For centuries, artistic representations of power, status and beauty often featured individuals whose physical characteristics would today be associated with higher body mass indexes, according to physician and researcher Dr. Hutan Yafi.

The observation reflects a broader debate among scholars and medical experts over how changing perceptions of health and attractiveness have influenced the interpretation of historical artworks.Yafi argues that throughout much of recorded history, larger body size frequently functioned as a visual indicator of wealth, authority and social standing.

In artistic depictions, rulers, religious figures, members of royal households and other influential individuals were commonly portrayed with fuller physiques. Similar characteristics were often associated with idealized representations of women, particularly in portraiture and other forms of figurative art.

According to Yafi, these portrayals reflected prevailing social and economic realities. In many societies, access to abundant food and resources was unevenly distributed, making larger body size a visible marker of prosperity and privilege.

As a result, artistic representations frequently reinforced social hierarchies by associating physical abundance with power, influence and desirability.“Strong men, leaders, royal families, religious people, high people in the society were portrayed with high BMI,” Yafi said. “Beautiful women and models were also portrayed with high BMI.”

The relationship between body size and cultural ideals remained relatively stable for long periods, Yafi said, before undergoing significant changes during the 20th century. He linked that shift to developments in medical research, particularly growing scientific understanding of nutrition and cardiovascular health.

According to Yafi, perceptions began to evolve during the second half of the 20th century as researchers increasingly examined the role of saturated fats and trans fats in metabolic disorders and cardiovascular disease. Public health discussions around diet and weight gained prominence, influencing both medical guidance and broader social attitudes.

As scientific research expanded, body image standards in popular culture and visual media also changed, Yafi said. He argued that thinner body types increasingly became associated with attractiveness and health, while obesity became more likely to be viewed negatively.

“This led to images of thin, often unrealistically thin, men and women being glorified and obesity being stigmatised,” Yafi said. “Suddenly, thin people became beautiful and the women who inspired artists for centuries were no longer considered attractive.”The evolution of beauty standards has attracted attention from researchers examining the intersection of medicine, culture and visual representation.

Some have sought to analyze historical artworks through a modern medical lens, looking for physical features that may suggest underlying health conditions. Such efforts remain controversial because they rely on interpretations of artistic representations rather than direct clinical evidence.

One of the most frequently discussed examples involves the Mona Lisa, the iconic portrait painted by Leonardo da Vinci during the Renaissance. The painting has long been the subject of academic inquiry across disciplines ranging from art history and conservation science to medicine and psychology.

Yafi noted that some scientists have proposed retrospective medical interpretations of the portrait’s subject. Among the hypotheses advanced in academic discussions are suggestions that features visible in the painting could indicate elevated cholesterol levels, issues related to body mass or endocrine disorders such as hypothyroidism.

“Some scientists believe Leonardo da Vinci’s Mona Lisa was very unhealthy and that she had a problem with her BMI, cholesterol and severe hypothyroidism,” Yafi said.At the same time, Yafi acknowledged the limitations inherent in such analyses. Because the subject lived centuries ago and no direct medical examination is possible, any conclusions remain speculative and dependent on visual interpretation.

“We don’t know because we cannot go back and make a diagnosis, we are just analysing her features,” Yafi added.The debate highlights a broader challenge faced by researchers attempting to apply modern medical frameworks to historical figures.

While advances in medical science provide new tools for interpreting visual evidence, artworks were not created as clinical records. Portraits often incorporate symbolism, stylistic conventions and artistic choices that can complicate efforts to draw conclusions about physical health.Art historian Bendor Grosvenor has cautioned against treating artistic depictions as reliable diagnostic evidence.

He argues that portraiture operates within artistic and cultural contexts that extend beyond physical resemblance.“Poor Mona Lisa, she’s always being diagnosed with something she almost certainly never had,” Grosvenor said.His comments reflect concerns shared by many art historians who view retrospective medical diagnoses as inherently uncertain.

According to Grosvenor, visual characteristics in a painting cannot be separated from the artistic intentions of the painter or the conventions of the period in which the work was produced.“If a doctor today diagnosed someone only on the basis of how their face looked, we wouldn’t take them seriously,” he said.Grosvenor emphasized that portraiture often serves purposes beyond recording physical appearance.

Artists may alter proportions, emphasize particular features or incorporate symbolic elements intended to communicate status, personality or cultural values rather than provide an exact representation of the subject.“Art is art, and a portrait – even one by Leonardo – is usually about so much more than likeness, let alone health,” Grosvenor said.

His remarks underscore a longstanding tension between medical interpretation and art historical analysis. While physicians may view visual details as potential indicators of health conditions, historians generally stress the importance of understanding artworks within their original social, cultural and artistic contexts.

