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Technological Discipline, Obese Bodies and Gender: a Sociological Analysis of Gastric Banding Surgery

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Technological Discipline, Obese Bodies and Gender: a Sociological Analysis of Gastric Banding Surgery TECHNOLOGICAL DISCIPLINE, OBESE BODIES AND GENDER: A SOCIOLOGICAL ANALYSIS OF GASTRIC BANDING SURGERY A Dissertation Presented to The Academic Faculty by Lisa J. Borello In Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy School of History, Technology and Society Ivan Allen College of Liberal Arts Georgia Institute of Technology December 2013 © 2013 Copyright by Lisa J. Borello TECHNOLOGICAL DISCIPLINE, OBESE BODIES AND GENDER: A SOCIOLOGICAL ANALYSIS OF GASTRIC BANDING SURGERY Approved by: Dr. Willie Pearson, Jr., Advisor Dr. Jennifer Singh Ivan Allen College of Liberal Arts Ivan Allen College of Liberal Arts Georgia Institute of Technology Georgia Institute of Technology Dr. Wenda Bauchspies Dr. Karen Throsby Ivan Allen College of Liberal Arts Department of Sociology Georgia Institute of Technology University of Warwick Dr. Amanda Damarin Department of Cultural and Behavioral Science Georgia Perimeter College Date Approved: August 16, 2013 For my hero. ACKNOWLEDGEMENTS Writing a dissertation is certainly a labor of love – the long hours, the personal sacrifices, and the moments of doubt exist alongside the thrills of meeting deadlines, finishing a profound interview, joys of writing the perfect sentence, and hopes that somehow what you have done will make a difference to someone, most of all yourself. In some ways, the journey I undertook is analogous to those who have the gastric band, or any type of bariatric surgery, but I give those who elect to have surgery far more credit than myself – what they have done (and must do each and every day) I could not do. This dissertation could not have been conceived of nor written had it not been for the patients who opened up their lives and their hearts to me. I am grateful for and humbled by their kindness. I am eternally thankful for all the participants in this study who assisted me with this research and likewise generously gave of their time; their willingness to let me see, hear and experience things that not many people ever have the opportunity to do was critical to producing something of which I am proud. To express my profound gratitude to all is not enough. My gratitude always to God for giving me the strength and the courage to persevere through all the challenges; I may not know what His plan is for me yet, but I believe great things are ahead as long as I have faith. I thank my husband Kevin for his support, encouragement and willingness to sacrifice our time together so that I could finish what I began long before we met. While this past year has been trying at times, I know our family will face our next adventure with love and much, much laughter. I love you always and forever. To my parents, I am indebted to them for their unconditional love and unwavering support throughout my entire life and especially during this process – they saw me through many tears along the way and at times when I wanted to give up, iv they never let me falter or doubt my ability to finish this work. To one of my biggest supporters, Uncle Joe, I am humbled to follow in your esteemed footsteps. My deepest appreciation to my committee chair and advisor Dr. Willie Pearson, Jr. who has been a steadfast supporter, teacher and mentor ever since I first took his “Gender, Science & Technology” course in my first year of graduate school at Georgia Tech. I have been honored and blessed to have known you and I am so grateful for all the opportunities you have presented me with during my time at Georgia Tech. To my committee members, Dr. Bauchspies, Dr. Damarin, Dr. Singh, and Dr. Throsby – I am indebted to you for your insightful comments in improving this work and, most importantly, for your support of this project from its inception. In particular, I am grateful to you, Dr. Throsby, for your willingness to provide oversight on this project from overseas; I am so fortunate to have not only your scholarly expertise but also your mentorship. v TABLE OF CONTENTS Page ACKNOWLEDGEMENTS iv LIST OF TABLES ix LIST OF FIGURES x NOMENCLATURE xi SUMMARY xvi CHAPTER 1 INTRODUCTION 1 1.1 Study Scope 4 1.2 The Obesity Epidemic in the United States 12 1.3 The Emergence of Bariatrics 17 1.4 Statement of the Problem and Purpose 33 1.5 Significance of the Study 35 1.6 Theoretical and Conceptual Orientation 37 1.7 Overview of the Dissertation 39 2 LITERATURE REVIEW 42 2.1 Obesity, Science and Weight Loss Surgery 42 2.2 The Social Construction of the Body 47 2.3 Gender, Science and Medicine 51 2.4 The Medicalization of Illness 61 2.5 Technological Development, Users and Gender 76 2.6 Summary 79 3 