Abstract
This article argues that Durham, North Carolina configures itself as a place for weight loss through its dieting industry and its identity as the “Diet Capital of the World.” Building from archival data from the 1930s through the 1980s, I trace the historical development of Durham’s diet industry. Following work in crip studies this article theorizes weight loss as a “cure” that works to remove fatness from individual bodies and remove fat people from the future. Engaging with work in urban geography and critical geographies of fatness, this article analyzes how anti-fatness and place co-produce each other across scales in the city. The Rice Houses and Durham’s broader dieting landscape illustrate how places are created for spatial and temporal disciplining of fat bodies. Attending to these sites, this article understands how anti-fat cure constructs places to discipline fat people’s bodies and create futures without fatness.
Introduction
The Rice Diet, created by Dr. Walter Kempner in 1939 as a treatment for malignant hypertension, required patients to adhere to a strict diet of white rice and fresh fruit to reduce sodium and cholesterol levels. As a side effect, many patients lost significant amounts of weight, encouraging Dr. Kempner and Duke University Medical Center in Durham, North Carolina, to invest in the Rice Diet as a weight loss program. The diet’s success led to an influx of dieters relocating to Durham from the 1940s through the 1980s. This served as a catalyst for rapid growth in the city’s diet industry and the eventual nicknaming of Durham as the “Diet Capital of the World.” While the Rice Diet Center closed its doors in 2012, it left economic, social and historical impacts on Durham’s status as a place for losing weight.
The intersections between place, futurity, and fatness are evident across the histories and practices sanctioned under the Rice Diet. Jean Renfro Anspaugh, a folklorist and former patient of Dr. Walter Kempner, details initial medical testing required for patients. She writes: At Duke University Medical Center, we go through three days of testing with X-rays, cardiograms, blood counts, and even a blood gases test to measure the oxygen content of our fat-saturated blood. A medical photographer takes a ‘before’ photo of each of us. We take home an ‘after’ photo if and when we reach goal weight … A week after tests are completed, each one of us receives the ‘dead letter.’ This letter states that unless we stick to the Rice Diet and follow it totally and absolutely without question until goal weight is obtained, we will die an early and painful death. (Anspaugh, 2001: 106)
Durham's identification as the “Diet Capital of the World” makes it an important case study for understanding the relationship between space, place, and fatness. As a Southern U.S. city, Durham is uniquely positioned as a place where fatness is more acceptable (see Anspaugh, 2001). The U.S. South is produced as a space of fatness filled with “deep-fried and sugared foodscapes” (Eaves, 2017: 82). Alarmist narratives of Southern citizens’ bodies growing fatter rely on stereotypes of fat people as drains on the economy and impediments to social progress (Conway et al., 2018). This mirrors constructions of the South as “oppressive,” “socially backward,” and a space of moral failure (Jansson, 2017: 132). Compounded by anti-Blackness and classism, the South is figured as a region in need of control. Therefore, Durham’s identity as a diet capital in the South serves as a place for enacting cure on individual bodies and the region. Durham emerged as the home of Black Wall Street 1 and flourishing historically Black neighborhoods, like Hayti District, but was quickly dominated by Duke University’s elite, private interests and processes of urban renewal. Today, the expansion of Duke’s influence and gentrification across the city contributes to extreme racial and class inequalities.
The aim of this article is to infuse feminist geographies, critical geographies of fatness, and urban geographies with theorizations futurity in crip studies through a case study of Durham, North Carolina. Using archival data from the 1930s through the 1980s, I trace the development of Durham’s diet industry. Following Kafer (2013), I understand the pursuit of weight loss as a “move towards cure” that seeks to normalize thin bodies and remove fat people from the future. As the “Diet Capital of the World,” Durham relies on anti-fat cures, including the Rice Diet, to eradicate fat people from the city and its future. Feminist geographers and fat geographies scholars highlight the gendered, racialized, and spatial processes of disciplining the body. Bringing these subdisciplines together, this article analyzes how places are produced to eliminate fat bodies. Two sites, Rice Houses and the city’s dieting landscape, offer examples of places reproduced through anti-fatness. While geographers have engaged critically with the home as a site of care and place-making, less attention has been paid to how these processes intersect with anti-fatness (see McPhail, 2009 for a notable exception). The Rice Houses exemplify the convergence of domestic and medical space, the violence of cure, and the disciplining of fatness within the home. In conversation with work in urban geography, I analyze how Durham’s branding as the “Diet Capital of the World” constructs the city’s dieting landscape. The article offers urban geographers insights into how anti-fatness changes the material landscape of the city in an attempt to control the fat body. Through an historical analysis of the “Diet Capital of the World,” the article intervenes in and expands on geographic conversations on anti-fat cure, gendered and racialized disciplining of the body, the reproduction domestic and urban space, and the spatial and temporal dimensions of anti-fatness.
