1932

Abstract

Contesting ideas about what is “normal” human behavior or biology is a core contribution of anthropology. In efforts to provide more inclusive views of what it means to be human, anthropologists challenge judgments about diverse ways of being, which include assumptions about what it means to be normal. Meanings of the term normal encompass the descriptive (statistical) and the evaluative (normative), i.e., judgments about a given characteristic. In biomedicine, “healthy” is often the value ascribed to normal, but embedded in healthy are biases that derive from particular cultural and historical contexts. Here I review how the term normal is understood and used in anthropological and related studies of human biology and biological variation. I propose the biological normalcy framework for understanding how the statistical and normative meanings of normal mutually inform each other and their consequences for human population biology. Several examples provide illustrations of the framework.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-anthro-052721-090632
2023-10-23
2024-06-13
Loading full text...

Full text loading...

/deliver/fulltext/anthro/52/1/annurev-anthro-052721-090632.html?itemId=/content/journals/10.1146/annurev-anthro-052721-090632&mimeType=html&fmt=ahah

Literature Cited

  1. Allport GW. 1954. The Nature of Prejudice Reading, MA: Addison-Wesley
    [Google Scholar]
  2. Amato KR, Mallott EK, McDonald D, Dominy NJ, Goldberg T et al. 2019. Convergence of human and Old World monkey gut microbiomes demonstrates the importance of human ecology over phylogeny. Genome Biol. 20:201
    [Google Scholar]
  3. Arnegard ME, Whitten LA, Hunter C, Clayton JA. 2020. Sex as a biological variable: a 5-year progress report and call to action. J. Womens Health 29:858–64
    [Google Scholar]
  4. Bayless TM, Rosensweig NS. 1967. Incidence and implications of lactase deficiency and milk intolerance in white and Negro populations. Johns Hopkins Med. J. 121:54–64
    [Google Scholar]
  5. Bernard MA, Clayton JA, Lauer MS. 2018. Inclusion across the lifespan: NIH policy for clinical research. JAMA 320:1535–36
    [Google Scholar]
  6. Bixby H, Bentham J, Zhou B, Di Cesare M, Paciorek CJ et al. 2019. Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature 569:260–64
    [Google Scholar]
  7. Blackburn H, Jacobs D Jr. 2014. Commentary: Origins and evolution of body mass index (BMI): continuing saga. Int. J. Epidemiol. 43:665–69
    [Google Scholar]
  8. Blaut JM. 1993. The Colonizer's Model of the World: Geographical Diffusionism and Eurocentric History New York: Guilford Press
    [Google Scholar]
  9. Bonner JT. 1965. Size and Cycle: An Essay on the Structure of Biology Princeton, NJ: Princeton Univ. Press
    [Google Scholar]
  10. Brewis A, SturtzSreetharan C, Wutich A. 2018. Obesity stigma as a globalizing health challenge. Global Health 14:20
    [Google Scholar]
  11. Brewis AA. 2014. Stigma and the perpetuation of obesity. Soc. Sci. Med. 118:152–58
    [Google Scholar]
  12. Brewis AA, Wutich A, Falletta-Cowden A, Rodriguez-Soto I. 2011. Body norms and fat stigma in global perspective. Curr. Anthropol. 52:269–76
    [Google Scholar]
  13. Carpenter KJ. 2003. A short history of nutritional science: part 2 (1885–1912). J. Nutr. 133:975–84
    [Google Scholar]
  14. Chrzan J, Cargill K. 2022. Anxious Eaters: Why We Fall for Fad Diets New York: Columbia Univ. Press
    [Google Scholar]
  15. Chung A, Rimal RN. 2016. Social norms: a review. Rev. Commun. Res. 4:1–28
    [Google Scholar]
  16. Colantonio DA, Kyriakopoulou L, Chan MK, Daly CH, Brinc D et al. 2012. Closing the gaps in pediatric laboratory reference intervals: a CALIPER database of 40 biochemical markers in a healthy and multiethnic population of children. Clin. Chem. 58:854–68
    [Google Scholar]
