The Anthropology View of Obesity

What’s obesity? What’s “overweight”?  At their most basic, these words are ways to describe having too much body fat. The commonly used tool for measurement is the body mass index, or BMI. People are considered obese when their body mass index exceeds 30 kg/m2. Obesity is often linked with images a heavy people shuffling slowly through life; obesity is usually tied to America or other western countries. Unfortunately, the problem of obesity today is larger than we think. According WHO2012-World Health Statistics, worldwide the prevalence of obesity almost doubled between 1980 and 2008. Once just a problem of wealthy nations, it now impacts countries at all economic levels. Despite the rates of obesity being higher in wealthier countries than low- and middle-income countries, it is indeed a worldwide problem today. There isn't a region in the world untouched by it and it has become a global epidemic.  

 Why is obesity defined as a problem? What’s the danger of obesity? WHO2012 - World Health Statistics reports that there are about 2.8 million people that die each year as a result of being overweight or obese. Obesity brings a wave of illnesses. It is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and increased health problems. It is linked to musculoskeletal, respiratory and psychological problem; people can suffer from Diabetes, Heart disease, stroke and several common cancers. It affects people not only physically, but also emotionally. It can lead to isolation, and a decrease in self-esteem. WHO warns that “Obesity is one of the most serious public health problems of the 21st century.” Overweight bodies will soon be the modal human form, and  to acknowledge what are the real causes of obesity will provide breakthroughs in the global struggle. For anthropologists, it’s clear that the reasons behind obesity are complex and there is no simple answer.

John. M. Janzen once defined medical anthropology as a study of the meaning of the signs of illness and suffering in the light of wider traditions.The remark of an anthropological research is the form behind the text --- the hidden structure of phenomena.  In the article “Obesity and Human Biology: Toward a Global Perspective”, author Alexandra Brewis combines various approaches from different research to examine the expansion of obesity. Through a biocultural  lens, she shows readers the embodiment of culture, social, economic and other environmental processes that an individual is exposed to through their lifetime, and how these processes are expressed in their physiology.  By screening these contributions, she highlights the complex pathways between biology and health related to excess weight--- they occur at multiple levels, dealing with the persons’ life experience as well as socio-ecological context.  It's a great piece which reflects the heterogeneity of medical anthropology.

Obesity and hunger are both related to food. They are two factors that the world does not rate together. But they are linked in a way that many individuals wouldn't connect themselves. Using Alexandra’s words, “obesity [has] emerged as exemplars in recent advances in understanding the role of early life history …” (Alexandra, 2012). To interpret this, we can use America as an example. Today America is the nation with the highest prevalence of overweight and obese individuals in the WHO region (62% overweight in both sexes, and 26% obese)(WHO P36), but historically it’s easy to draw a parallel with the poorer countries in the 1930s. During WWII, many draftees were rejected because of malnutrition. Until recently, privileged individuals and groups have been able to display embodied wealth by above-average body size, and it was a common condition only among the upper classes. Hunger, in many cases, resulted from disruptions to the food supply caused by war, plagues or, natural environment such as adverse weather changes. Hunger usually relates to poverty: The poor are hungry, and the hungry are usually poor. Hunger motivates people to change. Technological developments provided part of the solution to hunger, and the rise of industrialization created more efficient ways to produce less expensive food. With this historical background, we see the pathway people used to fight hunger and gain access to enough food.  With this historical background, we can gain a better understanding of the ironically opposite phenomenon today--- obesity. While technology benefits people, it also has altered patterns of life almost everywhere on Earth.

With the rising rate of obesity, there is an explicit linkage to diet, and obesity mediates an understanding of developmental processes in shaping disease. The rise of technology changed the way we farm and what we farm. They affect how we eat and what we eat. Processed food appears everywhere in today’s market: more refined grains, more added fats and oils, and more added sugar.  “…the very foods that are most traditional, fresh, and local—are in turn obesogenic” (Alexandra 2012).  Trends in calories consumed, snacking behavior, soft drink and modern fast food consumption have become part of the cause of obesity. In the essay, some anthropologists also present a different but equally ironic view of unforeseen trade-offs related to it--- The rise of technology makes people less active. Cars replace bikes; shopping online, socializing online, and playing online interactive games  has created a culture of sedentary lifestyles. Technology is also partially responsible for the increasing rate of obesity.

