Publications

Books

SturtzSreetharan, Cindi, Alexandra Brewis, Jessica Hardin, Sarah Trainer and Amber Wutich. 2021. Fat in Four Cultures: A Global Ethnography of Weight in Samoa, Paraguay, Japan and the US. “Teaching Culture” series. Toronto, CA: University of Toronto Press.

Traits that signal belonging dictate our daily routines, including how we eat, move, and connect to others. In recent years, "fat" has emerged as a shared anchor in defining who belongs and is valued versus who does not and is not. The stigma surrounding weight transcends many social, cultural, political, and economic divides. The concern over body image shapes not only how we see ourselves, but also how we talk, interact, and fit into our social networks, communities, and broader society.

Fat in Four Cultures is a co-authored comparative ethnography that reveals the shared struggles and local distinctions of how people across the globe are coping with a bombardment of anti-fat messages. Highlighting important differences in how people experience "being fat," the cases in this book are based on fieldwork by five anthropologists working together simultaneously in four different sites across the globe: Japan, the United States, Paraguay, and Samoa.

Through these cases, Fat in Four Cultures considers what insights can be gained through systematic, cross-cultural comparison. Written in an eye-opening and narrative-driven style, with clearly defined and consistently used key terms, this book effectively explores a series of fundamental questions about the present and future of fat and obesity.

Faith and the Pursuit of Health: Cardiometabolic Disorders in Samoa. 2019. In the Medical Anthropology series, Health, Inequality, and Social Justice. New Brunswick, NJ: Rutgers University Press.

Faith and the Pursuit of Health explores how Pentecostal Christians manage chronic illness in ways that sheds light on health disparities and social suffering in Samoa, a place where rates of obesity and related cardiometabolic disorders have reached population-wide levels. Pentecostals grapple with how to maintain the health of their congregants in an environment that fosters cardiometabolic disorders. They find ways to manage these forms of sickness and inequality through their churches and the friendships developed within these institutions. Examining how Pentecostal Christianity provides many Samoans with tools to manage day-to-day issues around health and sickness, Jessica Hardin argues for understanding the synergies between how Christianity and biomedicine practice chronicity.

Edited Collections

Reconstructing Obesity: The Meaning of Measures and the Measure of Meanings. Edited by Megan McCullough and Jessica Hardin. Berghahn Books, 2013.

In the crowded and busy arena of obesity and fat studies, there is a lack of attention to the lived experiences of people, how and why they eat what they do, and how people in cross-cultural settings understand risk, health, and bodies. This volume addresses the lacuna by drawing on ethnographic methods and analytical emic explorations in order to consider the impact of cultural difference, embodiment, and local knowledge on understanding obesity. It is through this reconstruction of how obesity and fatness are studied and understood that a new discussion will be introduced and a new set of analytical explorations about obesity research and the effectiveness of obesity interventions will be established.

Hillary Kaell & Jessica Hardin. "Ritual Risk and Emergent Efficacy: Ethnographic Studies in Christian Ritual." 2016. Journal of Contemporary Religion 31 (3): 323-334.

Ritual is a domain of analysis shared across Christian confessions and continents. Yet in anthropological work on Christianity, studies of ritual have thus far remained piecemeal and disjointed, unwittingly perpetuating distinctions between north and south, ‘secular’ and ‘religious’ publics, Pentecostals and ‘the rest’. This introductory essay charts the analytic potential of developing a robust cross- cultural analysis of ritual from the perspective of anthropologists of Christianity. We employ ritual risk and e cacy to expand the ongoing study of the practice of Christian sociality, which we explore through three themes. Firstly, this collection is united by a shared interest in ritual ine cacy—the ‘infelicitous’ moments when ritual go awry— and the societal and metaphysical risks that may result. Secondly, the collection examines the social ‘work’ of ritual in de ning and authorizing particular forms of Christianity. Finally, the essays explore the ways Christian futures are imagined and created through ritual.

Refereed Journal Articles

Hardin, Jessica. “Life before Vegetables: Nutrition, Cash and Subjunctive Health in Samoa.” Cultural Anthropology 36(3): 428–457.

