Aside from libertarian polemic and reviewing sicko Korean horror films, I have two main confessable interests in my life. One is every aspect of the Ancient World. The other is diet and exercise and health and beauty—things which, I suggest, are so closely allied that they might as well be one. This article is an attempt to combine these latter interests. I want to discuss what the Ancients thought about obesity.

Because it was much poorer than our own, the Ancient World was not a place where many people were fat. The main problem, it seems, was that most people suffered endemic malnutrition. However, there were people in comfortable circumstances, and they grew fat. Both Greek and Latin have a full vocabulary to describe the varieties of obesity. For Greek, we have: γαστρῶδης or γαστροειδής, μεγαλόκοιλος, παχύς/παχύτης, πίειρα/πίων, πιμελῙδης, πολύσαρκος/πολυσαρκία, προγάστωρ, σάρκινος, and ὕπέρσαρκος/ὕπερσάρκωμα. For Latin we have: adeps, crassus/crassitudo, obesus, (prae)pinguis, subcrassulus, and ventriosus.

What we can say in short about ancient obesity is that it was at least as shameful among the Ancients as it is among us—perhaps more so—and there was a lively medical and philosophical literature to deal with its causes and treatment. It also comes up repeatedly in the various historical writings. We have this, for example, on the tyrant Dionysius of Heraclea (r. 337-306 BC):

Dionysius the son of Clearchus, who was the first tyrant of Heraclea, and who was himself afterwards tyrant of his country, grew enormously fat without perceiving it (ἐλαθεν ὕπερσαρκήσας), owing to his luxury and to his daily gluttony; so on account of his obesity (διά τῳ πάχος) he was constantly oppressed by difficulty of breathing and a feeling of suffocation… his physicians ordered thin needles of an exceedingly great length to be made, to be run into his sides and chest whenever he fell into a deeper sleep than usual… And he used to give answers to people who came to him, holding a chest in front of his body so as to conceal all the rest of his person, and leave only his face visible. (Athenaeus, Deipnosophistae 12.549a–d; Aelian, Varia Historia 9.13).

Aelian, whom I do not quote, suggests that he encased himself in some kind of portable stone tower to avoid being wholly seen by his subjects. However he concealed his bulk, I know of several boys at my school who might profit from his example. It would spare me the sight of their offensive bodies.

Ptolemy VIII of Egypt, nicknamed Physcon (“Potbelly”), offers a similar case. He was monstrously fat and a gross monster. He wore a long tunic to hide his corpulence, and was famously mocked for having to walk through Alexandria when Scipio Africanus came on a diplomatic visit. The story goes that he only ever exercised “because of Scipio” (διὰ Σκιπίωνα) (Athenaeus, Deipnosophistae 12.550a).

Vitellius, the last of the short-lived Emperors who followed the suicide of Nero, was also a monster of obesity and a beast. According to Suetonius:

Moreover, as a man not only of excessive but also of untimely and filthy gluttony, he never restrained himself—not even during sacrifices or on any journey—but would at once, right there among the altars, snatch up bits of entrails and spelt bread almost straight from the hearth and gobble them down, and he would devour the steaming dishes in roadside taverns, even if they were from the day before or already half-eaten. (Vitellius 13)

Fatness was seen not only as ugly in itself, but also unhealthy. Epaminondas, the Theban general, dismissed one of his soldiers for being so fat that “three or four shields would scarcely serve to secure his belly, which would not allow him to see his own erect penis” (Ps.-Plutarch, Regum et imperatorum apophthegmata 192c). The fat man was unfit for war, and unfit for pleasure.

Plato offers a more systematic account. In Laws (807A), he compares the obese man to “an idle beast, fattened in sloth.” Gluttony is condemned repeatedly: “The passion of greed and unrestrained satisfaction of instincts is inherent in man” (Laws 831C-E, 875B; Republic 519B).

In Gorgias (518C-D), Republic (557D), and Laws (691C), Plato links obesity with physical illness and the decline of moral faculties. Obesity was, for Plato, both cause and symptom: it revealed the absence of internal order, the victory of appetite over logos.

But I come back to obesity and health. According to the Hippocratic Aphorisms:

When more nourishment is taken than the constitution can stand, disease is caused (Aphorisms II.17).

And:

Those who are constitutionally very fat are more apt to die quickly than those who are thin. (Aphorisms II.44).

Galen develops this further. In his commentary on the Hippocratic Aphorisms, he writes:

When we compare those who are fat from an early age on with those who are lean (Τοῦς ἐκ τῆς πρώτης ἕλικίας παχεῖς καῖ ἐισχνοὺς ἀλλήλοις παραβάλλων), the comparison is not favourable to the fat, since they are prone to die sooner… Excessive weight causes more damage. (In Hipp. Aph. 2.44; 17.2.547-548 K.).

