This thesis is an analysis of how societal values shape our ideas of health and disease, the designs and marketing of weight loss surgery technologies, and the ways in which obesity reducing-operations are accepted and desired. Gender ideologies, American values of commodity capitalism, treatment that focuses on the individual, and a moral aversion to fat have all shaped the medical treatment of obesity as an epidemic and the promotion of weight loss surgery as the best available solution. In this project, I approach the question of obesity by deconstructing the terms that have framed it as a social problem and I show how and why specific technological remedies have been pursued. My thesis is that among obese Americans, females and their bodies are especially stigmatized and pathologized. Because of this, efforts and applications of science, technology, medicine, and policy focus to "fix" these bodies/people, which are considered out of control. / Master of Science

This dissertation provides an ethical justification of surgical weight loss interventions for the treatment of obesity. Situating obesity as not merely a public health concern but also fundamentally a problem of clinical medicine confronting individual patients and physicians, the dissertation argues that the time frame of public health interventions is too long for individuals presently facing obesity and its deleterious physical and social co-morbidities. It argues that failure to address weight loss on an individual level, and specifically to consider the clinical appropriateness of weight loss surgery (WLS), raises serious questions about failure to respect autonomy and promote patient welfare. Moreover, social skepticism or rejection of WLS as a treatment option raises concerns about fairness, as this failure indicates that obesity is not regarded in relevantly similar ways to other life-threatening and health-impairing conditions. The dissertation examines various reasons that obesity and its myriad interventions, including WLS, are inadequately addressed in the clinical setting. It argues that considerations with cultural and ethical valence play a critical role in obesity's different and unfair treatment within clinical medicine. Gendered and theologically informed attributions of blame, self-blame, shame, and self-stigma influence the attitudes and actions of both patients and clinicians with regard to addressing obesity. Inappropriate and conceptually confused ascriptions of responsibility impede social acceptance of, and access to, WLS. The dissertation's criticism and subsequent reconceptualization of these ascriptions of responsibility from a perspective informed by feminist epistemology and ethics provide the foundation upon which to consider reform of current clinical practices surrounding treatment of obesity. This dissertation concludes that WLS is both ethically and clinically justified. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

Obesity is a chronic and growing disease defined by weighing 20% or more than the ideal, or having a body mass index (BMI) of 30 kg/m2 or more. While natural weight loss is available, many patients are choosing weight loss surgery (i.e., bariatric surgery) as an alternative to lose weight and reduce their risks for comorbidities such as diabetes, heart disease, and sleep apnea. Tools and resources for post-surgical support in the bariatric surgery community have been limited and, in the past, most tools and resources for weight loss have focused on non-surgical weight loss communities; as such, analysis methods for measuring success in this population have not been clearly developed and tested. This research proposes and evaluates analysis methods that may be used in such studies. These analysis methods are evaluated using data from the Weight and Exercise Lifestyle Support study at Baystate Medical Center in Springfield, MA. In this study, a group of participants (n = 6) approved for bariatric surgery were followed by the research team starting roughly one month before surgery through three months after surgery. Participants received pedometers and weight scales, and access to an online patient portal where they could review their physical activity levels, and receive support from others in the study and an exercise consultant. Data collected included pre- and post-study dietary and exercise self-efficacy levels, self-reported and objective physical activity measures, self-reported dietary adherence, device usage, and usability and satisfaction with the program. This research evaluates whether the proposed measures can help determine the presence and nature of the relationships between the aforementioned variables. If these measures prove to be useful, they can be used in future interventions that use technology to support post-surgical weight loss communities.

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Purpose: Food cravings are common, more prevalent in the obese, and may differ in those who pursue surgical treatment for obesity. Food craving tools are most often validated in non-clinical, non-obese samples. Methods: In this retrospective study, 227 bariatric surgery candidates at a large medical center completed the Food Cravings Questionnaire-Trait (FCQ-T). The aim was to explore the factor structure of the FCQ-T. Results: Principal components analysis with varimax rotation revealed a seven-factor structure that explained 70.89 % of the variance. The seven factors were: (1) preoccupation with food, (2) emotional triggers, (3) environmental cues, (4) loss of control, (5) relief from negative emotions, (6) guilt, and (7) physiological response. The preoccupation with food factor accounted for 49.46 % of the variance in responses. Conclusions: Unlike other populations, food cravings in bariatric surgery candidates appear to be related most to preoccupations with food.