  17. Coren S, Halpern DF. 1991. Left-handedness: a marker for decreased survival fitness. Psychol. Bull. 109:90–106
    [Google Scholar]
  18. Cullin JM. 2021. Implicit and explicit fat bias among adolescents from two US populations varying by obesity prevalence. Pediatr. Obes. 16:e12747
    [Google Scholar]
  19. Cullin JM. 2023. Biological normalcy and body fat: obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults. Am. J. Biol. Anthropol. 181:575–87
    [Google Scholar]
  20. Daly M, Sutin AR, Robinson E 2019. Perceived weight discrimination mediates the prospective association between obesity and physiological dysregulation: evidence from a population-based cohort. Psychol. Sci. 30:1030–39
    [Google Scholar]
  21. de Onis M, Garza C, Onyango AW, Borghi E. 2007a. Comparison of the WHO child growth standards and the CDC 2000 growth charts. J. Nutr. 137:144–48
    [Google Scholar]
  22. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. 2007b. Development of a WHO growth reference for school-aged children and adolescents. Bull. World Health Organ. 85:660–67
    [Google Scholar]
  23. Di Angelantonio E, Bhupathiraju SN, Wormser D, Gao P, Kaptoge S et al. 2016. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 388:776–86
    [Google Scholar]
  24. Dressler WW 2018. Cultural consonance. Textbook of Cultural Psychiatry DB Bhugra, K Bhui 179–90. Cambridge, UK: Cambridge Univ. Press
    [Google Scholar]
  25. Dressler WW, Balieiro MC, dos Santos JE. 2017. What you know, what you do, and how you feel: cultural competence, cultural consonance, and psychological distress. Front. Psychol. 8:2355
    [Google Scholar]
  26. Dressler WW, Balieiro MC, Ribeiro RP, Dos Santos JE 2005. Cultural consonance and arterial blood pressure in urban Brazil. Soc. Sci. Med. 61:527–40
    [Google Scholar]
  27. Eaton SB, Eaton SB III, Konner MJ, Shostak M 1996. An evolutionary perspective enhances understanding of human nutritional requirements. J. Nutr. 126:1732–40
    [Google Scholar]
  28. Eveleth PB, Tanner JM. 1990. Worldwide Variation in Human Growth Cambridge, UK: Cambridge Univ. Press
    [Google Scholar]
  29. Evershed RP, Davey Smith G, Roffet-Salque M, Timpson A, Diekmann Y et al. 2022. Dairying, diseases and the evolution of lactase persistence in Europe. Nature 608:336–45
    [Google Scholar]
  30. Ferreira AA, Welch JR, Cunha GM, Coimbra CEA Jr. 2016. Physical growth curves of indigenous Xavante children in Central Brazil: results from a longitudinal study (2009–2012). Ann. Hum. Biol. 43:293–303
    [Google Scholar]
  31. Flegal KM, Kalantar-Zadeh K. 2013. Perspective: overweight, mortality and survival. Obesity 21:1744–45
    [Google Scholar]
  32. Gerbault P, Liebert A, Itan Y, Powell A, Currat M et al. 2011. Evolution of lactase persistence: an example of human niche construction. Philos. Trans. R. Soc. B 366:863–77
    [Google Scholar]
  33. Gluckman P, Hanson M. 2006. Mismatch: Why Our World No Longer Fits Our Bodies Oxford, UK: Oxford Univ. Press
    [Google Scholar]
  34. Graves JL Jr. 2021. Human biological variation and the “normal. .” Am. J. Hum. Biol. 33:e23658
    [Google Scholar]
  35. Grimberg A, Huerta-Saenz L, Grundmeier R, Ramos MJ, Pati S et al. 2015. Gender bias in U.S. pediatric growth hormone treatment. Sci. Rep. 5:11099
    [Google Scholar]
  36. Gudbjartsson DF, Walters GB, Thorleifsson G, Stefansson H, Halldorsson BV et al. 2008. Many sequence variants affecting diversity of adult human height. Nat. Genet. 40:609–15
    [Google Scholar]
  37. Gurven MD, Lieberman DE. 2020. WEIRD bodies: mismatch, medicine and missing diversity. Evol. Hum. Behav. 41:330–40
    [Google Scholar]
  38. Gustafsson A, Lindenfors P. 2004. Human size evolution: no evolutionary allometric relationship between male and female stature. J. Hum. Evol. 47:253–66
    [Google Scholar]
  39. Haahtela T, Alenius H, Lehtimäki J, Sinkkonen A, Fyhrquist N et al. 2021. Immunological resilience and biodiversity for prevention of allergic diseases and asthma. Allergy 76:3613–26
