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Nimeshiba How Food Insecurity Contributes to Rising Rates of Obesity in the Developing World: A Case Study in Tanzania
Emma Chapman BA Candidate in International Affairs
The Elliott School of International Affairs The George Washington University
April 2015
Primary Reader Dr. Roy Richard Grinker │Professor of Anthropology, International Affairs, and Human Sciences Secondary Reader Dr. Stephen C. Lubkemann │Associate Professor of Anthropology and International Affairs
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ABSTRACT Current literature points to rising affluence in the developing world as the key factor contributing to the ever-growing global obesity epidemic. In conjunction with increased material wealth and a preference for a more “Western” lifestyle, however, are the social aspects of food culture. In Tanzania, food is equated with beauty, status, and power and those of a heavier weight are considered to be more desirable. An extended history of regional and national food insecurity has contributed to this cultural enshrinement of larger bodies, a value that directly perpetuates the public health concern of rising obesity rates. This paper will examine the relationship between a history of hunger and a cultural preference for larger bodies in Tanzania, as well as its future health implications. This understanding of the complex socio-cultural undertones of the growing obesity epidemic in developing nations will lead into a discussion regarding the need for a more holistic approach in combatting this dangerous trend.
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TABLE OF CONTENTS
INTRODUCTION ......................................................................................................................................... 1
Reframing the “Obesity Epidemic” ..................................................................................................... 2
A DOUBLE BURDEN .................................................................................................................................. 5
WEALTH AND HEALTH: WHAT’S MISSING? ................................................................................. 6
TANZANIA’S BURDEN ............................................................................................................................. 8
TANZANIAN FOOD CULTURE AND BODY AESTHETICS ........................................................ 11
Big is Beautiful ........................................................................................................................................ 13
Status in Stature ..................................................................................................................................... 16 A HISTORY OF HUNGER ....................................................................................................................... 18
Colonialism: The Creation of Dependency ...................................................................................... 19
Socialism: Ideology versus Implementation .................................................................................. 21
Post-‐Nyerere: The Problem with Food Aid .................................................................................... 23 OBESITY IN THE DEVELOPING WORLD: CURRENT INITIATIVES AND FUTURE
SOLUTIONS ................................................................................................................................................ 26
Obesity Prevention Strategies: India ................................................................................................ 27 A Different Approach: Counterintuitive, Yet Historically Grounded ....................................... 29
CONCLUSION ............................................................................................................................................. 30
REFERENCES ............................................................................................................................................. 32
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INTRODUCTION
Worldwide obesity has more than doubled in the past thirty-three years, growing
exponentially from 857 million to 2.1 billion individuals.1 The obesity epidemic has not
gone unnoticed, however. In most developed countries, a new media story or published
study concerning the detrimental effects of obesity is released every day. As of 2015,
almost all developed countries have both created, and widely publicized, a specific set of
strategies to combat the epidemic. However, this health concern is not concentrated
within industrialized nations.
As of 2014, seven out of the ten countries with the highest rates of obesity were
still considered to be “developing” according to their Gross National Income (GNI).2 In
fact, 62% of the world’s obese population resides in developing countries.3 How has
obesity been inaccurately framed as a problem only developed countries face? What
factors contribute to soaring obesity rates in developing countries? And what can be done
to combat this?
Each of these questions will be explored in this piece. Although contextually
relevant, certain themes such as the dangers of socially influenced body images and
eating disorders in the West; the detailed relationship between obesity and hunger in the
developed world; and the injustices of the food system in a more industrialized context,
will not be discussed. I will instead be centering this piece around the developing world
and, more precisely, around Tanzania.
1 The Lancet. "Obesity rates climbing worldwide, most comprehensive global study to date 2 Ibid. 3 Ibid.
2
I have selected Tanzania as a primary case study firstly because of its status
within the developing world. Although classified as a Least Developed Country (LDC)
by the World Bank, Tanzania escapes the bottom 10% of the Human Development Index
rating.4 In contrast to both BRICS nations and extremely fragile states, Tanzania is seen
as a “middle ground” where obesity trends are only just appearing, marking it as an ideal
case study for this paper.
I also selected Tanzania because of the personal observations I gained while
studying there in the spring of 2014. This firsthand experience has helped to both form
and support the arguments I will present.
In short, this paper will dictate that a lengthy history of food insecurity in
Tanzania, from the colonial period until present, has created a unique food culture. More
specifically, the language and customs concerning food in Tanzania have formed a
society that associates larger bodies with the powerful, rich, and beautiful. As is the case
in many other developing countries, curvier Tanzanian women are idolized and fatter
Tanzanian men are associated with higher status. This paper will then synthesize this
information to propose how a cultural “enshrinement of obesity” may lead to national
health implications in the future.
Reframing the “Obesity Epidemic”
This thesis will examine the ideas of a “global obesity epidemic” and culturally-
contingent body preferences. However, speaking to these topics requires the
anthropological context associated with both the words “obesity” and “epidemic.”
4 "Table 1: Human Development Index and Its Components." Human Development Reports. UNDP, n.d. Web.
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The United Nations defines “extreme poverty” as living on less than $1 per day,
but this stringent definition is inherently problematic. Does a person living on 98 cents
per day live the same life as someone living on 55 cents per day? Are those living on
$1.05 per day truly not experiencing “extreme poverty”? In short, obesity, like poverty, is
relative.
The World Health Organization (WHO) defines overweight and obesity as
“abnormal or excessive fat accumulation that presents a risk to health.”5 This definition is
further specified as those with a body mass index (BMI) of >25 being considered
overweight and >30 being considered obese. However, the social definitions and
associations surrounding larger bodies are much more potent than their explicit
categorization.
A general history of the body ideal within the West exemplifies the socio-cultural
significance of body shape. As different eras have passed, the definition of “fat” has
evolved as well. For example, the Middle Ages promoted larger bodies as representations
of force and prosperity, while the Renaissance supported the idea of moderation.6
Eventually, with the evolution of nutrition sciences, the body-as-machine mentality began
to take hold in the West.7 This lengthy, gradual transformation of body ideals in
developed countries discounts the idea that “obesity” holds a fixed definition.
