The Weight of Obesity: Hunger and Global Health in Postwar Guatemala 9780520961906

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THE WEIGHT OF OBESITY

california studies in food and culture Darra Goldstein, Editor

THE WEIGHT OF OBESITY hunger and global health in postwar guatemala

Emily Yates-Doerr

university of california press

University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its activities are supported by the UC Press Foundation and by philanthropic contributions from individuals and institutions. For more information, visit www.ucpress.edu. University of California Press Oakland, California © 2015 by The Regents of the University of California All photographs by Emily Yates-Doerr. Library of Congress Cataloging-in-Publication Data Yates-Doerr, Emily, 1978– author. The weight of obesity : hunger and global health in postwar Guatemala / Emily Yates-Doerr. p. cm.—(California studies in food and culture ; 57) Includes bibliographical references and index. isbn 978-0-520-28681-8 (cloth : alk. paper) isbn 978-0-520-28682-5 (pbk. : alk. paper) isbn 978-0-520-96190-6 (ebook) 1. Diet—Guatemala. 2. Obesity—Guatemala. 3. Obesity—Social aspects—Guatemala. 4. Food consumption—Guatemala. 5. Food habits—Guatemala. I. Title.II. Series: California studies in food and culture ; 57. tx360.g9y38 2015 394.1′2097281—dc23 2015008551 Manufactured in the United States of America 24 23 22 21 20 19 18 17 16 15 10 9 8 7 6 5 4 3 2 1 In keeping with a commitment to support environmentally responsible and sustainable printing practices, UC Press has printed this book on Natures Natural, a fiber that contains 30 postconsumer waste and meets the minimum requirements of ansi/niso z39.48–1992 (r 1997) (Permanence of Paper).

To Donna Fae

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CONTENTS

Acknowledgments Map

1. 2. 3. 4. 5. 6.

Introduction: The Richness of Eating Disease and Modernities Nutritional Black-Boxing Care of the Social Contemporary Body Counts Bodies in Balance Many Values of Health Conclusion: The Opposite of Obesity Notes References Index

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ACKNOWLEDGMENTS

I cannot ever be in Guatemala without learning something that I wasn’t even aware that I didn’t know. This, then, is my first acknowledgement: I have gained far more from the place than I can hope to return. But if this is an important truth, it is also true that more and less are disappointing terms through which to acknowledge the many who have shaped this project, who would never frame the practice of living and learning in this way. So many Guatemalans are working to build better worlds. The families, the patients, the nutritionists, and the health workers—they have been with me on every page, through every word. I have been privileged to be an affiliate of the Center for the Studies of Sensory Impairment, Aging, and Metabolism since 2006. I thank Noel Solomons for always pairing incisive criticism with kindness and also for introducing me to Gabriela Montenegro Betencourt, Marieke Vossenar, Viki Alvarado, Rosario García, Mónica Orozco, Raquel Campos, María José Soto-Méndez, Liza Hernández, Sheny Romero-Abal, Evelyn Mayorga, Julisa Gallego, and Rebecca Kanter. I also thank Jorge Luis Gramajo and the Rafael Landívar nutritionists, Glenda Lopez and El Quetzal, the educators at CORSADEC, the staff at CIRMA, Esther and Marvin, Byron Ixcayau, Consuela Guerra, Carlos Xícara, Jose, Lizbet, Dulce, and Eva, and all of mis ángeles. The Anthropology Department of New York University was an incredible place to be a doctoral student. I could have had no better committee to oversee this project from its inception than Emily Martin, Tom Abercrombie, and Rayna Rapp. They have been the best of advisers, and my research questions ix

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and approaches have been entirely shaped by theirs. To acknowledge them adequately here is an impossible task. Sally Merry and Renato Rosaldo were ideal readers of an early version of this book. I also thank Bambi Schieffelin, Faye Ginsburg, Susan Rogers, Arlene Dávila, Jeff Himpele, Fred Myers, and especially Don Kulick. In other departments Marion Nestle, Krishnendu Ray, and Rafael Sánchez provided valuable feedback. It was a humbling and inspiring journey to develop this project in the company of Mercedes Duff, Amali Ibrahim, Orlando Lara, Sandra Rozental, and Sabra Thorner, who were with me from the beginning, as well as Vanessa Agard-Jones, Scott Alves Barton, Elise Andaya, Barbara Andersen, Robert Chang, Alison Cool, Lily DeFriend, Rene Gerrets, Becca Howes-Michel, Jelena Karanovic, Amy Lasater-Wiley, Rachel Lears, Tate LeFevre, Deborah Matzner, Ram Natarajan, Ariana Ochoa Camacho, Jason Price, Pilar Rau, Louis Philippe Römer, Naomi Schiller, David Schleifer, Christy Spackman, Damien Stankewitz, Ayako Takamori, Will Thomson, Chantal White, and especially Anna Wilking. I have been working in Guatemala since my undergraduate days at Stanford. This early work was funded by research grants from the Department(s) of Anthropology, the Program in Human Biology, the Department of Visual Art, and the Center for Latin American Studies. Stanford’s structural and financial commitment to undergraduate research benefited me tremendously; I am still seeking answers to questions that emerged at this time. Renato Rosaldo introduced me to a version of anthropology that changed my life, and Kathleen Morrison, Joel Leivick, and Mary Louise Pratt provided valuable guidance along the way. I am grateful for Annemarie Mol’s boundless creativity and sharp intellect. I have been beyond lucky to write and rewrite this book in the company of Sebastian Abrahamsson, Filippo Bertoni, Rebeca Ibáñez Martín, Else Vogel, Tjitske Holtrop, Hasan Ashraf, Cristóbal Bonelli, Michalis Kontopodis, Anna Mann, and Jeltsje Stobbe. I have also benefited from the generosity of our guests: Hannah Landecker, Emilia Sanabria, Anna Tsing, Simon Cohn, Matei Candea, Deborah Gewertz, Fred Errington, Marianne de Laet, Diane Paul, Rebecca Lester, Stefan Ecks, Josh Lepawsky, Pierre de Plesis, Jeremy Brice, Alex Nading, Darryl Stellmach, Oliver Human, Victor Toom, Emil Holland, Emma Roe, Luísa Reis de Castro, Carolina Dominguez Guzman, Line Hillersdal, and Bodil Just Christensen. At the Amsterdam Institute of Social Science Research I have tremendous colleagues in Anita Hardon, Amâde M’Charek, Rachel Spronk, Jeannette Pols,

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Rene Gerretts, Trudie Gerrits, Robert Pool, Niko Besnier, Vinh-Kim Nguyen, Eileen Moyer, Catherine Montgomery, Maarten Boekelo, and Kristine Krause. The Department of Anthropology at the University of Washington helped to make a childhood dream come true. The scholarship of Janelle Taylor, Ann Anagnost, Rachel Chapman, Bettina Shell Duncan, María Elena García, James Pfeiffer, Megan Carney, Marieke Van Eijk, Alejandro Ceron, and Nora Kenworthy influenced my thinking at exactly the right time. I am also grateful for the unsung heroes throughout who have kept so many bureaucratic hurdles unnoticeable: Evelyn Castaneda, Jennie Tichenor, John Cady, Mike Caputi, Rick Aguilar, Danny van der Poel, Yomi van der Veen, Muriél Kiesel, Cristina Garofalo, and Janus Oomen. Conversations with Nica Davidov, Harris Solomon, Ellen Sharp, Stacy Pigg, Sue Erikson, Lesley Sharp, Eric Hoenes del Pinal, Hanna Garth, Liz Roberts, Megan McCullough, Jessica Hardin, Ken MacLeish, Helena Hansen, Jonathan Metzl, Christine Labuski, Eugene Rakheil, and Jenna Grant have all inspired me to be a better scholar. Emily McDonald, you do not fit here easily because you have been so important throughout. The research for this book was generously funded by research grants from the Wenner Gren Foundation (Grant 7763 and EAG-15), Fulbright Hays, the Social Science Research Council, and the Ford Foundation; a Doris M. Ohlsen Research Award; and two fellowships from the Tinker Foundation. Quiet time for writing was enabled by the Dean’s Dissertation Award from NYU, the ERC Advanced Grant AdG09 Nr. 249397, and a VENI innovational research award from the Dutch Science Foundation. Without this support, this book would not have been written. I have presented sections from this book at EPICENTER, Aarhus University (Denmark); the Bremen University NatureCultures Lab; the Unit for Biocultural Variation and Obesity at Oxford University; the Food Research Colloquium at the University of Washington; the Cascadia Seminar in Vancouver; the University of Amsterdam’s symposia “Eating Drugs” and “Markets in Practice”; and, at New York University, Emily Martin and Rayna Rapp’s Science Ethnography seminar, the Center for Latin American and Caribbean Studies working group WiPLASH, and the Steinhardt Food Studies’ colloquium Feast and Famine. The questions posed by these audiences were invaluable in shaping the project, and special thanks go to Stanley Ulijaszek, Michelle Penecost, Frieda Gesing, Bjarke Nielsen, and Jens Seeberg. Early chapters of this book received the Rudolf Virchow Graduate Student Paper Award from the Critical Anthropology of Global Health Caucus; the Charles

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Hughes Graduate Student Paper Prize from the Society for Medical Anthropology; the Alex McIntosh Paper Prize from the Association for the Study of Food and Society; and the Christine Wilson Graduate Student Paper Award from the Society for the Anthropology of Food and Nutrition. Members of these committees gave me insightful and encouraging comments for rewriting. An early version of chapter 2 was published as “The Opacity of Reduction,” in Food, Culture and Society 15, no. 2 (2012): 293–313; I thank Berg Publishers, an imprint of Bloomsbury Publishing Plc, for letting me reproduce portions of this here. At the University of California Press, I couldn’t have asked for a more considerate editor than Kate Marshall. I also thank Stacy Eisenstark, Jessica Moll, and Tom Sullivan. I was extremely lucky to have Susan Silver copyedit the text and Margie Towery create the index. The manuscript also benefited considerably from thoughtful reviews by Edward Fischer and Heather Paxson. Emilia Sanabria, Sandra Rozental, Megan Carney, Anna Harris, Mercedes Duff, and Claudia Casteñeda each gave generous, line-by-line feedback of the entire manuscript, asking all the right questions and helping me to see old materials in new ways. Rebeca Ibáñez Martín and Rafael Sánchez gave muchneeded feedback on chapter 4. Ann Anagnost did the same with chapter 5. My family has not always understood why a field founded in the study of kinship would take me so far from home, and for so many years, yet their support has been unconditional. Mom and Phil, Dad, Bren, Riley, Emily, Isaac, Dorothy, Zoe, Steve, Maddie, Carol, Ted, and Katherine: thank you. Andrew, you walked my bike to the repair shop in the snow this morning so that I could finish this writing, and last night, when I came to bed after working late into the night, you took the baby when he cried so I could sleep. No one has taught me more about the impossibility of the calculation. Orion, and now Saul, you have made my life richer than I imagined possible. The next book will be for you. This one is for my grandma, Donna Fae, who made beautiful meals and taught me to love to read. Emily Yates-Doerr Amsterdam Institute of Social Science Research 2015

MEXICO BELIZE

G UAT E M A L A DEPARTMENT OF QUETZALTENANGO

Xela

HONDURAS CA1

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Map of the city of Xela in the state of Quetzaltenango, Guatemala.

A photograph of downtown Xela (Zona 1) taken from a hillside at the southern edge of the city.

Introduction The Richness of Eating And here is the beginning of the conception of humans and of the search for the ingredients of the human body. —The Popol Vuh: The K’iche’ Book of Community

I arrived at Guatemala City’s Hotel Conquistador at 6:45 a.m., just before the Guatemalan military’s annual medical conference was scheduled to start. Obesity (obesidad), the chosen theme of the 2008 event, was also the topic of my ethnographic research. In my work in Guatemala over the previous decade, the military had been a haunting presence: the uneasy boundaries between state and structural violence were recurrent themes in my interviews. Yet I had never before been so close to its bureaucratic center, and though I had associated the military with chaos and terror—the United Nations had found military and paramilitary groups responsible for nearly all arbitrary executions and forced disappearances of the country’s thirty-sixyear civil war—the scene was calm and organized. A woman at the reception desk gave me a professional-looking binder and a bag filled with program materials. With a swift smile she pointed toward signs directing me past rooms named after Spanish conquistadors—Vasco Núñez, Juan Ponce, Francisco Pizzaro—to the hotel’s Gran Salón, where the opening ceremony would take place. The Salón was still mostly empty when I arrived, but nearly seven hundred chairs were waiting. I took a seat and used the time to look at the materials, as men and women in military attire, uniforms emblazoned with medals of war, began to fill the room around me.

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“Overweight and obesity do not just affect the body image of the patient,” read the headline of a flier depicting a white mannequin. Arrows connected parts of the mannequin’s body to possible effects of weight gain: strokes, heart attacks, respiratory problems, fatty liver, cancer of the colon, infertility, degenerative arthritis. A sidebar listed psychological complications: depression, low self-esteem, bulimia, social rejection, suicide. Another flier for the diet drink Salufit showed a thin, light-skinned woman in white clothing, with a measuring tape wrapped around her body. “The best diet plan for your patient,” it advertised. “A quick and easy way to lose weight.” Several of the advertisements were presented in the style of scientific reports. The pharmaceutical company Abbott—makers of the weight-loss drug Raductil and distributors of the nutritional-supplement drink Ensure— had produced an impressive brochure, quoting international scientists who had studied the “psychological correlations of obesity and women.” The brochure classified obesity as a psychological disease: “People cannot control their impulses; they feel the need to eat compulsively; they lack autonomy. They have difficulty establishing the boundaries of their identity and live with the surreal feeling of being governed by external forces.” “There are things that the mirror won’t reflect,” stated another pamphlet, picturing a blue-eyed woman with Goldilocks curls peering into a mirror. The inside contained two images: a graphic depicting how the weight-loss drug Vintix would influence neuronal synapses in the brain that governed appetite and a drawing of a very thin woman standing inside the outline of a curvaceous silhouette. “Lose weight, improve your life and self-esteem. Prevent complications of overweight and obesity,” the caption read. I first encountered Vintix, a brand name of the drug sibutramine, in my work at the recently opened outpatient obesity clinic at Guatemala’s third largest hospital, located in the highland city of Xela. The clinic was an attempt on the part of Guatemala’s Ministry of Health to respond to rising concern about metabolic illnesses. Patients frequently arrived asking for the drug. The nutritionists, meanwhile, would emphasize changes in diet. They gave patients instructions such as “six tablespoons nutritional powder with one tablespoon oil and one cup of boiling water” or “supplement meals with three glasses of water and one cup of plain yogurt per day.” They would write out these recetas, a word that in Spanish means both prescription and recipe, in an effort to offer nonpharmaceutical-based treatments for patients’ afflictions. Still, Vintix-sponsored gifts, such as a chart with body mass index

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(BMI) cut-off points for healthy weight and overweight, could be found throughout the clinic. In 2010, when sibutramine was banned in the United States, China, India, and numerous other countries—research showed that it contributed to an increase in the very heart attacks that its users sought to prevent—the drug flooded Guatemalan markets, becoming even more common. As I read through handouts promoting a mixture of pharmaceutical and dietary treatments for obesity, a brass band began to assemble in the back of the room and a panel of men and women in military attire lined up on the stage in the front. Above the podium hung a banner with the year’s conference logo: a four-part evolutionary series featuring a quadruped primate, a caveman, a thin but muscular man, and then a shorter man with a bulging stomach holding a soft drink. Just before eight o’clock the brass band signaled the start of the national anthem. The audience stood with hands over hearts and began to sing. The chorus echoed through the hall: “Conquer or die, for your people, with fiery heart and soul, would prefer death to slavery.” Afterward, the military Medical Center’s director shifted the imagery of war onto obesity, referring to it as “a dangerous enemy that grows stronger daily, a deadly foe that must be engaged in battle.” When this introduction ended the audience dispersed, and over the next few days the camouflage-green military uniforms were replaced with the business suits of medical specialists, who gave talks such as “Surgical Treatments for Obesity,” “Post-bariatric Plastic Surgery,” “Poor Attention as a Factor of Risk for Obesity,” “Instruments for Diagnosing the Severity of Obesity,” “Obstructive Sleep Apnea,” “Pediatric Obesity,” “Esthetic Periodontal Surgery,” and so on. Nearly all speakers began by emphasizing the dangers of fat, and the treatment strategies they proposed—be they surgical or chemical— evaluated success in terms of measurable weight loss. I attended these talks in the company of nutritionists from Xela’s obesity clinic. The hospital, which had no funds to hire staff to run the clinic, had partnered the year before with the only local university to offer a degree in nutrition. Its third- and fourth-year students operated the clinic in exchange for the valuable experience of working with patients. The clinic’s director had arranged for them to travel to the conference, offering scholarships to those who could not otherwise afford the trip. The nutritionists had looked forward to it, but over the three days of the event many expressed frustration that scarce governmental resources had been spent in this way. Most of their patients were

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extremely poor, and the costly surgeries and medications emphasized by the conference would be inaccessible. During the scheduled breaks I walked among the booths, where smiling salespeople distributed product samples. To enter the exhibition room, conference participants had to walk past a video featuring a bariatric surgery patient mid-operation, body sliced open, with fat and blood exposed. Behind the television screen, an expensive machine used to measure body composition was advertised with the slogan, “know thyself ” (conócete a ti mismo). Adjacent to this was an advertisement for a pill that would inhibit absorption of fat in the small intestine. It showed a picture of a person struggling to button his pants: “Less fat, more grace” (Menos grasa, más gracia), read the banner, elaborating below the picture: “In Guatemala a high percentage of the population is overweight or obese. Remember the serious physical and sociological consequences of this illness. Are you in this risk percentile? A new alternative for losing kilos and reducing caloric absorption has arrived. Ask your doctor or nutritionist about Logra Tu Figura [Achieve Your Figure].” A man next to the banner handed out samples of a low-fat, low-sugar chocolate cookie. I was joined by one of the nutritionists from Xela as I approached his booth. We each took a sample, and as we walked toward the Hernán Cortés auditorium, where the next event was held, she told me she wouldn’t stay for the afternoon talks. Several of the nutritionists had criticized the conference as being “obsessively clinical,” “bizarre,” and “inappropriate,” and she too felt it was a waste of time. She held up the dry, plastic-wrapped cookie in her hand, telling me that these kinds of things were for los ricos. Guatemalans generally used the classification rico to reference a social class that carries out opulent displays of monetary wealth. The term is often associated with a violent abuse of power, but the nutritionist, nodding to the scene around us, said instead, “For my patients, there is nothing effective or powerful here.”

A few weeks later, two hundred kilometers west of Hotel Conquistador, Carla returned home from one of Xela’s neighborhood health clinics. She set down a heavy bag of vegetables, placed some papers beside them, and went straight to her sewing kit. Her two teenage daughters, who had been watching television, stood up to see what she was doing as she pulled out a flexible measuring tape—the kind used to measure yarn—which she then wrapped around her

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body. “Thirty-seven,” she read out loud, her finger marking the spot where the tape formed a circle around her waist, just above her navel, which was hidden under the thick fabric of her handwoven huipil. She looked up, noticed us watching her, and then added, “They say the number should be smaller.” Carla had just attended the first in a series of five weekend classes on healthy cooking (comida saludable) taught at a neighborhood school. Her doctor recommended that she enroll; at her last visit her blood sugar levels were high— too high, he said, given her diabetes. She had been looking forward to the class since I moved into her home the previous month. She hoped to learn something that would alleviate the numbness in her limbs and the sharp, pinching pain she felt in her heart in the quiet of the early morning while the rest of her family slept. At her most recent checkup I heard her tell the doctor she could afford the daily medicine he recommended. But because it was expensive, she took it only when the pain felt especially strong. She hoped the nutrition class might offer a treatment that was more sustainable, and she felt fortunate that her husband had agreed to cover the cost of the course (100 quetzales, or $12.50)—which she planned to repay through the door-to-door sale of food in her neighborhood. Yet now, home from class, she seemed discouraged. “What happened?” the youngest daughter asked, no trace of her grandparents’ strong K’iche’ accents in her Spanish. “They started the class by weighing us, one by one. I couldn’t believe it, we were all overweight. All of us. Many of us had obesity! Then they told us about the masa of our bodies, which they said we could reduce by eating less.” Carla’s voice hesitated uncertainly over the word masa, which is part of the global health metric used to assess overweight (índice masa corporal, or body mass index) but is also the word for the soft corn dough of the tortillas and tamalitos eaten at nearly every meal. In the K’iche’ story of human creation, human bodies were composed of this corn masa—not measures of pounds or kilos. She continued, “And they gave us these recetas, saying these would help us to lose weight.” She sighed as she turned off the water, her disappointment palpable. “Do you see them? I don’t know what to think. This isn’t the way I cook.” I looked at the recetas that she handed me, which included foods I knew she could not afford to eat regularly: fruit salad with Dos Pinos Lite Yogurt, Jell-O cake made with Splenda, roasted red-pepper chicken breast, and low-fat ham sandwiches with Bimbo whole wheat bread. The ingredients were listed in carefully measured quantities—2 tablespoons, 1/4 cup, 8 ounces—alongside

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detailed preparation instructions. I then looked at Carla’s well-worn kitchen, the kitchen of someone who cooked by memory, adjusting flavors in response to taste. She did not own the requisite mixer or kitchen scale. She didn’t even have measuring cups. “This is not cooking; this is following orders,” she said, pointing to the papers. She then patted her stomach affectionately: “And why would I want to be thin?” A history of scarcity and recurrent plagues of famine had instilled in the women in the community the importance of satiety and the value of providing abundant and delicious meals for others. Carla was proud of being financially resourceful in her cooking. But as careful as she was with her food budget at the marketplace, she regularly invited friends and neighbors over to eat. As she filled their plates with second and third helpings, I never once heard her mention cost. “I want people to leave satisfied,” she would say. “Tomorrow our plates may be empty. When there is food we must enjoy it.” Many people told me that a fullness of stomach as well as of figure had been desirable for as long as they could remember. A decade earlier, when I began conducting research in Guatemala, women had taught me how to wrap a skirt around my waist in such a way as to appear plump, and at the time of my research for this book, fatness was commonly viewed as evidence of health and prestige. The local expression “donde no hay gordura, no hay hermosura”—where there is no fat, there is no beauty—articulates the historical desire for abundance of feast and flesh. Rising rates of metabolic illnesses in Guatemala were changing this, recasting experiences long believed to be valuable as potentially harmful. For many of the women with whom I spent time, the nagging presence of their illnesses called into question the aptitude of their culinary skills, challenging the importance they placed in pleasures of taste, satiety, and satisfaction. These women had learned to cook by patiently observing their mothers, aunts, and sisters. The expertise involved in the transformation of raw materials into good meals was one acquired slowly, through kinesthetic practices that depended on being in relations with others. Today, however, women were learning to assess culinary skill through technologies focused on discrete, individualized metrics, such as measurements of weight, blood sugar levels, centimeters of fat, or grams of carbohydrates or proteins. In Carla’s case, she was learning to use the tape measure from her sewing kit to obtain the circumference of her waist and upper arm. In the market

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children standing next to scales would read her weight for the price of one quetzal (thirteen cents). At the doctor’s office she encountered the sphygmomanometer and stethoscope for blood pressure, and a blood sugar machine that would take a pinprick of blood to reveal her glucose level. Her doctor would send her to a separate laboratory, where she would give a blood sample that produced numbers reflecting cholesterol and triglycerides. And then there were the metabolic standards derived from equipment in faraway laboratories: the calorie, the serving size, and recommended daily allowances of vitamins and minerals, all of which were printed on the packaged, single-serving foods that had become part of the region’s dietary landscape. These foreign devices were increasingly abundant in Guatemala, existing uneasily alongside women’s expertise with regard to food and flavor. Yet, despite the growing public health interest in weight loss, many rejected the link between health and dieting, and the culinary knowledge held by women remained highly valued. During mealtimes in all the homes where I lived, family members would take turns praising the foods prepared by grandmothers and mothers: “Que rica la comida” (This food is delicious) they would exclaim, expressing pleasure in a richness that was not translatable into unit measures.

rica, wealth, and value I began the book with these two vignettes to highlight the diverse repertoires of richness and power that I came across in my fieldwork on obesity. The circulation of weight-related biomedical technologies in Guatemala’s stilltenuous postwar, postcolonial landscape generated numerous epistemic and ontological collisions pertaining to how people knew their bodies and organized their lives. This book documents how emerging attention toward weight management connects to the governance of persons and populations, showing how dieting techniques configured both individual and social bodies as bounded objects to possess and control. Yet though the evaluation of health through weight could have haunting and dangerous effects, I also illustrate how people worked around and refigured standards and measures. My research makes clear that nonmetric forms of rica and health remain valuable—and powerful—in people’s lives. The term rica that Carla’s family used to talk about food is an expression of enjoyment, implying positive stimulation and gustatory satisfaction. Rica,

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which translates to “delicious” or “tasty” in this context, shares etymological roots with the English word rich. In English, people often ascribe richness to foods with ingredients considered “heavy”—that is, fat, butter, eggs, or oil. Whereas rich might still be associated with “choice or superior quality,” it is often equated with “unhealthy”—an imagined heaviness of food weighing down the body. For the Guatemalans with whom I worked and lived, rica does not have these negative or quantitative associations when applied to food, referring instead to the pleasures of eating. Value is central to richness: to proclaim food to be rica is to compliment it, to express that it is desirable. But the assessment of rica is contingent not on the calculations of calories or grams of sugar or fat but on an intuitive, sensorial practice of valuing. There is, of course, another long-standing meaning of rica—highlighted at the end of the vignette from the military’s obesity conference—in which richness refers to a measure of wealth. The oft-made assertion that “Guatemala is ‘one of the poorest countries’ in the world” is an assessment of richness and poverty based on standardized units of income or income inequality (cf. Grandin 2010). Even when richness is associated with more fluid indicators of wealth such as health, education, literacy, and nutrition, the field of global health generally situates these terms within a quantitative framework in which value ultimately becomes translated into units (i.e., educational capital or human capital). Given the diverse values that motivate everyday activities, there are pragmatic reasons for why richness becomes evaluated—and valued—through measurements that can be transported across regions, countries, and languages (Latour 1987; Porter 1995). Moreover, there are reasons why money becomes a primary scale for this standardization. Influential social theorists including Karl Marx, Georg Simmel, and Max Weber have argued that money is the principal mode of engagement for actors widely separated in time and space because it purports to offer an easy and precise means of translating differences into equivalents, which can then be quickly and accurately compared. As Emily Martin writes, given a desire for the rapid and free-moving circulation of goods across numerous geographic and social boundaries, money—with its divisible, unit-based, fungible form—becomes “our chief token of value” (2007, 237; see also Serres 1995). As a framework for value, economics has taken innumerable forms, many of which have nothing to do with unit-based systems of money. As one example, the term economics has roots in the ancient Greek oikonomia, which

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referred to a general practice of household management. In the eighteenth century Adam Smith’s political economic theory of value distilled economics into wealth derived from the “natural price” of agriculture, which would wax and wane with its production. By the nineteenth century, views of economics encompassed matters as diverse as the taxation economics of David Ricardo (1772–1823), the labor theory of value developed by Marx (1818–83), and the economic sociology of Weber (1864–1920). Yet while there have long been extensive and varied understandings of economics, Timothy Mitchell argues that “the economy” as a distinct sphere of social life to be “measured, managed, developed, analyzed, restructured, and compared” did not emerge until the 1930s to 1950s (2002, 114). Mitchell’s analysis of the appearance of a unified and singular economy draws heavily on the writings of Simmel, who argued that in the nineteenth century money “filled the daily life of so many people with weighing, calculating, enumerating, and the reduction of qualitative values to quantitative terms” (cited in Mitchell 2002, 80). Whereas Simmel’s writings address a broad change in attitudes and relations, Mitchell highlights the emergence of a distinct social sphere, imagined as representing the entirety of material life, which came into being only after Simmel’s death. Mitchell looks to early twentieth-century transformations in the structure of government institutions, the mapping of landscapes, a growing proliferation of censuses and surveys, and new forms of engineering, science, schooling, and statistical knowledge—all of which had the effect of “redistributing ideas and values in a simplified way, to manufacture the apparent separation of objects and values, things and powers.” Mitchell’s argument is that “only a world reorganized to generate this simple two-dimensional effect could give birth to the economy” (2002, 98). I outline this argument because in roughly the same period that Mitchell ascribes to the emergence of the economy, there appeared another sphere of daily life where qualitative and sensory values became formulated in quantitative terms. The 1930s did not simply mark the beginnings of a global concept of the economy, but historians have also deemed it the “golden age of nutrition” (Carpenter 2003, 3031). While concern with food and feasting extends deep into the recesses of human history—the household management of oikonomia was certainly connected to eating—the shape of nourishment radically changed form across the globe during this time. Indeed, over the same time frame that Simmel’s general vision of “objective culture” became reified as “the

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economy,” in a different sphere of social life the atomized nutrient body was emerging in public view. In the 1930s mineral upon mineral was discovered and identified, and scientists determined the chemical structure for most vitamins (thiamine, 1936; vitamin C, 1932; vitamin D, 1932; vitamin E, 1938; niacin, 1937; vitamin K, 1939; pantothenic acid, 1939; riboflavin, 1934; vitamin B6, 1938). By the 1940s scientists had developed assays that allowed for the calculation of the chemical scores of food proteins—information that shaped the creation of national food guidelines focused on daily nutrient recommendations. And by the 1950s governments around the world had joined forces to establish nutrition research centers such as the Guatemala City–based Institute of Nutrition of Central America and Panama (INCAP, founded in 1949) to address the recently discovered problem of population-wide nutritional inadequacies. In parallel with the appearance of the economy, the field of nutrition was emerging as a transnational sphere of social activity to be measured, managed, developed, analyzed, restructured, and compared. Situated alongside the newly established field of the economy—imagined as “the sum of every occasion on which money changed hands”—was nutrition, reframing nourishment as the sum total of human metabolic activity (Mitchell 2002, 98). I draw attention to the overlapping timelines in which the economy and the field of nutrition came into being to highlight the possibility that the synchronized appearance of these domains of knowledge is connected to deeper transformations occurring in understandings of balance, energy, and social activity itself. Mitchell writes that the economy came to function through a “sphere of calculability” that operates by separating image from object and representation from reality (2002, 117). I suggest that the emerging transnational field of public health nutrition similarly developed through a consolidation of the fluid, relational practices of eating into the apparently fixed, self-contained, and objective measures of chemicals and nutrients. Just as the economy attempted to circumscribe all forms of wealth into calculable values, so did nutrition aim to distill the richness of eating into that which could be counted, compared, and controlled. Lest such a nutritional calculus be accepted outright, it is important to remember that even in a monetary realm the creation and comparison of equivalence proceeds through a quantitative “alchemy” in which nonmonetary valuations appear to disappear, but nonetheless remain present (Merry 2009; see also Preda 2009; Sunder Rajan 2012; Zaloom 2003). In other words, the

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value of money, operating through the apparently inflexible, objective measure of price, is still shaped by the richness of social activity. Likewise, I show in the chapters that follow that relational, incommensurate values that materialize through food and eating persist as powerful, even in a landscape saturated with the generalities and standardizations of metrics. This project has unfolded around an interest in diverse notions of richness in the context of body-weight management in Xela, Guatemala—a city that has seen a dramatic rise in reported rates of metabolic illness in Guatemala’s postwar period. This book explores what the Guatemalan public health community counts as valuable knowledge when it comes to dietary training, what is ignored, and how “dietary accounting” takes place. Diane Nelson (2010), who has spent decades analyzing the effects of colonial violence on bodies and their representations in Guatemala, notes that the Spanish word contar means both to tabulate numbers and to tell a story. As Bill Maurer has written, making reference to practices as diverse as audit, narration, and religious judgment, “accounting is everything and everything is accounting” (2002, 647). Still, cuisine, as I encountered it in Xela, presented accounting practices with a challenge. Constraining the practices of eating into either numeric tabulations or spoken words rendered visible accounting’s inevitable imprecision (see Tsing 1997; Gluck and Tsing 2009). The engagements of eating could be communicative practices, existing as a means for people to express themselves to others and to build families and communities around the exchanges of meals (see especially Abercrombie 1998; Douglas 1982). But as I learned from the women around me, this communication often complicated existing strategies of representation. Culinary practices frequently unraveled the objectification entailed in both numeracy and spoken language, as the acts of cooking or eating were not “acts” in any bounded sense of the term but intertwined digestive processes in which boundaries between self and other, culture and biology, and past, present, and future were persistently made and remade. I saw in my research that many people were struggling to reconcile their experiences of rica with the metrics that pervaded regional approaches to obesity prevention. While the field of nutrition tended to focus on numeric standards and prescriptive guidelines, for the men and women with whom I lived, foods and eating were not translatable into unit measures or step-by-step instructions. The deliciousness of tasting, the satisfaction of satiety, the pleasures entailed in caring for others and in being cared for—in short, the worlds of rica—were not fungible units to be transposed from discrete variable to

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discrete variable as though their values remained constant. Quantitative representations of the richness of eating purported to capture bodies and their energies, but the bodies around me refused to be captured. When instructed in “healthy eating,” Carla—like many of the people with whom I lived and worked—ignored the recipe.

the field I first traveled to Guatemala to study Spanish in the late 1990s and returned in 2000 and 2001 to conduct summer fieldwork in the mountainous Mam community of Todos Santos, near Guatemala’s northwest border with Mexico. Guatemala is known throughout the global health community for its prevalence of food insecurity. The World Bank reported in 2010 that rates of chronic malnutrition in Guatemala were the third highest in the world, and Guatemala is regularly cited in international reports documenting regions where starvation is common (“Nutrition” 2010). Photographs of hollow-eyed children held by the wafer-thin arms of their mothers illustrate these reports, and iconic images of skeletal famine run regularly in Guatemala’s own newspapers. Yet as I spent more time in Guatemala’s indigenous highlands, I began to see a different form of hunger than that which was readily visible. In 2001 Coca Cola representatives came to Todos Santos, painting the red-and-white logo everywhere; that red and white were also the colors of the handwoven pants worn by men in the town gave the multinational brand an appearance of local character. I was there two years later, when the small tiendas began to regularly stock Pepsi and Coke in diet form—for diabetics in the community. I was there in 2005 when the region’s first cell phone tower was completed, connecting residents of Todos Santos with family members who had moved away in search of work. At the time I was living with a family whose patriarch had recently had both of his legs amputated above the knee from complications with his circulation. I was there again the following summer, when the Central American Free Trade Agreement took effect and a large subsidiary of Walmart opened in the closest city, its mass-produced food products entering rural markets and homes. Each time I returned, the changes in the dietary landscape of the community were palpable. The containers of soda and cooking oil expanded in size, and their prices dropped. “Healthy cooking classes” appeared as reported rates of previously unfamiliar metabolic illnesses accelerated. And even the

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Central Park in Todos Santos, with Coca Cola advertisement visible in the background.

vegetables—grown with no small amount of pesticides—seemed fresher and more abundant than they had been when I first arrived. One might be tempted to call this modernization. Indeed, the global health community has dubbed diabetes, cardiovascular disease, stroke, and other metabolic illnesses diseases of modernity. But, as I show in this book, such a label is far too simple. The changes I saw were jagged and asynchronous. The historical continuities that persisted in the midst of radical upheaval unraveled the imagined linearity of “progress” in this story of modernity. In 2006, after years of annual travel to Todos Santos, I made the decision to conduct most of the research for this book in Guatemala’s second largest city, called Xela, roughly 135 kilometers to the south of Todos Santos. I wanted to know more about how scientific depictions of obesity in Guatemala were becoming translated as they moved across policy boardrooms, clinics, classrooms, and everyday life. Most formal nutrition science in the country is headquartered in Guatemala City, which is also home to one of the world’s eminent global health nutrition centers: INCAP. But epidemiological research carried out at the time reported that Xela would make a valuable site for understanding obesity trends in the country, since the city was undergoing rapid urbanization and, with this, changes in diet and physical activity and

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an increase in deaths from chronic and metabolic illnesses (cf. Groeneveld, Solomons, and Doak 2007). Numerous scientists were traveling regularly from the capital to Xela—four to five hours away when road conditions are good— to carry out studies of nutrition and metabolic health. Xela’s municipal government had also begun to offer an array of classes and public events focusing on obesity prevention, and in 2007, shortly before I moved to Guatemala for sixteen months, Xela’s public hospital, which served patients throughout the western highlands, opened the region’s only government-sponsored clinic to treat obesity. This clinic became indispensable to my fieldwork. To learn about obesity’s biomedical formation, for ten months I attended consultations on the two days a week the clinic was open. In the end, I observed approximately six hundred consultations, nearly all of which I recorded digitally. I simultaneously took field notes that described interactions between nutritionists and patients, and at the end of each day I transcribed selected sections from the digital recordings, matching the verbal dialogue with the written notes. To contextualize the reception and dissemination of the hospital’s medical treatment strategies, I met with thirty patients at their homes for follow-up conversations at least once, and often several times. Over the intensive sixteenmonth phase of my fieldwork I also lived with twelve families, in which at least one member of the family had been diagnosed with a metabolic illness. I participated in the everyday activities of eating, cooking, and shopping with these families and carried out a combination of oral histories and semistructured interviews with the people with whom I lived and members of their extended social networks (including several housekeepers, schoolteachers and principals, a beauty queen, a health food store owner, gym instructors, a diabetes medicine vendor, and the director of a plastic surgery clinic). Most of my time was spent in Xela, but my interest in how obesity was translated across various epistemic domains took me outside the city as well. Roughly once a month I traveled to Guatemala City to attend events organized by Guatemala’s Ministry of Health, INCAP, or the Pan American Health Organization, which also had an office in the capital, and to carry out interviews with the steady stream of global nutrition experts who passed through. As my research progressed, I found that discursive divisions between urban and rural dietary health were widespread enough to warrant ethnographic attention. I became affiliated with a rural health outreach organization (it called itself a “government-sponsored nongovernmental organization” since it

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was funded but not run by the national government), and for four months I joined the staff for three days a week on their clinical rotations through the mountain communities surrounding Xela. To supplement the oral histories I was gathering, I collected historical documentation on nutrition from the Dirección General de Estadísticas de Quetzaltenango, which stored the region’s hospital reports and body mass statistics; gathered articles on nutrition from the newspaper archives held by Xela’s public library; and spent three weeks combing through the archives of the Center for Mesoamerican Research, which contained back issues of Diario el Imparcial, Guatemala’s largest newspaper printed between 1922 and 1985. I am often asked to describe my project through established social categories. Do I study urban obesity? Indigenous obesity? Obesity among women? Obesity in the poor? This is an understandable question, as much sociological analysis aims to isolate patterns surrounding certain variables (gender, class, race, and ethnicity typically receive the most attention) and study these patterns. But in the region where I worked, these categories did not hold stable enough to deploy them as analytic variables. Rather than examine the emergence of obesity within particular social categories, the book examines how emerging interest in obesity dovetails with techniques of social standardization. It is a study of attempts at classification and the failures of these attempts. I am also commonly asked to compare the obesity education and dietary health protocols that I studied in Guatemala to what is happening in the United States or Europe, among other sites in the world. Much in the stories that follow resonates with obesity-prevention programs elsewhere, given the transnational nature of the networks and institutions through which concern for obesity becomes mobilized. The directors of even the smallest health centers where I spent time received regular training from United Nations– affiliated institutions; many of the Guatemalan scientists I interviewed held degrees from European or other American universities and traveled regularly abroad for expert meetings and additional training; and media and advertising sources that I draw on were developed with keen awareness of obesityrelated news outside of Guatemala’s borders (for example, Prensa Libre, a widely distributed newspaper, ran a weekly New York Times insert that regularly contained dietary advice). The book, however, undertakes its analysis of global nutrition programs through a rich case study of the specific highland region where I worked, leaving much of the project of explicit cross-cultural comparison to its readers.

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Paige West (2014) has noted that anthropologists’ theoretical orientations tend to reflect the places where they spend their time. It no doubt influenced this book’s concern for classification that the city where I carried out much of my fieldwork is exceptional, in the sense that categories of social life that may be fitting elsewhere in Latin America and even in Guatemala were obviously ill-suited to descriptions of social life in Xela. Comemos tamalitos, residents would tell me. They used this in reference to how they prepared masa— Guatemala’s iconic source of nourishment, which, in Xela, was often boiled in a banana leaf instead of patted into a flat tortilla—to remind me that life in Xela was unique. Xela was once the political capital of a small, independent country called Los Altos (The Highlands), and residents still commonly extolled pride that their homeland, with its economically and politically powerful K’iche’ influences, stood apart from elsewhere in Guatemala. Epidemiologists were drawn to Xela because of ways that knowledge about obesity in the city could be used to predict health risks and outcomes among certain populations elsewhere in the country. Meanwhile, I was drawn to Xela because of how the city’s complex particularities challenged the project of standardizing health and, with this, commonplace understandings of obesity at play in the field of global nutrition. As a telling example of the complexity of regional categories, Xela has not one but two names: Quetzaltenango is the city’s official Spanish-language name, which is also the name of the Guatemalan state where the city is located; Xela, the popular name, which comes from the K’iche’ phrase Xelajú no’ j (below the ten spiritual guides), is said to reference the ten mountains that surround the city. This duality in name is emblematic of how people spoke of the city’s cultural landscape; my informants regularly drew stark divides between indigenous and nonindigenous, urban and rural, Catholic and Christian, tortillas and bread, and so on. But categories that were rigid and fixed in people’s speech were far more fluid in their practices. Ancestries blended, as constant movement between city and country destabilized rigid ethnic classifications; Evangelicals—most of whom had been raised Catholic— celebrated the city’s patron saint, Rosario, with vigor; and bread, which had arrived to Guatemala half a millennium ago, was eaten alongside tamalitos and tortillas by most everyone. The economic heterogeneity of Xela further complicated easy binaries. The recently constructed Scandinavia gym, with its glass walls offering impressive views of the Santa María Volcano to those making use of its world-class

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facilities, was evidence of an elite sector of the city that held tight to claims of European heritage. Yet many—perhaps even a majority—of those in Xela who did not identify as indigenous lived hand to mouth (and most of the city’s gyms were damp, fluorescent-lit spaces filled with little more than rusty weights, tattered mats, and a sound system). Further destabilizing class binaries, two indigenous-language communities fed into Xela’s city center. Several of the Mam towns along the city’s northwest border were poor enough that the national government delivered weekly food aid packets to women with small children living there. But the K’iche’ towns on the opposite side of the city were well networked into international agriculture markets, and several extended K’iche’ families in Xela were politically powerful, with inheritances that have accumulated through centuries of conquest (Grandin 2000a). As a result, even when repeating national stereotypes about the “impoverished Indian,” people also regularly pointed out that in Xela, being indigenous did not necessitate underclass status. Standing in contrast to a well-rehearsed division between the poor indigenous peasant and the rich ladino landowner was the sense that in Xela one could be indigenous and also very wealthy. One could also be indigenous and university educated. In writing about medical pluralism in Guatemala, Walter Adams and John Hawkins describe a commonly accepted refrain throughout the region that health care is either “primitive, natural, and Maya” or “modern, technological, and Western” (2007, xv). They describe Maya health care and ladino health care as “two worlds” and suggest that “the chasm between the two systems is growing” (3, 4). This dichotomy made little sense to one of my homestay mothers, Bertha, who had an advanced degree in chemistry, ran a pharmacy with a dozen employees, and spent her evenings helping her teenage daughters with their studies in chemistry and medicine. Bertha, at forty-five, wore K’iche’ clothing to work each day; her mother, who lived next door, spoke to Bertha in K’iche’ (though Bertha responded in Spanish); and she was active in her K’iche’ community. When I became ill with a stomach bug while living with them, Bertha had her live-in housekeeper prepare a medicinal herbal tea for me to take with my antibiotics. Unlike the “chasm” between so-called indigenous and nonindigenous lifestyles described by anthropologists working elsewhere in Guatemala, I lived with several families for whom “bi-polar” (C. Smith 1997; Warren 2001) ethnic categories were clearly problematic. Life in Xela also undermined a common Latin American narrative that draws rigid boundaries between the city (ciudad) and the country (campo).

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This narrative depicts the city as the heart of modernity, while people from the countryside become imagined as both other and provincial—campo means both local or regional as opposed to national, and lacking in education, culture, or sophistication. It is no coincidence that in Spanish the word for citizen (ciudadano) connects directly to the word for city. It is a common trope throughout the Americas that to belong within the nation-state, one must be city-like: urban, modern, Western, cosmopolitan, and scholastically educated. Greg Grandin notes strict divisions drawn in Xela’s historical record between “Indians of the valley” (who speak K’iche’ and go barefoot) and “Indians of the city” (who speak Spanish and wear shoes) (2000b, 316). Yet despite these discursive valuations, I found divisions between the city and the countryside to be based on an ideologically fragile logic. Instead, many in Xela’s surrounding rural communities have endured centuries of conscripted labor that has resulted in regular migration from countryside villages to densely populated plantations. Beatriz Manz (2004) describes an intensified fracturing of land in the 1950s that drove highlanders, no longer able to cultivate enough food to feed their families, to seek seasonal employment in the banana and coffee fincas on Guatemala’s coast. There, they lived through—or, as was often the case, died from—conditions of severe famine while producing food that would be used to feed the rest of the world. During Guatemala’s civil war, which officially lasted between 1960 and 1996, roughly half of Guatemala’s rural population was displaced (C. Smith 1990, 10). Many fled to the expanding slums of the capital, as the military disappeared entire villages throughout the rural countryside. Others sought refuge by crossing into Mexico, many then heading for the United States. Between 1980 and 1990 the number of Guatemalan migrants to the United States was estimated to have increased fourfold (“Remittance” 2003). Though migration is notoriously difficult to document, according to a Pew Hispanic Center study carried out at the time of my fieldwork, more than 860,000 people living in the United States self-identified as Guatemalan (“Hispanics” 2009). U.S. migration has deeply influenced Guatemala’s rural communities, including those that surround Xela. During my first trip to the highlands in 1999, a Mam woman explained to me that she and her neighbors had begun to send their children to school “so they could learn Spanish.” She was not primarily concerned about their integration into Guatemalan life; rather, she wanted facilitate their travel to the United States. When I conducted the research for this book nearly a decade later, the dozens of rural villages

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I visited in the state of Quetzaltenango showed signs of a strong migratory connection between the United States and Guatemala: houses painted with U.S. flags, monuments to the World Trade towers in living rooms, and children wrapped in red-white-and-blue blankets. It was more common for me to encounter people who spoke English in Quetzaltenango’s indigenous countryside than in Xela’s city center, despite Xela’s numerous universities. I frequently met people in remote hillside villages who had lived in New York or San Francisco, cities I have also called home. Residents of the region’s rural communities followed changes in U.S. politics and economics closely, since the survival of their family members was directly tied to these changes. So many Guatemalans lived in the United States at the time of my fieldwork that Guatemalan cell phone companies had standardized their per-minute rates so that calls to the United States were the same rate as calls to one’s neighbor. Far from being primitive and provincial, the countryside was closely connected to both international markets and the desires and futures therein produced (see also Fischer and Benson 2006). This constant mobility across regional, national, and international landscapes unsettled clear-cut urban/rural—as well as Guatemalan/United States—dichotomies. It also destabilized attempts at socioeconomic classification. To give one clear example of this, during a summer of preliminary fieldwork that I spent in Guatemala City, I had a chance to edit several papers on obesity that a group of scientists was preparing for journal submission. One of my first comments pertained to the identification of the urban private school students they had studied as “middle class.” “This must be a mistake,” I wrote on a draft of one of the papers. “You’re speaking of upper-class, not middle-class, Guatemalans.” In writing this, I had been comparing the manicured gardens and organized classrooms of the Guatemala City private schools, where the scientists conducted their research, to Guatemala’s overflowing rural public schools, which regularly lacked classroom walls, let alone desks, educational materials, and teachers. The upper-class status of the schools where the scientists carried out their research seemed unquestionable. The scientists’ response was that the usage of “middle class” would hold. They were writing for an international audience and were comparing the schools not to others in Guatemala but to schools in the United States and Europe. Although we were both envisioning the same population of Guatemalan City students, the referent—and the corresponding identities attached to this referent—had shifted.

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The instability of class boundaries was common when referencing Guatemala as not only part of an imagined international community but within its borders as well. A campesina (female farmer) who might be rich when she wakes up on her family’s land in the countryside can become poor that afternoon when she travels to the city to sell her vegetables on the side of the street. I lived with some families in Xela who struggled to pay their rent each month, who spoke of wealthy people in the countryside who owned their own land. Meanwhile, the people in these communities frequently referred to wealthy people who lived in the city, where water ran from taps and their homes were wired for electricity. Back in the city center, urban dwellers would speak to me of their wealthy relatives who lived in the United States, where tap water did not have to be boiled, and electricity did not regularly fail. And on occasions when I met with these family members in the United States, stories about how extreme, and inescapable, they found American poverty to be were common (see also Carney 2015). The complex ambiguities of everyday life in Xela also affected how I began to approach Guatemala’s violence and histories of war. Hours after my first arrival in Todos Santos in 1999, I was invited to a community-run school to watch a documentary series, screened weekly for foreigners, that reported on how the town was affected by La Violencia—as the most violent period of the civil war is called. “Hundreds of Mam Indians from Todos Santos and nearby communities were executed, suspected of aiding the left or the right. Over 2000 men, women and children were killed in raids on Indian villages, reportedly by army and security forces,” the film relayed (Carrescia 1982). But whereas many people I met in Todos Santos had obvious “war stories,” as Jennifer Burrell (2013) has aptly called them, the afterlives of genocide in Xela were far quieter. When prompted, nearly everyone from older generations had a story of knowing someone directly affected by the war. Others told me about how the progressive San Carlos University became a space of fear and anger in the wake of students’ disappearances. In September 2008 hundreds of barefoot men from the countryside appeared in Xela’s central park, where they waited several days and nights to collect bank payments for their involvement in the civil patrol system (see Fischer 2014), reminding the city that war was close—in geographic distance, in memory. But people more typically responded to my interest in the period of civil war by redirecting my attention to the gangs, drug wars, robberies, rapes, migrations, corruption scandals, and persistent hungers they grappled with today. Their message was

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clear: La Violencia, with its marked temporal boundaries, had transformed into las violencias that were diff use, unbounded, and difficult to pinpoint or name. The lessons I learned about the dissolution of seemingly established boundaries—wealth, ethnicity, geography, violence, humanity—through broad, ethnographic engagements in Guatemala became important as I turned my focus toward obesity. In the clinics where I carried out my work, there was considerable effort to assert, and naturalize through biology, the classifications of normal weight, overweight, and obese. Though these categories were based on the seemingly indisputable facts of weight and height, I found that even these truths fell apart around me. Instead of finding unequivocated dichotomous categories (Western/non-Western, rich/poor, powerful/powerless, perpetrator/victim, fat/thin, well-fed/hungry), fieldwork in Xela was an experience of being among overlapping and semipermeable boundaries. To live and work in Xela was to learn to look past the dichotomies of either/or and to embrace the terrain of and . . . and . . . and of the everyday.

chapter outline This book describes the social lives of obesity in the Guatemalan highlands, analyzing how obesity is understood by various actors, the ways in which diagnosis proceeds, and how people respond to protocols of treatment. It is not my aim to explain what weight, fatness, and nourishment mean in Guatemala in general; I could not begin to know or explain this, as meaning is neither uniform nor stable. In my research I was instead drawn to particular stories and exemplary cases: the hospital patient with a leg amputated from a diabetes-related surgery who joked as he struggled to balance on a scale that he had finally lost the weight he had been aiming to lose; the women who would sigh with impatience at my questions about weight loss (couldn’t I see they had more important matters to tend to in their lives?); the office executive who told me in a hushed voice that he was worried about his weight but could not diet since this would feminize him; the patient who unambiguously rejected the doctor’s advice to eat fewer tortillas with the response, “si me quita las tortillas, me quita la vida” (if you take away tortillas, you take away my life). While these examples may not be representative of how most Guatemalans engaged with obesity, this does not mean they are insignificant. As I will show, significance takes many cultural forms.