Theoretical background
Temporality and fatness
Much work in critical geographies of fatness details the everyday experiences of fat people moving through space. These contributions apply feminist and critical race geographies to fat embodiment and place-making. However, this work does not adequately address the temporal nature of anti-fatness. Examining the temporal and spatial manifestations of anti-fatness together offers novel ways of theorizing anti-fat disciplining. This article considers how normative ideals of body size and time curtail fat people’s futures through the disciplinary processes of dieting and weight loss. Alison Kafer’s work in crip studies is particularly instructive for theorizing the temporality of dieting technologies. In Feminist, Queer, Crip, Kafer (2013) argues, “futurity has often been framed in curative terms, a time frame that casts disabled people (as) out of time, or as obstacles to the arc of progress” (28). Kafer’s framing of “curative futures” offers much to fat studies work on temporality. Anti-fatness figures “the fat [as] history itself – that is, they are the past that must be dispensed with as we move toward our seemingly inevitable future progress” (Levy-Navarro, 2009: 18). Rodier (2015) furthers that “the futural meaning of obesity is solidified through temporal narratives of progress – directly connected to a better future” (179). A unidirectional understanding of progress necessitates the eradication of fat people. Framing fatness as a threat to progress relies on the construction of the fat body as one which requires a cure. Work in critical disability studies complicates the notion of “no future” (Edelman, 2004), arguing ableism also relies on futures of debilitation, risk, and injury of disabled people (Garland-Thomson, 2017; Puar, 2017). Similarly, anti-fatness and ableism create fat futures as “haunted” by fatness, illness, disease, discomfort (Jeffery, 2019). The present, then, becomes a time for securing the future by pursuing cure.
Through this elimination of fat futures, thinness becomes cure. Cure needs to be understood through other histories, including gendered and racialized interpretations of the body. Eradicating fat futures are rooted in racist and patriarchal tropes intended to exert power. Kafer (2013) notes, “within this frame of curative time, then, the only appropriate disabled mind/body is one cured or moving toward cure” (28). To secure a future under ableism and anti-fatness, disabled and fat people must pursue cures designed to norm their minds and bodies. Harrison (2021) expands “Thinness is a system that seeks to subjugate and ultimately eradicate fatness and fat people” (4). Kafer (2013) and Harrison (2021) illuminate how moves towards thinness can be read as curative acts which seek to eliminate fatness and fat people. Fat studies scholarship argues that the moralization and medicalization of the fat body rely on anti-Blackness (Harrison, 2021; Strings, 2015, 2019), misogyny (LeBesco, 2004), classism (Choudhury, 2021), and ableism (Mollow, 2015). Strings (2019) outlines the historical development of anti-fatness alongside the Transatlantic Slave Trade and the spread of Protestantism, arguing that fatphobia became “one way the body has been used to craft and legitimate race, sex, and class hierarchies” (Strings, 2019: 6). Strings suggests “racial theories had linked fatness to blackness … [and] thinness to whiteness” (2019: 98). Eugenicists and racial scientists in the U.S. viewed thinness as integral to “the preservation of the white race” (Strings, 2019: 175). These racial logics constructed thin white bodies and fat Black bodies in opposition to one another. In order to distance oneself from the supposed moral suspicion of the fat Black body, white people needed to pursue thinness. Concerns around maintaining racial power among Anglo-Saxons manifested in “dietary anxiet[ies]” (Strings, 2019: 105). The Anglo-Saxon diet became a mechanism for maintaining a thin white body. Anglo-Saxon women were the primary targets for new dietary reforms, including the milk diet, to control their bodies’ size and shape (Strings, 2019: 117). Diets offered a new way of “curing” the white body of moral suspicion. Cure becomes both available to, but also the obligation of, white people to accept and pursue in order to distance themselves from the morally suspect Black body. Here, fatness on white bodies threatens the supposed superiority of the white race. Therefore, white people pursuing thinness must always be understood in relation to securing the full benefits of white supremacy.
Kafer (2013) suggests that “cure” constitutes a myriad of “normalizing treatments that work to assimilate the disabled mind/body as much as possible” (Kafer, 2013: 28). Anti-fat disciplining technologies can also be thought of as “cures” for the supposed threat of fatness, including the clinical use of the BMI (Anderson, 2012), reduction diets (Besio and Marusek, 2015; Lee, 2020), weight loss (Parker, 2014), and gastric bypass surgery (Boero, 2012). Feminist geographers consider spatial processes as central to the management and control of certain bodies. “Curing” fatness necessitates the creation of places, including weight loss facilities, dieting restaurants, and fitness studios. I offer the Rice Houses and Durham’s broader dieting landscape as two examples of places produced through anti-fatness where curative futures dictate the present discipline and control of fat people. Both sites, while at different scales, demonstrate how cure happens in space and creates place. The restructuring of Durham around weight loss provides geographers with critical insights into the intimacies between anti-fatness and place-making.
Dieting landscapes as cure
Much geographic work on fatness draws connections between body size and the built environment, emphasizing the impact of food deserts, lack of green spaces, and fast-food advertisements on residents’ BMI (Egli et al., 2019; Shannon, 2014; Townshend and Lake, 2009). Critical geographies of fatness suggest that these relationships are tenuous, rely on the normalization of the thin body, and present the fat body as “excessive” within the built environment (Evans et al., 2012; Guthman, 2011; Pritchard, 2014). This reinforces the notion that fat people are “out of place and not welcome in everyday places” (Hopkins, 2008: 2115). Processes of spatial exclusion work to remove fat people from space across scales. The gym (Windram-Geddes, 2013), the clothing store (Colls, 2006), and the nation (McPhail, 2009) produce the fat body as excessive, thus encouraging the removal of fatness from the body and of fat people from space. Windram-Geddes (2013) understands these sites as “place[s] of inescapable accountability for both creating and monitoring health” (46). Relocating the fat body to places designed to induce weight loss, like the gym or the dieting facility, reveals the spatial logics of anti-fatness. I understand such places as “spatial fixes” for managing and disciplining the fat body.