The discussion surrounding the Mona Lisa also reflects broader questions about how contemporary societies interpret historical images. Standards of beauty, health and physical appearance have shifted significantly across different eras, often influenced by changing economic conditions, scientific knowledge and cultural values. As a result, characteristics that were once celebrated or considered desirable may later be viewed differently.

Yafi’s observations suggest that modern assumptions about body size and attractiveness cannot always be applied to earlier periods without considering historical context. Artistic depictions of rulers, aristocrats and celebrated women often reflected the ideals of their time rather than contemporary expectations.

Grosvenor, meanwhile, argues that efforts to diagnose historical figures based on portraits risk oversimplifying works of art whose significance extends beyond physical appearance. For historians, paintings remain cultural artifacts shaped by creative decisions, social conventions and symbolic meanings that cannot be reduced to questions of medical status alone.

“This is as likely for the art of the future as the art of the past,” Grosvenor said. “Art is art, and a portrait is usually about much more than health.”

Sustained weight loss is primarily driven by maintaining a calorie deficit over time, according to Bethan Crouse, a performance nutritionist at Loughborough University. She states that this deficit can be achieved either by increasing physical activity to raise energy expenditure or by reducing caloric intake through dietary adjustments.

The approach, she notes, depends on individual preference and feasibility, but both methods aim to create a consistent gap between calories consumed and calories burned.Crouse explains that increasing exercise can contribute to this deficit by elevating daily energy expenditure.

However, she cautions that relying exclusively on physical activity may present practical challenges. Achieving a daily deficit of 300 to 500 calories through exercise alone would require a significant time commitment and sustained physical effort, which may not be realistic for many individuals. As a result, she indicates that dietary modification is often necessary to complement physical activity in order to achieve meaningful results.

Reducing energy intake is presented as an alternative and often more manageable strategy. Crouse notes that selecting less calorie-dense foods allows individuals to create a deficit without increasing their level of exercise. This approach focuses on altering food choices rather than overall consumption volume, thereby enabling individuals to maintain satiety while lowering caloric intake.

She recommends structuring meals around balanced nutritional components. According to her guidance, an effective meal composition includes a reliable source of protein, a substantial portion of vegetables and fruit, an inclusion of healthy fats, and a wholegrain carbohydrate component.

However, she emphasizes that carbohydrates should not dominate the plate. This balance, she suggests, supports both energy needs and satiety while helping to regulate overall calorie intake.

The emphasis on protein and fiber-rich foods aligns with established nutritional principles, as these components are associated with increased fullness and reduced likelihood of overeating. While Crouse does not provide specific quantitative targets, her framework reflects a broader consensus within nutritional science that diet quality plays a critical role in weight management outcomes.

Crouse highlights the limitations of depending solely on structured exercise routines for weight loss. She notes that burning several hundred calories per day through workouts requires sustained effort that may be difficult to maintain over time.

This constraint underscores the importance of combining exercise with dietary interventions rather than viewing physical activity as a standalone solution.

Instead of focusing exclusively on formal workouts, she advocates for a broader view of daily movement. This includes integrating physical activity into routine behaviors, particularly for individuals with sedentary lifestyles.

Office workers, for example, may incorporate walking during lunch breaks or choose more active forms of social engagement. By increasing overall daily movement, individuals can incrementally raise their energy expenditure without relying entirely on intensive exercise sessions.

Crouse suggests that such lifestyle adjustments may be more sustainable in the long term. Activities like walking, recreational sports, or other forms of light to moderate movement can contribute to calorie expenditure while also being easier to maintain consistently. This approach reflects a shift from episodic exercise toward continuous, low-intensity activity embedded in daily routines.

While emphasizing the challenges of exercise-only weight loss strategies, Crouse underscores the broader health benefits of physical activity. She points to established public health recommendations, including guidelines from the National Health Service, which advise adults to engage in at least 150 minutes of moderate-intensity activity per week or 75 minutes of vigorous activity.

In addition, strength training is recommended on two days per week.These guidelines are not framed solely in terms of weight reduction but are associated with overall health outcomes, including cardiovascular fitness, muscle strength, and general well-being.

Crouse’s comments suggest that while exercise may not always be the most efficient method for creating a calorie deficit, it remains an essential component of a healthy lifestyle.Her perspective reinforces the idea that weight management strategies should be multifaceted.

Diet plays a central role in controlling energy intake, while physical activity contributes to both energy expenditure and broader physiological benefits. The combination of these elements, rather than reliance on a single intervention, is presented as a more effective and sustainable approach.

The analysis reflects a pragmatic understanding of behavioral and physiological constraints. By acknowledging the difficulty of achieving large calorie deficits through exercise alone and emphasizing achievable dietary changes, Crouse outlines a framework that prioritizes sustainability and consistency.

Her recommendations align with widely accepted principles in nutrition and public health, focusing on gradual, maintainable adjustments rather than extreme or short-term measures.