In the same passage he distinguishes between “natural” fatness (ευσαρκία) and morbid obesity (πολυσαρκία), the latter defined as a condition in which a man couldn’t sit, breathe, walk, or even wipe himself. This is the kind of man who, to use his words, “cannot reach the table because of the mass of his stomach” (ibid).

It was better to be thin than fat, even if thinness carried other risks. The worst fate was early-onset obesity, which distorted the body’s natural proportions and robbed it of vital heat.

The doctors were not passive in their study of obesity. They had treatments to suggest. See Galen again:

This is one of the tasks of a doctor… if a patient reaches such a degree of obesity that he cannot walk without pain, or that he cannot sit down because of the size of his belly, and that he cannot even breathe, then it is necessary to relieve him from his fatness. (De Methodo Medendi 14.15; 10.993 K.).

The Hippocratic regimen, too, was well developed. Fat patients were advised to take only one full meal a day, avoid baths, lie on hard beds, and exercise vigorously: “Fat people who wish to become thin should always fast when they undertake exertion, and take their food while they are panting” (Regimen in Health 4, p.49). Remedies included purging by hellebore, vomiting, enemas of milk or barley water, vigorous walks, sun exposure, and sexual activity.

All of this was aimed at rebalancing the humours—too much phlegm or blood meant too much softness. Obesity was softness. The aim was dryness and discipline. But, if they lacked our—admittedly contested—nutritional science, they were shrewd and careful observers, and they had a body of experiential knowledge that was effective for those willing to follow it.

Now we come to something more speculative: surgery. Was the ancient world aware of something like liposuction? We have this passage from Pliny the Elder:

Greasy fat has no sensation, because it does not possess arteries or veins. For most animals fatness is insensate. Therefore pigs have been gnawed by mice when still alive. And the son of the consular Lucius Apronius had his fat (adipes) removed by an operation and relieved his body of unmanageable weight. (Natural History 11.85)

This is very interesting. The observation that pigs could be eaten alive by mice because fat has no nerve endings suggests a crude but intelligent grasp of physiology. Were both Apronius and Dionysius of Heraclea treated with some kind of surgical fat removal? The needles used on Dionysius were of “an exceedingly great length” and were inserted into his sides. Their purpose is unclear. Galen speaks of dangerous accumulations of moist humours in the belly, and these needed to be “pierced” or drained. It is not hard to imagine an early attempt at subcutaneous drainage—what we might now call an aspirational technique, if not quite liposuction.

So where does this leave us? The Ancients knew what caused obesity: gluttony and indiscipline. They knew its dangers: illness, death, dishonour. They knew what to do about it: move more, eat less, purge the humours, sweat out the filth. They even had crude surgical interventions. Most of all, they understood that obesity was not simply a medical issue. It was a moral failing, a rejection of order, a descent into beastliness.

I come back to my opening. You know what my interests are in the Ancient World and in my own appearance and health. But I’m a libertarian and I’m writing this for libertarians. There aren’t many of us, and most of us are surrounded by either slobs or nannies. If we want to win the argument for liberty—if we want to survive long enough to find or train others who might one day carry it forward—then we must stay alive, stay sharp, and stay healthy. We have no business resembling Dionysius, nor any excuse for behaving like Vitellius. I suggest instead the discipline of the Greeks, who knew what mattered and were not ashamed to say so.

Bibliography 

• Aelian, Claudius. Varia Historia. Edited by N.G. Wilson. Cambridge, MA: Harvard University Press, 1997.
• Athenaeus. Deipnosophistae. Translated by S. Douglas Olson. Cambridge, MA: Harvard University Press, 2006–2012.
• Galen. In Hippocratis Aphorismos Commentarii and De Methodo Medendi. In Opera Omnia, edited by C.G. Kühn, vols. 10 and 17. Leipzig: Knobloch, 1821–22.
• Hippocrates. Aphorisms, Regimen in Health, Epidemics, and Nature of Man. Translated by W.H.S. Jones and E.T. Withington. Cambridge, MA: Harvard University Press, 1923–1931.
• Laes, Christian. “Writing the History of Fatness and Thinness in Graeco-Roman Antiquity.” Medicina nei Secoli 28, no. 2 (2016): 583–638.
• Plato. Republic, Laws, Gorgias, Protagoras, Hipparchus, Epistles. Edited by John Burnet. Oxford: Oxford Classical Texts, 1901.
• Pliny the Elder. Naturalis Historia. Edited by and translated by H. Rackham. London: Harvard University Press, 1938–1963.
• Plutarch. Moralia: Sayings of Kings and Commanders. Translated by Frank Cole Babbitt. Cambridge, MA: Harvard University Press, 1931.
• Suetonius. The Lives of the Caesars. Translated by J.C. Rolfe. Cambridge, MA: Harvard University Press, 1914.