Though many of the processes examined by geographers are apparent at the scale of the city, rarely is the city itself analyzed as a place for enacting anti-fat cures. Masuda and Bookman (2018) argue “neighbourhood branding has become more frequently deployed as part of governmental strategies to intervene in the urban political economic arena” (166). Branding cities as “fat” or “fit” has profound impacts on the local economy and its citizens (Evans et al., 2012; Marvin and Medd, 2006). Herrick (2009) suggests the overemphasis on changing the built environment within anti-“obesity” policies “marks out places out as pathogenic, or essentially ‘unfit’” (2447). Fat cities become sites of impeded progress. Characterizing neighborhoods or entire cities as unhealthy encourages the disciplining of fat residents through public health policy. Evans et al. (2012) note “cities that have the misfortune to be accorded ‘fat city’ status are thus being shamed into anti-obesity campaigns and strategies of collective weight loss” (106).
The financial power of the dieting industry both motivates the search for cure, and also plays an important role in ‘fixing’ the cure within specific places and material locations. The weight loss market in the U.S. is valued at $58 billion (The U.S. Weight Loss Market: 2022 Status Report & Forecast, 2022). At its peak in the late 1980s, diet programs brought in $6.5 million into Durham (McPherson, 1980a). Durham demonstrates the proliferation of anti-fatness into the built environment and the landscape of the city, the imagining of a thinner future for the city, and sells this future to residents and visitors through its numerous weight loss programs. The diet industry profits off “curative” futures that figure fat people as threats to the future of the city. They also rely on the city’s response to capital flows from the dieting economy. Through the investment in places from Duke University Hospitals to dieting services in strip malls, the cure for fatness becomes a normalized part of the material landscape in the urban environment.
In the remainder of this article, I extend to consider how cities configure themselves through dieting and weight loss. I draw on the example of Durham because of its importance in the dieting industry and as a place that forms itself around dieting in three ways. First, through its public-facing identification as the “Diet Capital of the World,” a marketing strategy used to encourage fat people to relocate the city to become diet patients. Second, as a “dieting landscape” where anti-fatness becomes embedded into the city through the proliferation of dieting and weight loss centers. Third, as a diet industry reliant on the economic investment of fat people into the city and its weight loss programs. My intent is to explain how the expansion of the city’s diet industry creates a landscape predicated on the erasure and removal of fat people while relying on their capital. Each conceptualization of Durham as a place offers insights into how the city spatially excludes fat people from urban space and advertises itself as a city moving towards progress through dieting and weight loss. I offer the Rice Houses and Durham’s dieting landscape as two examples of places produced through anti-fatness where curative futures dictate the present discipline and control of fat people. Both sites, while at different scales, demonstrate how cure happens in space and creates place. The restructuring of Durham around weight loss provides geographers with critical insights into the intimacies between anti-fatness and place-making.
Methodology
Despite the importance of historical approaches in both feminist geography and fat studies, critical geographies of fatness rarely engage with the history of anti-fatness and its connection to place (see McPhail, 2009 for a notable exception). Through historical research and archival methods, feminist historical geographers and fat studies scholars challenge the innateness of social, political, and cultural categories. Feminist historical geographies analyze power and difference over time, space, and place (Domosh, 2015; Eaves, 2019; McDonagh, 2018; McKittrick, 2006; Olson, 2017). Fat studies scholars rely on historical analysis to trace the development of anti-fatness and anti-Blackness (Strings, 2019), the growing adherence to the thin ideal (Fraser, 2009), and the development of fat activism (Cooper, 2016). Historical approaches and archival analysis are useful for examining the development of dieting and weight loss industries in Durham.
My data emerge from archival work performed in the summer of 2021 at the University of North Carolina at Chapel Hill’s Wilson Library Special Collections, the Duke University Medical Archives, the North Carolina Digital Collections, and NewsBank digital archives. At UNC-CH’s Wilson Library Special Collections, I used Hill’s Durham City Directories from 1940 through 1982 and Polk’s Durham City Directories from 1980 through 1989 to create a detailed list of 67 weight loss facilities, recreation centers, educational diet programs, health clinics, and health organizations constituting Durham’s diet industry. From this list, I searched NewsBank, the North Carolina Digital Collections, and clippings from Walter Kempner’s Papers and Records (Duke University Medical Center Archives, MC.0038), for references to the city’s dieting industry from the 1930s through the 2000s. Articles from the Durham Herald-Sun and The Carolina Times formed the bulk of the data. Clippings from newspapers in North Carolina and the U.S. supplemented the data. After this stage, I decided to focus on Walter Kempner due to his impact on Durham’s diet industry.
