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- Convenors:
-
Darlene McNaughton
(Flinders University)
Bodil Just Christensen (SCIENCE Faculty, University of Copenhagen)
- Location:
- JUB-G22
- Start time:
- 11 September, 2015 at
Time zone: Europe/London
- Session slots:
- 2
Short Abstract:
Since 2003, the use of surgery as a 'treatment' for obesity and diabetes has more than doubled globally. We invite papers exploring, contextualising and critically reflecting on the practice, paradigms, ethical, economic and discursive practices surrounding bariatric surgery.
Long Abstract:
In the last decade, weight loss or bariatric surgery has gone global and is now the most rapidly growing 'treatment' for reducing obesity globally. Recent estimates indicate that the number of surgeries globally has more than doubled since 2003 with a 69% increase in Europe, 74% in Latin and South America and 54% increase in the Asia Pacific region. The scale and geographical distribution of this rise speaks to the growing availability and acceptance of surgery to ameliorate a larger than average body.
The rise of bariatric surgery parallels a rise in concern about the 'threat' posed by weight, the alleged global obesity epidemic, the apparent failure of lifestyle interventions, reconstructions of obesity as a disease, the increasing availability of surgery through national healthcare systems and/or private health insurance and claims about its success, cost effectiveness and capacity to ameliorate diabetes.
Few studies explore, contextualise or critically reflect on the practice and paradigms of bariatric surgeries; the hopes, expectations and experiences of those seeking surgery; the growing acceptance and normalisation of surgery; issues of equity, access and health care privatisation; or the framing of weight loss surgery in popular, public health or biomedical discourses and how these are responded to, negotiated and resisted.
We seek papers exploring these and related issues across diverse political and geographical settings. We envisage a lively discussion drawing on a range of perspectives from anthropologists working at the intersections of anthropology, sociology and public health, as well as anthropologists of public health.
Accepted papers:
Session 1Catherine Homer (Sheffield Hallam University) andrew thompson (University of Sheffield) Angela Mary Tod (University of Manchester)
Paper short abstract:
NHS funded bariatric surgery (BS) in England is increasing, as are interventions to support patients. Little research exists about the experience of BS or how pre-operative expectations may influence outcomes. This longitudinal study explored patient's narratives pre and post BS.
Paper long abstract:
Bariatric surgery rates in England have nearly doubled, increasing from 4200 (2008/09) to over 8000 (2012/13) (HSCIC 2014). Many patients access NHS funded surgery via a tiered model consisting of lifestyle intervention through to specialist clinical services to manage complex obesity. The tiered model aims to assess whether patients are physically and psychologically prepared for surgery and manage expectations of the surgery. The narratives of an obese person's journey to bariatric surgery and the experience of life in the first months after surgery are rarely investigated.
This study took a qualitative longitudinal approach using in-depth semi-structured interviews, modified Photovoice techniques and framework analysis. Patients were interviewed pre-surgery (n=18), three months (n=16) and nine months post-surgery (n=15).
The social and emotional burdens of obesity were major motivating factors to patients seeking bariatric surgery. Aspirations included improved health and appearance and feeling 'normal'. Three months post-surgery, most participants were rejoicing in their weight loss, had improved confidence and hoped for a better future. Coping with dietary changes, excess skin and comorbidities were outweighed by positive changes participants experienced. For many, reduced social isolation, increased self-esteem and contentment with appearance and life were evident at nine months. For others, dissatisfaction with the levels of weight loss and health, seemingly impacted on compliance with lifestyle change. The benefit to quality of life was prominent throughout. However the discourse in which participants reframed normality throughout their journey indicates how pre-surgery expectations may not be fully realised.
Cathy Greenhalgh (Independent)
Paper short abstract:
This paper tracks UK National Health Service medical and psychological discourse and environments experienced before, during and post (one year) the author’s weight loss surgery journey. Auto-ethnographic observations track reaction and realisation accompanying rapid physical change.