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The first chapter outlines how transformations in the global food economy—including technological innovations surrounding food production and cooking and the expansion of transnational grocery store chains—connect to recent social and scientific concerns for obesity. While public health scientists tend to frame nutritional transition in linear, teleological terms, I illustrate that this oversimplifies the complexities of dietary change in Guatemala today. This chapter, which weaves through scientific seminars and recent historical memories of feast and famine, introduces a central theme of my research: that Guatemala’s epidemiological transformations also entail changes in ways of knowing and relating to bodies, food, and health. Chapter 2 examines the social life of the public health concept of nutrición. I focus on three sites in which educators teach basic nutrition principles: an elementary school, a rural health clinic, and an urban obesity clinic. I study moments in communicative practice where ideas shift as they move from one domain of knowledge to another—diabetic patients who might add extra sugar to their coffee since sugar is fortified with iron; mothers who keep their children from eating so-called healthy produce because of concern for microbes and pesticides; women who avoid vegetables because they fear the effects of vitamins. This chapter highlights an observation that I return to throughout the book: the simplicity promised by reductive approaches to nourishment often led to advice that was unintelligible or even destructive. Whereas educators tended to link failures of compliance with obesity-prevention guidelines to patient ignorance, my research showed that many pedagogical collisions were not just epistemic—that is, they did not just pertain to knowledge and information—but also tied to differences in politics and practice. Chapter 3 considers how women who had never viewed body weight as a matter of personal control were learning to diet. I illustrate how public health outreach projects directed at the “crisis” of obesity were teaching people to move and exercise not only for the good of their own health but for the health of their country. I analyze reactions to the preponderance of deeply gendered messages that frame dieting as a moral responsibility to illuminate the new forms of sociality produced by concern for dietary self-care. Finally, I suggest that the concept of possession—rather than individualization—more accurately describes the dietary transitions underway in Guatemala today. Chapter 4 focuses on how Guatemalan women were stigmatized on the basis of weight to consider how the classification of bodies as normal, overweight, and obese relates to the measurement practices of nineteenth-century

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scientific racism. In the nineteenth century scientists and public officials working in Latin America used the measurement of biological forms to delineate discrete racial types. I suggest that concern for obesity relates to this earlier practice of race making—that measurement of obesity becomes a way to instantiate social and gender hierarchy through biological form. Though discourses of weight management portrayed social and civic inclusion as “accessible to all” (a diet product slogan), my fieldwork showed that the ability to obtain lightness of weight—and race—remained rooted in historical, economic, and biological forces that lay beyond self-control. Chapter 5 draws from my observations in the nutrition clinic of Xela’s public hospital to examine the sociopolitical underpinnings of the widely expressed desire for a “balanced” diet. First, I show how instruction about metabolism routinely frames body weight through a homeostatic ideal as the sum of a calculation of foods eaten and energy expended. I then suggest that metabolic calculations parallel an accounting logic of balance in which it is possible to convert social activity into precise and fi xed variables, to be exchanged like currency. Just as the seemingly objective balance of money has always been underpinned by social activity, I show that so too does the dietary ideal of numerical equilibrium remain deceptively beyond reach. I conclude this chapter by exploring the forms of balance—and imbalance—that mattered in patients’ lives but went unrecognized through a public health focus on numerical equivalence. The final full-length chapter, chapter 6, considers the shortcomings in public health attempts to create measurement-focused guidelines for healthy eating. Many social theorists have explained growing concerns about obesity through the expanding medicalization of social life, but I suggest that this is an inadequate descriptor of the transitions underway in Guatemala, a country where medical resources are largely understaffed and underfunded—whose absence, not expansion, is at issue. Highlighting the proliferation of metricbased healthy eating formulas, I suggest that a range of processes often referred to as medicalization might be better understood as metrification. I end with examples of obesity treatment strategies that people seeking care found to be both valuable and sustainable. These strategies relied not on measured standards but on situated engagement with everyday negotiations of the complex and often contradictory terrain of healthy eating. I conclude the book by examining how committed Guatemalan nutritionists sought to redefine the standards of ideal weight through an emphasis on

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the importance of fatness. Whereas the BMI situated thinness in opposition to obesity, these nutritionists positioned fatness as obesity’s opposite. While they associated obesity with metabolic illness, an increased reliance on processed foods, and the stress of urbanization, they used fatness to refer to a hearty, healthy appetite and a life in which balance was fluid and imprecise. Fatness did not reference measures of weight, but the fullness experienced by finding deep pleasure, satisfaction, and richness in bodies and food. This focus on experiences and relations and not on quantities of calories or weight destabilized the dangerous practices of restrictive dieting; with fatness—a way of being that defied measurement—the commonly taught equation “input minus output = dietary balance” simply did not add up. Through this final examination of forms of health that cannot be quantified, the book makes a case for the value of anthropological approaches to knowledge making in the fields of nutrition, medicine, and global health.

chapter 1

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, 27

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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.

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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

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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).

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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 animalsource 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

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Bartering for chicken at the market La Democracia in Xela.

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

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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 semiurban communities transformed household purchasing patterns: as the costs of mass-produced canned and processed foods dropped, their sales and subsequent consumption rose. The women I lived with, who with rare exceptions did all the shopping for family meals, still purchased most of the food they used to feed their families from the crowded open-air and individual-stall markets scattered throughout the city. These dense, busy marketplaces overflowed with people and goods. Farmers from Xela’s surrounding towns sold produce picked the evening before; butchers sliced beef or pork from animal carcasses in covered stalls that smelled of blood and bone; untold numbers of venders sold spices, clothing, CDs, and plastic wares. Children peddled bushels of garlic. Men circled

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with goats offering to sell fresh milk. Everywhere people called out prices for salted cod, tamales, batteries, magazines, and other goods. On Fridays, when prices dropped, I regularly joined the women’s weekly shopping trips to Minerva—the largest and cheapest open-air market in the western highlands. The buses we rode would slow considerably as they drew closer to the dense crowd of shoppers, eventually dropping us off amid the crowded corridors of fruits and vegetables. We would quickly fill our bags with an assortment of cauliflower, carrots, green beans, squash, sesame seeds, red peppers, dried chili peppers, onions, garlic, limes, cucumbers, sweet potatoes, tomatoes, potatoes, plantains, and many goods with names that do not translate well into English. My presence might have raised the prices slightly, but the women were expert barterers and always encouraged me to accompany them. It helped that I could lend a hand in carrying the heavy costales (nylon bags, used for grocery shopping). Xela’s open-air markets were filled with activity and life, but in line with Asfaw’s (2008 or 2009) research, the visibility of another kind of market noticeably increased during even the relatively short sixteen-month period of my intensive fieldwork. Down a side alley from Minerva—not much farther than a long city block—was the entrance to Hiper Paiz, part of the recently built and well-policed Pradera Mall, with its Gap, Adidas, movie-theater multiplex, and food court, containing chains such as Dominos, Pizza Hut, and McDonald’s. Though “the Hiper”—as it was locally called—and the Minerva market were adjacent to each other in geographic space, the contrast between the markets was striking. The Hiper was nearly identical to its U.S.based Walmart counterparts (in 2010 it would officially take Walmart as its name), with wide aisles that were always cleanly mopped and shelves lined with products that never ran out. Florescent lights illuminated the building, which had no windows; commercial holidays were the only evident seasons, as the store offered Christmas stocking stuffers, chocolate Valentine’s Day hearts, Easter baskets, even stuffed turkeys for Thanksgiving (Día de Acción de Gracias: a celebration, like Halloween, that everyone said was new). Every product had a price tag—no bartering possible—and when items were scanned at checkout aisles, the plastic bags in which they were placed were offered at “no additional charge” (anathema to most sales in Guatemala). I learned while traveling to communities outside Xela that the store was a popular weekend vacation destination for indigenous families from across the rural highlands. “We rarely buy anything—maybe just something small,” one

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man told me, adding that his family liked to walk down its aisles of cleanly packaged products, sit on the mall’s indoor public benches, and take in the ambiance of consumer goods. Most people I spoke with did not shop there, though every once in a while a well-advertised sale might draw them to buy a specific product: a gigantic carton of eggs, a bulk container of sugar, a tub of vegetable oil. They pointed out that the store, surrounded by a large parking lot, was designed for people with cars and able to transport supplies bought in bulk—not for women who traveled by bus, limiting them to quantities a single person could carry. Though the families with whom I lived did not shop at the Hiper, they regularly stocked up on staple commodities at the more prevalent Dispensa Familiar, a chain of smaller and more crowded supermarkets also owned by Walmart, with several locations around the city—many conveniently located next to the city’s open-air markets. Women found the sugar, cereal, instant Maggi Soups, oil, rice, pasta, and even beans—which were sold in small handwrapped plastic bags—to be cheaper at the Dispensa than in the outdoor markets. While shopping for these staples, they might also purchase the weekly advertised specials: 3.3 liters of Super-Cola for Q8.60 ($1,00); a box of Kellogg’s Corn Flakes for Q12.25 ($1.25); “Pan Sandwich Europa Gigante”— twenty-five slices of white bread for Q11.25 ($1.20); a 900-milliliter bottle of Aceite Ideal (corn oil) for Q16.25 ($2.00); or the large 48-ounce tub of Wesson Corn Oil for Q45.35 ($5.50). Several of the grocery stores in the city were newly constructed, and women spoke of their patronage of supermarkets as a recent phenomenon. “I don’t remember any of these when I was a child. Well, there was one, but we never went there. Even today, my mother refuses to shop at stores like this.” Lizbet, a woman in her forties with whom I lived, told me this as we walked through the aisles of a Dispensa, filling a basket with packaged foods that could also not be found in Guatemala’s highlands when she was a child. We had shopped for produce in an outdoor market the day before, and I knew that the processed foods in our basket would be blended with vegetables at our meals. But I also knew that Lizbet counted on oils, pasta, rice, and bread to fill our stomachs in ways that vegetables alone would not. Indeed, during lunch a couple of days later she served a salad she had made following a recipe on the back of a large package of Tortrix (a Guatemalan brand of corn chips) she had purchased at the Dispensa: shredded carrots with a dressing of lemon juice, salt, and chilies, tossed together with crumbled chips.

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While “industry analysis” suggests that just 2.3 million of Guatemala’s 11.8 million citizens can afford imported foods (cf. Hawkes and Thow 2008, 353), in my experience imported foods or foods made from partially imported ingredients were everywhere and consumed, albeit to varying degrees, by everyone. At health stations serving communities so poor that governmentfunded aid workers traveled door-to-door to hand out powdered vitamin, protein, and caloric supplements, it was still common to see children sucking on lollipops, eating chips, and drinking soda. “We have been people of corn,” one nutritionist told me, stressing its importance in all aspects of Guatemalan life. She then voiced the caution that because of the preservative procedures used in the international trade of corn, people in her community were well on their way to becoming “people of the corn-syrup.”

a universal transition? Global health epidemiologists have linked the transformations in dietary staples described here to an increasing prevalence of metabolic illness in Latin America. Enrique Jacoby, a nutrition specialist for the Pan American Health Organization (PAHO), specifically pinpoints the increased consumption of sweeteners and fats as important to the rise of illnesses constituting what he calls Latin America’s “obesity epidemic”: Both have been heralded as major technological accomplishments by food technologists and the agribusiness industry. Cheaper than common sugar (sucrose), high-fructose corn syrup is now the basic sweetener in soda beverages. This makes big profits possible for the soft drink industry, but it is also responsible for triggering high levels of fat (triglycerides) in the bloodstream of individuals as well as possibly triggering insulin resistance and diabetes. Trans fatty acids, on the other hand, were welcomed by the food industry since it is easier to transport hardened oils than liquids and because trans fats extend the shelf life of many products. That’s great for the food industry, but there is a downside: Trans fatty acids also clog arteries and accelerate cardiovascular disease. (2004, 280)

Although dietary changes contributing to rising rates of chronic illness in Guatemala were already well underway in the 1990s—for example, reported deaths from cardiovascular disease in Guatemala nearly doubled from 7 percent to 13 percent of deaths between 1986 and 1999 (Mendoza Montano et al. 2008, 2)—public and scientific attention to dietary-related chronic illnesses in Guatemala increased rapidly at the start of the twenty-first century.

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In 2009 Manuel Ramírez-Zea, an obesity specialist for INCAP told me, “Ten, even five, years ago I was a maverick for being interested in obesity, but people here have quickly begun to accept it as an important field of study. Today—in the capital at least—studies of obesity are no longer met with the degree of skepticism that they were met with until recently.” In 2006 when I first met with Ramírez-Zea, he had just concluded a study of 1,397 people in a poor suburb of Guatemala City that indicated that the prevalence of overweight and obesity was approximately 54 percent (Mendoza Montano et al. 2008, 2). He said people didn’t believe his results at the time, and his work encountered resistance among his colleagues. In a conversation three years later he told me, “Today it is common to read about obesity and dieting in Guatemalan newspapers. A few years ago people still assumed that obesity and diseases like metabolic syndrome were ‘Western diseases’ that didn’t apply here. But these changes we are seeing have happened much faster than anyone anticipated.” Several hours from the capital, where rugged highland mountains give way to the valley in which Xela is located, I heard similar stories of communities and families being caught unawares by the sudden, unanticipated increase in metabolic affliction. The global health community has a term for the linkage between rapid demographic, dietary, and metabolic changes outlined here, calling this the “nutrition transition.” Public health scholars Benjamin Caballero and Barry Popkin note in their seminal book on the topic that the nutrition transition reflects a global shift away from “traditional” plant-based diets to “Western pattern diets” high in processed and animal-source foods. In their framing of it, the concept also “goes beyond diet, recognizing that most of the health effects of diets in human populations are strongly affected by lifestyle, particularly physical activity” (2002, 1). Also key to the nutrition transition is an epidemiological shift away from early-life infectious-disease mortality and toward increased morbidity from chronic diseases such as cancer, diabetes, hypertension, metabolic syndrome, atherosclerosis, and heart disease. When describing the nutrition transition, global health workers, in line with what Jennifer Johnson-Hanks calls the “principle of unilinear progress” (2008, 302), predominantly characterize transition as a singular, inevitable event that happens in a similar way across different global regions. The global health community frames the nutrition transition as broad in scope, linking it to agricultural yield, pasteurization, public hygiene, and biomedical  innovations such as smallpox vaccines (Barrett et al. 1998). They

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also routinely view this transition as globally universal, so countries as diverse as China, India, and Guatemala—not to mention the diverse regions within these countries—will undergo the same process of nutritional change. Even when addressing varied aspects of dietary change, they rarely speak of transitions in the plural. They instead describe these places as following a predictable pattern—one that “modern” or “Western” nations have already passed through. Early in my fieldwork, while trying to understand the concept of the nutrition transition from the perspective of public health workers in Guatemala, I attended a conference aimed at health professionals and university nutrition students that focused on the theme of nutrition. One of the first presentations of the day was a PowerPoint lecture titled “Analysis of the Nutrition Transition in Central America,” given (in English) by a prominent global health expert affiliated with INCAP. The speaker described the nutrition transition as occurring in a set of three linear stages. He called the first stage “Pre-transition,” telling the audience that this stage had existed in Guatemala from time immemorial until the past few years and that it was characterized by a predominance of nutrient deficiencies and malnutrition. Bolivia, Haiti, Honduras, and Nicaragua were countries in this stage. The second stage, “Transition,” corresponded to a high prevalence of both malnutrition and obesity and was seen in Guatemala, Paraguay, El Salvador, Panama, Mexico, Brazil, Colombia, Ecuador, and Peru. He identified the third and final stage as “Post-transition,” marked by the populationwide prevalence of obesity and hyperlipidemias (disorders of high cholesterol), and seen in Costa Rica, Chile, Cuba, Uruguay, and Argentina. He indicated that this third stage was where Guatemala was headed. The speaker’s characterization of the nutrition transition echoed a common tendency within the global health community to treat development and progress as following a teleological and sequential global pattern when it came to nutritional change. But when considering the specifics of nutrition science carried out in Guatemala, none of the speaker’s claims was as straightforward as they seemed. The consolidation of thousands of years of history into a single dietary stage could be achieved only by overlooking the considerable agricultural flux revealed in Guatemala’s archaeological record. His statement that Guatemalans were historically malnourished was particularly contentious. Countering this claim, several scientists have linked acute malnutrition in Guatemala to the recent effects of colonial exploitation and not to histori-

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cal practice. In this vein many people told me with pride that their ancestors were responsible for the cultivation of corn, numerous kinds of beans, squash, tomatoes, and cacao, lamenting that today these foods were more expensive than imported chips and candy. Debates also surrounded the scientific details of progressive transition underlying the stages presented in this lecture. According to the speaker’s vision of the nutrition transition, obesity would eventually replace undernutrition; indeed, much of the global health literature on the nutrition transition at the time of the conference framed obesity and undernutrition as “incongruous problems” (cf. Kennedy, Nantel, and Shetty 2006). I commonly heard health workers describe countries as being in a particular stage of transition, as did the speaker here, as though this was a liminal place they were simply passing through. Emerging research on metabolic health in Guatemala, however, suggests such a notion of transition may be founded on an erroneous model of linear temporality. The research, which I return to later in this chapter, draws attention to the constitutive entanglement of undernutrition with obesity. As impoverished histories become infolded into unstable futures, the narrative of progress that underpins much of the discussion of nutritional transition loses force. After the presentation I spoke with a Guatemalan scientist in the audience whose research focused on intergenerational effects of undernutrition. In our conversation he addressed the uncertainty that surrounded the duration and intensity of the supposed stages of nutritional transition. He then reframed the very idea of transition itself, saying, “transition may not be a point along a path but something of a permanent state.” I came to see that the division of nutritional experience into stages operates as a means by which the flow of life’s movements becomes anatomized into discrete, measurable parts. Not unlike the stages of theater, these stages create a space for the performance of expertise, since someone (here a figure in a United Nations–funded institution) assumes the authority of marking the boundary of a beginning and an end. Uncertainty and debate exist among each of his classifications, yet the speaker did not mention controversy, instead presenting the stages as accepted facts. Guatemalan newspapers, which often report on public health conferences such as the one I had attended, are quick to reproduce this kind of progress narrative in their articles. They commonly describe Guatemalan illness profiles as approaching Western illness profiles, and Guatemalan eating habits

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as trailing Western habits. A newspaper article on obesity printed during my fieldwork quoted a national policy maker as saying, “the Guatemalan has adopted the lifestyle of the U.S. American, preferring fast food and enjoying distractions like video games” (cited in Ruiz 2009b, 19). A nutrition teacher in Xela echoed this sentiment, saying to me, “We are turning into U.S. Americans [estadounidenses]. In part, this is because so many people travel to the United States for work. There we learn your customs and become used to your food, and when we return we bring these preferences and habits with us. Of course, you have adjusted to these foods. They don’t make you sick. But we haven’t yet adapted.” Though the idea that Guatemalan eating practices followed behind those in “the West” was pervasive, it was also an idea undermined by the coeval character of all contemporary beings. As Johannes Fabian convincingly argues, the relegation of colonial others to a past that Westerners have already passed through is a technique of cultural superiority that serves to justify ongoing (post)colonial dominance (1983, 4, 69). As I elaborate in forthcoming chapters, those described as suffering from diseases of modernity were often presented as not quite modern enough to truly master the refinement and restraint required by “modern” civilization. They are situated as modern in the way that Homi Bhabha’s other is modern: a resemblance that is also a menace, an attempt at mimicry that is always on the precarious verge of failure since it operates as the lesser, inauthentic form of imitation (1987; see also Escobar 2012). In the face of narratives in which Guatemalans are situated as behind or as catching up with U.S. Americans and other Westerners on the timeline of transition and progress, it becomes crucial to remember that these two countries and the places within them have long been deeply interdependent. I now turn to ethnographic accounts of how obesity was experienced in the everyday to illustrate that diet and dietary illnesses were neither linear nor predictable.

yellow holes and the double burden At the northwest edge of Xela’s urban sprawl, just up the hill from the Burger King and a short distance from the Pradera Mall with its gigantic Walmart, sits the third largest hospital in Guatemala. In 2007, in response to what its director referred to as “skyrocketing” diagnoses of diabetes, renal failure, high cholesterol, gastritis, and high triglycerides, the hospital began to run a modest outpatient obesity clinic, open two mornings a week.

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I spent these two mornings at the clinic during my fieldwork, observing consultations and talking with people in the waiting room, many of whom arrived early, from long distances away, and all of whom were taking time away from their daily routine because they were desperate for help. Nearly everyone was adamant that dietary-related chronic illnesses in the region were a recent appearance. Most patients were women; men, who were more likely to be employed in wage labor, could not take time away from work without the risk that they would lose their jobs. It was also the case that the realm of eating was, as many told me, “women’s realm,” so the responsibility for eating well fell on women’s shoulders (women typically came to the clinic with their daughters; men came with their wives). The women waiting in the clinic’s long lines had learned how to cook and nourish their families from their mothers, aunts, and grandmothers and found these illnesses particularly destabilizing because they had no historical referent. I heard from several patients that they could not turn to their elders to make sense of what was happening to their bodies, since these were modern illnesses—illnesses that left them waiting amid crowds of strangers seeking treatment from experts who were stranger still. Yet while people commonly spoke of a modernity that diverged sharply from the past, as I learned more about lived experiences of obesity it became obvious that history was interwoven into so-called modern metabolic illnesses in complex ways. In everyday life there was not a past separate from the present but a persistent entwining of spaces and temporalities. This section tacks between stories detailing chronic illness in a community at the edge of Xela where “progress” has been itinerant and illusive and the nutritional research of a group of Guatemalan scientists. This juxtaposition—that is, my own narrative blending of these two different sites in which obesity materializes as a matter of concern—aims to illuminate how dietary transitions did not proceed in linear fashion but were fractured while entangled, asynchronous while coeval. The name Cantel, a municipality roughly ten kilometers southeast of Xela, comes from the K’iche’ Q’an tel—words that together mean yellow holes. Some people say the town acquired this name because beehives used to hang from the dark cliffs that surrounded the town, their honeycombs glinting yellow in the sun. But even those who know about the bees, which have long since disappeared, point to an ancient malediction cast over the town by elders as the community began to castellanizarse, or “adopt Spanish customs.” The

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essence of the curse was “These changes will kill you. Many will die.” And now townsfolk ask themselves, as one man asked me, “Can it be coincidence that shortly after the clothing factory was built one hundred years ago, the heart attacks began?” The man continued to tie the narrative threads together: “You see, today we know that heart attacks come from blockages of fat in the arteries to the heart—in other words, a problem with yellow holes.” I might have thought the connection between yellow holes and blockages of fat too wild, except in one of the clinical rooms in Xela’s hospital hung a poster from Merck that advertised a drug aimed to treat atherosclerosis and coronary illness. It showed the cross section of four blood vessels in which yellow fat had begun to fill the arterial walls, each artery more congested than the next. “Powerfully effective for improving survival” (eficacia poderosa para mejorar la supervivencia), read the poster’s text. As I learned that illustrations like this were a key means for teaching people about heart attacks, I began to understand the association between the ancient admonishment, the name Q’an tel (yellow holes), and the prevalence of heart attacks in their community. The arrival of metabolic illnesses to Cantel coincided with the arrival of factory labor. As one man explained, “it was Quetzaltenango’s Samala River that brought us the heart attacks.” The river has today carved a deep valley out of the region’s hillsides, checkered in various shades of green, yellow, and brown from family-owned plots of corn. The force of the river as it swept through the landscape made the town an ideal spot for a mill, which was built for Basque owners by K’iche’ laborers in 1884 and which, for the first half of the twentieth century, was the largest textile factory in Central America (Nash 1954; Smith and Adams 2011). The mill transformed the previously agrarian community into a manufacturing center, bringing wage labor to Cantel generations before the neighboring villages. At its prime several thousand people—roughly one quarter of the town—operated the weaving and spinning looms and ran the dyeing rooms and machine shops. Arturo, a widely respected K’iche’ man from the community—referred to by his friends as a mil cosas (jack of all trades) because he was a schoolteacher, ran a corner store out of his home, operated a “taxi service” with his dilapidated truck, and helped coordinate mail delivery—told me about the influence of the mill in his community: Because of the factory, we have had wage employment in our families for over a century. This has enormously impacted our diet. We have our own plots of land where we grow corn and beans, since these crops don’t require constant work. But

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if you see someone selling fruits or vegetables, you know that these have come from somewhere else; we do not grow fruits and vegetables here. We do not have time. Also, the thing you have to understand about our diet is that because we are hard workers, we like heavy, filling foods. But the other thing you have to understand is that not everyone works hard all the time. There’s also a lot of unemployment, so there’s a lot of variation. But there’s not as much variation in what we eat because meals are prepared for the home, not for an individual person. So everyone will consume a lot of fat because this is the way we like the food and the way that some of us need it. But not everyone will do the labor necessary to burn it off.

Arturo’s explanation does not assert a dialectic meeting between tradition and modernity. He instead integrates a range of different logics of nourishment so seamlessly that the terms tradition and modernity themselves begin to unravel. He employs a calculable sense of food as fuel burned by the individual body at the same time that eating practices link to entrenched agricultural production and culturally shaped modes of preparation and digestion (cooking for the family, not the individual; eating together and not alone). Much like sugar candies that have been sold at festivals for millennia or the bread rolls present since before the first Catholic church was founded in the region in 1524, the textile factory was not a foreign institution but one the community was built around. “Modernity” was likewise not simply imposed, unidirectionally, from afar but experienced in the condition of living. Moreover, this experience of modernity was deeply uneven: some experienced it as the hard work of industrious labor, others as the carotid arteries of unemployment. Arturo, like many others I met from Cantel, was worried about the prevalence of heart attacks and diabetes. “We eat a disproportionate amount of fat,” said one woman who explained to me that a broth made from beef leg, brimming with fat, was a common addition to lunchtime. But when I asked about chronic illnesses at the town’s Centro de Salud (Health Center), the nurses spoke instead of undernutrition. The nurses arrived to the town each day from Xela, where they lived and where they had studied for their degrees. Having observed some of the continuing-education classes they were required to attend, I knew their classes followed the unilinear progress narrative I described earlier, in which obesity was a problem of urban and affluent areas and hunger—a separate thing—was a problem of rural or semirural areas such as Cantel. When I brought up the topic of cardiovascular disease in the region, the nurses shook their heads and showed me charts printed from old

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handbooks listing national health data that indicated that 80 percent of the children in Xela’s surrounding communities suffered from one of two types of malnutrition, subdivided as “grade 1” or “grade 2.” Pointing to health information from PAHO that provided diagnostic criteria for the childhood illness Kwashiorkor, one of the nurses told me that numerous children came to the health center with weakened immune systems, their hair falling out, and their skin infected. “Obesity is problem of the city. In the city we don’t need more food but need to diet,” she told me, continuing the explanation: “Obesity is not the problem here; here people are hungry.” Global health narratives about the nutrition transition, such as the one I outlined earlier in this chapter, commonly instantiate binaries between the city and its peripheries, hunger and obesity, and the need for food and the need to diet. Emergent scientific research on nutritional illnesses in Guatemala, however, tells a different story. Several Guatemalan nutrition scientists and epidemiologists I met during my fieldwork suggested that seemingly opposed illness—cardiovascular disease and heart attacks one end, and severe nutrient deficiencies at the other—are deeply linked. Their research suggests that metabolic illness patterns are far from linear and contiguous, but show complex, almost fractal-like, overlaps: obesity persists amid widespread starvation, overweight mothers raise underweight children, and many people experience temporal fluctuations, where those malnourished at birth may become overweight later in life (Uauy and Solomons 2006). The basic premise of malnutrition’s “double burden” is that in environments with abundant processed foods, people will consume high quantities of macronutrients (lipids, proteins, and carbohydrates) while still consuming insufficient amounts of micronutrients (vitamins and minerals), resulting in the simultaneous prevalence of over- and undernutrition in the same populations, the same households, and even within the same body (Kennedy, Nantel, and Shetty 2006, v). While much public health discourse frames obesity as a problem of overnutrition (too much fat, for example) this research draws attention to the consequences of a persistent scarcity of micronutrients. According to the double-burden theory, bodies may ingest and absorb sufficient calories for their energetic needs, but these calories lack the amount or variation in nutrients required for adequate bodily functioning. Negative health outcomes are less a consequence of excess, than they are a result of ongoing nutritional deficiencies. Much of the research on the double burden of malnutrition focuses on connections between gestational undernutrition and the subsequent propen-

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sity toward chronic diseases later in life. This research draws on a hypothesis that global health workers call the “developmental origins of health and disease,” which suggests that the prenatal environment affects the metabolic development of offspring (through pathways admittedly not yet understood). As a result, women who are malnourished during pregnancy may have children “predisposed” to both obesity and obesity-related illnesses (Corvalan et al. 2007). In this line of thinking, bodies are entangled in the inadequacies of the past while also confronting the false promise of modernity. At one PAHO conference I attended, a speaker presented an unpublished study that showed that between 1995 and 2002, the prevalence of overweight and obesity among nonpregnant mothers in Guatemala had grown to approximately 40 percent (of the population of nonpregnant mothers), despite widespread reports of famine. A follow-up study illustrated a pattern that surprised some scientists: one in five Guatemalan families was found to “include an overweight or obese mother with a malnourished child” (see also Schroeder, Martorell, and Flores 1999). The nutrition community has historically taken the “household” as a meaningful unit for measuring dietary health, assuming that patterns will emerge at the level of the household: some households showing overweight, others malnutrition. Yet scientists are finding that the units of measurement they are used to relying on in their assessments of nutritional health are breaking down. Overweight, rather than being opposed to underweight, is proving to be a related form of malnutrition. Much global health concern for the “developmental origins of health and disease” still operates though teleological frameworks in which a cause at one point in time leads to a determinate effect in another. The global health community commonly evokes spatial metaphors in its descriptions of obesity as a form of disease moving from the modern West to the developing rest. For example, Dr. Catherine Le Galès-Camus of the World Health Organization describes contemporary metabolic illness patterns as follows: “We are currently seeing many individuals, families, and communities around the world making the rapid transition from undernutrition to poor nutrition: the changing nature of globalized food supply, easier access to processed foods high in fats and sugars, coupled with more sedentary lifestyles makes for a lethal mix which leads quickly to overnutrition” (2006, 6). But this core-to-periphery model of obesity is challenged by many Guatemalan communities where “progress” has been uneven, discontinuous, and difficult to map onto cause-effect patterns (see also Escobar 2012; N. Smith

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1984). Communities such as Cantel, with their extended industrial history that has not led to obvious urbanization, tend to break the unitary model. That which may seem distant in time and space was enfolded into the eating practices, the bodies, and the livelihoods of Cantel’s residents. At the time of my fieldwork, the textile factory that had carried a promise of affluence was closed—rumors suggested that this time it was permanent—and heart attacks were on the minds of many. Guatemalan scientists studying the intergenerational effects of obesity were finding that behaviors and bodies intertwine in the formation of one’s biology—which simultaneously loops back to effect behaviors and bodies. Countering imagined divisions between the global and the local, the public and the intimate, and the past and the modern, in studies of nutritional health these binaries collapsed on themselves, coming to appear nonsensical in their evocations. These binaries similarly collapsed in stories about Cantel’s yellow holes. Arturo asked me rhetorically, “Did our ancestors know about cardiovascular disease? No, I don’t think so. But they could also see things we today cannot see. They told us mountains are spirits. Is it possible the yellow holes once in the cliffs now fill our bodies, causing us pain because we did not listen? Yes, I think it is possible.” It was Arturo’s sense that flesh was shared between beings—between the spirits of mountains and the bodies of the people in his community. The logic was different than that followed by epidemiologists—who did not speak to me of curses—but the resulting belief was similar, as both groups held that the practices of cooking, eating, and working would become embedded in the tissues and cells of bodies that are at once local and global, whose shape would carry in it the past while also hailing the future.

changing diets and cultural transformations “We are losing our culture,” Ernesto, who had spent much of his thirties and forties in Spain before recently returning to Xela, told me while describing the introduction of fast food chains in the city. “Lunch was Guatemala’s most important meal of the day,” he said. “But now people can’t get home to eat during the afternoon, and so they instead eat close to work. Now, we grab ‘fast food’ ”—a phrase he said in English. “We are forgetting how to enjoy a leisurely meal.” In line with much of the global health discourse described earlier, he connected Xela’s changing food environment to urbanization.

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The fast food court of the Pradera Mall, Xela.

In the past fifteen years so much industry has entered the economic center of Quetzaltenango. I’m not saying that everything about the development is bad, but I am pointing to the unquestionable changes it has brought with it. Quetzaltenango used to be known for its apples, but it is now impossible to find an apple farmer here. Instead, we have imported fruit, imported apples. With all of this urban development has come all of this, well, we call it comida chatarra [junk food]. In our pueblito, we now have three McDonald’s, four Pizza Huts, five Pollo Camperos. And what’s more, we have what we call pollos rostezados de calle [fried chicken from the street], the taco stands, and all of these prepared foods and processed products. And then there are the beverages, which young people love. It’s incredible how many more canned and bottled drinks there are today. It’s for all of this that we’re abandoning our traditional meals—for all of this basura [trash].

As he outlined the growing social alienation emerging from the industrialization of Xela’s dietary practices and epitomized by the rapid “unnatural” consumption of junk food that was leading to chronic illness, it occurred to me that aspects of his message did not resonate with practices of eating this food in which I had participated. Earlier that month I had joined Pilar, a woman with whom I lived, on a Sunday morning ritual she shared with her

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mother, Beatriz. Pilar was forty-seven years old, had three children attending a local university (they still lived at home), and worked full-time in an office building, while also managing her home. Every Sunday she and her mother drove across town in the family’s sedan to the cemetery, where they bought as many flowers as they could carry. They would walk, arms full, to a three-year-old tomb engraved with the message, “For me you have not left; you will always live in my heart, with love from your wife” (Para mi no te has ido, siempre vivirás en mi corazón, con amor de tu esposa), where they would spend the next hour together cleaning and adorning the site and talking to each other and to the spirit of Pilar’s father—who they said also still cared for them. Afterward Pilar and Beatriz would go shopping, chasing down a woman who sold farm-raised chickens and filling the trunk of their car with groceries from an outdoor market. But first, the two traje-clad women participated in a weekly breakfast ritual. They would stop at Ricca Burger—known as the “local McDonald’s”—where they would each order the breakfast special: two eggs, two sausages, refried beans, and a plate of tortillas. It was a special occasion, a weekly indulgence that these women who had spent lifetimes preparing food for others now allowed themselves. The meals, which the waiter brought to our table in less than five minutes, were clearly made from prepackaged, highly processed foods. Yet these women’s experience at breakfast was anything but one of alienation. Instead, under the fluorescent lights of the restaurant, they deeply enjoyed each other’s company, attending to the well-being of the heart in a fashion not typically recognized by epidemiological narratives of cardiovascular health. In speaking with people about culinary transitions underway in Xela, they, like Ernesto, regularly lamented that children and teenagers were increasingly preferring processed foods and, with this, abandoning their culture. Standing in contrast to this common narrative was the comment of an elderly Guatemalan woman I had met during earlier fieldwork in Todos Santos, who castigated those worried about the loss of culture for having a myopic vision of cultural change. Referring explicitly to tourists, she told me (through a MamSpanish translator): “You spend a fixed amount of time with us, and think you understand change in our communities. You start to see the complications in our lives and you mistakenly conclude that our lives were once simple and are just now becoming complicated—you do not realize they have always been this way. You mistake changes in your own amount of knowledge about our community for changes we are undergoing ourselves.” I pointed out that while

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most adults in her community still wore indigenous clothing, many of the children in the town wore sweatshirts and sweatpants. To this she responded, “Don’t you know that children have always abandoned the ways of their elders? Then they grow up, put the formal clothing on, and start acting just like their parents, complaining that their own children are abandoning tradition. Change? Only the details change.” I often recalled this woman’s trenchant critique of nostalgic narratives of change over the course of my fieldwork—especially when people lamented the changing diets of their children. Her comments were atypical; most people I talked with voiced concern, especially when it came to culinary traditions, for “the loss of our culture” (la perdida de nuestra cultura). Yet whereas people around me worried about the replacement of a wholesome past with a mechanical future, this woman challenged the urgency of now with generational perspective. Historical insight also informed the disapproval I once received from an elderly friend who chided me for reading the daily newspaper: “They have been running those same sensationalist headlines for decades. They just change a few facts and the date of stories they’ve had on file for years—then reprint it and call it news.” Indeed, for all the talk of the recent encroachment of processed foods on the diets of people in Xela, Sidney Mintz (1985) reminds us that sugar was at the heart of the project of colonialism and has been prominent in Central America for centuries (see also Oglesby 2013). And whereas public health nutrition programs might in many ways be new in form and content, they bear similarity to the public hygiene programs that swept through Latin America in the early twentieth century, insofar as they create a class of knowledgeable experts who must teach an ignorant populace how to eat (Abercrombie 2003, 177; Briggs and Mantini-Briggs 2003). Though I heard from many that the onslaught of junk food was replacing the structure of traditional meals, I came across several advertisements for a form of “fast food” in a newspaper collection from 1899—the oldest collection stored in Xela’s periodical archive. “We will serve you exquisite tamales,” advertised the store at the national brewery. Three days a week, Quetzaltecos could stop at the window of the factory and pick up this prepared meal—a meal now discouraged in the hospital obesity clinic for being, in the words of one nutritionist, “too full of fat and unhealthy for the body.” While nutrient-centered discussions of dietary health were—according to the nutritionists and patients with whom I spoke—a recent introduction to

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daily life in Xela, filling this newspaper were ads for recuperative nutritivo (nutritional) tonics. Imported from Europe, these supplements targeted “anemia, stomach pains, scurvy, fevers of all kinds, skin and chest ailments,” as well as numerous problems such as bankruptcy or jealousy that may not be classified as illnesses today. Frequent healing! Permanent relief! (¡Curación frecuente! ¡Alivio siempre!) announced the headlines. Among the cod oils and plant juices advertised in the newspaper from November 5, 1899, I saw an ad for a nutritive drink made of quinoa and cacao. I noticed this because, over one hundred years later, the print date of this newspaper, November 5, fell on the same day that newspapers announced the results of the U.S. presidential election. I followed this in good company with the Guatemalans around me and was surprised to see that the most e-mailed article in the New York Times that day was about the health properties of quinoa (Shulman 2008). The message of these nineteenth-century ads about nutritional tonics may have differed in style and tone from the messages accompanying the proliferation of ads for nutritional health circulating in Xela today. But they were nonetheless, as my elderly friend had said, a demonstration that what seems new(s) is often an iteration of something long present. In emphasizing the historical continuities in Xela’s dietary practices, I do not aim to diminish the impact of contemporary changes on the lives and bodies of people today, nor do I wish to challenge the assertions of those who said the 1990s was a decade of profound destabilization. In the wake of the explicit governmental terror of the scorched-earth campaign of the 1980s, this decade clearly ushered in a different form of violence, as trade agreements led to the proliferation of processed foods and to cities filled with the bodies of people no longer able to make a living from the produce they cultivated. These products, though branded with familiar names, emanated from corporations headquartered in countries that most people around me could not legally enter. Many also contained the energy-dense ingredient corn syrup, produced from corn grown on U.S. soils, thousands of kilometers away. It is certainly no coincidence that the 1990s—on the heels of a neoliberal era that David Harvey has referred to as a “revolutionary turning point in the world’s social and economic history”—was a decade in which anthropologists began to conceive of the world as global (2005, 1; cf. Mascia-Lees, Sharpe, and Himpele, 2007). Yet as many anthropologists have since noted, this now-familiar vision of a global world is an abstraction—what Henrietta Moore (2004) calls a “concept-metaphor” that, along with its binary other, the “local” can obfuscate the

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ways in which people relate to and experience their surroundings. Take, for example, the tortillas made from imported Maseca corn flour found throughout Guatemalan kitchens today. For many it remained critical that Maseca corn is not grown in the nearby field; they abhorred both its taste and its politics. But for others, Maseca tortillas, which are patted out by hand with great care and considerable talent, were not laden with global significance but simply something to eat. The notion of a postmodern break imagined to accompany the current global era occludes the deep continuities in forms of exploitation that have been in operation in Guatemala for centuries. Contrary to the common trope that modern, global life presents a radical rupture from the traditional, local past, there is reason to suspect, as Bruno Latour has argued, “we have never been modern” (1993). I highlight Latour’s popular turn of phrase not because of the relevance of his argument about interconnectedness of the natural and the social (an argument made by feminist anthropologists decades earlier) but because of the often-overlooked implications of this argument on the nature of temporality itself. Rather than frame transition through a narrative of evolution and progress—“a headlong flight into post-post-postmodernists”—Latour suggests that time does not pass irreversibly, but that past, present, and future have always been wound together (1993, 47; see also Rofel 1999). Emily Martin’s description of scientific representations of the human body similarly helps to illuminate this notion of nonprogressive time. In contrast to a mechanistic cause-and-effect view of a controlling head dominating peripheral limbs in the materials she analyzes, she describes one of her informant’s understandings of the body “as a complexly interacting system embedded in other complex systems, all in constant change. No one part is ever in charge. Change is nonlinear in the sense that small initial perturbations can lead to massive end results” (1998, 34). It is this nonlinear model of transformation that I saw at work around me and that I, in turn, employ in my own analysis of nutritional transitions in Guatemala. Readers will no doubt find that my examination of obesity in forthcoming chapters is shaped by an interest in how life becomes organized by the principles of abstraction and calculative regimes of governance that have long been connected to modernization (Simmel 2004; Weber 2001). But while many social scientists understand modernity to be a characteristic of the city that spreads outward into the countryside, my interest in what Anthony Giddens has called “forces that are distant and unfamiliar” takes a different turn (1990,

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19). Rather than understand modernity as a looming urban future (contrasted with a traditional, rural past), the modernity of relevance in my fieldwork was one woven into various places and various times, moving in and out of relevance in different, situated ways. I draw from this to suggest that if metabolic illnesses and their consequences—amputated limbs, shortness of breath, numbness in feet and hands, heartbeat arrhythmias, and persistent fear about what is healthy to eat—are to be understood as diseases of modernity, then modernity must be understood as a mode of being and a way of relating to the self and others and not a point existing in historical time or geographic space. Modernity, in other words, is not something to be achieved but rather a style of practice that is contested, negotiated, and fraught with ambiguity. A central theme that I illustrate in the chapters that follow is that nutritional transitions do not simply encompass changes in what people eat or transformations in demography or epidemiology but also arise out of new languages and new measurement techniques through which people come to know the substances of their food and their bodies. But, countering an image of a singular affliction that spreads from a western center outward, I will show that there is no stable, determinate directionality to these transformations. The many different modernities implicated in the emergence of obesity in Guatemala I describe in this book do not follow linear pathways, nor do they have the grip and consequences they may seem, at first glance, to have.

chapter 2

Nutritional Black-Boxing

“I was so embarrassed when they referred me to a nutritionist. I thought they had it wrong. I thought nutrition was only for people who were starving, and, well, look at me.” Berta, a patient I had met during my work at the nutrition clinic, was sharing her confusion about nutrición with me over a cup of coffee during a visit to her home. Nutrición, as she had understood it, was for those who were starving. She lived in a rundown neighborhood on the outskirts of the city, and we sat at a dining room table made of cobbled-together scrap wood and covered with a sheet of green plastic. She was not wealthy, but the previous month Berta had agreed to buy the expensive low-fat milk and canola oil recommended by the nutritionists; her husband was currently employed, and it was within their means. Tending to a large stew simmering on her stove, Berta continued, “I thought, ‘I am plump. How could I need a nutritionist?’ ” By the time I was sitting at Berta’s table, several months into fieldwork, I had heard many stories like this, recounting exposure to and the ensuing confusion about the meaning of nutrición. Following these conversations, my own understandings had also shifted. When I arrived in Guatemala to examine what scientists call the “nutrition transition” (Popkin 2001), I had conceptualized nutrition in terms akin to those found in the Oxford English Dictionary: “The action or process of supplying, or of receiving, nourishment or food.” Yet countless people who I knew to be excellent cooks—including mothers who had raised several children—told me their knowledge of nutrition was murky at best. “I have heard a bit about nutrition, but really I know nothing 55

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about it” was a recurrent phrase in my interviews. Sitting at a dining table in front of what appeared to me to be a beautifully balanced meal of beans, guacamole, salsa, soup, and tortillas, I might protest, “But look at this food you’ve prepared!” My comments were often met with looks of confusion, suggesting a disconnect between good food preparation and nutritional or dietetic know-how. I began to understand that nutrición did not refer to the ability to care for oneself and others through food, but to a nutrient-based approach to health centered on vitamins and minerals. As a result, women skilled in culinary techniques nonetheless saw themselves as ignorant about nutrition. Culinary knowledge—an awareness of the pleasures and tastes of food, the skill necessary to transform a limited budget into an abundant meal, an ability to give and receive food in socially appropriate ways—had nothing at all to do with nutrición; however mysterious, nutrición was technical, scientific, precise. Bruno Latour has written that “the word black box is used by cyberneticians whenever a piece of machinery or a set of commands is too complex. In its place they draw a little box about which they need to know nothing but its input and output. . . . No matter how controversial their history, how complex their inner workings, how large the commercial or academic networks that hold them in place, only their input and output count.” We do not see the black box—the conduit of scientific objectivity—as a site of complexity and controversy; taking it for granted, we often do not even see the box at all. Yet while the black box presents itself as “unproblematic and simple” (1987, 2–3), Latour suggests that it is always grappling with its Janus-faced twin: “sciencein-the-making”—that is, the potentially fallible practices by which life’s complexities become reduced into standards and facts. Latour advises his readers that by moving closer to places where black boxes are made, we will encounter controversies illuminating their process of assembly and their underlying complexity, as well as the means through which they gain their appearance of immutability and authority (30). This chapter explores a process that, following Latour, I call “nutritional black-boxing”—the process of consolidating technical and historically contingent ideas about nourishment and the myriad relationships surrounding dietary practices into seemingly unproblematic terms: for example, a vitamin or a nutrient. Although nutrition educators black-boxed the social complexities of nourishment through their emphasis on seemingly objective facts—nutrients are good, fats and sugars are bad—I show that the inner workings of these

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facts remained part of the systems in which they operated. Reductive labels such as healthy/unhealthy and good/bad were presented as truths that existed independent of cultural practice, but these labels contained intricate sociopolitical histories shaping what counts as food, environment, body, and self. My examination of nutritional black-boxing begins by describing the arrival of nutrición as a technical science to Guatemala in the 1950s. I then trace the translations of nutritional science to daily-life understandings of nourishment through three examples of present-day nutrition instruction: in a grade school, in a rural nutrition clinic, and in the urban public hospital where I worked. “Nutrition educator,” as I encountered it in my fieldwork, was by no means a homogenous category. Some educators, like those who worked in the city hospital, had advanced university training in nutrition; others had received basic governmental health certification; and others had taught themselves from textbook materials. Some nutritionists were economically well-off, while many were not. Some cared tremendously about their patients and worked tirelessly to provide meaningful support, while others had stumbled their way into the field, seemed to enjoy the privileged status of educator, and were not especially invested in the health concerns of their audiences or patients. This chapter does not aim to unpack the complex negotiations in which nutritionists themselves were often engaged—a topic to which I return in future chapters—but focuses instead on the generic messages about nutrition commonly conveyed around me and the social lives of these messages. Whereas many educators claimed that simplistic nutrition terminology allowed for the abstract meanings of nutrition science to most easily benefit people’s lives, I illustrate how black-boxing the intricate negotiations that surrounded eating produced knowledge that could be dangerously opaque. While the black box of the nutrient was treated as stable and universal, I show that as nutrients shifted contexts they transformed. The sites I examine are ones in which controversies remain visible; the boxes are closing, but they are not yet closed.

nutrición arrives in guatemala A brief history of nutritional science in Guatemala illuminates reasons why many Guatemalans, like Berta, might be inclined to associate nutrición with the threat of starvation. A highly respected scientist in Guatemala, Dr. Noel Solomons, gave a pithy summary of this history, saying, “For six decades, Guatemala has been a Mecca for hunger research.” INCAP has been

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headquartered in Guatemala City since it opened in 1949. The institute was established in the wake of the Universal Declaration of Human Rights (1948), Article 25, of which identifies access to adequate food as both an individual right and a collective responsibility. Since its founding, the institute has maintained affiliations with both PAHO—an offshoot of the United Nations’ World Health Organization—and the national Ministries of Health from each of the countries it represents (Belize, Costa Rica, El Salvador, Guatemala, Nicaragua, and Panama). Although INCAP began as a scientific research center, shortly after its inception it also began to respond to public health and public-policy needs. By its fifty-year anniversary it had trained some forty thousand staff members on matters of food and nutrition; roughly ten thousand physicians, nurses, and nutritionists from throughout Latin America had utilized its distancelearning programs; and it had published roughly 3,000 scientific articles, 80 monographs, and 350 collected volumes with other institutions (INCAP 1999). A former INCAP researcher described the period in which INCAP began as a time of great international optimism: “There was tremendous hope of changing the well-being of children—this was a new idea—note that this is also when Head Start was launched, as well as the War on Poverty by Johnson” (Patrice Engle, personal correspondence, November 12, 2009). Relatively straightforward and effective treatments for conditions such as rickets or goiter had led many global health officials to think that vitamin and mineral fortifications, which could be added easily to staple foods like sugar or salt, might serve as magic bullets in their quest to improve global health. During my fieldwork, despite widespread awareness within the Guatemalan public health community of the complicated and often disappointing realities of nutritional therapy, many health care workers still told me they were drawn to the field of nutrition because it—in one woman’s words— “provides low-tech, and generally low-cost, solutions to devastating health problems.” For more than a half century INCAP scientists have conducted nutritional studies throughout rural Guatemalan communities where formalized nutritional training is scarce. Some of these studies are small—for example, a cluster of households who will learn a few details about the importance of nutrients from the scientists who draw their blood and feed them vitamin supplements. Others, like the famed longitudinal study of the effects of earlylife supplementation that has been ongoing since 1969, are more comprehen-

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sive. An article in the American Journal of Clinical Medicine sites this study as “one of the richest sources of information about the importance of nutrition for growth and development in children from developing countries” (Martorell 1995, 1027S). An overview of the study provides context for how nutrición is often understood in Guatemala today. In 1969 INCAP researchers—many trained in the United States—selected four Spanish-speaking villages in a region of eastern Guatemala where most people worked as tenant farmers and lived in adobe or thatched-roof homes without electricity and running water (Martorell et al. 2005, S7). For eight years researchers provided half of the villagers with fresco—a Kool-Aid–like beverage that added calories to their diet but that initially contained no vitamins. They served the other villagers protein-fortified atole. Modeled after a locally consumed beverage of the same name, INCAP’s atole was described as “pale gray-green, and it tasted smooth but slightly gritty and sweet; it was served hot” (Martorell, Habicht, and Rivera 1995, S1030). Each village had a feeding station and twice a day individuals arrived and drank as much as they desired, while researchers—focusing on pregnant and lactating mothers and children up to the age of seven—recorded how much each person consumed. Researchers also monitored dietary consumption through twenty-four-hour and three-day recall surveys, recorded medical complaints and treatments, and collected anthropometric measurements and demographic data. As Reynaldo Martorell, Jean-Pierre Habicht, and Juan A. Rivera note, collecting panel data “involved intensive contact between data collectors and villagers” (1995, S1028). This intensive contact lasted for a nearly decade. Then, in 1977, scientists withdrew the atole and fresco feeding stations, taking the data they had accumulated—these hundreds of thousands of intimate, personal exchanges between scientist and “subject”—to Guatemala City, where they would be run through statistical calculations. The data would then gain new life, circulating through scientific working groups, board meetings, desks of curriculum designers, and offices of policy makers. Talal Asad writes that “statistics is not merely a mode of representing a new kind of social life but also of constructing it” (1994, 70). Statistics gave INCAP a language to translate research encounters—the running of a tape measure just above the belly button of a pregnant woman, the waiting for atole in humid rain, the entry of stacks of muddy data sheets into a master file—into nutritional pamphlets, newspaper headlines, and posters of hungry children.

