“The World is Fat”
—BM Popkin, Scientific American 2007
When I first read this proclamation, it inspired great fear. How do we avoid further marginalization and shrinking funds to address the suffering of the world’s hungriest citizens? In short, how do we balance the emerging trends of obesity against the estimated 842 million chronically hungry people in the world (FAO, 2013)? In this essay, I suggest that (1) the fight against hunger can teach us important lessons that can inform strategies to address the obesity pandemic, and (2) rather than juxtaposing obesity and hunger, anthropologists can be at the forefront of reframing the discussion to highlight the important and overlapping role that poverty and inequality play in patterning both of these problems. Finding a balance has implications that extend beyond further marginalization of the hungry people of the world. As W Phillip T James suggests in much of his work, there is an urgent need for a more integrative approach to global nutrition.
Situating Hunger and Global Obesity
The economic distribution of hunger versus obesity is complex but generally well described. Much of the more recent work from global obesity literature suggests that high income countries exhibit a pattern of obesity among the poor and least educated. For middle income countries, overweight and obesity occur more commonly as gross national product approaches US $2500. For these countries, overweight and obesity dominate nutritional patterns in both urban and rural areas, but with evidence for lingering hunger in rural areas.
According to a recent Food and Agriculture report (FAO, 2008), approximately 923 million people were undernourished in 2007. This report suggests that the rate of global undernutrition has risen since 2003, largely due to rising costs of global agricultural commodities (FAO/FOSI, 2008). In Sub-Saharan Africa, one out of three people is chronically hungry (FAO/FOSI, 2008). In these and others of the lowest income countries, obesity is a problem among only the wealthiest individuals in urban areas, with some evidence of increasing levels of overweight in rural towns (see Mendez et al, 2005 Am J Clin Nutr). To make matters worse, Subramanian, Kawachi, and Davey-Smith (2007 J Epidemiol Community Health), using the gini-coefficient as a community proxy for income inequality, reveal a strong association between rising income inequality and the emergence of obesity, even in contexts of recent abject poverty. Thus, linking hunger, food insecurity, and the prevalence of both underweight and overweight as an integrated circumstance of inequality becomes a vital next step.
Remembered Hunger and Inequality
My argument here is that as communities who have a history of hunger find themselves increasingly enmeshed in globalized food markets, hunger research will be vital in both documenting and predicting the most vulnerable individuals. These predictive tools draw heavily on the frameworks developed in the anthropology of food and nutrition and from lifespan and intergenerational biology approaches used in biological anthropology.
The stigmatizing and accusatory approaches of “lifestyle factors” associated with obesity research would benefit greatly from a shift to a household approach. Households, as the unit of analysis, are comfortable anthropological terrain. Anthropological case studies abound that link broader historical and political economic processes to local communities and the impacts on livelihoods and access to food. Case studies such as Thomas Leatherman’s “Spaces of Vulnerability” article (2005 Ethos) situate hunger in subtle ways. Similar political economic examinations of the “nutrition transition” are emerging (eg, B Piperata 2007 Am J Phys Anthropol) but drawing direct links to obesity is the next obvious step. An emphasis on the household offers the opportunity to then closely examine the contextually-specific strategies households use to make ends meet and how food decisions are parsed. Household level analyses do not, unfortunately, completely remove the “mother blame” associated with infant and child undernutrition so poignantly described by Nancy Scheper-Hughes and so many others, and evidence suggests that we should expect to see an increase in the shaming of mothers (and fathers) as the prevalence of childhood obesity rises (see A Brewis 2010 Obesity: Cultural and Biocultural Perspectives; T Moffet 2010 Med Anthropol Quarterly).
As part of contextualizing the emergence of obesity, we have an opportunity to examine the ways in which cultural patterns that are linked to inter-individual differences in under-nutrition might reverse or change in the face of rapid changes in food availability. For example, the work of Monica Das Gupta and Barbara Miller documented a strong cultural preference for boy children that was linked to better nutrition and survival with starkly lower nutritional status for girl children. Can we then expect these cultural preferences to translate into gendered patterns of obesity? Similarly, we know that the social responses to hunger differentially affect men, women, and children depending upon the culturally defined rules for buffering. In my work and the work of Kathleen Galvin and Sandra Gray with Turkana pastoralists of Kenya, we have observed that women buffer children from hunger as much as possible—with elder women buffering younger and pregnant or lactating women. How will such patterns of social protection and buffering transform or help us predict who is most vulnerable to obesity when food availability shifts?
Hunger serves as a powerful expression of deprivation and even hopelessness. As such, it seems unwise to underestimate the emotional impact of remembered hunger and to assume that food choices are made in some sort of vacuum. In my own research, hunger and the inability to feed one’s children serves as worrisome idioms of distress, with women citing thoughts of suicide as they lay awake at night thinking about how to feed their children. Sandra Gray’s work among Karimojong women of Uganda, and Catherine Maternowska’s moving assessment of women’s poverty in Haiti, offers two more accounts of such distress out of many others. Yet, just as we are learning some of the biological consequences of such distress, we know little about how these bio-psychosocial experiences shape food and health choices as circumstances improve, a gap in our knowledge I hope we can improve in the years to come.
Lifespan and intergenerational biology also serve as a powerful justification for the importance of linking hunger and obesity. Compelling evidence exists linking early life experiences of undernutrition and psychosocial stress to adult onset metabolic diseases. This work, pioneered by David J Barker and Osmond Hales, builds on the well-established links between poor maternal nutritional condition during pregnancy and low birth weight to suggest an altered pattern of fetal development that results in a thriftier metabolism. This thriftier metabolism is best viewed as a trade-off that may enhance early survival but simultaneously impose the potential for life-long negative consequences. If food intake remains low, then this thriftier metabolism results in few chronic disease consequences, but if nutritional circumstances change, the risks for a suite of metabolic disorders increase dramatically. Moreover, this biological compromise of low birth weight in the face of undernutrition or stress crosses generations, with the next generation of babies also experiencing higher risks for low birth weight. This lifecycle biology approach opens a critical “black box,” helping to make sense of the links between remembered hunger and rapid dietary shifts in communities across the globe (see J Guthman 2012 Annals of the Association of Am Geographers).
Plea for an Anthropologically-Informed Hunger to Obesity Continuum
Andrew Prentice, in an essay on the influence of famine on our evolutionary history, writes the following about the words famine and starvation: “[e]ven to most of us who have never experienced true hunger in our whole lives, they evoke a shudder of subconscious memory.” This subconscious memory clearly shapes the highly responsive plasticity of human biology, but these biological memories are only part of the story. As scholars focused on inequality and nuanced assessments of vulnerability, bridging our examinations of hunger to include remembered hunger seems vital for biological, cultural and emotional reasons. These reasons may offer the best path forward as we grapple with documenting the highly variable patterns of the emergence of obesity. For those of us focused on food insecurity, we should not ignore the emerging pattern of obesity; it may well represent an extension of the lived experience of hunger. Likewise, for those who examine obesity, hunger represents considerable suffering that may change how individuals, households, and communities engage in market economies. Finally, I follow the pleas for a comprehensive nutritional approach advocated by global nutrition leaders. The sooner we work to frame hunger and obesity as a contingent circumstance of inequality, the stronger our interventions and policies can become.
Ivy L Pike is associate professor of anthropology at the University of Arizona. She has examined nutritional, reproductive, and psychosocial health among East African Pastoralist communities for over twenty years. Her training and research questions blend biological and sociocultural approaches to global health inequalities.