Monday, October 14, 2013 5:46 pm
Portly Taft helped usher in modern obesity care
By LAURAN NEERGAARDAP Medical Writer
Got a nagging doctor? The 27th president, William H. Taft did, way back in the early 1900s. A medical historian has analyzed letters between the two, complete with food diaries and daily weigh-ins surely recognizable to many of today's dieters.
Have a problem with yo-yo dieting and weight gain? Yep, Taft did, too.
Monday's report offers a rare peek at the history of obesity, through the experiences of one of the first American public figures to struggle openly with weight - and how a doctor aided in an era when physician treatment of obesity was just emerging.
Taft's "rise to political power coincided with this change in medical thinking, which led to the first celebrity weight loss patient," said Deborah Levine, an assistant professor at Rhode Island's Providence College. Her report, part of research for a book about the course of obesity in the U.S., appears Monday in the journal Annals of Internal Medicine.
Sports fans might recognize Taft as the latest addition to the Washington Nationals' racing presidents. History buffs know he's the only president-turned-Supreme Court chief justice. But he's also remembered as the president whose weight, at times well over 300 pounds, made headlines.
Taft hired British dieting expert Nathaniel Yorke-Davies in 1905, four years before becoming president. Then 314 pounds, Taft was worried about heartburn and other health problems - he was famously fatigued, presumably from obesity-caused sleep apnea - and possibly also about his career, Levine wrote.
The candid exchanges between doctor and patient highlight the ups and down of weight loss.
"I feel in excellent condition. I used to suffer from acidity of stomach, and I suppose that was due to overloading it," Taft wrote at one point.
Dusting off those archives is important to remind people that obesity isn't some scary new 21st-century problem, said Dr. Scott Kahan of George Washington University and the STOP Obesity Alliance.
Yes, obesity rates have surged to epidemic levels over the past few decades. But waistlines actually began to expand in the mid-19th century, as food became easier to cultivate and distribute, Kahan said. Diet books and pamphlets began flourishing. Where women's corsets offered some tightening, Levine says obesity belts were developed for men.
Even then it was clear there was no quick fix. And if you think high-calorie restaurant food is only a recent problem, well, Taft wrote a relative that all the formal dinners required in politics sabotaged his efforts. In his first year with Yorke-Davies, Taft lost 59 pounds, Levine found, only to regain it. Only after leaving the White House did Taft shed significant weight and keep it off, with help from a different doctor, she noted.
"It's really, really hard to lose weight and keep it off. If it wasn't, we'd all be thin," said Kahan, who was struck by similarities between Taft's struggles and many weight-loss efforts today. "We recognize this problem as a disease, and yet at the same time we expect people to just be able to manage it once we write down a diet for them."
Today, doctors know that for someone who's obese, shedding even 5 percent to 10 percent of the original weight can improve health, he added.
Yorke-Davies had written a popular diet book, "Foods for the Fat: A Treatise on Corpulency and a Dietary for its Cure." He and Taft had a long-distance relationship. The doctor mailed a three-page list of allowed and forbidden foods - heavy on lean meats and reducing sugar, almost a prelude to the Atkins diet. Taft was to weigh himself daily and mail a weekly report.
Levine compared the handwritten weigh-ins and the typed letters to the doctor. Sometimes Taft cheated.
And Yorke-Davies nagged, politely, but a lot. One month the doctor fussed that Taft's weight loss was only 9 pounds, not the intended 14. When Taft slacked off, the doctor wrote that he'd heard "you are much stouter than you were a few months ago."
Levine concludes that some core practices - close doctor-patient communication, tracking weight and food diaries - still are in use.
The challenge is to find a balance between helpful advice and nagging, said Dr. Mladen Golubic of the Cleveland Clinic Wellness Institute. Some of the clinic's patients opt for daily, personalized emails to track their progress.
"You don't want to be harsh," Golubic said. But "you need to nudge them."