Female Fertility and the Body Fat Connection

Female Fertility and the Body Fat Connection, by Rose E. Frisch. Chicago, IL: The University of Chicago Press, 2002. 194 pp. $20.00 (hardcover).

Rose E. Frisch came to the study of fatness and fertility from outside of the "normal" disciplinary boundaries of human biology. She earned her M. A. in Zoology from Columbia University in 1940 and her Ph.D. in Genetics from the University of Wisconsin in 1943. Her doctoral dissertation examined growth rates of the primary flight feathers of the pigeon and the effects of X-radiation. Since Frisch came to human biology from outside of the discipline, her work on fatness and fertility generated a small industry of critiques. (Margie Profet comes to mind as a scholar who, later, did the same.)

Whether one agrees with the details of the 'critical fatness hypothesis' or not, and many human biologists have not, it is hard to ignore the fact that Frisch's ideas laid the groundwork for some of the current excitement in reproductive ecology. Decades ago, at a time when body fat "was not high on the agenda of reproductive endocrinologiste" (p. 3), Frisch demonstrated that fatness and fertility were related. Only within the past 10 years have geneticists and endocrinologists come closer to understanding the mechanisms by which hormones such as leptin, insulin, ghrelin, and PYY regulate appetite, weight gain, and reproduction.

Female Fertility and the Body Fat Connection is an autobiographical review of Rose Frisch's work. It captures the way she talks, her sense of humor, her love of learning and creativity, the breadth of her research interests, her stubbornness and vision, and, above all, her perseverance. Now in her eighties, Frisch is still reading, thinking, and writing. "I can barely keep up with all the leptin papers," she complained with a smile during a talk at Smith College.

The book is organized into 12 chapters. Beginning with a general discussion of female body fat in relation to reproduction (chapters 1 and 2), the book continues with a discussion of puberty, the author's early work with Roger Revelle, and secular trends in age at menarche (chapter 3), the biology of reproduction (chapter 4), and further details about secular trends in age at menarche (chapter 5). The book then settles into a discussion of Frisch's work with Janet McArthur on menarche, critical fatness, and physical activity (chapters 6 through 8). Chapter 9 presents the results of her work with Grace Wyshak on the Alumnae Health Study. Highlighted results pertain to exercise, diabetes, and breast cancer risk, as well as the relationship between cola drinks and bone fracture risk. Chapter 10 is devoted to the biology of leptin. Chapter 11 offers an historical survey of population growth and nutritional status. The book ends with a short chapter on how women can compute their BMI and determine their "desirable weight."

Rose Frisch is an excellent communicator. Peppered with case studies, personal anecdotes, and advice, Female Fertility was written for a general, primarily female, audience. Frisch does not assume that readers have a background in biology, nor does she assume that all people are comfortable with the topics of menarche, menstruation, and menopause. Throughout the text, basic terms are defined and there is a glossary at the end. This book would be useful in a general, undergraduate course on Women and Health, because many majors in the social sciences and women's studies have no background in biology or knowledge of the hypothalamic-pituitary-ovarian axis and lack an appreciation for the normal fatness of female bodies. Frisch's text presents basic information about nutrition and introduces a range of related topics for discussion, such as the thrifty genotype, 19th century medicine, and our current epidemic of obesity. One of her most important points is that women store fat to support the energy costs of human reproduction. For a woman to become too thin through anorexia nervosa or bulimia, a woman must fight against not only her own appetite, but the programming of evolution as well.

The text contains errors (particularly in chapter 4) and, because the book is meant for a general audience, some critical details and references are missing. The lack of references is frustrating because there are many facts that I would like to pursue or quibble with, but cannot identify the original sources. Studies are cited, but not always with authors' names (chapter 10 is an exception). Sometimes authors are cited, but not noted in the Suggestions for Further Reading. Furthermore, human biologists will be particularly frustrated by the omission of current work by reproductive ecologists. However, Rose Frisch has always aligned herself more closely with biomedicine, perhaps because physicians have consistently been more receptive to her ideas.

That being said, it is hard to argue with Frisch's advice: Women shouldn't be too fat or too thin, shouldn't drink Coke, and should get more exercise. And, frankly, Rose Frisch is, herself, an inspiration. She was in her late 40s when she re-entered academia after taking time off to care for her children. In 1966, she published Plants that Feed the World and then shifted her interests to human biology after collecting published body weights as part of a project to calculate future world food needs. Although her ideas have been (sometimes brutally) criticized, many of her hypotheses, unsupported but unrefuted, still dangle in front of us. For example, her claim that poorly nourished women have an earlier age at menopause is based on observational data. This claim has entered conventional wisdom about menopause, but a direct relationship has yet to be shown.