Experiencias narrativas de pacientes obesos antes y después de someterse a cirugía bariátrica

Abstract

The existence of an obesity epidemic has become a mainstream truth claim in our society, favoring the medicalization of the fat body. The medicalization of weight through obesity has been indicated as a facilitator to stigmatize fat people. Individuals who are considered suitable for bariatric surgery are a particularly vulnerable group because they are at one end of the scale used to classify body weight, and their size makes them a central target for moral censure. However, the debate on fatness and its medicalization often neglects the daily experiences of people living in these situations. The aim of the present PhD thesis is to examine the experiences of people who have been clinically classified as obese and have decided to undergo weight reduction surgery in a narrative way. Taking into account both preand post-bariatric surgery experiences, this PhD thesis focuses on examining: a) the ways in which people who are considered to be obese patients explain their decision to undergo bariatric surgery and cope with the stigmatization that such a decision may represent; and b) the identity dilemmas that the decision to undergo weight loss surgery and subsequent transformation of the body entails. Seeking a wide variety of participants, 23 patients (15 women and 8 men) took part in the study, each of whom had been selected to undergo bariatric surgery in either public or private health centers. After obtaining their informed consent, each participant was interviewed in depth before and after receiving the bariatric surgery, over a period of approximately two years. The interviews were recorded and subsequently transcribed for analysis. To examine the stories told by the participants in accordance with the narrative resources available to them socially and culturally, the interviews were analyzed through dialogic narrative analysis. In line with this type of analysis, the data were examined by considering not only what the participants recounted, but also how they did so. The aim was to analyze the themes they addressed as well as the effects they tried to create with their stories. The results showed that, prior to undergoing surgery, the participants made an effort to justify the origin of their weight, their failure to control it, and the irremediable decision to undergo surgery as a last resort to solve their weight problem. When explaining the origin of their fatness, the participants relied mainly on genetic, biological, and personal factors, with hardly any mention of structural or social factors. Their explanations of the origin of their fatness paved the way for presenting themselves as being sick and advocating surgery as a medical solution that they were deserving of. In addition, apart from the physical limitations and health problems, the participants had a history of suffering and of a deteriorated identity, so that the decision to undergo surgery was also shown to be an attempt to restore the damaged identity. This should be interpreted as a way of integrating their decision to undergo surgery into a coherent self. The bariatric surgery was, therefore, more than a medical solution, and reflected the identity dilemmas faced by the participants. After receiving the weight loss surgery, the participants' accounts revealed that the process was not perfect, as the interaction with their material body was decisive in the changing way they related to and explained the world. The results of this PhD thesis show that bariatric surgery is not only a medical intervention on the bodies of individuals, but also that it affects their identity process. Based on the results obtained in this research, several implications are outlined regarding the conceptualization of the obese patient and the medical practice of bariatric surgery.