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Bariatric surgery as prophylaxis: an emerging protection discourse

Abstract

As the medicalization of ‘‘obesity’’ has become more formalized, bariatric surgery is taking on new meaning in both medicine and society. Through repeated qualitative interviews (3 interviews every 3 to 5 months) and deploying interpretative phenomenological analysis, we examine the discourses and perceptions of patients post-bariatric surgery (n = 15). Results suggest participants’ perceive bariatric surgery not as a cure, but a tool, alleviant, prophylaxis and suppressant. The findings highlight that responsibility for a healthy future is constructed as a matter of individual responsibility and pressing concern.

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Notes

  1. We use the term fat in keeping with fat acceptance communities who seek to reclaim these terms as neutral descriptors and not in a pejorative sense (Meadows and Daníelsdóttir 2016). ‘‘obesity’’ is presented in quotes to acknowledge the contested meanings of this word and its political implications. For readability, quotes are used only for initial usage.

References

  • American Medical Association. 2013. Recognition of ‘obesity’ as a Disease. (Resolution 420-A-13).

  • American Society for Metabolic and Bariatric Surgery. 2016. Estimate of Bariatric Surgery Numbers, 2011–2015—American Society for Metabolic and Bariatric Surgery. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 01 Aug 2017.

  • Attride-Stirling, J. 2001. Thematic networks: An analytic tool for qualitative research. Qualitative Research 1 (3): 385–405.

    Article  Google Scholar 

  • Aykan, B., and S. Guvenc-Salgirli. 2015. Responsibilizing individuals, regulating health: Debating public spots, risk, and neoliberal governmentality in contemporary Turkey. New Perspectives on Turkey 53: 71–92.

    Article  Google Scholar 

  • Backman, O., D. Stockeld, F. Rasmussen, E. Näslund, and R. Marsk. 2016. Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery. British Journal of Surgery 103 (10): 1336–1342.

    Article  Google Scholar 

  • Bacon, L., and L. Aphramor. 2011. Weight science: Evaluating the evidence for a paradigm shift. Nutrition Journal 10 (1): 9. https://doi.org/10.1186/1475-2891-10-9.

    Article  Google Scholar 

  • Bell, K., and S. Ristovski-Slijepcevic. 2015. Communicating ‘evidence’: Lifestyle, cancer, and the promise of a disease-free future. Medical Anthropology Quarterly 29 (2): 216–236.

    Article  Google Scholar 

  • Boero, N. 2012. Killer fat: Media, medicine, and morals in the American ‘‘obesity’ epidemic’. Killer Fat: Media, Medicine, and Morals in the American Obesity Epidemic.

    Book  Google Scholar 

  • Brookes, G., and K. Harvey. 2015. Peddling a semiotics of fear: A critical examination of scare tactics and commercial strategies in public health promotion. Social Semiotics 25 (1): 57–80.

    Article  Google Scholar 

  • Conrad, P. 2005. The shifting engines of medicalization. Journal of Health and Social Behavior 46 (1): 3–14.

    Article  Google Scholar 

  • Creswell, J.W. 2009. Research design: Qualitative, quantitative, and mixed methods approaches, 3rd ed. Thousand Oaks: Sage Publications.

    Google Scholar 

  • Drew, P. 2011. But then i learned…: Weight loss surgery patients negotiate surgery discourses. Social Science and Medicine 73 (8): 1230–1237.

    Article  Google Scholar 

  • Emerson, R.M., R.I. Fretz, and L.L. Shaw. 2003. Writing ethnographic fieldnotes. Chicago: University of Chicago Press.

    Google Scholar 

  • Evans, B. 2010. Anticipating fatness: Childhood, affect and the pre-emptive ‘war on obesity’. Transactions of the Institute of British Geographers 35 (1): 21–38.

    Article  Google Scholar 

  • Evans, J., B. Davies, and E. Rich. 2008. The class and cultural functions of obesity discourse: Our latter day child saving movement. International Studies in Sociology of Education 18 (2): 117–132.

    Article  Google Scholar 

  • Felder, K., U. Felt, and M. Penkler. 2015. Caring for evidence: Research and care in an obesity outpatient clinic. Medical Anthropology: Cross Cultural Studies in Health and Illness 35 (5): 404–418.

    Article  Google Scholar 

  • Fuchs, H.F., R.C. Broderick, C.R. Harnsberger, et al. 2015. Benefits of bariatric surgery do not reach obese men. Journal of Laparoendoscopic & Advanced Surgical Techniques 25: 196–201.

    Article  Google Scholar 

  • Gard, M., and J. Wright. 2005. The ‘obesity’ epidemic: Science, morality and ideology. Abingdon: Routledge.

    Book  Google Scholar 

  • Greenhalgh, S. 2015. Fat-talk nation. Ithaca: Cornell University Press.

