Further Thoughts on Ancient Obesity

I should give up the pretence that I am writing anything here of specifically libertarian argument. I could insist, as before, that libertarians are a diminishing minority, and that we have a duty to ourselves and our ideology to stay alive and healthy, and that this involves not becoming grossly fat. But that really is a pretence. I have been reading more of the ancient medical literature on obesity, and I am simply interested in its mixture of common sense and bad science. So here is a supplement to what I wrote on the matter earlier this month.

What the ancient doctors agreed on, with reasonable justification, was that eating too much could make you fat. They observed the correlation, but they forced it into the framework of a theory that was more elaborate than accurate. Central to both Hippocratic and Galenic medicine was the theory of the four humours: blood, phlegm, yellow bile, and black bile. Each humour had associated qualities: hot, cold, wet, and dry. Health was a matter of balance; disease came from excess or deficiency.

In Galen’s physiology, food was transformed directly into blood. His model of digestion involved invisible holes in the gut through which food passed under the influence of liver and veins (Properties of Foodstuffs, 17). Therefore, overeating meant an excess of blood—the humour most strongly associated with obesity. The condition of morbid obesity he termed polisarkia, and he described it as resulting from a “surplus of bad humours,” particularly blood (Galen, De Tumoribus Praeter Naturam, Vol. 7, 708). A person so afflicted might be unable to sit, walk, breathe, or wipe himself. Galen even gives a practical checklist: “the body deviates towards obesity to such a point that the person cannot walk without sweating, cannot reach [when sitting at] the table because of the mass of his stomach” (Methodo Medendi, Vol. 10, 993–94).

Hippocrates, writing centuries earlier, had framed the same condition in similarly humoral terms. The Aphorisms declare: “Those who are constitutionally very fat are more apt to die quickly than those who are thin” (Aph. II.44). Obesity was not just unattractive. It was a deviation from the ideal of metron, balance, which underpinned all Greek thinking—from sculpture to ethics. Fatness was softness; softness was weakness.

To treat obesity, the physicians prescribed a mixture of diet, exercise, purging, and in some cases, what looks suspiciously like early behavioural therapy. Galen describes one method in full:

Now, I have made any sufficiently stout patient moderately thin in a short time by compelling him to do rapid running, then wiping off his perspiration with very soft or very rough muslin, and then massaging him maximally with diaphoretic inunctions, which the younger doctors customarily call restoratives, and after such massage leading him to the bath, after which I did not give him nourishment immediately, but bade him rest for a while or do something to which he was accustomed, then led him to the second bath and then gave him abundant food of little nourishment, so as to fill him up but distribute little of it to the entire body. (De Sanitate Tuenda, Vol. 6, 26).

Exercise was not a matter of rebalancing calories in against calories used, but of restoring physical harmony in the wider sense. Galen preferred exercises involving the whole body, though not those that were excessively tiring. He recommended endurance activities like walking. One particularly curious suggestion was the use of the “small sphere,” a kind of ball game resembling a miniaturised version of modern football. The rules were unknown, but Galen believed it helped restore symmetry and health, even if it did not directly contribute to weight loss (De Parvae Pilae Exercitio, Vol. 5, 908). Swimming in the sea was especially recommended because of its combined benefits: full-body motion, drying powers of salt water, and the cooling effects needed to counterbalance the warm and moist temperament associated with obesity (Methodo Medendi, Vol. 10, 995–96).

None of this sounds that far from the truth as we now see it. Nor is the dietary advice that very far from what we believe. Barley was praised for facilitating urination and sweat—we might praise it for its glycaemic index. Among plants, garlic, leeks, mustard seed, and celery were said to have slimming properties—they are low in calories and carbs. Wild animal meat was preferred, as valley-dwelling animals were supposedly of a wetter temperament—and the meat tends to be leaner, if you believe eating fat makes you fat. Milk, cheese, honey, and wine were forbidden—as they are from most modern diets of whatever kind. This being said, water was suspect unless it was thin and salty.

Hippocratic advice was much the same. It included fasting during exertion, eating while panting, taking only one meal a day, and avoiding soft beds and baths. Vomiting, enemas, diuretics, and herbal purgatives such as hellebore were commonly employed. One recommended laxative was boiled ass’s milk with honey (Internal Affections, VI.46). Take what you will from this.

It is easy to laugh at the ancient medical theories. Yet we should be cautious. Our own science of nutrition changes every decade. Butter is bad, then it’s good. Carbs are essential, then dangerous. Red meat is the devil, then a misunderstood friend. We sneer at humours, but have our own dogmas and contradictions. One day we may be seen as the Galens of our age—wrong for the right reasons.

Reading ancient medical texts is therefore less about instruction than reflection. These men were highly intelligent. Their theories were often wrong, but their observations were meticulous. In the absence of modern physiology, they worked with what they had: a theory of balance, a lot of sweating, and some scary enemas. If the statues are any indication of how the higher classes looked, none of it did the Greeks any visible harm.

Bibliography

Athenaeus. Deipnosophistae. Translated by S. Douglas Olson. Cambridge, MA: Harvard University Press, 2006–2012.

Galen. Opera Omnia. Edited by C.G. Kühn. Leipzig: Knobloch, 1821–22.

Galen. De Sanitate Tuenda, Vol. 6. Hildesheim, New York: G. Olms, 2001.

Galen. Methodo Medendi, Vol. 10. Hildesheim, New York: G. Olms, 2001.

Galen. De Tumoribus Praeter Naturam, Vol. 7. Hildesheim, New York: G. Olms, 2001.

Galen. De Temperamentis, Vol. 1. Hildesheim, New York: G. Olms, 2001.

Galen. De Parvae Pilae Exercitio, Vol. 5. Hildesheim, New York: G. Olms, 2001.

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.

Pliny the Elder. Naturalis Historia. Edited and translated by H. Rackham. London: Harvard University Press, 1938–1963.

Powell, Oswei. Galen on the Properties of Foodstuffs. Cambridge: Cambridge University Press, 2003.

Papavramidou, Niki S., et al. “Galen on Obesity: Etiology, Effects, and Treatment.” World Journal of Surgery 28, no. 6 (2004): 631–35.

Christopoulou-Aletra, Helen, and Niki Papavramidou. “Methods Used by the Hippocratic Physicians for Weight Reduction.” World Journal of Surgery 28, no. 5 (2004): 513–17.