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A newspaper article, “900,640 Niños Desnutridos” (900,640 Malnourished Children), printed in the Diario de Centro America in 1977, the last year of supplemental feeding, speaks to how INCAP’s findings have shaped Guatemalan conceptions of diet, nutrition, health, and eating. The article, which spans four full pages in the popular newspaper, uses INCAP data to report that 81.4 percent of Guatemalan infants are malnourished: “In every five children under five years old that inhabit the Republic of Guatemala, only one is well nourished.” The author draws on INCAP’s longitudinal study; an INCAP report titled The Problem of Malnourishment in Guatemala: A Foundation for a Solution; and interviews with INCAP professionals (a doctor, a nutritionist, and an agricultural economist) to describe the health affects of anemia and dental cavities, as well as deficiencies in protein, calories, vitamin A, and riboflavin (Oliva 1977). The article features a photograph of children wearing Maya dress, some carrying heavy bushels of wood down a dusty road. The text below the picture states, “The scene is common: a family living in substandard conditions, where surviving children grow in inhospitable environments, victims of chronic malnourishment, with frequent and severe attacks from infectious illness.” At the end of the article the author writes, “According to INCAP, the calamity we are suffering should not be considered inevitable. . . . Much of it is preventable; other parts of it can be avoided.” Still paraphrasing INCAP scientists, the article emphasizes the need to define and execute national nutritional policies “at the country’s highest political levels,” while “bringing these policies to people in ‘a direct and simplified model.’ ” (Oliva 1977). In 1991, after decades of working to formulate an official policy on educational outreach, INCAP officials approved the “Policy of Information and Communication,” which formally recognized that a core function of the institution was to facilitate access to information and communicate this information to the public (2000, 31). The information policy promotes the dissemination of basic, nutritional health education in three arenas: home environment, schools, and the development of life skills. It states that it is important to keep information about food and nutrition “basic” because people are able to better understand and incorporate basic information into their lives; basic information is here treated as a stronger and more effective foundation for behavioral change than information that retains complexity. To explore how this model for knowledge dissemination unfolds in practice, I next turn to analyze the circulation of simplified knowledge in three educa-

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tional settings. The cases that follow illustrate that while reductive language may camouflage the complexities of the “epistemological units” (Poovey 1998) known as nutrients or vitamins, this complexity remains, resurfacing in unexpected and often unwanted ways.

the simplified model Scene 1: The Classroom Two decades after INCAP established its “Policy of Information and Communication,” I sat in a small rural schoolhouse in a village outside of Xela, listening to a nutritional class for fifth- and sixth-grade students that was a result of continuing governmental efforts to transmit information about health and nutrition in a “direct and simplified” way. Many of the students’ mothers would arrive at the school for their own health class once a month, where they received nutritional training that was similar in format and content to that taught to their children. But the teacher, Alfonso, a man in his mid-twenties who was from a small town about an hour away, told me that it was important to teach children about “healthy eating” directly. “Children exert a lot of control over what they eat and don’t eat,” he said. “If they are not willing to eat healthy, if they just want to eat junk food, well, that’s what they’re going to do.” He also told me that most people he worked with—both children and parents—were ignorantes sobre nutrición (ignorant about nutrition). Because of this, he said it was important that he keep his material as basic as possible. Alfonso had received a degree in education from the public university in Guatemala City, and the notes for his lesson came largely from a classroom textbook for children that he had acquired in his training and from a children’s health-and-hygiene workbook that a Spain-based nongovernmental organization had produced for Guatemalan children. With eighteen children aged ten to thirteen sitting in a circle around him, he outlined the classroom rules: “Everyone must participate; everyone must respect their neighbor.” He then began the lesson by asking the students to name foods that were comidas malas (bad foods). They were shy about responding, so Alfonso began to list bad foods: “Sugar is bad because it is sweet. Ice cream is bad because it is bad for your teeth.” He paused and then asked, “Why are these foods bad?” His audience said nothing, so he answered his own question: “They are bad because they don’t have vitamins.”

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The next half hour was an exercise in transforming the familiar social negotiations that surround eating into abstract and unfamiliar terms. While the children sat quietly around him, he used handmade cards to explain the meanings of vitamin and mineral. His explanation for vitamins was short: “They are in our blood, and they help to keep us healthy.” He then began to flip through the cards. He read from the front of the first card: “Vitamin A: a good source of nutrition.” He turned the card over, revealing a picture of eggs, carrots, and a popular Guatemalan squash called whiskil. “These are good for your eyes,” he said. “Do you understand?” Heads nodded, silently. He moved to the next card: “Vitamin B: it keeps the body healthy.” He had no examples of foods connected to vitamin B, so he moved to the next card, which was illustrated with pictures of a lemon, orange, and pineapple: “Vitamin C.” He explained vitamin C to the children, looking at notes he had written: “It helps us be stronger. It helps our immunological system. It keeps us from catching a cold.” He had grouped vitamins D and E on the same card and read aloud what he had written there: “For keeping our body healthy.” He turned the card over, where there was a rough drawing of a young boy and girl, arrows extending from their bodies to the words piel (skin) and pelo (hair). While describing the importance of vitamins D and E for the skin and hair, Alfonso added a message about the sun to his students, many the children of farmers who spent afternoon hours in the fields: “The sun gives the body vitamin D, but five minutes. Five minutes in the sun is enough. You stay longer and you’ll burn yourself and hurt your skin.” Having finished the material on vitamins, he turned to a discussion of minerals. “What is a mineral?” he asked the class. A few students, growing restless, tossed out suggestions in quiet voices: “A fruit?” “Water?” “No,” he corrected them, “a mineral is something like calcium. It is good for our bones. We can find it in milk. It makes us strong. It is also in fruits and almonds.” He tested them by asking whether calcium was a vitamin or a mineral. A couple of boys shouted out “mineral,” before doubling over in the embarrassed laughter of schoolchildren. The next card read “Iron,” which Alfonso explained was good for strengthening the body and was found in beans, spinach, vegetables, red meat, and cereal. He also explained, “iron is good because iron gives you energy.” Then came “Protein,” a card that was illustrated with pictures of eggs, chicken, fish, and red meat. He explained that the function of protein was to build anticuerpos (antibodies). He repeated this word a second time—“anti . . .

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cuerpos”—though he provided no further explanation about what these were. Sitting on the side of the classroom, I wondered how the group understood a concept that sounded, to me, like against-the-body. The final card read, “Carbohydrates.” He asked where these came from, and when once again he was met with silence, he offered, “wheat, rice, bread, whole wheat bread, maize, potatoes.” With the initial review of vitamins, minerals, protein, and carbohydrates covered, Alfonso asked the classroom, “What is a good food?” The students’ silence encouraged him to monologue: Carrots, for example, are a good food. Fruits and vegetables are good. They have all four groups: minerals, vitamins, proteins, and carbohydrates. They are good— we should eat these three times a day, every day of the week. Why is this especially important for you? Because your bodies are growing. What else should you eat? Dairy. Three to four times a week, you should eat dairy. Cereals, you should have three to four days a week. Meat, you should eat two to three times a week. I know you don’t have enough meat to eat this every day, but it’s important to eat meat to strengthen your body. To strengthen your body you should eat red meat, and you should have cereals. You can tell your parents that I’ve taught you this. Do you remember what the bad foods are? The bad foods are cake, sugar, fat, Coca Cola. You shouldn’t have any of these any more than once a week.

He paused, and then asked the question, “Can you think of other bad foods?” This time, he waited for the kids to respond. One said, “Pepsi.” Another said, “dulces” (sweets). Another suggested, “bonbones” (lollipops). Alfonso praised them, “Yes, you should avoid Tortrix [chips], golosinas [candies], Pepsi’s, dulces, pasteles [cakes]. Why are they bad? They are bad because they don’t have iron. They are bad because they have sugar and fat. Remember that sugar and fat are bad for the body. The good foods, though, they are good because they have lots of vitamins and minerals. The good foods you should eat often: fruit, vegetables, pure water, boiled water.” Alfonso spent the last ten minutes of the class quizzing the students on which foods had which vitamins and which had protein, iron, or carbohydrates. While the students didn’t miss a beat when asked how many drops of chlorine to add to a gallon of water to sterilize it (essential knowledge when washing produce), there was considerable confusion about the food groups Alfonso had used. While they spoke Spanish in school, most were raised in K’iche’-speaking homes. Their parents would certainly be familiar with the Spanish words fruta (fruit) and verdura (vegetable), since these words have

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entered the K’iche’ lexicon. Still, there are no K’iche’ translations for these taxonomic classifications; in K’iche’, as with other Maya languages, there is a category for plants (k’yes), but plants are normally called by their individual names—for example, pix (tomato), oj (avocado), muqun (a kind of squash)— and not categorized in the food groups used within public health nutrition programs. This classroom’s classification of foods by vitamin and mineral content was a similarly foreign mode of ordering, an unfamiliar way in which to classify and relate to food. As a reward for sitting through the class, the students were each to receive half a banana, which Alfonso said he would give them once they answered a final question. He paused for a minute, before asking, “What is a good source of iron?” The shyness of the group had lessened, and a few kids in unison shouted out an answer: “Sugar!” Alfonso, shaking his head and noticeably annoyed, promptly corrected them, listing beef, pork, beans, and spinach as food items that contained iron. Later that night, while helping my family prepare coffee, I noticed the packaging on the sugar that we mixed into the communal pot. It contained a cartoon image of a green triangle with arms, legs, eyes, and a smiling mouth who stood under the message: “sugar with iron.” Below the cartoon, bright red text read, “fortified with vitamin ‘A.’ ” Following legislation initiated in 1974 (that became law in 1989), the Guatemalan government has required sugar companies to fortify sugar with vitamin A, and many have also added the minerals zinc, copper, and iron to the sugar they produce (Pineda 1998). On several occasions when I watched people spoon sugar into their drinks, they said to me, as if anticipating a critique that this extra sugar was reprehensible, “it’s for the vitamins.” Although I have described a children’s class here, it illustrates the general tenor of the Guatemalan public health community’s approach to nutrition communication. Health educators, supported by INCAP’s emphasis on basic knowledge, were taught that providing simplified information about vitamins and nutrients would help people to make healthy choices. We see in the sugar example, however, making healthy choices is not as simple as it seems. In his lesson Alfonso became frustrated when his students’ knowledge about iron did not conform to his pedagogical model, which categorized foods into simple binaries of good/bad and healthy/unhealthy. “Just Get the Facts Straight,” says the black box of ready-made science (Latour 1987, 7). Yet straightening out “the facts” is not a straightforward task; the students were,

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after all, correct: their sugar did have iron. Here, the model of simplified nutrition could not handle the intricacies of dietary practice, wherein the health value of foods does not conform to fixed standards. Gyorgy Scrinis (2014) has examined how the global health community’s desire to rapidly translate nutrition science into dietary advice for the lay public has contributed to a reductive framing of food in terms of nutrients. In the next case I illustrate how the simplified classification of food connects to other forms of what Scrinis terms “nutritional reductionism.” This case follows nutritional training at a rural health clinic. I show that as food is divided into increasingly abstracted and unfamiliar component parts, so does the focus of attention shift from fluid relations to responsible, discrete individuals.

Scene 2: The Village Clinic Nutrition education is a part of the Guatemalan government’s extensión de cobertura (health-coverage extension), a program that sends doctors and promotores (health workers) to communities that are too small and too remote to have a health center of their own. The health coverage program I worked with during my fieldwork rotated between ten villages, arriving to each every other week with vaccines, food-fortification packets, assorted medications, and educational seminars. The women in the rural communities we visited, many of them pregnant, waited in long lines for their turn with the doctor. In the early morning, when the line was the longest, Eva, the program’s certified health educator, gathered the women together for the day’s nutrition class. Eva had received her nutrition training in a five-day governmental certification program run by instructors whose own expertise lay in business management, not nutrition. She felt she was underprepared—though also lucky to have had any training. She had been given a set of standardized materials that formed the basis of her lesson plans, mandating that she begin each lesson by reciting the “seven steps for healthy eating” (siete pasos para una alimentación sana). INCAP had designed these steps in 1998, modeling them in the style of the U.S. Department of Agriculture’s Dietary Guidelines for Americans and tailoring them for Central America: 1. Include in all your meals grains, cereals, and potatoes because they are economical and flavorful; 2. Eat herbs and vegetables everyday to benefit your body;

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3. Everyday eat whatever kind of fruit you like, because it’s healthy and easy to digest; 4. If you eat tortillas and beans everyday, eat a spoonful of beans with every tortilla because this will be more substantive; 5. Eat eggs at least twice a week, or a bit of cheese, or add a glass of milk; 6. At least once a week eat a bit of liver or meat to fortify your body; 7. To stay healthy, vary your eating as indicated in the Olla de la Alimentación.

The Olla de la Alimentación, INCAPs version of the American food pyramid, was based on the iconic Guatemalan image of the double-handed earthen pot. The lip of the pot was filled with sugar and fats. Beneath this the pot was divided into five groups, each illustrated with representative foods: meats, dairy, herbs and vegetables, fruits, and, finally, the base of the pot made of grains, cereals, and potatoes. Next to each group were guidelines about how often to eat it: carne, at least once a week; dairy, at least twice a week; and fruits, vegetables, and grains, every day. Beneath the pyramid was the advice: “to maintain your health, wash your hands and cover your food and drinking water.” Shortly after the development of INCAP’s dietary steps, scientists at a Guatemala City–based metabolic-studies think tank with which I was affiliated published a critique of the direct application of U.S.-based recommendations to the Guatemalan context. Describing the results of a study they conducted that compared Guatemalan diets to the U.S. guidelines, they wrote, Dietary Guidelines for Americans is perhaps well named, to the extent that “Americans” means northern North Americans. The epidemiological bases for the dietary prescriptions and proscriptions are generally derived from observations in affluent, industrialized countries. . . . From the point of view of Latin America, the question of dietary guidelines may not so much be a matter of promoting dietary change, but in maintaining traditional practices. . . . Diets evolve in cultural context. It is not simply a matter of combining foods from each food group, but combining them into an integral cuisine that is required for better compliance with the Dietary Guidelines for Americans. (Valdés-Ramos, Mendoza, and Solomons 2001, 88)

INCAP’s attempt to reformulate the steps for Guatemala likely attenuates some of my colleagues’ concerns about cultural sensitivity, but it does not address their more general unease that a focus on nutrients draws attention away from locally contingent understandings of health or that broad national standards gloss over diverse dietary needs. I often saw that when health edu-

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cators presented the seven steps, an emphasis on “integral cuisine” became circumscribed by a didactic focus on the steps themselves. Rather than responding to the realities of local conditions, the teachings I observed emphasized fixed standards, as if the standards could be applied universally. Eva told me, when I began observing her lessons, “Since most of these women have never attended school, the information must be as simple as possible.” Here again was a focus on the need for simplicity. Yet, as I will show, the pretense of simplicity masks the complex negotiations that underpin nutrición. While the metabolic operations of nutrition may appear self-evident to those raised in environments where mechanistic explanatory structures are commonplace (cf. Mudry 2009), these depend on historically specific understandings of food, bodies, eating, and living. Even a seemingly simple statement like “eat more vegetables” is anything but simple. In the specific class I next describe, a representative of the several months of rural health instruction I observed, Eva stood in a white laboratory coat in front of a group of Mam women holding a poster of INCAP’s food pot. She began the lesson by repeating the steps, concluding with the message, “These are very important for our body [nuestro cuerpo].” I often heard people speak of “our body” in this way—conveying the sense of a shared body among women in the community. Yet in Eva’s teachings, this reference to a shared body, while common, countered her emphasis on an individual who must be responsible for her own diet. It is, I suggest, a momentary digression from the style of lesson plan she is following—a trace, perhaps, of another way of relating to food. Next, following a pattern that more closely reflected the overall style of the lesson, she singled out one woman from the group to ask, “What do you eat everyday? Do you eat herbs? Do you eat proteins?” The woman did not respond, so Eva turned to address the group: “It is very important that you eat from all these categories. Do you know why?” Without waiting for an answer she continued, “Because food gives us energy. And this food here,” she pointed to a section of the pot labeled “herbs/vegetables,” “this food helps us with our defenses against the flu. It also helps our skin heal from infections. Why? Because our skin is fragile, and we need vitamins to help it repair itself. This food has vitamins that help the skin repair itself. These vitamins help us have beautiful, strong hair. They help make our skin strong and beautiful. They help strengthen our fingernails.” She paused from the formal instructions to engage the women in a discussion of the kinds of foods they grew in their community. The women listed,

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after considerable prompting, potatoes, radishes, carrots, squash, beans, and cabbage. The group had not yet mentioned the staple food surrounding us all, so Eva asked them: “Is anything missing?” Met with silence, she gave them another hint: “There’s something else, something very important.” Again there was silence, so she finally answered the question herself: “And the famous maize of Guatemala! See you have everything you need right here.” I believe Eva said this to encourage the women to eat the produce they grew and not spend money on processed foods, like the chips and candy that many of the women bought for their children while waiting for the doctor. Yet though it was perhaps well intentioned, Eva’s assertion that they grew everything they needed was not correct. The village, at an altitude of about 2,700 meters, was too cold to grow fruit, which was transported in from the coast. People in the community, though remote, had long been involved in the trade of food. She next made a statement that was also false, a promise she could not keep: “If we eat well, we won’t get sick.” Turning to a discussion of maize, Eva pointed to the area of the food pot listing grains. “Some of your foods have what is called carbohydrates,” she explained. “Perhaps you aren’t familiar with this term, but carbohydrates are our source of energy. If you don’t eat them, you won’t be able to get up. You won’t be able to accomplish anything in the day. You won’t be able to run. You won’t be able to do your work. You won’t be able to care for your children, even. So we need to eat these things”—she pointed to the illustrations of the carbohydrates—“in order to have energy. Our body needs vitamins to keep going. We must feed ourselves well. We need to eat enough, with enough variety. At least two eggs a week,” she encouraged them. “It’s very important for the health of your children that they get a bit of fat in their meals. Perhaps mix a little vegetable oil into your beans when you can. And they need lots of vitamins as well. You must be very careful. Very, very careful. [Tiene que tener mucho cuidado. Mucho, mucho cuidado.]” With this message, her lesson ended. I have presented Eva’s twenty-minute lesson in some detail to give a sense of the potential richness of nutrition discourses, entailing myriad connections to healing, strength, energy, and well-being. Take, for example, the connection Eva makes between work and food: “trabajar para comer, comer para trabajar” (work to eat, and eat to work) is an adage I heard from many farmers—both men and women—who spoke to me about the cycle of growing maize, eating, and returning to the fields to begin the day anew. I learned from them that,

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as maize depends on human skill to grow and flourish, humans, in return, depend on maize (see also González 2001). Yet in contrast to this message that eating and feeding were distributed across a network of human and maize relations, Eva’s message emphasized maternal responsibility. “We must feed ourselves,” she told the women, while also charging them with the well-being of their children. Individualized risk also materialized through the lesson. “You must be very careful,” asserts responsibility, while also underscoring the potential for failure. Eva’s speech was didactic; her bullet points were obvious: “Vitamins are small. Vitamins are found in food. Vitamins give you energy. Vitamins are good for you. We must feed ourselves.” But as I show in more detail in the next case, each of these “simple” instructions carries with it profound, and often destabilizing, assumptions about what health is and how it is achieved.

Scene 3: The City Hospital The nutritionists at the outpatient obesity clinic of the regional hospital gave every patient a sheet of dietary recommendations. While nutritionists tried to personalize the recommendations to accommodate different metabolic illnesses, they worked from a standardized template taken from a Spanishlanguage nutrition textbook authored by a prominent global nutrition expert from Colombia. The template listed foods in two columns: permitted and prohibited. Permitted foods included skim milk, low-fat yogurt, poultry without skin, whitefish, most kinds of eggs, whole wheat cereals, whole wheat bread, boiled plantains, fresh fruits, fresh vegetables, olive or canola oil, diet or “fat free” (in English) mayonnaise, mineral water, and tea and coffee (without sugar). Prohibited foods included whole milk, butter, cream, cheese, pork (or anything pork-based), hamburgers, lasagnas, any fried meats or fish, anything battered in egg, sweet cereals, fried potatoes, a long list of traditional foods cooked with lard, canned fruits, vegetables cooked in butter or margarine, most desserts, all oils (except olive and canola), hot chocolate, all alcoholic beverages, sodas, and a long list of snack foods. Nutritionists described permitted foods as good, emphasizing their vitamins or protein content. Prohibited foods meanwhile were bad: these were foods with fat and sugar. After weighing the patient and then calculating his or her body mass index, nutritionists would evaluate a typical day of food. The aim of the consultation was to produce a dieta or menú that would list all the foods a patient should eat over a given day, for each day of the week, including portion size and

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suggested time of consumption. To create the dieta, nutritionists again categorized certain foods as “good/healthy” and others as “bad/unhealthy.” Sugar was bad. Fat was bad. By extension, foods associated with fats and sugars were also bad. I present an extended portion of one conversation between a nutritionist, a patient, and her grandson to show that concerns for caregiving and kinship are not entirely absent from discussions of nutrición, as was also the case in the example with Eva. Yet despite the diverse directions in which an interest in nutrition takes, in this exchange the lived experiences in which foods are consumed are downplayed, as foods are instead treated as if their sole function was to improve health. As they are thus abstracted, they become endowed with fixed ontological properties—properties presumed to move with the foods across time and context. Carrots and beets are bad. Fats are bad. Herbs are good. Like the universal and generalizable properties associated with numbers, foods take on absolute identities; judgments that might be made through taste and texture and in conversation with kin or community instead become compressed into fixed rules and standards. Nutritionist: Do you eat cakes, crackers? Patient: Yes, ma’am. Sometimes I eat chocolate. It’s a need. I am bad, aren’t I? N: Ay! This isn’t good, ma’am. Let’s see. Well then, chocolate: no! Crackers: no! Jams: no! No honey. No cakes. Anything sweet: nope. Figs of whatever kind in honey: none of it. None of this can you eat. Only vegetables, fruits, meat, and rice. P: Okay, rice and beans. Grandson: Bread? N: Not very much. Yes, you can eat it, but only every now and then. Except sweet breads. You must help your grandmother so that she doesn’t eat them. When she eats them you have to tell her, “No grandmother, don’t eat this.” Okay? Yes? G: [laughs] N: You must tell your cousins too—to watch that she doesn’t eat. G: The young ones have all the responsibility. N: Yes! You tell your cousins, your uncles and aunts, “She can’t eat this.” Okay? You’ll help me with this? G: Yes. N: Good! Very good. [Pause.] Mazola oil or canola oil. That’s what you want— either of these is best. Okay? Herbs, whatever kind of herbs, you can eat. They’re good.

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P: N: P: N: P: N: P: N: P: N: G: N:

Soup with herbs? Yes, anything like that. Herbs with egg? We’re going to avoid beets and carrots. These I can’t eat? No, because they’re very sweet. No beets and carrots. They’re bad. Potato also? No potato. No pasta either. No pasta? What about mayonnaise? No. That is fat. Excellent—that’s right! He’s got it! No hamburgers. No pizza. Nothing like that. No sausage. The worst is pork skins for all the fat they have. No cream. No cheese. Now you’re thinking, “Jeez, they haven’t left me with anything to eat!” But we are leaving you something. P: No cheese either? N: No, it has too much fat. Perhaps requesón [a ricotta-like cheese]. It’s better—that you can eat. Okay?

Many of the nutritionists used colorful images of foods in the consultations. As they conversed with the patients about a normal day of eating, they would assemble the images into three piles: healthy foods—to be eaten often; unhealthy foods—to be avoided; and what they called “middle foods”—to be consumed in moderation. “These are confusing and complex diseases; patients’ income, family size, health history—this all matters,” one of the nutritionists told me when explaining the need for the cutouts. “They come in confused, and because we don’t want to confuse them even further, we try to keep the lessons as simple as possible. You see, they might speak another language [not Spanish], but they will certainly recognize that this is a tomato and this is a carrot.” Despite attempts made toward reductive categorization, many of the foods resisted easy placement into the piles by being low in fat (good) but high in sugar (bad) or high in some vitamins (good) but also high in simple carbohydrates (bad). The nutritionists often disagreed among themselves about where to place the images. Eventually they always chose a pile, but the root of the conflict would never disappear, since at issue was not just the question of how to classify the foods but whether this was a useful approach to health at all. The placement of the cutouts into one of the three piles (healthy, middle,

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unhealthy) hinged on the idea that the health property of a food inhered within it, unaltered by the circumstances of its consumption. Meanwhile, the disagreements that emerged between the nutritionists and the ways in which foods would shift categories because of these disagreements suggested that health was not located within the food but came into being through a series of negotiations.

everything good is harmful In the three pedagogical encounters I have detailed, educators treated vitamins as though they were straightforward. Instructors often presented them through the use of colorful pictures of familiar foods, describing them in basic language: they are small; they are good; they make us healthy. Yet though vitamins were described as simple, they are not. The nutrients of today— though invisible under most circumstances—carry with them assumptions about value. They do not simply reflect the truth about the health property of food but also produce truths about bodies and health. When the educators shifted from the dictate to “eat healthy vitamins” to the instruction to “take care of oneself ” they were using nutrients to teach their audiences how to manage themselves and their relations with others. In these cases nutrients act as a mode of representation that serves to organize the world and the people within it. And they do this while appearing to be disinterested, freefloating signifiers without an interpretive dimension. While these lesson plans present as self-evident the idea that nutrients are necessary for bodily function, the idea that illness could be born of a lack of nutrients and not the presence of a pathogen or toxic agent countered the scientific paradigm of the nineteenth century. Medical historian Walter Gratzer writes this about nutrients: “To conceive of such enigmatic essences required an intellectual leap of faith of which few physiologists, much less doctors, were capable” (2005, 162). Nutrition scientist Kenneth Carpenter describes the laborious processes by which the mysterious workings of nutrition became a reputable science. He provides the memorable example of U.S. director of public health Joseph Goldberger, who in 1916 used his own body to test whether pellagra, which was causing epidemic rates of death in the American South, was infectious. “He received subcutaneous injections of blood from patients [who had pellagra], then had skin eruptions rubbed into his nasal mucosa, and finally ate some of their excreta” (2003, 3027). Goldberger

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did not become ill, giving credibility to the idea that pellagra was caused not by the spread of microbes but instead by deficiencies of a small, invisible substance—what would later be known as niacin, nicotinic acid, or vitamin B3, which scientists began to understand to be an organic compound necessary for life. Between 1913 (with vitamin A) and 1941 (with folic acid), scientists identified the chemical structure of vitamins and then labeled and arranged by the activity of their compounds. Metabolic research on nutrients would become assembled into the charts, graphs, and labels of recommended daily allowances, which in turn began to adorn the packaging of processed foods (Nestle 2002). Wendy Nelson Espeland and Mitchell Stevens write that commensurate systems—one of which, I suggest, is the RDA—unite objects through a “shared cognitive system,” where qualitative differences and similarities are transformed into quantities that can be expressed in magnitudes of more or less (2008, 408). That which might be treated as continuous and interpersonal took on an impersonal, discrete, and hierarchical appearance. Nourishment becomes nutrición: equated with elements. Health, meanwhile, began to appear as the sum of elemental parts. Rather than lessen patient confusion, this apparent simplicity often exacerbated it. To give an example, nutritionists commonly advised patients suffering from metabolic illness to eat more vegetables. “Vegetables have a lot of vitamins and are healthy,” the nutritionists would say. The advice sounds simple and easy to follow. Yet when I spent an afternoon with a patient, Viki, in her home, I noticed that she avoided eating the vegetables she served her family and me for lunch. When I later asked her about this, she told me that she thought that vegetables had too many vitamins. Inquiring further, I learned that at a health training she had attended at her children’s grade school, the teacher had advised her to feed her children vitamins so they would “grow big” and “gain weight.” Many children in Xela remain malnourished, and although concern about childhood obesity is on the rise (Groeneveld, Solomons, and Doak 2007), childhood weight gain and well-being are tightly linked. Viki, however, was treated for hypertension and was trying to lose weight. Associating vegetables with vitamins, and vitamins with weight gain, she consequently avoided their consumption, although she said several times while we spoke that she wasn’t sure if this was the correct thing to do. The following exchange between a hospital nutritionist and patient treated for both hypertension and diabetes provides another example of the potentially

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harmful effects of nutritional reductionism. Here, fears about food and health have caused the patient to avoid drinking atoles and cereals entirely; uncertain and scared about what to eat, she found safety only in total avoidance. Nutritionist: Cereal? Do you drink any kind of cereal? [Cereal in Guatemala is consumed as a beverage.] Patient: No, I drink only purified water. That’s all I drink, Doctor. N: Just purified water? You don’t drink atole anymore? P: I don’t drink atole anymore. N: Not at all? P: No. N: Why? Do you not like it? P: Well, I like it, but it scares me. N: No, atole is okay. P: Ah, that’s good, Doctor. N: So what we are going to want to drink—we’re going to have two tablespoons of dry oatmeal. P: Very well. N: It’s very good this way, and it will take away all the fat you have in your body. P: Very well, Doctor.

Though the hospital nutritionists frequently bemoaned the tendency of patients to think in “all or nothing” terms, I suggest that the pedagogical framework they employed contributed to this tendency. In this example, the nutritionist might have taken this opportunity to direct the patient toward an awareness of tastes or textures. She might have talked about sensations of satiety, obligations to her kin, or other contextual concerns of consumption. Instead, following a formula learned in her nutritional training, she circumscribed the recommended eating behavior into a carefully measured prescription: two tablespoons of dry oatmeal with one cup of water. Removing the specificity of the situation, she leaves the patient with formulaic guidelines: “it’s very good” and “it will take away all the fat you have in your body”—the obvious implication being that fat is categorically bad. A reductive valuation of foods as good or bad has the additional effect of assigning to individuals the personal responsibility of following these ostensibly self-evident rules. Eva’s warning to her nutrition classes, “you must be very careful,” places responsibility for health on the individual, overlooking the complex structural environments shaping how and what food is eaten.

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The presentation of foods in black-and-white terms was often an impediment to treatment. On several occasions I heard health educators scold their students when the students admitted to eating prohibited, bad foods. Viewing nutritional advice as simple and consequently easy to follow, health educators framed their students’ decisions to eat fats and sweets to me as willfully noncompliant (intencionalmente no cumplen). Patients and students, on the other hand, spoke about conflicting pressures they faced. Eating fat might be bad from the vantage of a nutrition class, but it was also bad socially to forego eating what a friend or family member had prepared. Since food rules were presented through a simplistic framework, educators were often ill-equipped to help their students negotiate the complicated interstices of lived realities where “goods” and “bads” exist as continuums-in-conversations and not as absolutes. Moreover, a reductive treatment of foods as good or bad had the effect of situating illnesses as the result of simple food choices, with the expectation that they could be treated by equally simple changes in dietary behaviors (remember, for example, Eva’s promise that “If we eat well, we won’t get sick”). In the exchange that follows we see a patient who, despite desiring foods she believes to be fattening, is following a recommended diet. Unable to map this patient’s illness to an obvious dietary failing, the nutritionist offers no further assistance, leaving the patient in silence. Patient: I have to tell you that I love fried plantains with refried beans. And cream. Nutritionist: And cream? P: But from a distance, because I know they’re harmful, right? Everything good is harmful. N: Yes, that’s right. P: I also don’t make fried chicken. N: No, absolutely not. That’s forbidden. P: No. I told you I never ever have it. Only boiled or stewed. But, most important, with no fat. N: Exactly. P: Now, it’s me with my problems. N: [Pause, turns to chart. Picks up again thirty seconds later to ask about a typical day of food.]

Underlying many pedagogical frictions was the attempt to define “health” in absolute terms. “¡Vamos a Comer Sano!” (We’re Going to Eat Healthy!)

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was a slogan for many governmental health classes, which educators reiterated in their lessons by identifying specific foods as sano or saludable (Spanish synonyms for healthy). Yet health, for the patients and audiences with whom I interacted, was not a property that could be fixed within a food; existing in the specificities of dietary practices, it was a process to be negotiated, not an object to hold. Within my field notebook I carried a picture of a brightly colored fruit stand. The photograph showed sliced pineapples, papaya, and melon, to be served with lime and salt and chili powder for one quetzal (thirteen cents) a bag. In the back of the scene was another stand, where for the same price, vendors sold bags of chips packaged in colorful and shiny plastic wrapping. During an afternoon conversation with Brenda, one of the first women with whom I lived who became a friend that I visited often, the picture slipped out of my notebook. Brenda, who was familiar with my project, picked it up and, as she handed it back to me, smiled mischievously. She pointed at the fruit and then the chips and then asked me, “Emily, which of these do you think is healthier?” According to the health-education classes I attended, the correct answer was the fruit. “Fruit is good and healthy” was a mantra I had heard hundreds of times. Yet in contrast to this generalization, there was no clear answer to Brenda’s question. The fruit might have been sitting on the street for hours, where it would have absorbed the exhaust of the traffic; the knife used to cut it might not have been clean; it might have been grown on land covered in pesticides in communities where rates of stomach cancer are high. These were all possibilities that Brenda, who had two young children, pointed out as she told me that she didn’t allow her children to eat fruit from stands like the one in the picture because it wasn’t, in her view, healthy. While chips might be fattening and filled with unfamiliar ingredients, at least they would not make her children sick. “Not in the short term, anyway,” she added. Many of the people I worked among were terrified by the changes happening within their bodies: the pain or numbness in their limbs, the violent and unfamiliar urges of appetite or thirst, the repetitive need for urination even when they had not been drinking, the unusual palpitations of their hearts, or the heat felt in their chests. While metabolic illnesses such as diabetes and heart disease have existed in small numbers in Guatemala for a some time, the reported rates at which they are occurring are unprecedented (Mendoza Montano et al. 2008; Uauy, Albala, and Kain 2001). Scared, people listened

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carefully to the ideas of nourishment that came from health educators. That people reinterpreted nutritional guidelines—adding extra sugar to drinks because it was fortified with iron, avoiding vegetables because they associated vitamins with weight gain, eating chips because they were safe from microbes, and so on—was not a result of their lack of interest or attention. It was instead a result of the sheer impossibility of translating the sensations, emotions, and relations of eating into the immobile categories of food groups and standardized prescriptions.

indigenous medicine and another sense of health It would be convenient for my research if there was currently a widespread cosmology of nourishment in Xela to contrast with the mechanistic and reductive logic of nutrient health that I observed in the school, rural clinic, and hospital. When I first began my fieldwork I had hoped that such a belief system might exist. When I conducted background research for this project on Guatemala’s national health care system, numerous people directed me to speak with Dr. Juan José Hurtado and his daughter Elena, held widely to be experts on indigenous medicine. INCAP had employed Elena Hurtado as its resident anthropologist for decades, and Dr. Hurtado—a professor at Guatemala’s elite Universidad Francisco Marroquín—had for nearly half a century trained Guatemala’s most prestigious doctors and nutritionists in techniques of indigenous medicine. Before meeting Dr. Hurtado, I accompanied a Guatemalan friend to the home of a medical resident, now a surgeon, who had studied with him a few years prior. The surgeon still had his notebooks from the classes, and he showed me several handouts where he had fastidiously highlighted and made notes about the temporal qualities of certain foods. He still remembered the essence of the practices as he had learned them, and he explained this to me: “Health is achieved through the balance of these different qualities; adjusting how much of the foods and herbs one eats helps to create this balance.” I later met with Dr. Hurtado, who enthusiastically gave me several of his papers to study and a pencil-drawn map to a training clinic founded in a Kaqchikel community in the mountains a few hours outside the capital. The clinic has long provided the Marroquín medical students with an opportunity to live and practice medicine in an environment where healing takes a different form than in the national hospitals and private clinics of Guatemala City

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(where most of the students will ultimately work). The clinic was closed for holidays when I arrived, but I tracked down Catarina, a curandera (midwife/ healer) who has trained the Marroquín students in Maya healing techniques since the clinic’s inception. She lived just off the town’s center square in a concrete house with no garden of its own, but her counters were covered with drying herbs, some of which she had collected from the mountains outside the town that morning. Over the sound of television cartoons that her grandson watched in the background, she spoke to me about the importance of life’s humors, her wizened hands sorting through various plants used to treat different pains and fevers. She also said that few people still practiced this form of medicine, and she credited the preservation of her own knowledge to the efforts of Dr. Hurtado. Indeed, at the time of my fieldwork, the very few people in Xela who had substantial knowledge about a hot/cold system of dietary health were those who had read about it in books or magazines. Since the government documents, legal records, and newspaper publications that I encountered in my archival research said little about dietary beliefs, I turned to anthropological monographs, some now written nearly a century ago, for clues about historical understandings of the relation between food and health (e.g., R. Adams 1952; Cosminsky 1975; Logan 1973; Redfield and Villa Rojas 1971). There is a risk in doing so, since early ethnographic work in Guatemala, by focusing on cultural differences, tended to downplay the degree to which even Guatemala’s most remote communities had been shaped for centuries by global flows of knowledge about health and healing. Also problematic is that much early ethnographic work in Guatemala was aimed at overviewing a village’s everyday life. Barbara Tedlock (1984) makes the important point that indigenous healing, though not biomedical, remained an expert practice, and, as such, looking for the details of expert knowledge through lay experience would be a misguided tactic. The challenges of translation are also numerous, as anthropologists maneuvered between Mayan, Spanish, and English languages in writing about hot/cold health systems without often acknowledging the roughness and failures of their translations. These records do, however, provide an interesting contrast to reductive nutritional frameworks, and given their historic prevalence in Guatemala, I describe them here. For Guatemalan communities that followed hot/cold practices, it appears that the health of foods was determined not through nutrient contents but rather by whether what was eaten helped the body achieve a balance between sensory qualities of frio (cold) and caliente (hot). If one ate a hot food, it must

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be balanced with a cold food or else the body would become too hot, causing an array of hot illnesses. Much of the literature on the topic specifies that qualities of hot and cold are not related to temperature measurements; in other words, a fever might be caused by a cold illness, and oven-warmed foods might help to heal a hot illness. The classic descriptions of hot/cold practices given by Robert Redfield and Alfonso Villa Rojas warn readers that it would be a mistake to try to overlay categories onto indigenous practices since the “categories are blurred and run into one another. . . . The native probably does not feel that he has to select one category rather than another” (1971, 160). Whereas the idea of balance is crucial to both nutritive and cold/hot logics of food and health, the balance of the former is necessarily impersonal, focused on imposing abstract guidelines on the body and determined with reference to international standards and principles. This approach was anathema to the hot/cold practices of Guatemala’s indigenous health systems, which depended on listening to, and making decisions based on, the circumstances surrounding the specific social and ecological contexts of food consumption. Susan Weller describes the desire of Guatemalan health care professionals to create rules out of hot/cold medical practices—such as orange juice is cool; measles is hot (1983, 256). While they sought to establish these rules to simplify and expand the delivery of health care services, this led to widespread misunderstanding about the workings of indigenous medicine, which resisted classification. Here, an individual food would never—could never—be understood as healthy or unhealthy on its own; rather, its health is determined through its relation to the different foods consumed and the state of the individual at the time of consumption. The good or bad character of foods is not fixed but “dependent upon the condition of the person who eats them” (Redfield and Villa Rojas 1971, 161). Early anthropological depictions of indigenous medicine were optimistic about its future. In their analysis of medicine in Guatemala in the 1960s, Richard Adams and Arthur Rubel argue that there is reason to think that the hot/cold categorization of medicine “will become increasingly important . . . because it readily adapts to the increased cultural inventories of expanding societies” (1967, 353). Walter Adams and John Hawkins have suggested, however, that while there remains some lingering evidence of hot/cold practices in Guatemala, “the categorization may not be as important as it once was” (2007, 10). Some current research in the villages outside of Xela suggests that indigenous medical traditions remain important for

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postpartum women (García et al. 2013), and there are, no doubt, “epistemological survivals” (Daston 2000, 36) of a historical hot/cold classification system. But in Xela and the broader region today, the dietary education I encountered stressed abstract classifications of vitamins, calories, proteins, and carbohydrates. Contextual specificities and local forms of expertise were treated as all but irrelevant.

the experience of nourishment Latour writes that knowledge is understood to be “familiarity with events, places and people seen many times over.” Yet knowledge, he clarifies, must also account for the “whole cycle of [its] accumulation” (1987, 220). Most health educators I worked among would be judged as knowledgeable when considering the first part of this definition. They have been taught to match certain foods to certain vitamins; to arrange foods into piles according to their quantities of fats and carbohydrates; and to explain a carbohydrate in the terms in which they have learned it (“if you do not eat them, you will not have energy”). Yet their knowledge of nutrition, with its emphasis on simplicity, is typically cut off from the history of the production of this knowledge. Nutritional black boxes give an appearance of stability to the otherwise processual experiences of nourishment; this stability allows black-boxed facts, “straight out of textbooks” (Latour 1987, 8), to travel around the world so that even in Guatemala’s remote highlands people are taught to value food and eating on the basis of nutrients. Nutritional black boxes also make formerly separate objects—take the classically incommensurate apple and orange—appear in like terms. Yet while they may help to create a scale of comparison that can travel widely, they also lead to numerous sites of collision and confusion. Hot/cold frameworks for health are no longer strong in Xela. I draw attention to them because they help us to imagine other ways in which to communicate dietary health, and they provide a window to the existence of other—potentially many other—ways in which people relate to their food and their bodies. It is relevant that in K’iche,’ the experiences of desire and pleasure (utz) must be expressed through three other sensory experiences: sight, feeling (which encompasses touch, taste, and smell) and sound. Instead of simply saying “I like,” as we do in English (and in Spanish, gustarse), K’iche’ speakers linguistically conjugate the experience of pleasure with reference to

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these three different sensory experiences, identifying whether something pleases their sense of sight (ilo), their sense of feeling (na’), or their sense of sound (ta). I do not want to create a false sense of difference between K’iche’ cosmologies of pleasure and the beliefs of those who speak other languages. English and Spanish speakers also experience pleasure through sight; pleasure through touch, taste, and smell; and pleasure through sound. But I suggest that the pedagogical and discursive models that surrounded nutrición as I saw it practiced downplayed the diversity of the ways in which pleasure and its related forms of health were shaped and cared for. In a complex world these models presented rigid grids and reductive language. It was from these reductions that people began to say, “this food is bad, unhealthy; this food is good, healthy,” and from there that people diagnosed as overweight avoided vegetables or those with diabetes added nutrient-fortified sugar to their drinks. It is important to the story I am telling that in most classes I observed, those being “educated” remained quiet. Whether classes were for children or adults, the assumption built into the pedagogical approach of the courses was that the audience had no nutritional knowledge of its own. Instructors did not often ask about—or, by extension, value—the knowledge about dietary health of the people they addressed. Make no mistake: the women whom Eva asked to list the foods grown in their community valued maize; their family and community gatherings, their patterns of sustenance, and their everyday labor literally and metaphorically revolved around its production and harvest. That they did not name maize as an important food stands as a reflection not of their knowledge but of failures of this classificatory approach. Theodore Porter argues that in democratic societies, institutional classroom instruction has supplanted the “kind of wisdom that comes from long experience, which is often passed on from parent to child or master to disciple.” Formal instruction, he suggests, appears “more open and less personal,” thereby appearing more objective (1995, 7). In a similar vein, Lorraine Daston has argued that aperspectival objectivity—in this context, the removal of individual idiosyncrasies central to nutritional black-boxing—became a scientific value when scientific knowledge had to be communicated across boundaries of nationality, training, and skill. She writes, “Indeed, the essence of aperspectival objectivity was its communicability, narrowing the range of genuine knowledge to coincide with that of public knowledge. . . .

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Aperspectival objectivity may even sacrifice deeper or more accurate knowledge to the demands of communicability” (1999, 112). As I have aimed to show in this chapter, formal nutritional education in the Guatemalan highlands sacrifices many forms of knowledge to an ostensible demand for communicability. Yet by ignoring or overlooking practices that do not easily fit within the standards, communication is precisely what remains undervalued. In the cases I have described, people wound up confused, following protocols they did not understand in ways that were never intended, and their own wealth of expertise and knowledge became systematically discounted. The example of research on pellagra I described in my earlier discussion of the history of nutrition illuminates potential effects of silencing alternative knowledges. “Outbreaks” of pellagra often occurred in communities around the world where maize was a staple food, while the illness of pellagra was mostly absent in Mesoamerica, the ancestral homeland of maize. Nonetheless, it took U.S. and European scientists nearly two centuries to move from this observation to the recognition that pellagra resulted from a deficiency in niacin—two centuries in which tens of thousands of the world’s poorest laborers died slowly and painfully, as their flesh decomposed on their still-living bodies. Meanwhile, Maya peasants with no knowledge of nutrición continued to mix their maize with cal (limestone), its minerals helping to transform the niacin in maize to an unbound form that could be utilized by the body. Lacking a periodic table of elements—lacking the very concept of the vitamin— they nonetheless followed careful tortilla-making practices that staved off pellagra. I conclude by returning to the comment made by my scientific colleagues that public health dietary guidelines in Guatemala might aim to encourage people to maintain traditional practices rather than promote dietary change. At the heart of their comment is the suggestion that public health nutrition has much to learn from listening to and valuing the knowledge that people already possess, even when this knowledge takes inconvenient and ineffable forms, even when it resists reductive simplicity. In this chapter my aim was not to critique nutritional science directly. Nor have I intended to place the blame for the shortcomings in education on the shoulders of specific educators, as they were in most cases following their training or otherwise precariously employed in jobs that demanded they stick to protocol. Instead, I have aimed to illuminate the lack of attention paid

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to the processes of scientific translation and communication and to stress the importance of approaching dietary health care in a way that attends to the lived practices of eating. Despite efforts to black-box the experiences of nourishment through the expert categories of nutrición, the flesh of experience remained powerful. It is to an analysis of this flesh that my next chapter turns.

chapter 3

Care of the Social

bodies in transition An art show featuring Colombian painter Fernando Botero’s rotund men and women came through Xela during my fieldwork. On a weekend afternoon when the skies and streets were wet with rain, I went to see the paintings with a friend—a woman trained as a nutritionist who had herself struggled over the previous decade to lose weight. We wandered past the images, stopping before one of a stately, buxom woman, when my friend turned to me and said, “This may be our heritage, but I’m still following my diet.” Her point, as we discussed it later, was that people gathered around the paintings because the past the art exemplified—a past that had not in fact existed for most Guatemalans—was far behind them. For the elite audience of the show, thinness, not fatness, was in style. Botero was popular among affluent Guatemalans and his iconic images of decadent corpulence appeared regularly in the news. Earlier in the year a Prensa Libre newspaper article had featured one of his paintings alongside the announcement of the discovery of a second “gene for obesity.” The image showed a broad, blond-haired woman in a pink dress that was cropped above the knees, sitting with a small child dressed in a suit on her lap, while two fat, well-dressed children played at her feet. A plump man in a black-tie suit stood behind them, his arm wrapped protectively around his family. The word OBESIDAD (obesity) ran in bold letters above the image, which was captioned, “Obesity has a genetic origin, but bad eating habits and physical

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inactivity are also an important factor.” The article was among a growing number of public messages recasting once-desirable body forms in terms of disease (see, e.g., Ruiz 2009a). Although obesity in Guatemala had recently become a medical diagnosis of its own, determined by the same BMI standards used in the United States since 1998, it was still a compliment to call children “gordito/a” (little fat one), and I often heard people associate fatness with the health of a hearty appetite. The pairing of the headline “obesidad” with the image of this plump family conflated illness and fatness in a manner that was not self-evident for most people I met and interviewed. In referencing “genetic origins” of fatness this caption also drew on an understanding of genetic inheritance that was as atypical as the light-skinned nuclear families the image portrayed. I draw attention to this newspaper article not because it is representative of local attitudes— it is not—but because it indexes changing depictions of health. Many people still saw fatness as desirable, but media and public health outlets were regularly connecting corpulence with biological illness and moral failure—as seen in the caption, which linked girth to “bad eating habits” and a sedentary lifestyle. While my friend and I were at the art show, we ran into family friends of hers: two middle-aged women and an elderly man. Standing amid Botero’s images of epicurean prosperity, they began discussing weight. The images represented for them a different time, a part of their “heritage,” as my friend had said, undesirable in “modern” lives. After my friend told them the subject of my research, they made it clear that they were concerned about rising rates of adult and childhood obesity in Guatemala. INCAP had recently conducted several studies in a poor suburb of Guatemala City, and the results—60 percent overweight, 13.0 percent with hypertension, 8.4 percent with diabetes— had circulated widely through Xela’s local news (“Survey” 2007). “We know that slimness is healthy,” said one of the women. The second woman added that today fatness was attractive only among Guatemala’s poor, those without the education to know that fat was unhealthy. She added that it was sad that this was the same population among whom metabolic illnesses were a growing public health concern. She patted her slim stomach and told us, proudly, that she had been following a dieta that she had taped to her refrigerator at home, so every time she went to eat she was reminded to ask herself, do I really need this? I was seeing versions of this dieta—a breakdown of permitted foods for each meal—everywhere. Newspapers printed diets next to weight-loss recipes.

