Obesity was quite rare for most of human history. Food was not as plentiful as today. The attention paid to fat characters in literature over the ages points to the relative scarcity of the corpulent. The Book of Judges describes Eglon, King of Moab, as being so large that the dagger used in his assassination “disappeared beneath [his] fat.” Moving ahead 2,500 years, Shakespeare used weight to various dramatic effect. Julius Caesar states that “Yon Cassius has a lean and hungry look … Let me have men about me that are fat,” presumably because their bulk indicated a lack of ambition. And his greatest comic creation, Falstaff, is practically defined by his obesity—”a tun of man … that stuft cloak-bag of guts.” Now, of course, excess weight is understood to cause a host of health problems that are life-threatening and diminish quality of life. Patients who qualify as obese should be helped to lose weight, whether by counseling and diet, medications, gastric surgery, or (perhaps to come) deep brain simulation.
The discomforts and disabilities of great weight in fact were recognized before the advent of modern medicine. George Cheyne was an eminent British doctor of the early 18th century. Born in Scotland in 1671, he studied medicine at Edinburgh and moved to London to make his name as a physician. Cheyne built his practice in part by regular attendance at taverns, where he indulged freely in food and drink. In part this behavior may have spurred his 1724 treatise, “An Essay of Health and Long Life.” This work included the observation that “to preserve health, the quantity and nature of our food … must be proportional to the strength of our digestion.” Cheyne is often referenced as a father of vegetarianism, advocating a meat-free diet based on milk and vegetable consumption. He himself practiced this diet with variable consistency and for most of his adult life was morbidly obese, weighing over 32 stone (that’s about 450 pounds).
In general, physicians now as in the 18th century are not immune to the perils of obesity. Looking specifically at neurosurgery, no notably obese practitioners have been chronicled in biographies of leading neurosurgeons; perhaps this reflects our restless natures and cognizance of the need to set an example for our patients and others. But as a group we surely are not immune to the perils of too much eating and too little exercise. Seriously overweight doctors, including neurosurgeons, should be treated as would any patient, thus setting a standard for others to follow. And all who battle the bulge may take some small comfort from George Cheyne. He died in 1743, age 72, “in full possession of his faculties to the last, and without experiencing a pang.”
Michael Schulder, MD, is vice chair of the Department of Neurosurgery and director of the Harvey Cushing Brain Tumor Institute at the North Shore Long Island Jewish Health System, Manhassett, N.Y. The author reported no conflicts for disclosure. Send topic ideas for Timeline to Dr. Schulder at [email protected].