Alongside the impact of technology, obesity simply cannot be understood without placing it in its social context. “Convenience” has become major selling point in many different ways. Convenience stores are an example of this. They often offer less variety, higher prices, and lower quality products. In this article, the author uses term ‘Food Desert’ to describe areas that lack access to supermarkets with fresh and unprocessed foods but filled with “seven elevens and Q-marts”.  Food deserts often occur in lower income neighborhoods where grocers are unwilling to invest in a store for fear that they will be unable to turn a profit. More surprisingly, she finds households that grow in wealth eschew the market and shop more conveniently for what proves to be less nutrient dense and more expensive food sold in corner stores. She frames this as an example of a concrete type of microlevel mechanism that underpin the macrolevel processes like lifestyle changes. It’s notable that the appreciation for cooking is quickly disappearing. A few decades ago cooking was the center of a family home, women stayed home to cook and clean and the men brought home the bacon. But now a lot of the younger generation doesn't know how to cook, the ones that do know how to cook have difficulty finding the time to do so. Fast food is everywhere, and frozen, packaged and processed food is always available in the grocery store. Both partners in a marriage usually work full time, and have a hard time balancing work, relaxation and cooking.  The change of social structure together with "convenient fast food" make it more difficult to prepare a nutritionally balanced and healthy meal than defrost a frozen pizza.

Without culture context, a study may not be considered as anthropological study. Obesity is also a particularly fertile medium for exploring pathways between cultures, in part because it is universally imbued with symbolic meaning. Big body size and fatness often profoundly and shape and reflect identities. It’s hard to avoid the influence because we are surrounded by "our culture" and are constantly bombarded by people’s ideals toward body norms. In many countries today, where bodies are the dominant and preferred symbols of self, slimness is associated with health, beauty, wealth and attractiveness. In contrast, fatness and obesity are associated with ugliness, sexlessness, and undesirability but also with specific moral failings, such as a lack of self-control, social irresponsibility, ineptitude and laziness. Alexandra summaries the similar examples in Arab countries and describes how this affects people. Changing body norms creates fat fear, and a fear of food. People begin with pathological eating behavior, which leads to difficulty in the regulation of weight and results in weight gain. The resulting eating-disordered behavior and experiencing weight increase are example of cultural interference. 

While obesity is stigmatized in much of the modern world, particularly in the Western world, it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of today's world.  Fatness is associated with wealth and abundance. Despite the number of ethnographic studies conducted which have detailed cultural contexts in which fat bodies express beauty and marriageability, many males worldwide still think the that fatness is related to fertility, familial responsibility and social belonging. The perceptions of ideal body size and corresponding behaviors are greatly influenced by culture and gender. Increasing body size of children also is a substantial secular trend in human biology . There is no denying that the shift to richer diets is a cause of this, but a few studies also show that children are more likely to be obese if they are boys, or from small households with few or no other children (Alexandra, 2003). China will be a good example.  In smaller middle-class families, kids normally have more permissive, less authoritarian parents. The values parents place on children, especially sons, can result in indulgent feeding because food treats are a cultural index of parental caring. Parents often value child fatness as a sign of health.  And their idea of feeding a child, including with food treats is an act of loving and caring. This could well translate into overfeeding at home and obesity..

Connecting the global changes over time in trade and periodic climatic disruptions, the increasing rates of obesity across the world are also broadly attributed to environments that are "obesogenic". In the essay, the author shows how trade and globalization of the food system affects people.  The dominant explanatory framework is that of nutrition transition which relates globalization, urbanization, and westernization to changing food environments across the populations of the world.  In this formulation, the rise of big industry and corporations make it difficult for small business and farmers to compete and stay in business. Communities previously reliant on subsistence farming now must enter the job market for monetary work and rely on the cheapest, nutritionally devoid, factory produced food items. In this formulation, changes in food prices have been linked to changes in how much we eat, as well as our risk of obesity. Global food supply becomes increasingly abundant, less expensive, and more-aggressively marketed, coupled with fast raise of fruit and vegetables. Andrew Seiden et al. suggest that “decreasing costs of highly processed foods leads over time to declining dietary quality and increased obesity (Alexandra,2012). In addition, economic inequalities within and between nations have ensured food security for significant sectors of society and for some nations as a whole, while denying food security for many others. WHO data indicates that in 2008, around 80% of all NCD deaths (29 million) occurred in low- and middle-income countries. Being limited to the healthy foods available, those that are of less wealth rely on cheap but unhealthy foods to bring an end to their hunger. They are less likely to receive adequate diets but more likely to access higher calorie foods that are affordable. They are victims of their economic status.

