Henry VIII, after Holbein

I'm delighted to welcome Tudor Life magazine contributor and freelance academic Kyra Kramer to the Tudor Society today as part of the booktour for her latest book, Henry VIII's Health in a Nutshell. I hope you enjoy her article.

MadeGlobal Publishing is giving away a paperback copy of Henry VIII's Health in a Nutshell to one lucky commenter here at the Tudor Society. Simply leave a comment on this post saying what you'd like to know for sure about Henry VIII's health. Leave your comment by midnight on 24th December. A winning comment will be picked at random and the lucky winner contacted via email after Christmas.

Henry VIII was fat. Well, he was only fat during the last dozen or so years of his life, but most people have forgotten his 40 years of god-like athleticism because all the most iconic images of him show the "fat Henry" of popular imagination.

Henry has become associated with fat. It is a rare documentary or book that does not bring up the fact that Henry eventually had a 54 inch waist. It's reputed that three men could fit in his doublet. People were so confused that the Henry depicted in The Tudors and Wolf Hall was thin that newspapers ran articles explaining that the king was only obese in his later years. Moreover, Henry's ill health is implied to be a manifestation of his weight, and therefore his sloth and gluttony, the end result of his failure to control himself. Henry's fat thus fits the cultural narrative of the kind of impulsive, self-serving man who would behead his wives and leave his church. Fat Henry is analogous with Tyrant Henry.

With Henry's reputation for fat has come increased speculation that he had type II diabetes. Not only is he theorized to have had type II diabetes, this disease is becoming increasingly mentioned as the underpinning causal factor in Henry's ill health, from his ulcerous legs to his reproductive difficulties. Where syphilis once reigned supreme in the court of Henry-had-this, type II diabetes has arisen to usurp the position of illness most often ascribed to Henry VIII. Perhaps more people think Anne Boleyn had six fingers, but Henry the type II diabetic is definitely becoming a Tudor "known".

In my latest book, Henry VIII's Health in a Nutshell, the king's weight is important in my examination of the theory that he had type II diabetes. Frankly, I think it is likely that Henry did develop this disease at the end of his life... but not in the way people believe and not as a factor in the majority of his ailments. The popularity of type II diabetes as a scapegoat for nearly all Henry's maladies is due more to the fact that the link between adipose tissue and this illness is wildly overestimated by the general public than it is to any valid data. As I explain in the book:

This is probably a shock to most people, since the correlation is implied in almost every media report about type II diabetes or the ‘obesity’ epidemic, but in reality almost half of all type II diabetes sufferers are of normal weight and the large majority of obese people will never develop the disease. Type II diabetes occurs when the body can no longer process insulin correctly, and is a metabolic disease that can strike regardless of the patient's weight. Genetics and poverty, rather than weight or diet, seems to be the biggest factor in type II diabetes... being poor also doubles (or triples) your risk of type II diabetes, even when ALL other factors - including weight - are taken into account. Nevertheless, obesity and type II diabetes are so often studied together that general misinformation linking them remains strong even in the medical community. What can be correlated to both obesity and diabetes is a sedentary lifestyle. Sitting at work and then coming home and sitting some more (usually in front of the TV) "were both associated with significantly increased risk of diabetes in multivariate analyses adjusting for dietary and nondietary covariates"¹. Basically, sitting down too much is a bigger risk to your health than almost anything else, including what you eat and what you weigh ... The king did not attain truly gargantuan proportions until after he was bedridden and unable to ride any longer... Henry's sedentary existence would have subsequently encouraged the development of type II diabetes, which would have caused attendant venous ulcers and depression which would have in turn made it harder for Henry to move or get exercise.² Henry would thus have become trapped in a perpetual circle of worsened health until, wherein his ailments fed and sustained one another in a kind of ‘perfect storm’ that only ended with his death in January of 1547.³

In sum, Henry probably gained weight and developed type II diabetes because he had become ill for some other cause or causes, rather than becoming ill and developing type II diabetes because of his obesity. As long as Henry was still active then his health would not have been adversely affected by his weight, even after he crossed the "severely obese" threshold of 35 BMI.