I accessed Walter Kempner’s Papers and Records at the Duke University Medical Archives, which included personal correspondence between Kempner and stakeholders, advertisement and informational materials for Rice Diet patients, and information on visitors to the Rice Houses. Additionally, I listened to Kempner’s colleague Barbara Newborg’s oral history, where she discusses the origins of the Rice Diet and accessed her book (co-written with Florence Nash) Walter Kempner and the Rice Diet: Challenging Conventional Wisdom through the Duke University Medical Archives. Through UNC-CH’s Davis and Wilson Libraries, I accessed Anspaugh’s Master’s Thesis (1993) and subsequent manuscript (2001) on her experience as a Rice Diet patient.
Archival work presents a series of constraints, biases, and methodological concerns. Crawford and Mills (2020) write: Archival work is fraught with challenges due to the inevitable distance from the ‘live’ events or lives themselves, the partial truths and memories that the archives house and the political creation and curation of what and who ‘counts’ as history. (490)
With close attention to the archive's biases, I consider how the promotion of Durham as the “Diet Capital of the World” relies on racialized, classed, and gendered representations of the city’s dieting industry. Part of this politicized approach is recognizing my experience as a fat white woman working in the archive. My positioning impacted which kinds of materials I sought out, how I coded them, and the conclusions I drew from them. I coded each piece of data using ATLAS.ti’s qualitative data analysis software. Following Cope (2010), I coded for both “manifest” and “latent” messages in archival pieces on dieting, weight loss, and popular understandings of dieters (281). Because of my own positioning, I read materials through a fat liberationist lens where I consider dieting practices as disciplinary rather than health interventions. For example, when I read an excerpt on Rice Diet patients feeling proud of themselves lowering their sodium levels thus “earning” the opportunity to eat chicken after months of only eating rice and fruit, I coded this as “restrictive eating,” “disciplinary behavior,” “surveillance,” “control,” and “forbidden foods.” Visual and textual analysis demonstrated shifting attitudes around dieters from the 1930s into the 1980s demonstrating the historical formations of Durham’s diet industry and anti-fatness.
Creating the “Diet Capital of the World”
Work in crip studies and fat studies illuminates the temporal dimensions of disciplining disabled and fat bodies (Garland-Thomson, 2017; Levy-Navarro, 2009). Kafer (2013) draws attention to curative imaginaries which construct the future as a time without disabled people. This article considers how curative imaginings of the future also rely on the elimination of fatness and fat people. Curative imaginaries construct space as well as time. Geographers must recognize both the spatial and temporal disciplining of fat people and their bodies. This section addresses how the cure for fatness, through the development of Durham’s dieting industry, emerges in place. Durham becomes a place for curing fat body and creating thinner futures.
Durham’s history as the “Diet Capital of the World” begins with Duke University's desire to develop a world class medical research facility. In 1934, Dr. Fredrich Hanes, head of Duke’s medical school, traveled to Berlin, Germany to recruit Dr. Walter Kempner, whose work on malignant hypertension had garnered significant attention (Walter Kempner Papers and Records). Swayed by Dr. Hanes’ offer, Dr. Kempner relocated to Durham to serve as Duke’s first jointly appointed professor and medical researcher (Walter Kempner Papers and Records). Kempner’s research on malignant hypertension and acute nephritis led to the development of the Rice Diet, which requires patients to primarily eat white rice and fruit. The diet was originally administered to patients in two-week intervals to treat malignant hypertension. By eliminating protein, salt, and fat from their diets, patients reduced their blood pressure and sodium levels. At this time, successful interventions for treating hypertension did not exist and about “ninety percent of patients died within a year of diagnosis” (Anspaugh, 1993: 26). The Rice Diet became the most effective treatment for hypertensive patients. In 1942, one of Kempner’s patients misunderstood his instructions and followed the Rice Diet for two months rather than two weeks before returning to Duke University Medical Center. At this patient’s checkup, Kempner noticed a significant decrease in blood pressure, a reduction in the size of her heart, and sixty pounds of weight loss (Anspaugh, 1993: 25). As a result, Kempner began prescribing the Rice Diet to patients with a variety of chronic illnesses – most notably to induce weight loss. A new cure for fatness emerged in Kempner’s Rice Diet. Curing fatness through weight loss becomes a way to “normalize” the body by making it thinner (Clare, 2017).
By 1943, Kempner’s diet became so popular that he overran his bed capacity at Duke, prompting the opening of the first Rice House. Mrs. Walter Newton, a widow of one of Kempner’s former patients, housed Rice Diet patients at her home on Shawnee Street in Durham (Newborg and Nash, 2011: 168). As word of the effectiveness of the Rice Diet spread, patients traveled from around the U.S. and the world to lose weight in Durham. The growing number of patients necessitated more Rice Houses. In 1945, Mrs. George Smith, a nurse at Duke, opened her Rice House on Buchanan Street (Newborg and Nash, 2011: 168). Rising demand caused Mrs. Smith to relocate to larger homes on Gloria Avenue and then Lamond Street (Newborg and Nash, 2011: 168). By 1952, Mrs. Alline Hogan and Mrs. Hazel B. Vickers bought Mrs. Smith’s Rice House and operated it for several more years (Newborg and Nash, 2011: 176). The longest-running Rice House, opened in 1946 by Mrs. Newton on North Mangum Street, remained open until 1992 (Newborg and Nash, 2011: 168). As centralized spaces for the lodging, feeding, and medical care of patients, the Rice Houses served an essential function for the Rice Diet. They also became social hub where patients exchanged tips and tricks to stick to their diet, organized walks and restaurant outings, and discussed their weight loss goals. The Rice Diet’s success and the use of Rice Houses provided an important model for housing patients within weight loss facilities.
