Abstract
While higher-weight bodies have been radically medicalized in modern Western discourse, they are also culturally conceived as a moral project. In clinical settings aimed at transforming the body, the consultation sessions between bariatric professionals and patients reveal nuanced moral deliberations. I suggest that bariatric surgery becomes a site of a “moral breakdown,” where professionals direct patients to morally recuperate not only through technologies of the self, such as intensive bodywork and diets, but through “moral laboratories,” which invite moments of experimentation in everyday life. Drawing on ethnographic inquiry in a bariatric clinic, I argue that this moral project is understood through new relationships within various registers of patients’ subjectivity. First, patients are instructed to “listen to their bodies” and to reconnect to their embodied sensations. They are further guided to cognitively imitate an effortless “thin state of mind.” And finally, they are instructed to “put themselves first” by reorganize their interactions with significant others. Professional guidance encourages dialog and reflexivity within the patient that are consonant with neoliberal understandings of the self-disciplined subject, yet they expand, and at times undermine these neoliberal notions by attending to other body ethics and contesting elements of fat stigma.
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Notes
In this paper I maintain the terms used by the authors quoted. For instance, Mattingly uses the terms ‘ethical’ and ‘moral’ interchangeably (2014:5), so the sections that follow her work use her terms, such as ‘moral laboratories’; ‘moral experimentation’; ‘moral deliberations’. Zigon defines morality as “the unreflective mode of being-in-the-world and ethics as a tactic performed in the moment of the breakdown of the ethical dilemma” (2007:137). Generally, I use the word ‘moral’ to refer to social constraints or social norms, and ‘ethics’ to describe more reflective moments and to describe behaviors (Mattingly and Throop 2018).
As of 2019, the most common procedures performed in Israel were one-anastomosis gastric bypass (which includes one anastomosis duodenal switch), sleeve gastrectomy, Roux-en-Y gastric bypass and laparoscopic adjustable gastric bands (“The Israeli Bariatric Surgery Registry (IBSR) 2019” 2020).
Bariatric therapists include social workers (three) and psychotherapists with different training (two). Since they had different professional training and credentials, I use the term ‘therapist’ for all.
In Israel, individuals are eligible for WLS if they have a BMI of 40 or higher, or have a BMI of 35 and suffer from other obesity related diseases (Israel Ministry of Health Order 33/2013 2013). A bariatric committee designed to evaluate and screen the pre-surgery applicants must convene at each institution in Israel where such surgery takes place. These committees are composed of a social worker, a dietitian, and a physician.
Ethical approval for the research was granted by my home university’s Institutional Review Board before contact, as well as by the Helsinki Committee.
Sometimes referred to as ‘the sleeve’ or ‘the pouch’ (the shape of the stomach after sleeve gastrectomy or bypass surgery, respectively).
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Nehushtan, H. The Ethical Work of Weight Loss Surgery: Creating Reflexive, Effortless, and Assertive Moral Subjects. Cult Med Psychiatry 47, 217–236 (2023). https://doi.org/10.1007/s11013-021-09756-z
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DOI: https://doi.org/10.1007/s11013-021-09756-z