Obesity, as its heart, the result of many personal decisions---change diets or eat less. But the rise of obesity across many countries and disproportionately among the poor suggests that becoming fat cannot just be blamed on individual frailty. Medication like drug or surgery can  help in the most extreme cases; they don't, however, offer a solution to the wider problem. John. M. Janzen introduces the word "fabric" in relation to health in his book. He explains that fabric can become a useful image to show how anthropologist speaks about health and illness, and it includes cultural fabric, social fabric and economical fabric. They are the net that can envelop individual with life-enabling such as basic fresh water, shelter, and health; and how they are maintained or how they change also can torn and tatter people’s life. As we can see, one’s biology is manifested and affected by different aspects of society, culture and classes of economic; it is not just a single component. Face the fact that the world now filled with more people who are overweight than underweight, public health like WHO and medical perspectives paint obesity as a catastrophic epidemic that threatens to overwhelm health systems and undermine life expectancies globally. Yet, despite the loud messages about the health costs of being obese, weight gain is a seemingly universal aspect of the modern human condition. Obesity is a problem that cannot be fully understood independent of the culture or social group in which it appears; it will not be fully understood without the particular environment in which obesity is examined. Also, the growth of obesity has to do a lot with economic growth, which brings change in lifestyle. Even more, it may with an underlying genetic basis.

After all, there is no single solution to obesity, not the cause nor the cure; it cannot be tackled by individual action alone. We will only succeed if the problem is recognized, owned and addressed at every level and every part of society. For an anthropologist, the idea is that they can see through the surface to the pattern from which it springs, and look for the essentials to define it.  Disease is a language, is a way of communicating and storytelling. What we eat or what we choose to eat plays a large role in determining our risk of gaining weight. But our choices are shaped by the complex world in which we live — by the kinds of food available at home, by how far we live from the nearest supermarket or fast food restaurant, or even polices made by politicians. For an anthropologist food is a basic necessity, but it’s also much more. It can evoke memory and emotions; it is “toxic” because of the way it corrodes healthy lifestyles and promotes obesity. For an anthropologist, it’s about social relations, biological identity and self-hood. Drawing on many different studies with her own fieldwork, Alexandra A. Brewis addresses the critical questions as why obesity is defined as a problem and why some groups are so much more at risk than others. Grounded in a holistic anthropological approach and using a range of ethnographic and ecological case studies, Alexandra A. Brewis shows that the human tendency to become and stay fat makes perfect sense in terms of evolved human inclinations and the physical and social realities of modern life. Beyond the obesity epidemic, Alexandra Brewis presents us with topics like cultural perspectives, social determinants and the global economy which all prove indispensable when considering endemic obesity rates. They are interconnected with each other and influence people in interdependent ways. She suggests that a systems approach, which can place human biological and biocultural variation within the broader contexts, will be a useful step to informing effective prevention and intervention efforts. 

Bibliography

Brewis Alexandra, Biocultural Aspects of Obesity in Young Mexican, AMERICAN JOURNAL OF HUMAN BIOLOGY 15:446–460 (2003)

            Obesity related to over-nutrition is investigated in a sample of 219 Mexican children from affluent families, ages 6–12 years. Binary logistic regression shows that children are more likely to be obese if they are boys, from small households with few or no other children, and have more permissive, less authoritarian parents. The differences in obesity risk related to specific aspects of children’s developmental microniche emphasize the importance of including a focus on gender as a socio-ecological construct in human biological studies of child growth, development, and nutrition.

Brewis Alexandra, Obesity and Human Biology: Toward a Global Perspective, AMERICAN JOURNAL OF HUMAN BIOLOGY 24:258–260 (2012)                                                 In this special issue of American Journal of Human Biology, authors use varied approaches to examine the expansion of obesity globally, particularly what shape variability in people’s vulnerability to weight gain and its negative effects. The contributions together highlight how complex pathways between biology and health related to excess weight are strongly medicated, at multiple levels, by both socio-ecological context and life history. A systems approach, which can place human biological and biocultural variation iteratively within the broader contexts of developing and globalizing adiposity, will be a useful next step to informing effective prevention and intervention efforts.

WHO: WHO2012-World Health Statistics-W1