How does a person’s life change after he or she is asked to tackle a disease caused by a problematic metabolism, like diabetes?

Cultural anthropologist Harris Solomon explores the dilemmas faced by such people in his book, Metabolic Living: Food, Fat, and the Absorption of Illness in India, which was released last month.

Solomon conducted his research in Bandra, Mumbai. He spoke of how we need to expand our views on tackling metabolic disease in the country, and how it cannot be restricted to the notions of diet and exercise.

It is said that lifestyle diseases are caused by sedentary work life and unhealthy eating. What did you find out?
I’d ask: What kind of life is entailed in the idea of lifestyle? The dominant discourse is that the strong growth of certain social classes leads to lives that make them fat and sick. One of the aims of the book is not to begin with that assertion. It is tempting to find a single cause for this problem. My interest was to see how people live and eat. How is everybody living in this grey zone where nutritional science is changing constantly and also prolifically? I explore the life of people connected to metabolism; this could include a doctor, a dietitian, a marketer, or surgeon who conducts metabolic surgery.

As you said nutrition is a relatively nascent science and new research on this subject keeps coming up each day. How does a person decide what to eat and what not to eat? Who wields the influence?
One could ask: Who has the power to put things inside us? What goes in and what does not is often a top-down instruction. Metabolism always poses the problem of knowledge and also power. I describe the circumstances and dilemmas of this problem.

For instance, what does it mean to prescribe food like it was drugs? It changes the value of the food. The boundary between food and drug is not so clear anymore. People are eating karela on one hand to reduce diabetes, while also taking insulin shots. How do people live in a world where dietary knowledge is so prolific, when so much is told to you about how your body relates to food?

I read hundreds of diet books here. They all attempt to rearrange food with the hopes that it will rearrange our lives. Diets are an incredible repository of hope. A diet is a vision of our future self. But how do we live with these re-arrangements?

These rearrangements are based on will power?
Will power is one of the dominant narratives. It tells us that we are our metabolisms. This definition equates will power with beauty, aspiration, and compliance. My job is to find out: What is the difference for someone between having a metabolism and being their metabolism?

Metabolism seems like it equates the totality of the person. But I am not sure we must give metabolism that much credit. For various reasons, we feel we make ourselves with every bite. It causes a lot of suffering. There is some truth in this, but it is not the entire truth.

The book takes up this challenge by writing about metabolism and obesity and backgrounding cause-effect relationships. It seems like the metabolism is confined to our bodies and can be controlled at will. But there are certain moments where the openness of metabolism becomes evident. Those are the dilemmas that the book takes up.

You write about how Indian doctors scaled down the Body Mass Index from the internationally recognised standard for Indians. Do you think it was a right move?
The initiative says much about the challenges in public health. How do you handle the problem of correlating one man to a billion? How viable is this metric in the long run? Fatness is not always a sickness. We tend to associate fatness with sickness. And sometimes it is well reasoned, and sometimes it is not.

There is an episode in the book where you challenge the marketer’s notion of a housewife feeding her family healthy food? How is metabolic living gendered?
The question here is: Who is feeding whom? Metabolism also poses the problem of feeding. It is deeply gendered. During my research, I met women who would try…to cook food prescribed as a diet for their employees, cook another kind of food for their own family, and cook prescribed diets for themselves. That’s three levels of cooking. That is a diet upon a diet upon a diet. One metabolism and three diets.

Who is going to make that diet happen? The problem is not just of will power. It is also about who is doing the cooking. One cannot talk about treatment through diet without talking about gender and labour. Metabolism is then linked to beauty, marriageability, or even fertility when it comes to polycystic ovarian syndrome. All these issues become deeply gendered and are also are a class issue.

What is the role of metabolic or bariatric surgery in trying to cure obesity or diabetes vis a vis medical ethics?
Metabolic surgery changes the pace and amount of food and nutrients the body absorbs. It changes biochemical pathways and the signals sent along those pathways.

What counts as fixed or cured? And how does the surgery become a topic of medical ethics? The surgery offers a different vision of bodily science than diet science. It changes the metabolism from within. It carries over from eating to surgical change. Metabolism crosses the divide that is not often crossed- between the surgical and the medical.

Surgery offers a portal for a person to change the metabolism. It is both the problem and possibility of the surgery. Surgery becomes a resolution to the problem. We have to think about what it means to willingly go through a life-changing operation. So the questions most pressing are how the patient deals with life after the surgery.

What is the role of processed food in increasing obesity in populations?
You could reframe the question and ask, what actually is processed food? It can be food that is chemically altered or sometimes packaged. In this book, I tried to explore what processed food looks like. I wanted to examine food processing as a change in value in a broader sense. It can be the food whereby someone unknown is feeding you. It is already in the language – ghar ka khana, bahar ka khana (food made at home, and food made outside home). But what does it mean for a corporation to be feeding people?

The same values are ascribed to what is termed as adulterated food. Is it poison or nutrition or a bit of both? One aim of the book is to understand how people live in the grey zone between nutrition and poison. In this context, food can be seen as both life-giving and life-draining.

Writers such as Michael Pollan blame the increase in obesity on processed food.
This philosophy tends to see processed food as the enemy. When the conceptual camera lens is on food, it fails to capture the lived environments of how people feed each other. With the camera on food, we can’t see the role of will power, food adulteration, street food, politics, or gender for that matter. We only see food. But we need to open up the lens.