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Response to “The Weight of Obesity”

The Weight of Obesity is a wonderful book. It is a book that invites the reader to read aloud brilliant insights and moving, sometimes truly piercing observations. The book contrasts myriads of local intricacies with the global health attempts at ‘treating obesity’. The book links eating practices to such heterogeneous things as pesticides, traditional social obligations of food preparation, the workings of bodies, global politics and hunger, fortified sugar, the beauty of fatness, and racism. This is done with great sensitivity for the particular ways the language of her informants frames practices of eating, health, and happiness. The book is rica, the Guatemalan word for delicious, tasteful, rich.

I am honored to be put in the position of the wise discussant. But I admit that I am also a bit daunted by it. Because: How can I summarize for you what this book is about? Certainly, it is about obesity concerns and practices in Xela, Guatemala. But what are ‘obesity concerns and practices in Xela, Guatemala’? It is exactly this question that is crucial for grasping the intervention this book makes.

I will give you some context why it is difficult to summarize what this book is about. Particularly in the first part of the book I was sometimes put on the wrong foot. Sometimes I wasn’t sure if the author thinks that obesity is actually a problem for the people in Xela. Is her attempt to criticize global health programs and science as creating problems that are not really there? Is obesity ‘not really’ a Guatemalan problem, but ‘constructed’ through globalized forces and uniformators and metrification? What exactly is the relation between the hunger of the past and the metabolic problems of today? And what is the relation to violence? Why does the author, at one point, contrast medical dietary practices with ‘beliefs’? Are the Xela people ‘wrong’ after all?

Another message could be: obesity is a real problem in Guatemala, but there are better and worse ways to respond to this problem.

A blurb on the back of the book suggests this. The blurb tells us that “the book provides a tough analysis of how one resource-poor Guatemalan population responds to an increasingly globalized food supply as it transitions rapidly from widespread hunger and malnutrition to the increasing prevalence of obesity and its health consequences.”

This is a very good and gripping blurb. I am sure it helps in selling this book. But I don’t think this is exactly what the political message of the book is. It is too clear, the variables are too fixed, and the bad guy (globalized food supply) too well delineated.

The statement is too general.

So here is my suggestion for a title that could summarize the message of the book:

Against generalization!

If obesity is not one thing that can be defined on a singular scale, you cannot say something general and coherent about it. Obesity is indeed a problem to the people in Xela, but it manifests itself in very different ways. So we need to ask how it is a problem, where and for whom. We need to ask: what is obesity, in this particular practice? There is no general thing called obesity. There are only local practices in which obesity is shaped through the ways it is framed and handled. There are many different problems of obesity. As there are many kinds of health.

I don’t know if the author agrees with my reading of her book, but I would like to think with these ideas for a moment, obviously because it shows some of my own preoccupations. It puts on the agenda the question of what is ethnographic knowledge and how this contextual knowledge—knowledge that does not add up to a whole—creates generalities while it resists generalizations. In other words, how can we theorize ethnographic narratives?

This question is addressed most clearly in the wonderful concept of metrification that Emily has coined. She circles practices of metrification, by probing dietary practices, and by living their consequences. She traces ‘metrification in the wild’. For instance, by recounting the story about the woman who got the message that it is she who is the problem, not the calories. Or the heart breaking story of the woman who eats toilet paper in a desperate attempt to make her body ‘fit’ through dieting. Metrification, we learn, is about quantification. It is about adding and subtracting fixed properties and calculating the precise result. It is about invariables that make some foods good and others bad, always and everywhere. It is about making things seem equivalent, such that skipping breakfast can be swapped for a loss of pounds. It is about making things simple: eat less, exercise more. It reduces food and eating to the certain functionalities of nutrients. This, Emily shows, erases endless complexities when put to practice.

So there is a lot to learn about metrification and its workings in this book. But the book also shows very nicely how Emily puts together the others of metrification, quantification, and universalization. Not with a recipe, of course, but by trying and tasting, mashing and mixing unexpected ingredients, carefully mapping tensions and contradictions, and by bringing together stories and elements that may or may not add up. This includes ruptures, layeredness, incommensurabilities and contradictions that can be observed. The book serves many high quality dishes, but never adds up its elements as if they could be equivalents or wholes.

So I understand this book as a radical plea for situated, localized ethnographic research in care for health. For the importance of ‘nonmetric forms of rica and health’ in concrete lives and practices, as Emily writes.

The book also shows the urgency of attending to these concrete practices, by illustrating how metrification can be a violent way of colonizing these different forms of life and rica through its singular mode of theorizing through quantification. Instead, we learn about the value of familiarity and intimacy for gaining knowledge about eating. And about intimate knowledge needed to distinguish beautiful fatness from disease related obesity. One of the failings of global science is to ignore rather than build on traditional and situated knowledges. Such as mixing limestone through one’s maize, preventing the painful death of pellagra. The book teaches us about the difficulties and the imperative of translating scientific knowledge to lived practices, and shows the possible consequences when they fail.

So what kind of knowledge and handholds for action does this radical contextualism and persistent ethnographic perspective bring? What is left for us to theorize about? Can we still speak of theory if the general and coherent have disappeared—or if they have been swapped for a collection of salient differences?

I think a beginning of an answer could be to think about transportability. What can one site or set of configurations of problems learn from another? How may things travel, not by making them equivalent and general, but rather through attending to specificities? We learn about crafting relations rather than assuming they come in one size only. We learn about the importance of keeping bodies warm rather than starving them. About eating the maize or harvesting it for the production of biofuel for cars.

So the quest for everyday eating practices, and the practices and objects entangled with them can be as diverse as growing food, organizing labour, or balancing a basket on one’s head on the way through the market. This is a very different kind of balancing than that of weight and counterweight, of adding 1+1. In the end this should lead to better care practices. Not by some linear idea of implementing pre-given solutions. But by considering the specificities one needs to attend to, in order to both design and care for the many different problems of obesity.

 

Jeannette Pols is Associate Professor and Principal investigator at the section of Medical Ethics of the Academic Medical Centre in Amsterdam. She is appointed as Socrates professor ‘Social Theory, Humanism and Materialities’ at the Department of Anthropology, program ‘Health, Care and the Body’, at the University of Amsterdam. She is the author of Care at a distance: On the closeness of technology (Amsterdam University Press, 2012), as well as articles on medical ethics and healthcare practices.


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