Instructing / improvising health: neoliberalism and prediabetes prevention on a US college campus

ABSTRACT

Global rates of type 2 diabetes have doubled since 1980. From a biomedical perspective, the most effective ways to manage type 2 diabetes is through prevention and behaviour change among ‘at risk’ populations. In the United States, public institutions, such as universities, have increasingly become involved in America's ‘war on fat’. This ethnographic study of a campus-based diabetes-prevention programme tracks the links between neoliberalism and instructions for ‘health’. It outlines the production of a ‘prediabetic’ population and changing notions of what constitute health risks. It describes how students come to interpret their bodies with respect to its capacity to be (re)productive. The paper argues that new conditions for higher education exhaust students in ways that ironically jeopardise their ability to be ‘productive’. Health programming works to hold individual bodies accountable for the structural demands of contemporary overwork and exhaustion.

Acknowledgements

This article is in honour of Bonnie Urciuoli who taught me that we can derive political and theoretical insights without going far from home. She is a model for making the field of linguistic anthropology make a difference. I am grateful for her generous mentorship and support over the years. Next, I want to extend my deepest gratitude to the young women who spoke with me so candidly about their ambitions to be well. I would also like to thank the programme coaches and faculty. Without their generosity and openness to expanding what wellness is, I would not have been able to do this work. This project grew out of the research interests of honour's student Mia Fasanella. She scheduled interviews, conducted observations and was a wonderful interlocutor as we analysed the material. Her commitment to diabetes as a social justice issue is an inspiration. Support to venture towards this new line of enquiry came from K. Anne Amienne. David Knapp and Kori Allan provided essential comments on earlier versions of the manuscript. Chaise LaDousa and Ilana Gershon provided encouraging editorial comments. The anonymous reviewers helped to sharpen my purpose.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Lindsay A. Bell is an assistant professor of anthropology at the University of Western Ontario, Canada. Her scholarship explores intersections between language, political economy, aspiration, and embodied social inequality. Her primary research has focused on large-scale resource extraction in the arctic. She is a co-author of Sustaining the Nation: The Making and Moving of Language and Nation (Oxford UP, 2015) and is editor of the Journal for the Anthropology of North America (Wiley-Blackwell).

ORCID

Lindsay A. Bell http://orcid.org/0000-0001-5750-3838

Notes

1 This stands in contrast to Gremillion’s (2003) study of an in-patient treatment programme for young women with eating disorders. Strategies like the meticulous measurement of patients’ progress in terms of body weight and calories consumed ultimately fed the problem of anorexia. This evidence becomes particularly relevant when a self-described anorexic signs up for Hop into Health as will be elaborated later in this paper.

2 The contradiction here is that the programme needs quantifiable data to show its success. Weight proves easy in this regard. And yet, there is a desire to think of health holistically and not exclusively in terms of weight.

3 The research assistant, Mia, was a fourth year anthropology major and the lead yoga instructor on campus. She is a type 1 diabetic with an interest in the cultural aspects of diabetes and its treatment. She was better able to attend the weekly meetings than I was, however we did all of the interviews together with her sometimes helping to prompt from the student's perspective.

4 Helene's experience is part of a larger transformation wherein would be workers understand themselves as businesses, rather than labour/property to rent to the employer (Gershon 2011, 2017). The coaches’ participation is also part of a larger trend that normalises unpaid work through internships (Perlin 2012).

5 The campus dietician ensures that ‘healthy’ items are available. Largely this is a salad bar. As a faculty member, I lived on campus as a resident mentor and ate in the cafeteria for a year. I gained twelve pounds. The ‘healthy’ options are often unappealing and are not chosen by students. This then reduces the likelihood that they are offered again. Instead, the students mainly eat from a pasta bar or have fast food style items like chicken burgers and French fries. At private American universities, generally the food is higher quality and diverse.

6 This is a pseudonym.

7 The program was modified from something similar delivered in local area public elementary schools.

8 We elected not to interview the male participant, although his meetings were observed. He was a student athlete attempting to gain weight for performance reasons.

9 Ellipses in transcriptions mean that sections of the text have been removed for clarity and do not indicate a pause in speech.

10 Griffin (2012: 380) writes, ‘The modern practice of food journaling – recording caloric food intake to monitor body size and weight – can be seen as one instantiation of this posthuman amalgam. Humans and computers are increasingly bound together, and this is evident as computer applications are introduced into our eating practices’.

11 I am grateful to an anonymous reviewer for this insight and framing.

12 Again, I am grateful to an anonymous reviewer for this insight and framing.