While Kempner’s Rice Diet focused on the medical dimensions of weight loss, a significant number of “reducing salons” and “health spas” opened in the 1950s and 1960s to cater to the thin aesthetic. Slimorama Health Salon, Salons Inc., Figurecare of Durham, and Elaine Powers Figure Salon advertised their services to women who saw weight loss as a tool for enhancing their social lives and romantic prospects and boosting self-esteem. This shift towards aesthetic approaches to weight loss mirrored broader pressures to slim down across the U.S. (Schessler-Jandreau, 2009). Salons and spas expanded Durham’s diet landscape beyond medical facilities.
By the late 1960s and into the 1970s, weight loss programs provided Duke University and Durham with significant revenue and acclaim. Following in Dr. Kempner’s footsteps, several Duke University faculty and physicians began developing weight loss programs. In the late 1960s, Dr. Siegfried Heyden began hosting weekly “diet dinners” for patients. Heyden's dinners served as the initial stages of Duke’s Dietary Rehabilitation Clinic (DRC). Duke’s DRC, which eventually turned into the Duke Diet and Fitness Center, offered programming that catered to both the physiological and behavioral aspects of weight loss (Green, 1992). In 1972, Dr. Kempner retired from active status at Duke University (Walter Kempner Papers and Records). That same year, two of Durham’s most notable weight loss physicians began working at the DRC: Dr. Richard Stuelke headed the clinic and Dr. Gerard Musante served as the clinic’s Behavioral Program Director (McPherson, 1980b). Eventually, both physicians left Duke to open their own weight loss clinics. Dr. Musante opened the residential weight loss facility, Structure House, in 1977 which still operates today (McPherson, 1980b). Dr. Stuelke opened the Thin for Life Clinic (eventually renamed the Stuelke Institute) around 1975. In addition, Dr. Andrew Wallace founded the Duke Center for Living in 1976 (Anspaugh, 1993: 23).
Weight loss programs and dieting clinics were massive business opportunities for physicians, dieticians, and investors in Durham and across the U.S. The notoriety and economic benefits garnered from operating weight loss facilities became driving forces for expanding Durham’s diet landscape. While they varied in their approaches, each of these facilities sold weight loss as a cure for fatness. Between 1969 and 1989, the number of diet-focused businesses tripled in Durham. The success of Durham’s diet industry led Dr. Gerard Musante, Dr. Richard Stuelke, and industry stakeholders, to nickname the city as the “Diet Capital of the World” (Green, 1992). Durham solidified its reputation as a place to become thin through its extensive media campaign spanning two decades (Gill, 1991; Haac, 1991; Snider, 1973).
Rice Houses and the relocation of the fat body
In Durham, cure required not just thinking about time and the future, but also considering place and space. The call for cure always requires the arrangement of space and place (Nishida, 2022; Piepzna-Samarasinha, 2018). Residential homes played an essential role in configuring Durham as a place for dieting. Feminist geographers have written extensively on the gendered and racialized dimensions of care work and domestic labor (Bastia, 2015; England, 2015). Much of this work focuses on the labor politics of caretaking and the role of neoliberalism in creating global care networks (England and Dyck, 2012). Lawson (2007) argues “researching care relations allows us to more deeply understand the operation of power and the production of inequality at a range of sites and scales” (5). Expanding on this, I consider the Rice House as a place for enacting care and cure in the material landscape.
When the first Rice House opened in 1943, most weight loss facilities in the city were commercial business or informal gatherings in domestic spaces. The Rice House represented a novel approach to dieting: a formalized weight loss program within. Widows and Duke University Medical Center nurses created Rice Houses by renting rooms in their homes. Most Rice House operators were middle-aged white women with varying degrees of experience in the medical field. They often hired waitstaff and cooks. The archives used for this study revealed little about the lives of the waitstaff, servers, and cooks who worked alongside Rice House operators. Given the racial demographics of Durham, one could assume that the Rice Houses relied on the domestic labor of both Black and white women. Instead, newspaper articles, accounts of the Rice Houses in Newborg and Nash’s (2011) book, and other sources, highlight the work of white women, like Mrs. George Smith, and other Rice House operators. The overemphasis on white women’s domestic labor within these spaces demonstrates the importance of whiteness in maintaining and controlling the bodies of the predominately white Rice Diet patients.
Rice House operators, cooks, and waitstaff worked together to “prepare and serve the special diets prescribed by the professional staff” (Walter Kempner Papers and Records). Whether renting a room at a Rice House or elsewhere, the majority of patients ate at least two meals per day at the Rice House for about $100 per week (Walter Kempner Papers and Records). At their peak in 1970, Mrs. Smith and Mrs. Newton’s Rice Houses fed 330 patients per day (Newborg and Nash, 2011: 169). Operators organized regular visits from Kempner and his staff to conduct weigh-ins, urine tests, and ensure that patients were adhering to their strict diets. In this section, I provide the Rice Houses as an example of the co-production of anti-fatness and place in the city at the scale of the home. The creation of Rice House formed a new kind of place: part home, part medical facility. With attention to Rice House operators and staff, I consider anti-fat cure relied on domestic labor.
