Sunday 17 May 2009

Gastric Bands and the Body Beautiful

A couple of weeks ago I attended a paper by Samantha Murray of Macquarie University, Sydney. Her piece, 'Gastric Banding and the Trans-En Abled Body', looked at the cultural anxieties surrounding weight gain and obesity and the discourse that justifies medical solutions to "the epidemic". Sam's arguments were interspersed with reflections on her own experience as someone who has had a gastric band fitted.

Sam started with a short description of the cultural framing of obesity. Everyone is aware of the discourse of bodily aesthetics that informs the vast dieting industry. For women shedding those pounds it is about acquiring a desirable body. For men the emphasis is on shedding the feminine flesh and becoming masculine. The medicalisation of obesity feeds on this and in turn gives it legitimacy. Obesity is coded as an infectious public health hazard, and in extreme cases requires medical intervention to normalise fat bodies. In Australia the favoured method is gastric banding, a procedure that has become increasingly popular in Britain and the US thanks to high profile patients like Sharon Osbourne and Fern Britton (a detailed description of gastric banding can be found
here). Gastric banding is able to effect rapid weight loss and convey an appearance of a healthy and normal body. It is also an operation that is theoretically reversible, but one that is ethically dubious - as we shall see.

Prior to her surgery Sam herself had suffered with a series of pathologies that, in the opinion of her doctors, were caused by and in turn reinforced excessive weight gain. She however was unconvinced by this medicalisation of he weight. But after going through all the familiar weight loss plans without much progress they persuaded her on the grounds of health (she suffered a great deal of pain and exhaustion) to have a band implanted, which went ahead in October 2005. Over the following six months she lost 40kg and has continued to lose weight. So from the medical point of view, a success But one thing Sam wasn't prepared for were the psychological effects of a rapidly shrinking body. She spoke about seeing people in the street who made a point of congratulating her about the weight loss, and the difficulty of transitioning to strict new eating habits.

Turning to what she accurately dubs 'medico-moral' discourse, the normative and the medical work together to produce an anxiety about the body. They contrive to conceptualise fatness as something that exists beyond individual control and is used to code bodies as morally weak, completely ignoring the diverse literature on the complex psychological causes of obesity and emerging evidence pointing to the role of genetics. This takes place against a backdrop where fat exists as the last acceptable prejudice, and one that has provoked the development of
fat acceptance movements. These not only lobby for the rights of fat people (for example, in favour of recognising obesity as a disability) but have contributed to the questioning of the normative body - a questioning reinforced by Sam's experience.

Banding is positioned by medico-moral discourse as an unproblematic technology that can enhance and preserve aesthetic appeal. It is sold as an operation that can be performed through keyhole surgery (no scars!) and can be manipulated post-operatively as the patient adjusts to life with the band. All the before and after
imagery imply a seamless and linear transition from a fat to a slimmer body, but conspicuously fail to mention the after effects. Sam experienced gall stones (leading to the removal of her gall bladder), a scarred oesophagus (thanks to repeated acid reflux), chest pains, vomiting, and hair loss due to depleted nutrient levels. Despite the marketing of banding as a route to good health, in Sam's case a slimmer body has not meant a healthier one.

On top of this comes a new diet regimen. For four weeks after the operation one's diet consists solely of fluids and purees before moving on to small and soft foods. Because the passage to the stomach is restricted eating has to be carefully paced between and during meals. Therefore the tyranny of the diet returns with renewed vengeance, on pain of frequent and potentially embarrassing trips to the bathroom. If that wasn't bad enough only foods with little nutritional benefit can easily get through the band - medical instruction more or less advises against healthy eating! This however is ignored by medico-moral discourse which prefers to code patients' "lapses" into bad diets as a manifestation of their uncontrollable food addiction.

Taken together this calls into question monolithic notions of health and what constitutes a healthy body. If we accept fat bodies are disabled (if not physically, then at least socially), and that gastric banding is marketed as a strategy for "enabling" them, for Sam we have reached the advent of a 'trans-enabled' body. Far from overcoming disablement gastric banding encourages the internalisation of disability. Successful procedures present a normative body to the world which is coded as 'healthy' while behind the facade, bariatric enabling calls its disabling opposite into being. Sam for example may have suffered a set of medical problems that have disappeared as her weight loss has got underway, but in their place have come other ailments. Furthermore medical practitioners prefer to close their eyes to the complicated consequences of their procedure. They will remove a band if it has damaged the stomach or has produced other serious complications, but it is nigh on impossible for a surgeon to remove one simply because the patient wants the operation reversed. Having spoken to large numbers of fellow patients, Sam is not aware of one reversal of this type. This itself is unsurprising seeing as it's tantamount to practitioners admitting to failure.

Therefore, despite the promise of being liberated from the fat, gastric banding imposes its own set of social constrictions.


Anonymous said...

Awesome post. Thanks for sharing.

Highlander said...

There was a program on C4 a few weeks back which looked at banding. The surgeon fitting them basically said he would make them compulsory and would virtually make it the first option for obese patients. His argument was that a band now will save however many medical problems down the line (diabetes, heart disease, cancer et al) which would also save the NHS cash long term. He offset the ongoing costs of diabetes against the cost of a band operation by way of example. As your post highlights, a far-from-quick fix.

The problem with body image, and its manipulation, is that it feeds an entire range of industries who all want our money. From gyms to diet drinks to diet groups to surgeons to health magazines and so on. The reasons for any individual to end up overweight are far too complex for a one-size-fits-all (pun intended) solution like a band to work for everyone. But it is also those complex reasons which preclude the necessary investment of time, effort and money to resolve all cases through support, diet, etc. And that also assumes the individual wishes to lose the weight.

How long before we see the ostracisation of the obese in much the same way as we have the smoker?

thinkingdifference said...

very interesting! the speaker points out that for her loosing weight was a health matter. i wonder if she also spoke about the relation btw this health discourse and the gender discourse of the desirable female body?