Abstract
This ethnographic work is an important contribution in the area of global health discourses around metabolic illness. Through a theorisation and an ethnographic engagement with metabolic living, Solomon shows us how ‘bodies and environments are porous’ (p. 9). Solomon is drawing and building on Hannah Landecker’s influential work on metabolism, which shows how biology and philosophy have understood ‘the inside-outside-ness of metabolism’ (p. 11). Solomon’s work does not take the inside and outside of the body as opposites; instead, he treats them as mutually constitutive. He introduces readers to the various complexities in the medicalisation of metabolic illness—it has lapsed into either a personal pathology of a culture of weight loss or of over-consumption, where the focus of assessment is the stomach to the extent that existing discourses of illness have collapsed ‘being a metabolism’ and ‘having a metabolism’ into one. This collapse is largely studied through a reading of middle class over-consumption in urban South Asia. Solomon feels that this collapse does not offer a space to understand how people negotiate with porosity and permeability and draws our attention to an important category—absorption. He suggests that a study grounded in absorption rather than over-consumption can offer us a nuanced understanding of the relationship between food and fat. By absorption, Solomon does not want to understand how consumption of food is converted into fat; instead, he offers us a multi-layered reading of how bodies and environments are ingested and infested with ideas about food and fat.
Any discussion on food and fat is linked to urbanised food habits and Solomon chooses for us one of the biggest megacities of India, Mumbai, as the site of study. He chooses a lower-middle class neighbourhood in Mumbai to understand its everyday health discourse by observing and interacting with residents about food habits. The second axis of his study is interviews with patients, nutritionists and physicists, and the third—and the most important—is the commercialisation of food. Here Solomon interacts with street food vendors and Mumbai’s obsession with vadapao (a bread and potato-based snack), and focuses on how its absorption is interpreted as metabolic illness by doctors treating patients in clinics.
This ethnographic work is divided into five chapters interspersed with five interludes. The choice of objects in the section on interludes allows the reader to engage with the porous nature of the problematic of metabolic living. Solomon chooses two popular food items—birthday cakes and mango—two identity documents—ration cards and stamps—and an interesting site of metabolic care—the walls of waiting rooms—to show how bodies and cities come to shape each other. These interludes are nestled between the chapters and, according to Solomon, provide insights into metabolic living and care.
Chapter 1 contextualises the medicalised debate on obesity through a detailed discussion on what being ‘thin’ or ‘fat’ means in the rising context of ‘globesity’. Medical discourses have constantly redefined various indicators and ‘scales’ become an important site to understand how bodies and cities come to interact with each other through various forms of scales, be it weighing machines for measuring human weight, body mass index, or scales that become the medium of negotiation in vegetable, fish or meat markets across Mumbai. Scales, as Solomon shows us, assume many forms across multiple sites and define various parameters of ‘thin’ and ‘fat’ over a period of time.
Chapter 2 makes an exciting read as Solomon introduces us to the concept of metabolic living and how bodies and the cityscape of Mumbai shape each other through the ‘killer’ vadapao (considered so because of the health risks it poses). Solomon takes us through a journey of this dish as he traces its politicisation, standardisation and the discourses of medical concern that also shape its reception to show how a city’s obsession with a food item is perceived by multiple actors. This chapter shows why discourses of medical care cannot overlook the culture and politics of food.
In Chapter 3, Solomon offers us an ethnographic reading of what ‘healthy living’ means in the context of the home and family. By following homemakers in kitchens and a discussion on ‘healthy’ branding strategies, Solomon offers a non-linear historiography of adulteration of food in India, the measures taken by the government and their impact on everyday discourses around safe food. The concern around food safety, Solomon argues, has paved the way for stringent food laws, and this chapter gives a fascinating account of how new food safety laws were negotiated by the city’s civic authorities. This chapter also revisits marketing campaigns around ‘healthy’ strategies and questions the way in which homemakers are assumed to play an important role to negotiate with the ‘processed’ food industry.
Chapter 4 gives an insight into medicalised care around metabolic diseases to show the various challenges the medical fraternity faces around the bodies that inhabit the city. This chapter is mostly based on the medicalisation of the city’s bodies: important actors are patients, doctors, dieticians and nutritionists. Their interactions shape the therapeutic environment under which regimes of absorption are co-created with an aim to diagnose and increase metabolic activity. The book concludes with a chapter titled ‘Gut Attachments’, where the site of study is the renewal of metabolism through surgery.
To conclude, this ethnographic work is an important contribution to medical anthropology, urban studies and food studies as it emphasises the intersections that the city’s bodies negotiate vis-à-vis metabolic living. Instead of advocating for stringent medical monitoring around associated health risks, Solomon shows the porosity between the city’s substantive bodies, built environments and medical discourses associated with metabolic care.