As seen, the perception of “fat” may change over extended periods of time, but
rapid shifts have also been documented. Although the WHO has given a precise,
universal definition for “obese,” variations from and within this definition are common.
5 "Obesity." Health Topics. World Health Organization, n.d. Web. 6 Vigarello, Georges. The Metamorphoses of Fat: A History of Obesity. New York: Columbia UP, 2013. Print. 7 Ibid.
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As Anne Becker’s research in Fiji has shown, the form of a “healthy,” desirable body can
morph alongside a cultural shift. As the small island nation became more developed, and
more at will to globalizing forces, individual body preferences—especially among
adolescent girls—began to shift. The idea of the “Western” slender beauty ideal became
increasingly salient, resulting in the prevalence of obesity giving way to the prevalence of
eating disorders.8 This drastic example of a shift in preferred body shapes and localized
definitions of “fat” highlights the true relativity of the term “obese.”
The weight of the word “epidemic” must also be dissected. The Center for
Disease Control and Prevention (CDC) has defined “epidemic” as “an increase, often
sudden, in the number of cases of a disease above what is normally expected in that
population in that area.”9 However, only recently was this biomedical definition used to
refer to non-infectious diseases, such as obesity.
Can this “outbreak” of obesity even be classified as an epidemic? Scale, time
period, and divergence from “normal” are all ambiguous factors within the CDC
definition. Without the proper language to discuss the noticeable trend towards larger
bodies, health organizations and the media alike have chosen to coin the term “obesity
epidemic.”
In short, the contingent and often vague definitions of “obesity” and “epidemic”
must be considered throughout this paper. Although these words will be used for
convenience, it should be recognized that their connotations and implications hold
historical and anthropological weight. 8 Becker, A. E. et al. “Globalization and eating disorder risk: Peer influence, perceived social norms, and adolescent disordered eating in Fiji.” International Journal of Eating Disorders 47.7 (2014): 727–737. Web. 9 "Section 11: Epidemic Disease Occurrence." Lesson 1: Introduction to Epidemiology. Centers for Disease Control and Prevention, 18 May 2012. Web.
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A DOUBLE BURDEN
Those that discuss, and attempt to fight, the growing obesity epidemic in
developing nations often speak of a “double burden of disease.” This phrase refers to the
exhaustive challenge faced by most developing nations to battle obesity in addition to
infectious disease and malnutrition. Many low- and middle-income countries are thus
confronted with the task of creating sweeping healthcare strategies that must be both
inclusive and intensive. Typically lacking the funds to do so, these nations are ravaged by
the ailments of malaria, tuberculosis, HIV/AIDS, micronutrient deficiencies, and stunted
growth, in addition to the non-communicable diseases (NCDs) typically caused by
obesity, such as cardiovascular problems and diabetes.
In the 2011-2012 fiscal year, the Indian government allocated 5.6% of its public
health funds to the National Programme for Prevention and Control of Diabetes,
Cardiovascular Disease, and Stroke and only 1.6% to the National Institute of
Communicable Diseases.10 This data indicates that India is battling with a double burden
of disease. Additionally, the disparity in percentages indicates a shifting focus towards
obesity—rather than infectious disease—prevention.
This double burden afflicts not only large healthcare systems, but financially
plagues the average citizen as well. In 2004, out of pocket expenses for either heart
disease- or hypertension-related hospital visits in India was equal to about $2.25 billion,
10 Ministry of Health and Family Welfare Demand No. 47 Department of Health and Family Welfare. Rep. N.p.: n.p., n.d. India Budget. National Informatics Centre. Web.
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with an additional $803 million being spent on diabetes.11 These findings allude to the
monetary implications of obesity in developing countries. The proper resources to battle
NCDs are much too expensive for most developing nations that may already struggle
with the “single burden” of infectious disease.
Although this double burden requires attention to be placed in all areas, most
health-oriented organizations in sub-Saharan African countries do not address obesity. Of
the fifty Africa-based healthcare non-governmental organizations (NGOs) listed by the
University of Pennsylvania, none mention an initiative to combat obesity.12 It seems that
much more attention has been paid in BRICS nations, as seen above. Though these
countries do have much higher rates of obesity than most sub-Saharan African countries,
preemptive measures to halt the trend towards larger bodies must be implemented.
WEALTH AND HEALTH: WHAT’S MISSING?
This newfound “double burden,” and the subsequent growing number of
overweight and obese people in developing countries, has encouraged many scholars to
contribute work on the subject. One study, published in 2000, found obesity to be a
severe problem among women in the Middle East and North Africa, Latin America and
the Caribbean, as well as Central and Eastern Europe, all regions that are host to
developing countries.13 Although women in sub-Saharan African nations were found to
11 Mahal, Ajay, Anup Karan, and Michael Engelgau. The Economic Implications of Non-‐Communicable Disease for India. Rep. N.p.: n.p., n.d. World Bank. Health and Nutrition Population, Jan. 2010. Web. 12 "NGOs & Community Health Organizations in Africa." Resources on Health and Diseases in Africa. University of Pennsylvania African Studies Center, n.d. Web. 13 Martorell, R., and M. L. Hughes. "Obesity In Women From Developing Countries." European Journal Of Clinical Nutrition 54.3 (2000): 247-‐252. Academic Search Premier. Web.
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have generally low BMIs, strong patterns emerged concerning education level and place
of residence. In this region, women with higher education levels as well as women living
in a more urban environment were found to have higher BMIs.14 Perceiving these factors
as wealth and social class indicators, the study concluded that in sub-Saharan Africa,
obesity was an issue of higher social classes, or the “elites”.15 Additionally, it found that
within developing countries, increases in national incomes and a rising prevalence of
Westernization were at the root of a growing obesity epidemic.
Other research has supported these findings, recognizing urban elites at the
epicenter of obesity in developing countries. For example, 2004-2005 WHO data
indicates that 10.9% of the urban population, but only 1.7% of the rural population, was
obese in Tanzania.16 This disparity lends further proof to theories suggesting that
increased access to “modern” amenities is at the root of rising obesity rates.
