Loading ...

A pediatric endocrinologist recently proposed a unique idea to help address the stigma against patients with obesity in the healthcare system: an art history lesson.

Until recently, obesity was a sign of wealth and power in men and of beauty in women, and that positive perspective was portrayed in art, Michael Yafi, MD, pediatric endocrinology specialist at UT Health Houston, told Medscape Medical News.

Yafi presented his concept of art history as a lesson in compassion at the recent European Congress on Obesity in Istanbul, Turkey, with an accompanying slide presentation titled: “Obesity: An Art Journey.”

Among his many examples of obesity representing positive attributes was the Venus of Willendorf, a stone figurine believed to be up to 32,000 years old. The woman depicted had excess body fat and exaggerated hips and breasts — features that were symbols of fertility, prosperity, and survival in what was then a harsh environment, noted Yafi, professor at McGovern Medical School at UT Health Houston.

In the Middle Ages, children and angels were portrayed with folds of skin and excess body fat, he pointed out. The Ottoman emperors, who reigned up to the 1920s, were depicted with abdominal obesity.

Baroque composers Bach and Handel also had excess body fat. The Mona Lisa, widely believed to depict Lisa del Giocondo, the wife of a wealthy silk merchant, also had excess body fat. Yafi contends she may have had a lipid metabolism disorder or simply accumulated weight from five pregnancies.

Stereotype Shifts

This perception of generous body proportions reflecting power, wealth, and beauty continued until the second half of the 20th century, Yafi said. Then, modern medicine discovered the relationship between saturated fat, diet, and metabolic and cardiovascular disease, and the perception of obesity shifted negatively in the media and then in art, he said. People with the condition started to be stigmatized, and thin became beautiful.

As a result, art began glorifying images of women who were unrealistically thin and men with unrealistic physiques, Yafi said.

Now, we’ve entered the so-called Ozempic era. While GLP-1s have helped many lose excess weight and improve cardiovascular and other parameters, their use can result in what’s called “GLP-1 face” or “Ozempic face” — a sunken look caused by loss of fat from the cheeks, temples, and under the eyes.

As even more people use the medication, Yafi predicted, “GLP-1 face” will become a more common portrayal in art.

More to the Story

Yafi’s idea may have value, but the story of overweight’s portrayal in art is more complicated, Rebecca Puhl, PhD, professor of human development and family sciences at the University of Connecticut in Storrs, Connecticut, told Medscape Medical News.

“Using art history as a teaching tool is an interesting idea to potentially help clinicians reflect on how cultural ideas about body size change across time and how those ideas influence bias in healthcare today,” she said. In her research, she has found physicians treating patients with obesity and type 2 diabetes demonstrate stigma about both conditions.

However, Puhl added a caveat: “I would caution against oversimplifying historical artistic representations into a narrative that larger bodies were universally admired until modern medicine or modern media came along.”

She pointed to historical evidence that shows weight stigma and moral judgments about body size existed centuries ago in many cultures.

Reducing stigma, she said, depends on addressing and refuting misconceptions about obesity, such as thinking it is simply a matter of willpower or personal responsibility.

Yafi remains hopeful that learning about how overweight was handled in art over time could help healthcare providers better understand obesity and treat patients with more compassion.

As a pediatric endocrinologist, Yafi treats children with obesity and believes they suffer from being stigmatized.

He urges his colleagues: “Look at the patient from a holistic point of view. Screen for mental health issues. Understand the patients’ feelings and try to be more sympathetic.”

Yafi reported having no disclosures. Puhl reported receiving grant funding from Eli Lilly & Company and WW.