Understanding the Gendered Nature of Weight Loss Surgery: Insights from an Australian Qualitative Study

By Jose, Kim; Venn, Alison et al. | Health Sociology Review, January 1, 2017 | Go to article overview

Understanding the Gendered Nature of Weight Loss Surgery: Insights from an Australian Qualitative Study


Jose, Kim, Venn, Alison, Sharman, Melanie, Wilkinson, Stephen, Williams, Danielle, Ezzy, Douglas, Health Sociology Review


Introduction

Weight loss surgery is gendered, but existing research has rarely examined the factors that contribute to this process (Welbourn et al., 2014). Traditionally, the different surgical rates have been attributed to the greater appearance concerns of women or the fact that women are more likely to be classified as severely obese (body mass index, BMI ≥ 35 kg/m2) than men (Keating et al., 2015). While these factors may contribute to the difference in surgical rates between men and women, these factors alone fail to account for the complex ways in which gender and the cultural ideals of masculinity and femininity influence individual experiences and social practices (Broom, 2009). This study of the experience of weight loss surgery utilises an embodied approach to gender differences. It provides important new insights into factors influencing the differences in uptake of weight loss surgery and the experiences following surgery for men and women.

Globally, the proportion of men and women classified as overweight or obese is comparable (36.9% compared to 38.0%), but more women than men are classified as obese (BMI ≥30 kg/m2) (Ng et al.). Rates of weight loss surgery differ significantly according to gender with 75% of all surgical procedures undertaken internationally occurring in women (Welbourn et al., 2014). Gender differences were identified as priority research areas in the first International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) report (Welbourn et al., 2014) and qualitative researchers have also indicated a need to include more males into studies of weight loss surgery (Temple Newhook, Gregory, & Twells, 2015). While more women are classified as severely obese and hence, potentially eligible for weight loss surgery, a Canadian study of patient attrition following referral to a weight loss surgery program found that men were significantly less likely to proceed with surgery than women (Diamant et al., 2014).

Obesity is determined using Body Mass Index (BMI) which is calculated using an individual's height and weight. A BMI of between 25.0-29.9 kg/m2 is classified as overweight while a BMI of over 30 kg/m2 is classified as obese. For people identified as overweight or obese, advice about lifestyle modification (i.e. physical activity, nutrition and behaviour change) is recommended using a team care approach. In Australia, weight loss surgery is recommended when nonsurgical approaches have failed in people with a BMI of 35.0-39.9 kg/m2 (class 2 obesity) with an associated comorbidity or people with a BMI > 40.0 kg/m2 (class 3 obesity) (National Health and Medical Research Council, 2013). The most common forms of surgery are gastric bypass, gastric sleeve and laparoscopic gastric banding (LAGB) that aim to restrict food consumption and/or calorie absorption. Globally, rates of surgery have slowed in recent years after a period of rapid growth (Buchwald & Oien, 2013). In Australia, rates of obesity are the same for men and women (both 27.5%) (Australian Bureau of Statistics, 2013), however, women are twice as likely to be classified with class 3 obesity than men (Keating et al., 2015).

Cultural and social ideals of gender, masculinity and femininity create expectations for, and influence the form of, people's bodies (Connell, 2009). This process is dynamic and ongoing (Shilling, 2012; Turner, 2008). Men and women are socialised to differently value how they look and what they do with their bodies, focusing on how the body functions or its appearance (Shilling, 2012). In contemporary western cultures the ideal body shape for women is slim and firm (toned), with many women disliking their body size and shape (Bordo, 2003; Davis, 1995; Kwan & Trautner, 2009; Shilling, 2012). Meanwhile men are socialised to take pride in their body and its capability (Shilling, 2012). However, popular culture also idealises a male body that is strong, fit and muscular with a 'sixpack' stomach (Lupton, 2013; Monaghan, 2008). …

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