President Taft's struggle with obesity chronicled through letters

Date: Oct-15-2013As the only person to have served as both President and Chief Justice of the US, William Howard Taft's political contributions are well-documented. And now, correspondence with his physician provides a rare view into how obesity was tackled in the early 20th century.

In an article published in the journal Annals of Internal Medicine, Deborah Levine, PhD, from Providence College, RI, analyzes how President Taft and English diet expert Dr. Nathaniel Yorke-Davies worked together long-distance to keep Taft's weight in check.

According to Levine's article, Taft wrote to Yorke-Davies because he thought losing weight would help with a multitude of symptoms he was experiencing - including heartburn, indigestion, fatigue and restless sleep - and he also thought losing weight would help him be a better civil servant.

When Taft initially contacted Yorke-Davies, he weighed 314 pounds, a weight that could be considered medically obese.

For a period of 10 years, the President wrote to his doctor in England at least weekly, and provided intimate details about his food intake, physical activity and even bowel habits.

Levine notes that Yorke-Davies' letters show an approach to managing obesity that focused on continued patient-physician contact during a time in history when weight increasingly became a "measure of a person's ability to lead and succeed in the modern United States of America."

The price of obesity treatment in 1905

William H. Taft, pictured here in 1905, struggled with his weight throughout his presidency and beyond. Source: Library of Congress, LC-USZ62-88514.

Although Taft lost 60 pounds while following his doctor's plan, he struggled with weight throughout his presidency and beyond.

He was famously rumored to have become wedged into a White House bathtub, and his obesity was fodder for cartoons, jokes and newspaper articles.

Levine notes that Dr. Yorke-Davies "responded enthusiastically" to Taft's first letter, and was immediately contracted to design a diet for the soon-to-be President.

Taft paid Yorke-Davies an initial fee of £14 ($22), after which the doctor sent him a long letter with advice and a custom diet. To retain his expertise for the rest of his life, Taft paid the doctor an additional fee of £25 ($40).

The diet plan

A handwritten account of Taft's weight loss from December 2nd-24th,1905, shows how regimented he was. Source: Library of Congress Presidential Papers of President William Howard Taft, MSS42234.

In his first letter, Yorke-Davies sent Taft a 3-page list of foods he could and could not consume. He also advised him to weigh himself daily without clothes on and to write to him weekly.

Levine says that during this period in history, therapy through written letters was losing popularity, but it was still in common use. Unlike other "diet reformers of the period," Levine notes that Yorke-Davies' diet was not vegetarian and did not restrict caffeine or alcohol.

Instead, the doctor encouraged eating lean meats and reducing sugar intake.

The basic guidelines of the doctor's recommendations for Taft are as follows:

8 am: a tumbler of hot water with lemon
9 am: unsweetened tea/coffee, two or three biscuits, 6 oz. lean grilled meat
12:30 pm: 4 oz. lean meat, 4 oz. cooked green vegetables (without butter), 3 oz. baked or stewed unsweetened fruit, one biscuit, one serving of "sugarless" wine
Afternoon cup of tea, coffee or beef tea without milk or sugar
7 pm: clear soup, 4 oz. fish, 5 oz. meat, 8 oz. vegetables and 4 oz. stewed fruit. Plain salad and two biscuits were also permitted with this meal.

Dr. Yorke-Davies also included a list of vegetables, salads and condiments that were acceptable substitutes for variation.

Levine notes that the doctor's specificity in identifying the exact times of day Taft should eat illustrates how regimented the plan was.

Taft's daily record of his weight would be sent along with a weekly letter to the doctor, providing details of his exact food intake and physical activity.

In one letter, Taft provides intimate details for Yorke-Davies:

"My bowels have usually moved, but there is a very great difference between the extent of the stool now from what it was when I was eating everything, and I rather think there is a tendency toward constipation, though not too marked. I have attempted to exercise every day, and have gone riding . . . I feel in excellent condition. I used to suffer from acidity of stomach, and I suppose that was due to overloading it. Since I have undertaken this diet I have not suffered from it at all."

Interestingly, Levine says the typed records Taft sent to the doctor regarding his daily weight sometimes differed by a few pounds from the handwritten journals he kept for himself, and these differences always showed more weight loss than what his private records reflected.

Levine says this is indicative of "another common problem with physician-directed weight loss in any era - patients exaggerate their progress."

Self-monitoring versus physician contact

Levine notes that the archived letters between Taft and Yorke-Davies offer clues about obesity treatment during the early years of medical approaches, as the doctor sent tailored advice to Taft and maintained frequent contact, monitoring his progress and offering encouragement.

When asked about how modern self-monitoring devices - such as phone apps - compare with the constant physician contact Taft received while tackling obesity, Levine told Medical News Today:

"I think it makes the most sense to compare the correspondence to email communication, which, though it has its novel elements, is really not as new a form of communication between a doctor and a physician as many tend to think."

Levine continued:

"Particularly with regard to long-term management of chronic conditions such as obesity, email and other forms of electronic communication offer the potential for clinicians to maintain more regular contact with patients, and to be available for the myriad daily questions and concerns their patients face.

On the other side of the debate are physicians concerned about the downsides of this more casual, frequent form of communication, and those concerns range from questions of liability and confidentiality to broader questions about the potentially compromised quality of the clinical encounter and concerns about patient adherence to physician prescribed activities."

Levine concludes her analysis by noting that although reading the letters between Taft and Yorke-Davies is the closest modern readers will come to getting an idea of obesity treatment in the early 20th century, it is still a long-distance correspondence between two public figures.

As such, she says it is "hard to extrapolate to a general experience of obesity in the period." However, it does shed light on the challenges of designing and sticking to a long-term treatment plan for obesity.

Written by Marie Ellis

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