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A number of the families with whom I lived had a daily dietary menu listing foods to be eaten at each meal along with portion sizes in their kitchens— guidelines for someone in the family who was trying to lose weight. One was taped in the pantry door of an exclusive home I visited in Guatemala City. Patients left the hospital holding them carefully, as the diet was typically the only tangible evidence of the visit. Some diets were crude, listing for example “fruit and grain” under breakfast. Others specified the foods and quantities that should be eaten in baroque detail. What the different versions of this device shared was an aim to regulate appetite and pleasure, encouraging carefully controlled moderation. The dieta, in Michel Foucault’s terms, is a technology through which individuals engage in strategies of self-conduct, learning to manage their behavior and appetites, while also learning to recognize the body and self as their own (see especially Foucault 1986; see also Canguilhem 1989). Marking “the self ” as distinct from its surroundings, and endowing it with a singular will, dietetic training encourages the belief that the self could be mastered by none other than itself. On display in the conversation at the Botero show, however, was evidence of both the frailty of this belief and another of Foucault’s key insights: dietary management does not just produce the individual but produces this individual in constant, attentive relation to its surroundings. In other words, dieting produces not just “the self ” but “the social” as a regulatory sphere as well. This chapter examines contemporary training in diet and exercise in Xela in relation to long-standing and deeply gendered understandings of eating, food, and beauty. I show how attention to la figura—a phrase that appeared often in discussions of obesity, referring to the form of the human body but separately connoting measurements—configured individuals as socially responsible by virtue of their size. “Everyone in Xela is on a diet; all my friends want to lose weight,” people often told me. While techniques of dieting operated through focused attention on the seemingly discrete object of the individual body, they also situated this body within particular social standards. Because of this, in the second half of the chapter I suggest that possession may be a more apt term than individualization through which to characterize the transformations in personhood occurring in Xela—and given the transnational circulations of dieting advice, perhaps elsewhere as well. The salient difference here is that whereas individualization elides the centrality of social activity, possession implies the cordoning off of an object from its surroundings, necessitating watchful interest in the activities of others. The argument

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I present is not that the figure of the individual is a social construction but rather that recent attention toward weight has brought into being onceunimaginable forms of sociality.

“but you eat what you are given” Dalia, who celebrated her sixtieth birthday just after I began to live with her, sold K’iche’ textiles in Xela’s central market. During earlier fieldwork I carried out in Guatemala’s Huehuetenango highlands, rural Mam women showed me how they rolled their huipiles under their skirts to look more robust. Dalia, who dressed me once in the clothing she sold, showed me how to do this as well—encouraging me to push out my stomach and elbows, to “make yourself bigger,” she said. She laughed as she told me this, believing that women my age wanted to be thinner, not bigger. She then shook her head in disapproval. “All you young people [jóvenes] are on a diet today.” Eager to be a gracious host, she often exclaimed with pride during our meals that her housekeeper, who had cooked and cleaned for Dalia for more than a decade, was conscientious of health, using a lot of vegetables and buying meat “without any fat.” While living in Guatemala I had made it a practice to happily eat whatever I was served (see Yates-Doerr 2015). But Dalia assumed that I would want my food “lite” (a word in Spanish borrowed directly from English)—with “little oil” and “lots of vitamins.” Since I was both American and part of a younger generation, I would be “watching my weight.” Dalia had referred to dieting as the terrain of jóvenes, which is a genderneutral term, and it was the case that both men and women spoke frequently about weight loss—though they did so through different terms. Men would lament working desk jobs that kept them office-bound, upset that as they spent more time sitting, they found themselves eating more processed food. While a far greater percentage of the patients treated at the hospital were women than men, epidemiological research has suggested there is no reason to think that women were sicker than men (recent research instead reports that though women tend to be plumper, men may suffer higher rates of metabolic illnesses [Orellana-Barrios et al. 2015]). Doctors instead explained that they had a difficult time drawing men to their clinics because food and nutrition were the domain of women: their source of expertise, but also their responsibility. Accordingly, the bodies featured on food and dieting advertise-

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ments were women’s bodies. The weekly “Mujer” (Women) supplement of the Prensa Libre invariably included columns linking health, diet, and weight loss. When men did arrive at the clinic with lab results reporting elevated blood pressure, blood sugar, or triglycerides, nutritionists would typically talk over the prescribed diet with their wives, making sure that the women knew how to cook the recommended food and putting the onus of following the diet on them. Nutritionists may have located illnesses in the male body, but treatments were given to the bodies of women. It is for this reason that even gender-neutral terms of dieting still implicated women—their responsibilities and their failures—in ways that left men relatively unburdened. This is also a reason that people such as Dalia routinely heard that I was interested in nutrition and then pointed me toward domains where men were not to be found. For example, Dalia, wanting to help me with my research, arranged for me to talk with several of the clients to whom she sold handwoven K’iche’ textiles—all of them women. Since those who arrived to her store were there to be fitted for clothing, she thought it would be a good opportunity to talk about bodies. Many of the conversations went smoothly, but in talking with the eldest women, those in their late seventies and eighties who had arrived with the help of their daughters and granddaughters, I encountered considerable confusion. The problem of communication wasn’t one of language per se; even if they preferred K’iche’, they all spoke Spanish. Still, they didn’t seem to understand my questions. I would attempt to explain my interest in body-weight management and then ask them whether they remembered dieting and what body-weight ideals were like when they were younger. Disregarding my concern for weight, they described beautiful friends from their youth, telling me about their long braids or intricately woven clothing. I heard a lot about the skill that went into the fabric and embroidery of handwoven huipiles. As a result of my prompting, they might describe attractive women as chaparritas (short and full-figured). But they would not speak of weight as something to be individually controlled. When I tried to talk about dieting—asking, for example, whether people had ever eaten different foods to try to gain or lose weight—they would launch into elaborate descriptions of meal preparations. They made very clear that they were expert cooks and knew how to prepare the dishes required for any celebratory feast, telling me about techniques, flavors, and ingredients. They took pride in these meals, and several women commented that they had been chosen as wives by their husbands because of the quality of their stews or how

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quickly they made perfectly round tortillas. When I tried to ask specifically about eating more or less of the prepared food, one woman cut me off abruptly: “But you eat what you are given!” When I pressed them on the subject of thinness—“when you were younger, did you know people who wanted to be thin?”—they skipped over my interest in desire entirely and told me stories of people they had known who became thin, unwillingly, when they encountered hardship in life: illness, loss, or grief. Because so many people were telling me that girth was desirable, I had expected to hear about what they had done to gain weight in their youth. But the women never spoke of gaining weight through conscious attempts to eat more. Weight, insofar as it entered our conversations, was an outcome of life, not an accomplishment to be achieved. They expressed no sense that the weight of their bodies was something to be willfully managed. Even when showing me how to pad clothing to look larger, it was appearance that changed and not their corporality. My questions about weight management quite simply baffled them. This was not something I encountered in other conversations. Most men and women with whom I spoke would talk easily about dieting. Even if they did not follow a diet themselves, they understood the general frame through which I asked my questions. Chatter about weight loss was common on television and radio programs. In the words of one man I interviewed, “It feels that everyone is adopting the idea that to eat well and to look better they must diet.” But with these elderly indigenous women, our conversations about bodies centered on dress and hair and had nothing to do with one’s control of her shape and size. I was not yet seeing the significance of these repeated misunderstandings, when a K’iche’ family with whom I had formerly lived invited me to a celebration honoring San Miguel at their home. It was a night at the end of October, before the rainy season ended and edging toward the coldest months of the year. Xela’s homes have no central heating, and so I wore my warmest clothes: leggings under jeans and three layers under my winter jacket, plus scarf and hat. The family had set up a large white open-air tent in the courtyard, arranging dozens of plastic chairs beneath it, and when I arrived recorded marimba music was playing in the background and the air was full of incense. A door I never entered while living with the family opened on a large, formal room also packed with plastic chairs, several of which were occupied by men in dark suits and women in their fanciest traje (indigenous clothing). In the far corner of the room, a ring of candles decorated an altar that held a large painting of the honored saint. People motioned me in, and I took a seat in the back.

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A young woman was sitting near me with her grandmother, and we struck up a conversation. “I don’t usually wear this,” she said abruptly, not long after we introduced ourselves. She was looking down at her handwoven huipil and skirt, which were thickly wrapped around her, her body hidden somewhere beneath. She added, “I usually wear clothes like yours. But, for community events like this I always wear traje. And with the cold this is especially practical since the fabrics are so warm.” As I sat there, shivering despite my layers, it occurred to me how strange it was to be contemplating body image in a place where bodies were covered in thick skirts, huipiles, and shawls. It’s no wonder, I thought, that when elderly, indigenous women spoke with me about appearance, they focused on women’s clothing and the quality of their cooking; theirs were not bodies to be weighed but bodies to be kept warm and nourished with food and connection with kin. Granted, the young woman would leave this party and put back on clothes “like mine” in which the figure of the body was visible. But as the group feasted on the ceremonial meal of paches de papa while celebrating the company of those around them, weight seemed altogether irrelevant. I know, having talked about the matter with many of my students, that it is difficult for those who have grown up in a place where dieting is commonplace to understand that weight has not always been a reflection of one’s self. Intentional weight loss as a pervasive, everyday life practice is recent in the United States and elsewhere in the so-called West (Levenstein 2012; Scrinis 2014). But as described in U.S.-focused scholarship, to grow up in the United States today is to grow up with awareness that eating and weight are tied to moral character (Biltekoff 2007; Bordo 2003; Greenhalgh 2012; Guthman and DuPuis 2006). The self-evidence of the link between dieting and one’s social fit was also common among the younger Guatemalans with whom I spoke. Many Quetzaltecos from an older generation told a very different story. “We ate to live” (Comimos para vivir), the elderly members of the households where I lived often told me as they described rituals employed during planting and harvest to encourage abundance. They explained they had lived through conditions of scarcity and that concern for excess—be it food or weight—was a very recent phenomenon. They said that although people might have linked weight and prosperity in the past, weight was not really a matter of much thought or discussion, and it was not seen as a matter of control— individual or otherwise. Yet if moral underpinnings of overweight were

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unthinkable in previous generations, I illustrate next that food and weight were becoming salient reflections of social worth in Xela today.

let’s move! On April 6, 2008, to celebrate the International Day of Physical Activity, Xela’s Centro de Salud (Health Center) sponsored an event to promote physical activity called ¡Movámonos Xela! or “Let’s Move Xela!” It was not a high-budget operation, but the city did close a busy arterial for several hours to make room for a small parade of people who walked, jogged, and cycled through the street, holding handmade signs painted with statements reading, “I live for exercise” (Vivo por ejercicio) or “I love my body” (Amo mi cuerpo), that celebrated the importance of physical activity. The event took place shortly after a widely publicized political controversy. The Guatemalan Supreme Court had sided with the decision of Xela’s mayor to sell a section of historic land—one of Xela’s few public parks—to international corporate interests who wanted to expand their retail stores. The park was located across from the San Carlos University, known throughout the country for its demonstrations against the spread of global capitalism into Guatemala, and people in Xela were reeling from this defeat. I had heard multiple variations of the statement, “The mayor cares about his pockets, not about our city,” daily since the decision was announced. All around me, people were bemoaning the widespread privatization of land and commodification of property (see also Dickins de Girón 2011). One woman expressed her frustrations, saying, “Our city was not designed to hold the numbers of cars that pass through it each day. There is no place to walk. Not only is it unsafe, but it is also impossible, since our sidewalks are too thin.” Discussions about body weight routinely made reference to the disappearance of public space—the outdoor fields where people had played soccer that had been turned into shopping malls or a creek and lake where women used to gather to wash their clothes that was now covered over by housing developments. I heard from many that on weekends in the past they had regularly hiked along quiet mountainside paths to natural steam baths; now they stayed away, fearing the possibility of violent crime. That the city was selling the park—one of the few open green spaces in the city they found safe during daylight hours—to foreign companies fanned the fires of a smoldering anger.

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I had wondered if ¡Movámonos Xela! was, in part, a political protest of the privatization of public lands, but Esther, the main social worker at the city’s Centro de Salud, later clarified that was not the case. She explained that it had instead started as a grassroots initiative on the part of city health workers who wanted to encourage exercise. While obesity as a major health problem was unrecognized at the city’s health center even just a few years prior, by the time of my fieldwork many of their resources went toward treating dietaryrelated chronic illnesses. If the event was responding to anything, she explained, it was to the pressure Xela’s health center had received from Guatemala’s Ministry of Health to encourage obesity prevention. (A few months later I would attend a PAHO-sponsored talk in Guatemala City where researchers estimated the “cost of obesity” to Latin American and Caribbean governments to be, conservatively, in the range of $10 billion.) Her comments reflected that the Guatemalan state was not a stable entity but comprised many differing and often oppositional governing factions (see also Das and Poole 2004). The local government might have made money by selling the city’s valuable parkland to multinational interests, but another sector of government was bearing some of the costs of this transaction. Esther explained that an increasingly sedentary lifestyle was a key concern among her public health colleagues. “Today, people take buses even short distances. Quetzaltenango was once a walking city. Now, no one exercises and because of this we are overrun with obesity, hypertension, diabetes, and many other diseases.” Of the many explanations I heard for obesity given by health workers I met—television, fast food, women’s increasing employment and a correlated reliance on processed foods at mealtimes, stress, insomnia, birth control pills or the side effects of other medications, the cost of fruits, vegetables, and clean water, and so on—a lack of exercise was often near the top of the list. Throughout our conversation Esther defined exercise broadly to encompass any kind of bodily movement—it could be as simple as walking to the market. By contrast, the speakers and events of ¡Movámonos Xela! emphasized select cardiovascular exercises such as aerobics and running. Running had been popular throughout the Guatemalan highlands for as long as people could remember, and even the poor turned out en masse for annual marathons. But exercise as an activity entailing directed attention toward oneself with weight management and enhanced fitness as an outcome was still unfamiliar for many. On one side of the event space, under a sign reading, “Healthy and Happy Heart,” an aerobics instructor had gathered together a group of onlookers to

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demonstrate how to do a jumping jack. “You must move for your health” (por salud, hay que moverse), he called out, as those around him repeated the motions. He then began to demonstrate stretching techniques, encouraging the audience to follow his lead by telling them that daily physical activity would have multiple benefits for their bodies. “Even if you don’t have access to a gym, just a few minutes of exercise a day can boost your metabolism. Anytime you have a moment, a break from work, while watching TV, you can do this; it will help prevent diabetes or cardiovascular disease and will make you more flexible. And if you can do more than a few minutes, that’s even better! See how easy this is,” he added as he began to run in place. The city health center had enlisted several corporate sponsors for the activities of ¡Movámonos Xela!; as was the case with many public services, it could not fund the event through governmental financial assistance alone. Representatives from gyms distributed fliers with their rates. A local plastic surgery center, a few private nutritionists, and several private doctors who specialized in diabetes and hypertension also handed out advertisements for their services. A Maya cooperative selling “natural foods” displayed its peanut butters, soy powders, and mezclarinas (mixes of different gluten-free seeds like amaranth that were high in iron and protein) on a large table. Several diabetes medicine vendors lined the streets, providing information about herbal treatments that were offered at special International Day of Physical Activity discounts. One man had set up a stand displaying information about Herbalife’s weight-loss supplements, drawing a large audience. He was quoted in a local paper the next day as saying, “Exercise is important for health, as is a good and natural diet. You see, the human body is an engine that must be kept healthy” (Chávez 2008). Alongside the corporate sponsors, state- and city-run health centers had set up informational booths. The nutritionists from the public hospital brought with them two scales and were, free of charge, calculating people’s BMI and offering mini dietary health consults. The hospital’s obesity outpatient clinic had recently opened, and people waiting in the lines to learn their BMI expressed surprise that this was a service offered by the public hospital. Many of the patients who came to the clinic over the following month had learned about the outpatient clinic that day. Next to the scales at the hospital’s booth, nutritionists had set up a table and chairs to simulate a clinical consultation space. I chatted with some of the people waiting in the line that encircled the pop-up clinic, explaining my research

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to them and receiving consent to record their exchanges with the nutritionists (no one seemed to share my concern that the consult might be a private event). As people shuffled to see what the nutritionists were doing, I found myself next to a middle-aged woman dressed in traje who was holding the hands of her two young granddaughters—their mother, she said, was somewhere else in the crowd. When it was her turn, she told the nutritionists that she had recently learned her blood pressure was high and that she had also been feeling pain in her feet and legs. The nutritionists repeated this information back to each other in front of the curious crowd. With the quiet children holding tightly onto her skirt, the nutritionists measured and calculated her weight and height. Onlookers leaned in as one of the nutritionists announced the verdict: “Ma’am, your weight is a bit high. You have a few pounds too many. So what is happening is that you have to lose some weight, okay? And modify some of your dietary customs. Okay? What we’re looking for isn’t too much to manage. Let’s start with a month, nothing more, okay? But try to get used to [acostumbrarse] eating in this way, to get used to this dietary rhythm so you can stay healthy for good, right? Think about the diet like medicine: if you stop taking your pills then your blood pressure will return to being high. So then, you have to keep taking your pills to stay in good health. It’s the same with the diet.” “With the diet?” the woman asked. “Yes, so that you stay healthy. So then—” The woman interrupted, “How much do I weigh, ma’am?” “You weigh 60.3 kilograms, 155 pounds,” one nutritionist responded, looking at the small plastic calculator. As the woman picked up one of her granddaughters who had been clutching her leg, she said to the nutritionists, “Okay, but I should tell you that all my life I have been fat, and small.” “Ah, okay.” The nutritionist nodded. “But now that I have this blood pressure, well, right now I am eating less, in order to watch my blood pressure and— “Have you lost any weight since you started to diet?” The nutritionist interjected to ask. “Yes, I’ve lost some. I used to weigh 170.” The nutritionist looked again at the numbers. “Ah, I see.” “I had been 170.” The woman repeated. The nutritionist paused as she looked between the calculator, a clipboard that rested on the table, and the woman. After some moments of silence, she

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said, “So, we’re going to try to lose a bit of weight because this will help you to feel better. When one is a bit thinner, it’s better. Not too thin, but thinner is better. And most important, when someone suffers from an illness, one has to take care of their constitution, which means in your case that you have to watch [cuidar] how much salt you eat. Do you eat a lot of salt?” The nutritionist spoke briefly with the woman about some of her personal dietary preferences before suggesting that she make an appointment at the hospital clinic for a complete dietary consultation. The nutritionist then shifted the conversation to the theme of the day: exercise. “Do you know that it’s important that you go out and walk about thirty minutes because it’s important to do exercise? Doing exercise like this will help you begin to lose weight. And as you begin to lose weight, you’re going to feel much better. And not just feel better, but feel better about yourself, really. [Se va a sentir mucho mejor, y no solo sentir mejor—uno se va a sentir mejor, con uno mismo, ¿verdad?]. It’s going to help you to feel less tired and fatigued. So it’s important that you go out and walk when you don’t feel pain in your feet or in your legs, okay?” The nutritionist didn’t ask the woman about the activities she already engaged in during her existing daily routine, instead framing “exercise” as something to be added to her days. The woman nodded, saying that she would try to do this. “Good,” another nutritionist responded. “It’s very important that you do this for your health. You need to stay healthy for yourself, but you also need to stay healthy for them,” she nodded at the woman’s granddaughters. “You see, when you care for your health, you aren’t just caring about yourself but also about the people around you. When you lose weight, you do this not just for yourself but for your family.” Later that day I noticed that the booth with the sign “Healthy and Happy Heart” had put up a second banner, decorated with blue-and-white stripes that symbolized the Guatemalan flag, displaying the words “Healthy for life, healthy for Guatemala.” An exercise instructor who stood nearby yelled into a megaphone, “Be conscious [tome conciencia] of the need to have a healthy body. You will stay healthier; it will contribute to a better community, a better country.”

“dieting for country” Dieting for country. It’s a new framing of an often-discussed matter of nationalism: dying for country (cf. Anderson 1983). In this case, however, death is

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not a marker of noble sacrifice but a sign of a moral and costly shortcoming that leads to the loss of a body imagined as belonging to a larger body politic. The logic of this message has it that people must care for themselves so as to strengthen their country. In being asked to engage in the self-directed obesityprevention strategies of exercise or buying diet foods, they are being asked to shoulder the financial burden of public health—asked, in other words, to secure the status of citizen by asking less of their government. In the days leading up to World Diabetes Day (El Día Mundial de la Diabetes) the Prensa Libre ran the following op-ed about diabetes care, written by Dr. Patricia Orellana Pontaza: In Guatemala it is possible that ten of every hundred people suffer from diabetes, but only half of those know it. It is the responsibility of each person to assess and get involved in his or her health and to care for themselves. But it is also the responsibility of the government to eliminate taxes on medications so those who aren’t on IGSS [Guatemala’s social security system] can be covered; the same goes for taxes on technical equipment (glucometers, strips, etc.). In the future, the government will not have the budget to support the costs of the complications of diabetes and other chronic diseases. Everyone is responsible for his or her own health. Go to the doctor, get involved, and take care of yourself. (2008)

The contradiction of this message—“Go to the doctor . . . take care of yourself ”—was compounded by the image of a blue circle next to the column. A caption explained that this circle, chosen by the International Diabetes Federation in 2006 to commemorate diabetes globally, “represented unity in the fight against this illness” and “demonstrated solidarity with patients” (Prensa Libre 2008). The message of solidarity could also be seen at the public hospital’s obesity clinic. When Quetzaltecos did “take care of themselves” by going to the doctor, they were greeted by a large banner displaying the slogan of the National Unity of Hope (UNE, the political party of the presidential administration): “Time of Solidarity.” Here, the practice of self-care was part of a project of nation building. The moral order being crafted in public health discourses about nutrition was one in which self-care was a measure of being part of a national community—the very strength of which was attenuated by the emphasis on the responsible self. People were routinely taught that “ just a few minutes of exercise a day” could not only prevent the onset of diabetes and heart disease but keep their families and communities healthy and happy. Though these are just a “few minutes,” this encouragement transforms every moment into an opportunity

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in which you can make yourself a socially responsible citizen. This smallest, softest, and most gentle of motivations (“see how easy this is”) expands at once outward and inward. “Limit the amount of salt you eat”—the advice seems extremely benign. But one cannot limit one’s salt in an environment where “you eat what you are given.” To limit one’s salt, there must be a one, separate from others. This one must have control over what is eaten, accepting some foods, refusing others. Guatemalan women have used clothing or hairstyle to differentiate a person from her surroundings for centuries, but the individuality that emerges through the limitation of salt is cleanly quantified and deeply internalized. Nonetheless, even in the practice of limiting salt, the self that emerges is hardly the atomistic self that it might appear to be at first glance. Instead, individuality here is formed through an emphasis on sociality: watching your salt is good for the country. I saw clearly in the training of weight management that what appeared as the “individual” and what appeared as the “social” emerged together and, rather than being oppositional, were contingent on the other. In the interaction described earlier, the nutritionist used the promise of “feeling better” to encourage weight loss, but while this feeling was associated with the patient (the “you” who will feel better), the impact of the feeling was not restricted to the patient. “You aren’t just caring about yourself but also about the people around you,” advised the nutritionist. While it is a seemingly singular body that steps on the scale, the meaning of this weight cannot be understood as straightforwardly individualized. This is not just because small hands were tugging on the woman’s skirt, potentially impacting the resulting numbers. Nor is it because the BMI standards through which her body became overweight were drawn from thousands of other bodies. Here, body weight was also made social through the emphasis on well-being as shared. “You also need to stay healthy for them,” the nutritionist told her. “When you lose weight, you do this not just for yourself but for your family.” Global health experts commonly frame dietary transitions as part of a process of “Westernization”—entailing consumption of manufactured foods and a sedentary lifestyle (Groeneveld, Solomons, and Doak 2007, 170; WHO 2002). Public health experts in Guatemala often bemoaned a concomitant process of “individualization”—which they imagined would produce a singular self, detached from others and without the obligations and connections of relationships, which they also associated with the West. What I have begun

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to suggest here, however, is that individualization is often an incomplete framework through which to understand how these so-called Western dietary practices operate in postwar Guatemala. “The self ” formed through dietary practices also brings about a precarious sociality in which decisions not just about what to eat but about who to be and how to belong must be continuously made. A question might here arise: is this interplay between individuality and sociality in obesity prevention a strategy unique to Guatemala, a place where the seemingly singular medical label “patient” clearly does not fit with the many family members that regularly appear for clinical treatment (see especially T. Harvey 2008), a place women prepare food in large pots that serve many at a time, and a place where kinship, though often stretched across war and international borders, remains central to life? Or is this how nutrition education operates globally? It is my hope that the ethnographic orientation of this chapter unsettles the expectation that I could ever answer this question, at least when it is posed in such a way that imagines there is a singular, global world out there to know. As Nicole Berry (2010) notes in her thoughtful study of global maternal-mortality campaigns in the Guatemalan community of Sololá, the global is always formed in local practice. Still, in focusing on situations were the category of the individual is shaky in those very practices taken as extremely Western by many around me, I aim to open up both the concept of the individual and the concept of the West. By showing that individualization is an ill-suited analytic for understanding dietary practices in these cases, I hope to make space for the possibility that it is inadequate elsewhere. Whether it is—and how this plays out—remains an empirical question. Instead of characterizing recent attention toward dieting through the analytic framework of individualization, in the next section I suggest that a different framework might more helpfully articulate the dietary transitions underway here (and perhaps elsewhere): that of possession. I employ the sociolegal idea of possession in terms of ownership: belonging to one and therefore not to another. If individualization evokes atomized detachment from the social world, possession emphasizes relations of property between one and this world (if one owns something, this implies that others do not). Though the terms are in many ways connected, they diverge in one key way. Whereas the individual self is imagined as autonomous, the possessive self is one that remains highly, and necessarily, watchful of its surroundings.

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possessing the body, possessing social anatomy As unfelt-but-lurking dietary illnesses started to become a matter of public health concern in Xela, so did messages linking metabolic practices to personal and social well-being begin to appear everywhere. A billboard for Toledobrand sandwich meats located in several places around the city showed a thin woman in workout clothes smiling behind a sandwich of turkey, lettuce, and tomato: “For those who have a taste for quality: new turkey products, low in calories.” A poster for whole wheat bread hanging in a grocery store reported that it was “naturally low in cholesterol and a good start to an active day.” “With nutrition,” advertised a brand of instant soup, next to the slogan “sentirse bien, estar bien” (feel well, be well). The ads generally promoted quick, easy-to-eat foods that were packaged individually: oatmeal, cereal, sliced bread, fruit juices, and yogurt. The milk company Dos Pinos marketed single-serving boxed milk with the slogan “100 natural, good for your health, and very delicious” (using the informal you—tu). The company Bimbo used the slogan “nutrition with love” to promote its whole wheat sandwich bread, multigrain granola bars, and the health bar PlusVita. Bimbo also cosponsored a cooking class, along with the Guatemala City– based League against Obesity, which it publicized with an ad that read, “More than 98 of people who try temporary diets return to their previous weight or more. If you want to control your weight permanently, attend our cooking class and learn to make quick, simple, and healthy dishes for you and your whole family.” A giant billboard on the street near the entrance to Xela’s busy Minerva market advertised the Nestlé milk product Svelty. It showed a white trail of formula tracing the pattern of the intestines over a firm, white stomach. “Unleash your beauty,” read the billboard, which informed its viewers that the product had “0 Fat; 100 digestion. Plus calcium.” Even though most people with whom I lived had never tried the product, they knew what it was. At times, nutritionists recommended it to patients in the city hospital, and I even once heard a nutritionist repeat Nestlé’s slogan (changing the informal form of “your” [tu] used in the ad to the formal “your” [su] that was used in the clinic). “Unleash your beauty” (destapa su belleza), she said, after recommending the product for the patient’s diabetes. She here framed “your beauty” as something you were in charge of—that you possessed. Elsewhere in the city,

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Billboard for Nestlé’s product Svelty, located near the market Minerva in Xela.

products were advertised in a similarly personalized manner. “It’s good for my heart” was a slogan painted on a truck selling the oil Aceite Ideal. A television commercial for Ensure showed an elderly couple walking briskly: “Do you know who is drinking Ensure?” it asked, answering, “People like you [tú], who lead healthy lives and recognize the importance of proper nutrition.” In contrast to the possessive pronouns used in these ads, in Guatemalan Spanish people often do not use possessive pronouns when describing bodies. In the previous section, when the gym instructor said that daily physical activity would benefit the health of his audience, the exact words he used were “La actividad física diaria provee múltiples beneficios al organismo.” Here, al organismo translates literally as “to the body” and not “to your body.” “El cuerpo necesita eso,” the women with whom I lived would say when encouraging me to eat more food, using the words “the body needs this” and not “your body needs this.” “Lo que pide el estómago es la comida” (the stomach asks for food) someone might say when expressing hunger. Living with families, I quickly learned from those around me to say, “the stomach is not hungry” rather than “I am not hungry,” which would seem to lessen my offense to the cook, since the lack of appetite was not my own but the fault of anatomy. This speech pattern is linked, in part, to a stylistic characteristic of the Spanish language, where use of passive voice is common and does not imply passivity of character. But, the separation of the body from one’s self through the statement, “the body is hungry,” also points to a different organization of

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agency than is mobilized by the statement “I am hungry.” It is revealing that people told me on numerous occasions that hunger was not controlled by an embodied self or even the stomach but by worms. Caroline Rosenthal describes this in one highland community in Guatemala: “These live in a pouch in the stomach and tell a person when he is hungry. Without them, we would not feel hunger, would not eat, and thus would perish” (cited in Barrett 1997, 584). I heard from many that when eating in front of a child it was imperative to give a bit of food to the child’s worm (“tiene que darle un pedazo para la lombriz”). It is not the child who needs the food, but the creature inside the child. While it is a colloquialism—a child truly believed to have worms would likely be given antiparasite medication—it also signals a different sense of responsibility than encouraged by public health instruction, which typically positions hunger within the self and not within a separate agent (the stomach, the worm). When listening to people talk about bodies during my fieldwork, I sometimes found myself recalling a passage in The Possession at Loudun, in which Michel de Certeau describes the social landscape in seventeenth-century France, where the boundaries of bodies were permeable, unstable, not divided into interiors or exteriors but fluid and to be shared by multiple persons. He writes of a woman who could not even utter the words “my body,” for this body did not belong to her but was distributed across a general public (2000, 46). He suggests that with the expansion of formalized scientific expertise, bodies became seen as individual, and selves became partitioned into separated analytic units, to test and treat individually. Persons became patients; patients became categorized through “nosological essences” (115), and an entire classificatory and typological schema of a self, distinct from the social body, was set in motion. Setting aside the debatable historical specificity of de Certeau’s account and instead focusing on the relation he draws between bodies and scientific expertise, there is resonance between this woman’s inability to vocalize “my body” and the refusal of the K’iche’ women who had not grown up with a language of dieting to respond to my questions about weight management. It is not that these women did not see themselves as selves in many aspects of life. In speaking of their beauty, their skills in cooking, and the care they provided to their husbands and children they unquestionably differentiated themselves from their surroundings. But, for them, the dieting body of a weight-regulating self was un-familiar, in the sense that this was not how their families operated. I suggest that when it came to eating, their bodies were not

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bounded bodies (individual, social, or otherwise). Food was historically communal, servings regulated by both circumstances and food-preparation practices. People no more controlled their individual patterns of consumption than they did their size. Clothing mattered, as did hair and other bodily presentations. But possession of one’s flesh and a sense of ownership that gives rise to a statement of “my weight” (mi peso) would make little sense, as weight did not have the broader implications of self-worth and self-control that it had come to have for their daughters, who were taught that their bodies were theirs and their weight their responsibility. The following exchange between a woman with whom I lived who suffered from diabetes and her doctor is instructive of the tension between an impersonal and possessive treatment of the body at play in clinical consultations: Ximena: So here I am now, all of the body hurts. The feet. It seems that they’re tied up with a lasso when I do this. Oh, the pain! Doctor: So when your sugar is very high in your body it affects your head, and everything is affected: your legs, your feet, your hands. Sugar is bad for everything, everything, everything. Because of this you have to maintain control of it—what you should do is nourish yourself better.

Ximena: Así estoy ahorita, todo el cuerpo me duele, los pies, parece que los tengo amarrados con un laso cuando hago así. ¡Re-bien, que dolor! Doctor: Entonces eso, el azúcar cuando Ud. lo tiene muy alto en su cuerpo afecta su cabeza, y todo afecta, sus piernas, su pie, sus manos, todo, todo, todo hace mal el azúcar. Por eso tiene que mantenerla—lo que debe hacer es alimentarse mejor.

While Ximena speaks of pain of the body, the doctor speaks of your body— a body that he charges her with controlling and feeding better. There was not a hard and fast rule around how people spoke about their bodies. But I saw this pattern often, as the customary Spanish way of referring to the body as a separate object—el cuerpo (the body), el estómago (the stomach), el hambre (the hunger)—became situated alongside, or replaced by, personal pronouns of the responsible, possessive self: my body, my stomach, my hunger. In my transcripts of clinical interactions, when people referred to the body in personal terms, usually it was the nutritionists that did so; patients tended to use impersonal descriptions customary to Spanish. It is beyond the scope of this research to trace a contemporary transition in national or global patterns of speech, but I do want to note that the language used by health educators to instruct Guatemalans about dieting regularly

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employed possessive terms common in the English language such that bodies and feelings were described as belonging to a singular self. I suggest that this is, in part, because much of the formal education about dietary health comes from the Guatemala City–based organizations PAHO and INCAP, whose researchers and policy makers are themselves from other countries or have trained and travel regularly abroad. Additionally, the wave of advertisements using personalized and possessive language to target potential customers that has swept through Xela is also designed through transnational media circuits. “With exercise, one will always have that sensation of well-being” (Con ejercicio, uno tiene siempre esa sensación de bienestar) announced a public health service announcement over the radio. A banner read, “50 years of improving your health” (50 años mejorando tu salud), to advertise the weight-loss product, Shaklee, which originated in California and was now sold in Guatemala though multilevel marketing. An announcement for the Prensa Libre’s weekly “Mujer” supplement is emblematic of this language. The ad focused on a spandex-clad woman on an exercise bicycle, a second woman in her spinning class visible behind her. “Care for yourself ” (Cuídate), the ad read, using the informal imperative for cuidarse, to which it added, “everything that you need to know is in your hands” (todo lo que necesitas saber está en tus manos). Whereas Spanish speakers in Guatemala typically employed a nonpossessive article to describe the actions of the hands, this ad describes hands with the possessive determiner (your hands). Next to this slogan was another message, which—as I elaborate on in chapter 5—also encouraged people to see the body in possessive terms, as an object they must manage: “Burn calories in style” (Quema calorías a la moda). While there is a long-standing agreement within the social sciences that some degree of selfhood and bodily awareness is likely universal (cf. Giddens 1991, 75; T. Harvey 2008; Mauss 1985, 3), the notion of one’s ownership over a bounded body connects to particular economic and political conditions. C. B. Macpherson argues that John Locke’s late sixteenth-century declaration that “man is free and human because he owns himself ” was, at the time, revolutionary, as it challenged commonly held beliefs about the subordination of individual bodies and beings to both God and a ruling authority (Macpherson 1962, 269). Contesting this subordination, Locke argued that an individual’s labor belongs to him by postulating as a fundamental right that “man has a property in his own person” (1988, 27).

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Jan Goldstein further documents the transition in Europe from the sensory self (ame) of the seventeenth century to the “salient scientific object” self (moi) of the nineteenth century (2000, 90). She describes the earlier self as a loose collection of the sensations one experiences and the memories one recalls. Yet by the turn of the eighteenth century, the sensualist ame was becoming replaced by the moi—a willful agentive self linked to both moral responsibility and political stability. Tying this latter self to the privatization of property, she argues that a responsible self is one on which claims to ownership could be made. Several scholars have argued that the notion of possessive individualism—a formulation of personhood where the self possesses both the body and the output of its labor—served as a primary precursor for a market-driven society (Duden 1991; Macpherson 1962). Similarly, in Xela the formation of a responsible dietary self—bounded and separate from society and who owns his or her body—might be connected to market-based changes: from the disappearance of public land to the expanding dependence of wage labor to the proliferation of grocery stores filled with individually portioned processed and packaged goods. Still, the market relations and corresponding categories of personhood that incited early transitions to capitalism do not operate in the same manner today as they did centuries ago. Andrew Lakoff (2005) is among many who have argued that shifts in contemporary categories of personhood in Latin America connect to an increasing emphasis on purchasing and consuming bodies rather than on the productive, docile, laboring bodies of capitalisms’ pasts. To clarify this transition further, another brief historical diversion is helpful—this one into the history of advertising. The 1928 text Propaganda has much to say about how various ideas of “the self ” can be manufactured and employed to sell everything from products to political movements. Its author, Edward Bernays—Sigmund Freud’s nephew, widely considered the “father of Public Relations”—describes the development of an individualized, willful, agentive, and self-conscious self as but a first step in the advertising process. The construction of a solitary self, which operates as an “individual machine,” remains important to the agenda he outlines, but he also encourages this mechanistic self to be developed in dialogue with “group structure” (1928, 76). He writes that effective advertising “takes account not merely of the individual, nor even of the mass mind alone, but also and especially of the anatomy of society, with its interlocking group formations and loyalties. It sees the individual not only as a cell in the social organism but

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as a cell organized into the social unit” (55; italics mine). The aim of advertising, he explains, was to create a “you” that—though aimed at each person as a unique self—would still appeal to an audience of millions. The advertised-self crafted by Bernays bears resemblance to the liberal individual as depicted by Nancy Leys Stepan. She describes this self as follows: Starting in the 17th century, and culminating in the writings of the new social contract philosophers of the 18th century, a new concept of the political individual was formulated—an abstract and innovative concept, an apparent oxymoron—the imagined universal individual who was the bearer of equal political rights. The genius of this concept . . . was that it defined, at least theoretically, an individual being who could be so stripped of individual substantiation and specification (his unique self) that he could stand for every man. Unmarked by the myriad specificities (e.g., of wealth, rank, education, age, sex) that make each person unique, one could imagine an abstract, non-specific individual who expressed a common psyche and political humanity. This Kantian notion of the abstract empty subject could be used to establish the theoretical grounds for moral autonomy and democracy. (1998, 28)

Central to Stepan’s argument is that universal individualism remains today an illusion—there are far too many ways in which this “individual” remains socially marked (concerns for race, sexuality, gender, and class proliferate the ads I have cited, and I return to these identities in the next chapter). Similarly, Bernays would seek to explicitly craft an image of a unique, personalized self by capitalizing on “interlocking group formations and loyalties” (1928, 55). In other words, the atomistic empty subject of traditional liberal individualism becomes remolded today through appeals to the surrounding world. In my study of dieting, I saw that insofar as persons were separated from their social surroundings, this separation did not produce the mythical Western individual, unconcerned or unaffected by the surrounding world. Instead, even the most Western of dietary practices I observed—those that divided people from their surroundings, transformed bodies into things, and focused attention on oneself—created selves who, by caring for themselves, were involved in the project of caring for their families, communities, and country. These were selves responding to social pressures and engaging in social performances, selves shaped by the relationships in which they participated. The individual/social binary—that classic descriptor of a difference between Western and non-Western societies—crumbled. What remained was not the individual or the social. The moral individual produced through the notion

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that one must feed oneself well for the good of the country configures “the social” and not just the individual as a bounded, measureable, controllable unit.

refiguring the social Clearly people in Guatemala have always eaten and moved—they have always dieted, in the broad sense of dietetics as a practice of eating. But careful attention to quantities of consumption and duration of movement has not always been part of the presentation of oneself as engaged in correct moral and aesthetic practices. In a space where people once cared about their clothing, their hair, their cooking skills, and the flavors of the food, they were now learning to care about the size and shape of their bodies, about what and how much they ate, and about their involvement in exercise. The dieting practices that I have been describing create a particular kind of person: a self that must focus on the body, its experiences of hunger and satiety, and the decisions made about eating or abstinence. It is a self located in a singular body, and, as seen in a common media caricature of obesity in which a measuring tape is wrapped around a budging stomach, it is a self literally bound by tapes and measures. It is a self that must follow a personalized exercise routine and a self responsible for controlling or limiting what it (in the singular) eats. Unsurprisingly, willpower and self-control were central to the global health framing of eating and exercise. People no longer lived in an environment where “you eat what you are given,” but in an environment where food was saturated with choices and where selves were responsible for themselves. Replacing the impersonal expression—the stomach feels hunger, so the body eats—was the possessive self-orientation of tengo hambre (literally, I have hunger). Yet there is a wrinkle in this thesis on emerging individuality: the very focus on the figure of the individual self was encouraged by emphasis on the importance of the good of the surroundings. In other words, it is not—or at least not only—the individual that emerges through an attention to dieting; a social world composed of responsible, interlocking selves materialized as well. The toggling between an emphasis on individual and social responsibility allowed for doctors to selectively emphasize—and selectively overlook— certain moral struggles their patients confronted. In 2006 I shadowed a

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doctor working at a government-sponsored diabetes clinic that checked blood sugar levels for five quetzales (sixty cents) and sold medications at a subsidized rate. I remember well one woman who came to the clinic with the dangerously high blood sugar level of 395. When the doctor pressed her about what she had been eating, she admitted to having eaten both soda and cake. There was a birthday, she explained. She had asked for small portions and had less than half a cup of soda and just a few bites of cake, but she could not refuse. The doctor scolded her with obvious annoyance, explaining that this was “irresponsible” and that she had an obligation to her family to look after her health. When she asked whether there was medicine that might help, he then turned back to her, informing her, “The problem is not a problem of medicine. The problem is with you.” Seemingly taken aback, the woman left the clinic abruptly, leaving the treatment plan he had written for her on the desk. Though the doctor had framed treatment in moral terms, he had also ignored the other moral obligations she was working to navigate, including the need to show respect to her family by eating their food. In many ways, a statement such as “the problem is with you” works to place the disease of diabetes within the individual and thereby devalue the social conditions of the illness (see also Ferzacca 2000; Rock 2003). Yet this statement was also made in the context of emphasizing familial and social commitments. Given the prevalence of this kind of back-and-forth between the individual and the social, I have suggested in this chapter that individualization is an inadequate framework through which to frame the expansion of dietary advice in postwar Guatemala. The body produced from increasing commercial and public health attention toward dieting was less that of a solitary individual than it was a body capable of being possessed by its self, laying the groundwork for society to be understood as a unit that could be divvied up and possessed while also directing attention away from the responsibilities of the state for all of its citizens. In the months that followed the Guatemalan Supreme Court decision mentioned at the start of this chapter, several multinational corporations had begun construction of fast food chains and retail stores on the space of the formerly historic parkland. In the footsteps of companies that had already established business on Xela’s soils, they would market their single-serving products through direct-to-consumer ad campaigns that target the personalized, but still universal, “you” of contemporary advertising. As a result, families of Guatemalan farmers, whose dwindling profits drove them from

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harvesting corn to already-bulging cities to look for work, now found themselves audience to ads imploring them to enjoy manufactured corn-flour and corn-syrup products for the good of their families, their communities, and even their country. A year after ¡Movámonos Xela! I noticed a billboard for Taco Bell being constructed at the edge of the space where the park used to be. “Crisis? What Crisis? Taste the flavor of savings!” it read, attempting to dispel concern about mounting global financial turmoil with the image of a happy family, responsibly feasting on meat tacos purchased for just six quetzales (seventy-five cents) each. Across the street was another billboard, this one for a plastic surgery clinic that showed a bikini-clad girl, a measuring tape wrapped around her thigh: “Looking good so you feel better. For your health!” Here, the appeal to appearance had the social underpinning of health. These ads appear quite different: one encouraged eating, the other weight loss; one displayed a family, the other a solitary person. Yet they have in common that they use dietary practices to make an appeal for responsible individuals, who care for the social by caring for themselves.

chapter 4

Contemporary Body Counts

90–60–90 Linda and I met at La Luna, one of Xela’s oldest coffee houses, which doubled as a museum. Black-and-white newspaper clippings from the turn of the century lined its glass tables, and portraits of historical politicians and onceprominent community members decorated the walls. Hundreds of mementos—of the wheat factories that had made the highlands a hub of agricultural commerce by the nineteenth century, of the German-designed railroad built in the 1920s, of beauty pageants that began three decades later—announced with pride the European influences on the city, which had once been the capital of a short-lived (1838–40), predominantly indigenous country of its own called Los Altos (The Highlands). The café was crowded with Quetzaltecos, both young and old, who had gathered inside to avoid the afternoon rain. I ordered the region’s traditional hot chocolate. Linda, who was on a diet, ordered a black coffee. Linda was the twenty-five-year-old niece of a woman I lived with at the start of my fieldwork. I had crossed paths with her by chance on the street earlier in the day, and since we both had the afternoon free, we decided to reconnect over a drink. We had met a few times the previous months. She was studying for a degree in business at a local university at night, but worked in a small office during the days as a secretary for a man she described as abusive and corrupt. Linda had applied for several other secretarial jobs since I had known her, and the forms required her photograph. She was unquestionably

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stylish; her clothes, even when it was raining, appeared freshly ironed; her eyes were always carefully framed by eye shadow; and she was adept at maneuvering Xela’s cobblestone streets in stilettos. But she was—in her own words— “short and dark.” Her hair was dark, her eyes were dark, and without heels she was under a meter and a half. “They always pick the canches,” she said about the hiring process, using a word that translates as blond, but which in Xela refers to anyone with lighter features. She was proud of her Maya heritage. After learning about my interest in nutrition, she exclaimed confidently that the intellectual achievements of the ancient Maya were connected to their remarkable agricultural prowess (she made sure I knew that the tomatoes on Italian pizzas had originated in Mesoamerica). But she also felt pressure to appear Western—she wore tall heels and blue jeans and was on a diet to make her already petite body even thinner. Our meeting at La Luna that day was bittersweet; she had finally quit her job but still hadn’t found anything to replace it. I had arrived at the café before Linda, and the daily newspaper I had been reading was open to an ad for a nonsurgical weight-loss procedure called Ultra Shape. “If you don’t have a flat stomach, it’s because you don’t want it. Dare yourself! And reduce fifteen pounds in fifteen days,” read text beside an image of a toned, naked woman, covered only by a wisp of blond hair (2008). A similar product was advertised during the commercial breaks of a popular soap opera watched regularly in the home where I was living. In this televised commercial for “passive” weight loss, a thin blond woman would strap an inflatable yellow band to her waist. As the band, which was plugged into an electric outlet, began moving, the woman on the television announced the miracle of a machine that did the work of weight loss for her; all she had to do was make the choice to use it. Linda noticed the newspaper while we waited for our drinks. “Ha!” she said, pointing at the picture of the woman’s body. “Just look at this body. I could diet all I want, and I would never look like that. It’s always 90–60–90. 90–60–90 is everywhere.” Most of the hundreds of people I spoke with about body image in Guatemala used these numbers—centimeter measurements that corresponded to the hourglass shape of a woman’s bust, hips, and waist—in their descriptions of the “ideal body” (cuerpo ideal). Regional newspapers, which typically ran an image of a swimsuit model on the centerfold, would print measurements of the woman’s size next to her image, so the audience could see how closely

