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The Stigma of Bariatric Surgery



That overweight and obese individuals face weight-bias and discrimination is no secret. It is also no secret that individuals who lose weight often experience significant positive changes in how they are treated by family, friends, colleagues and perfect strangers.

Interestingly, however, it turns out that these ‘positive’ attitudes to people, who lose weight, may very much depend on how these individuals actually managed to do so.

Thus, a study by Jasmine Fardouly and Lenny Vartanian from Sydney, Australia, just published in the International Journal of Obesity, suggests that knowing how the weight loss came about significantly determines the changes in weight bias following weight loss.

Participants (N=73) were first shown an image of an obese woman or a thin woman and asked to indicate their perceptions of the target with respect to the target’s behaviors (for example, how often she exercises), as well as some personality characteristics (for example, lazy, sloppy and competent).

Participants were then shown a more recent image of the obese target in which she had lost weight, and were informed that the target had lost weight through diet and exercise or through surgery, or were not provided with any explanation for the weight loss.

Regardless of the method of weight loss, all targets were rated as eating more healthily, exercising more, and being more competent and less sloppy after having lost weight.

However, participants also rated the target as less lazy when they learned that she had lost weight through diet and exercise, or when no information was provided about the method of weight loss, than if they were informed that the target had lost weight through surgery.

Or, as the authors point out:

“Weight-loss surgery patients may not be able to overcome the obesity stigma as surgery may be perceived as the lazy weight-loss option because of an assumption that it does not require effort and discipline that losing weight through exercise and dieting does. Thus, despite choosing to undergo weight-loss surgery to reduce weight stigma, obese individuals may continue to be viewed as conforming to the obesity stereotype, and hence be considered lazy and lacking in willpower.”

This certainly explains why many, who have successfully lost weight with bariatric surgery, will often not mention this to even their closest friends and why it may be awhile before gastric bypass surgery becomes to be viewed as as acceptable a treatment for severe obesity and its complications, as coronary bypass surgery is viewed as an acceptable treatment for heart attacks.

AMS
Edmonton, Alberta

Fardouly J, & Vartanian LR (2011). Changes in weight bias following weight loss: the impact of weight-loss method. International journal of obesity (2005) PMID: 21364528

15 Comments

  1. I’ve found this to be true in my own life. People who have raved about how much weight I’ve lost, how good I look, suddenly become very disapproving when they find out how I did it. I suspect that some of their disapproval is similar to the disapproval some people express for managing depression with antidepressants: somehow, it doesn’t “count” if you didn’t tough it out, do it without medical support, whatever.

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  2. It seems like we are always so ready to judge other people harshly, to criticize them, to belittle them.
    It’s really too bad.
    And from everything I’ve read, bariatric surgery certainly is NOT a “lazy weight-loss option” at all. Far from it.

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  3. Its true….

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  4. I lost my weight without surgery but found myself the center of gossip as to how I achieved this. The general assumption was that it was accomplished through surgery. I really could care less if I had accomplished this either way since both paths require tremendous effort. However, what I find disheartening is that the assumed chosen method, that of surgery, was perceived by others as a weak willed, lazy and somehow a less than commendable or ambitious route- a cop out. Since I don’t go around with a sign on my head stating how I lost the weight I am finding more and more that the initial response of others in not with a congratulations, but rather a down the nose inquiry such as-” You had surgery then?” When I explain it was through diet I find an immediate about face in attitude, somehow my effort and accomplishment is more worthy and special than surgical weight loss. Even after 4 years my old acquaintances forget how I lost my weight and I find them telling others it was through surgery. I don’t complain about this however, because it gives me the opportunity to educate others on the topic and to hopefully change attitudes about either approach.

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  5. Why is surgery the easy way out? It’s not like you don’t have to do all the mental work anyhow. I know a woman who had it done and lost weight, and when she goes out to dinner with friends, she can eat maybe a zillionth of what she’d like to to share the event with everyone, something like two tablespoons of food. With supplements that she has to track daily. It’s a giant pain in the backside for her, but she does it because she has to. That’s hardly an easy way out.

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  6. How do researchers determine how “lazy” or “competent” or “undisciplined” a person is?

    A group of participants can evaluate these attributes simply by looking at a person’s picture, but that in itself isn’t significant.

    What would be significant is not simply what attributes are perceived as being characteristic of the person, but how those perceptions differ from attributes which have been determined scientifically to be characteristic of that person (as representative of a group).

    For example, if you show someone a picture of a teenage boy, you might get responses that he’s likely to be impulsive and lack judgement.
    You could see that as bias and unwarranted stigma, but scientific studies show that, in fact, as a group, teenage boys have exactly those characteristics.

