In the 1980s in western culture there was general public concern about an eating disorder epidemic which had been building for a decade, and which affected particularly women. Figures suggested that 20 per cent of young women were anorexic, and of these 10 per cent might end in starving themselves to death. The disorder was called anorexia nervosa. It was (and is) understood as unavoidable and unfortunate – who would want to starve themselves or vomit after eating? Who would risk death by starvation voluntarily? It is positioned clearly as an illness, and sufferers are neither culpable or blameworthy.
Thirty years later obesity has become the new eating disorder ‘epidemic’ and, like anorexia, women are at the heart of it with a higher prevalence of obesity than men. Obese women however are positioned quite differently to anorexic women in terms of their ‘disorder’, and there are strong popular and treatment discourses which position them as culpable in their predicament. The reasons for these changes, both to the nature of the ‘disorder’ and understanding or interpretation of it, are connected to the changing interrelation of women’s social roles and constructions of femininity across history. By understanding the past of femininity, size and eating, we may have more of an analytic grip on present events.
Until recently fasting was done by women at the lower end of the social and economic scale, for religious dedication or monetary reward, but in that part of society where food was often scarce and hunger was common. Joan Brumberg has documented the distinctively feminine history of self-starvation in western culture, showing how until the nineteenth century female fasting was undertaken mostly by poor women to earn money as miracle-performers or to earn favour with God. It was only with industrialisation and the creation of a substantial middle class that it was repositioned as an illness – first as cholorosis and later as anorexia - and actual cases remained low until the 1960s. But whether religious or ill, the medical and popular view was and is of self-starvation as an achievement of mind over matter, and an assertion of individual will and strength.
Peter Stearns examines the paintings of voluptuous large women in western art throughout the ages and finds an aesthetic based around female fatness, even obesity, which linked it strongly with traditional values of health, fertility and sexuality. And until very recently, overeating was the prerogative of the rich and the privileged, and therefore fatness in women was the achievement of an affluence over which few women had direct control themselves. To be voluptuous was both to accept the masculine ideals of beauty and behaviour, and to acquiesce to the social and gendered status quo.
In the nineteenth century the place of fatness in idealised femininity and feminine qualities went far beyond the visual aesthetic. Hilde Bruch, a psychiatrist and psychoanalyst who wrote one of the most influential clinical books of the last century about eating disorders, documented the variety of cultural and social contexts where at the very least overweight (and more often obese) women were lauded and rewarded. Until very recently women’s main role was to preside over the home, to act as an ‘ angel of the hearth’. As homemakers and housekeepers they provided not only physical sustenance – food and domestic comfort - but the moral and spiritual core also. The home was both a refuge for family members from the vicissitudes of the harsh external world, and equipped them for it. The size of the matronly figure tangibly embodied nurturance, safety and security.
However we now occupy a society which medical authority now terms ‘ obesogenic’ - which solicits consumption at every opportunity of a huge variety of palatable, calorie rich forms. Food and drink is displayed temptingly in almost every corner of modern life - in shops, kiosks, takeaways, dispensing machines – at work, leisure, travel – at any time of the day, and at prices the majority can afford. Even the food consumed at home is often not made at home, and is of a large variety and ever larger portions sizes. The home is no longer the refuge in which refuelling and restoring of all kinds takes place. Being able to provide sufficient and palatable things to eat is no longer a major achievement; being able to resist the abundance available is.
Since the Second World War there has been a transformation in women’s roles. Women have economic, social and political freedoms and opportunities unparalleled in our history. This has led to a corresponding transformation and complication of idealised femininity – the changes in role have led to emphasis on self-control, individual will power and achievement of individual potential. But these changes are only added to the established canon of roles of wife and mother. It is not surprising then, given the history of self-starvation and what is has come to signify, that for women in Western culture slenderness embodies an assertion of self and 'necessary' moral qualities. Even though individual susceptibility to the lure of food or strength of appetite may well be genetic, ability to resist is considered not to be by our culture.
So self- control, strength of purpose and self-determination are requisites of both the new feminine roles and success in the obesogenic society. And by this reckoning, if to be an obese man is a failure of self and will, to be an obese woman doubles that load. Is this double burden the explanation for the majority of obese patients for radical medical treatment being women, and the greater degree of guilt they seem to feel?