Book Review: The Weight of Obesity: Hunger and Global Health in Postwar Guatemala

The Weight of Obesity: Hunger and Global Health in Postwar Guatemala. Emily Yates-Doerr, Berkeley: University of California Press, 2015, 248 pp.

Obesity is now a truly global phenomenon, and many lower- and middle-income nations are advancing their own “war on fat.” In Guatemala, as Yates-Doerr discusses in the opening of The Weight of Obesity, this war can seem very literal. The military, responsible for 36 years of atrocities and human rights violations during the civil war, is now one of the key players leading the charge against obesity in-country. With this in mind, further discussions throughout the book concerning the ways in which certain bodies are both targeted and excluded take on added significance. As has been noted in other contexts, too often medicalized discourses about weight and nutrition—while responding to very real shifts in food landscapes and traditions—are imposed on local bodies and understandings of health, social connectedness, and fat.

There are other reasons why Guatemala is an interesting case study to use to explore ethnographically the ways in which globalizing weight trends manifest and are interpreted in specific places at particular points in time. Guatemala has extreme food insecurity, stunting, and under-nutrition concerns at the same time that obesity has come to be perceived as a growing medical concern—a shift that actually occurred over the course of Yates-Doerr’s time in the region. As she documents, interventions aimed at the two ends of the nutrition spectrum (an artificial division, as she makes clear, since food insecurity and obesity often coexist and amplify each other) now intersect on the ground. Anthropologists and public health practitioners have not adequately juggled these shifting complexities. With long-term field experience in Guatemala, Yates-Doerr has seen the shifts through time, up close, and in detail.

The Weight of Obesity clearly focuses on what is happening in just one city—Xela—richly and historically described, and the on-the-ground experience of the author shines through. Yate-Doerr doesn’t just tell a story of biomedical and development techniques, norms, measurements, and expectations being imposed on a group of locals. Instead, she provides stories in which local interpretations of global norms and local agency proliferate, reinterpret, and retain power. The book moves through a range of different aspects of weight, ranging broadly (theoretically, although intentionally not geographically) between topics from across medical anthropology including beauty, health, power, and nutrition.

The book provides a detailed account of how medicalized body weighing practices and biomedical tropes about what constitutes “good” nutrition play out in individual daily life—inside and outside clinical spaces. The book also focuses on the difference between local understandings of fat vs. obesity. For example, people in Xela were accustomed to monitoring the physical weight and monetary value of the things they produced, sold, or bought, but not their own bodies. Thus, notions that “bodies should be in balance” didn’t translate well in health delivery. Yates-Doerr shows that nutritional clinics may create an important sense of support between client and health staff, but there are many descriptions of failed encounters between medical experts (mostly nutritionists) and citizens in Xela, as well as between practicing nutritionists and administrators and policy-makers. A specific focus in the book is the question of what obesity (and, more specifically, the units of measurement related to obesity) mean for the people being measured and doing the measuring. In essence, the book argues that health should not be quantified, and well-being is almost everything except the numbers used by experts to express it.

One interesting section near the end of the book considers how norms related to body size reflect larger historical ethnic differences that link to “whiteness,” so that Maya women are not as able to fit a norm or size or color as easily as Ladinos. Yates-Doeer explains how in Xela, blood, gender, and skin color used to be powerful social markers for generations, but now obesity is interfering with these categories because of its association with backwardness, passiveness, and expense (i.e., someone who is obese is framed as a drain on the nation). She convincingly argues there is an element of race-making in the talk around fat and the pathologization of certain lifestyles.

A particular strength of the book is Yates-Doerr’s treatment of the nutrition transition within a political economic/savage inequities framework and a nuanced explanation of how this plays out in the local foodscape. In this analysis, the transition is not linear but jagged and uneven. Moreover, she goes beyond the more typical focus on shifts whereby people eat more processed food to incorporate changes such as a new reliance on aluminum cooking pots, not listening to one’s elders (who are no longer as responsible for actual feeding of the family day-in and day-out), and transformed “vegetable economies.” More generally, the book successfully pulls together several different strands of current interest in both anthropology and in the public imagination: food and eating, nutrition and health, obesity and body size, and body norms. Despite their obvious overlap, there’s been surprising little research that manages to talk across these areas of scholarship in any meaningful way. Her theoretical entry point was not—as it has been with others—the obesity literature, but rather the dual development of economics (Marx, Adam Smith, Weber, Timothy Mitchell, etc.) and nutrition as fields of inquiry and technologies of power.

The diffuse ways in which body categories are discussed through the book is sometimes challenging for the reader. Since the book is about the ways in which categories are artificial, arbitrary constructions, and modes of oppression, a refusal to draw any comparisons, establish any categories, or draw any conclusions based on categories is a very conscious and deliberate strategy by the author. As Yates-Doerr observes, there is already a plethora of work documenting physical bodies and measures.

Yates-Doerr also explicitly presents her work as rooted in Xela and does not make comparisons with other places. Therefore, her case study stands alone, even as the broader themes would likely be highly generalizable to the rest of Guatemala and beyond. For example, one argument is that “rich” has quantifiable implications in English, and the Spanish rica defies such logic. The use of rica is thus a linguistic strategy—coupled with the continued consumption of socially important foods perceived to be rica—that local Guatemalans deploy to resist being told what to eat and cook by doctors, nutritionists, or public health practitioners. Similar strategies are undoubtedly occurring elsewhere.

Of course, such resistance in Xela is about Xela’s particular history of inequality, colonialism, military subjugation, and neocolonialism. It is also, as Yates-Doerr shows, about the importance of nonmedical understandings of health and nutrition in Xela, where abundance and fat are valued, even as obesity (and its connotations of incoherent consumption) is pathologized. Local engagements with both global “nutrition transitions” and with global medical interventions aimed at these transitions, however, in which interventions often end up not just targeting individuals rather than policies but also reproducing preexisting inequalities, are occurring everywhere as people interpret standard health and nutrition messages in far more unquantifiable, unstandardized, and idiosyncratic ways than is allowed for in a straightforward clinical understanding of nutrition.

The Weight of Obesity would be a useful teaching text in any introductory course on medical anthropology and/or the anthropology of food and nutrition.

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