Karen Synne Groven

‘‘My quality of life is worse compared to my earlier life’’ Living with chronic problems after weight loss surgery

Weight loss surgery is commonly regarded as improving individuals’ health and social life, and resulting in a happier and more active life for those defined as “morbidly obese.” However, some researchers have started to doubt whether these positive outcomes apply to everyone and this article explores this doubt further. More specifically, we focus on the experiences of women whose life situation became worse after weight loss surgery. The material draws on qualitative interviews of five Norwegian women undergoing the irreversible gastric bypass procedure. Our findings illustrate that the women lived seemingly “normal” lives prior to the surgery with few signs of illness. Worries about future illness as well as social stigma because of their body shape motivated them to undergo weight loss surgery. After the surgery, however, their situation was profoundly changed and their lives were dramatically restricted. Chronic pain, loss of energy, as well as feelings of shame and failure for having these problems not only limited their social lives but it also made them less physically active. In addition, they had difficulties taking care of their children, and functioning satisfactorily at work. Accordingly, the women gradually felt more “disabled,” regarding themselves as “outsiders” whose problems needed to be kept private. The results highlight some “subtle” consequences of weight loss surgery, particularly the shame and stigma experienced by those whose lives became dramatically worse. Living in a society where negative impacts of weight loss surgery are more or less neglected in research as well as in the public debate the women seemed to suffer in silence. Their problems were clearly present and felt in the body but not talked about and shared with others.

Dis-appearance and dys-appearance anew: living with excess skin and intestinal changes following weight loss surgery.

The aim of this article is to explore bodily changes following weight loss surgery. Our empirical material is based on individual interviews with 22 Norwegian women. To further analyze their experiences, we build primarily on the phenomenologist Drew Leder`s distinction between bodily dis-appearance and dys-appearance. Additionally, our analysis is inspired by Simone de Beauvoir, Merleau-Ponty and Julia Kristeva. Although these scholars have not directed their attention to obesity operations, they occupy a prime framework for shedding light on different dimensions of bodily change. In doing so, we were able to identify two main themes: The felt “inner” body versus the visible “surface” body and the “old” body versus the “new” body. In different, though interconnected ways, these main themes encompass tensions between changes the women experienced as contributing to a more “normal” and active life, feeling more accepted, and changes that generated ambivalence. In particular, their skin became increasingly problematic because it did not “shrink” like the rest of the body. On the contrary, it became looser and looser. Moreover, badsmelling folds of skin that wobbled, sweated and chafed at the smallest movement, aprons of fat hanging in front of their stomachs, batwing arms, thick flabby thighs and sagging breasts were described as a huge contrast to the positive response they received to their changed body shape when they were out and about with their clothes on. At the same time, they expressed ambivalence with regards to removing the excess skin by means of plastic surgery. Through their own and other women`s experiences they learned removing the excess skin by means of surgery could be a double-edged sword. By illuminating the experiences of the ones undergoing such changes our article offers new insight in a scholarly debate predominated by medical research documenting the positive outcomes of weight loss surgery.

Dilemmas in the process of weight reduction: Exploring how women experience training as a means of losing weight

Patients diagnosed with obesity are usually offered group-based behavior interventions which include dietary advice and exercise programs. In particular, high-intensity training—combining weight lifting with aerobic exercising—has been proven effective for losing weight. Moreover, recent studies have shown that persons participating in high-intensity training are more likely to maintain their weight loss compared to persons with lower levels of physical activity. However, most of the research in the field has made use of quantitative methods focusing on the measurable effect of such interventions. Therefore, the aim of this study was to show how the training is experienced from a first-person perspective, namely the patients themselves. Our hope was to shed some new light on the process of weight loss that concerns more than the measurable “impacts” of the training. A qualitative approach was used based on interviews with five women selected from a primary healthcare clinic in Norway. Our results show that experiences of training are connected to the participants’ general experience of being overweight. Both relationships to other people and earlier experiences are important for how the training is carried out and perceived. Five themes were identified supporting this line of argument: (1) the gaze of others; (2) a common ground; (3) dependence of close-follow up; (4) bodily discomfort as painful; and (5) aiming for results—an ambivalent experience. The results highlight the importance of finding the proper context and support for each patients needs.

Changing Bodies, Changing Habits: Women's Experiences of Interval Training Following Gastric Bypass Surgery

Patients undergoing weight-loss surgery are increasingly encouraged to change their lifestyles. Dietary interventions combined with physical exercise interventions are regarded as the most effective way to ensure that they do not regain the weight they have lost. Little research however, has been done on how patients who have had the surgery actually experience the process of changing their exercise habits. To help fill this gap, we investigated the experiences of women participating in a group-based rehabilitation program designed to radically transform these habits. Based on participant observation, and our interviews with 11 women in the program, we were able to identify a variety of potential benefits and negative consequences in group training, organized according to the interval principle. We also found that the experiences of these women were closely related to their views on how significantly the surgery had changed their lifestyle. Based on the experiences related by these women, we believe that the “effectiveness” of standardized group-based interventions for patients undergoing weight-loss surgery should be reconsidered. Some of the women in our study viewed the group-based standardized training intervention positively; others resisted it. Our research leads us to conclude that this type of program could be more successful if the forms of activity and their intensity were customized to meet the needs and desires of each participant.

