The experience of bariatric or weight-loss surgery (WLS) - with particular reference to changes in the relationship with food

Abstract

"The ancient prescription of Hippocrates (400 BC) that the obese should ‘eat less and exercise more’ is still today, and for the foreseeable future, the cornerstone approach to treat obesity despite its well-documented failures." (Dulloo, 2012 p1418) There is considerable research into bariatric surgery as a treatment for the purposes of weight-loss and reduction of co-morbidities associated with obesity, but very little of it is written from the patient’s point of view. This study is a contribution towards remedying that lack. Twenty participants, who were both pre- and post-surgery, were recruited from self-help support groups and asked to talk about their experience of WLS. A critical narrative-discursive approach is used to analyse the transcriptions of the interviews informed by my experience as a reflexively practising psychoanalytic clinician. Participant’s identity construction is explored with regard to the discourses chosen to account for their weight which enabled them to avoid being stigmatised as morally failing to fulfil the neo-liberal task of personal responsibility for their health. The concept of positioning over time is used to demonstrate the shift from being blameless for their past size, to one of being blameworthy were they to put on weight post-surgery. This facilitated a fattist discourse when those who had regained weight after WLS were othered as failing to use the ‘tool’ of WLS, which in turn made it necessary to locate control, or to account for the lack of it. It was expected that participants would express feelings of loss with regard to food, and some disturbance in their experience of their rapidly shrinking bodies, but neither manifested significantly.