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Childhood Obesity in America

Childhood Obesity in America

Laura Dawes
Copyright Date: 2014
Published by: Harvard University Press
Pages: 316
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  • Book Info
    Childhood Obesity in America
    Book Description:

    Obesity among American children has reached epidemic proportions. Laura Dawes traces changes in diagnosis, treatment, and popular conceptions of the most serious health problem facing American children today, and makes the case that understanding the cultural history of a disease is critical to developing effective public health policy.

    eISBN: 978-0-674-36957-3
    Subjects: Public Health, Health Sciences, History

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Introduction
    (pp. 1-18)

    Together, these five children, Charley, “J,” Francis, John, and Ashley, span a century of childhood obesity in the United States. Each, however, grew up during a different stage in the history of how childhood obesity has been understood and treated, and what fatness in a child meant. This book is about the changing environment of opinions, practices, and beliefs about childhood obesity in the twentieth century that surrounded and affected children like these—and many more like them.

    For Charley, at the beginning of the century, childhood obesity was a rare condition and one that doctors didn’t worry much about....

  4. Part 1 Measurement and Diagnosis

    • CHAPTER 1 How Big Is Normal? Quantifying Childrenʹs Body Size
      (pp. 21-40)

      How did childhood obesity come to be a condition requiring medical attention? Fat children existed before the twentieth century. But great fatness in a child was rare enough to be considered a titillating deviation from the much slimmer norm. Indeed, some very large children became famous for their unusual size. In 1896, nine-year-old Charley Bilcher was a local celebrity in his hometown of Catasauqua, Pennsylvania, having overtaken Anton Mochty of Austria and brought home to the United States the title of “fattest boy in the world.” Or there was “fat-boy prodigy,” young Irwin O. Schell (aged eleven) of Reading, Pennsylvania,...

    • CHAPTER 2 Measuring Up Height-Weight Standards and Diagnosis
      (pp. 41-58)

      By 1920, American society had been sensitized to a child’s height and weight. Widely available technologies of scales and stadiometers made it easy to pin down a child’s measurements. A visit to the doctor, a flick through a magazine, a trip to the department store; all of these activities brought home to parents that their child’s body size mattered and meant something. But what, exactly, did it mean? If your child was big, should you be worried—or proud? And if worried, worried for what reason? Was a fat child a sick child, or just socially disadvantaged? The answers to...

    • CHAPTER 3 Sugar, Spice, Frogs, Snails The Composition of the Fat Child
      (pp. 59-71)

      For most of the twentieth century, the picture of how to measure and diagnose childhood obesity was confused. There were a few options for how to do it—making an aesthetic judgment or diagnosis-by-eyeball; choosing one of the many “standard” tables of height and weight and using some cutoff point such as 20 percent in excess of average weight; or using some criteria based on an index that captured body shape, like the Quetelet or Ponderal indices. Each method had certain advantages in certain settings where it might be used, as well as certain detractions. Consensus—that foundation stone of...

    • CHAPTER 4 Insides Made Easy Measuring and Diagnosing Obesity Using Body Composition
      (pp. 72-84)

      By the 1960s, researchers had a number of technologies, including dilution methods, densitometry, and potassium counting, available to them for investigating childhood obesity. But all the technologies had a major drawback: they needed significant lab equipment, analysis time, and well-trained staff to carry them out. These were high-end laboratory techniques. None were suitable for a quick estimate carried out in the pediatrician’s office, during a school health examination, or for an epidemiological survey of thousands of children. One research team investigating childhood obesity in 1968 summarized their dilemma:

      Obesity among children continues to be a major health concern. Yet accurate...

  5. Part 2 Causes and Treatments

    • CHAPTER 5 Something Wrong Inside Childhood Obesity as a Biological Fault, and the Hope for a Drug Treatment
      (pp. 87-99)

      What makes a child fat? That is a question that has had different answers throughout the twentieth century. Driven by medical vogues, successes, and failures, each answer added a different way of understanding the condition and a different way of treating it. The result at the end of the century was a condition that was seen as complex and multifactorial, with a range of treatment options—each with problems.¹

      The idea that childhood obesity is caused by some kind of physical or “organic” problemwithinthe obese child’s body that can be corrected by drugs is a concept that has...