Weight loss surgery as a tool for changing lifestyle

This article critically explores the tension between perceptions of weight loss surgery as a last resort and as a tool. This tension stems from patients’ doubt and insecurity whether expectations for a healthy life will come through. Thus, even after surgery, traditional weight loss methods, including diets and exercise, are considered paramount. Drawing on a series of interviews with Norwegian women, we argue that the commercialization of weight loss surgeries as well as the moral stigmas attached to such operations serve to perpetuate this tension. More specifically, the women were advised to leave their old habits behind, and embrace a healthier and more active lifestyle. In such a climate, we argue that undergoing surgery without subsequently embodying dietary and exercise norms is hardly an option. On the contrary, these become a moral obligation that modern women need to relate to—and perhaps negotiate—in order to repudiate stigmas attached to weight loss surgeries as a quick fix for those incapable of losing weight in the “proper” manner.

The experience of regaining weight following weight loss surgery: A narrative-phenomenological exploration

ABSTRACT Weight loss surgery (WLS) is gaining ground as the most effective treatment against obesity. In the literature, however, we see a divide among individuals who have undergone WLS based on the amount of weight lost and maintained: successful and unsuccessful patients. In this article, we focus on the notion of unsuccessful patients—exploring the accounts of three women who have regained weight following WLS. In doing so, we endeavor to better understand how weight regain has meaning, and its impact and implications for the lives of individuals who undergo WLS. The findings reveal how weight-regain stories are easily silenced, buried beneath social, cultural, and institutional/medical narratives of successful weight loss and transformation. People who have such experiences may feel reticent to reveal them and in doing so increase their own suffering, therefore leaving the popular narratives unchallenged.

Becoming a normal guy: Men making sense of long-term bodily changes following bariatric surgery.

Background To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leders perspectives on the “disappearing” and “dys-appearing” body, combined with a gender-sensitive lens that draws on Connells theory of hegemonic masculinity and Robertsons conceptions of embodied masculinity. Findings Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Conclusions Our findings point to the need to acknowledge mens ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value.Background To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leders perspectives on the “disappearing” and “dys-appearing” body, combined with a gender-sensitive lens that draws on Connells theory of hegemonic masculinity and Robertsons conceptions of embodied masculinity. Findings Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Conclusions Our findings point to the need to acknowledge mens ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value.

Manipulating practices: A critical physiotherapy reader

Physiotherapy with horses and rider-patients builds on communication and interaction through groundwork and mounted work. This chapter discusses outdoor equine-facilitated physiotherapy on green care farms with three patients representing ideal types from the author’s clinical practice. The practice of co-creation and improvisation, i.e. devising, is used to discuss how the triad of physiotherapist, rider and horse, work together to support the rider’s step-by-step changes towards better health. Being with horses facilitates exploration of communicative strategies and embodied ways of being, whilst nature and physical activities add value to the therapeutic benefits. Horses represent risk and desire, as does the facing of bodily constraints or habits. Physiotherapy equinefacil itated phys iother apy 195 aims to facilitate a purposefully created change by playing with daring (out-of-the-ordinary experiences when usual boundaries are pushed) and compassion. Therapist, rider and horse face dares and desire together by experimenting, improvising, and testing new modes of co-being and becoming. The ideas and tools from applied drama (i.e. collaborative creation and contact improvisation) tune human and horse bodies to communication and action. Outdoor practice and devising equip physiotherapists with a larger toolbox for a playful practice.

Negotiating options in weight-loss surgery : "Actually I didn't have any other option".

In this study we explore how a selection of Norwegian women account for their decision to undergo weight loss surgery (WLS). We argue that women’s descriptions of their experiences leading up to this choice of action illuminate issues regarding social norms of bodily appearance and personal responsibility. The starting point is women’s own experiences within a cultural context in which opting for WLS often attracts moral scrutiny. Inspired by Merleau-Ponty’s notion of consciousness as embodied and de Beauvoir’s ideas concerning women’s situation, we argue that bodily as well as socio-cultural aspects intertwine with women’s choice of surgery as a means of losing weight. Although society’s stigmatization of women with obesity has been well challenged by scholars in the field of critical fat studies, women with obesity still experience the bodily hindrances associated with being overweight in an intense and subjective way. The findings suggest that women confronting the option of WLS do so in a context of pain, dysfunction and social stigma, a combination which illuminates the intricate ambiguity of the obese body as both subject (of agency) and object (of moral and medical scrutiny).

“Then I Can Become Very Ill”: Women's Experiences of Living With Irreversible Changes in Their Viscera

Over the past 5 years, interest in weight-loss surgery has increased in tandem with the growing obesity epidemic in both Western and developing countries. In particular, scholars have documented the health promoting aspects of weight-loss surgery. Nevertheless, few researchers have explored the side effects, most prominently “dumping,” that frequently accompany weight-loss surgery. Building on the one previous qualitative study of dumping, I focused my research for this article on the challenges associated with limiting food intake. Based on interviews with 22 Norwegian women, all of whom had undergone the gastric-bypass procedure, I concluded that the women who had a history of struggling with overeating found adjusting their food intake after the surgery particularly challenging. Appropriate personalized support for individuals struggling to establish new eating habits after the surgery requires a thorough understanding of the challenges associated with adjusting food intake. In this context, the findings of this article should be of interest to an international audience.