Academic journal article Health Sociology Review

The Meanings of Physical Appearance in Patients Seeking Bariatric Surgery

Academic journal article Health Sociology Review

The Meanings of Physical Appearance in Patients Seeking Bariatric Surgery

Article excerpt

Introduction

Humans interact with society, and the meanings of appearance are negotiated during social interactive processes (Stone, 1962). Goffman (1963)defined stigma as an "attribute that is deeply discrediting" (p. 3), and in his theory, obesity is characterised as a form of overt or external deformations, whose appearance violates normative cultural aesthetics of beauty. In most contemporary contexts, such a visually noticeable body condition as obesity puts a person in a highly vulnerable position for social rejection (e.g., Brownell, Puhl, Schwartz, & Rudd, 2005), thus negatively affecting the individual's quality of life (e.g., Link & Phelan, 2006) and psychological well-being (e.g., Friedman et al., 2005).

Like other important issues of the day, the social image of obesity, however, has drawn multiple perspectives, at times controversial, on obesity causation, blame, and intervention (Campos, 2004). Kwan and Graves (2013) have illustrated three framing approaches to deconstruct competing meanings about the fat body, which include the aesthetic, health, and choice and responsibility frames. The central claim of the aesthetic frame is that "the fat body is problematic, because it is physically unattractive" (p. 24). The advocates of this perspective argue that the source of fatness is personal failure, and the body is malleable within an individual's control. The health frame resonates the Centers for Disease Control and Prevention (CSC)'s perspective that "overweight and obesity are social problems because these conditions pose serious health risks" (p. 43). The central claim of the CDC is widely accepted in today's society, which acknowledges potential causes of obesity, including physical and biological factors (e.g., genetics and metabolism) and environmental, cultural, and socioeconomic factors. In this premise, the health frame blames overweight and obese individuals for their health failure, depicting the compliant body as a symbol of accomplishment. The choice and responsibility frame primarily asserts that "food consumption is a matter of individual choice and personal responsibility" (p. 71). Those who support this approach dispute the health researchers' claim, arguing that individuals have freedom to make their own decisions about what to eat and drink, and are responsible for the choices they make. In this frame, if an individual fails keeping the ideal body weight, the person tends to be criticised as "being lazy,""irresponsible," or "not intelligent."

Under these drivers, obesity is often viewed as the consequence of an individual's social, aesthetic, medical, and moral failure (Kwan & Graves, 2013), which forces the stigmatised individual to lose weight as a means to redefine his or her negative social image. While physical activities and nutritious diet are still common approaches to weight loss, a growing number of obese individuals are choosing surgical treatments (i.e., bariatric surgery) to lose weight (Dixon, le Roux, Rubino, & Zimmet, 2012), by reducing the stomach size to decrease the amount of food intake (Chikunguwo et al., 2009). Bariatric surgery, also known as weight-loss surgery, is currently considered one of the most effective solutions for successful weight loss and long-term maintenance (Picot et al., 2009). The global total number of procedures in 2011 was 340,768 worldwide (Buchwald & Oien, 2013), and in 2013, 179,000 patients underwent surgery in the United States alone (American Society for Metabolic and Bariatric Surgery, 2014).

Studies have suggested that obese individuals seeking surgical treatment tend to experience more severe impairment in their quality of life (e.g., physical health, social distress, selfesteem) than those not seeking treatment (Fontaine, Barlett & Barofsky, 1999; Kolotkin, Crosby, & Williams, 2001; Wott & Carels, 2010). While health reasons are the primary motivation for seeking the surgical procedures, improvement of non-health-related quality of life (e. …

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