Metabolic Living: Food, Fat, and the Absorption of Illness in India by Harris Solomon (review)

The global spread of “Western” diseases is widely documented, and India has emerged as a focal site for this trend, with rapidly rising rates of obesity, diabetes, and their comorbidities. These conditions have been attributed to “nutrition transition”: dietary changes such as increases in intake of fat, refined carbohydrates, and animal-source foods that often accompany economic transformations and the rise of a consumption-oriented, urban middle-class (Popkin 2002). At the same time, India has the world’s highest rates of child stunting, a measure of undernutrition (Black et al. 2013). Indeed, these two phenomena are likely interrelated: histories of protein-energy and/or micronutrient undernutrition, manifesting as low weight at birth, appear to set the stage for increased risk of developing metabolic disease later in life. Medical anthropologists have much to offer in terms of gaining a deep, ethnographically-informed analysis of India’s current epidemiological profile. A new analysis of metabolic disease in Mumbai is offered in Harris Solomon’s book Metabolic Living: Food, Fat, and the Absorption of Illness in India.

Other medical anthropologists have contributed valuable work on diabetes in India, especially in Delhi. Their work has focused on emic understandings of diabetes causation, which range from the biomedical to the socio-spiritual (Mendenhall et al. 2012), and the ways in which socio-cultural factors influence diabetes self-care and mental health outcomes (Weaver and Hadley 2011, Weaver et al. 2015). These authors argue that this research, which clarifies how individuals understand diabetes and why they act in ways that reduce or exacerbate the pathogenicity of the disease, can help inform public health initiatives aimed at addressing the rapid spread of diabetes, especially in urban India. Solomon takes a quite different approach, preferring to destabilize established public health narratives of “risk factors” and “compliance” around diabetes and obesity in India. Solomon’s research aims to complicate rather than explicate the causes and consequences of these conditions in Mumbai. His focus is on metabolism as an object of biomedical intervention, an “ethnographic heuristic,” and a means to gain rich insight into the experience of chronic disease in urban India. Such an analytic approach is informed by science and technology studies and more closely aligned with that of medical anthropologists Joseph Alter and Lawrence Cohen, whose work in India is referenced in the text.

Metabolism, or the broader “metabolic living,” is Solomon’s main ethnographic object. He defines metabolic living as “an actively ongoing process people endure to survive the porosity that all life entails” (9), and proposes that an anthropology of metabolic living would “explore the ways that people complicate and even dissipate boundaries across the skin and thus show how bodies and environments are mutually porous…” (9). Drawing on historian and sociologist of science Hannah Landecker’s (2013) work on metabolism as a conceptual domain, Solomon considers it “a concept, an embodied thing, a mode of diagnosis and therapy, and a social rubric” as well as a “salient analytic category of somatic trouble” when it becomes disordered (10). Diabetes, a diagnosis of metabolism gone awry, occurs when bodies “have reached their limits of absorbing a changing world” (4).

Solomon’s study of metabolism is anchored in this concept of “absorption.” His goal is “to develop an ethos of absorption at the interfaces between food and living” (227). More specifically, Solomon considers

how people make connections between food and urban life to explain that absorption is taking hold as the grounds for experiencing and making sense of chronic illness…A study of metabolic illness grounded in absorption, in contrast to one that assumes overconsumption as its starting point, can offer a thicker account of how people live through this phenomenon.

(5)

Used in this way, “absorption” is asked to do a lot of work in the book. Indeed, absorption is a potentially useful construct for a study of diabetes at multiple levels. Diabetes stems from either cellular resistance to insulin or [End Page 936...