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Dimitrov Ulian M, Fernandez Unsain R, Rocha Franco R, Aurélio Santo M, Brewis A, Trainer S, SturtzSreetharan C, Wutich A, Gualano B, Baeza Scagliusi F. Weight stigma after bariatric surgery: A qualitative study with Brazilian women. PLoS One 2023; 18:e0287822. [PMID: 37498887 PMCID: PMC10374044 DOI: 10.1371/journal.pone.0287822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/13/2023] [Indexed: 07/29/2023] Open
Abstract
Prior studies suggest that one anticipated benefit of bariatric surgery is the achievement of a thinner body, one that is less subject to perceived negative judgment and condemnation by others. However, additional analyses also indicate that stigma may persist even with significant post-surgery weight loss. To investigate the stigma-related perceptions and experiences of women who have undergone bariatric surgery and the resulting body transformations, we conducted individual, semi-structured interviews with thirty Brazilian women (15 aged 33-59 and 15 aged 63-72). The resulting text was then analyzed using thematic analysis. We found that some form of weight stigma persisted for our participants, regardless of weight loss. Ongoing experiences of stigma were also evidenced by the constant internal and external vigilance reported by the women, as well as their articulated efforts to distance themselves from their previous bodies. Additionally, participants reported being judged for choosing an "easy way out" to lose weight. Those in the older group reported that weight stigma was entangled with ageism: older participants received mixed messages underscoring the ways that weight and age may interact in doubly stigmatizing ways. Family and close peers were especially powerful sources of stigma experiences. Collectively, these results show that weight stigma persists even when people undergo a procedure to lose substantive weight and that the degree and types of stigma experiences are influenced by gender and age. Our study suggest future research should explore whether a targeted approach might be more effective, for example, an approach that would emphasize the importance of developing coping strategies with respect to experiences of stigma and discrimination after surgery.
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Affiliation(s)
- Mariana Dimitrov Ulian
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ramiro Fernandez Unsain
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ruth Rocha Franco
- Unidade de Endocrinologia Pediátrica do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marco Aurélio Santo
- Divisão de Cirurgia do Aparelho Digestivo, Unidade de Cirurgia Bariátrica e Metabólica, São Paulo, SP, Brasil
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Sarah Trainer
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Cindi SturtzSreetharan
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Bruno Gualano
- Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fernanda Baeza Scagliusi
- Departamento de Nutrição, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brasil
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Nehushtan H. The Ethical Work of Weight Loss Surgery: Creating Reflexive, Effortless, and Assertive Moral Subjects. Cult Med Psychiatry 2021; 47:217-236. [PMID: 34750744 DOI: 10.1007/s11013-021-09756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
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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Affiliation(s)
- Hilla Nehushtan
- Department of Sociology and Anthropology, The Hebrew University of Jerusalem, Jerusalem, Israel.
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