Other studies have delved deeper into the issue to find that the access to certain
modern amenities has created a generally fatter population. Specifically, it has been
found that subsidized agriculture and the ease of accessibility to highly refined fats, oils,
and carbohydrates underlies urban living and contributes to rising obesity rates.
Additionally, the increased prevalence of labor saving mechanized devices, affordable
motorized transport, and sedentary lifestyles can be to blame for urban obesity.17
14 Ibid. 15 Ibid. 16 National Bureau of statistics (NBS)[Tanzania], ORC Macro. Tanzania Demographic and Health Survey 2004-‐05. Dar es Salaam, Tanzania, Natioanl Bureau of Statistics, ORC Macro, 2005. 17 Prentice, A. M. "The Emerging Epidemic of Obesity in Developing Countries." International Journal of Epidemiology 35.1 (2005): 93-‐99. Web.
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While each of these studies recognizes climbing obesity rates in developing
countries as directly correlated to a rise in income and socioeconomic status, this
phenomenon is juxtaposed in most developed countries. For example, a 2005-2008 study
in the United States proved that low-income and less educated women were more likely
to be obese.18 Similarly, a 2013-2014 study found that the three states with the highest
obesity rates were also those with the lowest median household income.19 The inverse
relationship between obesity rates and income in developed countries undermines the
universality of the previously-mentioned theories.
In this way, it is necessary to view the direct relationship between affluence and
obesity as mostly a low- to mid-income country occurrence. As seen, in developed
countries, there is a larger association with low income and obesity.20 However, as
countries develop further, the problem of obesity tends to shift from being concentrated
in upper-income groups to becoming more prevalent in lower-income groups.21
TANZANIA’S BURDEN
As of 2015, the threats of malnutrition and infectious disease currently dominate
the healthcare scene in Tanzania. The World Food Programme’s 2012 report on Tanzania
found significant statistics concerning stunting across the various regions of the country
(see Figure 1). Stunting, defined as a statistically low height for age, is the key sign for
18 Ogden, Cynthia L., Molly M. Lamb, Margaret D. Carroll, and Katherine M. Flegal. Obesity and Socioeconomic Status in Adults: United States, 2005-‐2008. Rep. 50th ed. N.p.: National Center for Health Statistics, 2010. Print. 19 "Indicator Summary." CDC – NPAO Data Trends and Maps. Center for Disease Control and Prevention, n.d. Web. 20 McLaren, Lindsay. “Socioeconomic Status and Obesity” Epidemiologic Reviews 29.1 (2007): 29-‐48. Web. 21 Ibid.
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chronic malnutrition. Acute malnutrition, on the other hand, is indicated through
micronutrient deficiencies. One 2010 study sponsored by UNICEF and USAID found
that 33% of children ages 6-59 months and 37% of women ages 15-49 in Tanzania were
Vitamin A deficient.22 That same study also found 59% of children and 41% of women to
be anemic, the most intense form of iron deficiency.23 These statistics demonstrate that
both acute and chronic malnutrition are serious issues within the current Tanzanian
population.
In addition to malnutrition, infectious disease is another leading killer in
Tanzania. HIV/AIDS, malaria, and tuberculosis occupy ranks one, two, and five of the
top causes of death in Tanzania in 2010, respectively.24 These numbers indicate that
preventable infectious diseases are still a major concern for most Tanzanian citizens.
22 Micronutrients: Results of the 2010 Tanzania Demographic and Health Survey. Rep. National Bureau of Statistics; USAID; UNICEF, Sept. 2011. Web. 23 Ibid. 24 "GBD Compare." Institute for Health Metrics and Evaluation. N.p., n.d. Web.
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Although NCDs currently account for about 31% of deaths in Tanzania, most of
these are caused by either maternal, perinatal, and nutritional conditions or injuries.25
NCDs associated with obesity are largely insignificant. Cardiovascular disease accounts
for a mere 2.8% of deaths and diabetes for only 0.62%,26 indicating low national obesity
rates, currently.
Clearly, Tanzania suffers mostly from the single burden of infectious disease as
well as malnutrition. Dealing primarily with these issues, Tanzania spent only $49 per
capita on healthcare expenses in 2013. Although this represents a 32% increase from
2010, it still puts Tanzania on par with war-torn Afghanistan’s healthcare expenditure.
With resources already stretched so thin, the added cost of NCDs in Tanzania is
unimaginable. A double burden of disease within the country would not only be
unmanageable for the government, but disastrous for the entire population.
However, this double burden of disease seems to be looming on the horizon for
Tanzania. The Ugandan Heart Institute predicts obesity-related heart disease to be the
leading cause of death in sub-Saharan Africa in five years.27 Additionally, a little under a
third of Tanzania’s population suffers from high blood pressure, an indicator commonly
linked to obesity. Despite these risks, there are currently no resources dedicated to the
possible threat of obesity in Tanzania. The WHO has drafted nine national systems
responses to NCDs, two of which center around the promotion of physical activity and
25 Noncommunicable Diseases (NCD) Country Profiles: United Republic of Tanzania. Rep. World Health Organization, 2014. Web. 26 Ibid. 27 "Africa's Growing Obesity Problem." Newsweek. N.p., 23 Aug. 2009. Web.
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healthy diet. However, most likely due to a lack of available funds, none of these system
responses have been implemented in Tanzania.28
Is Tanzania truly the next target for the obesity epidemic? Although it may not be
within the immediate future, Tanzania is certainly following patterns set by developing
countries now struggling with a growing obese population.
