(D)-graded female bodies and the emergence of weight-loss surgery : a discourse analysis of narratives relating a precarious moment in the medicalisation of women's weight : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Health Sciences at Massey University, Palmerston North, New Zealand
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Date
2010
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Massey University
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Abstract
Within the last century, as large bodies came to be regarded as unattractive and deviant,
the project of appearance has become entangled in projects of health. In the assumed
legitimacy of discourses linking overweight with ill health, alternative understandings
of large body size and the possibilities for large-body health have been effectively
silenced. Within New Zealand’s gendered social order, women in particular experience
and enact surveillance and criticism of their bodies from an early age. Those whose
bodies do not fit within prescribed norms for health and beauty become (D)-graded
large bodies, especially vulnerable to discriminatory practices within consultations and
legitimate objects for practice, treatment and experimentation. In the failure of diets
and pharmaceuticals to produce ‘normal’ weight over the long term, some women
considered weight-loss surgery (WLS) options.
This thesis traced the spread of WLS within New Zealand and the conspicuous creep
of cultural prescription, morality and trade - including Direct-to-Consumer advertising -
driving that proliferation. In this thesis, I attend to the problematics of surgeons trading
in and promoting experimental and new procedures, especially where these were
performed as early-on procedures in private medical arenas. A range of narratives in
this account record some of the unexpected, unpredictable, and often adverse outcomes
experienced by some WLS patients: Elective weight-loss surgeries were risky
procedures and accompanied by significant iatrogenic injuries when surgeons had
minimal experience, training and proctoring. WLS patients experienced technically
induced eating disorders and multiple surgical and medical interventions, often for little
or no long-term weight loss. Informed consent was a legalised ritual that did not protect
patients.
In this reflexive, qualitative research project, reports, case material, emails and
interviews with 14 doctors and 22 patients were analysed with respect to the
power/knowledge relations implicit in them. This critical-health analysis challenges
any inevitability of benefits in the wider application of WLS. WLS consultation and
practice requires attention to the cultural and trade insistences that limit the parameters of weight/health and, secondly, to the development of respectful practices of
communication and consultation based within a relational ethics of care.
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Keywords
Weight loss surgery, Obesity surgery, Bariatric surgery, Overweight women, Discourse analysis