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En m’appuyant sur la sociologie des attentes technoscientifiques et les études critiques du handicap, j’analyse dans cette thèse l’expérience de personnes diagnostiquées comme obèses ou obèses « morbides » ayant subi une chirurgie bariatrique (ou de perte de poids). Alors que la lutte contre l'obésité a longtemps mis l’accent sur les changements de mode de vie, les discours de santé publique ont pris un ton plus urgent à partir des années 2000, qualifiant l’obésité d’« épidémie » justifiant des interventions radicales. Parallèlement, le stigmate contre la graisse corporelle s’est intensifié, et le nombre de chirurgies bariatriques a connu une croissance exponentielle, notamment chez les femmes. Je défends que ces phénomènes concomitants doivent être interprétés dans le contexte d’une « économie de l’espoir » qui englobe les anticipations des promoteurs de la santé publique, des chercheurs en obésité et chirurgiens bariatriques, des personnes en situation d’obésité, et de leurs proches. Au sein de cette dynamique, la clinique bariatrique devient un lieu où se croisent et se heurtent plusieurs définitions de l’« obésité » et différentes priorités de santé. En me basant sur des entretiens semi-directifs menés avec des patientes bariatriques et des cliniciens, j’explore comment les patientes qui s’est manifesté de manière à la fois discursive, émotionnelle et matérielle, influençant leurs adoptent, rejettent ou réinterprètent les notions médicalisées de l’obésité. Je le fais en examinant les motivations des personnes en obésité à subir une chirurgie bariatrique, ainsi que les transformations physiques, physiologiques, identitaires et sociales qui découlent de ce processus. Je fais valoir que la décision de recourir à la chirurgie de perte de poids n’a pas pour seul objectif l’amélioration de leur santé actuelle et future, mais vise également à obtenir une corpulence conforme aux normes sociales, qui leur permet d’accéder à certains espaces communs et partagés et de remplir des rôles sociaux spécifiques. Je montre que les participantes ont fait l'expérience d’un stigmate attentes à l’égard de la chirurgie, ainsi que leurs expériences de ses effets multiples et parfois contradictoires. J’analyse comment cet objectif de normalisation corporelle est atteint au prix de l’acquisition de nouvelles formes de chronicité, dont la gestion reconfigure le rôle de la patiente et la relation entre la patiente et le médecin. En analysant les contradictions propres à la clinique de l’obésité, cette analyse réinterprète le processus de biomédicalisation comme une logique de substitution ou de déplacement de la chronicité plutôt que de normalisation ou d’optimisation. / Drawing on the sociology of technoscientific expectations and critical disability studies, this thesis investigates the experiences of individuals diagnosed with obesity or morbid obesity who have undergone bariatric (weight loss) surgery. While the fight against obesity has long emphasized lifestyle changes, public health discourse has taken on a more urgent tone since the early 2000s, labeling obesity as an "epidemic” justifying radical interventions. Concurrently, the stigma against excess body weight has intensified, and the number of bariatric surgeries has grown exponentially, particularly among women. I argue that these concurrent phenomena should be understood within the framework of an "economy of hope" that encompasses the expectations of public health advocates, obesity researchers, bariatric surgeons, individuals with obesity, and their closed ones. Within this dynamic, the bariatric clinic becomes a site where multiple definitions of "obesity" and different health priorities intersect and collide. Using semi-structured interviews with bariatric patients and clinicians, I investigate how patients either adopt, reject, or reinterpret medicalized notions of obesity. I achieve this by examining the motivations of individuals with obesity for choosing bariatric surgery and the ensuing physical, physiological, identity, and social transformations. I argue that the decision to undergo weight loss surgery is not solely driven by a desire to enhance current and future health but also to attain a body shape that aligns with societal norms, enabling access to shared spaces and the fulfillment of specific social roles. I demonstrate that participants experience a stigma that manifests itself in discursive, emotional, and material ways, shaping their expectations regarding surgery and their experiences of its multifaceted and at times contradictory effects. I analyze how the pursuit of bodily normalization leads to the acquisition of new forms of chronicity, which, in turn, reshapes the patient's role and the patient-physician relationship. By highlighting the contradictions within the clinic of obesity, this analysis reinterprets the process of biomedicalization as a logic of substitution or shifting chronicity rather than normalization or optimization.