TANZANIAN FOOD CULTURE AND BODY AESTHETICS
As discussed earlier, increased access to high-priced amenities may be to blame
for rising obesity trends, however, other factors seem to be at work. One study found
urbanization and globalization to be “distant factors” of obesity in developing countries.29
However, it also determined social relationships and cultural perceptions of weight to be
“intermediate factors” contributing to the same trend towards larger bodies.30
Ultimately, socio-cultural influences should not be overlooked when considering
the obesity epidemic in developing countries. There are multiple, global initiatives—
including the high profile Millennium Development Goals—that aim at reducing hunger
and increasing body fat,31 and while these initiatives are necessary, they may have
unintended repercussions. The aid community’s consistent “bigger is better” approach to
body weight, especially children’s, can have harmful consequences. Along with macro-
level dialogue that supports larger bodies, there is substantial evidence that internal
cultural practices also contribute to a certain “enshrinement of obesity.” 28 Ibid. 29 Scott, A., C. S. Ejikeme, E. N. Clottey, and J. G. Thomas. "Obesity in Sub-‐Saharan Africa: Development of an Ecological Theoretical Framework." Health Promotion International 28.1 (2013): 4-‐16. Web. 30 Ibid. 31 "Growth, Development and Obesity in Developing Countries." Archives of Disease in Childhood 98.11 (2013): 861. Web.
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Wealth and socio-behavioral factors are complexly intertwined in their effects on
obesity in developing countries,32 but the global public health community is much more
aware of the former. The latter, however, will be further explored through the analysis of
specific language patterns and customs surrounding food that have produced a cultural
“enshrinement of obesity” in Tanzania.
In the spring of 2014, I traveled abroad to study in Tanzania. Soon after arriving
in country, I began to take Swahili classes to prepare myself for my homestay. Although I
was assured that my family would speak some English, it was advised, and I felt it
necessary, to learn as much Swahili as possible. After learning the basic greetings and
farewells, our class moved on to key phrases we would need in our homestay. The first
phrase we learned was nimeshiba, or “I am full.”
The density of food culture in Tanzania, as in many East African countries, is
incontestable. Food is a communal vessel and is often used to form and fortify ties
between individuals, families, and neighboring villages. One cannot enter a home without
being offered something to eat, and merely greeting a friend during their meal will result
in an offer to join.
A linguistic analysis finds that many Swahili proverbs hinge on hunger and food.
For instance, many Tanzanians indicate the necessity of a varied approach to problem
solving by declaring mchele mmoja mapishi mengi, or “rice is all one, but there are many
ways of cooking it.” This phrase underscores the significance of rice, a national staple
and the common base of many meals, to Tanzanian food culture.
32 Prentice, A. M. "The Emerging Epidemic of Obesity in Developing Countries."International Journal of Epidemiology 35.1 (2005): 93-‐99. Web.
13
Another popular phrase admonishes procrastination by claiming ngoja! ngoja!
huumiza matumbo, or “wait a minute! wait a minute! harms the stomach.” This phrase
speaks directly to the prevalence of hunger throughout Tanzania. The fact that many
Tanzanians feel that waiting to eat may result in not eating at all indicates a lack of
sufficient food within the household.
The significance of food is ingrained in Tanzanian culture to a high degree. This
specific food culture has created a cultural “enshrinement of obesity,” frequently seen in
developing countries. I will analyze the Tanzanian preference for larger bodies in two
specific sub-categories: beauty standards and perceptions of power.
Big is Beautiful
Finding beauty in certain body shapes has become culturally contingent. There is
a global, cross-cultural trend marking “bigger” bodies as more desirable.33 However, in
developed countries, “thinness in the midst of abundance,” provided that the individual
still remains tall and muscular, is now revered.34 In fact, it was found that North
American, European, and Japanese men generally prefer thin, compared to average or
overweight, women.35 This preference for slimmer figures is not the case in developing
countries.
There is sufficient research indicating that those in developing countries, or in
general those with a low socio-economic status, prefer females with a higher BMI. One
33 Cassidy, Claire M. "The Good Body: When Big Is Better." Medical Anthropology 13.3 (1991): 181-‐213. Web. 34 Ibid. 35 Pisanski, Katarzyna, and David R. Feinberg. "Cross-‐Cultural Variation in Mate Preferences for Averageness, Symmetry, Body Size, and Masculinity." Cross-‐Cultural Research 47.2 (2013): 162-‐97. Print.
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specific study found that men with few resources, or men who perceive themselves of
lacking resources, prefer females with a higher body weight.36 And as wealth is typically
concentrated in urban areas, a geographical study indicated similar findings. In South
Africa, men and women were asked to rate the ideal female body figure from 1 to 9, with
1 being the most slender and 9 being the most heavy. It was found that in rural Kwa
Zulu-Natal, women specified the ideal body size to be 5.5 while men found it to be a 5.6.
These ratings vary greatly from the urban data found in Cape Town, where women
indicated an ideal body size to be 3.1 and men denoted ideal as 3.6.37 Yet another study
found that Ugandans consistently rated larger body figures to be more attractive and
healthier than their British counterparts.38 These studies all conclude that those with little
access to resources, typically those in low-income areas, associate attractiveness with
larger body types.
Observing Tanzanian culture specifically, one can easily draw parallels to these
broader-based studies. An examination of the Hadza ethnic group in Tanzania found that
there was a high preference for heavier figures, especially in comparison to the
preference of Americans.39 Though the Hadza are Tanzanian, as a marginalized hunter-
36 Nelson, Leif D., and Evan L. Morrison. "The symptoms of resource scarcity judgments of food and finances influence preferences for potential partners." Psychological science 16.2 (2005): 167-‐173. 37 Swami, V. et al. "The Attractive Female Body Weight and Female Body Dissatisfaction in 26 Countries Across 10 World Regions: Results of the International Body Project I." Personality and Social Psychology Bulletin 36.3 (2010): 309-‐25. Web. 38 Furnham, Adrian, and Peter Baguma. "Cross-‐cultural Differences in the Evaluation of Male and Female Body Shapes." International Journal of Eating Disorders 15.1 (1994): 81-‐89. Web. 39 Wetsman, Adam, and Frank Marlowe. "How Universal Are Preferences for Female Waist-‐to-‐Hip Ratios? Evidence from the Hadza of Tanzania." Evolution and Human Behavior 20.4 (1999): 219-‐28. Web.
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gatherer tribe, they do not represent the majority of Tanzanians. Rather, an analysis of
Tanzanian pop culture may be more appropriate.
