Health and the French diet: not red wine, but puericulture

I meant to post something about this when I first spotted it in the NY Times; it has now been reprinted in the International Herald Tribune:

. . . the French are eating more like Americans these days. Snacking between meals, and fast food and convenience food consumption, are up, particularly among children in big cities. That has fueled no end of editorials about childhood eating patterns. . .

Yet in the battle of the bulge, the French definitely have an edge. They may indulge in wine and butter and pastry, but they do so with a better metabolism and with an ingrained feeling about when, where and how much to eat.

Nothing new so far; but what follows is rather eye-opening:

Those advantages are grounded in at least 100 years of state-sponsored, or at least state-supported, programs that have helped create and perpetuate a thin population. In France, it's the state that helps one say no to the seductions of modern fat culture.

These government campaigns did not have weight control as their main objective. At the beginning of the 20th century, industrialization had forced many of the rural poor into the cities, and France's infant mortality rate had become so high that it provoked scorn from other European countries. In 1904, the French Public Health Act gave the central government authority to compel local governments to take actions to improve the birth rate.

One important response was a movement known as puericulture. Intent on improving prenatal and maternal health, puericulture advocates set up clinics all over the country to teach young mothers how to breastfeed.

Puericulturists also taught that overfeeding was as bad as, if not worse than, underfeeding. A prominent obstetrician, Pierre Budin, who shocked the 1903 Conference on Hygiene with this view, liked to tell his medical students, "I always prefer to err by giving a little too little than by giving too much."

In the 15 years after puericulture took hold, child mortality dropped significantly. Childhood health improved so substantially that, by the 1920s, the first cases of childhood obesity began to appear. In typical fashion, the state retooled the puericulture effort.

By far the most effective advocate was Augusta Moll-Weiss, who wrote books about home economics that were considered definitive. For Moll-Weiss, the key to good childhood health was parental control of the table. Children, she insisted, should always eat at set times. Portions should be moderate; seconds were out of the question. Snacking was forbidden. Virtually every young French child was raised based on her advice.

Such boundary-setting continues today. Simply put, the state regulates the excesses of modern life. You will not find Coca-Cola in a French middle school.

What was the long-term impact of all this? In a recent paper the British epidemiologist D.J. Barker said it is puericulture, not red wine, that may be the secret behind the low rates of cardiovascular disease and obesity in France. Regulated feeding, erring on the "little too little" side, meant that French infants did not grow too quickly, an important factor in causing obesity in children in the first place.

Posted by David on May 24, 2003 7:14 PM