Obesity represents one of the most pressing public health challenges in contemporary societies, particularly in the United States

Sneineh MA (2026) Obesity in Historical Perspective: A Comparative Analysis of the Ottoman Empire and the United States. JSM Gastroenterol Hepatol 13(1): 1138

Obesity represents one of the most pressing public health challenges in contemporary societies, particularly in the United States. National surveillance data indicate that >40% of U.S. adults currently meet criteria for obesity, reflecting a dramatic increase since the latter half of the twentieth century. This rapid rise contrasts sharply with pre-industrial societies, in which sustained caloric excess was uncommon due to environmental, economic, and technological constraints.

The Ottoman Empire (1299–1922) provides a useful historical comparator for examining how structural determinants of diet and physical activity influence population-level obesity risk. Although standardized anthropometric measurements were not available during the Ottoman period, historical, anthropological, and medical sources offer insight into dietary patterns, labor demands, and health priorities. This narrative review compares obesity-related conditions in the modern United States and the Ottoman Empire to illustrate how social organization, food systems, and energy expenditure shape long-term population health outcomes.

Prevalence and Trends

Data from the National Health and Nutrition Examination Survey demonstrate a steady increase in obesity prevalence among U.S. adults since the 1970s, rising from approximately 15% to >40% in recent decades. This increase has occurred across sex, age, racial and ethnic, and socioeconomic groups, underscoring obesity as a systemic public health issue rather than one confined to specific subpopulations.

Dietary and Lifestyle Determinants

The rise in obesity in the United States is closely linked to changes in dietary intake and physical activity patterns. The widespread availability of ultra-processed foods—characterized by high energy density, refined carbohydrates, added fats, and low fiber content—has fundamentally altered dietary behavior. Concurrently, mechanization, urbanization, and digital technologies have markedly reduced occupational and leisure-time physical activity, resulting in a chronic positive energy balance.

Socioeconomic disparities further exacerbate obesity risk. Energy-dense, nutrient-poor foods are often less expensive and more accessible than fresh, minimally processed alternatives, particularly in low-income communities. Together, these factors reflect a broader shift in the U.S. food and activity environment that promotes excess energy intake and reduced expenditure.

Dietary Patterns

Ottoman dietary practices were shaped by subsistence agriculture, regional food availability, seasonality, and limited preservation technologies. Historical accounts describe diets centered on whole grains, legumes, vegetables, fermented dairy products, olive oil, and relatively modest quantities of meat. Refined sugar was scarce and costly, and most foods were consumed in minimally processed forms.

Medical and culinary manuscripts from the Ottoman period frequently emphasized moderation, balance, and digestion, reflecting prevailing humoral health theories that discouraged excess consumption. These dietary norms were largely incompatible with chronic caloric surplus for the general population.

Physical Activity and Labor

The Ottoman economy remained predominantly agrarian, with most individuals engaged in physically demanding labor, including farming, animal husbandry, and artisanal production. Transportation relied primarily on walking or animal power, further increasing daily energy expenditure. Under these conditions, sustained positive energy balance—and therefore widespread obesity—was unlikely.

General Population

Obesity was not conceptualized as a distinct medical condition in Ottoman society. Health concerns were instead dominated by infectious disease, food insecurity, and episodic famine. Anthropological evidence suggests that obesity was rare in pre-industrial populations and constrained by environmental factors such as food availability and high physical labor demands.

Obesity among Elites

An important exception appears among Ottoman elites.Retrospective clinical analyses of Ottoman sultans suggest a high prevalence of obesity-related characteristics and metabolic disorders, likely reflecting sedentary lifestyles and privileged access to abundant food. This pattern reinforces the concept that obesity emerges when environmental constraints on intake and activity are relaxed, even in non-industrial settings.

Comparative Analysis

The contrast between the Ottoman Empire and the modern United States aligns with the framework of the nutrition transition, which describes the shift from traditional, scarcity-based diets toward energy-dense, industrialized food systems accompanying economic development. In the Ottoman context, obesity was rare and socially stratified, whereas in the United States it has become widespread due to structural changes in food production, labor, and technology.

This historical comparison demonstrates that obesity is not an inevitable consequence of human biology but rather a condition shaped by social, environmental, and economic forces. Physically demanding lifestyles and minimally processed diets constrained obesity in the Ottoman Empire, while industrialized food systems and sedentary behaviors have driven high obesity prevalence in the United States. Viewing obesity through a historical lens underscores the importance of addressing structural determinants—rather than individual behavior alone—in contemporary public health and nutrition policy.