Tanzanian hip-hop, known as “bongo flava,” has become popular with the urban
youth over the past few decades. As a stark example of Westernization and very similar
to American hip-hop music, one finds bongo flava music videos to depict the artist’s
abundance of money, power, and women. Through a brief analysis of these videos, I
found that most incorporated some sort of female model to whom the artist would sing. In
each video that included a female model, she represented a curvier body type.40
An examination of the personal interactions I had while in Tanzania also denotes
the association between higher BMIs and attractiveness. Speaking with Tanzanian
women, I was consistently told to gain weight and that I had to “fatten up.” Additionally,
I found my host family to be very conscious of how much I ate. They consistently pushed
multiple, heaping portions of starch-heavy food onto me, even after I indicated being full.
Some of my other American counterparts, especially females, became sick at certain
points from overeating. Each of these small interactions has amounted to a larger
conclusion indicating the preference for curvier female body types in Tanzania.
Lastly, the use of colloquial language to denote the preference for larger women is
evident. The Swahili language is relatively inexpressive, using only one word to denote
“nice,” “cute,” “pretty,” and “beautiful.” However, I learned multiple slang words for a
curvier female’s large backside within my four months of living in Tanzania. The
intensity of language in this specific category suggests its importance to Tanzanian
culture. Even informal examples such as this support the claim that the feminine physique
is viewed much differently in Tanzania than in most Western countries. 40 Bongo Flava Video Mix 1. Felix Omwega, 2014. YouTube.
16
The preference for a curvier frame with a higher BMI is recognized across the
developing world, and specifically in Tanzania. This tendency contributes directly to a
cultural “enshrinement of obesity” that socially promotes larger bodies.
Status in Stature
Throughout history, those that have had stable, sufficient access to food have been
considered more powerful. Ingrained within the system of food production, distribution,
and consumption are issues of labor, justice, inexplicable inequalities, and—essentially—
the right to eat.41 Although this hierarchal structure ranging from the scarce to the
plentiful is detailed on a macro-level in the next section, I will be examining how it has
affected individual body image and consequential social status in Tanzania.
While “big” can be classified to mean tall, fat, or muscular, one study was able to
differentiate between these varied body types. Data indicates that a preference for tall
men is almost universal and that a preference for fatter body types had a similarly wide
support base not long ago.42 Recently, Euro-American preferences have shifted towards a
more muscular stature, but developing countries continue to prefer fatness.43
When investigating patterns of body modification towards the trend of “getting
bigger”, further research shows that those of a higher social status are more able to
modify their bodies to this preference.44 Therefore, people who individually represent
power and status are those able to achieve bigger bodies.
41 Falnnery, Ezekiel, and Diana Mincyte. "Food as Power." Cultural Studies -‐ Critical Methodologies 10.6 (2010): 423-‐7. ProQuest. Web. 42 Cassidy, Claire M. "The Good Body: When Big Is Better." Medical Anthropology 13.3 (1991): 181-‐213. Web. 43 Ibid. 44 Ibid.
17
This trend seems to flow in the reverse as well. Even within the animal kingdom,
a large stature is often a symbol of dominance and power. Within the human sphere,
those that aim to be viewed as dominant or powerful attempt to assert themselves through
a large presence as well.45 Whether through the display of material wealth and clothing
that enhances and enlarges, or through body modification itself, the association between
status and body size is not a foreign concept to many.
In Tanzania, on a national, regional, community, and household level, food is
used as an indicator of status and power. A study conducted in the small Tanzanian
village of Malinzanga found there to be social status associated not only with a family’s
abundance of food, but also with their chosen types food and its style of preparation and
consumption.46
On a more personal level, I found there to be many informal indications of food as
a status symbol while living in Tanzania. Despite the provision levels of the family, food
was always offered to guests who entered the home. This suggestion of excess, whether
genuine or contrived, emphasizes the power of food within Tanzanian society. Another
way in which I found food to be a status symbol was when I asked to take a picture with
my host family. To my confusion, my host father immediately insisted on bringing a plate
full of food into the photo. After reflecting on the incident, I realized the importance of
denoting food security and its relation to status within the community. Even the way in
45 Ibid. 46 Ohna, Ingrid, Randi Kaarhus, and Joyce Kinabo. "No Meal without Ugali? Social Significance of Food and Consumption in a Tanzanian Village." Culture, Agriculture, Food and Environment 34.1 (2012): 3-‐14. Web.
18
which elite politicians are continually described as “fat” in Tanzania symbolizes food
access—and larger bodies—as power.
In Tanzania, as in many developing countries, larger bodies are seen as visible
markers of sufficient access to food, and therefore, as indicators of desirable beauty and
status. This social enthusiasm and support for bigger bodies has culminated in a cultural
“enshrinement of obesity.” From where has this stemmed?
An extended history of food insecurity in Tanzania has contributed to this
overcompensation. Those with bigger bodies are revered as the few who have more than
enough food to support themselves and their families. They therefore represent the
powerful, the wealthy, and the desirable.
A HISTORY OF HUNGER
As one study found, “men who feel either poor or hungry prefer heavier women
than men who feel rich or full.”47 This research supports the relationship between a
partiality towards fuller figures and hunger. It also sparks discussion concerning countries
with lengthy periods of food insecurity.
Most developing countries not only have a long history with hunger, but also
continue to face that reality today. The case of Tanzania is no different. As discussed, a
non-Western culture surrounding food consumption and body image has evolved. In large
part, these two elements are very much related. Unlike in the United States, another
individual’s food security is not always assumed. In short, larger bodies are used to assert
47 Nelson, Leif D., and Evan L. Morrison. "The symptoms of resource scarcity judgments of food and finances influence preferences for potential partners."Psychological science 16.2 (2005): 167-‐173.
19
power and beauty as they represent health and adequate access to food. Therefore, as
many Tanzanians continue to go hungry today, the social acceptance, encouragement,
and even enshrinement of obesity has become the norm.
Food insecurity has not been contingent on a certain government or political
system, but rather has plagued the East African nation throughout its history. Through
periods of reliance and self-sufficiency, Tanzanian society specifically has battled with
hunger.