Paper long abstract:
This paper tracks UK National Health Service medical and psychological discourse and environments experienced before, during and post (one year) the author's weight loss surgery journey. Auto-ethnographic observations track reaction and realisation accompanying rapid physical change. To qualify for weight-loss surgery (in this case gastric sleeve) in Britain, one has to have a high enough BMI or several co-morbidity indicators. The process of becoming conditioned to expectations around the surgical event and aftermath are progressed through regular meetings with the surgeon's team, dieticians, doctors and seminar training sessions over the (currently) two or more years waiting period for operations. Although there was much advice and procedure to follow on diet and attitude, there was also a sense that the team were collecting experience narratives. I was told, for example, that little was known about why gastric sleeve surgery appears to work, that everyone reacts differently and how the "mysterious" grehlin hormone may regulate appetite. For this author the experience has been worthwhile and the reactions of colleagues and friends curious. The experience of transforming body shape so rapidly (over one hundred kilos lost in one year) appears to cause surprise and disruption as assumptions are made about lifestyle, health and wellbeing. Here, I draw on notions of body perception, cultural proxemics and terminology in weight-loss surgery as described by medics, patients (via blogs) and personal observation. I summarise mismatches and contentions between government / media rhetoric / obesity narratives with lived experiences over the process of the surgery journey.
Bodil Just Christensen (SCIENCE Faculty, University of Copenhagen)
Paper short abstract:
Researchers are divided on the subject of bariatric surgery, its efficiency, safety and morality. Based on ethnography from Denmark the paper discusses the normativities of bariatric surgery. What are patients’ expectations, fears and hopes? And how does surgery alter these concerns?
Paper long abstract:
Researchers are divided on the subject of bariatric surgery, its efficiency, safety and morality. The procedures provoke disagreement and strong opinions. The debate is dominated by an overall division between social sciences and medical sciences. On the one hand social scientists, notably from critical obesity studies, have argued that weight loss is not a choice but an obligation as obesity is seen as the result of a moral failure of individual responsibility. These perspectives conjure a conception of surgery as the epitome of bodily objectification, one that represents a medically mediated regime of governmentality and the neoliberal self - in short: surgery is coercive and 'bad'. In contrast medical accounts stress surgery as 'the most effective treatment in morbidly obese patients', facilitating sustained weight loss and important benefits on a range of health parameters; hence surgery is 'good'.
Based on ethnography from Denmark the present paper discusses the normative specificities of bariatric surgery from patients' point of view. What are patients' expectations, fears, hopes and desires? What happen to the body? And how does surgery alter concerns, aspirations and daily practices? What pains and pleasures are relevant for patients and how are these concerns facilitated by or made (more) difficult by surgery? A focal point in the presentation will be how surgery enables the emergence of objectifications and subjectifications.
Darlene McNaughton (Flinders University)
Paper short abstract:
Life after surgery in Australia: shaem, blame and healthism
Paper long abstract:
Little is know about people's experiences and lives post WLS in Australia where anti fat sentiments remain one of the last bastions of bigotry. Drawing on ethnograhhic research with 40 women and men, I describe the hopes and expectations attributed to post surgery weight loss and consider how and if these were met. Emphasis is given to respondent's experiences of shame and stigma: the nature and contexts in which these occur; there impact and responses to them; as well as the challenges they pose to fulfilling the promises that weight loss, WLS and healthism make. I argued that a change in body size/weight while seen as a positive by participants, often remains caught up in the hegemonic moralizing discourses that frame the larger than average person/body in Australia as a lazy, disgusting, abject, irresponsible citizen, overrun by desires and lacking self control. Those who have had surgery can find it difficult to move away from an earlier stigmatized fat identity and often find themselves reframed as the person who used to be fat, who needed a surgical intervention to control their weight/desires/lack of self control and address their irresponsible and poor lifestyle choices, with surgery being seen as the easy way out, the lazy option. The paper concludes by asking just how empowering is weight loss in such settings?