A woman with hypertension refuses vegetables. A man with diabetes adds iron-fortified sugar to his coffee. As death rates from heart attacks, strokes, and diabetes in Latin America escalate, global health interventions increasingly emphasize nutrition, exercise, and weight lossbut much goes awry as ideas move from policy boardrooms and clinics into everyday life. Based on years of intensive fieldwork, The Weight of Obesity offers poignant stories of how obesity is lived and experienced by Guatemalans who have recently found their dietsand their bodiesradically transformed. Anthropologist Emily Yates-Doerr challenges the widespread view that health can be measured in calories and pounds, offering an innovative understanding of what it means to be healthy in postcolonial Latin America. Through vivid descriptions of how people reject global standards and embrace fatness as desirable, this book interferes with contemporary biomedicine, adding depth to how we theorize structural violence. It is essential reading for anyone who cares about the politics of healthy eating.
About the Author
Emily Yates-Doerr is Assistant Professor of Anthropology at the University of Amsterdam.
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The Weight of Obesity
Hunger and Global Health in Postwar Guatemala
By Emily Yates-Doerr
UNIVERSITY OF CALIFORNIA PRESSCopyright © 2015 The Regents of the University of California
All rights reserved.
Disease and Modernities
For us, it began with the pot. When I was a child we would wake up early, 5:00 or so, when the sky was still dark and thick with mist. We all slept in the same room — my brothers and I in the same bed — and since it was early and we were still partially asleep we kept the silence with us as we slipped on our boots and stepped into the morning. Nothing was instant. We would gather kindling and bring it back to our mother, so she could start the fire. It started small and smoky, but she would tend to it and the wood would catch and the comal [plate used to make tortillas] would begin to hold the heat. This was before the forest was cut back, when firewood was still plentiful, in the time when the pots and bowls were made of clay from the earth. After my mother got the fire going, she would boil beans, grind the chilies, and start the coffee brewing. We would milk the cows — I still remember how to do this — and then we would turn to the fields. A couple hours always passed before breakfast was ready. We would arrive back to the kitchen with our fingers so cold, but with our bodies hot, still steaming from our work. Our mother would pour us atole [cereal] and we would eat beans, seasoned with salt and chilies, along with the tortillas she would be making by the fire. We would drink our thick coffee. We would be famished. We would eat everything. We were poor and the food was so simple, but I still remember how delicious it tasted. It would never enter into our thoughts to say no to the food, much less to our mother.
Manuel — my K'iche' instructor who lived in one of Xela's surrounding villages — began this story in his explanation of how children in Guatemala had learned to fight with their parents. The story he recounted was a story of change and loss — the dissociation from a past that no longer existed and a future where children do not follow the ways of their elders. He continued,
Then aluminum pots began to arrive. Salesmen showed up with them in the markets, telling women that they would make cooking easier. Everything heated up more quickly in these pots. And women and families, not wanting to spend so much time collecting firewood — which was becoming harder and harder to find as the forest retreated — began to pool together a bit of money to buy these aluminum pots. And then came the salesmen with the stoves — the famous gas stoves that would cook food instantly. There was no waiting: with a match you would have instant heat. A few people saved up the money to buy these stoves; our family did too. We couldn't believe it: in just a few minutes food would be boiling. Now, the thing is that beans can't cook instantly and in the beginning we didn't know this. We ate them and although the seasonings on them tasted good, they were really awful for digestion. I still remember how much our stomachs hurt those first few months with the new stove. We started using condiments around this time as well — the fruit of the beans tasted much more bland when cooked instantly than when simmered slowly over firewood, so we began to use condiments to add taste.
Well, this is another story. What I am telling you is that the style of cooking changes the culture. There are other changes as well: now corn porridges are made with machines and not by grinding corn on rocks. No longer do we spend our nights in the glow of pitch-pine candles; no longer are we comfortable in the dark. Today, well today, our routines are different. My daughters are in front of the television or up doing homework until midnight. My wife and I try to get them up early for school, but they never want to wake up, and they wake up to a different routine than I did. They get out of bed ten minutes before they must leave for school because they are so tired. Their mother and I know they must eat breakfast — they say it is the most important meal of the day — but our daughters have no appetite. So we placate them with sweet and instant foods: a bowl of cereal, perhaps, since it is quick. But they come to the table unhappily. They say no, they are not hungry. And from that "no" we began to hear many other no's. First the aluminum pot, then the bowl of cereal — now we have rebellious children.
In Manuel's narration the aluminum pot gave rise to an array of new cultural forms, irreversibly changing life in his community. I begin this chapter here because Manuel's nostalgia-filled account of transformation contains many of the narrative threads I heard throughout my fieldwork. Xela was, in the words of nearly everyone around me, in the midst of disquieting upheaval. In less than a generation the introduction of countless new technologies — aluminum pots, gas stoves, electricity, instant foods, washing machines, televisions, cell phones, computers, each tied to an ever-increasing reliance on a cash economy — had destabilized ways of life that had (so people told me) endured for centuries.