Colonialism: The Creation of Dependency
Before German, and then British, colonialism took hold of Tanzania in the late
1800s, most of the country relied on subsistence farming. Without access to external
economies, most communities fully produced and consumed their own food. This closed-
system diet, although labor intensive and “traditional,” served the population well.48
However, colonial forces soon descended upon Tanzania and began to promote
the cultivation of cash crops like sugar and cotton. British colonial rule directed its
economic policy in Tanzania towards the production of surplus.49 Recognizing the
continued need for subsistence farming, colonizers merely introduced cash crops as an
addition to, rather than substitution for, “traditional” farming techniques. The British
governor himself stated that “to save a native community from famine is more important
than the export of many bales of cotton.”50
48 Austen, Ralph A. African Economic History: Internal Development and External Dependency. London: J. Currey, 1987. Print. 49 Bryceson, Deborah Fahy. Food Insecurity and the Social Division of Labor in Tanzania: 1919-‐85. New York: St. Martin's, 1990. Print. 50 Ibid.
20
However, this British model severely overestimated the labor force and possible
production in Tanzania. The colonial strategy relied upon not only continued levels of
agricultural production, but also on additional male earnings either through cash crop
cultivation or migrant labor. 51 This intensive approach was largely unsuccessful.
Unfavorable weather conditions and lacking technological advancements prevented the
predicted increase in output and food shortages resulted by default.
The British governor’s words did not ring true. Instead, Tanzania fell victim to
Andre Gunder Frank’s “underdevelopment” through the trappings of dependency theory.
Fulfilling the classic model of a “periphery state,” Tanzania’s resources were mercilessly
extracted by the British.52 This parasitic relationship continued as Tanzania lacked the
technological advancements, and therefore comparative advantage, to compete with other
agriculturally based economies.
Besides this cash crop dependency, colonialism also undermined the Tanzanian
economy in many other ways. Firstly, many colonial powers seized, what they claimed to
be “empty lands.” However, these lands were typically very fertile and inhabited by
Tanzanians themselves.53 The displacement of many Tanzanians further prevented their
ability to provide food for themselves and their families.
Additionally, in the quest for more farmable land, diverse forest ecosystems were
rapidly clear-cut.54 This resulted not only in ecological destruction, but also in the loss of
51 Ibid. 52 Apter, David E. Rethinking Development: Modernization, Dependency, and Postmodern Politics. Newbury Park, CA: Sage Publications, 1987. Print. 53 Raschke, Verena, and Bobby Cheema. "Colonisation, the New World Order, and the eradication of traditional food habits in East Africa: historical perspective on the nutrition transition." Public health nutrition 11.07 (2008): 662-674. 54 Ibid.
21
diverse species of plants and animals that were often incorporated into the Tanzanian
diet.55
Without further options for food, local markets were destroyed.56 Any surplus was
gained through cash crops and immediately sold off to colonial powers. Therefore, not
only was food security lost in these colonial transitions, but a social element to the
Tanzanian lifestyle was undermined as well. As I will detail in a proceeding section
concerning food aid in Tanzania, these local markets are still being undercut by foreign
powers today.
In short, British colonial rule in Tanzania directed the economy away from
subsistence agriculture, exposing it to the variable shocks and low prices of the global
market. The introduction of cash crops as a means of extraction, in addition to a
noticeable lack in infrastructure development, left Tanzanians without sufficient access to
food. This, in combination with a multitude of other, more discrete changes (see Figure
2), resulted in increased external dependency and the weakening of the domestic
economy.
Socialism: Ideology versus Implementation
After gaining its independence peacefully from the British, Tanzania welcomed a
period of socialism, led by the charismatic Julius Nyerere, or Mwalimu (teacher).
Nyerere’s leadership brought to life the idea of ujamaa or “villagization” and, in 1963,
the subsequent collectivization of farming. “Villagization” was based on the idea that the
populations of various rural villages would physically converge. This would theoretically
55 Ibid. 56 Ibid.
22
promote a more familial atmosphere and it would also allow a greater ease of access of
goods and services to marginalized populations.
The socialist regime, and ujamaa specifically, was formed in direct opposition to
the extractive nature of colonialism. Without colonial powers encouraging cash crop
production, Tanzanian society returned to a neo-subsistence way of life. Nyerere’s vision
of collectivized farms not only discouraged external reliance, but also encouraged the
return of a self-sufficient food production strategy.57 Both increased production and
improved nutrition levels were the end goals of Nyerere’s food security policy.58
This political, social, and economic restructuring did result in an initial upswing
in food security.59 Rural populations were once again able to rely on themselves without
the constant struggle to integrate into the colonial economy. However, it soon became
clear that the ideological concept of “self-reliance” and ujamaa was proliferated much
more successfully than any sort of direct action.60 Many refused to move away from their
homes and onto collectivized farms located miles away. Nyerere decided not to resort to
forced migration tactics, reinforcing the idea of family, brotherhood, and the Tanzanian
ideal. This strength of character, however, produced weak results. Nyerere was never able
to fully actualize ujamaa and household self-sufficiency was never achieved.
Within the problematic restructuring of socialist Tanzania, we find the issue of
high modernism. As James Scott argues, the “scientific” and “rational” restructuring
57 Lal, Priya. "Self-‐Reliance and the State: The Multiple Meanings of Development in Early Post-‐Colonial Tanzania.” Africa 82.2 (2012): 212-‐34. ProQuest. Web. 58 Omari, C. K. "Politics and Policies of Food Self-‐Sufficiency in Tanzania." Social Science and Medicine 22.7 (1986): 769-‐74.ProQuest. Web. 59 Hodd, Michael. Tanzania after Nyerere. London: Pinter, 1988. Print. 60 Ibid.
23
proposed by elites held no tangible use or local significance to the general population.61
Implementing sweeping changes without thought to intra-national geographic, cultural,
and other social differences, the Tanzanian government’s “villagization” strategy
ultimately failed. Scott explains that scaled-up agriculture; complete with “proper”
villages, tractor-plowed fields, and communal farming was merely a teleological
arrangement rather than a practical national structure. 62 These new villages were
“thin”—lacking historical relevance and local approval.
