difference between overweight
and underweight in their influence upon vitality
becomes more marked with each year of age.
Of course, for the best interests of health, one
should be near standard weight, and that is the
sermon which you should preach to your patients.
Impress upon them the advisability of their being
within 10% of the standard, for within that range
is found the lowest mortality and the greatest
vitality.
Published by Oxford University Press on behalf of the International Epidemiological Association
ß The Author 2010; all rights reserved. Advance Access publication 21 July 2010
International Journal of Epidemiology 2010;39:957–959
doi:10.1093/ije/dyq088
Commentary: Symonds’ curious fat fact
Amanda M Czerniawski
Department of Sociology, Temple University, Philadelphia, PA 19122, USA. E-mail: [email protected]
Accepted
13 January 2010
Present-day readers will no doubt be unperturbed by
Dr Brandreth Symonds’ arguments that too much fat
is detrimental to one’s health, i.e. overweight individuals are at greater risk of heart disease and diabetes
and an expanding abdominal girth increases mortality risks. Living during what the World Health
Organization has dubbed a ‘globesity’ epidemic, we
take these modern medical facts on fat for granted.
But to Symonds’ contemporaries, these were revelations. Symonds’ paper, ‘The Influence of Overweight
and Underweight on Vitality’,1 marks both an important shift in popular and medical thought on body
weight and the birth of a trend to quantify and
track weight through use of height and weight
tables. In the following, I discuss why these actuarial
findings on this relationship between weight and
mortality were so novel at the time by tracing (i)
the evolving cultural conception of weight, (ii) the
use of actuarial data to substantiate medical opinion
and (iii) the development of height and weight tables
as a means of social control.
As Symonds wrote, the actuarial data used to construct height and weight tables revealed a ‘curious
fact’—the best mortality rates, i.e. longest life spans,
belonged to individuals whose weights were slightly
below the average listed in the tables. Understanding
this curiosity of the data requires an examination of
the underlying discursive shifts on the body during
turn of the 20th century America.
Throughout history, we see that the body speaks.
For Sylvester Graham and the slew of dietary reformers in Antebellum America, the body spoke of spiritual well-being, with excessive weight perceived as an
indicator of moral failings. After the Civil War, a new
connection was formed between size and prosperity in
the bourgeoning bellies of industrial tycoons (as famously caricatured by Thomas Nast; Figure 1). A popular physician of the time, Silas Weir Mitchell,
acknowledged that a fat bank account often produced
a fat man.2 Weir Mitchell, who developed a treatment
called the ‘rest cure’, also argued that a large number
of fat cells were necessary for a well-developed
personality.3
By the 1870s, American physicians believed, as
Symonds remarked on the view of fat as a form of
capital, that plumpness was a positive indicator of
health and necessary to combat contagious diseases
such as tuberculosis. Therefore, thinness was discouraged, especially in youth who were particularly vulnerable. For example, Dr John Gardner presented this
opinion of body weight in post-Civil War America,
‘The popular expression applied to persons of a
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INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Figure 1 Boss Tweed, by Thomas Nast 1871–75
rounded form, moderate embonpoint, clear skin, and
a ruddy color, - that they are ‘‘in good condition,’’ –
accords with science. This condition is most commonly accompanied by healthy internal organs, a very desirable and hopeful state. Yet, until it becomes
burdensome, it is generally disregarded.’4
As sanitary conditions improved, halting the spread
of infectious diseases, infant mortality decreased
while life expectancy increased. As individuals began
to live longer, a new breed of diseases began to inflict
the population—cancer and diseases of the heart. This
shift from contagious to degenerative diseases prompted physicians, like Symonds, to reconsider the benefits of a solid body weight, as extra weight in young
individuals, in particular, was losing its advantage.
Excessive weight began to be regarded as more of a
public health problem than merely a matter of personal discomfort or displeasure. Symonds’ paper
marks the start of this reevaluation of the utility of
fat as reserve capital and a growing reliance on actuarial data acquired not by a medical association but
by insurance companies.
The insurance industry’s authoritative voice in documenting the relation between weight and mortality
can be explained by the state of the medical field.
At the time of publication of Symonds’ paper and
well up through the 1920s, the medical community
was facing internal problems of consensus and external problems of legitimacy.5 As a professional field,
physicians suffered from a lack of cohesion and
public authority. For example, the American Medical
Association, originally established in 1846 and then
reorganized in 1901, struggled to survive internal
brawls that threatened its stability. Conflicts between
physicians over possible treatments ‘reached a point
where medical men resorted to fists, knives, pistols,
and shotguns to settle their professional differences’.6
The public lost confidence in the physician.