    [Google Scholar]
  40. Hacking I. 1990. The Taming of Chance New York: Cambridge Univ. Press
    [Google Scholar]
  41. Haspelmath M. 2006. Against markedness (and what to replace it with). J. Linguistics 42:25–70
    [Google Scholar]
  42. Hayes-Conroy A 2016. Doing Nutrition Differently: Critical Approaches to Diet and Dietary Intervention New York: Routledge
    [Google Scholar]
  43. Henrich J. 2020. The WEIRDest People in the World: How the West Became Psychologically Peculiar and Particularly Prosperous New York: Farrar, Straus & Young
    [Google Scholar]
  44. Heyberger L. 2012. New anthropometric history: an analysis of the secular trend in height. Handbook of Anthropometry: Physical Measures of Human Form in Health and Disease VR Preedy 253–70. New York: Springer
    [Google Scholar]
  45. Heyman MB, Comm. Nutr 2006. Lactose intolerance in infants, children, and adolescents. Pediatrics 118:1279–86
    [Google Scholar]
  46. Hruschka DJ. 2021. One size does not fit all. How universal standards for normal height can hide deprivation and create false paradoxes. Am. J. Hum. Biol. 33:e23552
    [Google Scholar]
  47. Hruschka DJ, Hadley C, Brewis A. 2014. Disentangling basal and accumulated body mass for cross-population comparisons. Am. J. Phys. Anthropol. 153:542–50
    [Google Scholar]
  48. Itan Y, Jones BL, Ingram CJE, Swallow DM, Thomas MG. 2010. A worldwide correlation of lactase persistence phenotype and genotypes. BMC Evol. Biol. 10:36
    [Google Scholar]
  49. Jablonski NG. 2008. Skin: A Natural History. Berkeley: Univ. Calif. Press
    [Google Scholar]
  50. Jablonski NG. 2021. Skin color and race. Am. J. Phys. Anthropol. 175:437–47
    [Google Scholar]
  51. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS et al. 2000. CDC growth charts: United States. Adv. Data 2000.314 https://www.cdc.gov/nchs/data/ad/ad314.pdf
    [Google Scholar]
  52. Lasisi T. 2021. The constraints of racialization: how classification and valuation hinder scientific research on human variation. Am. J. Phys. Anthropol. 175:376–86
    [Google Scholar]
  53. Lello L, Avery SG, Tellier L, Vazquez AI, de los Campos G, Hsu SDH. 2018. Accurate genomic prediction of human height. Genetics 210:477–97
    [Google Scholar]
  54. Lester JC, Jia JL, Zhang L, Okoye GA, Linos E. 2020. Absence of images of skin of colour in publications of COVID-19 skin manifestations. Br. J. Dermatol. 183:593–95
    [Google Scholar]
  55. Lettre G. 2011. Recent progress in the study of the genetics of height. Hum. Genet. 129:465–72
    [Google Scholar]
  56. Lock M, Nguyen V-K. 2018. An Anthropology of Biomedicine New York: Wiley
    [Google Scholar]
  57. Lucas P, Arai L, Baird J, Kleijnen J, Law C, Roberts H. 2007. A systematic review of lay views about infant size and growth. Arch. Dis. Child. 92:120–27
    [Google Scholar]
  58. Lucock MD, Jones PR, Veysey M, Thota R, Garg M et al. 2022. Biophysical evidence to support and extend the vitamin D-folate hypothesis as a paradigm for the evolution of human skin pigmentation. Am. J. Hum. Biol. 34:e23667
    [Google Scholar]
  59. Marume A, Archary M, Mahomed S. 2022. Validation of growth standards and growth references: a review of literature. J. Child Health Care 26:498–510
    [Google Scholar]
  60. Masud Y, Ajmal MA. 2012. Left-handed people in a right-handed world: a phenomenological study. Pak. J. Soc. Clin. Psychol. 9:49–60
    [Google Scholar]
  61. McDonald D, Birmingham A, Knight R 2015. Context and the human microbiome. Microbiome 3:52
    [Google Scholar]
  62. McManus IC 2009. The history and geography of human handedness. Language Lateralization and Psychosis IEC Sommer, RS Kahn 37–57. New York: Cambridge Univ. Press
    [Google Scholar]
  63. Mead M. 1947. The concept of culture and the psychosomatic approach. Psychiatry 10:57–76
