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      Library of Congress Cataloging-in-Publication Data

      Names: Trainer, Sarah, author. | Brewis, Alexandra, author. | Wutich, Amber, author.

      Title: Extreme weight loss : life before and after bariatric surgery / Sarah Trainer, Alexandra Brewis, Amber Wutich.

      Description: New York : NYU Press, 2021. | Includes bibliographical references and index.

      Identifiers: LCCN 2020028182 (print) | LCCN 2020028183 (ebook) | ISBN 9781479894970 (cloth) | ISBN 9781479803958 (paperback) | ISBN 9781479879274 (ebook) | ISBN 9781479857265 (ebook other)

      Subjects: LCSH: Obesity—Surgery—Popular works. | Gastric bypass. | Weight loss. | Obesity. | Obesity—Social aspects. | Ethnology—Methodology.

      Classification: LCC RD540 .T73 2021 (print) | LCC RD540 (ebook) | DDC 617.4/3—dc23

      LC record available at https://lccn.loc.gov/2020028182

      LC ebook record available at https://lccn.loc.gov/2020028183

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      Also available as an ebook

      Contents

      Introduction

      1. Weight as Pathology

      2. Weight as Judgment

      3. Weight Loss as Success

      4. Weight, Worry, and Surveillance

      Conclusion

      Epilogue

      Acknowledgments

      Appendix A: Ethnographic Methods

      Appendix B: The Survey

      Notes

      References

      Index

      About the Authors

      Introduction

      Today, in much of the world, a fat body violates widely held social norms about how people should look. A body with weight deemed excessive by social or medical standards also brings social, economic, political, and emotional consequences, precisely because it does not meet now-dominant norms. Across different cultures and communities, fat individuals are perceived to be lazy and undisciplined. Perhaps the most powerful, overriding meaning currently associated with a fat body, however, is failure. The idea that one fails as a person because of one’s weight increasingly dominates in both local and global discussions about health, beauty, and other forms of human capital. This environment, in turn, may feed profound personal self-doubt among those who feel out of sync with body norms because of their weight—and this self-doubt may grow over time into outright emotional misery.1

      The broader context—a widespread avoidance and despising of weighty, fat bodies—is the starting point for the ethnographic case study we explore in this book. Here, we consider what it means to be fat, obese, and overweight through a detailed analysis of the words of patients undergoing a body modification commonly known as bariatric surgery or weight-loss surgery (WLS) in one large hospital system in the United States. “Why pay attention to bariatric patients?” we are often asked. The reasons are twofold. On the one hand, bariatric patients are uniquely placed as keen participant observers of the social meanings and implications of “being fat,” because they come to surgery with long, often fraught histories of having lived with a very large body. On the other hand, the surgery then rapidly transforms their bodies, triggering pronounced weight loss over a very condensed period of time. Postsurgery, it is common to lose half of one’s excess body weight within a year. This transformation of the physical, biological body thus provides us with a particularly illuminating lens for examining the role that body weight plays in how Americans in the twenty-first century United States define themselves and each other, in social, interpersonal, and emotional terms.

      Our ethnography traces out the body and identity transformations that people underwent as a result of massive, surgically induced weight loss. It is also an intimate portrait of the “hard work” that people with larger-than-average bodies are willing to do to live up to current societies’ stringent norms of thinness. In this book, we share stories of the sacrifices people were willing to make to meet these norms, the triumph that came when they attained them, and the deep sense of disappointment that emerged when they could not. The journey to profound postsurgical weight loss for bariatric patients is a far-reaching and painful one—and not just in physical ways. Many bariatric patients, who undergo surgeries that alter their stomachs and intestines in order to facilitate drastic weight loss, spend years before and after the surgeries struggling with their weight. They do so in part to be healthy but also because of a deep need to find thinner “true selves,” ones that align with wider social norms.

      The notion that every individual should be struggling to reach and keep a certain weight resonates with an astounding number of people today, whether they identify as thin, fat, or in between. Around the planet, doctors routinely weigh people from birth onward, give advice about how to achieve healthy weights through lifestyle choices, and talk about the pathological consequences that will ensue if a healthy weight or lifestyle is not maintained.2 People living in a country like the United States are subjected to a constant barrage of advertisements selling the idea that weight loss is easy—with the right product and the correct amount of personal willpower. Images of allegedly successful and desirable thin people are everywhere. People are accordingly enjoined to compare their bodies constantly to those of others, both real and airbrushed, and to constantly worry how well they are doing with personal body-based “improvement” projects.

      In this (now widely globalized) paradigm, weight loss is read as a personal success, whereas weight gain is seen as a personal failure. Many people who pick up this book, for example, have probably already worried at least once today about eating the “wrong” food or not putting enough effort into exercising. Many probably start the day with a look at their weight as told to them by a scale and then interpret the results not simply as pounds up or pounds down but as a commentary on individual worth. Up five pounds? That means one has “lost control” or is “not working hard enough.” Down five pounds? One must have been “good,” and the proof is staring back at them, reflected in the numbers on the scale.

      In this context, the emotional and social struggles of people dealing with extreme weight allow us to examine ideas about which bodies belong, which do not, and how that belonging is enforced or not. To have so many millions—actually, now billions—of people working daily to lose or maintain weight, even while the average weights of most populations