Consequently, the medical field was ill equipped
to collect the necessarily large quantities of data
that could substantiate medical claims and, thus,
bolster its credibility. Instead, life insurance companies fueled the investigation of the relation between
weight and mortality. With the formation of the
Association of Life Insurance Medical Directors of
America and the Actuarial Society of America in
1889, medical directors and actuaries accumulated
data and exchanged ideas more readily.7
Over the next few decades, the life insurance industry combined both medical experience and actuarial
data to construct standardized height and weight
tables. Originally constructed to facilitate the standardization of the medical selection process throughout
the life insurance industry, by the 1940s, these tables
were transformed from a record of national averages
of weight to a guide for ‘ideal’ weight.8
In this socio-historical reading of Symonds’ paper,
we can see that we must not assume that fat has
always been viewed as a malignant thorn in our backsides. Insurance companies were instrumental in categorizing bodies and raising public awareness of the
dangers of obesity. They established welfare divisions
in order to implement programmes and publish
pamphlets to promote longevity and arouse public
support for disease prevention and treatment.9,10
While their motives may have been less than altruistic, their influence cannot be ignored. From Quetelet’s
table in 1836 to the body mass index today, measuring and controlling fat is a worldwide obsession.
Conflicts of interest: None declared.
References
1
2
3
4
5
6
Symonds B. The influence of overweight and underweight on vitality. J Med Soc New Jersey 1908;5:159–67.
Reprinted Int J Epidemiol 2010;39:951–57.
Stearns PN. Fat history: Bodies and Beauty in the Modern
West. New York: New York University Press, 1997.
Banner LW. American Beauty. New York: Knopf:
Distributed by Random House, 1983.
Gardner J. Longevity: The Means of Prolonging Life After
Middle Age. 3rd edn. Boston: W. F. Gill and Company,
1875.
Starr P. The Social Transformation of American Medicine.
New York: Basic Books, 1982.
Duffy J. The changing image of the American physician.
In: Walzer Leavitt J, Numbers RL (eds). Sickness and
Health in America. St Paul, MN: North Central
Publishing Company, 1967, pp. 131–37.
BODY WEIGHT AND MORTALITY IN THE LATE 19TH CENTURY
7
8
Dublin L. A Family of Thirty Million: The Story of the
Metropolitan Life Insurance Company. New York:
Metropolitan Life Insurance Company, 1943.
Czerniawski AM. From average to ideal: the evolution
of the height and weight table in the united states,
1836-1943. Social Sci History 2007;31:273–96.
9
10
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James M. The Metropolitan Life: A Study in Business Growth.
New York: The Viking Press, 1947.
Dublin L, Lotka AJ. Twenty-Five Years of Health Progress: a
Study of the Mortality Experience Among the Industrial Policyholders of the Metropolitan Life Insurance Company 1911–1935.
New York: Metropolitan Life Insurance Company, 1937.
Published by Oxford University Press on behalf of the International Epidemiological Association
ß The Author 2010; all rights reserved. Advance Access publication 21 July 2010
International Journal of Epidemiology 2010;39:959–963
doi:10.1093/ije/dyq089
Commentary: Body weight and mortality in the
late 19th century
Gary Whitlock
Clinical Trial Service Unit & Epidemiological Studies Unit, Richard Doll Building, University of Oxford, Oxford OX3 7LF, UK.
E-mail: [email protected]
Accepted
14 April 2010
On 18 June 1908, Brandreth Symonds presented the
results of an extraordinarily large prospective study of
weight and mortality to the annual meeting of the
Medical Society of New Jersey.1 The analysis related
the overall and cause-specific mortality among thousands of men and women accepted as life-insurance
policyholders to weight and height as measured when
they had applied for the policy, and was the product
of a pioneering collaboration between insurance companies across the USA and Canada.2 Although the
analysis is now over a century old, there is much in
it that seems presciently relevant to the current time.
Early evidence from life-insurance
mortality studies
During the first half of the 20th century,
life-insurance mortality studies provided much better
evidence about some causes of premature death than
mainstream epidemiological studies did. Large actuarial studies3 investigated the effects on mortality not
only of weight,1 but also of alcohol,4 smoking,5 glycosuria6 and blood pressure.6,7 The main motivating
force behind these studies was not the improvement
of public health, but insurance company profits: by
more accurately predicting who would die early and
thus be expensive, a company could appropriately
calibrate premiums and contain costs. But the studies
depended crucially on the work not only of actuaries
but also of medical doctors—including Brandreth
Symonds, who since 1903 had been Medical Director
of the Mutual Life Insurance Company of New
York8—and, thankfully, some of the results were published in medical journals, to the potential boon of
patients and the public. The financial incentive to collect detailed information on applicants, together with
the newly introduced technique of storing information on punch cards,3 soon produced rafts of analysable prospective data on a scale that would not be
seen in mainstream medical research for another
half century.9
Signal features of the 1908 analysis
By modern standards, the transcript of Symonds’
1908 presentation lacks the detail necessary to make
confident aetiological inferences, but it does describe
many features that today would be considered serious
strengths for assessing cause and effect. The first was
genuinely large scale: there were 1499 male deaths in
the most obese group alone, which is a high number
even by the standards of recent epidemiological studies. Second was a careful dissection of results for
weight not only by height and by sex but also by
age. This dealt with potential confounding by these
variables, while also informatively displaying modification of associations by them. Third, the results
may have been unusually free of contamination by
the effects of pre-existing disease on weight at the
time of measurement (i.e. reverse causality), because