Husky Dick and Chubby Jane: A century of childhood obesity in the United States.

摘要

This thesis examines changes in how childhood obesity has been measured and diagnosed in the twentieth century (Part I) and developments in understanding its causes and treatment (Part II).;The earliest diagnostic technique---aesthetic judgment---has been supplemented with quantitative techniques. Childhood obesity can be readily diagnosed by eye and this is responsible for much of the condition's social valence and how it is experienced. Quantitative techniques have measured different characteristics of children's bodies (size, contour, fat content), producing a plethora of techniques rather than a definitive method for diagnosing obesity. Measurement issues are an outcome of continued endeavors to establish whether, how, and why childhood obesity is harmful. Dilemmas are fuelled by vogues in research methodology, a desire to use avant guarde technology, but also by practical needs. Moving from lab, to pediatrician's office, school nurse's office and home, requires translations and compromises.;In part two, I argue that responses to childhood obesity reflect societal values and decisions about apportioning responsibility for children's well-being between parents, children themselves, and society. Over time, theories of childhood obesity's etiology have been layered, not replaced, producing an understanding of the condition as complex and multi-factorial. Chapters address biological explanations and drug treatment; family environment and psychological factors (Hilde Bruch as a case study); metabolic imbalance and treatment through diet and exercise, specifically diet books and fat camps. Parents' role in causing and treating their child's condition is one of the major threads traced.;Increasing rates of childhood obesity since the 1960s have been attributed to the nature of modern---especially American---society. "Treatment" has been conceptualized as changing the child's macro-environment through social activism, legal and public health measures. The increase is often framed as a sign that modernity is, ironically, pathological. Interventions are largely directed at children's behavior, but fail to engage with current understandings implicating the macro-environment. Recognizing that people enjoy and value certain features of the "obesogenic" environment, and the vested interests in maintaining the status quo, placing major responsibility for managing childhood obesity with children themselves is nonetheless an abrogation of adult responsibilities, and, as history suggests, likely to be ineffective.