    [Google Scholar]
  64. Minelli A. 2011. Animal development, an open-ended segment of life. Biol. Theory 6:4–15
    [Google Scholar]
  65. Natl. Acad. Sci. Eng. Med 2006. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements JJ Otten, JP Hellwig, LD Meyers Washington, DC: Natl. Acad. Press
    [Google Scholar]
  66. Natterson-Horowitz B, Bowers K. 2020. Wildhood: The Astounding Connections Between Human and Animal Adolescents New York: Scribner
    [Google Scholar]
  67. Nesse RM, Williams GC. 1996. Why We Get Sick: The New Science of Darwinian Medicine New York: Vintage
    [Google Scholar]
  68. Norton HL. 2021. The color of normal: how a Eurocentric focus erases pigmentation complexity. Am. J. Hum. Biol. 33:e23554
    [Google Scholar]
  69. Norwood KJ, Foreman VS 2013. The ubiquitousness of colorism: then and now. Color Matters: Skin Tone Bias and the Myth of a Postracial America KJ Norwood 9–28. New York: Routledge
    [Google Scholar]
  70. Nuttall FQ. 2015. Body mass index: obesity, BMI, and health: a critical review. Nutr. Today 50:117–28
    [Google Scholar]
  71. Oldham M, Robinson E. 2018. Visual body size norms and the under-detection of overweight and obesity. Obes. Sci. Pract. 4:29–40
    [Google Scholar]
  72. Ozarda Y, Sikaris K, Streichert T, Macri J. 2018. Distinguishing reference intervals and clinical decision limits—a review by the IFCC Committee on Reference Intervals and Decision Limits. Crit. Rev. Clin. Lab. Sci. 55:420–31
    [Google Scholar]
  73. Perkins JM, Subramanian SV, Davey Smith G, Özaltin E 2016. Adult height, nutrition, and population health. Nutr. Rev. 74:149–65
    [Google Scholar]
  74. Pettigrew TF, Tropp LR, Wagner U, Christ O. 2011. Recent advances in intergroup contact theory. Int. J. Intercult. Relat. 35:271–80
    [Google Scholar]
  75. Quillen EE, Norton HL, Parra EJ, Lona-Durazo F, Ang KC et al. 2019. Shades of complexity: new perspectives on the evolution and genetic architecture of human skin. Am. J. Phys. Anthropol. 168:4–26
    [Google Scholar]
  76. Reddy V, Grewal SK, Tomz A, Lee PK. 2021. Addressing structural inequality in dermatology—where do we go from here?. Dermatol. J. 1:4–5
    [Google Scholar]
  77. Robinson E 2017. Overweight but unseen: a review of the underestimation of weight status and a visual normalization theory. Obes. Rev. 18:1200–9
    [Google Scholar]
  78. Rocha J. 2020. The evolutionary history of human skin pigmentation. J. Mol. Evol. 88:77–87
    [Google Scholar]
  79. Scheffler C, Hermanussen M. 2022. Stunting is the natural condition of human height. Am. J. Hum. Biol. 34:e23693
    [Google Scholar]
  80. Schnorr SL, Candela M, Rampelli S, Centanni M, Consolandi C et al. 2014. Gut microbiome of the Hadza hunter-gatherers. Nat. Commun. 5:3654
    [Google Scholar]
  81. Secr. Pac. Community 2012. Healthy Living Healthy Life: Working Together to Prevent and Manage NCDs in Pacific Island Countries and Territories Noumea, New Caledonia: Secr. Pac. Community (SPC)
    [Google Scholar]
  82. Singh G, Nnorom O, Dahlke E. 2022. Where's the colour? Advocating for morphologic and anti-oppressive fluencies in dermatology. Br. J. Dermatol. 187:1001–2
    [Google Scholar]
  83. Sirugo G, Williams SM, Tishkoff SA. 2019. The missing diversity in human genetic studies. Cell 177:26–31
    [Google Scholar]
  84. Sonnenburg ED, Sonnenburg JL. 2019. The ancestral and industrialized gut microbiota and implications for human health. Nat. Rev. Microbiol. 17:383–90
    [Google Scholar]
  85. Thompson AL. 2021. What is normal, healthy growth? Global health, human biology, and parental perspectives. Am. J. Hum. Biol. 33:e23597
    [Google Scholar]
  86. Thompson AL, Adair L, Bentley ME. 2014.. “ Whatever average is”: understanding African-American mothers’ perceptions of infant weight, growth, and health. Curr. Anthropol. 55:348–55
    [Google Scholar]
