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Chronic diseases have rapidly become the leading global cause of morbidity and mortality, yet there is poor understanding of this transition, or why particular social and ethnic groups are especially susceptible. In The Metabolic Ghetto, Wells adopts a multidisciplinary approach to human nutrition, emphasising how power relations shape the physiological pathways to obesity, diabetes, hypertension and cardiovascular disease. Part I reviews the physiological basis of chronic diseases, presenting a 'capacity-load' model that integrates the nutritional contributions of developmental experience and adult lifestyle. Part II presents an evolutionary perspective on the sensitivity of human metabolism to ecological stresses, highlighting how social hierarchy impacts metabolism on an intergenerational timescale. Part III reviews how nutrition has changed over time, as societies evolved and coalesced towards a single global economic system. Part IV integrates these physiological, evolutionary and politico-economic perspectives in a unifying framework, to deepen our understanding of the societal basis of metabolic ill-health.
Part I. The Physiology of Chronic Disease:
2. Models of chronic disease
3. Links between nutrition and health
4. The developmental origins of disease
5. Life-course models of chronic disease aetiology
6. Applying the capacity-load model
Part II. An Evolutionary Perspective on Human Metabolism:
7. Life history strategy
8. Ancestral environments
9. The evolution of human adaptability
10. Sensitivity in early life
11. The evolutionary biology of inequality
12. The metabolic ghetto
Part III. A Historical Perspective on Human Nutrition:
13. The emergence of agriculture
14. Trade, capitalism and imperialism
15. Hierarchy and metabolic capacity
16. The emergence of consumerism
17. Enforcing obedience
18. The dual burden of malnutrition
Part IV. Power, Nutrition and Society:
19. A series of games
20. A question of agency
Jonathan Wells is Professor of Anthropology and Paediatric Nutrition at the Institute of Child Health, University College London, and a leading international researcher in the field of paediatric nutrition. His empirical research focuses on human growth, body composition and metabolism, and is complemented by the development of evolutionary perspectives on these topics. He has contributed extensively to the scientific literature and is the author of The Evolutionary Biology of Human Body Fatness: Thrift and Control (Cambridge, 2010).
"Is it really possible to bring together philosophy, economics, history, evolutionary biology, epidemiology, nutrition and metabolism to understand obesity and chronic disease? Jonathan Wells has done it in an immensely readable and insightful way. A wonderful book."
– Michael Marmot, University College London
"No other book before has provided such a sophisticated and eloquent argument integrating knowledge about foetal and childhood environment and nutrition, with impacts of social, economic and historical factors. Jonathan Wells persuasively argues that a broad scope and an evolutionary framework are necessary to build our understanding of chronic and globally important diseases. Consequently, [he] succeeds in achieving a true consilience of very disparate perspectives on our health."
– Grazyna Jasienska, Jagiellonian University, Poland