Since the 1950s, Samoa has faced rapid changes in food systems and labor practices, creating an environment in which health conditions such as diabetes touch every individual. Through an ethnographic analysis of Samoan people’s attitudes toward the novel food category of vegetables, this article explores how intersecting health promotion and development discourses instrumentalize vegetables as a source of both health and sickness, and as signs of poverty or wealth. This dual instrumentalization simultaneously positions vegetables as objects of trade that may generate wealth for farmers and as objects of health that may accrue nutrition to combat chronic sickness. I introduce the notion of subjunctive health to analyze people’s preoccupation with vegetables, even when these are rarely eaten. In Samoa, subjunctive health frames the consumption of vegetables in several ways: as if vegetables were both plentiful and essential to a proper meal, as if people were not healthy before imported vegetables were introduced, as if it were possible to sustain one’s family through gardening alone. The subjunctive highlights how health is constructed as aspirational, relying on an as if logic that entangles economic and nutritional conditions. It operates through the daily acts of nourishing one’s family to erase from view those biocolonial processes that generated an environment in which chronic diseases flourish.

Wutich, Amber, Cindi SturtzSreetharan, Sarah Trainer, Jessica Hardin, Alex Brewis. “Metatheme analysis: A qualitative approach to comparative and multi-sited research.” International Journal of Social Research Methods 20: 1-11.

In recent years, there has been a florescence of cross-cultural research using ethnographic and qualitative data. This cutting-edge work confronts a range of significant methodological challenges, but has not yet addressed how thematic analysis can be modified for use in cross-cultural ethnography. Thematic analysis is widely used in qualitative and mixed-methods research, yet is not currently well-adapted to cross-cultural ethnographic designs. We build on existing thematic analysis techniques to discuss a method to inductively identify metathemes (defined here as themes that occur across cultures). Identifying metathemes in cross-cultural research is important because metathemes enable researchers to use systematic comparisons to identify significant patterns in cross-cultural datasets and to describe those patterns in rich, contextually-specific ways. We demonstrate this method with data from a collaborative cross-cultural ethnographic research project (exploring weight-related stigma) that used the same sampling frame, interview protocol, and analytic process in four cross-cultural research sites in Samoa, Paraguay, Japan, and the United States. Detecting metathemes that transcend data collected in different languages, cultures, and sites, we discuss the benefits and challenges of qualitative metatheme analysis.

“Ceaseless Healing and Never-Natural Disaster.” Vital Topics Forum: “Chronic Disaster Reimagining Noncommunicable Disease.” American Anthropologist 122(3): 650-651.

Trainer, Sarah, Jessica Hardin, Cindi SturtzSreetharan, Alex Brewis. “Worry-nostalgia: Anxieties around the fading of local cuisines and foodways.” Gastronomica 20(2): 67-78.

Worry-nostalgia is a particular iteration of felt anxiety that certain material things and ways of being in the world are slipping away. We suggest that this particular shade of place-based nostalgia, expressed through stress, anxiety, and worry, comes from broader concerns about individual and community health, weight, and well-being, as well as from longing for the relations that made certain foods seem naturally embedded in a particular community and rooted in a specific landscape. We consider and compare three very different ethnographic contexts—suburban parts of Osaka, Japan; peri-urban Atlanta, Georgia, in the United States; and the peri-urban areas around the capital city of Apia, Samoa—to explore the intersection of memory and distress around what people eat and what they think they should eat, in the context of local cuisines that are believed to be fading. This parallel analysis of narratives reveals commonalities in how sense of loss is characterized, highlighting a shared experience of worry-nostalgia generated from the shifting wider global foodscape.

“Elemental Eating: Samoan Public Health and Valuation.” The Contemporary Pacific 31(2): 381-415, with Christina Ting Kwauk.

