Extreme Weight Loss: Life Before and After Bariatric Surgery

219 Pages·2021·1.448 MB·English

by  Sarah Trainer, Alexandra Brewis, Amber Wutich

Extreme Weight Loss

Extreme Weight Loss
Life Before and After Bariatric Surgery
Sarah Trainer, Alexandra Brewis, and Amber Wutich
NEW YORK UNIVERSITY PRESS
New York
NEW YORK UNIVERSITY PRESS
New York
www.nyupress.org
© 2021 by New York University
All rights reserved
References to Internet websites (URLs) were accurate at the time of writing. Neither the
author nor New York University Press is responsible for URLs that may have expired or
changed since the manuscript was prepared.
Library of Congress Cataloging-in-Publication Data
Names: Trainer, Sarah, author. | Brewis, Alexandra, author. | Wutich, Amber, author.
Title: Extreme weight loss : life before and after bariatric surgery / Sarah Trainer, Alexandra
Brewis, Amber Wutich.
Description: New York : NYU Press, 2021. | Includes bibliographical references and index.
Identifiers: LCCN 2020028182 (print) | LCCN 2020028183 (ebook) |
ISBN 9781479894970 (cloth) | ISBN 9781479803958 (paperback) |
ISBN 9781479879274 (ebook) | ISBN 9781479857265 (ebook other)
Subjects: LCSH: Obesity—Surgery—Popular works. | Gastric bypass. | Weight loss. |
Obesity. | Obesity—Social aspects. | Ethnology—Methodology.
Classification: LCC RD540 .T73 2021 (print) | LCC RD540 (ebook) | DDC 617.4/3—dc23
LC record available at https://lccn.loc.gov/2020028182
LC ebook record available at https://lccn.loc.gov/2020028183
New York University Press books are printed on acid- free paper, and their binding materials
are chosen for strength and durability. We strive to use environmentally responsible suppli-
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Also available as an ebook
Contents
Introduction 1
1. Weight as Pathology 21
2. Weight as Judgment 51
3. Weight Loss as Success 75
4. Weight, Worry, and Surveillance 105
Conclusion 137
Epilogue 143
Acknowledgments 145
Appendix A: Ethnographic Methods 147
Appendix B: The Survey 155
Notes 177
References 185
Index 205
About the Authors 213