This narrative also highlights the methodological challenges encountered in an ethnographic study of epistemic transition. The stories of eating I heard during my fieldwork did not just recount the past but formed and performed one's relation with — and distance from — that past. I had been drawn to the study of obesity because of interest in how people were grappling with the introduction of this new medical category in their everyday lives. But since traditional archives of government and bureaucratic records provided scant information about shifts in the relations between bodies and foods, and the archive of memory proved to be slippery and ever-changing, the project began to change. Alongside my interest in obesity as an emerging medical phenomenon, I also became interested in obesity as a discursive phenomenon in which newness entangles with Guatemala's long-standing histories of hunger.
Within the field of global health, dietary-related chronic illnesses are very often called "diseases of modernity." The World Health Organization writes that obesity and its related illnesses are "frequent outcomes of the modernization/acculturation process" (2000, 102). A common notion held by public health officials is that obesity is an unwanted consequence — a side effect — of development and progress. But as I began to trace obesity in highland Guatemala throughout its discursive lives, I saw it as not only an effect of a changing city but also as a way of organizing how bodies fit into this city. Manuel's story of dietary change, if analyzed through the perspective of the World Health Organization's framework for obesity, would have been fairly straightforward: the metal pot ushered in a wave of modernization, bringing pain to bodies and leading to the dissolution of families. In stringing stories about obesity together, however, the relations between technology and the diseases that emerged proved to be far more complex than any model of teleological change would have it.
This chapter delves into this complexity by overviewing material transformation in regional patterns of diet and disease, while also holding onto the challenge of studying the truth(s) of transformation as, at least in part, discursively produced. I have divided the chapter into four parts. First, I draw from oral histories and ethnographic encounters to provide a description of recent changes in Xela's food supply. I then illustrate how the global health community has linked dietary changes to the emergence of obesity in Guatemala through a process called the "nutrition transition." This framing of the nutrition transition suggests that change happens globally in a linear, determinate fashion, but in the section that follows I question the premise of this model of transition. I then juxtapose nutritional change in one rural community outside of Xela with emerging scientific work on the complexities of biological development to suggest that the everyday practice of modernity is far less progressive than portrayed by imagery in which change spreads from a central (modern) point into rural (nonmodern) peripheries. I continue this argument in the final section, where I consider historical continuities alongside the unpredictable outcomes of the dietary transitions currently underway in Guatemala.
WHEN STAPLES CHANGE FORM
"The style of cooking changes the culture," Manuel had told me, thinking of the arrival, when he was a child, of the aluminum pot and gas stove and the changes they brought with them. Global trade routes have influenced the dietary landscape of Guatemala for centuries, and much of what appears new has deep historical roots (Wilk 2006). Yet, as people constantly reminded me, Xela's recent history has seen especially widespread transformation. Throughout Xela people pointed to the postwar period as particularly tumultuous when it came to dietary change, as a series of unfamiliar technologies became commonplace, impacting both their "style of cooking" and the broader cultural practices surrounding mealtimes.
The recent urbanization of Guatemalan cities was a recurrent theme in my interviews. Following a process that economists call "trade liberalization" — which allows for the import and export of products between countries without tariffs — cheaply imported, mass-produced U.S. corn and corn-based products flooded Guatemalan markets in the 1990s. Highland farmers, no longer able to make a profit selling corn grown on their small family plots, fled to the cities looking for employment. In 1950 the national census recorded 36,001 people living in Xela ("Sexto Censo" 2015). In 1994 the official census put the population of the city at just shy of 110,000 people. An article from the local newspaper printed during my fieldwork estimated the city's population in 2008 to be more than 200,000. "Disorganized Growth in Xela" read its headline, announcing that between 2002 and 2007 the number of residences in Xela had grown from 30,730 to 41,485, not including the 41,000 or so people who commuted to the city daily from surrounding rural communities, nor the families who had set up corrugated metal shacks at the edges of the city, nor the undocumented Salvadoran workers who had arrived in pursuit of jobs that were scarce in their country of origin (Martín Racancoj 2008).
Scholars working in Guatemala have long noted that population statistics from the region should be treated with caution, as they have helped to produce the very categories they have claimed to neutrally represent (cf. Early 1974; C. Little-Siebold 2001). I present them because they consolidate the innumerable comments I heard about how an increasing population density had changed the city's character: "When I was younger, Xela was just a town. I don't even recognize this landscape as my own," said countless people who had seen the perimeter of Xela expand outward, transforming wheat fields and pastures into highways lined with shopping malls and fast food chains. Complaints about traffic were ubiquitous, and many people bemoaned no longer returning home for lunch — the main meal of the day — as they once could, because of the time spent stuck on streets originally designed for fewer buses, cars, and people.