    Google Scholar 

  • Groven, K.S. 2014. They think surgery is just a quick fix. International Journal of Qualitative Studies on Health and Well-being 9 (1): 24378.

    Article  Google Scholar 

  • Groven, K.S., B. Ahlsen, and S. Robertson. 2018. Stories of suffering and success: Men’s embodied narratives following bariatric surgery. Indo-Pacific Journal of Phenomenology 18 (1): 1–14.

    Article  Google Scholar 

  • Groven, K.S., M. Råheim, and G. Engelsrud. 2010. My quality of life is worse compared to my earlier life : Living with chronic problems after weight loss surgery. International Journal of Qualitative Studies on Health and Well-being 5 (4): 5553. https://doi.org/10.3402/qhw.v5i4.5553.

    Article  Google Scholar 

  • Groven, K.S., M. Råheim, and G. Engelsrud. 2013. Dis-appearance and dys-appearance anew: Living with excess skin and intestinal changes following weight loss surgery. Medicine, Health Care and Philosophy 16 (3): 507–523.

    Article  Google Scholar 

  • Groven, K.S., M. Råheim, and G. Engelsrud. 2015. Changing bodies, changing habits: Women’s experiences of interval training following gastric bypass surgery. Health Care for Women International 36 (3): 276–302.

    Article  Google Scholar 

  • Holden, V. and C. Brennan. 2017. Diabetes type 2: Offer gastric surgery regardless of weight, says surgeon—BBC News. http://www.bbc.com/news/health-37567101. Accessed 03 Aug 2017].

  • Jutel, A. 2006. The emergence of overweight as a disease entity: Measuring up normality. Social Science and Medicine 63 (9): 2268–2276.

    Article  Google Scholar 

  • Kaczynski, D., M. Salmona, and T. Smith. 2014. Qualitative research in finance. Australian Journal of Management 39: 127–135.

    Article  Google Scholar 

  • Knutsen, I.R., L. Terragni, and C. Foss. 2011. Morbidly obese patients and lifestyle change: Constructing ethical selves. Nursing Inquiry 18 (4): 348–358.

    Article  Google Scholar 

  • Knutsen, I.R., L. Terragni, and C. Foss. 2013. Empowerment and bariatric surgery: Negotiations of credibility and control. Qualitative Health Research 23 (1): 66–77.

    Article  Google Scholar 

  • Kroes, M., G. Osei-Assibey, R. Baker-Searle, and J. Huang. 2016. Impact of weight change on quality of life in adults with overweight/obesity in the United States: A systematic review. Current Medical Research and Opinion 32 (3): 485–508.

    Article  Google Scholar 

  • Kuzminov, A., A.J. Palmer, S. Wilkinson, et al. 2016. Re-operations after secondary bariatric surgery: A systematic review. Obesity Surgery 26: 2237–2247.

    Article  Google Scholar 

  • Kwan, S., and J. Graves. 2013. Framing fat: Competing constructions in contemporary culture. New Brunswick: Rutgers University Press.

    Google Scholar 

  • Larkin, M., and A. Thompson. 2012. Interpretative phenomenological analysis. In Qualitative research methods in mental health and psychotherapy: A guide for students and practitioners, ed. A. Thompson and D. Harper, 99–116. Oxford: Wiley.

    Google Scholar 

  • Larkin, M., S. Watts, and E. Clifton. 2006. Giving voice and making sense in interpretative phenomenological analysis. Qualitative Research in Psychology 3 (2): 102–120.

    Article  Google Scholar 

  • Lupton, D. 1995. The imperative of health: Public health and the regulated body. London: Sage Publications.

    Google Scholar 

  • Meadows, A., and S. Daníelsdóttir. 2016. What's in a word? On weight stigma and terminology. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2016.01527.

    Article  Google Scholar 

  • Monaghan, L.F. 2008. Men and the war on ‘obesity’. Abingdon: Routledge.

    Book  Google Scholar 

  • Monaghan, L.F., R. Hollands, and G. Prtichard. 2010. ‘obesity’ epidemic entrepreneurs: Types, practices and interests. Body and Society 16 (2): 37–71.

    Article  Google Scholar 

  • Murray, S. 2009. ‘Banded bodies’: the somatechnics of gastric banding. In Somatechnics queering the technologisation of bodies, ed. S. Murray and N. Sullivan, 153–168. Farnham, Surrey; Burlington, VT: Farnham, Surrey; Burlington, Ashgate.

  • Murray, S. 2010. Women under/in control? Embodying eating after gastric banding. Radical Psychology 8: 1.

    Google Scholar 

  • Padwal, R., S. Klarenbach, N. Wiebe, M. Hazel, D. Birch, S. Karmali, A.M. Sharma, B. Manns, and M. Tonelli. 2011. Bariatric surgery: A systematic review of the clinical and economic evidence. Journal of General Internal Medicine 26 (10): 1183–1194.