Introduction
Today, in much of the world, a fat body violates widely held social
norms about how people should look. A body with weight deemed
excessive by social or medical standards also brings social, economic,
political, and emotional consequences, precisely because it does not
meet now-d ominant norms. Across different cultures and communi-
ties, fat individuals are perceived to be lazy and undisciplined. Perhaps
the most powerful, overriding meaning currently associated with a fat
body, however, is failure. The idea that one fails as a person because of
one’s weight increasingly dominates in both local and global discussions
about health, beauty, and other forms of human capital. This environ-
ment, in turn, may feed profound personal self- doubt among those who
feel out of sync with body norms because of their weight— and this self-
doubt may grow over time into outright emotional misery.1
The broader context—a widespread avoidance and despising of
weighty, fat bodies—i s the starting point for the ethnographic case
study we explore in this book. Here, we consider what it means to be
fat, obese, and overweight through a detailed analysis of the words of
patients undergoing a body modification commonly known as bariat-
ric surgery or weight- loss surgery (WLS) in one large hospital system
in the United States. “Why pay attention to bariatric patients?” we are
often asked. The reasons are twofold. On the one hand, bariatric patients
are uniquely placed as keen participant observers of the social mean-
ings and implications of “being fat,” because they come to surgery with
long, often fraught histories of having lived with a very large body. On
the other hand, the surgery then rapidly transforms their bodies, trig-
gering pronounced weight loss over a very condensed period of time.
Postsurgery, it is common to lose half of one’s excess body weight within
a year. This transformation of the physical, biological body thus pro-
vides us with a particularly illuminating lens for examining the role that
body weight plays in how Americans in the twenty- first century United
1
2 | Introduction
States define themselves and each other, in social, interpersonal, and
emotional terms.
Our ethnography traces out the body and identity transformations
that people underwent as a result of massive, surgically induced weight
loss. It is also an intimate portrait of the “hard work” that people with
larger- than- average bodies are willing to do to live up to current so-
cieties’ stringent norms of thinness. In this book, we share stories of
the sacrifices people were willing to make to meet these norms, the tri-
umph that came when they attained them, and the deep sense of disap-
pointment that emerged when they could not. The journey to profound
postsurgical weight loss for bariatric patients is a far- reaching and pain-
ful one— and not just in physical ways. Many bariatric patients, who
undergo surgeries that alter their stomachs and intestines in order to
facilitate drastic weight loss, spend years before and after the surgeries
struggling with their weight. They do so in part to be healthy but also
because of a deep need to find thinner “true selves,” ones that align with
wider social norms.
The notion that every individual should be struggling to reach and
keep a certain weight resonates with an astounding number of people
today, whether they identify as thin, fat, or in between. Around the
planet, doctors routinely weigh people from birth onward, give advice
about how to achieve healthy weights through lifestyle choices, and talk
about the pathological consequences that will ensue if a healthy weight
or lifestyle is not maintained.2 People living in a country like the United
States are subjected to a constant barrage of advertisements selling the
idea that weight loss is easy—w ith the right product and the correct
amount of personal willpower. Images of allegedly successful and de-
sirable thin people are everywhere. People are accordingly enjoined to
compare their bodies constantly to those of others, both real and air-
brushed, and to constantly worry how well they are doing with personal
body- based “improvement” projects.
In this (now widely globalized) paradigm, weight loss is read as a
personal success, whereas weight gain is seen as a personal failure. Many
people who pick up this book, for example, have probably already wor-
ried at least once today about eating the “wrong” food or not putting
enough effort into exercising. Many probably start the day with a look
at their weight as told to them by a scale and then interpret the results
Introduction | 3
not simply as pounds up or pounds down but as a commentary on in-
dividual worth. Up five pounds? That means one has “lost control” or
is “not working hard enough.” Down five pounds? One must have been
“good,” and the proof is staring back at them, reflected in the numbers
on the scale.
In this context, the emotional and social struggles of people dealing
with extreme weight allow us to examine ideas about which bodies be-
long, which do not, and how that belonging is enforced or not. To have
so many millions— actually, now billions— of people working daily to
lose or maintain weight, even while the average weights of most popula-
tions continue going up,3 is one of the strangest contradictions of mod-
ern human society. It demands investigation. It requires explanation.
This fundamentally complex cultural phenomenon is the departure
point for this book. The expectation that people must engage in everyday
weight loss is now deeply socially ingrained in countries like the United
States. The science of weight loss suggests that the more people try to lose
weight through dieting, the more likely they are to gain even more weight
in the long term.4 Thus, weight- loss efforts are only loosely related to
actual weight, and they are only loosely related to success at weight loss.
Moreover, obesity itself does not always equate with ill health. There are
plenty of skinny people with diabetes, high cholesterol, and other physical
pathologies that are commonly portrayed as co- occurring with obesity.5
There are also plenty of people who, if weighed in a doctor’s office, would
find themselves diagnosed with morbid obesity and quickly thereafter
classified as diseased from a medical (and social) standpoint . . . but who
would have no other symptoms of disease aside from a higher weight-
to- height ratio. In other words, weight deemed excessive is viewed as in-
herently diseased, whether or not it correlates with lived experiences of
illness symptoms and diseases such as diabetes, cardiovascular disease,
and the like.6 In other words, social beliefs about obesity map poorly onto
current scientific and medical evidence. Making the situation still more
confusing, “fat” and “obese” are slippery words/concepts that are often
used interchangeable by many people. What is clear, however, is that it
has become a basic social fact in many countries in the world today that
fat bodies are unacceptable, are unhealthy, and reflect a lack of personal
commitment to other valued traits that include hard work, personal re-
sponsibility, and goal- oriented individual success.
4 | Introduction
In this book, we use detailed ethnographic data collected with
bariatric surgery patients in one hospital case study to understand
how and why the cultural obsession with weight loss is such a pre-
vailing characteristic of our modern, media- connected societies. We
stress that this obsession is at its core a cultural one, although it uses
medicalized rhetoric and many of the flows of power and influence
happen in and between clinical settings. This book unravels how and
why weight and our efforts to escape it have become such a collective
and heavy burden, taking up so much of our attention and causing
so much daily worry. Our story is about understanding how and why
weight norms are core to so many people’s basic senses of self. Our
case study in based in one city in the United States, but in many ways
it is a universal story about life in an increasingly globalized world in
the new millennium.
It’s Not Just about Weight— It’s about Fitting In
The lifelong struggles with weight and size, as described by the bariat-
ric patients we got to know, are not unique. However, the avenue that
they eventually chose to go down to lose weight— that is, opting for
bariatric surgery— does make them unusual. The surgery and its con-
sequences also give people who undergo it unusual insights into both
weight and weight loss. This is one of the reasons why we chose to focus
on bariatric surgery as a rather unique lens for understanding (and,
hopefully, disentangling) weight- related experiences. Where else, in the
early twenty- first century, might one find a community of people who
have—c ollectively and individually— experienced the social and physi-
cal consequences of extremely high weight, followed by the loss of a
significant portion of that weight?
Among other things, this expensive surgical intervention facilitates
rapid weight loss to an unparalleled degree. Bariatric surgery encom-
passes a number of different types of surgical interventions on the stom-
ach and intestines, usually through the reduction of stomach capacity
and gut length. All trigger weight loss because they profoundly alter how
the body takes in, absorbs, and excretes food. Bariatric surgery is also
sometimes referred to as metabolic surgery because it manipulates (via
surgery) a normal organ system to change an individual’s biology to im-