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they matched 90–60–90. The people I spoke with about these numbers would usually qualify that this wasn’t the body they wanted. Men told me they preferred women with waists larger than 60; women told me that they had more pressing concerns than the shape of their bodies. But everyone knew that 90–60–90 was the unofficial ideal. Linda slapped the newspaper. “It doesn’t matter if I eat or diet; I am simply not made to look like that. I am square. We are short and square. Look around, this is not the way our bodies are made.” Still, the message on the page stared up at us: “if you don’t have a flat stomach, it’s because you don’t want it.” After our conversation ended, I went back to the newspaper. On the next page was another full-page ad, this one promising that a toned, revealing backside was “Accessible to All” through plastic surgery. The image of the accessible ideal body serves as an introduction to this chapter, which explores how metrics surrounding size and shape connect to histories of race and exclusion in Guatemala. At the time of Spain’s conquest, race (raza) in the region today known as Guatemala was used in reference to social presentation and legal claims surrounding property inheritance, and not in reference to physiology. In the late eighteenth century raza became more tightly linked to the material of the body, as scientists working in Latin America developed techniques that categorized racial difference through the measurement of physiological attributes (Poole 1997; Pratt 1992). These techniques, combining with older notions of blood purity, aimed—with varying degrees of efficacy—to naturalize the idea that people were stratified into discrete blood types, with European blood marked as superior (Wade 2008; Wade et al. 2014). In this chapter I suggest that new techniques for classifying decency and superiority are emerging—that fat is joining historical discourses of blood as a salient characteristic of race. The subordination through racial classification continues, and so-called scientific measurement techniques are still used. This subordination takes a cunning form, however, as notions of race upheld by the expertise of scientific measurements do not rest on a determinate, inevitable physiology. Instead, in framing fatness as the embodiment of willpower and agency, medical experts, joined by commercial interests, present “proper” body types as something that anyone can have (accessible to all!). Yet despite the appearance of malleability, lightness—with its connotations of both weight and color—remains deeply rooted in sociohistorical forces that exceed selfcontrol. I focus on stories of people caught in this apparent contradiction to

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illustrate ways in which attention directed toward the measurement of fatness by health workers in Guatemala is, to borrow an apt phrase from Carlota McAllister and Diane Nelson, “a new means of waging a long fought war” (2013, 10).

blood, fat, heredity Though the idea of race in Latin America has long been used to demarcate social and civic position (Quijano 2000, 535), race became attached to the phenotypic trait of skin color only in the twentieth century (cf. de la Cadena 2001, 260). Before this, racial classifications were made on the basis of other aspects of difference, including lineage, place of birth, language, last name, dress, or religion. Archival records preserved from the region today called Quetzaltenango show a complicated ancestral past, with many categories of citizenship that are no longer recognizable: españoles, españoles-europeos, españoles-indios, españoles-ladinos, castas, mulatos, indios, pardos, mestizos, sambos, esclavos, negros, caciques, laborios. It would be misleading to directly translate these terms; many of their meanings have been lost, and, more to the point, their meanings cannot be fixed into translations, since the words and relationships they once referenced have also transformed over time. Suffice it to say that it was a poignant exercise of power when the government changed the way in which identities were tabulated in the second half of the nineteenth century, compressing a multitude of relations into two official categories: indígena and ladino. The consolidation of myriad ways of being into these categories was aided by the arrival of governmental statistics. Todd Little-Siebold writes that when Guatemalan elite gained political power in 1871, they “brought with them a vision of identity politics that they sought to impose on the nation.” This vision entailed the creation of an “apparatus for counting and naming their subjects”: the Dirección General de Estadística (Statistical Reporting Center) (2001, 123). Through the implementation of a national census, as well as through increasing governmental reliance on numerical documentation more generally, individuals became slotted into one of the two categories. By the turn of the twentieth century, the Guatemalan national census stated, “The Ladinos and Indians are two distinct classes; the former march ahead with hope and energy through the paths that have been laid out by progress; the latter, immovable, do not take any part in the political and intellectual life, adhering tenaciously

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to their old habits and customs” (cited in Grandin 2000a, 130). Though the census used the word class (clase) as a means of categorization, over the coming decades this term was conflated with the term raza to refer to something one naturally is and not a set of actions one does (López-Beltrán 2007; Stolcke and Coello de la Rosa 2008). The census’s demarcation of two racial types was naturalized by locating difference within the material of the body. In her writings on Peru, Marisol de la Cadena suggests the sixteenth-century dualism between nature and culture became extended in the eighteenth and nineteenth centuries as race became conceived of as a “scientifically discernable biology” to be measured and taxonomically organized (2005, 267). It was over this time that the physiology of blood became an especially critical synecdoche of racial power in Xela, as blood became linked to determination of ancestry and purity of descent. Miguel Angel Asturias, eventual recipient of a Nobel Peace Prize, made blood type a central focus of his argument for the importance of what would become known as mestizaje. In his 1923 dissertation Sociología guatemalteca: El problema social del indio (Guatemalan Sociology: The Social Problem of the Indian), he writes, “The Indians have worn themselves out. Their blood has only flowed round in a circle over innumerable generations. New blood, renewing streams that mend the fatigue of his systems, life that bubbles vigorously and harmoniously, is needed. New blood: this is our hope for saving the Indian from his present condition. His functional deficiencies, moral vices, and biological fatigue must be counterbalanced” ([1923] 1977, 102). Blood has long been ideologically powerful in Xela, entwined with notions of the body, sexuality, and social power (Grandin 2000a). Numerous anthropologists have shown that the language of blood has been used in Latin America to organize and reproduce property-based power relations, making technologies of race inextricable from those of gender and sexuality (C. Smith 1995; Stolcke and Coello de la Rosa 2008; Wade 2009). The argument that I offer in this chapter is that the material of blood is no longer as singularly powerful for the reproduction of power relations—that is, for the making of race and the forms of gender and sexuality to which race is tied—in Guatemala as it was in past eras. I suggest that the substance of fat is emerging as relevant to race making, with effects on how gender and sexuality are practiced as well. That a person’s nature and character were reflections of his or her blood was an idea once promoted and upheld by measurement-based technologies of scientific expertise. Significant research shows that Latin Americans still

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commonly link the substance of blood to attributes of moral worth, including cleanliness, strength, and purity (e.g., Roberts 2012; Sanabria 2009; Sanabria, forthcoming). Still, in my fieldwork, scientists and health professionals tended to treat blood as impersonal—neutral enough that it could be donated or received from strangers. Frequent blood drives taught hospital patients that they had a blood type that was not necessarily the same as the blood type of their kin and that no amount of education, perseverance, volition, or adherence to practices of decency will cause this type to change. Scientific concern about the quality of blood surfaced clearly in discussions of AIDS and diabetes, where some types of blood were treated as far better than others. But the worry was typically for what blood carried (a virus, sugar) and not that this blood was itself an inherent quality of the person. Important to the argument I develop, there was another key bodily substance that was becoming treated as reflective of social position and worth in expert discourse. By the time I began fieldwork, “lifestyle” had become central to the way that many health professionals in Guatemala were framing obesity.

a new type of type It is critical to the transformations in race making and consequent forms of racism that I describe that scientific accounts of fat do not share the fixity of scientific accounts of blood. If the biological form of the body was once seen by scientists as inherited, changing only over generational time, it was routinely described by health professionals I met as something that could be sculpted and controlled by any given individual at every moment in time. The previous section illustrated how racial distinction is scientifically coded through attention toward biology, further suggesting that while blood has been central to race making in the past, fat is becoming central to race making today. This section shows that in contrast to scientific discourses of blood (or its more recent corollary of genes) that evoke a determinate biology, expert discourses of obesity present biological form as malleable. I build on this to then suggest that the emphasis on the malleability of fatness aligns conveniently with powerful race-making politics in Guatemala. First, however, I will tell you about Vilma. Vilma, a woman with whom I lived, showed me many pictures of herself— as a child, as a teenager, in her first marriage, and then later, when her children were grown. “Era delgada,” she said. “Pero aquí estaba gorda,” pointing at a more recent picture. The Spanish distinction made in the verb “to be” provides

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insight into how Quetzaltecos linked their weight to their sense of self. While ser suggests “to be” as an integral part of identity, the verb estar marks a state of being that one will pass through. “Era delgada” (I was thin) indicates that in youth Vilma experienced thinness as inherent to who she was. “Pero aquí estaba gorda” (But here I was fat) indicates that she saw her fatness as a temporary condition of her body and not as a fundamental aspect of her self. I noticed that people referred often to themselves as fat or thin using a combination of ser or estar, “to be” verbs, suggesting that they connected fatness/thinness to their identity but that their size might also fluctuate. As I explained in the last chapter, this does not necessarily mean that fatness or thinness were linked to self-control or that size carried moral connotations. Many people told me that they were (or had been) thin or fat as though it was something that had happened to them, not something determined by will or intention. Moreover, there was nothing precise about these categories—they were not measured or standardized but interpreted and felt. When Vilma spoke to me about fatness she talked not of weight—she did not know how much she weighed—but of the fit of her clothing. It started to get tight after her first child was born. She would replace her clothes, but soon she would outgrow them. Now, however, she told me that her clothing was comfortable again. When I asked her if she had done anything to make this happen she said no—that these changes had been “God’s will.” While I lived with Vilma, she made an appointment with a doctor. She was having trouble with her vision and wanted an evaluation. I was working at the public hospital two days a week but had not yet been to a private clinic, so Vilma invited me to come along. Evaluations in the public hospital were free of charge, but patients had to endure long lines in crowded waiting rooms. Many patients treated by private clinics, such as Vilma, were far from wealthy, but unlike patients at the public hospital, they had managed to produce the payment that would keep them from spending unknown hours waiting for a short consultation. Vilma’s evaluation began with a routine weigh-in. She then sat down at a small metal table opposite the doctor and explained that her sight went blurry and she sometimes became dizzy. The doctor asked her to stand against a wall and read various lines of letters from a card on the other side of the room, a task she completed without difficulty. Next, he shined a bright light into her eyes, asking her to look left and then right. Then he pulled out a chart listing BMI classifications. He explained that her index was determined from the

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calculation of her weight in meters divided by the square of her height in meters; from this calculation he could see that her weight was high. To have a normal weight (peso normal) she would need an index between 19 and 25; between 25 and 30 and she would “have overweight” (tiene sobrepeso); between 30 and 40, she would have obesity (obesidad), and above 40 she would have grade-two obesity (obesidad grado dos, extremadamente obeso). “And where am I?” she asked, the fear in her voice palpable. “You are right here,” he said pointing at the mark for 29. “You almost have obesity.” He wrote out a sheet to give to a laboratory, requesting triglyceride and cholesterol analyses. It was only after filling out the paperwork that he explained that he was worried that she might have diabetes, which could cause blurred vision. He suggested that she make an appointment with a nutritionist to begin a weight-loss diet. “Sugars and fats are bad for your health; you should avoid them,” he explained. He added that she should not skip meals to lose weight, but that at every meal she should try to eat just a bit less. “If you cut out just a few tortillas at each meal, over time this adds up. I want you to be here”—he pointed at the area of the chart in the normal weight range. Then, pointing to the area next to the label “overweight,” he added, “this area is dangerous.” Whereas it was common in Xela to use “to be” verbs to describe fatness or thinness (soy gorda, estoy delgado), this was not the case with overweight or obesity. In the Spanish spoken around me, people did not typically say, directly, “I am overweight” or “you are overweight,” as they do in English. Instead, excess weight was something one had—the verb tener (to have) maintaining ontological distance between the affliction of overweight and one’s identity. I never heard people refer to themselves as being obese; they would instead say, “I have obesity” (tengo obesidad). Yet, whereas being obese was not something people would say about themselves, on a number of occasions I heard nutritionists, doctors, or health educators slip between tener (to have) and ser/estar (to be). “You are all obese?” (¿Todos son obesos?), a nutritionist once asked her patient, after the patient explained that everyone in her family was heavy. Another time a doctor reviewed a patient’s BMI calculations and reported, “You are not obese (usted no está obeso), but you have high triglycerides.” In clinical interactions, nutritionists typically presented patients with their BMI, explaining that the number fell into one of three categories: “normal, overweight, and obese.” These were not value-neutral but contained judgments about which measures were appropriate and which were excessive (the category

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“overweight” carries the normative implication that one is over the weight he or she ought to have). Nutritionists showed patients these ranges in the context of encouraging them to lose weight. If the number was high, it typically came with the warning that “it is not healthy to have the weight you have” (No está saludable tener el peso que tiene). These exchanges drew boundaries around normal, overweight, and obese and placed people—now patients— into one of these categories. By locating bodies at a point along this continuum, weight became configured not as a neutral quality but as reflective of one’s position within a now-imaginable population of people with bodies whose weight can be controlled. The results of this placement pertained not just to illness (or illness potential) but to one’s fit within this population. In terms made famous by Georges Canguilhem (1989), an inability to fall within the norm served as evidence of social, as well as physiological, pathology. That the boundaries around inclusion in Guatemala have long been drawn by statesupported violence (Grandin, Levenson-Estrada, and Oglesby 2011; Smith and Moors 1994) added to the pressure facing those whose bodies fell outside the acceptable measurements to eat, purchase, act, and think in ways that would bring them back into the range of “normal.” While attention toward weight created a new type of type, it also contributed to a changing vision of what “type” indicated. Whereas the disciplinary apparatus of the census once consolidated heterogeneous identities into two categories of inherent blood type—ladino and Indian, the former desirable, the latter excluded—the BMI creates a vision in which the possibility of social and civic inclusion is ostensibly “accessible to all.” The BMI delineates who is normal and who is overweight or obese, but these positions are not treated as permanent. Instead, everyone can potentially have the right body, and, as a result, everyone is expected to actively adapt and conform to the standards. When will is tamed and correct habits formed (or, alternatively, if enough products or procedures are purchased), anyone can reach the ideal. At least this is how the predominant discourse goes. In the case of Vilma, who did not know her weight before the clinical consultation, the doctor gave her a BMI index connected to broader population norms. He then told her to remember her measurements and to track them over time to find out if she was becoming heavier or lighter. She was, he warned her, at the edge of danger, and he told her to “be aware that if you continue at this weight, you will become sick” (Usted sea consciente de que si usted sigue con sobrepeso, se va a enfermar). Before the consultation ended,

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he gave her suggestions about how to change her weight. She should buy yogurt and cheese in their low-fat and lite versions and look for lite cereal. She should use Splenda packages instead of sugar in her coffee and juices. Then he gave her a leaflet picturing a thin, smiling woman surrounded by olive oil, feta cheese, and garbanzo beans. It blended contemporary global health concerns with commercial interests in its message: “If you want your body to stay healthy, you should modify your dietary habits and practice the Mediterranean diet. With this new lifestyle promoting long-term well-being, you will be able to taste the fruits of olives, grapes, and wheat as if you were actually in the south of Europe.” I draw from the example of Vilma—and many others I met diagnosed with obesity—to suggest that new scientific biosocial identities (normal weight, overweight, obese, grade-two obesity, etc.) have emerged out of the focus on body-weight measurements; these identities, while they might take a different form than historical understandings of race, are nonetheless what Ian Hacking calls “the linear descendant[s] of racial identity” (2007, 291). As with older ideas of blood type, the visible performance of physiology is still a central mode by which people enact their civic position; here, the measurement of fatness instantiates types that reinforce long-standing stratifications of superiority. Geoff rey Cannon (2005) notes that the language of “lifestyle,” as seen in the leaflet on the Mediterranean diet given to Vilma, was all but absent in public health concern for obesity in the early 1980s but became commonplace as the focus of concern turned global. Numerous global health reports, issued as international concern for the “growing global obesity epidemic” gained steam, referred to obesity as a “lifestyle” illness (Uauy, Albala, and Kain 2001; WHO 2003; WHO 2004). Guatemalan newspapers regularly conveyed to their readers the message that by changing one’s lifestyle, one could influence the expression of illness: “Obesity is not genetically conditioned, but is caused in 90 of cases by eating excessively, more than three times a day, having bad dietary habits, ingesting too many calories, doing too little exercise, living a sedentary lifestyle and drinking sugary drinks. It pertains to a disequilibrium between the calories you consume and those you spend” (Ruiz 2009b). I noticed in my fieldwork that doctors and health educators were quick to suggest to their patients that they could shape their phenotypes and physiologies by changing their lifestyles. Several scholars have linked this vision of an individual who not only can, but must, control the self and the future to

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the expansion of neoliberal politics (Guthman and DuPuis 2006; LeBesco 2011; Valverde 1998). In the section that follows I illustrate how this language of lifestyle is additionally entangled in Guatemala’s politics of racial violence.

terroir and race making Before she even entered the consultation room of the public hospital’s obesity clinic, we knew from her chart that Concepción was a forty-eight-year-old woman, born in the state of Chiquimula in Guatemala’s eastern lowlands, with a weight of 132 pounds, a height of 1.5 meters, and a BMI of 26.67. The nutritionists reweighed her—the numbers held—and then one nutritionist asked how she was feeling. “So-so” (más o menos) was her reply. She had a good medical history, she said—just one operation to remove her gallbladder after the birth of her daughter. But she had begun to feel aches in her bones and a doctor had recently diagnosed her with gout. As she was talking, one of the nutritionists made some calculations. When Concepción finished, the nutritionist responded, “Doña Concepción, you have a bit too much weight [tiene un poco de sobrepeso]. You must lose a bit of weight. It’s not a lot that you have to drop—” Concepción interjected, “How much do I have to lose?” The nutritionist made some more calculations. “Just five pounds. What you have to do—what you have to do, is to avoid all fat. Sometimes when people go to the butcher they say ‘give me the fat.’ But you can’t do this.” Concepción laughed, “It’s because what’s skinny has no flavor [Es porque la flaca no tiene sabor].” The nutritionist continued, “But you need to give up the fat [el gordo]; you must control your diet. You can eat any fruits and vegetables, but no fat. You must control your weight.” Concepción nodded at first and then abruptly stopped to ask whether it was okay to eat the skin of the chicken. “You see,” she said. “I like to eat flavorful foods.” The nutritionists both shook their heads: “No. No. No. If you eat fat you will become fat,” one said. The second added, “We are the experts, and it will help you if you follow what we say. If you do what we say, you will become thinner. Of course, you don’t have to change your lifestyle, but it will help you.”

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Fat, in this conversation, is not a simple or singular thing for either the patient or the nutritionists. It is a substance in food and in bodies, a source of flavor and illness, and a site of self-control and external expertise. When speaking with Concepción, the nutritionists used the term gordo, which comes from the Latin gurdus, indicating abundance. They also routinely spoke with patients of grasa, from the Latin crassus—which suggests a meaning of rudeness as well as stoutness. The variation was not just semantic. While Guatemalans commonly associated fatness with prestige and wealth, several of the university-educated Quetzaltecos I interviewed linked girth to gluttony, describing its presence as evidence that a person—very often an indigenous woman—was not sharing her resources. A common narrative thread in my interviews with this elite demographic was that poor women, women from el campo, or women without education did not know how to feed their children. Public health scientists at the time of my fieldwork were finding that Guatemalan mothers diagnosed as obese or overweight often had children who suffered from underweight, a fact reported widely in the news (Corvalan et al. 2007). Research suggests that this pattern relates to structural conditions that range from ancestral starvation to toxicity and contamination (cf. Solomons et al. 1993; Solomons 2013), but elite Quetzaltecos regularly linked this to both personal weakness and “cultural” inferiority. As one woman put it, “Don’t you see that they’re very fat [son bien gordas], but their children are dying from hunger?” She said that it was very sad that these women were so poorly educated that they could not care for their own children. In the context of telling me about a cultural tradition where mothers send their children to school with a quetzal to buy junk food instead of preparing a nutritious meal, she called the women both uneducated and lazy. She continued, “But then look at them; they clearly have enough food for themselves.” She spoke explicitly of culture, not race, but, critical to my discussion here, the culture to which she referred was carried in the form and fat of the body. Many people I lived with made reference to heredity when speaking about their own shapes and sizes. One woman told me her weight came from “her mother’s side.” Another explained, “My mother was fat. My grandmother was fat. Now I am fat,” linking bodily form to lineage in a way that was common. Someone versed in logics of genetic inheritance might hear resonance with Mendelian transmission in these statements. Yet in discussions of inheritance (herencia) of body size or type, people rarely referred to the immutability of genes but instead discussed the stylized patterns of familial practices. To

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complicate what Diane Nelson has artfully referred to as “assumed” terminologies further, heredity was biological insofar as it was carried in the body, but this did not make it determinate (1999). De la Cadena gives an example of the seventeenth-century expression—still alive and well in Latin America today—that “He who suckled liar’s milk, lies, and drunkard’s milk, drinks” (2005, 265). In the hereditary logic of this expression, what people eat and not genetic structure gives shape to what and who they become. Two more examples of how the specificities of food and eating shaped biosocial positions are warranted, given their local prominence. First, I could sit in Catholic churches with my host families, sing their music, and recite their prayers, but when they stood to take communion, I could not join them. Not a Catholic myself, I could not place their God—not simply represented but materialized through the wheat and water of the host—in my mouth, where it would become part of my body. Catholicism teaches its followers that through the consumption of the body of Jesus, discrete individuals become blended into a unified body (note that company and companionship come from communis, “common” and panis, “bread” [Coveney 2000, 40]). Upon eating the host, “my” body would no longer belong to me, but to the collective body of Catholics. Prohibited from this activity, however, I stood out as— indeed, I became—singular, waiting amid vacated pews while others saw the priest. The centrality of food to the classificatory structures of humanity is also central to the historical Maya book of counsel, the Popol Vuh. As this book explains, before people existed, there was a population of manikins with “no hearts, nothing in their minds, no memory of their mason or builder”; these people were “ just an experiment and just a cutout for humankind. . . . They had no blood, no lymph. They had no sweat, no fat. Their complexions were dry, their faces were crusty. They flailed their legs and arms, their bodies were deformed” (D. Tedlock 1996, 70). When the makers and modelers redesigned the manikins, they thought long and hard about what to use as the ingredients for flesh. They ultimately decided on staple foods—yellow corn, white corn, pataxte, cacao, zapotes, anonas, jocotes, nances, matasanos—and it was these foods that finally made the manikins human. As food is the foundational material through which bodies and the boundaries of inclusion drawn around them take shape in Guatemala, directives over how fats should be used were fraught with tension. The laughter of Concepción’s response that “what’s skinny has no flavor” is revealing. She is

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playful in the conversation with the nutritionists, but I nonetheless take her laughter as indicative that she understood the ban on fat to interfere with the “race-class-gender” matrix of biosocial reproduction (A. Smith 1963). Put in slightly different terms, the advice “to avoid all fat” does not simply address taste in the sense of sabor—the richness of flavor—but also in Pierre Bourdieu’s (1984) sense of taste as a means of producing hierarchy and distinction. I cite Bourdieu because he famously suggested that the performance of taste “functions as a sort of social orientation, a ‘sense of one’s place,’ guiding the occupants of a given place in social space towards the social positions adjusted to their properties, and towards the practices or goods which benefit the occupants of that position” (1984, 466; italics mine).” In his account embodied practices of taste—he called these the primary form of classification—were central to the creation of social hierarchy. Following from this, we might also think of prohibitions that surround certain tastes for foods and fats as a means of asserting bodily, biological superiority—a way, in other words, of instantiating embodied racial hierarchy in Guatemala today. The concept of terroir, which gained currency among food connoisseurs over the same decade that obesity became a global health concern, has interesting resonance with the practice of race making in Guatemala. Terroir, a word with French origins, which has been loosely translated to mean “sense of place” (Heath and Meneley 2007)—or even “biology of place” (Paxson 2013, 197)—originated in Mediterranean vitaculture and has recently been globally adopted in descriptions of heirloom crops and cheeses and other expensive foods and drinks. When it comes to terroir, geography matters: the soil, the temperature, the humidity, the topography of the landscape, and the particles in the air are all recognized to fundamentally influence crop development. Seeds are important, but so too is the land on which a crop grows. Following principles of terroir, when a grape originating in Europe is raised in American climates and on American land, it produces a different kind of wine than the European variety. There is a canny similarity between the logic of terroir and a common Guatemalan framework for race that has it that a Spaniard raised in Guatemala, eating Guatemalan food and breathing Guatemalan air, becomes a questionable Spaniard, if considered to be a Spaniard at all. One reason I emphasize this similarity is that despite the influx of eighteenth- and nineteenth-century scientific discourses that linked race to a fixed type of blood, these discourses failed to take hold throughout Guatemala (Nelson 1999).

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Instead, elite Guatemalans explicitly promoted that idea that racial position was shaped by environment—the land on which one lived, the language one spoke, the clothes one wore, and the school where one was educated. Greg Grandin suggests that the link made between environment and heredity allowed elites to develop a national agenda that “purportedly denies the importance of blood, yet is viciously racist.” As he explains it, this form of racism allowed elites to think of themselves in nonracist terms, while also allowing them to “blame Indians for the failure of Guatemalan development” (2000a, 230). Something similarly pernicious was at work in the framing of obesity as an illness of lifestyle. Adding to the historical race-based regulation of individuals through the clothes one wore and the languages one spoke was regulation of the hunger felt within the body and the foods that one reached for to satisfy this hunger. “You must control your weight,” the nutritionist says, advising Concepción to adjust her lifestyle by avoiding the flavor of fat. With illness at stake, there was justification for thinking of this advice in neutral terms. But given the linkages between food, bodies, and their reproduction, I have suggested that the normalization of some types of bodies and the pathologization of others was a technique of race making—something of which Concepción was well aware. Amy Trubek notes that terroir is associated with “racines, or roots, a person’s history with a certain place” (2005, 261). Similarly, the notion of race I have highlighted here might be understood in terms of terroir as a history of place. It is telling that the Spanish word raza shares etymological origins with raíz (root); as is the case for both roots and races, while their form is subject to change, their flexibility is limited. Patients were routinely encouraged to change their lifestyle. They were told that if they strictly followed their diets, they would normalize themselves on a numerical spectrum that at first glance may seem inclusive, since according to its logic anyone can achieve “normal weight.” Yet there remains much that may nonetheless hold people apart from the promised inclusion (and health) of dieting. Identities, and the cultural technologies and artifacts around which they coalesce, are not just individually performed but are built up over time in individuals, families, communities, and generations (see also Weismantel 2001, 93). People may strictly follow their diets, placing themselves on a numerical spectrum that at first glance may seem inclusive. But bodies, and the roots and races to which they are connected, are still deeply tied to a “history of place”—and that place is largely

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arranged by deep sociopolitical forces that lie beyond any one person’s will and self-control.

lightness of weight, lightness as race A report compiled by the Historical Clarification Commission at the end of Guatemala’s civil war found that “the undeniable existence of racism expressed repeatedly by the State as a doctrine of superiority is a basic explanatory factor for the indiscriminate nature and particular brutality with which military operations were carried out against hundreds of Maya communities in the west and northwest of the country” (Arenas Bianchi, Hale, and Palma Murga 1999). The report documents that more than two hundred thousand people were killed or disappeared and that of the fully identified victims 83 percent were Maya and 17 percent were ladino (CEH 1998, 17). The report notes that state forces were responsible for 93 percent of all violations, and “the massacres, scorched earth operations, forced disappearances and executions of Mayan authorities, leaders and spiritual guides, were not only an attempt to destroy the social base of the guerrillas, but above all, to destroy the cultural values that ensured cohesion and collective action in Mayan communities” (23). The violence that I have drawn attention to is less spectacular than the bloodshed of Guatemala’s genocide. Yet the focused attention on the size and shape of the body is, I suggest, an also brutal means by which racial discrimination is practiced, and I have chosen cases that are comparatively benign—a short woman with brown features who cannot get a job, a doctor reframing a problem of vision as one of food choice, a woman advised to skip that part of eating she finds delicious—precisely to make apparent how violence may be untethered from the terror of active war. Whenever I find myself questioning whether the pain of genocide can be (or should be) related to the pain of dieting, I recall the lines of patients at the hospital nutrition clinic whose tissues and tendons were failing them at a relatively young age. Whether their bodies refused to hold onto the nutrients they ate or refused to let them go, the diets they received paled in comparison to their needs. The ancestors of many of these patients had been forced onto plantations, their labor providing the world with the luxuries of coffee, bananas, and sugar; now, as the patients’ bodies revolted, the world had little to offer in return beyond the paltry advice to eat more nutrients and less fat to normalize their weight.

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I also recall the different circumstances of a friend of Linda’s. The friend (I will not give her a pseudonym to remind readers that she asked for anonymity) was a successful lawyer when we met. But though she appeared confident as we spoke, she told me about several years of devastation she endured while trying to lose weight during her time in law school. In her words, she was not white, not rich, and not thin in a place where she was supposed to be all these things. She spoke of being caught between worlds. She lived with her mother, who celebrated fullness and encouraged her to eat, yet she was also surrounded by the proliferation of diets that encouraged her to starve. She told me of months in which she would go into the bathroom of her house—the only room with a door that locked—and eat toilet paper. She wanted to satiate her stomach but didn’t want the calories; she wanted both fullness and lightness. She never used the language of “eating disorder,” with its intonations of individual pathology (Lester 2007). Instead, she spoke of the ontological struggle of living in a body that did not belong. Her story carries with it extreme imagery (a woman, locked alone in a bathroom, ingesting paper otherwise used to clean excrement so as to shrink in size), but less evocative, less private versions of this struggle circulated widely. As an example, I frequently encountered newspapers and regional billboards displaying an ad for Mayonesa Gourmet Light. The ad showed a woman with light skin wearing only a pink bikini, wrapping a tape measure around her exposed navel. She held it at nineteen inches, though her waist took up just sixteen inches of the space. “Always delicious, now with fewer calories,” read the caption, the desired “lightness”—with its connections to both weight and race—reflected in her skin, her body, and her food. In this chapter I have examined lightness, as a property of weight as well as color, to suggest measures that appear mundane—what could be less spectacular than a small, flexible tape measure?—might nonetheless carry with them profound and unsettling racial violence. My desire to frame the growing concern for thinness in Guatemala as a form of racialization is not made in spite of the cruelty of genocide that continues to haunt the country (cf. Olson 2013) or the direct femicide that has grown far too common (cf. Godoy-Paiz 2012; Menjívar 2011); it is, rather, precisely because of these horrors that something as comparatively innocuous as an advertisement for light mayonnaise warrants concern. The measurement techniques of nineteenth-century scientific racism presented blood as an inherent substance, but this did not mesh well with the

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popular understanding of race as persistently malleable. Meanwhile, contemporary approaches to measurement of the body present fatness as based in choice and will, where biology is shaped “at every meal,” to use the words of Vilma’s doctor. This treatment of weight as the embodiment of lifestyle confers scientific legitimacy on long-standing boundaries of exclusion, and does so in culturally familiar terms where race is something to be personally controlled. In his exploration of quantitative forms of governmentality, Nikolas Rose shows that “numbers are integral to the problematizations that shape what it is to be governed” (1991, 675). While he is thinking of numbers in terms of the collection of national-level statistics—in Guatemala, a process that has historically consolidated diversity into a dualism of two racial types—I suggest that another form of body count is emerging as a relevant form of what the Historical Clarification Commission refers to as a “doctrine of superiority”: the counting, at a cellular and nutrient level, that occurs in the management of the weight of the body. Rose describes the census as a nonreligious communion that confers a group or national identity on its participants, even while it divides the group into contrasting classifications (1991, 684). Through number-driven practices of dieting, people similarly demonstrate themselves as fitting into a community, while the numbers, at the same time, establish that many do not belong (see Krieger and Davey Smith 2004). Some measurements are better than others, and some bodies emerge much closer to the given standard. Still, for many, the norm remains as persistently impossible as the ideal. Obesity and thinness may today operate along a sliding scale, but this is a scale on which some people remain disadvantaged. Linda’s frustration—“It doesn’t matter if I eat or diet; I am simply not made to look like that”—is doubleedged. Despite the message of the possibilities for inclusion, bodies are not infinitely flexible and certain measurements are not accessible to all. And the very focus on the body’s flexibility conceals that what does not, and will not, fit may be desirable too.

chapter 5

Bodies in Balance

markets and scales At the start of 2008 the price of oil in Guatemala began to steeply climb. By July a barrel was selling for $145.00 in the capital, and daily warnings were ubiquitous on the news. “The cost of living increases 13.56 in just one year!” read the headline of one article that charted the rising prices of the region’s stable foods. A pervasive worry that they would not have enough to eat gripped many. “¡Cuesta!” was a common refrain around me—an expression that things were difficult, derived from the verb costar, “to cost.” In marketplaces in Xela women explained to disappointed customers that they were selling their products for “good value, given the cost of oil.” Using handmade scales—two plastic palanganas, each suspended from three strings of rope that connected at the top to a stick—they would measure out an amount of tomatoes worth, say, five quetzales, adding them to one container until it became level with the second container, which held the weights. Customers would look skeptically at the resulting quantity, which was inevitably fewer tomatoes than they wanted. The vendors would hand them the produce: “see, five pounds.” The customers had spent their lives making these negotiations and could perceive the weight of five pounds without the use of a scale. They could feel in their hands that the vendors were not fooling them and would take the bag, heads shaking in disappointment as they walked away. Women had recently begun to serve their families meals of tortillas fried in processed corn oil. It wasn’t a customary dish, but corn oil, which had

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become common, helped to fill stomachs left hungry as prices of traditional ingredients rose. These women were joined by global health experts in their concern about the impact of crude oil on their dining room tables. The keynote lecture given to celebrate INCAP’s fifty-ninth anniversary in 2008 was titled “High and Rising Food Prices.” The talk centered on biofuel subsidies on U.S.-produced maize, which it cited as a direct cause of the surge in food prices in Guatemala. Countless Quetzaltecos I spoke with were angered by U.S. maize subsidies, arguing that when combined with the stipulations of free trade agreements they contributed to massive unemployment among the region’s small-scale farmers, who could no longer compete with the price of U.S. maize in international trade and whose lands now lay barren. It infuriated people that this sacred food was transformed into oil for cars while they went hungry. At an INCAP nutrition conference a scientist familiar with my research gave me a cartoon he had cut out of the Prensa Libre. It was a drawing of an ear of maize, captioned, “World Food Fuel Supply.” As the word fuel replaced the word food, so did rows of identical yellow cars in the drawing replace the kernels, indexing discomfort around the country about the conversion of maize into fuel for machines. By 2009 world economies were embroiled in financial turmoil—a topic of conversation everywhere around me, as the country’s already precarious employment opportunities became scarcer and the value of the quetzal on international markets plummeted. Media sources widely reported that the U.S. government had deported twenty-eight thousand Guatemalans in 2008 and that the monthly number of deportees was rising as the U.S. economy faltered. That many of these Guatemalans had traveled to the United States because they could not find employment in Guatemala, whose cities were filled with children of farmers desperate for work, added to the widespread frustration. I introduce this chapter with discussion of the price of these various oils— petroleum, cooking oil, ethanol—to underscore that the people with whom I lived and worked were fluent in commodity calculations. Whether talking about the “costs of living” or the effects of biofuel, Quetzaltecos I spent time with—even in remote corners of the state—were highly attuned to world markets and the relationship between what they grew (or could not afford to grow) and the cost of the meals they ate. They knew much about quantities and scales. Several of the families I lived with cultivated produce for both household consumption and trade. They would weigh their goods carefully

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as they packaged them in large storage bushels. Watching the price of foods rise and fall with the global economy, they would try to sell when the time was right. Also accustomed to navigating local markets, many women were able to determine by touch, as in the earlier example, the weight of five pounds. Yet, for many, the prospect of stepping on a scale and monitoring the fluctuations of their own weight was both anathema and unsettling. Nutritionists in the public hospital commonly apologized to patients for weighing them. The measurement of a patient’s weight usually came with caveats. “We’re going to weigh you. I know that at times people don’t like to be weighed, right? But it’s necessary [Le vamos a pesar. Yo sé que a veces no le gusta a uno que la pesen, ¿Verdad? Pero es necesario].” I saw many people laugh at this requirement, finding humor in the treatment of the body as though it were an object on the market to be measured and sold. Others found nothing funny about this request. For many who arrived at the hospital, the application of marketplace quantification practices to one’s body was unsettling enough to elicit pause, and with this skepticism, disbelief, and sometimes refusal. Though patients were familiar with fluctuations in the price of produce, they were not accustomed to, nor comfortable with, applying similar metrics to their own bodies. Their discomfort with this request lies at the heart of this chapter, which examines how practices of body-weight measurement intersect with and diverge from practices of market exchange. If this seems like an unlikely juxtaposition—the scales of a clinic with the scales of a marketplace—consider that underpinning both sets of practices is a presumption of equivalence: substantively different forms of energy become commensurate through numeric quantification. In the market, just before tomatoes are exchanged for coins, the two palanganas appear level. In the clinic, just before the patient’s weight is recorded, the scale (in Guatemala, balanza) appears to balance. These practices of weighing articulate the various energies that go into these transactions as a single measure. In the market this becomes the measure of price; in the clinic this becomes the measure of health. As the topic of energy has become a matter of focused anthropological concern, much of the conversation has centered on fossil fuels; nuclear conductors; solar, wind or hydroelectric installations; and other manifestations of power that are on the agendas of governmental and bureaucratic institutions (e.g., Boyer 2011; Nader 2010). In Guatemalan nutrition clinics, energy was also a recurrent theme in conversations. The unit-based form of calories

A scale in a consultation room in Xela’s public hospital.

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enabled the tidy conversion of very unlike items: food into bodies, bodies into labor, labor back into food. But the pause at the scale—the refusal of this logic—remains instructive, for these conversions leave energetic excess whose presence, though often overlooked, does not disappear. In spite of attempts to monitor and control the body (configured here in the singular) through systems of counting and calculation, the bodies I examine resisted the balanced perfection that underpinned metabolic calculations. Bodies, and the people who inhabited them, were left to resort to other forms of care.

forms of balance Practices of balance are culturally diverse and historically contingent. The marketplace scale, in which people use counterbalance to demonstrate that objects have similar weight, is seen throughout Guatemalan marketplaces today. Indigenous medical practices prevalent in the region until recently have also emphasized balance—in this case, of the hot and cold forces of bodies and food (B. Tedlock 1984). Yet notions of balance that I encountered in Guatemalan nutritional protocol also break from these more fluid, experiential forms. Michael Power points to numerical abstraction as central to the kind of balance deployed by medical technologies today. He notes that the current ubiquity of scales and thermometers makes weight, hardness, and temperature appear to be obviously quantifiable, but there was a time when “the ambition to measure heat was regarded as no more different in principle from the measurement of virtue” (2004, 768; see also Chang 2007). The link between techniques of numerical abstraction and heat is especially pertinent for my research. While heat persists as a quality that is immediate and situated—it transforms inedible corn dough into delicious tortillas throughout Guatemala every day—it is not just something to be measured with thermometers and scales; it is itself a measure. Calories, a technique of abstraction through which unlike foods become equivalent, are, after all, unit representations of the kinetic energy of heat (see also Mudry 2009). In pinpointing the development of numerical abstraction, Rivka Feldhay highlights the work of seventeenth-century mathematician Paul Guldin. She suggests his work marks a point of departure from other forms for balance, given that he sought to understand gravity and motion not through

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mechanics, rotations, or dynamics but through mathematical abstractions with no tangible referent in the physical world (2000, 51–52). Brian Rotman directs attention to a more “primitive and elemental” form of abstraction than the mathematics of Guldin. For Rotman, the balance made possible by the equation 1 − 1 = 0 incited a powerful abstraction, producing—and produced by—mercantile capitalism and its colonial exploits. While this equation undoubtedly appears self-evident today, Rotman suggests the association of zero with nothing (not anything) was a paradoxical idea that developed in the thirteenth century hand in hand with the adoption of paper money. For money—the “dominating source of ‘value’ ” in Western culture—to function as an international medium of exchange, it was necessary to have a system of writing and calculation and ultimately the sign of neutral equivalence proffered by the idea(l) of zero (1987, 5–6). This zero enabled a concept of balance predicated on stasis. He further argues that although the ability to signify absence was revolutionary, this metasign was also an illusion, a fictional representation unsustainable when faced with itself. In other words, absence, when represented, is always something. The magical balance of the zero is also central to Mary Poovey’s account of the origins of finance. The story she tells began during a time in which numbers were suspect—widely held to be supernatural and associated with conjecture—and ended with a system in which numbers were taken as simple, objective descriptions of an external world. She argues that double-entry bookkeeping practices of the sixteenth century were central to this transformation. In the records she examines, merchants placed credits on the left hand of the ledger, while debts were placed on the right. At the end of the day, the accountant would sum the left- and right-hand columns with a goal of the arithmetic zero of nothing. Yet despite the straightforward and impersonal appearance of these numerical additions, they remained deeply embedded with human judgment. The accountant did not produce this balance simply by adding all the numbers on each page, however, for given the nature of commercial transactions, it almost never happened that expenditures and receipts concerning jewels, for example, actually equaled each other. . . . Producing the balance thus required something in addition to arithmetic. To balance the sums on the facing pages, the accountant had to supplement records of actual transactions with numbers that had no referent in the company’s business. To make the sums on the pages tally, the bookkeeper added a number to the deficient side sufficient to offset their difference. (1998, 43, 54).

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Poovey shows that the process of making financial accounts even—a process that eventually conferred cultural authority on numbers—was driven by numerical wizardry. The formation of balance in double-entry bookkeeping depended not on actual prices or even items that could be (and had been) counted but on what she calls a “wholly fictitious number—the number imported not to refer to a transaction but simply to rectify the books” (1998, 54–55). As a result, the ostensible numeric accuracy of the books stood in for “what could not be verified: the accuracy of the initial record” (56). The situation she described is one in which the accountant’s interest in formal precision (an appearance of balance) worked to create what it purported to describe (an inherent balance) (see also Maurer 2006; Preda 2009; Zaloom 2004). The argument that I develop here is that quantitatively focused dietary treatments that I observed in Guatemala operated through a similar sleight of hand. Despite an incitement to measure bodies, transforming their qualities into precise and equivalent values, these measurements continually failed to reach a perfect, even balance. It was simply not possible to calculate a diet in which all nutritional inputs and exercise expenditures added up. Even with the reliance on personalized measurements, diets could not accurately represent the energetic balance of human life as a single “sum total.” The perfection desired of energetic calculations remained a technical impossibility—a fantasy of experimental science in which all of life’s variables could be known and controlled.

your body is like a bus “Some patients still think that it is good to have extra weight [sobrepeso]. We have to teach them that this can be harmful, that excess weight can hurt them.” I heard this in my first week of work with nutritionists at the obesity outpatient clinic at Guatemala’s public hospital. Patients arrived from other clinics in the hospital, referred by doctors who felt that their illnesses—most typically hypertension, diabetes, and high triglycerides—were connected to the foods they ate. The nutritionists at the recently opened clinic were charged with helping these patients control their illnesses through changes in dietary practice. Most patients were middle-aged women from indigenous communities surrounding Xela, unable to afford the private treatment that would allow them to bypass the public hospital’s long lines. For many patients, the practice of controlling weight by monitoring food intake was entirely novel. After

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explaining that patients did not understand the meaning of overweight, the nutritionist told me that the services they provided were often confusing for their patients: “It isn’t like in the United States, where people know they need to lose weight but don’t know how to do this.” She continued her explanation, “Here, many people are sick, but they don’t even know where treatment should start.” In the consultation I describe here, the nutritionist outlined for the patient the meanings and implications of “excess weight.” The patient had arrived expressing concern about shortness of breath and fatigue. After measuring her weight and height and making some calculations, the nutritionist replied, knowingly, “Ah, you see here, ma’am. There is a problem with your weight.” The nutritionist then used an analogy that she had learned in her training, which was frequently repeated in some form by public health experts and nutrition educators during my fieldwork: “You see, the body is accustomed to a certain weight, and when we give it too much weight . . . well, it’s like a car.” She stopped and looked at the patient, a woman with deep lines in her face from a life lived beneath the high-altitude sun, whose hands revealed years of farmwork. The nutritionist, realizing the image of a car was out of place, changed the expression. “Or maybe think of it like a bus. Yes, like a bus. When you’re traveling on a bus, and they start packing it too full—when they add too much weight—the bus has to work harder. Soon, you just get, rrrrrraaaaa.” She made a noise simulating a motor stalling. “Well, it’s the same with your body. Your body is suffering [se está resintiendo] under the weight. You see?” Many of the nutritionists in the clinic used this analogy, articulating the body as a “human motor,” a term that Anson Rabinbach develops to illustrate the “vision that the working body was but an exemplar of that universal process by which energy was converted into mechanical work, a variant of the great engines and dynamos spawned by the industrial age” (1990, 1; see also Landecker 2013). Excess weight, in this framework, was configured as a misuse of resources—a failure that impedes possibilities for productive work. This mechanistic vision of body weight emerged in the clinic alongside messages of measured calculation pertaining to food. Nutritionists often described eating to patients through a series of exact conversions: the body turns food into energy, all of which must be expended to maintain a balanced weight. The following conversation between a patient and nutritionist illustrates this kind of exchange:

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Patient: [Can I eat] potatoes? Nutritionist: Yes, potatoes and pasta, you can eat these things, but in the quantities that I’ve prescribed for you here. They are high in triglycerides. [She pointed to the diet that she’d written out, where portion sizes were indicated.] P: Okay. N: Half a cup, boiled, with just a bit of olive oil. No more than half a cup or it will cause damage. P: Okay, I won’t. For my triglycerides—for this I am cutting back on everything. N: Yes, well, what I was going to explain is that foods like potatoes and pasta are dangerous for your triglycerides when consumed in excess. P: Yes? N: Because the body won’t convert the excess into energy but will store it. So when you eat a lot, you store more than you need. You add extra weight to the body, and this becomes damaging. You can eat them, but not a lot. P: Yesterday I ate more vegetables than pastas. N: So don’t eat more than these amounts. That’s why I’ve made this list; this here is what you can eat. When you eat too much, the body will store it as extra sugar or extra fat—both harmful. The excess is what is bad.

The nutritionist’s depiction of the conversion of potatoes into triglycerides and energy illustrates how metabolic knowledge, in the hospital and elsewhere, operates through an “accounting ideal” (Porter 1999), where a reliance on norms and numbers offers people a kind of expertise extending far beyond their personal judgment. Theodore Porter describes accounting in this way: “All the meanings—religious, cosmological, ideological—are lost” (1999, 402). What remains instead is a price, a number, or a ratio. I show that all meanings are not, in fact, lost through these conversions, but the logic of metabolism at work in the clinic presumed them to be irrelevant. Human activity and the meanings that adhere to it became consolidated into chemical formulas with calories serving as a currency that must be added to or subtracted from the balance. “The excess is what is bad,” the nutritionist said as she implored the patient to balance her diet. Numbers became the arbiter of this balance. They transformed activity into a quantity of exercise to be subtracted from the quantity of food consumed. The patient’s weight was the end product of this equation: the sum of eating minus exercise. A similar logic was at work in a presentation on diet and nutrition that I attended in Guatemala City sponsored by INCAP. A public health worker showed a PowerPoint slide defining obesity as a “chronically positive energy balance” (balance energético positivo crónico). Below this, “energy balance”

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was defined as “energy input = energy output” (ingestión energética = gasto energético). He explained to the audience that someone ingesting too much or expending too little energy would become obese. Yet while this calculation might appear straightforward in theory, it was anything but when put into practice, where even the most basic calculations of weight remained elusive. In part, this was because weight in Guatemala was itself measured in both kilos and pounds, depending on the provenance of the scale (much of the hospital’s equipment came used from the United States or Spain). Though pounds were most typically used, I observed that nutritionists would switch between both indexes of measurement when speaking with their patients, often forgetting to clarify which terms they employed and thereby leaving the significance of the number uncertain. The nutritionists would make the conversions between pounds and kilos with calculators brought from home (there were no funds for the hospitals to supply these). Very often the small plastic buttons would stick, rendering the quantified values for food and exercise prone to uncertainty. From my sideline position in the consultation room, where I tracked calculations with my computer, I observed several discrepancies in reported calculations of weight, height, or BMI that disappeared into the chart without remark. Many of these calculations would likely become buried forever within the paperwork—it would never matter that their arithmetic was not identical to mine. Sometimes unsettling discrepancies would resurface, creating a rupture in the authority of calculation. I encountered several situations in which the stability of the conduit connecting the number with its referent was challenged. Patients often entered the clinic confident they had lost weight, only to find the number on the scale to be higher than it had been before. “The scale is a liar,” is a statement I heard on several occasions. One woman, who was dissatisfied with her measured weight, told us that she had been weighing herself on scales in pharmacies around the city over the past month and that the reported weight always changed. The scales used by the hospital were old and had to be recalibrated after each use. A few times patients pleaded with nutritionists to be weighed on more than one scale, and it was not uncommon for the second measure to differ from the first. Though numbers were mysterious and fallible—at times more like a magic spell cast by a knowing expert than a stable and publicly accessible fact—their presence in the clinic remained strong. Power argues that the spirit of mea-

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surement is forceful, reproducing and reinventing an “institutional demand for numbers” (2004, 769). Indeed, I saw that many nutritionists employed numbers as evidence that their treatment plans were modern, cosmopolitan, and supported by scientific rigor. They presented patients with their diets alongside documentation of their BMI, handling the papers tenderly and reading through the numbers as if they were tea leaves that could predict the future. The following two exchanges between nutritionist and patient are emblematic of the way in which health in the clinic was situated through a schema of numbers. Exchange 1: The patient, a short middle-aged woman from a Mam community just outside Xela’s city limits, entered the room. The nutritionist took her sweater, shawl, and apron and asked her to step on the scale. The nutritionist then measured her weight and height, entering the numbers in her calculator. Turning to the patient, the nutritionist then began the following exchange: Nutritionist: Well, we just saw how much you weighed. We saw that you’re 62 kilos and that you have an index of 32. We use this index to determine if your weight is in correct proportion to your height, okay? And we see that yes, we’ve got a bit too much weight here. You have, you have, obesity. So what we are going to have to do is to teach you to diet so that you start to lose weight. This will help you to feel better. It will make you less tired and will help the ache in your bones. This will improve your quality of life. Patient: How many kilos do I need to weigh? N: About 110 pounds. So you need to go down 26. Yes, 26 pounds. P: How much do I have to lose? N: Well, you are at 32, but you need to get down—in the end we want you to be less than 25 [these units referred to the BMI, through this is not specified]. Which means that you have to go from 62 to, just a minute, from 62 to, well, let’s aim for 50 for now [these units refer to kilos, though again, this is not specified]. Just 26 pounds, which we will take on little by little. In fact, let’s not think about 26; for now let’s concentrate on losing 2, 2 tiny little pounds. We’re going to make you a balanced and equilibrated diet to help you. Will you tell me what kinds of foods you eat?