METHODOLOGY 80 3.1 Study Purpose and Overview of Methods 80 vi 3.2 Semi-structured Interviews 88 3.3 Participant Observation 107 3.4 Content Analysis 117 3.5 Data Analysis 119 3.6 Study Focus 125 3.7 Summary 128 4 THE RISE (AND DEMISE?) OF THE GASTRIC BAND 130 4.1 Selling the Gastric Band 132 4.2 (De)Constructing the Gastric Band 135 4.3 Summary and Conclusions 191 5 GENDERING THE GASTRIC BAND 194 5.1 Design for Everyone? Universalism and the Contradictions of Usage 195 5.2 ‘Piggers’, ‘Cheaters’ & ‘Emotional Eaters’: The Construction of the ‘Right’ (and Wrong) Patient 200 5.3 “I Wanted to be Around to See My Kids Grow Up”: Gender Norms, Idealized Motherhood and Breaking the Cycle of Obesity 215 5.4 Health, Appearance and Avoiding the ‘Sick’ Look 226 5.5 Summary and Conclusions 237 6 BANDED FOR LIFE? NEGOTIATING PERMANENCY AND REVERSIBILITY AMONG GASTRIC BANDING PATIENTS 243 6.1 Death, Extremity and Re-Defining the Natural 244 6.2 The Foreign and the Familiar: Banded Bodies and Technoidentities 252 6.3 ‘My Band and My Bones’: Permanency, Commitment and the Fear of Removal 267 6.4 Summary and Conclusions 280 7 THE ‘SCIENCE’ OF FILLS: MAINTENANCE, STANDARDIZATION AND PATIENT CONTROL 285 7.1 Maintenance, Hunger and the Search for the Elusive ‘Green Zone’ 286 vii 7.2 Subjectivity, Standardization and the Challenge of Post-Operative Management 298 7.3 Being ‘Tight’: Constriction, Restriction and Patient Control 310 7.4 A Piece of Plastic With a Mind of Its Own: The (Un)Intended Consequences of Living with a Gastric Band 325 7.5 Summary and Conclusions 334 8 CONCLUSIONS, LIMITATIONS, CONTRIBUTIONS, AND FUTURE DIRECTIONS 338 8.1 Discussion 338 8.2 Limitations 344 8.3 Contributions to the Field 346 8.4 Future Directions 348 8.5 Conclusions 354 APPENDIX A: INTERVIEW QUESTIONS: GASTRIC BANDING PATIENTS 357 APPENDIX B: CONSENT FORM: PATIENTS, SURGEONS AND MEDICAL PRACTITIONERS 359 APPENDIX C: INTERVIEW QUESTIONS: SURGEONS 362 APPENDIX D: INTERVIEW QUESTIONS: MEDICAL PRACTITIONERS 364 APPENDIX E: INTERVIEW QUESTIONS: TECHNOSCIENTISTS 366 APPENDIX F: CONSENT FORM: TECHNOSCIENTISTS 368 APPENDIX G: VEW SCORING RUBRIC 371 REFERENCES 373 viii LIST OF TABLES Page Table 1.1: Common Bariatric Procedures in the United States 5 Table 3.1: Overview of Methods and Data Collection 82 Table 3.2: Semi-structured Interviews 89 Table 3.3: Description of Band Patients (n=22), Select Demographics 94 Table 3.4: Information Sessions 111 Table 3.5: Support Groups 114 ix LIST OF FIGURES Page Figure 1.1: Adjustable Gastric Band, Allergan’s LAP-BAND 9 Figure 1.2: Anatomical Representation of the Gastric Band 9 Figure 4.1: Billboard Advertising the LAP-BAND 151 Figure 4.2: Ethicon’s “IT’S TIME TO DRAW THE LINE” Campaign Poster 179 Figure 5.1: Allergan’s ‘Success Story’ 225 Figure 7.1: The ‘Green Zone’ 295 x NOMENCLATURE Adjustment Also termed a ‘fill’, it is the process of adding or removing saline to or from the gastric band via a port. The purpose of adding fluid is to induce satiety. Band patients generally have their first adjustment four to six weeks after surgery. Allergan, Inc. Irvine, California-based biomedical firm that manufactures and sells the LAP-BAND. Allergan also sells Botox, Latisse, and other cosmetic products. American Society of Metabolic and Bariatric Surgeons (ASMBS) The largest professional association for bariatric surgeons in the United States. Previously named the American Society for Bariatric Surgery (ASBS); ASMBS has more than 4,000 members. Band Erosion Erosion of the gastric band through the gastric wall and into the lumen of the stomach; this is one of the most serious complications associated with the gastric band and requires surgical removal. Band Slippage When part of the stomach below the gastric band, migrates up through the band, requiring surgical intervention. Bandster Term for an individual who has gastric banding surgery and is engaged in the gastric band lifestyle. Bariatric Related to the field of medicine that deals with the prevention and treatment of obesity. Bariatric Surgeon A surgeon who specializes in the surgical treatment of obesity. Body Mass Index (BMI) The most widely used measurement for obesity. The BMI is calculated using a mathematical ratio of weight and height [(weight in kg ÷ height in meters2) or (weight in pounds ÷ height in inches2 x 703)]. A BMI of 30 or more is considered obesity. A BMI of 40 or more generally qualifies as morbid obesity. xi Comorbidity A medical condition that exists in addition to and/or is caused or worsened by obesity. Common co-morbidities associated with obesity include type 2 diabetes, hypertension and sleep apnea. Insurance companies generally cover bariatric surgery if patients have a BMI of 35 with a comorbidity. Dumping Syndrome A physiological reaction frequently seen following gastric bypass surgery.
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