    Article  Google Scholar 

  • Petersen, A., and D. Lupton. 1996. The new public health: Health and self in the age of risk. St Leonards: Sage Publications.

    Google Scholar 

  • Puhl, R.M., T. Andreyeva, and K.D. Brownell. 2008. Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. International Journal of Obesity 32 (6): 992–1000.

    Article  Google Scholar 

  • Puhl, R.M., and C.A. Heuer. 2010. Obesity stigma: Important considerations for public health. American Journal of Public Health 100 (6): 1019–1028.

    Article  Google Scholar 

  • Raisborough, J. 2016. Fat bodies, health and the media. London: Palgrave MacMillan.

    Book  Google Scholar 

  • Saldaña, J. 2003. Longitudinal qualitative research: Analyzing change through time. Walnut Creek: AltaMira Press.

    Google Scholar 

  • Smith, J.A. 1996. Beyond the divide between cognition and discourse: Using interpretive phenomenological analysis in health psychology. Psychology & Health 11 (2): 261–271.

    Article  Google Scholar 

  • Smith, J.A. 2011. Evaluating the contribution of interpretive phenomenological analysis. Health Psychology Review 5 (1): 9–27.

    Article  Google Scholar 

  • Smith, J.A., P. Flowers, and M. Larkin. 2009. Interpretative phenomenological analysis: Theory, method and research. London: SAGE Publications Ltd.

    Google Scholar 

  • Smith, J.A., and M. Osborn. 2008. Interpretative phenomenological analysis. In Qualitative psychology: A practical guide to research methods, ed. J. Smith, 53–80. London: Sage.

  • Stearns, P.N. 2002. Fat history: Bodies and beauty in the modern west. New York: New York University Press.

    Google Scholar 

  • SturtzSreetharan, C., S. Trainer, A. Wutich, and A. Brewis. 2018. Moral biocitizenship: Discursively managing food and the body after bariatric surgery. Journal of Linguistic Anthropology 28 (2): 221–240.

    Article  Google Scholar 

  • Throsby, K. 2007. How could you let yourself get like that?: Stories of the origins of ‘obesity’ in accounts of weight loss surgery. Social Science and Medicine 65 (8): 1561–1571.

    Article  Google Scholar 

  • Throsby, K. 2008a. Happy re-birthday: Weight loss surgery and the ‘new me’. Body and Society 14 (1): 117–133.

    Article  Google Scholar 

  • Throsby, K. 2008b. Gender and interpersonal violence: Language, action and representation, 83–99. New York: Springer.

    Book  Google Scholar 

  • Throsby, K. 2009. The war on ‘obesity’ as a moral project: Weight loss drugs, ‘obesity’ surgery and negotiating failure. Science as Culture 18 (2): 201–216.

    Article  Google Scholar 

  • Throsby, K. 2012. ‘obesity’ surgery and the management of excess: Exploring the body multiple. Sociology of Health & Illness 34 (1): 1–15.

    Article  Google Scholar 

  • Trainer, S., A. Brewis, and A. Wutich. 2017. Not ‘taking the easy way out’: Reframing bariatric surgery from low-effort weight loss to hard work. Anthropology & Medicine 24 (1): 96–110.

    Article  Google Scholar 

  • Van Hout, G.C.M., P. Boekestein, F.A.M. Fortuin, A.J.M. Pelle, and G.L. Van Heck. 2006. Psychosocial functioning following bariatric surgery. Obesity Surgery 16 (6): 787–794.

    Article  Google Scholar 

  • Weber, B. 2012. Reality (celebrity) check: Fat, death and the ageing female body. Celebrity Studies 3 (1): 64–77.

    Article  Google Scholar 

  • Wright, J. 2004. Post-structural methodologies: The body, schooling and health. In Body knowledge and control. Studies in the sociology of physical education and health, ed. J. Evans, B. Davies, and J. Wright, 19–31. London: Routledge.

    Google Scholar 

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Acknowledgements

The authors thank participants, Hannah Reagan for flyer design and Dr. Anna Kirkland for insightful conversation.

Funding

Faculty Research and Creative Endeavors Committee (FRCE), Central Michigan University, Type B Research Grant.

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Correspondence to Andrea E. Bombak.

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Bombak, A.E., Eckhart, N., Bensley, J.H. et al. Bariatric surgery as prophylaxis: an emerging protection discourse. Soc Theory Health 19, 282–297 (2021). https://doi.org/10.1057/s41285-019-00121-0

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  • DOI: https://doi.org/10.1057/s41285-019-00121-0

Keywords

  • Bariatric surgery
  • Critical weight studies
  • Fatness
  • Medicalization
  • Risk
  • Stigma