Exchange 2: The nutritionist finished weighing and measuring the patient— a woman in her twenties from the city center, referred to the clinic by a doctor who had diagnosed her with obesity. The nutritionist added the numbers to her chart and then spoke to the patient:

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Nutritionist: 88 kilos; 194 pounds. Well then. So, you weigh 88 kilos, you see. This is a bit high, because the relationship between your weight and your height should be between 20 and 25. And right now the relationship is 34. You have a body mass index of 34, which indicates to us that you are on the high side. So give us one second, and we’ll tell you more or less what should be a more normal weight. [She made some calculations and then turned back to the patient.] 140 pounds. Right? Right now you weigh 194 pounds, which tells us that you have about 54 pounds, more or less, of excess weight, you see. You will have to begin to go down steadily. So, I don’t know if you like to walk or run, or if there’s some sport that you like to practice? Patient: Well, I was going to the gym, but I had to let it go because I study. N: Oh, you study? Do you study all day? P: No. Just at night. N: Oh, just at night. Okay then. Are you working right now, ma’am? P: Well, right now, no. N: Ah well. You see, we’re going to recommend that you try to do a bit more exercise. Do you understand? Some kind of exercise, like cardiovascular exercise, for example. It could be that you walk or run for thirty minutes or that you ride a bike or swim, okay? If you could go back to doing regular exercise, it would be great. For what reason? Because in your case we need you to start burning fat. Burning fat will lessen the percentage of fat in your body and help you lose weight, and you should also try to increase the fiber in your diet. So we strongly recommend that you return to a regular exercise routine because it will help you. Along with a good workout routine one has to have a healthy diet, don’t you think? A diet more healthy than what you eat now. Now let’s do a twenty-four-hour recall—will you tell me everything that you ate yesterday?

The first exchange focused on pounds and the second on exercise, but in both the nutritionists linked a numerical value of weight to quality of life, energy, and pain relief. Advice that a fat-burning workout routine along with a healthy diet would improve the patient’s life (le va a ayudar, or “help you,” in the most general of terms) was predicated on a vision in which health is the measurable outcome of a carefully regulated metabolic balance. They further suggested that the calibration of dietary intake and energy expenditure would produce balance and equilibrium in the patient’s life. In other words, balanced quantities would produce balanced qualities. The treatment of food and movement through quantitative equations also makes it possible to represent bodies as abstract units—not the least of which is the anatomic, individual body that steps on a scale to be weighed. Numerous diverse energies become compressed into the singular unit of the calorie,

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an apt unit for mathematical calculations, in which desired balance can be— and should be—straightforwardly achieved by lining up both sides of the equation. Underlying this dietary counsel was an understanding of dietary equivalency, in which weight operates through a system of credit and debit. Eating created a surplus of energy. If this energy was not used up (i.e., spent), it would be stored in the body in the form of harmful sugars or fats. Nutritionists regularly taught their patients that the consumption of high-sugar foods caused sugar to “accumulate in the body, where it produces fat.” They also explained that “the consumption of fatty foods will cause the body to gain weight.” Meanwhile, it was “very important to stay active in order to keep losing weight” and “to follow a healthy diet to keep burning fat.” In the time I worked in the clinic, I was able to see that diets often failed in the terms of the guidelines: that is, patients did not lose weight. When this happened, nutritionists tended to raise two key concerns. The first was compliance: Were patients adhering closely enough to the recommendations? The second was that they had not prescribed the right amount of food, and they had to adjust their recommendations: What about decreasing the quantity of tortillas with lunch? What about a half a cup of juice instead of a full cup? What about not adding sugar to the coffee? In both concerns, the details of the balance, and not the expectation for energetic balance itself, were held at fault for the failure of weight gain. This led to recommendations such as “consume fewer and burn more calories,” “exercise more,” or “eat less.” It also led to a vision in which the dietary ration was something to be selected through weighed, individual choice. In other words, dietary failures, understood here as a failure of balance, indicated a failure of rationality. Patients had allowed too much excess into their lives.

culinary equivalency In both public and private nutrition clinics, the diet (dieta) was a common end result of a consultation. Whether the exchange lasted twenty minutes or an hour, nutritionists would typically ask patients about their dietary practices over the course of a “normal day,” learning about the foods they liked and disliked and their average portion sizes. The nutritionists would consider the patient’s diagnosed illness(es) to determine the kinds of foods to prescribe: low-acid foods for someone with gout, low-fat foods for someone with hypertension, low-sugar foods for

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someone with diabetes, and so on. They would evaluate the patients’ current and recommended BMI to determine daily caloric allowances and portion quantities. They would also account for patients’ typical habits and preferences in their recommendations (someone who disliked eggs or cheese or cantaloupe should not find these foods in their menus). Using this information, nutritionists would prepare the patient’s recommended weekly diet. The diets consisted of an organized grid of seven vertical columns for the days of the week and five horizontal rows for the recommended three meals and two snacks of the day. Nutritionists would make suggestions for each meal, aiming for balance by drawing from a range of food groups. They also considered the quantities of calories, proteins, fats, sugars, calcium, and iron in each item of food, keeping in mind their end goal: that the sum of the items over the course of a day would equal the desired per-day calorie count (i.e., 1,500 calories, 1,800 calories, 2,000 calories) and that vitamins and minerals would total the international recommended daily allowance. (I was impressed by the incredible amount of time it took to accurately personalize each diet, until I learned that many nutritionists composed the diets by slightly tweaking prepared templates downloaded from the Internet.) Nutritionists commonly acknowledged to patients that it might be difficult to follow the diet as prescribed—an important caveat, which I return to later—but that it could be used for the general principles it offered. Foods could be substituted within the same food groups (e.g., tamales for tortillas, apples for peaches), and meals from one day could be swapped for meals from another, so long as they were the same category of meal (e.g., Monday’s lunch for Tuesday’s lunch). The idea behind these exchanges was to, in the words of the nutritionists, “trick the body” into dietary improvements by making changes that the body wouldn’t register as different from its customary routine. Many of these substitutions struck me as less obviously equal than others—for example, the suggestion to replace second helpings with purified water so that one could feel full (“as if you had eaten seconds”) without adding any extra calories. Still, many of the suggested exchanges did build on obvious similarities: whole wheat bread for white bread, low-fat milk for whole milk, olive or canola oil for corn or vegetable oil. Take, for example, the following advice: Nutritionist: You should drink low-fat milk when you get up in the morning with your plate of fruit. This could be your breakfast. Another day it could be a bit of egg with some beans.

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Patient: Yes, I eat a lot of yogurt. But not di—, but not di— [she struggles to find the right word]. N: Not di—, not di—[also struggles to find the word]. P: Not diet. I buy my yogurt by the liter, but I have to replace it all the time. N: This is another thing: it’s better to buy those that are low-fat. P: Huh? N: That are “lite” [in English]. Because if, if you eat it, well, it’s good to eat it. But if you eat it a lot, well imagine! And full of fat! P: And sugar. N: The same with milk and flour. So, here’s the thing. Right now, your yogurt should be lite; your milk low-fat; your cereal whole wheat. That’s how it should be.

A classic example of these identical-but-different substitutions can be seen in advice about imitation sugar: Nutritionist: Well, I don’t know if it’s possible that you, instead of buying table sugar, try a different kind—another sugar that has no calories but which is recommended to patients suffering from diabetes. It’s called Equal—what’s the other brand? Second Nutritionist: Equal and Splenda and Sweet are a few of the brands you can get at the grocery store. They should be used instead of table sugar. They’re the same. Patient: Very good.

In these examples the original food and the replacement food were described as “equal” or “the same” in the key sensory domains of taste or satiety. Yet in abstract domains of calorie counts or grams of fat and sugar—which could not, presumably, be deciphered through sensation—these foods had radically different measurements. The ostensible equality in the realm of taste was used to “fool” metabolic regulation. “You will feel full, but you will not gain weight,” nutritionists explained. Though a common approach of nutrition pedagogy, it is a remarkable maneuver: two foods appear as equal, but that which is less in the invisible measure of calories becomes more highly valued. The notions of credit and debit that run through these nutritional calculations bear strong resemblance to the system of credit and debit in the field of finance. Anthony Giddens describes money as a mode of deferral, a means of bracketing time, and a way of creating the kind of “time-space distantiation” that allows for economic engagements to become impersonal (1990, 24). Similarly, metabolic calculations create bodies that are explicitly engaged in

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a balance of now-and-future tradeoffs. Differences in tastes are overwritten through conversion into numeric standardization, which then allows for these differences to be evaluated as though the difference was never there. This reframing of daily activity in terms of a caloric input and output creates a generalizable, numeric formulation of health that is able to spread widely, overshadowing concerns for well-being that cannot be standardized. Yet this logic is also based on what nutritionists themselves called an illusion—that is, the idea that two substantively different things can ever be equal. When reviewing the diets with their patients, nutritionists would explain that it was “very important to maintain a balanced diet.” This was something I heard in nearly every consult, and from nutrition educators throughout the country. “Balance,” they would say, was key to health. There are many available repertoires of balance, some of which emphasize the gentle give-and-take of adaptive flexibility, but the balance implied by these diets was one in which meals and foods should be rigidly calibrated. Reduced to the metrics of calories, dietary balance presumed a perfectly calibrated, determinate exchange of equal parts: eat less or exercise more and one will lose weight. But if this balancing act was clean and self-evident in mathematical theory, nutritionists also found it to be “deceptive.” Metabolism would slow down; patients would become fatigued; appetite would take over. Although the balance appeared precise, nutritionists would point out that it was impossible to calculate the perfect balance in which all calories, proteins, and grams of sugar and fat would add up to the exact required quantities. The perfect balance—the ideal that incited dietary accounting—remained a model. Though this model was suspended over these practices as a goal to work toward, even for the most carefully calculated and regulated dietary practices given to the most compliant patients it was an impossibility—an illusion, a deception, a trick.

balance in theory, balance in practice In reviewing my transcripts of hospital interactions, I noticed that when nutritionists spoke of dietary balance (una dieta balanceada, una dieta equilibrada) they generally described activities that had to be tightly managed. “You must eat a snack in between meals in order to produce balance with your food.” “To maintain balance, you should eat often, in small quantities, and not let too much time lapse between meals.”

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“You must eat natural, low-fat, or sugar-free foods to have balance.” Even the “natural” dietary balance–a balance that operated without conscious management—was one of mechanical precision, in which the body would function as a homeostatic machine, consuming exactly what it burned, burning exactly what it consumed. A focus on equilibrium might appear to be counterintuitive to weight loss (where one is advised to burn more while consuming less), but it was the case that even for patients who had weight to lose, weight loss was but a temporary goal. The ultimate goal, the ideal state of the body, was a perfectly balanced metabolism—the zero of nothing: no gain, no loss. The balanced life was a life without excess. It is telling that the Oxford English Dictionary definition of equilibrium is “a state of a material system in which forces acting about the system . . . are so arranged that their resultant at every point is zero.” By following the rules of the diet precisely, nutritionists and patients alike hoped that patients might eventually reach this point of carefully calibrated stasis. Herein lies a paradox of dietary balance: on one hand, natural balance should be effortless; on the other, it must be rigidly controlled. Timothy Mitchell suggests that a parallel paradox of balance has served as a foundation for neoliberal economic exchange: The language of neo-Ricardian economics was employed to imagine a naturally achieved balance between forces of agricultural supply and demand, a balance called “the market.” The market is a simple image for picturing the relations between farmers, laborers, landowners, state officials, international agribusinesses, and consumers, an image that reduces these interrelated but very unequal concentrations of power into nominally equivalent buyers and sellers, and represents the inequality between them as the market’s equilibrium. (2002, 227)

In his account this version of economics rests on continual attempts at restoring imagined market equilibrium. Yet, as Mitchell points out, this form of balance has never existed—and a demand to reduce disequilibrium through decentralization and privatization has merely rearranged sites of exploitation. In the cases he reviews, cries to restore imagined market harmonization served to divert attention away from feasible changes in structures of inequality and toward the unattainable goal of “natural balance.” Decades ago, from a different angle, Elizabeth Colson cautioned that anthropologists must break with the idea that sociocultural systems are homeostatic systems, pointing out that social phenomena are always “in flux,

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never reaching an equilibrium” (1976, 264). The notion of equilibrium she refers to is one taken from thermodynamics, where an object in equilibrium is an object that does no “work”—that is, a pendulum at rest, without movement. It is, she argues, a social impossibility. In the case of weight management, equilibrium is also a physical impossibility, as tremendous work, albeit often unnoticed, goes into the regulation of weight. Calorie input − calorie output = 0, the hallmark equation of the field of nutrition on which much dietary advice is predicated, is emblematic of the way in which the fluid diversity of social life is silenced. That we read the equation from left to right says nothing, as the equation does not have a start or finish. There is no time in this abstraction. Completed before it began, it contains no space for the processes inherent in movement and action. Life, on the other hand, is filled with the jagged edges of temporality. Buttons on calculators get stuck. Scales break. Wrists and bones ache. People stop going to the gym because they work long nights and must study during the day. Gain is never a clean, perfect 1, loss is never a −1, and the summation of the two—in contrast to the resultant point of an equilibrated balance—is also never 0. The assignment of numbers to eating and exercising enables a vision of equilibrium implicit in the ideal of 1 − 1 = 0, with its desired stillness of nothing. Yet this ideal ignores that the eating, exercising body is always a body in flux. Whereas the zero purports to be outside of time, bodies are always in time. In my research, the caloric zero—the point of balance for the ideal healthy adult body that neither gains nor loses weight—parallels the paradox detailed by Rotman and Poovey of a quest for absence that is in fact marked by the presence of action. Whereas the realm of numbers might appear free from the qualifications of judgment, clinical practice was rife with negotiations about what made proper diets, correct portion sizes, the right amount of exercise, or the proper amount of weight to lose. The desired weight gain of nothing—the set point of the natural, healthy, balanced metabolism—was surrounded by the fluid values of social activity. The ideal of a natural balance gains power by hiding the numerous sleights of hand that surround indicators for “healthy” weight. It makes it hard to see that disequilibrium in dietary habits is not an unnatural state but an inevitability. It sets up the expectation for a form of balance that will only ever exist in abstraction. And by doing so, it creates the vision of control and numerical perfection that forecloses attention toward forms of balance that have nothing to do with numbers.

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A nonmetric form of balance evident in Xela.

Though they are perhaps increasingly difficult to identify, articulate, and describe, I remained surrounded in my fieldwork by forms of balance where quantification was irrelevant. Many of the women treated in the hospital found the body-weight scale unintelligible or insulting, but they were highly skilled at another form of balance: the balance required to navigate a marketplace, goods piled high on their head, one child wrapped on their back, perhaps, while holding the hand of another. This was a balance requiring strength, agility, and an ability to keep calm amid the persistent, inevitable motion of the market. It was a balance dependent on awareness of relations. In these markets—where weight had long been associated with produce and other goods but not with the human body—this very different style of balance was also highly valued. It was a form of balance that could never be abstracted through formulas or standards, a form of balance learned in practice, which could not be priced. When considering the everyday importance of navigating Guatemalan markets, it is telling that several of the patients treated at the hospital complained not of weight gain but of a different problem that accompanied

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metabolic illness: the imbalance they felt from the vertigo of unstable blood sugar, from walking on swollen ankles, or from managing crutches that had replaced an amputated limb. Many times health workers reframed this as a simple problem of excess weight. But there was a sense, from those involved in all sides of these diagnoses, that the balance of the scale remained an inadequate descriptor of the many other concerns for balance that people confronted in their lives. Take the following example: Daughter: She loses her balance when we go walking. It happens all of a sudden, and she almost falls. N: Oh [she looks at her chart, where she sees a BMI of twenty-seven and then turns to the patient], you see the problem is your weight. Daughter: No, she has always been this size. This is her normal weight. N: Oh, well, yes. I see [fifteen seconds of silence, before asking about the patient’s occupation].

In this exchange the reduction of balance to that which was imagined as measurable did not encompass the imbalances with which the patient grappled. The balance of equilibrium, with its zero at every point, was not helpful here, for this was a woman who was busy balancing many things in life and who needed and wanted to move. When the nutritionist began to speak of fluctuations in BMI, the patient’s daughter quickly corrected her, pointing out that her weight was not an issue, thereby silencing the explanatory framework based on the measurement of weight. The numbers were not instructive, intelligible, or meaningful to her. They result in a long and empty pause—a silence that offers no care for the woman and her daughter.

the excess of metabolism According to those with whom I spoke, life and its energies were not calculated through calories and weight a generation ago in Guatemala. Today, this is changing rapidly. In just a few years, body-weight scales have appeared throughout public spaces: in markets and parks, outside of hospitals, at festivals alongside games and rides. Salespeople wait next to them, and those who pay a quetzal (or less, depending on their bargaining skills) can step on them and learn their weight. Some of the fancier scales—those in pharmacies, GNC vitamin shops, or grocery stores—might also measure height, producing a receipt that included a precalculated BMI.

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The people treated in the hospital clinic did not generally know what to make of the BMI—they looked to children, younger kin, or apparent experts to interpret it for them. But they knew the number was important, that it reflected not just their health but the degree to which they fit within society. As I have illustrated in earlier chapters, weight was not just a quantitative “modern fact” (Poovey 1998), but was also becoming a moral fact—a way in which people understood themselves to be responsible kin, community members, and citizens. The calculus of equivalency that nutrition provides can have striking effects on personhood. Numbers are commonly printed on processed foods in Guatemala, suggesting to people how many calories a single serving has and what percentage of their daily intake this quantity should be. The people I lived with rarely looked at these numbers: no one I knew counted calories in any kind of systematic way. But the logic of metabolic homeostasis was in the nutrition education, advertisements, and public health materials that surrounded us: one bowl of Corn Flakes translated to a certain quantity of energy, which in turn corresponded to the amount of time that one should exercise. The calculations of metabolism operated by quantifying everything from bodies (through BMI) to food (through RDAs) to physical activity (through the expenditure of calories). Reciprocities and relationships that surrounded the practice of eating became situated within “a standard value that can be tabulated as easily as currency or petroleum” (Cullather 2007, 4). It might be argued that as Guatemalans become exposed to this logic, beliefs tied to consumer capitalism shift from functioning at the level of the state or market in the form of regulation of trade agreements, taxes, or subsidies to the level of the self, in the form of body-weight management. Scholars from an array of disciplines have suggested that discourses of nutrition contribute to the embodied legitimation of the state and market, naturalizing visions of the body in which labor practices and life processes are quantified (Rabinow 1999, 414; Guthman and DuPuis 2006; Coveney 2000). But I saw in my research that quantitative techniques of nutritional governance did not have a determinate impact on the bodies they touched. In a variety of ways, people refused the logic of such an equivalency. Sometimes they made this refusal explicit: they simply did not step on the scale. Other times the refusal lay in the patient’s absence at a follow-up appointment or, more often, in the implicit dismissal of the relevance of dietary guidelines that happened when eating, for example, tortillas instead of whole wheat bread. What nutritionists

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might take as a failure of patient compliance was rather a failure to craft meaningful forms of care—a failure to prioritize a repertoire of balance not dependent on the precarious, impossible balance of zero. The textbook framing of physical power is “the rate at which energy is converted from one form into another.” What I have demonstrated in this chapter is that energies that refuse conversion are powerful too. The bodies I studied were undoubtedly becoming shaped by standards of and deviations from metabolic metrics. The energetic equations utilized in the clinic and its surrounding social milieu aimed to produce a responsible, rational, controlbalanced body. Yet these bodies, with their flesh and life of appetite and their diverse expansive energies, could not be cleanly bounded. Numbers were everywhere, but they carried with them the permeable, unquantifiable excess of human activity—excess that was not irrelevant but central to the ways in which people ate and lived. Insofar as numbers and metrics have come to discursively dominate Guatemala’s nutritional landscape, they remain unable to transform bodies and their energies into clean, self-contained equations. I want to end this chapter by returning to the nutritionists’ suggestion that the body is more like a bus than a car. In the replacement of bus for car the imagined mechanics of the body radically shift form and, in doing so, the failure of a rational-choice model of dietary control becomes apparent. In Guatemala buses bulge with humans and animals and goods for sale. Certainly they follow rules—both spoken, such as carefully regulated fares, and unspoken, such as those that enable passage through crowded narrow streets or wet mountain slopes. But insofar as they are to be managed, they are not singularly driven or individually directed; rather, they teem with the inevitable excess of material sociality. A bus will rarely pass someone without a honk or bodily exchange—“Do you want on?” the driver or ayudante will motion the offer with hands and eyes. No matter how crowded the space inside, there is almost always room for more. Though the weight of passengers might overtax the tired motor, when the motor does stall, dozens of passengers will routinely use the force of their weight to start it up again. The same weight that may cause the motor to struggle is what ultimately keeps it going.

chapter 6

Many Values of Health

formulas and recipes The lights in the hospital’s basement were out. Perhaps the generator had failed again. Perhaps the administration was saving money. Either way, I stood in a line of silhouettes lit only by a distant window. I could see in the shadows that the people in front of me were mostly industry representatives. One held a container of infant formula from Similac/Abbott Nutrition called Isomil; another held a package of a vanilla-flavored protein powder from Victus. The door opened and the director greeted me with a strong hug and warm welcome. It was 2013. Nearly three years had passed since I was last at the hospital, and we had a lot of catching up to do. As we talked, she walked me through the labyrinth of the basement’s dark corridors, taking me upstairs to the nutrition consultation room. When I worked here between 2008 and 2009, the clinic was open just two days a week. Four years later it was open every day. As diagnoses of dietary-related illnesses became more common, the university’s nutrition program expanded, providing more residents to operate the clinic. It was lunch hour, so the room was unoccupied and we could take our time. The space was intimately familiar in feel and smell. Still, the details were different. The diet sheets were neatly organized on a shelf, listed by calorie content: 1,250; 1,500; 1,750; 2,000; 2,250. Instead of a single scale, as there had been when I observed consultations regularly, there were three scales for adults and a small flat one for babies. Someone had pasted an outline of feet on the

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back of a cardboard box of Corn Flakes to show patients how to stand on the scale, and it was propped up against a blue wall. Another wall was decorated with colorful cutout illustrations of various food groups (meats, cereals, dairy, sugars, vegetables, fruits, and fats) and a food wheel categorizing foods according to their amount of cholesterol. A large poster hung above the examination table. In it, a smiling woman with light skin and white teeth gave a thumbs-up. “I feel so good!” read the caption, followed by the slogan “Take a load off.” The left side of the poster contained graphics illustrating the BMI and the World Health Organization’s diagnostic criteria for normal, overweight, and obese. At the bottom of the poster was a picture of two small pills of sibutramine—the ten-milligram one pink, the fifteen-milligram one green—produced by the company Vintix. When representatives from Vintix donated the poster to the clinic, the nutritionists had been grateful for the didactic tool. BMI, the ratio on which their treatments and guidelines were based, was unfamiliar to most patients, who were not used to thinking about or monitoring their weight. The poster provided an illustrative referent for the nutritionists’ explanations that too much weight was harmful. Bright red was marked clearly as normal— “healthy,” the nutritionists would say. The darker the red, the more severe the risk for illness. Nutritionists did not typically prescribe sibutramine, so they did not have to worry that the drug had been banned in several countries after studies found a convincing link to an increased risk for heart attacks. Anyway, their patients typically did not read, and they certainly did not identify with the woman in the poster, with her light skin and blue jeans. To me, the presence of the poster was haunting: a drug that causes heart attacks advertised in a clinic for those seeking care for the condition of their hearts. But the nutritionist who had brought me to the room was not bothered by the poster in the least. The focus in the clinic was on eating, not pharmaceuticals, she reminded me, when I asked about Vintix. Indeed, in my months working in the clinic, I saw that nutritionists would routinely steer patients away from pharmaceuticals and toward making dietary changes. An example, from field notes made during this time illustrates this well: February 2009: The patient, a middle-aged woman, Mayra, who lives not far from the hospital, enters the clinic, her daughter at her side. The first thing the nutritionists do is measure her weight. As the patient and her daughter sit at the con-

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sultation table, they calculate her BMI and quickly tell her that some weight loss is necessary—roughly ten pounds. One of the nutritionists inquires into what has brought Mayra to the clinic. She explains that she can’t seem to lose weight on her own. Several months ago she started taking some pills to help, but they made her blood pressure rise and so she stopped. Her weight then started to go back up, so a doctor she saw at a private clinic gave her a new prescription, this time for a medicine called “Vitrix— Vintrix—Vintix?”—she struggles for the name. “Vintix,” the nutritionist clarifies. Yes, Vintix. For several weeks she has been taking fifteen milligrams of Vintix each morning and another pill for blood pressure. She can’t remember its name. It will be more than a week before she can see the doctor to find out whether her blood pressure is okay. She is also bothered by pain in her stomach. The nutritionist says not to worry—there is a treatment that will help. She tells Mayra that many of our nerves are in our stomach and intestines, so when we have stress in our lives it affects digestion. She asks whether Mayra has an ulcer. Mayra says no, but that the inner part of her stomach is damaged. The nutritionist nods and explains that much of what we eat is filled with irritants and by changing her diet things will improve. She asks Mayra to tell her what she ate the day before and they begin to work through the list. Water. Coffee. Bread. Porridge with a little banana. Scrambled eggs for lunch and, for dinner, three small corn tamales with chirmol (a tomato sauce that can be made spicy). “Do you add much oil to this?” the nutritionist asks. “Just a little,” Mayra replies. The nutritionist nods again and then tells Mayra to be careful with oil. It’s one of the easiest things to cut back on to reduce calories. She should also work to eliminate coffee and spice: “nada picante.” Bland food— that’s what she should be eating. Bland. Bland. Bland. The nutritionist says it three times for emphasis. On her desk is a pad of paper that says “State Pharmacy” across the top, with the address of the hospital below this. The nutritionist pulls it out to give Mayra a receta, a word which means, conveniently enough given the hospital setting, both cooking recipe and pharmaceutical prescription. She writes “Nutrition Recuperation Formula” across the top of the pad. Below this she provides the following list: In one bowl add 6 tablespoons of Incaparina; 4 spoons of sugar; 11/2 tablespoons of oil, 3 cups of cold water. She then turns the page over and writes, “Preparation: Stir it well, heat it until it boils for ten minutes. Add the oil when it’s boiling. Drink one glass, three times a day.” She hands it across the table to Mayra with a smile.

The patient arrived at the hospital asking for a drug to help with her weight. She was in pain; her stomach hurt. The nutritionist wanted to help. She entered the field of nutrition because small changes—not adding spice to food, for example—can theoretically make big differences in how people feel. The

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patient wanted to replace food with a drug; the nutritionist gave her a recipe instead. Observing this, we might suspect that this prescription medicalizes eating, but insofar as this individualizes and anatomizes the woman’s meal, it was made with the aim of keeping the woman off of yet another pharmaceutical. It might look like medication, the nutritionists would say. But with medication patients still needed money for food. At least here she was also getting nourishment. Situations in which different priorities of care collided were everywhere in my fieldwork. The manager of the nutrition program, an advocate of breastfeeding who nursed her own son until he was three, gratefully accepted formula donations. Sometimes women didn’t produce milk or even died during or shortly after labor, leaving the thin, hungry bodies of their babies behind. The hospital treated the region’s poorest, and sometimes these families would have no other option but to give their babies bottles of corn milk or sweetened coffee. The manager reasoned that formula, though not ideal, was better than sugar water. Elsewhere, I saw that grade schools raised revenue to be able to offer nutrition-education classes by selling candy and that public health events were often funded through food and beverage industry sponsorship (a PAHOaffiliated event I attended promoting cardiovascular health was sponsored in part by Pepsi; see also Nestle, forthcoming). The prescription pad in the nutrition clinic was there because many pharmaceutical companies provided slight reimbursements to those dispensing prescriptions, and these reimbursements might help to keep the clinic open for longer hours or to keep it better staffed. Even Incaparina’s own history was fraught with these difficult negotiations. The history of Incaparina is important enough to the development of the field of public health in Guatemala that it warrants elaboration. I will begin in 1961, one year after the official start of Guatemala’s civil war and the first year of the product’s development. Even for scientists, the concept of a nutrient was still fairly new, but there was already ample evidence of widespread protein deficiency throughout the country. The directors of INCAP had been charged with doing something about this, and they set about to create a protein-and-calorie supplement that would be suitable for small children. From the start, they enlisted anthropologists to help them, recognizing that the product would fail if it was not “culturally acceptable.” These anthropologists studied what they referred to as “local customs” for preparing atoles made of maize (Scrimshaw 1980, 2). They concerned themselves with matters

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of palatability and taste and in the end came up with a product that resembled the physical consistency of atole, and which people seemed to like. One of the first mixtures that they tested on the public—Mixture 8—was made with locally sourced materials. But after calculating the costs, they realized it was too expensive for the people they wanted it to reach. They decided to import vitamin A in synthetic form. The next mixture, Mixture 9, was made of corn flour (29 percent), sorghum (29 percent), cottonseed flour (38 percent), torula yeast (3 percent), and CaCO3 (1 percent). They added 4,500 units of synthetic vitamin A to each 100 grams of the dry product, sourcing the vitamin from a factory in New Jersey (Scrimshaw 1980). They named the mixture Incaparina after the research station. The idea of a fortified nutritional powder would eventually be taken up in countries as far away as India and China, but the target for this particular product was quite specific: the women and children of Maya communities who typically drank atole throughout the day. The Guatemalan government, embroiled in the first year of a civil war that would last for the next thirty-six, could not, or perhaps would not, sponsor the product. Incaparina remained trademarked by INCAP so that its scientists could control the formula, but public funding was so limited that production rights were granted to a single corporate producer: Cervecería Centroamérica, a privately held manufacturer, known everywhere in the country for its Gallo beer. It was not ideal, Nevin Scrimshaw, the director of the project, acknowledged years later, but the benefit of giving it to a big company was that the price for the product remained lower than it would be otherwise. They had researched cooperative production, but costs would have been higher and far too many people would remain excluded. (He did not mention this, but a different branch of the same government with which they were affiliated was at that time slaughtering people throughout the country who were involved in systems of cooperative production. Scrimshaw, a U.S. American, was among the first global health experts to insist on the link between nutrition and agriculture, but an effect of La Violencia was that concern for land and land reform would disappear from INCAP’s agenda.) The scientists reasoned that cooperatives would likely be hard to oversee and even the Cervecería, with its decades of experience, had trouble handling the demand for the product— which proved to be far greater than they could have hoped. Because it still came at a cost, the scientists recognized that those without some disposable income would never be able to buy it. The same anthropologists

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who devoted themselves to its development warned that only political and economic policies that improved the purchasing power of the lowest income groups will “truly make a significant contribution.” So there was neither claim nor expectation that Incaparina would solve the problems of hunger in Guatemala. Still, there was need for a nutrient source for malnourished mothers and children that was less expensive than milk. As Scrimshaw put this, “It would be the height of arrogance to deny developing countries the benefits of a nutritionally comparable food at the lowest practical costs” (Scrimshaw 1980). His review of the product would note that although Incaparina was of limited benefit to the Maya population living at subsistence level, without it the nutritional situation of Guatemala would have surely been far worse. A half century after its development, while I conducted my research, INCAP remained a household name. The poorest were still unable to afford to drink it often, but most everyone had tried it. The children and adults I lived with consumed it regularly at home, and it was served throughout the nation’s schools. When I mentioned it, people invariably started to hum its advertising jingle: “Usa la fuerza para lo bueno: Toma Incaparina” (Use your strength for good: Drink Incaparina). The nutritionists in the obesity clinic would tell their patients that six tablespoons a day would help with headaches, fatigue, blood pressure, cravings, and weight loss; six tablespoons would improve their health.

the metrification of health Many social theorists have argued that the expansion of dietary awareness is emblematic of the body’s medicalization—which Adele Clarke and colleagues define as the “processes through which aspects of life previously outside the jurisdiction of medicine come to be construed as medical problems” (2003, 161; see also Zola 1972). Susan Bordo (2003), John Coveney (2000), and Deborah Lupton (1996), working in the United States and Australia, all associate the emphasis of discipline, calculation, and self-monitoring seen in attention to dieting with the creation of medicalized subjects. In my fieldwork I observed much that might be taken as evidence supporting this thesis. People called their diets both tratamientos (treatments, a medical term) and menús (menus, a culinary term), hinting at a possible medicalization of eating, as dieting became a way of caring for one’s health. When giving patients dietary guid-

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ance, nutritionists regularly outlined meals or preparation styles on the same prescription pads used to prescribe pharmaceuticals. The link between dietary health and medicine was made explicit in the slogan used by numerous food supplements to advertise their products: “Let your food be your medicine, and your medicine be your food.” Yet when I considered the absence or insufficiency of medical care throughout Guatemala, it struck me that it was inaccurate to speak of medicalization or biomedicalization. Though health may be “extended” and “reconstituted” through growing public interest in self-regulatory practices such as bodyweight management (Clarke et al. 2003, 162), I suggest that medicalization is an incomplete—and potentially misleading—framework through which to understand activities surrounding dieting in the region today. Some forms of health are no doubt well on their way to becoming a product bought and sold (cf. Dumit 2012a, 2012b). Yet, as both Margaret Lock (2001) and Nikolas Rose (2007) have argued, medicalization seems too blunt a term to adequately capture the diverse “medical” motivations and operations of those groups whose work it attempts to encompass: federally employed public health workers; private clinicians; pharmaceutical, food, and media corporations; or kin networks. Whereas much critique of medicalization expresses concern about the commodification of “health itself ” (Metzl and Kirkland 2010), I saw in my fieldwork that health did not have a singular, essential property (an “itself ”) to be straightforwardly commodified. When I spoke with nutritionists, I sometimes raised my concerns about the convergence between public health advocacy for “dietary health” and the messages of “dietary health” encouraged by the processed food industry in Guatemala. They commonly responded that their work operated at cross-purposes to Guatemala’s expanding industrial food supply—against commodification. The dietary health they advocated could be achieved through a diet of staple foods and without buying expensive, processed products. Rural health educators regularly encouraged people to “eat the vegetables you grow, rather than buying chips and sodas.” In the city hospital, when people worried about the cost of “healthy” food, it was not uncommon for nutritionists to point out that a snack of fruit cost no more than a small bag of chips and that, given the nutritional benefits to be found in corn and beans, eating well didn’t have to be expensive. When nutritionists prescribed nutritional supplementation, this was often because they knew that a package of Incaparina (which cost just few quetzales, or roughly

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0.25 cents) was much less expensive than the pharmaceutical medications that doctors might otherwise recommend (which commonly ran in the $10–20 per week range). If nutritionists bristled at my concern about parallels between their work and the “health” on sale in pharmacies and supermarkets, most shared my concern that dietary well-being in Guatemala was closely linked to financial capital: the resources to afford fresh and clean fruits and vegetables, to take time for exercise, to pay a private doctor and avoid the long lines of the public clinic, or to buy prescribed medications. They recognized that Guatemala’s poorest were the hardest hit by metabolic illnesses, and they typically agreed with my concern that food and drug companies had seized—literally, capitalized—on messages of dietary care advocated by public health services. In the words of one nutritionist, “the problem is that the idea of health sells products.” The result, she said, was that while many public health workers encouraged lifestyle changes that might prevent illness, they often found themselves competing against those companies working to habituate Quetzaltecos to dietary lifestyles merely branded as “healthy,” in which the companies’ products played a role. Similarly, one senior INCAP employee told me, “Generalized obesityprevention programs directed at an entire nation unfortunately produce ideas of health that can be easily co-opted and transformed by the food industry.” He pointed out that his organization had far fewer economic and political resources than food corporations. Strapped for funds, he felt unable to design and implement locally attentive, context-based programs that could address people’s diverse concerns. Michel Foucault suggests that dietetics—which requires permanent and continuous oversight of the self by the self—can supplant the medical model of care in which a patient seeks a doctor’s support; in dietetics “one must become the doctor of oneself ” (1988, 31). For the Guatemalans with whom I lived and worked, dietary concerns fostered an ethos of self-care, yet they did not assuage the need for external care. Instead, the coupling of dieting with awareness of metabolic illness was changing how people understood health and disease; these were no longer conditions to be felt but potentials to be diagnosed by someone else. As a result, people found themselves embroiled in contradiction: on one hand they were expected to care for themselves; on the other they needed to look outside themselves for treatment. The dilemma was made all the more complicated by the absence or inaccessibility of medical services in Guatemala. Quetzaltecos very often found

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themselves without the professional support they desired for coping with the considerable fear and unease they felt about what might be happening to and within their bodies. Food, drug, and media corporations swiftly entered this lacuna. “Health for all your life,” read a slogan outside a GNC vitamin store in the Pradera Mall. Profit-driven promises such as this sought to make “healthy” consumers—those who purchased products to maintain or achieve health—out of people who might have wanted to be patients. Many of Guatemala’s public health workers described practices of good dietary health care in a way that aligns with Annemarie Mol’s description of “doctoring”: they aimed to establish the “attentive, inventive, persistent and forgiving” techniques for living with and coping with disease (2008, 55). But they also felt they were confronting the insurmountable obstacle of, in the words of the INCAP employee, “making due with scant resources, not enough personnel, and not enough time.” In the profit-driven commercial landscape of Guatemala, with companies compelled toward financial gain, what pervaded visions of health were not the contextually attuned, healing-oriented practices that Mol refers to as good care. Instead, people were left with frightening discourses about probabilities and percentages of risk, blunt standards, and an overburdened health care system wherein “doctoring” was supplanted by numbers. In the shadow of formulas for weight loss, ever-present sensationalist threats such as “people with obesity are 50–100 percent more likely to die of various causes in comparison to people of normal weight” (a quote from a Guatemalan newspaper article printed during my fieldwork), and a nearubiquitous focus on body measurements in official governmental protocols for responding to metabolic illness, I came to view metrification as a better descriptor than medicalization of the transitions occurring in the treatment of bodies, weights, and selves. In their critiques of medicalization as too crude to depict the processes that it attempts to encompass, Lock and Rose each suggest that analysts should look carefully at context when describing approaches to medicinal care. My employment of the term metrification similarly risks flattening out the social lives of metrics; after all, there are certainly times when numbers can be useful for care and healing. But, to clarify, by metrification, I aim to describe those very processes that remove situational context, leaving in its place abstract standards, quantitatively driven rules, and a focus on universal norms. I do not mean to force too strong a division between the arenas of medicine and

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metrics, as they often work in tandem: measurement being part of medicine, medicine being part of measurement. But if medicine is, as medical historian Paul Unschuld argues, the endeavor to understand and interpret bodily states and to then apply this knowledge onto the body so that “a person feels well” (2009, 6), metrification is the application of numeric standards derived from an anonymous population onto an abstract self, without regard for interpretation or feeling. A headache or poor eyesight becomes transformed into a number on a scale; the nuanced negotiations that go into any practice of eating become transformed into fat grams and calories. Mary Poovey describes how numbers—once seen as supernatural—came to appear as transparent and impartial representations of truth, replacing “observed particulars” with “units” of measure (1998, 4). She suggests that despite their presentation as unbiased, numbers are implicated in the creation of a system of knowledge that prioritizes numerical accounting. The priority acquired by numbers, given their “brevity and the ease of calculation,” privileges quantification—in which materials seem easily translatable—over qualification, which required extensive time and detail (54; see also Dunn 2005; Porter 1995). Numeric standards produce an image of similarity and homogeneity, allowing for far-flung people and organizations to represent their concerns through ostensibly commensurable measurements. The application of metrics to complex problems makes unlike things not simply comparable but potentially equivalent. It is out of metric-based comparison that rules and regulations can be both generalized and normalized. While the deployment of measurable standards in obesity care may be entangled with concerns for patient well-being, my research also suggests that medical abandonment (Biehl 2005) and commercial profit incite the turn toward dietary metrics in Guatemala. At the very least, treating health as a standard measure often ignored the complex dilemmas facing those people seeking and needing care.

failures of calculation Throughout my research I encountered a desire on the part of many health workers to make health quantifiable: a number of calories eaten in a day, a weight or a range of BMI (normal = 18.50–24.90), a prescription for food (three tablespoons of supplements) or a pharmaceutical dosage (fifteen-milligram pills, once a day). But, as I have suggested, an ease of calculability was often

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not a route to good care. I want to conclude with a final story that illustrates the ramifications of this failure. This story is set in the K’iche’ community of Almolonga, about a fifteenminute bus ride from the hospital obesity clinic, when traffic is light. The first time I traveled to Almolonga was with the hospital nutritionists. Resident nuns had invited us to their home to speak with a group of women about malnutrition. As concerns for nutrition in Guatemala have long been conjoined with concerns for hygiene, the nutritionists had focused the first half of the seminar on the topic of hand washing and cleanliness, teaching the women about adding chlorine to their water and washing their hands (“up to their elbows”) with soap. After explaining that diarrhea can cause malnutrition, they turned to the topic of nutritional health, explaining what nutrients and foods would do for the body. (“Vitamin A is found in carrots and is good for the eyes. . . . Vitamin C is found in oranges and is good for the immune system.”) On the day I describe here, I arrived to Almolonga without the nutritionists. The nuns had invited me to join an event they were hosting on the making of mezclarina. Roughly a dozen women from the community had formed a nutritional cooperative to prepare this nutrient-rich powder to share among themselves. Individually it would be too expensive, but by distributing their resources they could manage the costs. Each woman arrived with an ingredient: sunflower seeds, pepitoria from squash, sesame seeds, corn flour, pinol de haba, wheat, peanuts, and bran. The nuns donated the space, the gas oven where seeds were roasted, the mortar and pestle for grinding, the filters, and the bottled and boiled water used for cleaning. Children were welcome at the gathering: the younger ones sat at a table with books and colored pencils, and older children played games on the computer in the corner of the room. It took us several hours to make the paste. Considerable manual labor went into the grinding and shelling of the seeds. It was cold outside, but we were sweating. Though the grim specter of malnutrition bought us together, it seemed that we spent the entire time laughing, and there was only an occasional, off-hand mention of nutrients. Much more attention was paid to toasting the seeds for the right amount of time and grinding and sifting them until they were the proper consistency. The women were experts in these matters. When we finished, we divided the materials, distributing portions on the basis of how many children the women had to feed. They told me there was a

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Making mezclarina in Almolonga.

version of the powder sold in health food stores, which they could never afford. They knew of and drank Incaparina, but they also said with pride that it was not nearly as healthy as what they had just made. There was nothing synthetic in their powder. The soreness in my shoulders from the milling was a reminder that, like Incaparina, this powder was processed too, but there was a difference here, as it was processed by hand. The workshop ended here, but my story does not. I left the red-and-white roofed house on the edge of the farmland and walked back toward the center of town. On my way, I passed a group of women carrying heavy bushels of onions on their heads. The road turned to parallel the river, and then I came to a bridge. I looked down to see a group of children washing enormous carrots in a place where the river had pooled. I had my camera in my hands, and one

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of the children looked up to me with a carrot in his hands, smiled as if posing for a picture, and then took a bite. Coming from a day spent focused on making a nutrient mix, I might have been tempted to look at him eating that carrot and think, “there it is: good, nutritional health.” The women, though not focusing on nutrients in their conversations, had nonetheless spent the day making a nutritional powder. Improving access to nutrients has been a hallmark of good health policy for decades (Sen 1981) and an area where the field of global health has directed considerable energy. The classes I have detailed in this book placed tremendous emphasis on the importance of selecting nutrient-rich foods. And here was a boy eating a carrot filled with vitamin A, which would be good for his eyes and which would keep him strong and healthy. But this story is not so simple. Almolonga is set in a wet and fertile valley and was in the nineteenth and early twentieth centuries a stopping point between the cotton plantations on the coast and the nearby textile factory in Cantel. In the 1940s cabbage and carrot seeds from the United States were planted, and an export market developed, bolstered by improvements in the highway system. It was rumored that U.S. Americans, home from the war, wanted “healthy” vegetables but the truth of this is lost in history (Arbona 1998; see also Levenstein 1988). What was known is that pesticides and fertilizers, including Cobre (copper oxychloride) and Gamexan (BHC), accompanied these seeds, which could not grow without chemical assistance (Arbona 1998). Between the 1950s and 1970s the production of trade vegetables was consolidated. At the time of my research, produce that came from seeds imported from the Netherlands and the United States dominated the marketplace, accompanied by sales of also-imported synthetic fertilizers and pesticides. The vegetables people grew did not end up in these northern countries. Too full of chemicals for U.S. and European markets, they instead went to El Salvador and Costa Rica. It was these countries’ healthy produce that traveled north. The water in Almolonga was not centrally treated with chlorine, which might have killed the microbes that were present (see Nading 2015). But even if it were, this would not strip away the heavy metals of the toxins that blanketed the produce and land. Sonia Arbona (1998), an epidemiologist who has researched agrochemicals in Almolonga, reports that farmers applied pesticides more often and at higher dosages than recommended and then dumped the empty bottles and bags among the fields. She writes of the familiar smell of the fungicide Antracol that greeted her and of protective gear that went

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A man sprays pesticides over fields in Almolonga.

unpurchased, farmers sometimes preferring to go barefoot so as to not injure the delicate seedlings. A midwife told her about babies born with anencephaly, microcephaly, twisted extremities, and wrinkled skin. There is a haunting mention in her writing of children born without eyes. While pesticides leave traces in the soil, the illnesses that might result are far more difficult to trace. Infections of the upper respiratory tract, potentially caused by damage to the epithelial cells of the lungs, were among the most common illnesses in Almolonga when Arbona conducted her research. This was followed by stillbirth and then cancer of the liver, intestines, stomach, and uterus. Animal trials have linked all of these affl ictions to pesticides, but causality is difficult to trace when working outside the laboratory. When it comes to linking pesticides to human illness, evidence is scarce, scattered, and missing. Arbona writes, “Almolongueños are exposed to toxins directly through their work and indirectly through the contamination of water, air, and food. Yet diseases associated with parasitic infections and nutritional deficiencies, with their more immediate manifestations, mask the effects of pesticide exposure.” This reality is what she calls a “concealed reality” and a

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A Tortrix stand in Xela.

“virtually unrecognized public health problem” (1998, 60–61; see also Guthman 2011; Holmes 2013). Ten years later in a nutrition class, educators would focus on how healthy it was to eat fruits and vegetables. When worried that women could not afford vegetables, they encouraged nutrient fortification. This logic of health does not encompass the fact that women regularly purchased packaged chips and candies for their children when they were out shopping because they were afraid of microbes and pesticides. That laboratory research (e.g., KaramiMohajeri and Abdollahi 2011) has linked the chemicals helping to produce the region’s so-called healthy vegetables to an increase in the very metabolic illnesses that vegetable consumption is supposed to prevent is a complexity that no health educators in the area had begun to confront.

when health is not a number Western tradition has it that a property—such as the property “healthy”— corresponds to a value that is not opposed to itself. But viewed just through

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the terms of nutrition science, health was full of apparent contradictions and impossible to value in a single, stable way. Healthy eating was eating chips because vegetables might cause diarrhea. It was eating vegetables because they had vitamins. It was eating packaged food because produce was awash in pesticides. It was eating nonprocessed food because chemicals used in processing were deadly. It was eating a lot so as to become big and strong. It was eating little so as to lose weight. For a particularly insidious contradiction, healthy eating entailed fortifications like Incaparina that provided pregnant women with prenatal nutrition, even as public health scientists have begun to voice the warning that unborn infants in Guatemala may grow too big too fast, increasing the risk of obstetrical complication for the many women who birth at home (Solomons 2013). Dying in childbirth is certainly not healthy. One scientist I interviewed in Guatemala in 2013 referred to the possible impacts of “good” prenatal nutrition as “genocide at an unimaginable scale”— a haunting statement given the country’s history. In my research, health could be a technical term, causing women who had spent lifetimes cooking for their families to claim no knowledge, whatsoever, of nutrition. It could also relate broadly to care for land and the food that comes with it. That these two different ideas of health could both, at once, be true signals the inevitable impossibility of representing and containing health within standardized or measureable values. As the field of global health was focused on improving health through calculations of nutrients and calories and standardized dietary messages (e.g., eat less, exercise more), I was also learning from the people around me that health, as a practice of living, resisted these formulas. Improvements in health, when they occurred, emerged through complex and often fraught negotiations, achieved not once and for all but in situated and often fleeting ways. To make assessments of health, let alone develop strategies for treatment, did not just require knowledge of historical and cultural specificities, but required staying with them as they changed across place and time. When it came to providing good care for patients (and the land on which they grew their food), there was no universal prescription, recipe, or formula to follow. What does this say about the social lives of obesity and practices of dietary care more generally? The stories I have presented suggest that locating health in objects—be these objects items of food or bodies of individuals—bypasses the situational contingency of health. Even seemingly simple directives like “eat more vegetables” become entangled in a matrix of other concerns when

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this directive is put into practice. Where will these vegetables come from? How are they grown? What is in the water used to wash them? How are they then prepared and eaten? When health is compressed into numbers, pathways of treatment that rely on prescriptive formulas emerge. Telling patients to lose weight and eat more vitamins is surely easier than addressing the specificities of agri/cultural histories, the pleasures of taste, and the ways of relating to oneself and others that are a part of eating and feeding. But metric-based approaches to eating well neglected so many aspects of the social, environmental, and political lives of obesity in Guatemala that the need for nonmetric treatment strategies was obvious to most everyone around me. As a woman from Almolonga and I were spooning the mezclarina into glass jars, I asked her if she thought the supplement was healthy (using the Spanish word saludable). She responded, also in Spanish, that it had been a good day—that the day had given the women strength (fuerza). I would later learn that whereas people in the region commonly associate salud with what happens in clinical settings, they use a K’iche’ term for health, rutzil wachaj, more expansively to refer to that in life which is precious, full of vitality, durable, beautiful, or simply good (see Fischer 2014). Embedded in the woman’s response was a profound repositioning of my question. Is this food healthy? (my question) assumed the values of health to be fixed in the object of food and assumed that these values could, like the values of measures, be assessed through abstract standards. Meanwhile, the day was good (the woman’s response) suggested that it might make more sense, when evaluating health, to look at what the food does in the politics of everyday life: What are its histories? How is it used? What relations does it bring about? This shift departs from a metric-based approach to care that locates dietary health within the body and its food, evaluates through global standards, and treats with universal recipes and formulas. It encourages an approach to medicine in which health is necessarily relational and in which care for health implies staying with its instabilities and complexities.