Like Manuel, people often discussed the urbanization of the city with me through stories about how eating practices had transformed. In addition to descriptions of the proliferation of fast food chains, people spoke of a general increase in comida chatarra. Literally translated as "scrap-iron food," this recently adopted term is a direct translation of the English expression for "junk food," which people used to describe the food sold in the abundant snack stands where Quetzaltecos purchased inexpensive hot dogs (referred to as U.S. food) or tacos (referred to as Mexican food), as well as chips, candies, cookies, and sodas. Many vendors still walked through markets or hopped from bus to bus selling "traditional" snacks of peanuts, bags of cut fruit with lime and chilies, and handmade tamales, but they also sold — at comparable prices — chocolate bars, ice cream, and prepackaged chicken burgers.
Both scientific and anecdotal accounts note the recent decline in the consumption of plant-based staple foods (Hoddinott, Behrman, and Martorell 2005; Stein et al. 2005). Nutrition research in Xela suggests that when people do eat vegetables, these are often deep fried; meanwhile, they consume fruits in the form of heavily sweetened juices (Montenegro-Bethancourt, Doak, and Solomons 2009). Replacing the classic essentials of corn, beans, rice, eggs, and vegetables are new foods consisting of "energy-dense, processed and animal-source foods which tend to be high in fats and/or sweeteners" (Hawkes and Thow 2008, 345). Many public health workers pointed to the Central American Free Trade Agreement (CAFTA), which went into effect in 2006, when we spoke about shifts in Guatemala's food supply. On the heels of earlier trade agreements, CAFTA further reduced tariffs on numerous U.S.-produced imports, resulting in the increased availability of pork, poultry, soybean meal, and yellow corn; and highly processed foods such as potato chips, sandwich cookies, frozen french fries, soy-based imitation meat, and prepackaged Kraft cheese. CAFTA also created trade routes for U.S. goods such as hydrolyzed vegetable protein, mechanically deboned meat, and dehydrated potatoes to enter Guatemalan marketplaces (Hawkes and Thow 2008, 352).
Obesity-prevention programs I attended commonly linked growing obesity rates to the proliferation of comida chatarra, but many people I spoke with about obesity also noted changing vegetable economies. Vegetable export markets in the communities surrounding Xela, having expanded to meet international demand for healthy produce, depended on the importation of both seeds and synthetic pesticides used to grow them (Dowdall and Klotz 2013; Fischer and Benson 2006). Women, afraid of these pesticides, would commonly purchase packaged chips and candies for their children when they were out shopping. They spoke to me about "chemicals of the dead" that had entered their food and cautioned me to avoid purchasing from women whose headscarves marked them as being from Almolonga, a regional center for export just a few kilometers from Xela's city center. Vegetables were not to be trusted.
People also described architectural changes in their homes and structural changes in their families. "We have more kitchens today," I learned from one woman with whom I lived. When she was young, her entire family lived in a series of connected houses, her grandparents and aunts and uncles all sharing a central hearth where everyone would gather during mealtimes. "If you consider the typical foods of Xela — jocom, pepian, cichom — they are all stews because it's relatively easy to make stew for twenty. But now, all of my cousins — well, we have our own kitchens. We cook for five or six." She explained that her mother and aunts used to cook together, sharing responsibilities. She told me she thought it was a lot more work for one person to cook regularly for five others than for four people to cook together for twenty. "Since I'm the only one responsible for cooking, I end up using premade ingredients: I buy bread from Xelapan (a chain bakery); sometimes I even buy cornmeal for my tortillas."
Abay Asfaw (2009), a researcher for the Centers for Disease Control and Prevention, additionally connects nutritional transformation to the changing infrastructure of marketplaces, finding that whereas people once relied on crops grown and purchased directly from farmers, they were becoming reliant on transnational supermarket chains. The first supermarkets in Guatemala sold high-end luxury foods to wealthy patrons in elite urban centers, but this changed significantly in the 1990s, when the number of supermarkets more than doubled, and they began to specialize in "cheap, processed and junk foodstuffs, items known for their disproportionately high fat, sugar and salt content" (2008, 228). Agricultural economists Thomas Reardon and Julio Berdegué describe this shift: "In one globalising decade, Latin American retailing made the change which took the US retail sector 50 years" (2002, 371). The rapid expansion of multinational giant companies such as Ahold, La Fragua, Walmart/Hiper Paiz, and Carrefour into impoverished and semi-urban communities transformed household purchasing patterns: as the costs of mass-produced canned and processed foods dropped, their sales and subsequent consumption rose.
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Table of Contents
Acknowledgments Map Introduction: The Richness of Eating 1. Disease and Modernities 2. Nutritional Black-Boxing 3. Care of the Social 4. Contemporary Body Counts 5. Bodies in Balance 6. Many Values of Health Conclusion: The Opposite of ObesityNotes References Index