The failed restructuring of Tanzania resulted in a great, national economic
downturn. Throughout Nyerere’s leadership, and more specifically towards its end,
Tanzania continued to suffer greatly from food insecurity, especially in the remote areas
that state-provided goods and services were unable to reach.63
Post-Nyerere: The Problem with Food Aid
Tanzania pursued increased production through the collectivization of agriculture
during its socialist, self-reliant period. However, just after Nyerere stepped down in 1985,
Tanzania relied more than ever on foreign food sources.64 The early 1980s in Tanzania
were a period of economic despair and poverty. Just after Nyerere’s resignation, the
country quickly reverted to a dependence on foreign economies, reforming a neo-colonial
structure.
61 Scott, James C. Seeing like a State: How Certain Schemes to Improve the Human Condition Have Failed. New Haven: Yale UP, 1998. Print. 62 Ibid, 253. 63 Lal, Priya. "Self-‐Reliance and the State: The Multiple Meanings of Development in Early Post-‐Colonial Tanzania.” Africa 82.2 (2012): 212-‐34. ProQuest. Web. 6 Feb. 2015. 64 Omari, C. K. "Politics and Policies of Food Self-‐Sufficiency in Tanzania." Social Science and Medicine 22.7 (1986): 769-‐74.ProQuest. Web. 8 Feb. 2015.
24
Criticisms of direct food aid have shown that it can undermine local economies.
As an influx of free or heavily subsidized food permeates rural areas, those whose
livelihoods rely on the sale of food are put out of business. This practice is commonly
referred to as dumping. In 2003, the United States exported cotton at an average price of
47% below cost of production and wheat at an average price of 28% below the cost of
production.65 This data exemplifies the continued problem of dumping in the global
marketplace.
Food aid also creates a reliant relationship from recipient to donor. Apart from the
psychological detriment of dependence66, recipients of food aid often become unable to
provide for themselves and their families. In 2009, Tanzania received almost net $3
billion in development assistance and official aid from the United State alone, about 14%
of its GDP.67 This large sum denotes the dependent relationship formed between donor
and recipient country and is cause for comparison with colonial forms of extraction.
This form of neo-colonialism has many of the same effects of its predecessor. As
food production is outsourced, the inherent power within the food system is once again
concentrated within the hands of a small number of large, multinational corporations.68
Along with this repetitive, extractive relationship comes similar issues (see Figure 2).
Transnational corporations, rather than colonial powers, prevent the possibility of self-
65 WTO Agreement on Agriculture: A Decade of Dumping: United States Dumping on Agricultural Markets. Rep. Institute for Agriculture and Trade Policy, Dec. 2005. Web. 66 Montero, Maritza, and Tod S. Sloan. “Understanding behavior in conditions of economic and cultural dependency.” International Journal of Psychology 23.1-‐6 (1988): 597-‐617. 67 Tanzania, Net official development assistance and official aid received (current US$). N.d. Raw data. World Databank, n.p. 68 Raschke, Verena, and Bobby Cheema. "Colonisation, the New World Order, and the eradication of traditional food habits in East Africa: historical perspective on the nutrition transition." Public health nutrition 11.07 (2008): 662-674.
25
sufficiency as they monopolize arable land holdings.69 This land-grabbing forces African
farmers that would typically be producing their own food, to seek employment from these
conglomerates for grotesquely low wages. Rather than contributing to their own
household’s and community’s food security needs, they are instead producing exotic
flowers and fruits for export.70
Along with this increase in exportation comes the replacement of indigenous
crops with imported staples. In the 1980s, decreases in Tanzanian maize led to a spike in
levels of imported rice.71 As this foreign commodity began to replace the domestic staple,
an increasingly dependent relationship with external forces was formed.
69 Ibid. 70 Ibid. 71 Ibid.
Figure 2: Colonial and neocolonial factors related to the eradication of traditional food habits in East Africa.
26
The way in which foreign food aid and food imports have disrupted local
Tanzanian economies is apparent. Neo-colonialist economies have reinvigorated
dependent relationships between “core” and “periphery” states. Not only have they
brought about similar issues to the colonial period, but have also caused upswings in fast
food consumption, socio-economic inequality, and the deterioration of the traditional
Tanzanian family structure.72
Tanzania’s sustained history of food insecurity has produced marked social
reactions. As is clear, those who identify themselves as “resource-scare” tend to have a
preference for larger bodies. In this way, Tanzania’s “enshrinement of obesity” puts it at
risk of the obesity epidemic.
OBESITY IN THE DEVELOPING WORLD: CURRENT INITIATIVES AND FUTURE SOLUTIONS
The threat of obesity is expanding. Initially thought to solely plague developed
countries, the obesity epidemic has now spread to low- and middle-income nations.
Although increasing wealth and Westernization may be the surface level factors
contributing to rising trends in obesity, they are not the sole elements to consider.
The painful history—and present reality—of food insecurity in developing
countries has resulted in a unique culture surrounding food and body image. Both women
and men that inhabit developing countries are socially encouraged to put on weight.
Curvaceous women are seen as the most beautiful and fatter men are seen to hold status
and power. These sociocultural components underscore the drastic increases in weight
now seen in developing countries.
72 Ibid.
27
How are rising nations combatting their newfound “double burden”? And is their
strategy sufficient? An analysis of current obesity-prevention strategies in developing
countries, as well as possible alternatives, is necessary.
Obesity Prevention Strategies: India
Most literature concerning the reduction of obesity and associated NCDs in
developing countries focuses on improving national health care systems73 or supporting
individual-based healthcare interventions.74 While many articles suggest the underlying
or historical presence of food insecurity as a contributing factor to the obesity epidemic in
developing countries,75 few of them speak to it as a solution.