Conclusion The Opposite of Obesity

Gloria lived on a rundown alley across from the Gallo cervecería (beer factory), in a house surrounded by a high gate topped with broken glass and barbed wire. She was born in that home, now more than fifty years ago. The street was once quiet, she said, though when I lived with her it was bustling with construction, as the municipal government, wanting to accommodate the steady flow of cars heading toward the city center, expanded the road into a highway. Her three children were married and had moved away and now had children of their own. Her husband left years earlier, and she filled the empty rooms in her house with university boarders, whose families lived several hours outside the city. She charged only Q200, or $25, per week for a room and meals, but this did not keep her from devoting an impressive amount of energy to cooking. As she sliced, simmered, and seasoned, she would tell me about why she had chosen particular meals and ingredients. She was proud that her cooking was nutritious, pointing out that she did not oversaturate the flavors with salt or oil and that, when she mixed powdered juices, she did not add as much sugar as the package recommended. She was also proud that the food was flavorful. “Rica!” the grateful boarders would exclaim, satisfied at the end of every meal. I often accompanied Gloria on her trips to Xela’s large open-air markets, where I watched as she carefully selected her goods. She prepared no grocery list but would wander from stall to stall, stopping where food looked fresh. She knew which vendor to go to for cinnamon and which to go to for cumin. 173

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She would select each vegetable—carrots, onions, peppers, garlic, güisquil— from different stalls, always in the same way: first asking about the price, then feeling the produce, and finally adding it to her expanding cloth bag. Usually, she did not shop at the nearby Despensa supermarket, which sold packaged foods such as pasta, rice, sugar, crackers, instant coffee, and canned fruits and vegetables, but bought her food from women in the market. She said she didn’t like the supermarket, and when I asked her to explain, she said simply, “It’s not familiar.” Semana Santa, the week of Easter celebrations, was approaching. The boarders were returning to their families for the holiday, and her own children were arriving for her youngest grandson’s baptism, which coincided with the week’s celebrations. Her two eldest—a son and daughter—lived in the capital; her youngest had married an agricultural engineer and moved with him to a mountain community a few hours in the opposite direction, toward the coast. They didn’t visit often enough, and Gloria was glad that the house would soon be overflowing with food and relatives. During the week before their arrival, the smells of boiled plantains and charred peppers began to fill the rooms. For several nights the blender churned well past midnight, and early the next morning, on my way to the hospital, I would find Gloria standing over a boiling pot on the stove, tasting a particular sauce or mixing spices into a pan of simmering beans. She was most proud of the tamales she was preparing. The day before her family arrived, I sat with Gloria for several hours while we hand wrapped more than two hundred in banana leaves; boiled them in small, careful batches; then stacked them in her refrigerator. She had chosen a special white maize that a friend had grown and had ordered the meat for the filling from a butcher who raised animals in the countryside. Before she brought the maize to a mill to be ground into masa, she sat me down and had me touch the kernels in the brown paper bag to feel how precious they were. She explained, as I did this, that the seeds of maize do not just reproduce by growing more of themselves; they reproduce by becoming eaten, where they then take on human form. Her three children, seven grandchildren, and two uncles arrived on a Friday night, bringing with them the chaos of family reunion. Cots and suitcases filled the hallways. A large race car–shaped piñata took over part of the living room, and dozens of bags of candy spread across shelves and countertops. Gloria shared her bed with four grandchildren, and on Saturday others crowded into her room to watch a pirated cartoon movie (twice in a row), while

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eating the candy that did not fit in the piñata. Along with the bags of candy came a box of generic-brand aspartame, which was added to a pot of mysterious herbs occupying one of the stove’s burners—a “tea for blood sugar” purchased from a traveling salesman, Gloria explained when I asked. Her son and her son-in-law who lived in Guatemala City were both diabetic. She blamed this on office jobs that kept them from eating lunch—the day’s main meal—at home. On the morning of the baptism, Gloria rose before the others to heat tamales and sugar-infused coffee. Distant family members arrived, and a line began to form around the kitchen, as Gloria and her daughters filled paper plates with food. Shortly after breakfast the dozens of people who had gathered piled into cars to drive the one kilometer to church—a distance covered on foot when they were younger, but which had become an unpleasant if not dangerous walk because of the traffic. When leaving the ceremony two hours later, they bought snacks from the church vendors: honey-covered cookies, coconut candies, and syrupy snow cones. “It’s a custom,” they explained, offering some of the sweets to me. Back at home, I learned that Gloria’s son-in-law, the father of the grandchild who had been baptized, had decided to buy lunch for everyone from Pollo Campero, Guatemala’s most popular food chain. Since lunch was the main meal of the day, I had thought Gloria would be disappointed that we were not going to eat the food she had laboriously prepared. But she shrugged this off: “It’s a treat; we’ll eat the tamales later.” Over a meal of fried chicken, tortillas, mashed potatoes, and Pepsi, neighbors and relatives commented several times how lucky we were to be eating food from Pollo Campero. This was followed by a thickly iced sugary white cake. An hour and a half later, handfuls of kids formed a circle around the gigantic race-car piñata, now dangling from a wire in the street. Within ten minutes they had beaten it down and filled their pockets and grinning mouths with candy. The next day, amid piles of dishes, Gloria told me that she worried about her grandchildren raised in Guatemala City. She was concerned they would become diabetic like their fathers. Because her daughters worked away from home, they could not devote as much time to food preparation as she had while raising them. She told me that all of her grandchildren who lived in the capital except the baby could lose some weight. Her comment surprised me, since I had often heard her say that telenovela stars were far too thin—even ugly—and that she found fatness (gordura) attractive.

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She clarified to me that fat could be attractive, but obesity wasn’t something anyone would desire. When I asked her more about this she connected obesity to fast food restaurants, traffic, and too much time spent inside watching television. She feared her grandchildren were heavy from junk food (comida chatarra) and not from healthy appetites. I asked about her other grandchildren—those raised in the mountain community. To me, they looked similarly plump. Gloria clarified that they were healthy and went on to say that for them, the experiences of the weekend—the television, the candy, the Pollo Campero—were rarities. “Most of the time they’re outside playing. They’re fat [gordos], but not overweight [no tiene sobrepeso].” As we spoke, I realized that the distinction she was drawing between overweight and fatness did not pertain directly to size but to something else. Fatness, as Gloria used the term, was a quality of health and happiness. Obesity, meanwhile, related to the potential for illness. “How do you know the difference?” I asked. She was confused by my question. “They’re my grandchildren. I know,” she said.

I draw the book to a close by focusing on the work of a few hospital nutritionists who, during their consultations, drew a distinction similar to the one Gloria made between fatness and obesity. As illustrated in the previous chapters, global health attention toward dietary-related chronic illnesses in the Guatemalan highlands is reframing desirable weight. People who recently associated fatness with health and prestige are now exposed to a flood of public health and diet-food campaigns that encourage thinness as a new standard of fitness. Yet in some nutrition consultations I observed a powerful rejection of the equation between thinness and health on the part of both patients and nutritionists. This was not systematic; there was not a distinct group of nutritionists who consciously, actively rewrote the protocol. It was rather that the global health standards that nutritionists were supposed to follow too often failed to fit with kinds of pains and bodily failures with which their patients were grappling. I suggest that the way they translated global guidelines to fit the context of the clinical maladies, though not necessarily representative of nutritional advice in Guatemala, has potentially useful implications for public health nutrition. In their work they often made use of the belief—important for the lives of their patients but unrecognized in the field of global health—that

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obesity and fatness were not necessarily the same. Whereas they linked obesity to metabolic illness, an increased reliance on processed foods, and the stress of urbanization, they linked fatness to a malleable, nonmetric, contextdependent notion of health. Global health discourses typically describe thinness as obesity’s opposite, but the nutrition-education techniques that I describe here contrast fatness—not thinness—with obesity. This notion of fatness rejects the metabolic zero underpinning most dietary protocols. It evokes a different form of balance than that produced through metabolic equations, focusing attention toward forms of health, which, though powerful, cannot so easily be standardized. Several nutritionists from the hospital clinic found that one of the largest obstacles they confronted was that people wanted diets that contained small portions and few calories so they could lose weight quickly. In the words of one nutritionist, “Dieting to lose weight is the worst thing patients can do, and yet many people start here: they hear ‘diet’ and they think ‘weight loss.’ ” Another nutritionist told me at the end of a consultation, “This is all a very slow process, and when patients judge success through weight loss they tend to be disappointed.” She elaborated that weight loss could take years, and those who were dieting to lose weight often lost interest in nutrition when this goal was not met. There was also concern that diets aimed at weight loss would have the unintended consequence of weight gain. Here, the translation of the word ansias to mean both anxiety and appetite is revealing. It was common for patients who were anxious about losing weight to skip breakfast or dinner or otherwise begin to starve themselves. These same patients would explain they felt their appetite could be “out of control” and overtake them. In an attempt to control their bodies, they found themselves controlled by their bodies. “I’m afraid to start eating because I can’t stop,” said one patient, when her nutritionist encouraged her to eat more. Another patient, referring to the ansias of appetite, said explicitly, “it possesses me” (me posee). Given that these expressions were common, many nutritionists held that restriction was the most obvious way to “create metabolic disorder” and set the body up to “overeat.” “Your body knows if you are going to starve it. It will make you eat more than you want to,” said one nutritionist, when explaining that ansias would compel people to eat against their will. In this framing, dietary illness was cyclical: the ansias of anxiety feeding the ansias of appetite, which led to more of each. By directing attention toward weight and metabolism, both

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of which were difficult to control, nutritionists were concerned that they were adding to and not alleviating their patients’ suffering. To counter the persistent attention to weight loss, nutritionists often focused instead on getting patients to eat well and to do so regularly. Take, for example, the following advice: So I want you to eat in a way that is delicious [rica]. I don’t want you to be hungry. Don’t say to yourself, “Oh no. Right now I’m going to just eat a bit, and I’m going to skip dinner.” No, you’re going to eat. You need to eat more, and more often than you’re eating. To be fat like this is good for you.

Rather than focus on limitations, they encouraged patients to fill themselves, keeping hunger at bay. The nutritionists gave several explanations for why this was important: “an empty stomach produces acid that causes pain” or “the nerves are located in the stomach and intestines, and when these are not fed correctly, it will affect the way we feel.” Another common explanation was that the stomach was the locus of ansias and consequently must be kept happy. “If we make it angry then it will create ansias,” a nutritionist told one patient. “To keep the stomach content, you must eat well,” nutritionists would say, referencing a notion of health that had no necessary relation to measures of vitamins or calories. Emphasizing eating well instead of losing weight in a clinical setting is no definitive panacea. Much about eating well is tied to conditions beyond personal control, including regulations surrounding import and export tariffs, food subsidies, workday schedules, food availability, seasonality, and the gendered and generational obligations of eating or abstaining. Nonetheless, the emphasis on the stomach’s satisfaction and not on weight loss was made in an effort to help ease the burden of responsibility patients felt in living with dietary disease. Insofar as there were decisions to be made to achieve the ends of eating well, a focus on the influence of the stomach suggests that these decisions would not be made by a single individual but depended on the negotiations and considerations of the many relational bodies responsible for producing, procuring, and consuming foods. Although lite, no-fat, or low-calorie products were a routine part of the hospital’s diet templates, several of the nutritionists felt that “diet foods” did not have a place in good treatment since they necessarily targeted weight loss.

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These nutritionists were also tired of beginning consultations with the measurement of BMI, tired of diets focused on counting calories, and tired of the emphasis that clinical protocols placed on weight. It was in this vein that nutritionists would move away from universal, generally applicable guidelines in their consultations. As one nutritionist told the daughter of a patient when discussing what the patient should eat, “The good for you is not the good for her” (el bien para usted no es el bien para ella). This did not mean that “the good” was individualized; the nutritionist immediately qualified her statement, saying that by eating well the daughter could help her mother do the same. The emphasis was that the good of eating was tied to both specific situations and the relations tying various situations together (see also Fischer 2014). A lesson emerging from this approach to treatment is that, unlike the BMI designation of “normal weight”—which is a standard in both senses of the term standard, at once an “exemplar measure” and a “value which is treated as invariable”—assessments about the health value of particular foods necessarily require contextual knowledge. The celebratory treats such as the sugary candy and fried chicken consumed by Gloria’s family were not inherently bad for health (notably, in the days that followed the celebration these foods disappeared, and the family consumed all the tamales we had made, as Gloria had indicated they would). Instead, their value could be assessed only through familiarity with the situation at hand as well as familiarity with the situation’s historical and cultural context (see also Paxson 2013). Were these foods eaten often or was this a once-a-year feast? What was eaten during the remaining days? What kinds of pleasure, satisfaction, and forms of relationality were achieved through their consumption? What in one’s medical and dietary past might linger, still to be reckoned with? What kinds of “health” were patients looking to achieve? Weight loss might have offered the powerful motivation that it did because it was implicated in the notion of a modernity in which the civilized body was a thin body. I have also suggested that weight has become a central idiom of nutrition education in Xela because the metrics of weight appear to follow universal (natural) principles that make them applicable across Guatemala’s diverse languages, income brackets, and systems of value. Moreover, the metrics of body weight appear seductively simple, offering the promise that if numbers are followed, future results can be predicted: “If you eat less and exercise more you will lose weight. If you eat well, you will be healthy.” Life, when translated into formulas, seems straightforward and consequently easy

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to control. The objectives of weight loss appear to be objective. Meanwhile, assessing more expansive forms of health requires commitments of time and intimacy—a daunting burden for an overextended public health system. Yet patients and nutritionists both routinely found the simplicity of weight not only to be deceptive but to offer a useless, and even harmful, route toward of care. As I have illustrated in previous chapters, overlaying the abstract equation 1 − 1 = 0 onto dietary activities requires several acts of faith. First, the dynamic processes of eating and exercise must be converted to static numbers (calories gained, calories burned). Then, as a requirement of homeostasis, each of these numbers must precisely cancel the other out. Following this logic, any margin of error would produce metabolic imbalance. This notion of balance is as precise as it is precarious. In practice, the calculative, clean arithmetic zero of equilibrated metabolism was an impossible standard to achieve. It caused cautious patients to skip meals, cut out snacks, and otherwise undereat. Because, and not in spite of, these calculations, patients would then become enmeshed in an anxious, appetite-filled cycle of hunger and metabolic instability. Sometimes even the most thoughtful of the nutritionists I worked with became exasperated and shifted blame to their patients: “Why, Doña Berta, aren’t you eating breakfast? Don’t you know breakfast is the most important meal of the day?” In their more reflective moments, however, nutritionists would worry that patients’ supposed noncompliance was a consequence of the protocol’s emphasis on numbers and weight. “In a calculation there’s just one right answer, but the diet should not be understood in black-and-white terms,” I heard from one nutritionist, who added, “Calculations produce perfectionism, and perfectionistic thinking is the worst kind of thinking for dietary health. It sets patients up for failure before they have even started.” Departing from calorie counts and rigid guidelines, many felt that diets should be designed and approached with tolerance, adaptability, and patience. It was here that their emphasis on fatness instead of obesity was radical. Whereas obesity signaled a bodily measurement accompanied by illness, fatness could never be determined through a scale. Since beginning this project, I have heard many global health experts cite a cultural preference for obesity as an explanation for why the poor suffer overwhelmingly from metabolic illness. Framing the problem as a lack of education or knowledge, the implication was that “they do not know better.” But in my fieldwork, this is not what I saw. Even in remote places or in regions

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devastated by economic poverty and the complex afterlives of war, those afflicted by metabolic illnesses expressed concerns about obesity. This is not to say that Guatemalans did not struggle with competing expectations about what, when, and how much they should eat. But it is to say that in places where metabolic illnesses were present, people linked obesity to affliction. It is also to say that the people I spoke with were not duped by cultural beliefs into desiring obesity. That they might hold fatness in high esteem while also fearing obesity suggests that these terms could refer to qualitatively different experiences of the body. “Tan bonito el gordito,” was an expression I heard several times during my research. This rhyme, which translates loosely as “what a cute little fatty,” highlights a sense among many of the people I met that fatness could be attractive and desirable. For many, fatness could also be healthy. Public health experts often recited some form of the following phrase, “En el campo, ser gordo es ser sano” (In the countryside, to be fat is to be healthy). They presented this as evidence of the erroneous—and provincial—thinking of someone who did not understand the consequences of weight gain. What I came to understand, however, is that those who held fatness in high esteem were not necessarily mistaking obesity for a desirable condition but were placing value on forms of health that could not be measured. The conceptual distinction drawn between obesity and fatness is critical. Obesity was contingent on illness and diagnosed through measures, whereas fatness more generally encompassed an expansive condition of abundance. One could be fat in a moment, the way one might feel content—for example, when surrounded by kin at a meal where food and conversation were plentiful or when bringing home a basket brimming with carefully selected produce from the market. To be fat meant life was going well. These assessments of fatness could not be standardized into formulas. Instead, fatness pertained to an imponderable, innumerable richness that might loosely approximate happiness but which was more akin to the fullness—the ¡rica!—of satisfaction. When I asked Gloria why she felt that some of her grandkids were overweight and some were fat, her response was not organized through metric calculations. Indeed, with casual or cursory knowledge of a situation, obesity and fatness might appear the same. Instead, she said simply, “They’re my grandchildren. I know.” The implication of this statement, as I came to understand it, was that evaluations of health or illness must be made in the context of intimate knowledge about people and their lives. From a distance, one cannot

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Shopping at the market Minerva in Xela.

know if a body is fat or overweight, and neither is this something that can be determined through scales, surveys, or statistics. These assessments must be made through dialogue and interaction and can be known only through effort, time, and the strength of connection. Gloria’s knowledge of the health of her grandchildren did not take the form of an external truth; it was a knowledge that was necessarily relational. In most nutrition-education programs I observed in Xela, the overwhelming message about fats and sugars was that they “were bad.” I heard several nutrition educators tell people to “not eat any fat,” and patients often professed to be working to eliminate all the fat in their diet. Yet several of the nutritionists in the public hospital, working regularly with families who were too poor to buy lite foods and too saddled with existing obligations to prepare individual meals or otherwise follow a dieta, took a different approach, instead emphasizing that “fat is a healthy part of food” and “the body needs fat.” They might impress on patients the idea that “excess is bad for you” (lo malo es el exceso). But this excess was not a fixed quantity—a measure of calories or a number of tortillas, for example—but a relative quality that could be determined only through engagement with the always-moving terrain of health.

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As such, excess and fatness were not correlated, as were excess and obesity. A moment after cautioning against excess, several nutritionists advocated the condition of fullness. “When you eat, it is important to fill yourself ” (llenarse), I heard them say, evoking a notion of fullness that was incongruous to illness. They devoted considerable time during their consultations to encouraging patients to be satisfied when eating and to eat ¡rica! foods. The emphasis on the joys of fatness rather than the metrics of obesity sought to redirect attention away from restrictive calculations and toward delicious food. It sought to lessen the grip of ansias—to lessen the weight of the body. To be clear, the nutritionists whose work I refer to here were not advocating that their patients gain weight. Their aim, in emphasizing the value of fatness, was rather to concentrate their energies on the subject of nourishment that might be addressed through cooperative care and not on the subject of weight that was remarkably difficult to control. It was to dismantle the confusing black boxes of “fat is bad” or “sugar is bad,” to make people aware that sugar and fatness were a part of eating and living. It was to advocate the fullness, richness, and satisfaction of ¡rica! that was at odds with calculations of restriction and excess. It was to embrace, as Michel Foucault suggested decades ago, “bodies and pleasures” (1978, 157). Deborah Gewertz and Frederick Errington have suggested that social scientists who study public health concerns of food and chronic illness have an “obligation to struggle toward a position which conveys a policy” (2010, 11, 162). Similarly, health professionals I met during my fieldwork and beyond unfailingly asked of my research: “So, what should we do?” Policies are often based on the kind of broad standards I have been challenging, and I do not wish to give generic advice. I can, nonetheless, make an observation that pertains to the field of global health and which might potentially have useful implications: The weight of the body may be too much weight to bear. One of the fliers from the military’s obesity conference that I addressed at the start of this book suggested that obesity was a problem linked to a lack of autonomy and difficulty establishing boundaries around one’s body and identity. I have suggested instead that perhaps there is no autonomy to lack—that this might be a misplaced, even dangerous, ideal. Rather than take unstable boundaries as emblematic of disease and pathology, dependence may be an

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inevitable reality of feeding and eating. In this vein, the field of global health might work to recognize the limitations of applying calculative abstractions, in which bodily boundaries are taken as fixed, to the contextually contingent and permeable activities of dieting, moving, and life in its myriad forms. Building on this observation, I suggest that those concerned about the spread of global obesity might work to approach both bodies and health in context-dependent terms. Treatment strategies might themselves be designed ethnographically—that is, with consideration for the mess and contradiction of everyday life and concern for how various entities, places, and times enfold together (see Martin 2013; Rapp 1999). Clearly, there are times when people may want the guidance provided by detailed instruction. The recipes Carla rejected as “following orders” in my introduction might be useful in some circumstances for some people. To know when dietary prescriptions would be helpful and when they would be rejected requires interaction and conversation. It necessitates taking into account the particular situation at hand, and, as I have shown, counting is often not an easy way to go about this. Granted, counting is not always and necessarily—as Bill Maurer has also written of money—violent, alienating, sacrilegious, or just plain bad (2006, 18; see also Urton and Nina Llanos 1997; Verran 2012). Numbers can provide an entry point into more intimate conversations, and numbers, when incorporated into people’s practices, are not determinate but have social life themselves. Still, all too often, numbers, as used in obesity treatment as I saw it unfolding in postwar Guatemala, created anxiety and discomfort—they were a stopping point, a blockage, an impediment to care. People could not easily use a language of numbers to communicate the frustration they felt in not having safe open spaces to walk or play. Numbers would not encompass the challenge of finding satisfying food when resources were scarce and chips and sodas were cheap and abundant. They would not help to attenuate the difficulties of employment that did not permit a lunch break long enough to return home to eat with kin. They failed to capture the frustration felt that micronutrient-dense produce was grown in chemicals that were another source of illness. Nor were numerical guidelines like calories or recommended daily allowances particularly useful when shopping, preparing foods, feeding, feasting, exercising, or engaging in leisure. They circumscribed balance within the impossible abstraction of equilibrium rather than facilitating a form of balance that might reflect the mobility in patients’ bodies, needs, and lives.

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An overwhelming amount of the energy and resources of the field of public health nutrition in Xela was devoted to measuring food and the body, and much of the dietary education that people received was orchestrated around abstract standards. But, as I have shown, the use of these metrics presumes both fixed individuals and stable relationships. It imagines that mathematic ideals might be achieved in daily life. “If you eat less and exercise more, you will lose weight,” says the simple formula, disregarding the complex histories underpinning each variable in the equation. Meanwhile, the human body is neither motor nor machine, and the self is not a stable unit. These calculations are not without effect, but their effects cannot be neatly measured, predicted, or controlled. The Guatemalans I worked and lived among continued to find pleasure in fat, satisfaction in the commensality of the feast, and health in abundance. Joyfully gathered around carefully crafted meals, they were busy transforming, in ways that were as understated as they were radical, the terms of power. The pressure to possess the body was strong, but so too was a form of richness that refused possession.

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NOTES

introduction 1. Guatemalans typically follow the metric system of measurement for distance but use a mixture of Spanish and U.S. imperial measurements for weight, volume, and size. Since the incongruities of conversion are important for the arguments I make throughout the book, I have translated measurements in accordance with how they were locally used. As I elaborate in chapter 5, this distinction was rarely specified. 2. Oxford English Dictionary, 3rd ed., s.v. “rich.” 3. In her work on U.S. cheese production practices, Paxson notes that “market rationality is one organizing principle of economic activity but not the only one” (2013, 65). Her concept of “economies of sentiment,” which points to diverse cultural, emotional, ethical, and political motivations that surround cultivation and consumption, brilliantly illuminates the interweaving of market and nonmarket relations. 4. For example, the Journal of Nutrition—today a leading journal for nutrition research—published its first issue at the end of 1928. 5. The medical physiologist Albert Szent-Györgi, widely credited with the discovery of vitamin C in the 1930s, defined vitamins, saying, “A vitamin is a substance you get sick from if you don’t eat it” (Gratzer 2005, 163). While this may today appear to be obvious, it countered the pathogenic model of sickness prominent in the nineteenth century. For more on the discovery of malnutrition, see Arnold (1994). 6. For a fascinating history of nutrition, see Carpenter (1994), as well as four equally compelling articles by Carpenter in the Journal of Nutrition, vol. 133 (2003). 7. For more on the influence of Coca Cola in the region, see Leatherman and Goodman (2005) and Nestle and Baer (forthcoming). 8. People unfamiliar with Xela often ask me how I came to live with twelve different families. People familiar with the region never ask this question, since homestays are the modus operandi of foreign backpackers. While just half of the families I lived with

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during my fieldwork had hosted students in the past (sometimes in the distant past), they all were familiar with the desire of foreigners to travel to Guatemala to live with a Guatemalan family. 9. For an analysis of nongovernmental organizations in Guatemala, see Maupin (2009). 10. For rich ethnographic analyses of obesity elsewhere, see Carney (2015) for research based in California; Solomon (forthcoming) for India; Vogel and Mol (2014) for the Netherlands; Ibáñez Martín (2014) for Spain; and Hardin (2014) for Samoa. 11. I thank Eric Hoenes del Pinal for first pointing this out to me. 12. Thoughtful ethnographic accounts of how this has played out in Guatemala City can be found in O’Neill and Thomas (2011) and O’Neill (2015). 13. See Burrell’s (2005) writing about Todos Santos for a careful analysis of the cultural impacts of this migration. See also Sharp (2014). 14. Deleuze and Guattari expand on this idea in their development of the concept of the rhizome, which aims to replace the arboreal structures of trees (with their roots of subjectivity). They write that “the tree imposes the verb ‘to be’ but the fabric of the rhizome is the conjunction, ‘and . . . and . . . and’ ” (1987, 25).

chapter 1 1. See Gálvez (2011) for a comprehensive discussion of nostalgia in ethnographic narrative. 2. For an excellent anthropological analysis of how similar political and economic changes play out in neighboring Mexico, see Vilà (2010) and Gil-Romo, Pérez, and Díez-Urdanivia Coria (2007). 3. For an analysis of the ancient Maya diet, see White (1999). 4. In a now-classic paper, Béhar, a widely renowned nutrition specialist who directed INCAP from 1961 to 1974, argued that although the historical Guatemalan diet was known to be deficient in protein, calcium, and niacin, “in general, the children were healthy” because of cultural practices such as nixtamalization (the process of soaking corn in alkaline solutions to release vital nutrients) and prolonged lactation (1968, 116). For more on the history of corn and malnutrition, see Warman (2003). 5. Gal similarly works to position the distinction between categories such as global/ local or public/private as a “semiotic or sign phenomenon in communication” (2002, 85). She uses examples of public space being transformed into private space (a whispered aside or a confidential turn of bodies), while also pointing out that many private spaces (the living room, the kitchen) also serve social functions. She suggests than an ever-changing context does not just determine the location of shifting boundaries but collapses the very idea of a boundary. Yet the boundary reasserts itself in the “fractal play” (86) of communication, where the recursive, reiterative, and nested character of binary distinctions becomes easily forgotten, and the numerous levels of embedding come to appear as a single demarcation (see also Star and Griesemer 1999).

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6. The developmental origins of health and disease share much with a recent strand of science called epigenetics. For more on epigenetics, see Landecker (2011) and Lock (2012). For more on how epigenetic logics influence Guatemalan kitchens and eating practices, see Yates-Doerr (2011). 7. For more on the pleasures of eating fast food, see Gewertz and Errington (2010). 8. See especially Schneider (1968), Rapp (1978), MacCormack and Strathern (1980), and Collier and Yanagisako (1987).

chapter 2 1. Oxford English Dictionary, 3rd ed., s.v. “nutrition.” 2. Article 25 of the declaration states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control” (“Universal Declaration” 2009). 3. Porter (2000) links the creation of knowledge about metabolic illness in the United States to life insurance companies. In Guatemala, however, the ability to purchase insurance is overwhelmingly absent. For more on the complexities of Guatemalan epidemiology, see Cerón (2013). 4. Sugar meets the important international health criteria of being a processed food that is widely consumed and whose production is relatively centralized in just a few refineries (maize, while widely consumed, is processed in hundreds—if not thousands—of sites) (Dary, Martínez, and Guamuch 2005). 5. These programs are funded by the government but coordinated by nongovernmental organizations, making them both governmental and nongovernmental—a common way many of the country’s health services are delivered. See Copeland (2014) for an excellent analysis of these partnerships elsewhere in Guatemala. 6. The exact distinctions of which are hot and cold foods, as well as which are hot and cold illnesses, are extremely variable. Also, Barbara Tedlock notes that not all regions that follow humoral epistemologies prioritize balance in the way here described; in the community where she worked, there was a tendency to treat all illnesses through hot foods (see 1984, 1075). She additionally points out that illnesses might not be fixed as hot or cold, but might move through hot or cold stages, requiring different medicines at each stage.

chapter 3 1. In her work on the cultural formation of “the child,” Castañeda (2002) mobilizes the term figuration to describe the processes through which concepts or entities are brought into being while simultaneously producing effects on the worlds into which they emerge. I have found this focus on the generative effects of figures to be useful for understanding how the human figure has emerged out of concern for

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obesity. My analysis of the figure of “the social” also draws inspiration from Latour (2005). 2. The Spanish expression cuidar el peso, which is used in a similar way to the English expression “watching one’s weight,” literally translates to caring for or about weight. 3. Though many people spoke of diet campaigns as U.S. American in provenance, it would be almost two years until Michelle Obama would inaugurate her obesityprevention program in the United States with the name “Let’s Move!” 4. The data used in the PAHO presentation I saw is viewable at “Economic Impact” (2007). 5. I observed a similar reliance on commercial interests in Guatemalan elementary schools, where principals allowed vendors to sell products like candy and chips in their schools in exchange for a percentage share of the profits. While the school’s administrators did not like these products being sold, they were desperate for financial support for basic school supplies and saw the inclusion of these products into their schools as a concession that they made to have funds to operate. 6. If we accept Deleuze and Guattari’s (1987) metaphor of the organ as an expression of subjectification, then this two-dimensional stomach, frozen six feet over the noisy huipil-clad crowd that passed below it, might be read as the quintessential body with organs. The body this ad displays as healthy and desirable is also one in which Bakhtin’s (1984) famous potentially subversive “lower bodily stratum” is resignified as white, beautiful, and thin. 7. For more on multilevel marketing, see Cahn (2008) and Nelson (2013). 8. For example, the literal translation of “I wash my hands” in Spanish would be “I wash the hands”; “she raises her hand” would be “she raises the hand.” 9. For an excellent analysis of related shifts in personhood in the United States, see Martin (1994); and in the context of contemporary postsocialist Russia, see Caldwell (2004). 10. Tacos are not a food traditionally consumed in Guatemala, but to give a sense of this value: street vendors sold them for three for ten quetzales (about $1.25), and for six quetzales ($0.75) one could buy twenty-four handmade corn tortillas.

chapter 4 1. The term ladino was used by the national census until 1964 to label someone as “not indigenous”; it was then replaced by “no-indígena” (Early 1974, 105). For an excellent example of the attenuation of state categories and to see how identity categories are complicated through the lived experience of census recording in Guatemala, see Christa Little-Siebold (2001a, 188–89). 2. Mestizaje is often loosely defined as the mixing of ancestries, but what is meant by “mixing”—and whether it results in homogeneity or heterogeneity—remains both an empirical question and a source of persistent confusion. Abigail Adams writes that whereas other Latin American countries promoted mestizaje, Guatemalan elites rallied

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around a desire for a “homogenous nationality” (2011, 19). Grandin suggests that elite ladinos promoted the idea that bodies adapted to their environments over time, but they eschewed cultural mestizaje, whereas K’iche’ elite in Xela held onto the idea of blood-based differences (2000a, 30). 3. For an extensive anthropological exploration of substance, see Carsten (2004). For a careful explanation of how race is made—or done—through practices, see M’Charek (2013). 4. They were in this sense both patients and customers. For more on this distinction and its effects, see Mol (2008). 5. Throughout Latin America there is a tendency to frame all foods processed to be low in fat, sugar, sodium, and so on as “light” or “lite.” Monteiro (2011) has illustrated how food companies, PepsiCo in particular, have conjoined “lightness” and “health” as a remarkably effective marketing strategy. 6. Since I am writing here in English, I will add that fat, in the earliest English use of the term (circa 1000), was a vessel, a place where substances—particularly fluid substances—were contained. Shortly thereafter it took on the associations of the bulk of animal or human form, and even a thousand years ago fat, in the English language, was linked to lifecycles of production and consumption: the fattest lambs were the first slaughtered, the fat of their bodies becoming through feast the fat of human limbs and beings (Oxford English Dictionary, 3rd ed., s.v. “fat”). 7. I thought often in the course of my fieldwork of a problematic of ethnographic exchange that Nelson has explained as follows: “Assumptions are not orderly, rational things. . . . They consist of different elements from various places and moments turned about, broken into fragments and jammed together. As researchers we may hear the word ‘genes’ in our interviews but the assumptions it carries may have less to do with Mendelian inheritance than religiously defined blood purity, neo-Lamarkian inheritance or nineteenth century notions of physiognomy where physical appearances give clues to ‘invisible inner worth’ ” (1999, 76). 8. Given the history of state control of reproduction in Guatemala (e.g., Few 2007; C. Smith 1995; Wertheimer 2006) and the frequent stories I was told about covert sterilization projects carried out through food and water supplies, there would be considerable precedent for this interpretation. For more on unwanted sterilization in Guatemala, see Cerón (2011). 9. Pérez (2014) suggests that sabor, as used in U.S.-Mexico borderlands, evokes the kind of social and spatial distinctions that are included in Bourdieu’s (1984) framework of taste, suggesting that the richness of flavor may itself be a form of instantiating hierarchy. 10. This understanding of race has parallels to the evolutionary theories of JeanBaptiste Lamarck (1744–1829), who held that traits acquired over the course of one’s life could become inherited by one’s progeny. Recent work on nutritional epigenetics in Guatemala also speaks to Lamarckian notions of inheritance by showing that changes in nutrition affect “heritable” changes in gene function and physiological development (see, e.g., Solomons 2009, S14). For more on Lamarckian notions of heredity in Latin

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America, see Grandin (2000a, 230); Hale (2005, 24); Nelson (1999, 99–100); and Stepan (1991). 11. Martin’s analysis of how a language of bodily flexibility parallels a language of capitalist accumulation has deeply influenced my thinking about the malleability of race (see, especially, 1992, 1994).

chapter 5 1. Ethanol production within Guatemala, though not mentioned at this talk, has additionally become an increasing concern. While Guatemala’s export revenues of ethanol have increased remarkably over the period of my fieldwork, the monetary benefits of this have remained highly concentrated. For more, see Alonso-Fradejas (2012). Especially relevant to my argument here, while Guatemalans have dealt in the exchange of corn and money for centuries, the anger that results from the use of corn for biofuel calls into the question the finality of relation and obligation often associated with capital-based systems of exchange. Even when corn is traded for the “general equivalent” of money, obligations (to this corn and to those in the country impoverished by its production) remained (Martin 2007, 237; Serres 1982). 2. Fischer (2014) states that by 2013 the demand for ethanol was driving up the price of U.S. corn, which would have had a beneficial effect on the price of corn for Guatemalan farmers. Fischer also notes, however, that the valuation of corn in Guatemala resists easy economic equations such that the treatment, care, and concern for corn far exceeded its price. 3. Rotman (1987) writes that zero was brought to Italy from the Hindu system, by way of Arab merchants. It was widespread in the Arab Mediterranean in the tenth century, but until the thirteenth century it would not be adopted by Christian Europe. By the seventeenth century, Arabic numerals would have almost completely replaced Roman numerals. The ancient Maya reportedly invented zero independently around 4 c.e.; for more on the Maya zero, see Closs (1986). 4. I am influenced in my analysis of the impossible ideal of equivalency by the work of Serres (see, especially, 1982). Yet while Serres describes metabolism as a necessarily unbounded process of continuous transformation (change rather than calculative exchange), in the clinic where I worked metabolism was figured narrowly as a system of closed, balanced exchange (with “the body” figured as a unity). 5. I extensively examine the idea that scales lie in Yates-Doerr (2013). 6. In the nineteenth century governments and industries became interested in the dietary ration (a precisely measured unit of food) to determine how much food was necessary to sustain large populations of soldiers, prisoners, workers, students, and so on (Foucault 1977, 239; see also Turner 1984). The growing relevance of the ration led, in part, to the conception of the discipline of chemical sciences, which in turn developed ideas about nutrients and calories that allowed for food, eating, and bodies to be understood in abstract, quantitative terms. Though the dietary ration and the conceptual rationality that has long been a hallmark of modernity are not often connected,

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the examples of nutrition education provided here illustrate how the ration remains deeply implicated in the construction of an individual who weighs numerous options to make wise, enlightened, and rational choices. 7. An insightful elaboration of the practicing of grid making can be read in Martin (2014). 8. Oxford English Dictionary, 3rd ed., s.v. “equilibrium.” 9. Mol also points out that medical systems often draw on a choice-based model of balance that comes from accounting, with its credit and debit columns. She points out that while the values of choices “are more difficult to quantify than sums of money, the model is used in a strikingly similar way. It is as if making a decision were like making a calculation.” She maintains, however, that there is a different way to conceptualize balance. In the care-based practices she studies, while balance is important, it is not achieved by adding or subtracting fixed variables. She writes, “In the logic of care no variable is ever fixed. All variables are variable—to some extent. The ‘balance’ sought, then, is something that needs to be established, actively, by attuning viscous variables to each other. Rather than the balance sheet of the accountant, the balancing body of a high-wire artist or a dancer come to mind” (2008, 54). 10. Oxford English Dictionary, 3rd ed., s.v. “power.”

chapter 6 1. For more on the link between nutrition and agriculture, see the seminal text by Scrimshaw and Béhar (1976). Thanks go to Rebecca Kanter for sharing this title, as well as her enthusiasm for the INCAP farm, with me.

conclusion 1. For more on how these herbs come to be bought and sold, see T. Harvey (2011). 2. Oxford English Dictionary, 3rd ed., s.v. “standard.” 3. For a careful analysis of how the concept of cultural duping has been deployed in Guatemala, see Nelson (2009). 4. Guthman is one among many in the fat studies community who have made the important argument for the U.S. context of obesity that “ ‘obesity’ is a medicalized term that does violence to fat people” (2009, 188). My point here is slightly different. As used in Xela, obesity was necessarily a medical term, but it could be entirely irrelevant to fat people. Granted, the conflation of the terms might (under specific circumstances) do violence. But I suggest that the term obesity, as used here, was not violent in and of itself. 5. My thinking on the permeability of bodily boundaries has been influenced by Kulick and Meneley (2005). I have also been influenced by Mol and Law (1994).

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INDEX

Page numbers in italics indicate illustrations. Abbott (maker of Ensure and Raductil), 2, 101 accounting practices: choice-based model in, 193n9; credit and debit system, 145–46; cuisine’s challenges for, 11; double-entry bookkeeping, 136–37; ideal of, 139; zero balance in, 136, 192n3. See also economy; metabolic calculations; numbers; statistics, uses of Aceite Ideal (oil), 101 Adams, Abigail E., 190–91n2 Adams, Richard, 79 Adams, Walter Randolph, 17, 79 advertisements and marketing: development of self-conscious self in, 105–7; at health events, 158; “health” used in, 161–63; “lightness” and “health” as strategies in, 191n5; metabolic diseases outlined in, 2; universal and possessive “you” in, 101–4, 108–9; women’s bodies used in, 88–89 —specific types: bariatric surgery, 4; drugs, 2, 4, 42, 94; food supplements, 161; Mayonesa Gourmet Light, 127; nutritivo (nutritional) tonics, 50; plastic surgery, 113; Salufit, 2; Shaklee, 104; soft drinks, 12–13, 13, 63, 158, 175, 191n5; Svelty, 100–101, 101; tamales, 49; Toledo sandwich meats, 100; Ultra Shape, 112 agency, in speaking of body and self, 101–7 agriculture: archaeological record of, 38–39; family’s cultivation and, 20, 30, 42–43, 76,

166–67; fracturing of land in 1950s, 18; health and, 170–71; pesticide use, 13, 32, 167–69, 168, 170; terroir concept and, 124– 25. See also maize; markets and marketplaces; rural communities AIDS, 116 Alfonso (pseud.), 61–64 Almolonga: making mezclarina in, 165–66, 166, 171; pesticide use in vegetables grown in, 32, 167–69, 168, 170 American Journal of Clinical Medicine, 59 ansias of appetite, 177–78, 183 anthropology and ethnography: assumptions in, 191n7; “equilibrium” rejected in, 147–48; of hot/cold practices, 78–80, 135, 189n6; methodology summarized, 13–15; protein supplement research and, 158–60; struggling toward a position on a policy in, 183 Antracol, 167 Arbona, Sonia, 167–69 artificial sweeteners, 120, 145, 175. See also candy and sweets Arturo (pseud.), 42–43, 46 artworks, 85–86, 87 Asad, Talal, 59 Asfaw, Abay, 33, 34 aspartame, 175 Asturias, Miguel Angel, 115 atoles, 27, 59, 74, 158–59

211

212

.

index

Bakhtin, Mikhail, 190n6 balance: “calculability” of, 10–11; in care-based practices, 193n9; daily realities of, 148–50, 149; forms of, 135–37; notion of fatness that evokes alternative, 177. See also metabolic calculations “balanced” diet: adjustments to, 143; equilibrium achieved by following rigid rules, 146–50; mechanistic model in, 138–40, 179–80; quantitative equations in, 141–43; refusals of calculated idea of, 151–52; sociopolitical underpinnings of idea, 23; technical impossibility of, 137, 140–41, 146 bariatric surgery, 4 bartering, 32, 33, 34 basura (trash), 47. See also comida chatarra Beatriz (pseud.), 48 Béhar, Moisés, 188n4 Berdegué, Julio A., 33 Bernays, Edward, 105–6 Berry, Nicole S., 99 Berta (pseud.), 55, 57, 180 Bertha (pseud.), 17 Bhabha, Homi, 40 Bimbo (bread company), 100 biosocial reproduction matrix: history of place in, 125–26; of race-class-gender, 121, 123–24; state’s sterilization projects and reproduction control in, 191n8; weight measurements in, 119–20 black boxes. See nutritional black-boxing blood and blood types: discourses on race/ blood, 124–25; racial power linked to purity of, 113–14, 115; shift to impersonal, biological approach to, 115–16 blood pressure: foreign devices for measuring, 7; high (hypertension), 95–96, 143, 157 blood tests, 7, 118 BMI. See body mass index the body: advertisements and possession of, 100–101, 101; “the body” juxtaposed to “your body,” 101–4, 190n8; bus analogy for, 138–39, 152; in context-dependent terms, 184–85; familial practices and inheritance of size/shape of, 122–23; ideal image as 90–60–90 model, 112–13; malleability of, 116, 192n11; market relations in context of, 104–7, 120–21; mechanistic model of, 138–40, 179–80; nonlinear model of transformation of, 51; refusals of being bounded by calculations, 150–52; selfconduct of, 87; shared in larger body poli-

tic, 67, 96–99, 102–3; in transition, 85–88. See also la figura; metabolic calculations body mass index (BMI, indice masa corporal): calculations of, 69, 94–96, 138, 141–42, 157; caloric allowances based on, 144; changes in awareness and response to, 150–52; criteria for normal, overweight, and obese, 117–18, 156; danger of being outside normal range, 117–19; discussed in healthy cooking class, 4–5; as standard, 86, 179; thinness vs. obesity emphasized in, 24; ubiquity of charts, 2–3; vision of social/civic inclusion inherent in, 119–21. See also health measurements; metabolic calculations; weight body weight. See weight Bordo, Susan, 160 Botero, Fernando, 85–86, 87 boundaries: breakdown of, 46, 188n5; of normal, overweight, and obese, 119; as permeable and dissolved, 19–21; refusals of being bounded by numbers, 150–52; rethinking ideal of autonomy and, 183–85. See also city (ciudad) and country (campo) boundaries; class boundaries Bourdieu, Pierre, 124, 191n9 Brenda (pseud.), 76 Burrell, Jennifer, 20 bus analogy, 138–39, 152 Caballero, Benjamin, 37 CAFTA (Central American Free Trade Agreement), 12, 31–32 “calculability,” economic and nutritional, 10–11 calories: allowances based on BMI, 144; changes in awareness and response to, 151–52; energy represented by, 133, 135; foods with less, as more highly valued, 145; processes absent in equations of, 148–50, 149; recommendations on balance and, 142–43. See also dieta and diet advice; energy canches, use of term, 112 candy and sweets: consumption of, 68, 75; cost of vegetables compared with, 39; family and church traditions, 174–75, 179; sold as educational fund-raiser, 138; sold at schools, 190n5; teaching children about, 61, 63–64. See also comida chatarra; soft drinks; sugar Canguilhem, Georges, 119

index Cannon, Geoff rey, 120 Cantel (municipality): location noted, 167; metabolic illnesses in, 42–44, 46; name of, 41–42 Cantel Centro de Salud (Health Center), 43–44 carbohydrates, 6, 44, 63, 68, 71, 80 cardiovascular disease: concerns about, 42–44, 46; drugs for, 3, 5, 156; exercise to prevent, 93–94, 96, 97–98; as metabolic disease, 2, 56, 76; mortality rates, 36; nutrition transition implicated in, 37; products to prevent, 101 Carla (pseud.): health measurements of, 4–7; recipes ignored by, 12, 184 Carpenter, Kenneth J., 9, 72, 187n6 Castañeda, Claudia, 189–90n1 castellanizarse (adopt Spanish customs), 41–42 Catarina (curandera), 78 Catholic beliefs, 123 celebrations and events: “Let’s Move Xela!” event, 84, 92–96, 109; public health events, 158; San Miguel celebration, 90–91; Semana Santa week, 174–75, 179; World Diabetes Day, 97 census, 114–15 Center for Mesoamerican Research, 15 Centers for Disease Control and Prevention (U.S.), 33 Central American Free Trade Agreement (CAFTA), 12, 31–32 Centro de Salud (Health Center, Xela), 92, 93, 94. See also “Let’s Move Xela!” event; Xela public health clinics cereals (consumed as beverage), 74 Cervecería Centroamérica (company), 159–60 chaparritas (short and full-figured), 89 children: abandoning then returning to tradition, 49; fatness viewed as health in, 86; feeding “worm” of, 102; figuration concept and, 189–90n1; grandmother’s view of weight of, 174–76, 181–82; how they learned to fight with parents, 27–29; INCAP study’s depiction of, 59–60; optimism about improving well-being of, 58; pesticides’ effects on, 168–69, 170; simplified model of nutrition taught to, 61–65; underweight, with overweight mothers, 122; weight gain and well-being linked for, 73. See also mothers cholesterol, 7, 38, 40, 100, 118, 156

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city (ciudad) and country (campo) boundaries: destabilized categories of, 20–21; interconnections across, 16–19; obesity and undernutrition problems perceived as following, 39, 43–46. See also rural communities ciudar el peso (“watching one’s weight,” or caring about weight), 190n2 civil war (1960–96): afterlives of, 20–21; chaos and terror in, 1; deaths in, 126; postscorched-earth-campaign destabilization in, 50; protein supplement developed in, 158–59; rural population displaced in, 18; La Violencia in, 20–21, 159. See also violence Clarke, Adele, 160 class boundaries, instability of, 19–20 classification: attempts at and failures in, 15; breakdown of distinctions in, 46, 188n5; of decency and superiority, 113–14; embodied practices of taste as form of, 124, 191n9; of good/bad foods, 56–57, 63, 69–72, 74, 103, 118, 121, 143, 145; of self and individual body, 102. See also body mass index; metabolic calculations; racial classification; socioeconomic classification Cobre (copper oxychloride), 167 Coca Cola, 12–13, 13, 63 coffee, sugar added to, 22, 64, 120, 143, 175 colonialism: malnutrition linked to, 38–39; numerical abstraction and mercantile capitalism in, 136; sugar at heart of, 49 Colson, Elizabeth, 147–48 comemos tamalitos, use of phrase, 16 comida chatarra (scrap-iron food or junk food), 31, 32, 47, 176 comidas malas (bad foods), 61, 63 “Comimos para vivir” (We ate to live), 91–92 Concepción (pseud.), 121–22, 123–24, 125 conferences: on nutrición, 38–39; on obesity, 1–4, 183 consumer capitalism, 151–52 contar, meanings of, 11 cooking classes: food-company-sponsored, 100; health measurements taken in, 4–5; recetas offered in, 5–6, 12 corn. See maize corn-based products: corn oil, 131–32; imports of processed foods, 26, 30–31; as sweeteners and preservatives, 36, 50 Costa Rica: nutrition transition in, 38; vegetables imported by, 167

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Coveney, John, 160 ¡Cuestra!, 131 culinary and cooking traditions: challenge to, 5–6; dietary guidelines in relation to, 66–67, 74–77; fracturing of place and cooks in, 33; learning of, 41; lunch as main meal of the day, 31, 46, 175; meaning of, 56; pride in, 89–90, 173–74; as process, 11; technological changes’ impact on, 27–30. See also celebrations and events; eating; familial practices; fatness; foods Cullather, Nick, 151 cultural duping, 181, 193n3 culture, body fat as, 122. See also fatness; ways of knowing and relating to bodies and food curandera (midwife/healer), 78 Dalia (pseud.), 88, 89 Daston, Lorraine, 80, 81–82 De Certeau, Michel, 102 De la Cadena, Marisol, 115, 123 Deleuze, Gilles, 188n14, 190n6 La Democracia (Xela market), 32 diabetes: “the body” juxtaposed to “your body” in, 103–4; concerns about, 175–76; contradictory message about, 97; diet recommendations for, 143–44; diet soft drinks marketed for, 12–13; effects of, 5, 12; milk product recommended for, 100– 101, 101; quality of blood as issue in, 116 El Día Mundial de la Diabetes (World Diabetes Day), 97 Diario de Centro America (newspaper), 60 Diario el Imparcial (newspaper), 15 dieta and diet advice: adaptability and patience in, 180; approach to studying, 87–88; bland food encouraged, 157; construction of, 69–70; doctor’s recommendations on, 120; failure of, 126–28; framed as responsibility to nation, 96–99; fullness encouraged in, 127, 181, 183; indigenous vs. mechanistic, 78–80, 189n6; individual and social bodies configured in, 7; rethinking presumptions in, 184–85; as tratamientos (treatments, medical) and menús (menus, culinary), 160–61. See also “balanced” diet; diets —forms for patients: food exchanges or equivalencies on, 143–46; grid structure of, 144; miscues in communication about, 89–91; multiples scales by calorie content,