Rice Houses are especially interesting because they blur the lines between home and medical institution. Feminist geographers examine how the places where care work occurs complicate our relationship between the home and the medical institution. In their discussion of home healthcare, Dyck et al. (2005) argue that through “the transformation of … the home into ‘care space’, the boundaries between the private and the social are blurred – in terms of both bodyspace and homespace” (181). This blurring between public and private as well as medical institution and home creates new places for enacting cure, care, and discipline. Over time, the Rice Houses became a central place for patients to live and diet. This convergence creates a place where one must always be monitoring themselves and managing their bodies. In her thesis, Anspaugh (1993) details the highly disciplinary nature of Kempner’s visits to the Rice House. She writes: The rest of the morning ritual involves avoiding confrontation with Dr. Kempner … when he is in Durham, and at the Rice House, and a patient catches his eye, there is no way out. The first words from Dr. Kempner to anyone is, ‘did you lose?’ There is no correct response. If one has lost weight, it is never enough. To Kempner one half a pound over goal weight is as detrimental as one hundred pounds. If one, unfortunately, has not lost weight, then a reprimand from Dr. Kempner is in order. (Anspaugh, 1993: 33)
Relocating Rice Diet patients from the hospital bed to the home not only shifts the spatial management of the fat body but also shifts who performs the primary care tasks for diet patients. Women are implicated in administering anti-fat cure through the gendering of domestic labor. McPhail (2009) argues the domestic labor of maintaining a “fit” nuclear family falls predominately on women. In her analysis of Canada’s post-war public health policies, she writes, “If husbands were fat, women were charged with doing something about it. If men were slim, the kitchen demon could easily make them fat” (McPhail, 2009: 1042). McPhail emphasizes the role of increased food options in anti-fat discourse wherein increasing choices represented more opportunities to become fat. Housewives were expected to prevent the threats of food choice by monitoring their family’s meals. The labor of preparing and serving food gets bound up with concerns around body size. Importantly, food becomes cure. The Rice Diet’s most significant feature is its removal of food choice. Since the Rice Houses’ staff prepared, portioned, and served meals to patients, they became bound up within the disciplinary nature of food restriction within the Rice Diet.
Like most weight loss programs, the Rice Diet relied on surveillance and “self-monitoring behaviors,” creating Rice Houses into places of hypersurveillance (Heyes, 2006). Kempner and the Rice House operators determined the contents and portions of patients’ food. These caretaking tasks were deeply rooted in discipline and surveillance. Anspaugh describes the extent of this control describing how patients celebrated “earning” particular foods after “proving” their commitment to the Rice Diet through decreased cholesterol and sodium levels. According to Anspaugh (2001) “each dieter’s daily calorie allotment … range[d] between four hundred and seven hundred a day” (106). The effects of this restrictive eating were “felt immediately and resembled the early stages of starvation” inducing “severe headaches, lethargy and disorientation” often referred to as “Ricerhead” (Anspaugh, 2001: 107). Through food restriction, patients suffered intense side effects in an effort to secure a thinner future for themselves. “Earning” vegetables and chicken formed a critical part of the diet. Anspaugh (2001) writes:
Most of us eat rice and fruit for six weeks. After that time, if all body levels such as blood pressure, blood sugar, and cholesterol are normal and the staff allows it, we are allowed to have vegetables. By this point, significant weight loss has occurred … very lucky Ricers [colloquial name for Rice Diet patients] received chicken twice a week. Receiving chicken was the ultimate compliment, meaning that you were being celebrated as a successful Dieter. (107–108)
Dieters look forward to the future for the “ultimate compliment” of being served chicken at the Rice House. Receiving chicken marks patients who effectively thinned their bodies and “normalized” their blood results. Drawing on Kafer’s (2013), dieters who effectively “move towards cur[ing]” their fatness receive praise (28). Incentivizing cure, however, was reliant on creating a dieting place in which reward was not only monitored, but observed by others who should – according to the rules of the Rice House – be striving for a similar outcome. Rice House staff were not only tasked with cooking and feeding patients but also were relied on to make decisions about when patients could “earn” vegetables and/or chicken, thus highlighting how these women were made responsible for both domestic and medicalized labor within the Rice Houses.
The use of care and discipline by Rice House operators and the regular medical testing and surveillance of fat patients create these places into sites for curing the fat body. The Rice Houses exemplify a place where cure is administered and celebrated. The effect of this endeavor is a violent one as anticipated by fat studies scholarship (Harrison, 2021; Mollow, 2017; Rinaldi et al., 2020). The use and promotion of anti-fat cures “discipline [the] body into the assemblage of full human” (Bahra, 2022: 82). In this sense, the Rice Houses become a place where fat people can gain dignity and humanity once they have lost weight. Once again, fat people are positioned towards a future where their fat bodies do not exist.
The transformation of the Rice Houses into a domestic and medicalized space reflects longer histories of the home as a space of discipline. Feminist geographers theorize the home as a space where gendered, sexualized, and racialized discipline emerge (Brickell, 2012; Milligan, 2018). Dyck and England (2011) illustrate these histories arguing the convergence of “homespace[s]” and “carespace[s]” reconfigure “disciplinary power” in domestic spaces (63–64). Rice Houses illustrate the home as a site for administering anti-fat cure through gendered domestic labor.