    • CHAPTER 6 The Enduring Promise The Continued Search for a Pharmaceutical Remedy
      (pp. 100-114)

      Organotherapy or gland treatment for childhood obesity, popular from the 1920s through to the 1940s, was just the first episode in an ongoing courtship with potential drug treatments for fatness in childhood. Itsrisewas buoyed by the bubble of enthusiasm for things endocrine and supported by a theoretical model of childhood obesity that ascribed the condition to failure of various glands. Itsfallwas due to that model breaking down and the realization that the apparently successful thyroid treatment was, in fact, poisoning children to make them thin, rather than dealing with any root cause of their fatness. Its...

    • CHAPTER 7 Feeling Fat Emotions and Family as Factors in Childhood Obesity
      (pp. 115-132)

      By 1930, the endocrine theory of childhood obesity was fast unraveling. There was a growing and somewhat sheepish sense in pediatric research circles that, as one pediatrician described, “when all is said on the score of the endocrine glands, it leaves one with the impression that their role in the production of obesity has been astonishingly overestimated.” Cases of childhood obesity that could be definitively attributed to underperforming glands were the small, rare minority. Once those rare endocrine cases had been identified, researchers looking at obesity in childhood were still left with what one researcher described as “this huge group...

    • CHAPTER 8 Kalorie Kids Energy Balance and the Turn to Child Responsibility
      (pp. 133-158)

      Dieting and, to a lesser extent, exercising have been a part of the treatment for childhood obesity for the entire twentieth century. Diet and exercise were, for example, sometimes part of the prescription even in the 1920s and 1930s when the cause of childhood obesity was believed to be glandular. The rationale for manipulating food intake or physical activity to influence the shape of the body was the idea that the body was an engine that needed to be kept in “energy balance.” Out of balance, it would get fat or thin.¹

      The concept of the body as a machine...

    • CHAPTER 9 Summer Slimming Fat Camps as a Diet-and-Exercise Obesity Treatment
      (pp. 159-170)

      The apogee of dieting-and-exercise treatment regimes in commercial life and youth culture is undoubtedly the “fat camp.” These are summer residential camps that combine controlled diet and dietary education with a program of physical activities to help children and adolescents lose weight. A more polite term is “weight-loss camp,” but “fat camp” is the popular culture term, and what children who attend them today call them.¹

      The first fat camp was Camp Seascape, a camp for girls established in 1959 in Brewster, Cape Cod. It was owned and directed by a nutritionist, Penny Peckos, and a pediatrician, John Spargo. Spargo...

  6. Part 3 Epidemic

    • CHAPTER 10 Bigger Bodies in a Broken World Television and the Epidemic of Childhood Obesity
      (pp. 173-190)

      In 1985, William Dietz of the Centers for Disease Control and Steven Gortmaker from Harvard’s School of Public Health presented a paper to the American Pediatric Society on their analysis of national survey data. They had used skinfold measurements collected since the 1960s to look at the prevalence of childhood obesity. What they found was that the proportion of overweight children had nearly doubled over that time. “These data,” they concluded, “indicate that obesity is epidemic in the pediatric population.” Dietz and Gortmaker’s statement, and particularly their choice of the word “epidemic,” marked the beginning of a massive increase in...

    • CHAPTER 11 Fat Kids Go to Court Legal Action as Public Health Response to Childhood Obesity
      (pp. 191-208)

      For activist groups like the Center for Science in the Public Interest (CSPI), the disappointment of the Kid-Vid saga in the late 1970s and the pro-self-regulation stance of the Federal Trade Commission (FTC) in the 2000s were signs that they needed to look for new forums beyond federal commissions to promote their agenda. Although there was congressional support for “doing something” nationwide about the epidemic of childhood obesity, it appeared that “reduce” or “regulate” were not words legislators or commissioners were comfortable using in regard to industry. As a result, activist groups instead turned to the state courts: “We are...

  7. Conclusion
    (pp. 209-216)

    In the United States at the start of the twentieth century, childhood obesity was a condition of little medical significance and relative rarity. In fact, considerable corpulence in a child could make him a local hero, feted by newspapers for his fatness. At the start of the twenty-first century, childhood obesity is epidemically prevalent, and painfully exposes the child and her parents to judgment. Newspapers now report on the condition’s risk factors, such as high cholesterol and high blood pressure; its dangerous connection with diabetes and heart disease; and its keenly felt social and emotional harms. Moreover, since the 1960s,...

  8. Notes
    (pp. 219-294)
  9. Acknowledgments
    (pp. 295-296)
  10. Index
    (pp. 297-305)