(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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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.
Weight loss surgery, Obesity surgery, Bariatric surgery, Overweight women, Discourse analysis