In this article, we suggest that indigenous foods are valorized and expanded through their
re-signification as nutritious as they are presented in Samoan health promotion campaigns. These campaigns elucidate how public health selectively valorizes culture, while expanding the category to include non-indigenous fruits and vegetables, and in turn reshapes meanings associated with indigenous foods as related to health. We first presented material that demonstrates the impact of health promotion materials on food knowledge. We highlight how nutrition as a value dominates official accounts and then explore health promotion media that encouraged viewers to deconstruct food into constitutive parts, particularly negative nutrients like fat and salt. We call this elemental eating, which mutes the distinction between imported, new foods and indigenous, local foods by foregrounding components. Finally, we examine a media campaign that presents the new food category, mea’ai paleni, as a hybrid of indigenous and local foods. Health promotion in this context revalued indigenous foods, and expanded
the category, by promoting a scientistic framework for interpreting nutrition. This interpretive framework reorganizes food categories from strictly new, imported foods and local,
indigenous foods, to healthy and unhealthy foods, both reflecting epidemic discourses in local media and scholarship while also complicating the typical epidemiological representation of the “nutrition transition.”

“On the Limitations of Barriers: Social Visibility, Fear of Consequences and Weight Management in Cuba and Samoa.” Social Science & Medicine (239), with Hanna Garth.

Obesity is an enduring global health challenge. Researchers have struggled to understand the barriers and facilitators of weight loss. Using a cross-cultural comparative approach, we move away from a barriers approach to analyze obesity and overweight through the lens of social visibility to understand the persistent failure of most obesity interventions. Drawing on ethnographic data from Cuba and Samoa collected between 2010 and 2017, we argue that social visibility is a framework for analyzing some of the reasons why people do not participate in weight management programs when they have high rates of health literacy and access to free or low-cost programming. Comparing these two places with very different histories of obesity interventions, we trace how weight management practices make people socially visible (in positive and negative ways), specifically analyzing how gender and economic inequalities shape the sociality of obesity. Our findings show that regardless of barriers and facilitators of weight loss at an individual and population level, the ways weight loss activities are incorporated into or conflict with the social dynamics of everyday life can have a profound effect on weight management. Employing visibility as a analytic framework de-individualizes weight responsibility, providing a contextual way to understand the difficulties people face when they manage their weight.

“Father released me”: Accelerating care, temporal repair, and ritualized friendship among Pentecostal women in Samoa. American Ethnologist 46(2): 150-161.

In Samoan Pentecostal churches, ritualized friendships among women are an informal but essential relationship through which churches grow. The mentorship that women provide when a new convert is introduced to church life creates escalating forms of care and obligation, as well as an experience of urgency and acceleration. Converts learn how to construct rupture in their narratives and spiritual practices, which are modeled in peer socialization practices. This period of intense yet temporary mentorship creates a temporality of “repair”—embodied, linguistic, and social practices that restore the convert's identity, which has been disrupted by conversion. This care work compels us to consider the temporalization of care as a future‐making endeavor.

“’It’s almost like paying for praying’: Giving Critiques and the Discursive Management of Denominational Difference.” Anthropological Quarterly 92(4): 1099-1122. Special issue: “Institutions, Infrastructures, and Religious Sociality,” edited Courtney Handman and Minna Opas.

Based on fourteen months of fieldwork, this article explores how in Samoa, Christians from diverse denominational backgrounds regularly talk about and critique church giving practices ranging from weekly announcements of offerings to tithing. By comparing Pentecostal and mainstream Christian giving practices, this article shows how Pentecostals discursively created denominational difference through valuation-- the comparative process of differentiating between ways of giving. Pentecostals cultivated moral awareness through giving critiques, which demonstrates the ways that denominational comparison is religious practice. By looking at the metapragmatics of giving, that is how accounts of giving are used in everyday life, discussions of giving become a primary means to evaluate the moral qualities of persons and communities. This article thus shows how critiques of giving collapse the distinction between "religious" and "economic" spheres showing that they are often co-constitutive.

"Body size, body norms and some unintended consequences of obesity intervention in the Pacific islands." Annals of Human Biology. 2018. 45(3): 285-294. Special Issue: “Human Biology in the Pacific, “ edited by Nicola Hawley and Stephen McGarvey. (Co-Authored with Amy McLennan and Alexandra Brewis.)

