Revisiting the complicated history of the Duke rice diet

Durham is a city known for many things, like being the “Tastiest Town in the South” for its restaurants and the “City of Medicine” for its many healthcare companies. But for over 50 years, Durham was known as the “Diet Capital of the World.” This reputation stems directly from our medical school, where over 80 years ago a physician would develop one of the most powerful and controversial metabolic treatment regimens, putting Duke Medicine on the map as a pioneer in the science and psychology of obesity.

Walter Kempner was a German physician who joined the Duke School of Medicine faculty in 1934. He arrived in Durham with a core group of German refugees fleeing Nazi persecution. Kempner was interested in studying metabolic diseases like hypertension and diabetes. He observed that those diseases were less common in cultures where rice was a staple food and further determined that diets with low salt and fat content can enhance weight loss. In 1939, Kempner developed a formula of rice, fruit, juices and vitamins called the “Rice Diet” and began using it to treat high blood pressure, which was considered fatal at the time with a life expectancy of just six months.

Kempner presented his preliminary findings at the 1944 American Medical Association convention and people were shocked by the results. Early participants of the Rice Diet program were reported to have a drastic reduction in weight, blood pressure and cholesterol, as well as a rapid improvement in kidney failure. As these dramatic results were repeated, many experienced physicians suspected him of falsifying data. They further critiqued the lack of a control group in his study and the 60 and 25 individuals out of his original 192-member cohort who did not show any health improvement or died, respectively. Nevertheless, given the lack of available treatments for metabolic conditions then, the Rice Diet was a revolutionary intervention, and the diet quickly grew to national fame.

By 1945 people around the world were moving to Durham to undergo the Rice Diet intensive regimen at an inpatient facility called the Rice House. Up until the early 90s, participants paid about $150 per week (the equivalent of about $3400 today) to eat Rice Diet meals, essentially just unsalted white rice and canned fruit, and rented apartments downtown. Participants were required to limit their fluid intake, go off any existing medications and give daily urine samples to monitor sodium levels, which Kempner would post on a community bulletin. The program had an impressive list of alumni including Buddy Hackett, Wendy Wasserstein and, allegedly, Elvis. 

The widespread acclaim of the Rice Diet prompted the establishment of several “reducing salons” or “health spas” in the 1950s and 1960s such as Figurecare of Durham and Slimorama Health salon, expanding Durham’s diet landscape beyond medical facilities. Between 1969 and 1989, the number of diet-focused businesses tripled in Durham, and at its peak in the 80s, these diet programs brought in 6.5 million dollars into Durham. Dieting was more than a treatment; it was a community, one with its own slang terms and social events built around weight loss. This is what made Durham the “Diet Capital of the World.”

Obviously, the Rice Diet is not without its controversies. It’s a highly restrictive regimen that is deficient in multiple micro and macronutrients. Undertaking the Rice Diet meant uprooting one’s entire life; for example, former Ricer and author Jean Renfro Anspaugh dropped out of law school and sold most of her belongings just to go on the diet. Some patients developed life-threatening electrolyte imbalances in his care and had to be hospitalized. Kempner was known to be a strict, uncompromising man who was reported to whip and sexually abuse patients who avoided or broke from the diet, resulting in a 1993 lawsuit by former Ricer Sharon Ryan. The lawsuit was only settled after Kempner’s death in 1997. The Rice House separated from its association with Duke Medical Center five years later. 

After nearly 70 years of operation, in 2013 the Rice House shut down as its customers dwindled. That same year, businessman and former Rices John Aycoth opened the Rice Diet Healthcare Program, a 13,000-square foot facility minutes from downtown Durham carrying on the legacy of Kempner’s work. The Rice Diet has treated 18,000 patients from all around the world. The detailed records of 16,155 adult Rice Diet patients can be found in a dataset under Duke Nephrology, the results of what is considered the largest diet intervention study ever undertaken. 

Although it’s now considered a “fad diet” on many popular health websites, it’s a mind-boggling reality to reflect on how powerful the Rice Diet was in shaping the landscape of diet culture not just in Durham, but the country. What this story shows us about the allure of weight loss and the lengths our culture pushes to pursue it can be an entire thesis. At the very least, what the Rice Diet leaves us is a complicated legacy of community built on restriction, science rife with controversy and treatment with a strained relationship with care. As written in the conclusion in a 2014 review of Kempner’s work by the American Heart Association, “Stubbornness is both a helpful and a harmful attribute in scientific discovery.”