Investing in Durham’s dieting landscape
Like the home, the city also excludes, disciplines, and manages bodies (Kern, 2020; Parker, 2016). Feminist economic and urban geographers argue that the city can be spatially designed for the flow of capital (Gibson-Graham, 2006). As a case study, Durham reveals a different spatial characteristic of the cure – one that responds to the circulation of capital. Branding the city as the “Diet Capital of the World” at once reflects the capital interests of dieting and weight loss stakeholders and defines Durham as a place for pursuing anti-fat cure. The development of a dieting landscape in the city reveals the material manifestations of cure in the built environment. The construction and maintenance of diet-related businesses in the city create new spaces of moralization and responsibilization outside the home. These spaces are constructed through curative imaginaries which envision a thinner future for Durham.
Anspaugh (1993) notes: “Durham literally lives off the fat of the land” (1). The parasitic visual reveals the importance of fat people, their bodies, and their desire to lose weight to Durham’s economy. The popularity of the Rice Diet and its financial success expanded commercial investment in Durham’s diet industry. The industry’s growth demonstrates the economic incentives for investing in anti-fat cure. Healthcare providers, hotel managers, restaurateurs, and shopkeepers catered to increasing populations of dieters. This creates a dieting landscape that “progresses” the fat body towards the thin body. Dieting landscapes confront fat people with places designed to shrink their bodies throughout the city. As the city’s dieting landscape expanded, individuals accessed a variety of services to enable their weight loss. Individuals who could not afford the high cost of residential weight loss programs often rented rooms in homes or stayed at hotels, including the Hilton Inn on Erwin Road, the Durham Hotel & Motel downtown, and the Ramada Hotel (Walter Kempner Papers and Records). The Rice Diet Clinic provided patients with “a list of widows renting rooms to Ricers” near the Rice Houses and Duke University (Anspaugh, 2001: 34). Many patients rented furnished apartments at Duke Towers on Trinity Street for $135 per month (Walter Kempner Papers and Records). Starting in the 1970s, diet restaurants, including Franklin’s Restaurant located within the Durham Residential Inn and Diet Center, and the Diet Dining Club at the Washington-Duke Motor Inn served calorie-conscious meals. Chapters of Overeaters Anonymous held meetings in the late 1960s and early 1970s. Hotels in Chapel Hill and Durham hosted twice weekly dance and entertainment events called the “Crisco Disco” for the city’s diet patients (Levine, 1985). The lodging, restaurants, and hotels catered to diet patients thus expanding the dieting industry into the city’s public landscape.
The economic benefits of the dieting industry shifted public discourses on Durham’s dieters. Diet professionals, business owners, and citizens actively framed dieters as contributors to the economy. In 1972, Duke University President, Terry Sanford, noted Dr. Kempner’s “patients have contributed to the growth of the [Duke University] Medical Center as a whole through their use of our facilities, and to the economy of Durham” (Walter Kempner Papers and Records). Additionally, “a 1986 City of Medicine survey found that dieters generated $80 million to $100 million a year in rents, food, real estate, shopping and salaries at the diet programs” (Green, 1992). The Durham-Herald Sun published a series between the 1980s and 1990s touting the financial benefits of dieters coming to the city. The paper ran a series of front-page articles on Durham’s diet industry emphasizing how diet patients “pump a minimum of $6,503,000 a year into the Durham economy, making the diet programs comparable to one of Durham’s top 15 or so industries” (McPherson, 1980a). Along with diet program fees, patients purchased an incredible number of pedometers, weights, scales, clothing, shoes, vehicles, and homes (McPherson, 1980a). In addition, many dieters spent money on restaurants and entertainment in the city. This influx of capital from dieters shifted attitudes around some fat people in the city.
The good fatty/bad fatty binary helps explain the different discourses around Durham’s dieters. While fat studies scholars offer critical theorizations of the good fatty/bad fatty binary, little work has been done to understand how this binary becomes spatialized. Fat studies scholars argue that fat people are framed as drains on local and national economies (Harrison, 2012) and wastes of medical, financial, and social resources (Colls and Evans, 2008). These discourses reflect broader anti-fat sentiments that produce fat people as lazy, inefficient, and selfish for not adequately contributing to the economy (McPhail et al., 2016). Gibson (2021) notes “if fat people exercise, eat ‘well’ and perform the appropriate duties of the ‘good fatty’ they remain ‘innocent’ of their fat bodies as they are doing all they can to change their weight (6). Harrison (2021) concludes that this dichotomy between the “good fatty” who performs and aspires to health and the “bad fatty” who does not work to control themselves “leaves ‘good fats’ as the only people who deserve to love themselves and feel confident in their bodies” (5). In the case of Durham, dieters are seen as “good fatties” because of their commitment to weight loss and their investment in the dieting economy. White dieters are constructed as “good fatties” for self-disciplining. Durham’s diet industry relies on the racialization of thinness, the prioritization of thinness, and curative futures that imagine fat people as impediments to progress.