There is scant evidence that Henry had type II diabetes before the last few years of his life. The arguments for Henry's type II diabetes diagnosis prior to the 1540s are his leg ulcers and his reproductive record. However, the leg ulcers were much more symptomatic of osteomyelitis in both duration and placement than they are of complications of type II diabetes. It wasn't until the king was sedentary that the kind of sore typical to type II diabetes -- venous ulcers on the lower leg -- appeared. Henry's reproductive record does not correspond to type II diabetes either:

Miscarriage due to diabetes is typically linked to the mother having diabetes, not the father. Although superstructure defects in the sperm of male diabetics can increase the chances of a miscarriage in their partners, these miscarriages would occur early in the first trimester because the embryo would be nonviable. The more common side effect of diabetes is erectile dysfunction and low sperm count, which could explain the lack of pregnancies in his marriages to his fifth and sixth wives, but could not account for the frequent pregnancies and subsequent late-term miscarriages experienced by his first two queens.⁴

Not only did Henry's body not axiomatically give him type II diabetes, it might have been a health advantage. Type II diabetes demonstrates what researchers call the "obesity paradox", in that rather than hurting the patient, excess adipose increases survival rates. As counterintuitive as it seems to the modern reader, overweight people with type II diabetes live longer than normal or underweight people diagnosed with the same illness. Henry's large body mass may have aided his longevity until he crossed the threshold of 30 BMI, or even higher according to some studies.

*I'm aware my facts about weight and health are going to cause some people to blow a gasket. The idea that overweight people live longer than "normal" or "thin" people is causing some people – even those in the "evidence based" medical community - to become very upset. In fact, they get so upset they are even hostile to the research regardless of its statistical validity. This is caused by the cognitive dissonance of a paradigm violation. The paradigm we've grown up with is that fat=bad=shortened lifespan, whereas thin=good=lengthened lifespan. Doctors have grown up in that paradigm too, and it has been presented as an immutable "truth" for decades. People do NOT like having their paradigms shifted. They resist. Evidence that contradicts the "truth" is both suspect and rage-inducing. I've read entire papers discussing the oddity that fat people who don't diet live longer than yo-yo dieters, yet that paper ends with the discursive advice that fat people should go on a diet to get their weight under control or their health will suffer. This means that the internet is chockablock with articles trumpeting that the fact that overweight people live longer is a "lie". Nonetheless, the math bears witness; in metadata studies of obesity there is statistically significant proof that overweight people live longer and exercise is more important for health than being the "correct" weight.

Do make sure you visit Kyra's other stops on her book tour to enjoy her excellent articles and to take part in the giveaways. Here's the schedule:

• 14 December - Syphilis vs. Osteomyelitis at OnTheTudorTrail.com
• 16 December - Blood type and pregnancies at Medievalists.net
• 17 December - The Mental Aberrations of Henry VIII at ThroughTheEyesofAnneBoleyn.wordpress.com/
• 18 December - Here!

Kyra Cornelius Kramer is a freelance academic with BS degrees in both biology and anthropology from the University of Kentucky, as well as a MA in medical anthropology from Southern Methodist University. She is the author of Blood Will Tell: A Medical Explanation of the Tyranny of Henry VIII, The Jezebel Effect: Why the Slut Shaming of Famous Queens Still Matters, and Henry VIII's Health in a Nutshell. Her essays on the agency of the Female Gothic heroine and women's bodies as feminist texts in the works of Jennifer Crusie have been published in peer-reviewed journals. She has also co-authored two works; one with Dr. Laura Vivanco on the way in which the bodies of romance heroes and heroines act as the sites of reinforcement of, and resistance to, enculturated sexualities and gender ideologies, and another with Dr. Catrina Banks Whitley on Henry VIII.

Ms. Kramer lives in Bloomington, IN with her cute geeky husband, three amazing young daughters, and assorted small yappy dogs garnered from re-homing and rescues. When not working she reads voraciously, plays video games with her family, does cross-stitch, and invents excuses to procrastinate about doing routine house cleaning.

You can read her blog at kyrackramer.com, or follow Kyra Cornelius Kramer on her Facebook page or Twitter.

Notes and Sources

1. Hu FB, Li TY, Colditz GA, Willett WC, and Manson JE. 2003. “Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women.” JAMA 289 (14): 1785–91. doi:10.1001/jama.289.14.1785.
2. Hu, Frank B. 2003. “Sedentary Lifestyle and Risk of Obesity and Type 2 Diabetes.” Lipids 38 (2): 103–8.; Katon, Wayne J., Carolyn Rutter, Greg Simon, Elizabeth H. B. Lin, Evette Ludman, Paul Ciechanowski, Leslie Kinder, Bessie Young, and Michael Von Korff. 2005. “The Association of Comorbid Depression With Mortality in Patients With Type 2 Diabetes.” Diabetes Care 28 (11): 2668–72. doi:10.2337/diacare.28.11.2668.
3. Kramer, Kyra (2015) Henry VIII's Health in a Nutshell, MadeGlobal Publishing.
4. Ibid.