Background: Pacific Islanders have experienced over 50 years of obesity interventions—the longest of any region in the world. Yet, obesity-related non-communicable diseases (NCDs) continue to rise.‘Traditional’ body norms have been cited as barriers to these interventions.

Aim: In this study, we ask: ‘What is the relationship between health interventions, body norms and people’s experience of “fatness”? How – and why – have these changed over time?’ We study two nations with high rates of obesity: Nauru and Samoa.

Subjects and methods: Ethnographic fieldwork with people in everyday and clinical settings in Samoa (2011–2012; 2017) and Nauru (2010–2011).
Results: Body norms are not a single or universal set of values. Instead, multiple cultural influences—including global health, local community members and global media—interact to create a complex landscape of contradictory body norms.

Conclusions: Body norms and body size interventions exist in an iterative relationship. Our findings suggest that Pacific island obesity interventions do not fail because they conflict with local body norms; rather, they fail because they powerfully re-shape body norms in ways that confuse and coun- teract their intended purpose. Left unacknowledged, this appears to have (unintended) consequences for the success of anti-obesity interventions.

"Embedded Narratives: Metabolic Disorders and Pentecostal Conversion in Samoa." 2018. Medical Anthropology Quarterly 32(1): 22-41.

Drawing from interviews and participant observation, this article explores the intersection of diagnosis of metabolic disorders and religious conversion among Pentecostal Christians in Samoa by analyzing what I call embedded narratives––conversion narratives embedded in illness narratives. Drawing from ethnographic data, I examine how using conversion narrative conventions enabled those living with metabolic disorders to narrate behavior change in a culturally and socially valorized way. By embedding their narratives, I suggest those living with metabolic disorders shifted the object of care from a disease process toward the creation of a religious life and in turn transformed the risks associated with metabolic disorders, including diet, exercise, and pharmaceutical use into moral risks associated with everyday religious life. In these cases, Pentecostal conversion created possible scripts for changing health practices, managing stress, and shifting resource use in the name of religious commitment, providing insights into how self-care can be an expression of religious practice. [metabolic disorders, Christianity, narrative, conversion, self-care]

"Challenging Authority, Averting Risk, Creating Futures: Intersectionality in Interpreting Christian Ritual in Samoa." 2016. Journal of Contemporary Religion 31(3): 379-391.

This article explores how prayer group leaders manage and interpret risk-in-ritual during a home-based Pentecostal intercession. The group was formed in an office setting and led by three female managers. They interceded together during their lunch hour for over a year. The intercession was the one time the prayer group moved from the office to the home of one of the female leaders. This transition sparked a number of problems associated with group unity, which indicated risks-in-ritual. Managing risk was focused on managing forms of social difference such as age, gender, rank, and denomination. I draw from the feminist theory of intersectionality to argue that in the process of translating social differences of gender, age, rank, and denomination into spiritual differences in ritual, future ritual agendas are created. This future-creating capacity of ritual reinforced the authority of those who adjudicated and interpreted those risks-in-ritual. My example is taken from 14 months of ethnographic fieldwork in Samoa between 2011 and 2012.

“'Healing is a Done Deal': Temporality and Metabolic Healing Among Evangelical Christians in Samoa." 2016. Medical Anthropology 35(2): 105-118.

Drawing on fieldwork in independent Samoa, in this article, I analyze the temporal dimensions of evangelical Christian healing of metabolic disorders. I explore how those suffering with metabolic disorders draw from multiple time-based notions of healing in order to draw attention to the limits of biomedicine contrasting this to the effectiveness of Divine healing. Specifically, by simultaneously engaging evangelical and biomedical temporalities, I argue evangelicals create wellness despite sickness and, in turn, re-signify chronic suffering as a long-term process of Christian healing. Positioning biomedical temporality and evangelical temporality as parallel yet distinctive ways of practicing healing, therefore, influences health care choices.

