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RESEARCH PRODUCT

Obesity in Aging and Art

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THIS issue of Journal of Gerontology: Medical Sciences highlights new findings on obesity in older persons and its consequences for health and function (1,2,3). The obesity epidemic is spreading rapidly in both developed and developing countries, and perspectives on the negative effects of overweight and obesity abound in recent medical literature. What do we know so far about obesity over the lifetime? Obesity does not spare older persons (4). Obese older persons experience a wide range of negative consequences, including metabolic abnormalities, arthritis, pulmonary diseases, cataracts, cancer, impaired mobility, disability, and mortality. Given the already extensive knowledge base, why a special section in Journal of Gerontology: Medical Sciences on obesity in old age? Obesity in older persons has unique implications that have not yet been adequately explored. The authors of this editorial feel it would be wrong to disclose in advance the major findings of these articles; it would be like recommending a wonderful book to a friend and then spoiling it all by revealing the ending. However, perhaps a few hints will stimulate your curiosity. First, it is quite clear that obesity in middle and old age is a risk factor for cognitive impairment and physical disability in late life (5–7). However, a body mass index slightly above the “magical” 24 may be OK. Also, cyclically losing and gaining weight may not be a good idea (8). Finally, obesity appears particularly threatening in the presence of other problems, such as metabolic dysregulation, poor muscle strength, and depression (9,10). The image we each have of our own body, its fat, its muscle, profoundly affects how we relate to society. It is not surprising that artists have selected the human body as the primary focus of their attention since prehistoric times. The representation of the body has varied dramatically under differing cultures and philosophies. Perhaps the oldest known human figure is the Venus of Willendorf (Superior Paleolithic, 20–30 thousand years BC.) (Figure 1), a short fat woman without a face and with oversized breasts and buttocks. This statue, considered the primordial artistic representation of obesity, inspires in the viewer a strong, reverential sense of respect. The idea that a certain amount of fatness was attractive and indicated good health, fertility, and high socioeconomic status remained dominant for many centuries. Figure 1. Venus of Willendorf (authors unknown, Superior Paleolithic, 20–30 thousand years BC.). In Greek mythology, Pluto, the God of wealth, was represented as an obese, blind man. In most religious medieval paintings, angels and even Jesus are often represented as overtly obese children (Figure 2). The Tuscan nobleman and soldier, Alessandro del Borro, who fought in the mid-17th century wars against the Ottoman Empire, was painted by Diego Velasquez as a man of overwhelming size (Figure 3). There is no shame in his proportions, only a sense of intense power. Glorious examples of obesity can be admired in the work of the Flemish Baroque painter Pieter Paul Rubens (eg, Venus at the mirror, Figure 4) and the impressionist Pierre Auguste Renoir (the bath series, Figure 5). Figure 2. Madonna with the Christ Child and St. John the Baptist. Lorenzo di Credi (1459–1537). Figure 3. Portrait of the Tuscan General Alessandro del Borro, 1645, attributed to Charles Mellin. Figure 4. Venus at a Mirror. Peter Paul Rubens, 1615. Figure 5. Woman at the well, 1910. Pierre Auguste Renoir. A perception of generous proportions as indication of health, beauty, and vitality continued until second half of the 20th century, when scientists discovered saturated fats, trans-fats, and their relationship with metabolic and cardiovascular diseases. Something profound changed. A well-rounded body was no longer a symbol of good health and gushing beauty. On the contrary, artists began to use the image of a massive body to symbolize conflict between the individual and society. Obesity became synonymous with frustration, poverty, stress, and unhappiness. The media began to celebrate images of thin almost malnourished women and men with unrealistically sculptured physiques. Fat became ugly and thin became beautiful. In art, the naked body is depicted more frequently than ever. Curves are no longer a celebration of the human shape, but rather a symbol of the many contradictions in society; humanity detached from nature; over consumption of artificial food. Indeed, nowadays, the women portrayed by Rubens and Renoir would be considered fat and even ugly. Fernando Botero, a famous Colombian contempory artist stands as one exception. Botero painted massive figures of men, women, and animals embedded in realistic environments (Figure 6). Some perceive his work as a satirical representation of society, but others question this interpretation. Many people see in Botero's work a sense of beauty and quiet harmony despite the massive figures. These paintings do not judge size and do not imply negative behaviors. Perhaps the viewer is influenced by the fact that Botero's men and women are big, but also solid and muscular. In a perspective from aging, we would certainly not consider them sarcopenic. But this may be taking things too far. The human body for Botero is only the starting point, a kernel that evolves abstractly, where any relationship to the real world belongs to the viewer and not to the artist. Depictions of obesity in art provide a context for thinking about the changing meaning of obesity to individuals and society. Of course, we now know that overweight and obesity are bad for health, and obesity prevention is a public health imperative. For the individual and for the society, less obesity may be the most effective way to prevent chronic diseases and promote a healthy, successful longevity. Yet, it is important to consider the broader cultural context of obesity and health behaviors while we search for effective strategies for prevention. Figure 6. A Family. Fernando Botero 1996. Conundrums remain. Despite all the evidence on the negative effects of obesity, its prevalence continues to increase. Peculiarly, given the relationship between obesity and cardiovascular disease, it is unclear why cardiovascular mortality is decreasing although obesity is increasing. Better treatment may play a role here. Interestingly, some scientists attribute increasing rates of obesity to a dysregulation of the hypothalamic pituitary axis, perhaps related to increasing levels of stress in modern life. Others argue that economic forces, such as changing patterns of food production, leisure time activity, and urban planning, are the real drivers of the obesity epidemic (11). The answer perhaps can be found in the words of Nero Wolfe, the massively overweight, sedentary, gourmet detective created by the pen of Rex Stout: “I carry this fat to insulate my feelings. They got too strong for me…If I had stayed lean and kept moving around I would have been dead long ago.”