Now, It's the Big Fat French Life
By GREG CRITSER

The French are measuring themselves. And the French government is paying for it.

The country's new National Sizing Campaign represents the figure- and fashion-conscious nation's attempt to update clothing sizes so they bear a closer resemblance to today's slightly fuller French figure. Emphasis on slightly: the obesity rate in France has now topped 10 percent. The rate in the United States is three times that.
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Still, the French are eating more like Americans these days. Between-meal snacking, and fast food and convenience-food consumption are up, particularly among children in big cities. That has fueled no end of newspaper and television features and editorials about childhood eating patterns. Not long ago Le Monde ran a cartoon showing an obese child eating while watching television as his parents look on saying, "He eats whatever he wants."

The government is concerned as well. The influential Institute of National Health and Medical Research in Paris has declared childhood obesity an epidemic. The rate has doubled in the last 20 years. Even McDonald's France got into the act last year when, to the chagrin of its American parent, it took out magazine ads saying it was best not to eat there more than once a week.

Yet in the great — and increasingly international — battle of the bulge, the French definitely have an edge. Yes, 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.

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 turn 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. The state required any factory doing business with the government to set aside areas for lunchtime breastfeeding.

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." Thus, early in its modern history, the French government lectured mothers on the medical value of dietary control.

The government also addressed body size. In 1904 the entire Paris school system began sending quarterly reports to all parents detailing their child's physical growth, carefully noting height, weight and chest measurements.

Ultimately, the point of puericulture was simple: raising a child could be a modern, rational act but only if the parents were given the encouragement, facts and tools to do so. Over and over, l'état tried to do just that.

In the 15 years after puericulture took hold, child mortality throughout France dropped significantly. Childhood health improved so substantially that, by the 1920's, the first cases of childhood obesity began to appear. In typical fashion, the state, joined by domestic feminists of the period, revved up and retooled the puericulture effort.

By far the most effective advocate was Augusta Moll-Weiss, who wrote books about home economics that were considered definitive. She began focusing on the needs of poorer, uneducated young women, and founded the Paris School for Mothers, where she taught her doctrine of rational cuisine.

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. All meals should be supervised by adults. Snacking was forbidden.

The child's preferences were unimportant, she said. "The essential thing is that the quality and the quantity of the diet correspond to the exertion of the young human being," she insisted. 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. By focusing on prenatal care, he argues, the nation produced healthier, more metabolically efficient babies. And by regulating feeding, erring on the "little too little" side, French infants did not grow too quickly, an important factor in causing obesity in children in the first place.

It is feared today that such habits are being eroded. Obesity is on the rise. So French health authorities have launched a vigorous effort to reinforce the old attitudes while addressing the needs of new immigrant groups.

Unlike the United States, where the head of the National Institutes of Health's obesity program is loath to use the words "obesity" and "childhood" in the same sentence, France has met the problem head on. There is already a comprehensive set of public health goals, including the training of all school nurses in screening for obesity and its prevention, special care for obese children and "rigorous control of advertisement messages about food products" aimed at children.

Many may take issue with such zeal. But the French experience seems to demonstrate that there is something to be said for zeal in the face of overwhelming temptation. It may turn out that "a little too little" may go further than anyone ever thought.

Greg Critser is the author of "Fatland: How Americans Became the Fattest People in the World" (Houghton Mifflin, 2003).

http://www.nytimes.com/2003/05/18/w....html?tntemail0