    (Of course, there is a problem here in extrapolating from characteristics of a group to characteristics of one particular individual. That particular teenage boy might be unusually cautious and mature in his judgement; his mother might be totally flighty.)

    If participants are shown a picture of someone they don’t know, they’re going to base their responses on general categories, especially according to how the study is set up. The picture isn’t an individual, it’s a “type”. The only comparison that can be made is how the participants’ perception differs from analysis already made in a scientific study of the attributes of that population.

    If the participants’ give the person a “negative” attribute, the tendency is to automatically blame bias or stigma. The assigning of a “negative” attribute is only bias if is is shown to be different from the scientific analysis of the attributes of a particular group. If there is no baseline to compare, there’s no way to tell if the the participants’ perception is biased or accurate.

    That goes for “positive” attributes as well.
    Maybe the participants see the weight-losers as ” eating more healthily”, whereas in fact the scientific study might show that weight-losers eat low-calorie but very unhealthy diets. The perception that people eat more healthily after weight loss would be biased if the scientific study showed the weigh-losers actually didn’t eat healthily.

    Any study of participants’ perceptions of certain attributes has to compare the participants’ perceptions to the actual attributes as shown in a scientific analysis.

    How would you analyze if someone is “lazy” or has “lack of willpower”? I’m sure a psychologist could set up a study so that there is a baseline to compare perceptions.
    The diet-exercise weight-losers and bariatric surgery weight-losers would each have profiles, scientifically determined. Then the perceptions of participants could be compared to these profiles, and it could be determined if their perceptions are accurate or biased.

    I personally don’t know how you’d measure “lazy”. (If someone goes for a bike ride in the morning, zumba class during lunch hour, and plays tennis in the evening – is that dedication to fitness or is that a selfish indulgence to avoid housework and child care? Who’s lazy, the busy mom or the exerciser?) However, if “lazy” is an attribute under discussion, it would have to be studied and evaluated so it could be compared to participants’ perceptions.

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  7. Great comparison to heart surgery!

    Dr. Sharma can you comment on today’s news media article that tells of doctors requesting that morbidly obese kids be removed from their homes and put in custody? Imagine a child answering the inquiry as to how he or she lost weight. “oh – authorities came to my house and took me away from my parents – doctors’ orders.”

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  8. I had Gastric Sleeve surgery in May and I haven’t told anyone outside a few friends and family. The reason… I don’t want to have to defend my decision or be ridiculed for taking the easy way out.

    There was nothing easy about being obese and struggling with my weight since I was 8 years old and I have committed myself through surgery to extreme behaviour modification- but there was nothing easy about the process or the mental work that goes along with the changes my body is going through.

    But in the end, when people know I’ve had most of my stomach removed- I tell them it was due to other health concerns and the weight loss is a happy side effect. I’m so happy with my new life, but I am ashamed of the measures it took.

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  9. In the UK, there was a furore when it was revealed that television personality Fern Britton had lost weight through gastric bypass and not, as was assumed, through diet. But then, she also chose not to reveal she’d had surgery, precisely because of the stigma.

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  10. so sad but true … I often say when asked “through portion control & exercise” … which is not really lying as I do control my portions. How I control them is up to me.

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  11. Thanks for the reference Dr. Sharma. The article I read did not show a picture. Interesting that my viewpoint has changed somewhat now that I see a picture. Also that I consider the pictured children to be far more than “just obese”. Begs the question of how obesity is defined in children. If these children in the picture were adults how much would they weight, comparably? 400 pounds? What would their body mass index be? These children are on their way to bariatric surgery already. They almost look like praeder-willie kids. It is a very sad situation that’s for sure!

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  14. I just wanted to say I was just told by a medical clinic that I am a good candidate to have surgery. I don’t know how I feel. My BMI is 45 my blood pressure is 128/80 I have osteoporosis and fibromyalgia and back problems. He put me down on the list and waiting for hospital to call me. He didn’t explain anything. I did ask him about the hanging skin?. He said not to worry about that. He said that theire will be sagging skin regardless which way I lose weight. The only reason I asked him about this is because my daughter had the surgery 15 months ago and she lost over 125 pounds and is happy most of the time but has some regrets. Do private clinics get a portion of the cost of doing the operation? Yes he told me it would cost $20,000. But no cost to me. I felt he just wanted me to have surgery and that’s it. I am going to go see a therapist about my eating habits. I will still have these bad mental eating habits even after having the surgery. I will get counselling and then have surgery. I was told I am lucky he told me I am a good candidate some people cannot have the surgery due to circumstances.

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