The racialization of thinness creates futures for certain kinds of fat people: white, wealthy, and those pursuing weight loss. Durham’s diet industry relies on wealthy, white, fat men and women seeking racialized and classed power through weight loss. Images of white diet patients filled the Durham Herald-Sun and diet programs’ promotional materials. A pamphlet for Duke’s DRC features white diet patients walking the grounds, attending nutrition meetings, therapy sessions, and cooking classes, eating meals together, doing yoga, swimming, and touring Durham (Walter Kempner Paper and Records). The final page of the pamphlet features the DRC’s fees: a one-time admission fee of $1099, which included admission services and diagnostic tests, and a weekly $130 fee, which covered “medical, psychological, behavioral and nutritional consultation” and regular “weigh-in[s], blood pressure [and] pulse readings and record keeping in the dining room” (Walter Kempner Paper and Records). Upper-middle class diet patients who can afford the program’s fees and relocation costs formed much of the program’s clientele. Representations of white dieters create Durham as the “Diet Capital of the World” as a place for disciplining the fat white body. Following work in fat studies on the racialization of fatness, I understand this representational process as one that seeks to secure the benefits of whiteness through thinness (Dame-Griff, 2016, 2020; Firth, 2012; Strings, 2015).
The racialized and classed discourses within Durham’s dieting landscape have particular resonance when considering Durham as a city in the U.S. South. Within the cultural imaginary of the United States, the South becomes a kind of regional scapegoat for the country’s ills. As Jansson (2007) argues, the South gets constructed as “a troubled space haunted by a deeply troubled past” in contrast to the rest of the country, particularly the North (401). Geographies of the U.S. South demonstrate how racist and classist stereotypes construct the region as “backwards.” Adding to this work, I understand anti-fatness as a key component for constructing the region as a threat to the nation’s progress and in need of cure. Durham’s dieting landscape responds to capital flows and moralized discourses of anti-fatness. Expanding Durham’s dieting landscape creates the city into a place for the enactment of anti-fat cure. Thus, Durham becomes a site for curing the U.S. South as a region. Durham offers a way to “cure” the region through the eradication of fat people and their bodies. Through the logic of anti-fatness, the future of the South becomes a thinner and more controlled space thus contributing to the rehabilitation of the region.
Conclusion
This article brings together work in feminist geography, critical geographies of fatness, urban geographies, and crip studies to analyze the connections between anti-fatness, place-making, and temporality in constructing a diet capital. Through historical analysis of Durham’s diet and weight loss industries, I analyze how anti-fat cure creates places throughout the city where fat people are oriented towards thinner futures. Work in fat studies clarifies the temporal dimensions of anti-fatness which construct fat people as threats to progress (Crawford, 2017; Levy-Navarro, 2009). Kafer’s (2013) theorization of cure and curative futures offers much to understandings of fatness and temporality. This article extends Kafer’s work on cure to include space and place. Spatializing cure, through an analysis of the Rice Houses and Durham’s dieting landscape, reveals how the built environment responds to cure. The development of Durham as the “Diet Capital of the World” is a story of a place forming from the desire to control and eliminate the fat body. The places created through anti-fatness, including homes, hotels, restaurants, and clothing stores actively create Durham’s dieting landscape. They form an expansive network of places that reinforce and encourage the practice of dieting amongst fat visitors and residents. The persistence of these places on Durham’s landscape configures the city as a place for dieting. The landscape recreates itself to manage the supposed “excess” of the fat body. Fat people’s bodies are no longer disciplined solely within the doctor’s office or the diet clinic but instead are surveilled in homes, restaurants, and recreation spaces thus creating a place for enacting anti-fat cure.
While feminist geographers have theorized the convergence of domestic and medical spaces and the racialized and gendered dimensions of domestic labor (Dyck and England, 2011; Dyck et al., 2005), less attention has been paid to how these spatial processes influence and reproduce anti-fatness in the home. The Rice Houses provide an example of how the home and medical space converge to form a new place for the enactment of anti-fat cure. Rice House operators and staff become implicated in the discipline and management of fat diet patients through domestic labor including preparing and serving food. Durham’s broader diet industry demonstrates how anti-fat cure generates opportunities for economic investment. Both of these places represent sites where fat, white, wealthy men and women can participate in a dieting economy to secure the benefits of whiteness through pursuing thinness. This article offers novel insights into the reproduction of anti-fatness in the home, the violences of anti-fat cure, and the role of racialized and gendered labor in enacting anti-fat cure. Feminist geographers are well positioned to expand on these ideas to consider the home as a site for controlling and maintaining the fat body.
Tending to the development of Durham as the “Diet Capital of the World” draws our attention to how anti-fatness recreates place. By understanding these spatial processes, we can imagine ways of constructing places around fat liberation. Instead of reproducing norms of thinness, we can consider new ways of designing cities to be more hospitable to fat people. Geographers are well positioned to do this work by tending to the intimate, everyday ways fat people navigate anti-fat spaces and places. In addition, more work needs to be done on the effects of dieting landscapes on individuals who cannot or choose not to diet. I am interested in researching how fat activists understand a city, like Durham, with a pervasive history of anti-fatness. Specifically, I hope to continue this work to understand how fat people are envisioning more caring futures for themselves and their communities.
Footnotes
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author received funding from the Center for the Study of the American South and the Department of Geography and Environment at UNC Chapel Hill.