155; “natural” foods in, 147; as normalizing tool, 125–26; paper pads for, 161 Dietary Guidelines for Americans (USDA), 10, 65–66 dietary health: commodification at crosspurposes with, 161–62; discursive divisions in rural vs. urban, 14–15; hot/cold practices in, 78–80, 135, 189n6 dietary ration concept, 143, 192–93n6 dietary transitions: asynchronous nature of, 12–13; food supply changes in, 30–36; framing of, 36–40; historical continuities in, 46–52; individualization as incomplete framework for, 98–99; linear temporality considered in, 37–40; linear view questioned, 40–46; possessive self as framework for, 100–107; refiguring the social in, 107–9; technological changes’ role in, 27–30. See also global food economy transition; nutritional transitions dieting: medicalization linked to, 160; nutritionists’ rejection of, 177–78; ubiquity of, 86–88, 111, 112 diets: historical, 38–39, 188n4; plant-based, 31–32, 37 Dirección General de Estadística (Statistical Reporting Center), 114–15 Dirección General de Estadísticas de Quetzaltenango, 15 discourses, complexities and interconnections, 29, 68–69. See also nutrition education; weight management diseases: developmental origins of, 44–46; as hot or cold, 78–80, 135, 189n6; of lifestyle, 120–21; of modernity, 13, 29, 36, 52; nutrient deficiencies linked to, 68, 72–73; obesity recast as, 85–86; pesticides linked to, 168–69; regional transformations in patterns of, 29–30; shift from focus on infectious to chronic, 37–38 —specific: goiter, 58; gout, 121, 143; hypertension, 95–96, 143, 157; Kwashiorkor, 44; pellagra, 72–73, 82; rickets, 58. See also cardiovascular disease; diabetes Dispensa Familiar. See Walmart doctors: BMIs discussed with patients, 117– 18, 119–20; drugs prescribed, 162; on individual choices, 120–21; nutrition information disseminated by, 88–89, 107–8, 118; outreach at public event, 94; rural community visits of, 65; training for, 77 Dos Pinos (milk company), 100

index drugs: diabetes, 94; dietary changes preferred to, 137–38, 156–57; heart disease, 42; selective use of, 5; weight loss, 2, 3, 4, 156, 157 eating: biosocial positions shaped by, 123–26; encouragement to eat well, 177–80; Guatemalan practices in relation to West’s, 40; as process, 11; regional transformations in patterns of, 29–30; “what you are given,” 88–90, 98, 107, 108; as “women’s realm,” 41. See also celebrations and events; culinary and cooking traditions; foods; healthy eating eating disorder, use of term, 127 “eat less, exercise more” equation, 143, 146, 170, 179, 185 economy: cost of living increased, 131; dietary well-being in relation to, 162–63; diverse understandings of, 8–10; “economies of sentiment” as one organizing principle of, 187n3; emergence of global concept, 9–10; nonmonetary valuations as influence on, 10–11; ownership of bounded body in relation to, 104–7; process of balancing accounts in, 136–37; role of money in, 145–46; “supply and demand” terminology in, 147; worldwide recession in (2009), 132. See also global food economy transition; globalization El Salvador: nutrition transition in, 38; undocumented workers from, 30–31; vegetables imported by, 167 employment, diet in relation to, 42–43 energy: anthropological research on, 133, 135; “calculability” of, 10–11; in metabolic calculations, 138–43; power defined in terms of, 152. See also calories Engle, Patrice, 58 Ensure (nutritional-supplement drink), 2, 101 epigenetics, 189n6 Equal (sweetener), 145 equilibrium, defined, 147. See also balance Ernesto (pseud.), 46–47 Errington, Frederick, 183 Espeland, Wendy Nelson, 73 Esther (pseud.), 93 ethanol production, 192n1 ethnography. See anthropology and ethnography Eva (pseud.), 65, 67–69, 74, 81 everyday life: as always already complicated, 48–49; ambiguities of, 20–21; anatomiza-

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tion of, 39–40; balance in, 148–50, 149; daily activities numerically standardized, 146 (see also metabolic calculations); economic discussions in, 132–33; health as always in context of, 169–71; nutritional research juxtaposed to experiencing obesity in, 41–46. See also eating; markets and marketplaces; ways of knowing and relating to bodies and food excess: balance as life without, 147–50; bus analogy for, 138–39, 152; categories of, 118–19; as individual choice, 120–21; of metabolism, 150–52; nutritional deficiencies vs., 44, 91; as relative quality, 182–83. See also obesity; overweight exercise: approach to studying, 22, 87–88; attempts to quantify, 137, 139–40, 142–43, 146, 148, 151, 179–80, 185; definition and activities recommended, 93–94, 96; finding time for, 162; as individual choice, 120–21; learning to care about, 107; “Let’s Move Xela!” event for, 84, 92–96; public messaging on, 104; as self-directed prevention strategy, 97–98. See also metabolic calculations exports: ethanol, 192n1; vegetables, 13, 32, 167–69, 168 Fabian, Johannes, 40 familial practices: caregiving and kinship concerns, 70; dual perspectives on, 108; importance of cooking for others, 6; longterm development of, 125–26; patterns of, 122–23; structural changes in families, 32–33. See also agriculture; celebrations and events; children; culinary and cooking traditions; eating; foods; mothers famine, 6, 18, 91–92 fast food chains: historical context of, 49; introduction of, 46, 47; proliferation of, 31, 47, 92, 108–9; Sunday morning ritual linked to, 48. See also processed foods fat and fats: alternative message about, 182– 83; as bad food, 56–57, 63, 69–70, 74, 100, 118, 121, 145; benefits of, 8, 43, 68; decisions to eat, 75; etymology of fat, 122, 191n6; in factory meal, 49; low-fat alternatives, 4, 5, 55, 69, 120, 143–45, 147; in metabolic calculations, 141–43; nutrition classes on, 68, 69–71; obesity linked to increased consumption of, 31–32, 33, 36–37, 46; taste and richness of flavor of, 121, 123–24, 125,

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fat and fats (continued) 191n9; triglycerides, 7, 36, 40, 89, 118, 137, 139. See also oil (food) fatness: as attractive (gordura), 175–76; deployed in racial classification, 113–16; iconic paintings of, 85–86, 87; as inherited, 122–23; meanings of, 6, 21, 24, 90, 122; obesity contrasted with, 176–77, 180–83; “to be” verbs to describe self, 116–17, 118. See also fullness Feldhay, Rivka, 135–36 la figura: connotations of term, 87–88; goal of, 4; miscues in communication about, 89–91; refiguring the social and, 107–9. See also the body Fischer, Edward F., 192n2 food insecurity, 12. See also malnutrition; undernutrition food pyramid (or food pot), 66–67 foods: biosocial positions shaped by, 123–26; changes in type and preparation of, 31–32; classified as good/bad and healthy/ unhealthy, 61–65, 69–72, 74–77; cost increases, 131–33; elimination of spicy, 157; fears about, 73–74 (see also pesticides); imports (from U.S.), 31–32, 33, 35–36; as medicine, 161; national and international issues surrounding, 178–79; preferred forms of, 31–32; quantification of, 139; as reflection of social worth, 92–96; temporal qualities of, 77; U.S. guidelines on, 10, 65–66. See also eating; fast food chains; supplements —specific: atoles, 27, 59, 74, 158–59; cereals (consumed as beverage), 74; cheese, 187n3; chicken, 32, 47, 175; corn-based products, 26, 30–31, 36, 50, 131–32; masa, 5, 16; paches, 54; quinoa, 50; tacos, 109, 190n10; tamales, 31, 34, 49, 157, 174, 175, 179; Tortix snacks, 169. See also candy and sweets; fruits; maize; milk and milk products; processed foods; tortillas; vegetables Foucault, Michel, 87, 162, 183, 192–93n6 France: ame replaced by moi in, 105; spirit and possession in, 102 fresco, 59 fruits: apples imported, 47; benefits of chips vs., 76; costs of, 161–62; nutritionists’ recommendations on, 121, 161; teaching children about, 61–64; women’s concerns about, 169–71 fullness, 6, 24, 127, 181, 183. See also fatness

Gal, Susan, 188n5 Gamexan (BHC), 167 gender and gendered messages: approach to studying, 87–88; of eating as “women’s realm,” 41; gender-neutral terms in, 89; race and sexuality linked to, 115–16. See also women genetics, obesity research in, 85–86. See also heredity Gewertz, Deborah, 183 Giddens, Anthony, 51–52, 145 global food economy transition: approach to studying, 22; food supply changes in, 30–36; framing of, 36–40; historical continuities in, 46–52; linear view questioned, 40–46; technological changes’ role in, 27–30. See also dietary transitions; economy; nutritional transitions global health discourses: on BMI, 5; dieting advice in, 87–88; on diseases of modernity, 13, 29, 36, 52; health as living practice lacking in, 170; hopes for vitamin and mineral fortifications in, 58; of individualization and Westernization, 98–99, 107; “nutritional reductionism” in, 22, 65, 72–77; nutritionists’ move away from, 177–80; on nutrition transition, 37–40; obesity as lifestyle disease, 120–21; poor blamed for obesity, 180–81; rethinking fi xed calculations of weight in, 183–85; shift from focus on infectious to chronic diseases in, 37–38; thinness as new standard of health, 86, 176–77 globalization: emerging idea of, 50–51; as local practice, 99; media circuits as influence in, 104; postcolonial Western dominance in, 40; privatization of public space in, 92–93. See also advertisements and marketing; economy Gloria (pseud.), 173–76, 179, 181–82 GNC vitamin store, 150, 163 goiter, 58 Goldberger, Joseph, 72–73 Goldstein, Jan, 105 gordito/a, use of term, 86, 181 gout, 121, 143 Grandin, Greg, 18, 115, 125, 190–91n2 Gratzer, Walter B., 72 grocery bags, 33, 34 Guatemala: author’s travels in, 12–14; census of, 114–15; dissociation from past and

index future in, 27–29; expansion of multinational giant food retailers in, 33; exports from, 13, 32, 167–69, 168, 192n1; governing factions of, 93; history of place in, 125–26; homestays in, 14, 187–88n8; imports of, 31–32, 33, 35–36, 167; map of, xiv; national anthem of, 3; official and local measurements in, 187n1; postwar health issues in, 11; sterilization projects and reproduction control in, 191n8. See also civil war; military; Quetzaltenango; Xela Guatemala City: fieldwork in, 14–15; location of, xiv; nutrition science headquartered in, 13. See also Institute of Nutrition of Central America and Panama Guatemalan Ministry of Health: attendance at events of, 14; government-funded, nongovernmental coordination of programs of, 15, 65–69, 189n5; health-coverage extension program of, 65–69; obesity prevention efforts of, 93; outpatient obesity clinic opened by, 2–3 Guatemalan Supreme Court, 92, 108–9 Guattari, Félix, 188n14, 190n6 Guldin, Paul, 135–36 Guthman, Julie, 193n4 Habicht, Jean-Pierre, 59 Hacking, Ian, 120 Harvey, David, 50 Hawkins, John Palmer, 17, 79 Head Start (U.S.), 58 health: “balance” as key to, 146; changing depictions of, 86–87; in context-dependent terms, 169–71, 184–85; defined in absolute terms, 75–76; destabilized assumptions about, 69–72; developmental origins of, 44–46; failures of calculation of, 164–69; fears about, 73–74; idea coopted by companies, 161–63; indigenous vs. mechanistic medical ideas about, 78–80, 189n6; for life, family, and Guatemala, 96; medicalization or metrification of, 160–64; thinness as new standard of, 86, 176; unmeasurable forms of, 181–83, 182 health care: choice-based models in, 193n9; colliding priorities in, 158; individualization and sociality juxtaposed in, 96–99; limitations of, 162–63. See also doctors; nutritionists; Xela public health clinics

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health measurements: in healthy cooking class, 4–5; nineteenth-century classification and, 22–23; of waist and upper arm, 4–5, 6–7; weight standards, 23–24. See also body mass index; energy; medical technologies; metabolic calculations; weight health workers. See doctors; nutritionists healthy cooking (comida saludable) classes, 4–6, 12, 100. See also culinary and cooking traditions; dieta and diet advice healthy eating: different views of, 13, 32, 167– 69, 168, 170; ignored by patient, 12; INCAP’s seven steps of, 65–67; slogan of, 75–76; teaching children about, 61–65; women’s concerns about, 169–71. See also dieta and diet advice; metabolic calculations; public health guidelines heart disease. See cardiovascular disease Herbalife, 94 heredity: environment linked to, 124–25; of fatness, 122–23; Lamarckian views of, 191–92n10. See also genetics high fructose corn syrup, 36 Hiper Paiz. See Walmart Historical Clarification Commission, 126, 128 hospital. See Xela public hospital Hotel Conquistador (Guatemala City), 1–4 huipiles, 5, 88, 89, 91, 190n6 humoral epistemologies, 78–80, 189n6 hunger and hunger research, 57–58, 101–4, 107. See also malnutrition; undernutrition Hurtado, Elena, 77 Hurtado, Juan José, 77–78 hygiene, nutrition linked to, 37–38, 49, 165 hypertension (high blood pressure), 95–96, 143, 157 imports: food (from U.S.), 31–32, 33, 35–36; seeds for vegetable growing, 167 INCAP. See Institute of Nutrition of Central America and Panama Incaparina (nutritional powder): benefits of, 160; cost compared to drugs, 161–62; development of, 158–60; mezclarina compared with, 166; as prenatal nutrition, 170; in receta for stomach pain, 157 indice masa corporal. See body mass index indigenous people: alternative sense of health and, 77–80; blamed for failure of development, 125; economic heterogeneity of,

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indigenous people (continued) 16–17; English spoken by, 19; hot/cold practices of, 78–80, 135, 189n6; killed in La Violencia, 20; miscues in questions about dieting, 89–90. See also K’iche’; Mam; Maya individualization and individual responsibility: for consuming good/bad foods, 74–77; dietary guidelines and, 70–71; emphasized in public messaging, 97–99; fatness viewed as failure of, 113–14, 143; possession vs., 22, 87–88; power over shape of body, 116; private property and idea of, 104–7; shared body juxtaposed to, 67, 68–69; social responsibility juxtaposed to, 107–9. See also moral individual; social worth and responsibility Institute of Nutrition of Central America and Panama (INCAP, Guatemala City): attendance at events of, 14, 132, 139–40; food and nutrition training at, 58; founding and location, 10, 57; “healthy eating” model of, 65–67; as influence on terminology, 104; nutrition education outreach policy of, 60–61, 64; nutrition transition research of, 38–39; obesity studies at, 37; protein supplement developed at, 158–60; role of, 13; rural nutritional research of, 58–60 International Day of Physical Activity (2008), 84, 92–96 International Diabetes Federation, 97 Jacoby, Enrique, 36 Johnson, Lyndon B., 58 Johnson-Hanks, Jennifer, 37 Journal of Nutrition, 187n4 junk food. See candy and sweets; comida chatarra; sugar Kaqchikel community, 77 K’iche’: belief in blood-based differences, 190–91n2; clothing and textiles, 17, 88, 89, 90–91, 103; creation story of, 5; history of, 16; labor of, 42; “my weight” as nonsensical for, 102–3; San Miguel celebration of, 90–91. See also Almolonga K’iche’ language: everyday use of, 17; expressing desire and pleasure in, 80–81; lack of terms for fruits and vegetables in, 63–64; phrases: rutzil wachaj (health), 171; Xelajú no’ j (below the ten spiritual guides), 16

knowledge, defined, 80. See also culinary and cooking traditions; metabolic calculations; nutritional black-boxing; science; ways of knowing and relating to bodies and food Kwashiorkor, 44 ladino classification, 114–15, 190n1 Lakoff, Andrew, 105 Lamarck, Jean-Baptiste, 191–92n10 languages: of blood, 115; the body distanced in Spanish, 101–4, 190n8; lack of terms for fruits and vegetables in Maya, 63–64; of lifestyle, 120–21. See also K’iche’ language Latour, Bruno, 51, 56, 64, 80 Le Galès-Camus, Catherine, 45 “Let’s Move!” program (M. Obama), 190n3 “Let’s Move Xela!” event, 84, 92–96, 109 lifestyles: obesity framed as illness of, 120–21, 125–28; sedentary, 93. See also agriculture; familial practices; market exchange practices lightness: as connoting both weight and color, 112–14, 126–28; foods framed as “lite” or “light,” 120, 127, 145, 178–79, 191n5; as wellness, 119–20 Linda (pseud.), 111–13, 128 Little-Siebold, Christa, 190n1 Little-Siebold, Todd, 114 Lizbet (pseud.), 35 Lock, Margaret, 161, 163 Locke, John, 104 Logra Tu Figura (Achieve Your Figure), 4 Lupton, Deborah, 160 Macpherson, C. B., 104 maize: cycle of, 68–69; harvested, xvi; nixtamalization of, 82, 188n4; nutrition education on, 68, 81; reproduction of, 174; subsidies for U.S. corn for biofuels, 132, 192n2; used for biofuel exports, 192n1. See also atoles; corn-based products malnutrition: cause of, 165; double burden of, 44–45; rates of, 12; researcher’s claims about, 38–39; types of, 44. See also undernutrition Mam: appearance of women, 88; economic situation in towns, 17; hopes to migrate, 18; nutrition class for, 67–69 Manuel (pseud.), 27–29 Manz, Beatriz, 18

index market exchange practices: bartering, 32, 33, 34; body-weight measurement’s intersections with, 133, 135; measuring out produce, 131; packaging home-grown produce, 132–33; scale and counterbalance in, 135; selecting fresh and best food in, 173– 74; shopping at, 182 markets and marketplaces, 130; balance needed to negotiate, 149, 149–50, 172; dense, busy nature described, 33–34; oil price increases’ impact on, 131–32; scales for body-weight measurement at, 7; in Sunday morning ritual, 48; textiles sold at, 88, 89. See also La Democracia; Minerva; supermarkets Martin, Emily, 8, 51, 192n11 Martorell, Reynaldo, 59 Marx, Karl, 8, 9 masa, meanings and preparation, 5, 16 Maseca corn flour, 51 Maurer, Bill, 11, 184 Maya: brutality against, 126; centrality of food for, 123; cooperative advertising at exercise event, 94; healing techniques of, 78; Incaparina developed for, 159–60; maize cultivation of, 82, 188n4; pride in heritage, 112; “zero” of, 192n3 Maya languages: lack of terms for fruits and vegetables in, 63–64. See also K’iche’ language Mayonesa Gourmet Light, 127 Mayra (pseud.), 156–57 McAllister, Carlota, 114 medicalization: concept, 160–61; metrification vs., 23, 163–64; of obesity, 86, 193n4 medical pluralism concept, 17 medical technologies: dieta as, 87; dietary changes prompted by, 27–30; forceful spirit of numbers in, 140–41; introduction to, 4–7; numerical balance key to, 135. See also modernities; scales, body-weight men: on dieting, 90; overweight, 88–89 Mendelian inheritance, 122, 191n7 Merck (pharmaceutical company), 42 mestizaje concept, 115, 190–91n2 metabolic calculations: as “accounting ideal,” 139, 145–46; approach to studying, 23; balance in theory and practice, 146–50, 149, 172; changes in awareness and response to, 150–52; discrepancies in equipment, 140–41; failures of, 164–71,

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180; forms of balance in, 135–37; impossible ideal of equivalency in, 139, 143–46, 180, 192n4; numerical balance in, 133, 135, 141–43; nutritionists’ alternatives to, 177– 80; processes absent in calculations, 148– 50, 149; rethinking efficacy of, 183–85; standards for, 7. See also dieta and diet advice; medical technologies; public health guidelines metabolic diseases: dieting embedded with, 162–63; as “diseases of modernity,” 13, 29, 36, 52; fear of, 76–77; fractal-like overlaps with deficiencies, 44; history interwoven with, 41; imbalance felt in, 150; insurance companies and awareness in U.S., 189n3; outlined in marketing materials, 2; patterns of, 44–46; pesticides implicated in, 168–69; as result of reductive food choices, 75–77; rising rates of, 6–7, 11, 12, 36–37, 86, 88. See also cardiovascular disease; diabetes; hypertension; obesity metabolism: closed vs. open system, 192n4; excess of, 150–52; exercise to enhance, 93–94; goal of perfectly balanced, 146–50. See also metabolic calculations metrification: concept, 23, 163–64; context of, 160–63; failure of, 169–71 mezclarina (nutrient powder), 165–66, 166, 171 migrants and migration, 18–19 Miguel (saint), celebration of, 90–91 military: obesity conference of, 1–4, 183; villages disappeared by, 18. See also violence milk and milk products: low-fat, 55, 69, 144– 45; Svelty, 100–101, 101. See also Svelty (milk product) minerals. See vitamins and minerals Minerva (market): Friday prices at, 34; shopping at, 182; Svelty (milk product) advertised near, 100–101, 101 ministry. See Guatemalan Ministry of Health Mintz, Sidney, 49 Mitchell, Timothy, 9, 10, 147 modernities: approach to obesity in context of, 51–52; critique of researchers’ narratives of, 48–49; diseases of, 13, 29, 36, 52; historical continuities in, 50–51; history interwoven with, 41–46. See also medical technologies Mol, Annemarie, 163, 193n9 Monteiro, Carlos A., 191n5 Moore, Henrietta L., 50–51

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moral individual: concept, 106–7; new techniques for classifying, 113–14; weight linked to idea of, 151. See also individualization and individual responsibility; social worth and responsibility mothers: breastfeeding vs. formula use, 158; confused about nutrition, 55–56; health classes for, 61; length of lactation, 188n4; prenatal nutrition for, 170; responsibility emphasized for, 68–69; undernutrition in gestation, 44–45; underweight children of overweight mothers, 122. See also children; women ¡Movámonos Xela! event, 84, 92–96, 109 “Mujer” (Women, newspaper supplement), 89 national agenda and nationalism: homogeneity sought in, 190–91n2; racism in, 125; self-care as strengthening country, 96–99. See also Guatemalan Ministry of Health; military National Unity of Hope, 97 Nelson, Diane, 11, 114, 123, 191n7 neoliberalism, 50, 121, 147 Nestlé’s Svelty (milk product), 100–101, 101 Netherlands, vegetable seeds imported from, 167 New York Times, 50 nixtamalization, 82, 188n4 noncompliance, 75, 151–52, 180 nongovernmental organizations: governmentfunded programs organized by, 15, 65–69, 189n5; health-and-hygiene textbook of, 61, 69 nonlinear model of transformation, 51 normalization of body types, 125–26, 164. See also body mass index nourishment: black-boxed social complexities of, 56–57; cooperative care in addressing, 183; experience of, 80–83; logics of, 42–43 numbers: abstraction of, 135–37; balance of, 146; diagnosis reduced to, 150; forceful spirit of, 140–41; processes absent in calculations, 148–50, 149; quality of life linked to weight, 141–43; quantification privileged in, 164; refusals of being bounded by, 150–52; rethinking privileged status of numbers in health context, 183– 85; Roman vs. Arabic, 192n3; zero, 136, 147–48, 150, 152, 177, 192n3. See also accounting practices; “balanced” diet;

body mass index; health measurements; metabolic calculations; metrification nutrición: approach to studying, 22; basic vs. complex information in, 60–61; conference on, 38–39; definition, 55, 56; diversity downplayed in, 80–83; indigenous beliefs about, 78–80, 189n6; meanings of, 55–56; simplified model taught in grade-school classroom, 61–65; in rural health clinic, 65–69; in urban hospital, 69–72. See also dieta and diet advice; nutrition field; nutritionists nutrients: deficiencies of, 68, 72–73; as epistemological units (modes of representation), 61, 72; insufficient micronutrients in processed food, 44–45; reductive framing of food in terms of, 22, 65, 72–77. See also nutrition field; and specific nutrients; supplements nutritional black-boxing: collision and confusion in, 80–83; concept, 56–57; “fat and sugar are bad” as examples of, 56–57, 63, 69–70, 74, 100, 103, 118, 121, 143, 145; simplified model as, 61–65. See also nutrition education nutritional reductionism, 22, 65, 72–77 nutritional transitions: concept and description of, 37–39; debates about, 39–40; as inherently unstable and nondirectional, 52; nonlinear model applied to, 51. See also dietary transitions; global food economy transition nutrition education: diversity downplayed in, 80–83; government-funded, nongovernmental coordination of, 189n5; heterogeneity of instructors, 57; INCAP policy on, 60–61; knowledge required to teach, 80; nutritional reductionism in, 22, 65, 72–77; patient confusion exacerbated by simplified approach, 73–74; simplified model in grade-school classroom, 61–65; in rural health clinic, 65–69; in urban hospital, 69–72 nutrition field: “calculability” in, 10–11; emergence as science, 9–10, 57–61, 72–73; measures as focus of, 11–12; nutrition transition framed by, 36–40; research journal of, 187n4; as transnational sphere of activity, 10 nutritionists: apologies for weighing patients, 133; attendance at conference, 3–4; bus

index analogy of, 138–39, 152; challenges faced by, 3–4; on commodification, 161–62; on corn’s importance, 36; on difficulty of following diet, 144; on eating vegetables, 73; exasperation with patients, 180; on excess weight, 135, 138–39, 152; expertise associated with, 140–41; fatness and obesity contrasted by, 176–77, 180–83; historical context of, 49; motivation of, 157–58; nonpharmaceutical treatments recommended by, 2; outreach at “Let’s Move Xela!” event, 94–96; response to failure to lose weight, 143; on weight loss, 177–80; on weight standards and importance of fatness, 23–24. See also body mass index; dieta and diet advice; metabolic calculations; recetas; Xela outpatient nutrition clinic nutritivo (nutritional) tonics, 50 Obama, Michelle, “Let’s Move!” program of, 190n3 obesity (obesidad): approach to studying, 21–24; attention to and research on, 36–37; caricatures of, 107; complexities of discourses of, 29; in context-dependent terms, 169–71, 184–85; core-to-periphery model of, 39, 43–46; costs to governments, 93; fatness contrasted with, 176–77, 180– 83; genetics research on, 85–86; intergenerational effects of, 46; as lifestyle disease, 120–21, 125–28; in mechanistic model of body, 138–40, 179–80; as medical category in everyday life, 29–30; as medical term vs. medicalization of, 193n4; military’s medical conference on, 1–4, 183; nutritional research juxtaposed to everyday experiences of, 41–46; rates, 32; as something one had, 118–19; translations of meaning across domains, 13–14. See also body mass index; excess; overweight; weight oil (food): costs of, 12, 35, 55, 131–32; in recetas, 2, 157; recommendations on, 68–70, 88, 120, 144, 157; as rich vs. unhealthy, 8; trans fats as, 36. See also fat and fats oil price increases (crude), 131–32 Olla de la Alimentación (INCAP), 66 Orellana Pontaza, Patricia, 97 organ as expression of subjectification, 190n6 our body (nuestro cuerpo), 67. See also the body

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overnutrition, 44–45 overweight: BMI for, 118; changing views of, 44–45; different attitudes toward, 137–38; as something one had, 118–19. See also excess; fatness; obesity paches, making of, 54 Pan American Health Organization (PAHO): attendance at events of, 14, 45, 93, 158; diagnostic criteria from, 44; as influence on terminology, 104; institutional affi liations of, 58; mentioned, 36 Paxson, Heather, 124, 187n3 pellagra, 72–73, 82 Pepsi and PepsiCo, 12, 63, 158, 175, 191n5 la perdida de nuestra cultura (the loss of our culture), 49 Pérez, Ramona Lee, 191n9 personhood: meanings and shifts in, 101–7, 190n8; nutrition’s calculations and, 151–52 pesticides, 13, 32, 167–69, 168, 170 Pew Hispanic Center, 18 Pilar (pseud.), 47–48 plastic surgery, 113 PlusVita (health bar), 100 “Policy of Information and Communication” (INCAP), 60–61, 64 Pollo Campero (restaurant), 175 pollos rostezados de calle (fried chicken from the street), 47 poor people: blamed for obesity, 180–81; elite views of fatness among, 86, 122; metabolic diseases of, 162; protein supplement developed in, 158–60; surgeries and medications inaccessible for, 3–4 Poovey, Mary, 61, 136–37, 148, 151, 164 Popkin, Barry M., 37, 55 Popol Vuh (Maya book of counsel), 123 Porter, Theodore, 81, 139, 189n3 possession: of body and social anatomy in advertisements, 100–101; “the body” juxtaposed to “your body,” 101–4; concept, 99, 185; development of self-conscious self and, 104–7; individualization vs., 22, 87–88 The Possession at Loudon (de Certeau), 102 poverty: situational nature of, 19–21; standardized measures of, 8–9. See also poor people Power, Michael, 135, 140–41 Pradera Mall (Xela), 34–35, 47, 163

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Prensa Libre (newspaper): on diabetes care, 97; on gene for obesity, 85–86; maize and biofuel cartoon in, 132; “the” vs. “your” hands in, 104, 190n8. See also “Mujer” preservatives, 36 The Problem of Malnourishment in Guatemala (INCAP), 60 processed foods: commodification of, 161–62; differences in, 166; imports of, 26, 30–31; insufficient micronutrients in, 44–45; “lite” or “light,” 120, 127, 145, 191n5; numbers on, 151; office workers’ consumption of, 88; preservatives in, 36, 50. See also fast food chains; and specific foods (e.g., sugar) produce. See fruits; markets and marketplaces; vegetables Propaganda (Bernays), 105–7 proteins: measurement of, 10; teaching children about, 62–63; widespread deficiencies of, 158–59 public health concepts. See nutrición; nutrition education public health guidelines: approach to, 23; failures of calculation in, 164–71; fatness distinguished from obesity and, 176–77, 180–83; historical context of, 49; Incaparina and development of, 158–60; metrification or medicalization in, 160–64; U.S. food guidelines and, 10, 65–66. See also global health discourses; metabolic calculations public messaging: of drug companies, 156; on exercise, 104; fatness conflated with illness in, 85–86; global health and commercial interests in, 120; metabolic practices linked to well-being in, 100; nationalism and moral order in, 96–99 “Que rica la comida” (Th is food is delicious), 7. See also rica Quetzaltenango (state): citizenship categories in, 114; migratory connection to U.S. from, 19; regional transformations diet and health patterns, 29–30; responsibilities to citizen health, 108. See also city (ciudad) and country (campo) boundaries; rural communities; Xela quinoa, 50 Rabinbach, Anson, 138 race (raza): etymology of, 125; gender and sexuality linked to, 115; Lamarckian views

of, 191–92n10; lightness and malleability of, 126–28, 192n11; social and legal implications of, 113 racial classification: consolidated into indígena and ladino, 114–15, 128; fat deployed in, 113–16; logic of terroir compared with, 124–25; new biosocial identities linked to, 119–20; in nineteenth-century, 22–23; pathologization of some bodies, 125–28; taste as embodiment of, 124, 191n9 Raductil (weight-loss drug), 2 Ramírez-Zea, Manuel, 37 rationality, 143, 192–93n6 rations. See dietary ration raza. See race Reardon, Thomas, 33 recetas (prescriptions and recipes): on food packaging, 35; for healthy cooking, 5–6, 12; Incaparina used in, 157, 161–62; for nonpharmaceutical treatments, 2, 157–58; paper pads for, 161 recommended daily allowances (RDAs), 73 Redfield, Robert, 79 responsibility. See individualization and individual responsibility; social worth and responsibility rhizome concept, 188n14 rica (delicious or tasty): Gloria’s food as, 173; meanings of, 7–8, 183; nutritionists’ advice on eating well and, 178; as untranslatable into discrete measures, 11–12 Ricardo, David, 9 Ricca Burger, 48 richness. See fatness; rica rickets, 58 los ricos, implications of term, 4 Rivera, Juan A., 59 Rosario (saint), 16 Rose, Nikolas, 128, 161, 163 Rosenthal, Caroline, 102 Rotman, Brian, 136, 148, 192n3 Rubel, Arthur J., 79 Ruiz, Viviana, 120 rural communities: displacement from, 18; health outreach organization for, 14–15; INCAP’s nutritional research in, 58–60; indigenous beliefs about food in, 78–80, 189n6; international connections of, 18–19; migration to cities from, 30–31; simplified model of nutrition taught in grade school, 61–65; in health clinic, 65–69. See also city (ciudad) and country (campo) boundaries

index salt, limiting intake, 96, 98 Salufit (diet drink), 2 San Carlos University (Xela), 20, 92 satiety, importance of, 6. See also fat and fats; fullness; rica scales, body-weight: changes in awareness and response to, 150–52; in public places, 7, 84, 110, 134, 150; refusal to step on, 135, 151; routine of weighing and calculations, 5–6, 69–70; that lie, 140 scales, market produce, 135 Scandinavia gym (Xela), 16–17 schools: benefits of commercial interests in, 190n5; fund-raising for nutrition classes at, 158; public vs. private, 19; simplified model of nutrition taught in, 61–65 science: accounts of fat vs. blood in, 115–16; nutrición’s emergence as, 9–10, 57–61, 72–73; persons as individuals in, 102, 104–5. See also metabolic calculations; numbers; nutritional black-boxing Scrimshaw, Nevin, 159–60 Scrinis, Gyorgy, 65 self and selfhood: as doctor, 162; as formed in dietary practices, 96–99; historical context of, 104–7; individual and social responsibility juxtaposed in, 107–9; production of, 87; weight linked to, 116–17. See also possession; social worth and responsibility; individual responsibility Semana Santa week, 173–76, 179 Serres, Michel, 192n4 Shaklee weight-loss product, 104 sibutramine (Vintix), 2, 3, 156, 157 Simmel, Georg, 8, 9–10 slimness. See thinness Smith, Adam, 9 sociality: body as social anatomy juxtaposed to advertisements, 100–107, 101; bus analogy and, 138–39, 152; dual perspectives on, 107–9; emerging forms of, 87–88; gendered messages and, 22; generational changes in, 88–92; individuality juxtaposed to, 96–99; “Let’s Move Xela!” event as, 84, 92–96, 109 social worth and responsibility: BMI as vision of, 119–21; body size as indicating, 87–89; food and weight as reflection of, 92–96; individual responsibility juxtaposed to, 107–9. See also individualization and individual responsibility; moral individual

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socioeconomic classification: destabilized categories in, 15, 19–21; taste as orientation to, 124, 191n9. See also poor people; social worth and responsibility Sociología guatemalteca (Asturias), 115 soft drinks: marketing of, 12–13, 13, 63, 158, 175, 191n5; sweeteners in, 36; teaching children about, 61, 63. See also candy and sweets Sololá (Guatemala), maternal-mortality campaigns in, 99 Solomons, Noel W., 57–58, 66 Spanish language, the body distanced in, 101–4, 190n8 Splenda (sweetener), 145 standardization: black boxes in relation to, 56; dietary guidelines and nutrition education materials, 10, 65–66; health value of foods juxtaposed to, 64–65; wealthy/ poverty measures, 8–9; Xela’s particularities as challenge to, 16. See also body mass index; numbers starvation. See food insecurity; malnutrition; undernutrition statistics, uses of, 59–60, 114–15, 128. See also accounting practices; metabolic calculations Stepan, Nancy Leys, 106 sterilization projects (covert), 191n8 Stevens, Mitchell L., 73 stigmatization: of being outside normal BMI range, 117–21; fat deployed in, 113–16; nineteenth-century classification and, 22–23 structural violence. See civil war; military; violence sugar: added to coffee, 22, 64, 120, 143, 175; alternative message about, 182–83; artificial sweeteners as “equal” to, 145; as bad food, 56–57, 63, 69–70, 103, 118, 143, 145; colonialist history of, 49; fortified with vitamin A and iron, 64–65; nutrition classes on, 61, 63–64, 69–70; obesity linked to increased consumption of, 36; refineries of, 189n4. See also artificial sweeteners; candy and sweets; comida chatarra superiority doctrine, 128 supermarkets, 33, 34–35, 154. See also markets and marketplaces; Walmart supplements: advertisements of, 161; dispensed by aid workers, 36; mezclarina

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supplements (continued) (nutrient powder), 165–66, 166, 171; nutritivo (nutritional) tonics, 50; PlusVita (health bar), 100; rural nutritional studies of, 58–60; in sugar, 64–65. See also Incaparina; vitamins and minerals Svelty (milk product), 100–101, 101 Sweet (sweetener), 145 Szent-Györgi, Albert, 187n5 Taco Bell, 109 tacos, 109, 190n10 tamales, 31, 34, 49, 157, 174, 175, 179 taste, embodied practices of, 124, 191n9 technologies. See medical technologies; modernities Tedlock, Barbara, 78, 189n6 Tedlock, Dennis, 123 temporality: linear approach to, 37–40; past, present, future entwined in, 51; as quality of foods, 77 terroir, concept and logic, 124–25 textile factory, 42–43, 46 thinness: attitudes toward, 90; feeling better about self linked to, 96, 121; modernity linked to, 179; as new standard of health, 86, 176; as racialization, 126–28; “to be” verbs to describe self, 116–17, 118. See also weight loss tiendas (groceries), 12–13, 26. See also markets and marketplaces Todos Santos community: critique of researchers’ narratives about, 48–49; dietary transition in, 12–13; La Violencia in, 20 Toledo sandwich meats, 100 tortillas: corn oil for frying, 131–32; cost to purchase, 190n10; differences in, 16; fastfood, 48, 175; government recommendations on, 21, 66, 118, 143, 151–52; heat for, 135; making, 27, 33, 51, 82, 132–33; pride in, 90; term for, 5 Tortrix stand, 169 trade agreements: anger over effects in Guatemala, 132; CAFTA, 12, 31–32; structural violence in effects of, 50 trade liberalization, 30 triglycerides, 7, 36, 40, 89, 118, 137, 139 Trubek, Amy, 125 Ultra Shape (nonsurgical procedure), 112 undernutrition: in core-to-periphery model of obesity, 39, 43–46; in gestation, 44–45;

overweight mothers with children suffering from, 122. See also malnutrition unemployment: diet in relation to, 42–43; increases in, 131–32 unilinear progress principle: concept, 37–40; questioned, 40–46 United Nations. See World Health Organization United States: corn subsidies for biofuels, 132; dieting in, 91, 190n3; Guatemalan migrants to, 18–19; Guatemalans deported from, 132; medicalization of obesity in, 193n4; poverty in, 20; vegetable seeds exported by, 167; War on Poverty in, 58 Universal Declaration of Human Rights (1948), 58, 189n2 universal individual, 106–7 Unshuld, Paul, 164 urbanization: culinary traditions forgotten in, 46–47; population growth and density in, 30–31. See also city (ciudad) and country (campo) boundaries U.S. Department of Agriculture, 10, 65–66 vegetables: costs of, 161–62; nutritionists’ recommendations on, 73, 121, 161; pesticides used in growing, 13, 32, 167–69, 168, 170; replacements of, 31; teaching children about, 61–64 Viki (pseud.), 73 Villa Rojas, Alfonso, 79 Vilma (pseud.), 116–18, 119–20, 128 Vintix (sibutramine), 2, 3, 156, 157 violence: boundaries of inclusion drawn by, 119; dissolution of boundaries in, 20–21; fears of, 92; of racial discrimination and classification of bodies, 125–28; uneasy boundaries of state and, 1 vitamins and minerals: chemical structures identified, 10; definition, 187n5; diseases linked to deficiencies of, 68, 72–73; as epistemological units, 61, 73; rural nutritional studies of supplementing, 58–60; simplified teaching about, 62, 67, 68, 72; sugar fortified with, 22, 64–65. See also supplements Walmart (earlier, Hiper Paiz and Dispensa Familiar supermarkets), 12, 34–35, 174 War on Poverty (U.S.), 58 water: contamination of, 167–68, 168; sterilization of, 63

index ways of knowing and relating to bodies and food: biomedical technologies and ontological collisions in, 7–12; dissociation from past and future in, 27–29; epidemiological transformations entailing changes in, 22; excluded from nutrition education, 80–83; generational differences in, 91–92, 102–3; of local nutritionists vs. military and medical experts, 1–4; of metabolic measurements vs. culinary traditions, 4–7; obesity introduced as medical category in everyday, 29–30; weighing produce not body, 132–33. See also eating; familial practices; fatness; rica wealth: situational nature of, 19–21; standardized measures of, 8–9 Weber, Max, 8, 9 weight: approach to studying, 11–12, 21–24; bus analogy, 138–39, 152; classification by, 21, 113–16, 179–80; as creating new type of weight, 116–21; generational differences in meanings of, 91–92, 102–3; judgment about, 118–19; lightness of, 126–28; meanings of, 98–99; “normal,” 21, 22–23, 118– 20, 125, 142, 150, 156, 163–65, 179; of produce vs. body, 132–33; as reflection of social worth, 92–96; sense of self tied to, 116–17; sickness as prompted by, 119–20. See also obesity; overweight —measurements: biosocial identities built from, 119–20; in kilos and pounds, depending, 140; moral character linked to (in West), 91. See also body mass index; health measurements; metabolic calculations; scales, body-weight weight gain: as consequence of dieting, 177– 78; implications of child vs. adult, 73 weight loss: as allegedly objective, 179–80; “balance” as key to, 143–50; failure to lose, 126–28, 143; nutritionists’ views of, 177– 80; outreach consultation concerning, 95–96 —techniques: bariatric surgery, 4; drugs and herbals, 2, 3, 4, 94, 156, 157; “eat less, exercise more” equation, 143, 146, 170, 179, 185; low-fat and lite foods, 4, 5, 55, 69, 120, 127, 143–45, 147, 191n5; nonsurgical procedures, 112. See also dieta and diet advice weight management: daily dietary menu as, 86–87; equilibrium impossible in, 148–50; marketing of, 2, 4, 104; measurements of,

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3; miscues in communication about, 89–91; sociality and individuality merged in, 98–99. See also dieta and diet advice; metabolic calculations —discourses: discussions and misunderstandings about, 89–91, 150–52; historical, economic, and biological forces underlying, 23 well-being, as shared in community, 96–99, 102–3 Weller, Susan, 79 West, Paige, 16 women: balance in lives of, 149, 149–50, 172; food and nutrition as domain of, 88–89. See also mothers World Bank, 12 World Diabetes Day (El Día Mundial de la Diabetes), 97 World Health Organization, 29, 45, 58, 156 Xela (Quetzaltenango): ambiguities of everyday life in, 20–21; art exhibition in, 85–86, 87; as capital of Los Altos, 16, 111; economic heterogeneity of, 16–17; fieldwork and homestays in, 13–15, 187–88n8; location of, xiv; population growth and density in, 30–31; postwar health issues in, 11; public park sold to private interests, 92, 108–9; view of Zona 1, xv. See also markets and marketplaces; Pradera Mall Xela outpatient nutrition clinic: confusion about nutrición’s meaning at, 55–56; expanded hours and days of, 155; expertise associated with, 140–41; goals of, 137–38, 156; health embedded in numbers schema in, 141–43; location, 40; meanings of excess weight explained, 135, 138–39; opening of, 14; outreach at “Let’s Move Xela!” event, 94–96; simplified model of nutrition taught in, 69–72; weight-loss messages at, 2–3, 121–22. See also nutritionists Xela private clinic, 117–18 Xela public health clinics: healthy cooking class at, 4–7 Xela public hospital: blood types discussed in, 116; body-weight scale in, 134. See Xela outpatient nutrition clinic Ximena (pseud.), 103 zero, balance of, 136, 147–48, 150, 152, 177, 192n3

california studies in food and culture Darra Goldstein, Editor 1. Dangerous Tastes: The Story of Spices, by Andrew Dalby 2. Eating Right in the Renaissance, by Ken Albala 3. Food Politics: How the Food Industry Influences Nutrition and Health, by Marion Nestle 4. Camembert: A National Myth, by Pierre Boisard 5. Safe Food: The Politics of Food Safety, by Marion Nestle 6. Eating Apes, by Dale Peterson 7. Revolution at the Table: The Transformation of the American Diet, by Harvey Levenstein 8. Paradox of Plenty: A Social History of Eating in Modern America, by Harvey Levenstein 9. Encarnación’s Kitchen: Mexican Recipes from Nineteenth-Century California: Selections from Encarnación Pinedo’s El cocinero español, by Encarnación Pinedo, edited and translated by Dan Strehl, with an essay by Victor Valle 10. Zinfandel: A History of a Grape and Its Wine, by Charles L. Sullivan, with a foreword by Paul Draper 11. Tsukiji: The Fish Market at the Center of the World, by Theodore C. Bestor 12. Born Again Bodies: Flesh and Spirit in American Christianity, by R. Marie Griffith 13. Our Overweight Children: What Parents, Schools, and Communities Can Do to Control the Fatness Epidemic, by Sharron Dalton 14. The Art of Cooking: The First Modern Cookery Book, by The Eminent Maestro Martino of Como, edited and with an introduction by Luigi Ballerini, translated and annotated by Jeremy Parzen, and with fifty modernized recipes by Stefania Barzini 15. The Queen of Fats: Why Omega-3s Were Removed from the Western Diet and What We Can Do to Replace Them, by Susan Allport 16. Meals to Come: A History of the Future of Food, by Warren Belasco 17. The Spice Route: A History, by John Keay 18. Medieval Cuisine of the Islamic World: A Concise History with 174 Recipes, by Lilia Zaouali, translated by M. B. DeBevoise, with a foreword by Charles Perry 19. Arranging the Meal: A History of Table Service in France, by Jean-Louis Flandrin, translated by Julie E. Johnson, with Sylvie and Antonio Roder; with a foreword to the English-language edition by Beatrice Fink 20. The Taste of Place: A Cultural Journey into Terroir, by Amy B. Trubek 21. Food: The History of Taste, edited by Paul Freedman 22. M. F. K. Fisher among the Pots and Pans: Celebrating Her Kitchens, by Joan Reardon, with a foreword by Amanda Hesser 23. Cooking: The Quintessential Art, by Hervé This and Pierre Gagnaire, translated by M. B. DeBevoise 24. Perfection Salad: Women and Cooking at the Turn of the Century, by Laura Shapiro 25. Of Sugar and Snow: A History of Ice Cream Making, by Jeri Quinzio 26. Encyclopedia of Pasta, by Oretta Zanini De Vita, translated by Maureen B. Fant, with a foreword by Carol Field 27. Tastes and Temptations: Food and Art in Renaissance Italy, by John Varriano 28. Free for All: Fixing School Food in America, by Janet Poppendieck

29. Breaking Bread: Recipes and Stories from Immigrant Kitchens, by Lynne Christy Anderson, with a foreword by Corby Kummer 30. Culinary Ephemera: An Illustrated History, by William Woys Weaver 31. Eating Mud Crabs in Kandahar: Stories of Food during Wartime by the World’s Leading Correspondents, edited by Matt McAllester 32. Weighing In: Obesity, Food Justice, and the Limits of Capitalism, by Julie Guthman 33. Why Calories Count: From Science to Politics, by Marion Nestle and Malden Nesheim 34. Curried Cultures: Globalization, Food, and South Asia, edited by Krishnendu Ray and Tulasi Srinivas 35. The Cookbook Library: Four Centuries of the Cooks, Writers, and Recipes That Made the Modern Cookbook, by Anne Willan, with Mark Cherniavsky and Kyri Claflin 36. Coffee Life in Japan, by Merry White 37. American Tuna: The Rise and Fall of an Improbable Food, by Andrew F. Smith 38. A Feast of Weeds: A Literary Guide to Foraging and Cooking Wild Edible Plants, by Luigi Ballerini, translated by Gianpiero W. Doebler, with recipes by Ada De Santis and illustrations by Giuliano Della Casa 39. The Philosophy of Food, by David M. Kaplan 40. Beyond Hummus and Falafel: Social and Political Aspects of Palestinian Food in Israel, by Liora Gvion, translated by David Wesley and Elana Wesley 41. The Life of Cheese: Crafting Food and Value in America, by Heather Paxson 42. Popes, Peasants, and Shepherds: Recipes and Lore from Rome and Lazio, by Oretta Zanini De Vita, translated by Maureen B. Fant, with a foreword by Ernesto Di Renzo 43. Cuisine and Empire: Cooking in World History, by Rachel Laudan 44. Inside the California Food Revolution: Thirty Years That Changed Our Culinary Consciousness, by Joyce Goldstein, with Dore Brown 45. Cumin, Camels, and Caravans: A Spice Odyssey, by Gary Paul Nabhan 46. Balancing on a Planet: The Future of Food and Agriculture, by David A. Cleveland 47. The Darjeeling Distinction: Labor and Justice on Fair-Trade Tea Plantations in India, by Sarah Besky 48. How the Other Half Ate: A History of Working-Class Meals at the Turn of the Century, by Katherine Leonard Turner 49. The Untold History of Ramen: How Political Crisis in Japan Spawned a Global Food Craze, by George Solt 50. Word of Mouth: What We Talk About When We Talk About Food, by Priscilla Parkhurst Ferguson 51. Inventing Baby Food: Taste, Health, and the Industrialization of the American Diet, by Amy Bentley 52. Secrets from the Greek Kitchen: Cooking, Skill, and Everyday Life on an Aegean Island, by David E. Sutton 53. Breadlines Knee-Deep in Wheat: Food Assistance in the Great Depression, by Janet Poppendieck 54. Tasting French Terroir: The History of an Idea, by Thomas Parker 55. Becoming Salmon: Acquaculture and the Domestication of a Fish, by Marianne Elisabeth Lien 56. Divided Spirits: Tequila, Mezcal, and the Politics of Production, by Sarah Bowen 57. The Weight of Obesity: Hunger and Global Health in Postwar Guatemala, by Emily Yates-Doerr 58. Dangerous Digestion: The Politics of American Dietary Advice, by E. Melanie duPuis