In the case of India, it has been suggested that stakeholders should collaborate to
modify Western campaigns against obesity to be more “ethnically appropriate.” 76
Specifically citing obesity reduction initiatives in Australia, England, Canada, and the
United States, experts suggested that slightly reworking these models to appeal to an
Indian audience would be successful.77
India has taken steps forward concerning its growing prevalence of obesity, while
still grappling with high rate of malnutrition. In 2012, the Department of Health Research
73 Samb, Badara et al. “Prevention and management of chronic disease: a litmus test for health-‐systems strengthening in low-‐income and middle-‐income countries.” The Lancet 376.9754 (2010): 1785-‐1797. Web. 74 Beaglehole, Robert et al. “Priority Actions for the non-‐communicable disease crisis.” The Lancet 377.9775 (2011): 1438-‐1447. Web. 75 Kar, Sitansu Sekhar and Kar, Subhranshu Sekhar. “Prevention of childhood obesity in India: Way forward.” Journal of Natural Science, Biology and Medicine 6.1 (2015): 12-‐17. Web. 76 Ibid. 77 Ibid.
28
(DHR) proposed a comprehensive plan to combat obesity in India.78 This included
specific initiatives to reduce tobacco use, prevent cardiovascular diseases, diabetes, and
cancer. The DHR also stressed the need for research on the effects of dental health and
the general promotion of a “healthy lifestyle.”79
In 2011, the WHO recommended a ban on junk food in Indian schools.80 The
Food Safety and Standards Authority of India has since taken this type of legislation
under consideration.81 Propositions to ban junk food advertisements directed at children
have also been announced and other recommended actions include the “health promotion
campaigns” and better surveillance and data collection concerning obesity.82
Interestingly enough, in 1993, just preceding this push for obesity prevention
legislation, the Government of India adopted a National Nutrition Policy that focused
almost exclusively on the prevention of malnutrition and undernourishment.83 Although
this issue has not yet been resolved, it remains largely absent in recent legislation
concerning food and public health in India.
Anti-NCD policy in India may serve as a jumping off point for other countries. It
is true Tanzania lacks India’s economic strength, and in this way, is not an ideal
comparison. However, India’s, and the rest of the BRICS nations’ “double burden”
should serve as a warning for Tanzania and other sub-Saharan African countries.
78 Khanekwak, S. an Reddy, K. S. “Eliciting a policy response for the rising epidemic of overweight-‐obesity in India” Obesity Reviews 14.S2 (2013) 114-‐125. Web. 79 Ibid. 80 Ibid. 81 Ibid. 82 Ibid. 83 Ibid.
29
Though still classified as “low income,” Tanzania’s estimated GDP growth rate
for 2014 remains at 7%, within the top 25 countries in the world.84 Considering the direct
relationship between wealth and obesity, this data suggests that Tanzania should soon
develop a national response future rising obesity rates.
A Different Approach: Counterintuitive, Yet Historically Grounded
Rather than refitting Western strategies to low- and middle-income countries,
addressing the root of the growing obesity epidemic in these nations may yield more
marketable changes. I propose focusing obesity-prevention initiatives on ensuring food
security for the entire population. While this strategy may seem counterintuitive, leading
a food secure lifestyle is essential to a healthy body.
Food security initiatives in Tanzania, as in the rest of the developing world,
should focus heavily on improving distribution methods, rather than increasing yield. The
history of genetically modified organism (GMO) use in Tanzania is largely negative,85
indicating that a lasting solution to food security involves restructuring global distribution
methods to follow a more equitable model.86 With the 13th fastest growing population in
the world,87 Tanzania requires a comprehensive strategy to ensure food security, rather
than a “quick fix.”
By ensuring this food security in developing countries, one may attack the deep-
seated social structures that enshrine obesity. Tailoring Western strategies to developing
84 Tanzania, GDP growth (annual %). N.d. Raw data. World Databank, n.p. 85 Katunzi, Alphonce, Yakobo Tibamanya, and Donati Senzia. "Status of Agriculture, Food Security and Impact of GMOs-A Country Report for Tanzania." Genetic Engineering and Food Sovereignty: 100. 86 Sen, Amartya. "The Food Problem: Theory and Policy." Third World Quarterly 4.3 (1982): 447-‐59. Web. 87 Tanzania, Population growth (annual %). N.d. Raw data. World Databank, n.p.
30
countries will have limited success without a sort of mindset shift. The ease of access to
healthy and nutritious food will eventually discourage the social factors that associate
larger bodies with the beautiful and powerful. This attempt to shift body image
perspectives, in conjunction with more “traditional” obesity prevention campaigns will
preemptively combat rising obesity rates in Tanzania.
CONCLUSION
A sustained history of food insecurity in Tanzania has created a cultural
“enshrinement of obesity.” This preference for larger bodies is purveyed through
the continued association between obesity and status or beauty in Tanzania.
Although affluence and subsequent access to “modern” amenities is often
pinned as the cause for soaring obesity rates in developing countries, this paper has
proven that the social acceptance, and support, for larger bodies may be another,
underlying factor. By attacking hunger in Tanzania, and thereby discontinuing its
history of food insecurity, the socio-‐cultural support for larger bodies will be
lessened. This strategy, in conjunction with conventional obesity-‐prevention
campaigns, will ensure that Tanzania does not fall victim to the “double burden of
disease.”
Additionally, international NGOs must be prepared to rework their current
strategies to fit the nuanced topic of body image in developing countries. Measuring
a baby’s health solely by his or her weight, or a child’s condition only by his or her
arm circumference, is insufficient and perpetuates a “bigger is better” mentality
concerning the body. Although typically more time-‐ and labor-‐intensive, holistic
31
measurements of health, including those that indicate risk factors for NCDs, should
be incorporated into routine examinations by healthcare NGOs.
Overall, further research must be done concerning the influence of the aid
community on local preferences for larger bodies. Although food security initiatives
are part of the solution to the “double burden of disease,” healthcare NGOs must also
integrate education on the specific structure of a “healthy” body.
In short, the relationship between food insecurity and the risk of obesity in
developing countries is complex, but significant. Moving forward, healthcare NGOs
must become increasingly self-‐critical and aware of the potentially harmful effects
they may have on local perceptions of the body.
32
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