What Kind of a Problem is Obesity? Teaching Ignorance, Knowledge, and Health with Emilia Sanabria

The February 2016 issue of Cultural Anthropology included the research article “Circulating Ignorance: Complexity and Agnogenesis in the Obesity ‘Epidemic’,” by Emilia Sanabria, who is a lecturer in social anthropology at the Ecole Normale Supérieure de Lyon, France. This Teaching Tools post presents some of Sanabria’s reflections on her work with the World Public Health Nutrition Association, as well as her suggestions for learning goals and supplementary readings when teaching her article in the classroom.

Obesity is generally framed as a problem, but as Sanabria points out in her article and underscores in the excerpt from her interview with contributing editor Susan MacDougall presented below, this framing emerges from a fraught process of knowledge production that delineates what is known and what cannot be known. This post offers some tools for using Sanabria’s article to prompt a classroom discussion on the process of establishing the un/known. It assumes an audience of anthropology students at various stages, including advanced undergraduates and graduate students, as well as other people with an interest in health, including anthropologists, medical professionals, and practitioners in health-related fields.

Author Interview

Susan MacDougall: What inspired this article? Did you have specific experiences or encounters that helped you to clarify your thoughts on ignorance and agnogenesis?

Emilia Sanabria: This article is inspired by the work I have been doing with the World Public Health Nutrition Association (WPHNA). I discovered the WPHNA at a conference they co-organized with the Brazilian Association of Public Health in Rio de Janeiro in 2012. I had recently begun new research on food and health education and had attended nutritional conferences, which are usually marked by the highly visible presence of industrial sponsors like CocaCola, PepsiCo, Kraft, Nestlé, Danone, and so on. The WPHNA event in Rio was very refreshing because the keynotes focused on the politics and economics of malnutrition, which is rather (and perhaps surprisingly) rare at events like these; nutrition conferences that bridge biological and political mechanisms are few and far between.

I decided to get involved and joined the WPHNA’s Executive Committee as membership secretary (a job that entails verifying members’ conflict of interest declarations). I was involved in discussions with colleagues in the field of public health nutrition leading up to the International Conference on Nutrition (ICN2) that was held in Rome in 2014, two decades after ICN1. These discussions brought together the World Health Organization, member states’ representatives to the Food and Agriculture Organization, as well as other nonstate actors, and they revealed the staggering level of corporate lobbying that had taken place over the yearlong process of drafting the Political Declaration and Framework for Action. This was nothing that we didn’t already know, but witnessing the process from this vantage point helped to clarify my thinking about agnogenesis.

SM: What would you want to highlight in a lesson for undergraduates about how to critically approach obesity as a public health problem? What would you want them to understand after that lesson?

ES: Part of the issue with the way obesity is approached is that it is often treated as a self-evident problem. Yet we know very little about the kind of problem that obesity is. We don’t know much about the relationship between obesity and poor health; many obese persons are in good health and many nonobese persons suffer from the pathologies commonly associated with obesity. The relationship between behavior, health, and obesity is not as straightforward as the public health interventions focusing on individual determinants of obesity suggest. This is something that scholars like Emily Yates-Doerr (2015) or Julie Guthman (2011, 2015) show beautifully in their work, which has done much to deconstruct the assumptions that plague how we think about the “problem” of obesity.  

I hope that this article helps to show that obesity is not a problem we can approach without considering the politics of how the problem is constructed as a problem, and how this might diverge from one place to another. My focus has been on the intricate relationship between what is known about obesity and how action and intervention are geared and evaluated with respect to this knowing. I am interested in showing how certain interventions gain traction and become legitimate, and how this is not unconnected to the kind of institutional, financial, and ideological backing that these interventions receive.

Suggested Goals

Emilia Sanabria suggests the following learning goals in conjunction with her article:

  • Encouraging students to see the “problem” of obesity as a construction emerging from a set of interconnected influences.
  • Connecting the process of knowledge construction to existing power structures.
  • Interrogating the assumption that obesity is synonymous with poor health.
  • Considering the role of agnogenesis, or the production and circulation of ignorance, in the construction of knowledge of obesity.

Suggested Readings

Bes-Rastrollo, Maira, Matthias B. Schulze, Miguel Ruiz-Canela, and Miguel A. Martinez-Gonzalez. 2013. “Financial Conflicts of Interest and Reporting Bias regarding the Association between Sugar-Sweetened Beverages and Weight Gain: A Systematic Review of Systematic Reviews.” PLoS Medicine, December 31.

Gross, Matthias, and Linsey McGoey, eds. 2015. Routledge International Handbook of Ignorance Studies. New York: Routledge.

Guthman, Julie. 2011. Weighing In: Obesity, Food Justice, and the Limits of Capitalism. Berkeley: University of California Press.

_____. 2015. “Binging and Purging: Agrofood Capitalism and the Body as Socioecological Fix.” Environment and Planning A 47, no. 12: 2522–36.

Moodie, Rob, David Stuckler, Carlos Monteiro, Nick Sheron, Bruce Neal, Thamarangsi, Thaksaphon, Lincoln, Paul, and Sally Casswell. 2013. “Profits and Pandemics: Prevention of Harmful Effects of Tobacco, Alcohol, and Ultra-Processed Food and Drink Industries.” Lancet 381, no. 9867: 670–79.

Stuckler, David, Martin McKee, Shah Ebrahim, and Sanjay Basu. 2012. “Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities including Processed Foods, Alcohol, and Tobacco.” PLoS Medicine, June 26.

_____, and Marion Nestle. 2012. “Big Food, Food Systems, and Global Health.” PLoS Medicine, June 19.

Ulucanlar, Selda, Gary J. Fooks, Jenny L. Hatchard, and Anna B. Gilmore. 2014. “Representation and Misrepresentation of Scientific Evidence in Contemporary Tobacco Regulation: A Review of Tobacco Industry Submissions to the UK Government Consultation on Standardized Packaging.” PLoS Medicine, March 25.

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

Students may also wish to consult the WPHNA’s journal World Nutrition.

Suggested In-Class Exercises

Invite students to reflect on the knowledge they draw on to decide what to eat. What kinds of foods do they consider healthy or unhealthy? Are these foods always available? Do they ever confront a wide range of choices, but still find themselves with “nothing to eat”?  

What other social problems take shape by way of reference to unknowns? Encourage the students to identify parallels with, for instance, global climate change or tobacco consumption.

Suggested Discussion Questions

  • Should individuals be held responsible for their own health, or does the state have an obligation to promote well-being?
  • Is obesity a medical or a political problem?
  • Is ignorance the opposite of knowledge?
  • Is industry-backed science bad science?
  • Is the notion of corporate disease vector put forward by Rob Moodie and colleagues (2013) useful for understanding epidemics caused not by infectious disease, but by corporate practices? 
  • Is abstract knowledge about nutrition useful or sufficient to tackle malnutrition?
  • Can you apply the distinction between romantic and baroque complexity, discussed in the article, to other areas of public policy? How portable is this distinction?