  87. Tidblad A. 2022. The history, physiology and treatment safety of growth hormone. Acta Paediatr. 111:215–24
    [Google Scholar]
  88. Tomiyama AJ, Carr D, Granberg EM, Major B, Robinson E et al. 2018. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16:123
    [Google Scholar]
  89. Turner BL, Thompson AL. 2013. Beyond the Paleolithic prescription: incorporating diversity and flexibility in the study of human diet evolution. Nutr. Rev. 71:501–10
    [Google Scholar]
  90. Tyrrell J, Jones SE, Beaumont R, Astley CM, Lovell R et al. 2016. Height, body mass index, and socioeconomic status: Mendelian randomisation study in UK Biobank. BMJ 352:i582
    [Google Scholar]
  91. Urlacher SS, Blackwell AD, Liebert MA, Madimenos FC, Cepon-Robins TJ et al. 2016. Physical growth of the Shuar: height, weight, and BMI references for an indigenous Amazonian population. Am. J. Hum. Biol. 28:16–30
    [Google Scholar]
  92. Vadiveloo M, Mattei J. 2017. Perceived weight discrimination and 10-year risk of allostatic load among US adults. Ann. Behav. Med. 51:94–104
    [Google Scholar]
  93. Vitzthum VJ, Ringheim K. 2005. Hormonal contraception and physiology: a research-based theory of discontinuation due to side effects. Stud. Fam. Plann. 36:13–32
    [Google Scholar]
  94. Waugh LR. 1982. Marked and unmarked: a choice between unequals in semiotic structure. Semiotica 38:299–318
    [Google Scholar]
  95. Weir CB, Jan A 2022. BMI classification percentile and cut off points. StatPearls Treasure Island, FL: StatPearls https://www.statpearls.com/point-of-care/35288
    [Google Scholar]
  96. Weller SC. 2007. Cultural consensus theory: applications and frequently asked questions. Field Methods 19:339–68
    [Google Scholar]
  97. WHO (World Health Organ.) 2000. The Asia-Pacific perspective: redefining obesity and its treatment Rep., Health Commun. Aust., Sydney https://apps.who.int/iris/handle/10665/206936
    [Google Scholar]
  98. Wiley AS. 2004.. “ Drink milk for fitness”: the cultural politics of human biological variation and milk consumption in the United States. Am. Anthropol. 106:506–17
    [Google Scholar]
  99. Wiley AS. 2011. Milk for “growth”: global and local meanings of milk consumption in China, India, and the United States. Food Foodways 19:11–33
    [Google Scholar]
  100. Wiley AS. 2016. Re-Imagining Milk: Cultural and Biological Perspectives New York: Routledge. , 2nd ed..
    [Google Scholar]
  101. Wiley AS. 2018. The evolution of lactase persistence: milk consumption, insulin-like growth factor I, and human life-history parameters. Q. Rev. Biol. 93:319–45
    [Google Scholar]
  102. Wiley AS. 2020. Lactose intolerance. Evol. Med. Public Health 2020:47–48
    [Google Scholar]
  103. Wiley AS. 2021. Pearl lecture: biological normalcy: a new framework for biocultural analysis of human population variation. Am. J. Hum. Biol. 33:e23563
    [Google Scholar]
  104. Wizeman TM. 2012. Sex-Specific Reporting of Scientific Research: A Workshop Summary Bethesda, MD: Natl. Acad. Press
    [Google Scholar]
  105. Wood AR, Esko T, Yang J, Vedantam S, Pers TH et al. 2014. Defining the role of common variation in the genomic and biological architecture of adult human height. Nat. Genet. 46:1173–86
    [Google Scholar]
  106. Wu Y-K, Berry DC. 2018. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review. J. Adv. Nurs. 74:1030–42
    [Google Scholar]
  107. Yatsunenko T, Rey FE, Manary MJ, Trehan I, Dominguez-Bello MG et al. 2012. Human gut microbiome viewed across age and geography. Nature 486:222–27
    [Google Scholar]
  108. Zuk M. 2013. Paleofantasy: What Evolution Really Tells Us About Sex, Diet, and How We Live New York: Norton
    [Google Scholar]
/content/journals/10.1146/annurev-anthro-052721-090632
Loading
/content/journals/10.1146/annurev-anthro-052721-090632
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error