“Producing Markets, Producing People: Local Food, Financial Prosperity, and Health in Samoa." 2015. Food, Culture, and Society 18(3): 519-539.

In the context of rising rates of metabolic disorders and global attention to the “obesity epidemic” in Oceania, public health in Samoa tends to focus on multi-sectoral efforts to increase vegetable consumption and production. To understand better what non-health officials thought about food environments and health, we sought out a group of food actors (food trade and agricultural entrepreneurs, distributors, producers and food policy practitioners) who were actively creating a “healthier” food environment in Samoa. They posited that the market was both the problem and the solution to the “obesity epidemic.” These food actors positioned themselves as social entrepreneurs, or more aptly as altruistic capitalists, who aimed to transform the food environment by fixing the market, a practice that would in turn produce healthier and more prosperous Samoans. We argue that while alternative food movements in the global north tend to link local production with local consumption, Samoan food actors have focused on local production as a way to provide Samoans with financial prosperity, which in turn will provide opportunities for healthier consumption. This article is based on qualitative interviews with food actors and an ethnography of food, public health and development in Samoa.

“Christianity, Fat Talk, and Samoan Pastors: Rethinking the Fat-Positive-Fat-Stigma Framework.” 2015. Fat Studies: An Interdisciplinary Journal of Body Weight and Society 4(2): 178-196.

Anthropology, public health, and epidemiology have long researched meanings of body size and factors that contribute to epi- demiological transition. The author draws attention to a dichoto- mous framework operating with these fields where fat-positive and fat-negative cultures are represented as oppositional. Drawing from fieldwork among Samoan evangelical Christians, the author argues that contextual analysis of fat reveals ambiguity and ambivalence. In Samoa, negative and positive meanings associ- ated with fat are dynamically engaged. In conclusion, she argues that representing fat in dichotomous terms is Othering because “the West” is represented as the fat-negative while “the rest” is represented as fat-positive.

"Everyday Translation: Health Practitioners’ Perspectives on Obesity and Metabolic Disorders in Samoa." 2015. Critical Public Health 25(2): 125-138.

Research in Samoa and the diaspora has documented the nutrition transition and related rising metabolic disorders. Research suggests cultural influences, including large body size preference, sedentarism, and dietary patterns, as well as political and economic influences, including changed labor patterns and food dependence, contribute to rising metabolic disorders. This article documents how Samoan health practitioners understand barriers to lifestyle change as primarily cultural rather than structural. They highlight differences between health, framed as individually oriented, and well-being, framed as socially oriented. Drawing from participant observation and semi-structured interviews, this article shows how health practitioners engage in ‘everyday translation’ by aiming to change the meaning of food, body, and wealth. Attention to everyday translation provides insights into the ambivalent ways interviewees identify culture as a barrier to health care. They avoid blaming patients, which has the paradoxical effect of suspending blame on individuals for not changing health behavior until cultural change occurs. This requires local leadership to effect community-wide change. When culture is recognized as the primary barrier to lifestyle change, health practitioners inadvertently reproduce structural inequalities in their daily interactions with patients. This has the effect of obscuring structural influences and promoting the idea that metabolic disorders are under individual control.

"Electronic Decision Supports for Obesity Prevention." 2012. Clinical Pediatrics 51 (5): 490-497. (Co-authored with Eileen Dryden, Julia McDonald, Elise Taveras and Karen Hacker.)

Despite the availability of national evidenced-based guidelines related to pediatric obesity screening and prevention, multiple studies have shown that primary care physicians find it difficult to adhere to them or are unfamiliar with them altogether. This article presents physicians’ perspectives on the use of electronic decision support tools, an alert and Smart Set, to accelerate the adoption of obesity-related recommendations into their practice.The authors interviewed providers using a test encounter walk-through technique that revealed a number of barriers to using electronic decision supports for obesity care in primary care settings. Providers’ suggestions for improving their use of obesity-related decision supports are presented. Careful consideration must be given to both the development of electronic decision support tools and a multilayered educational outreach strategy if providers are going to be persuaded to use such supports to help them implement pediatric obesity prevention and management best practices.