Food as a Gift: Chronic Disease and Culture

“Take more! You have eaten too little!”

Is perhaps the mantra of gracious Indian hosts. In many families, it is considered an act of generosity and the duty of a host to insist that their guests continue to eat, no matter how much has already been consumed. While I always appreciate the hospitality, I can’t help but feel a little unnerved when I get goaded to overstuff myself. As someone who has struggled with my weight for the majority of my life, I resent being pressured to act in a way that harms my health.

In a paper on diabetes among Emeratis in Dubai, Rosslyn Badar  wrote about how the culture of food as a gift is contributing to a rise of chronic disease in Dubai. Giving guests large amounts of food when they visit is considered expected, and the greater quantity and richness of the food, the better the host. As Dubai’s economy has boomed and processed foods have become increasingly accessible, this food culture has contributed to the growth of diabetes and chronic disease. The food culture also makes it difficult for those with the disease to maintain a healthy diet.

Indian meal

This culture exists, not because hosts want to make sure their guests get fat, but because it developed in a time of food scarcity. In the past, the quantity of food available was generally smaller and of higher nutritional quality. People also did plenty of physical labor, and were in need of large quantities of food.  Getting your guests to eat more food really was a gift that contributed positively to their health.

Now, there is a mismatch between environment and culture. I am fortunate that I get to control my own food intake on most days, but there are people who face such cultural expectations around eating food from their families everyday. In this environment, it is easy to lose a sense of what foods are healthy and of how much food is enough. It’s no wonder that obesity and chronic disease are rapidly growing in India and in the Middle East.

I have also noticed that sometimes the idea of eating for health, especially for young people without a chronic disease, simply does not exist among many of the older generation.

Last week at a meeting, my host served me some very sugary mango juice. I took a small amount to be polite, but the host insisted “Drink more! drink more!” I thanked him for offering but told him that the juice had too much sugar for me. He then said “Oh, I should have brought Pepsi.” I realized in his mind, he conflated sugar with sweetness, which was not what I meant. The idea of not drinking something because of its sugar content seemed foreign to him.

Another time, at a conference chai break, I saw “sugar free chai” and I went for it, given that I had already had a few servings of sugary chai that day. The older man who preceded me in line stopped me and said “No, this is sugar free chai” and I replied “Yes, I know.” He gave me a strange look and baffledly asked “You like drinking this?”

Last week, the maid at our apartment saw my leftover oatmeal, made without milk and sugar and got angry with me. “This is not good!” she said, “Do not eat it like this!” I tried to explain that I liked it that way, but she took my oats and made a sugary soupy concoction. “This is much better,” she said. I admit it was tasty, but I had trouble explaining that for me, “good” means healthy not tasty.

It seems to me that in many older Indian adults’ minds, it makes no sense to control one’s diet when young and healthy. Controlling one’s diet is something one does after being diagnosed with a chronic disease like diabetes or hypertension. Few realize that preventing a disease is much easier than managing or treating it. I have a family history of diabetes, so I know I am at high risk. I know that the best I can do is to develop a healthy lifestyle now, rather than later.

I realize I am also viewing these issues with my own cultural biases. Anthropologists have written about how many communities in the United States view being fit or thin as a cultural measure of one’s value as a person. People who appear more fit gain more respect and admiration in our culture. In a sort of social ritual, women especially, often discuss what they eat and how much they exercise to boost their image. Refusal to eat unhealthy food is highly admired, and eating excessive quantities of unhealthy food is shamed (especially for people who appear overweight or obese).

Ironically, our culture does not necessarily lead to better health. It can contribute to fat shame: feelings of inadequacy and hopelessness among people who struggle with controlling their weight. That sense of shame can make it even harder to change one’s habits. The American culture around food can also lead to obsessions about food and weight that result in eating disorders.

Worldwide, we need to find a way to think about food and our relationship to it in a healthy way: a way that celebrates food for the life it gives us, but ensures we eat it in a way that sustains us.

What do you think an optimal food culture would look like?