The Weight of Obesity

by Emily Yates-Doerr, author of The Weight of Obesity: Hunger and Global Health in Postwar Guatemala

This guest post is published to coincide with the joint 2016 Society for Social Studies of Science/European Association for the Study of Science and Technology conference, held in Barcelona August 31-September 3. Learn more about the 4S/EASST conference here.

Your book makes a powerful case for how life is being shaped by metrification. How does this depart from the more familiar analysis of medicalization?

Social theorists have tended to explain the growing attention toward body size as evidence of the expansion of the field of medicine into everyday life, i.e. medicalization. I thought I would see this form of medicalization in Guatemala, too, but then nearly everyone I encountered lamented the sheer absence of medical services. Meanwhile, I did observe that in the cavities of a massively defunded medical and public health system, body weight scales, the Body Mass Index, and calorie charts proliferated. These metrics carried with them the promise that health was a globally stable, definable and measurable entity—and also that people could obtain this health if only they would eat less, exercise more, and lose weight. The book is filled with stories about how metrics were overtaking medicine. Given that these metrics routinely failed patients, it is also filled with stories about how people worked to care for each other in non-metric ways.

Early in your discussion of the rise of metabolic illness in Guatemala you juxtapose stories about epigenetic science and ancient K’iche’ curses. It is almost as if there is sorcery in the science. Can you say more about this?

If there is sorcery in the science, there is also science in the sorcery—albeit a science that follows rules that English speakers are not typically taught to see. I spent extensive time with scientists who worked in Guatemala’s western highlands, while I also carried out fieldwork there myself. I was struck by the convergences in explanations given by scientists and Indigenous peoples for why obesity was on the rise. The stories I heard about heart attacks, arteries filling with fat, and other hauntings of colonial devastation unraveled the linearity of western history and time, asking us to see bodies, populations, and even causation itself in new ways.

As tens of thousands of people died of pellagra at the turn of the 20th century, nutrition experts all but ignored Indigenous practices of nixtamilization, a way of treating maize which staved off the disease. By bringing together epigenetic and K’iche’ illness narratives, I suggest that, once again, Indigenous approaches to ‘eating well’ may be prefiguring cutting edge science. I also aim to show that the imagery of linear transition underpinning much current public health discussion about “globesity” contains two related false premises: that illness profiles in the global south are catching up to those in the global north; and that scientific expertise expands outward from a northern center into the (post)colonial periphery. As I learned from Guatemalan biochemists and K’iche’ highlanders alike, neither global nor physiological transformations happen this way.

Can you say more about your argument that obesity in Guatemala operates as a form of racialized violence?

Race in Latin America has long served as a technique to classify people as superior or inferior, but what race is taken to be is hugely variable. Race can be metonymic of social or genetic inheritance, last name, language, dress, or more recently in Latin America of skin color— or some combination therein. What’s more, in addition to the variation in what race is taken to be, there is huge variation in how malleable race is taken to be. If race in US phrenology was treated as an immovable (natural) type, embedded in a person through his or her life, race in Guatemala has often been associated with environmental features, such that people can change their race by changing where they live and what they do.

In the second half of the 20th century, anthropologists typically sought to counter racism by arguing that there was no biological basis to race. I take a different approach. What I show through descriptions of how people are classified and reclassified by obesity metrics is, instead, that ‘biology’ is a social practice. Where 20th-century race-science may have associated biology with blood, I analyze a 21st-century clinical preoccupation with body size to show how the biology of fat is refiguring existing categories of race and techniques of racial stratification. What is especially pernicious about prevailing biomedical ideologies of fat is the message they carry that people can manage their size – and by extension their place in a ‘natural’ hierarchy of bodies – by managing what they eat. This promise of inclusion saddles people with individual responsibility for their health, while ignoring how little control over ‘the body’ people actually have. It turns out that not only can people not easily lose weight—but encouraging weight loss makes people sick while also making it difficult to see that fatness can be beautiful, desirable, and healthy.

Can you say more about the idea of ‘the body’ that you encountered in the clinic—how it came to be, and how it fits into the story of postwar Guatemala?

In the clinics where I worked it was common for entire families to enter the consultation room for treatment. The patient had to be literally cordoned off, measuring tape wrapped around the abdomen, demarcating a body (now, in the singular) where there had not been a body before. In these spaces it was very clear how much social labor was required to make ‘the body proper,’ as Margaret Lock and Judith Farquhar have called the individuated body. It was also clear just how fallible this individuated body was. Even in the act of weighing, for example, caregivers would often hold their patients hands lest they fall.

Many global health experts speak about obesity as the embodiment of social suffering, as if suffering is poured into the body such that good health or good lifestyle is made material in one’s weight. I worry about how this naturalizes the very object – the body – that should be opened up to inquiry. I try to make clear that treating obesity as a problem of ‘the body,’ is itself part of the problem. In my research, people did not just suffer from obesity. They also suffered from the body-focused diagnosis and the treatment approaches that ensued.

You focus considerably on care; can you say more about the role of power in your book and how this might relate to care?

The time I spent with Guatemalan women convinced me that the languages that we have to talk about power are still woefully inadequate. I could have centered the narrative more directly on how capitalist, exploitative systems of production are working their way into people’s flesh and lives. I do describe how trade agreements force farmers into joblessness, how Walmarts displace small-scale merchants, how chemical-laden produce saturates the food supply, and how billboards increasingly advertise ‘lightness’ of size and color through horrifically racist and sexist messages. The book opens in a large obesity conference sponsored by none other than Guatemala’s military— which was not so long ago involved in genocide! That is all part of the story.

Yet in the midst of this, I would join women in their kitchens, and as they made delicious meals the idea that they were marginal or disempowered fell apart. The women that I lived and worked with could navigate busy markets with very little money, two children strapped to them, baskets balanced on their heads, and, at the end of the day, their cooking would bring their communities joyfully together over one of the richest experiences of life. What sort of vocabularies do we have to talk about – let alone recognize – this sort of power?

In the book I work to articulate alternative powers: powers of laughter, of joy, of not giving a damn. The care that I describe relates less to a specific site of practice (e.g. health care or cooking) and more to how people navigated the contradictory challenges they encountered in feeding their families well. Care, in this sense, reflects a commitment to “staying with the trouble” – to use Donna Haraway’s apt phrase – rather than concern for the binaries of good/bad, strong/weak, right/wrong that continue to characterize many academic discussions of power. In this sense, the care I describe is not just an ‘other’ to power, but another way of being powerful.

Emily Yates-Doerr is Assistant Professor of Anthropology at the University of Amsterdam.