Kaitlin Smith
Anthro 327 (ULWR)
Prof. Elizabeth Roberts
8 November 2016
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Examining Implications of Free Will, Individualized Stigma, and Institutional Interest in “Bariatric Surgery: The Solution to Obesity?”
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The New Yorker’s article, “Bariatric Surgery: The Solution to Obesity?” by Rivka Galchen investigates obesity in the United States, evaluating the foundations and catalysts of its growth and the sustainability of different solutions for individuals and society. Profiling peoples’ experiences living with obesity, she examines the emotional implications of its stigmatization and treatment, and lifestyle improvements after weight loss. In addition to medical research, these case studies support her assertion that bariatric surgery is a more effective weight loss method than diet and exercise. However, Galchen emphasizes the need for population-wide preventative measures facilitated by medical, corporate, and political leaders. Galchen also evaluates institutional interests that conflict with both preventative and corrective obesity treatment. The article’s analysis of obesity explores complex relationships between free will and eating habits, perceptions of society and the individual, and institutional interest and healthcare. Applying medical anthropological ideas to Galchen’s research and evaluation illuminates certain elements of these relationships, challenging conventional ideas about choice in obesity, and raising questions of who is responsible for proliferating preventative or corrective treatment.
This paper seeks to provide insight into these questions by applying ideas from anthropologists A. Jamie Saris, David Horn, Monica J. Casper, and Adele E. Clarke. A. Jaime Saris challenges conventional ideas about medically acceptable drug consumption, and applying his concepts to Galchen’s article problematizes the way she attributes choice to bariatric surgery. Drawing on David Horn’s ideas about misinterpretations of individual behavior, this paper will also elaborate on Galchen’s portrayal of the misconceptions surrounding obesity. Finally, this paper will explore Galchen’s evaluation of the institutional interests that conflict with certain obesity mitigation efforts through the lens of Casper and Clarke’s examination of the popularization of the Pap smear.
The Role of Choice in Bariatric Surgery
Galchen’s depiction of the relationship between free will and weight loss is challenged by concepts explored in A. Jaime Saris’ article, “Committed to Will.” In “Committed to Will,” Saris questions conventional ideas about addiction, suggesting that free will is compromised not only in cases of addiction, but also in circumstances of medically regulated and socially acceptable drug consumption. He explains that the goal of many biomedically-regulated drugs is the achievement of a conventionally normal state of mind, and thus the recovery of free will. In these situations, a person is seen to have, “ascribed or achieved deficits needing pharmacological correction for individual choice to function at all” (Saris 2013:273). Similarly, Galchen suggests that for obese people, the recovery of choice is a primary goal of weight loss. She cites issues of obesity-related infertility, difficulties in mobility, and job limitations as negative effects of obesity, all of which inhibit individual freedom to make life decisions. Further, she suggests that successful weight loss allows patients to realize the goal of conventional normalcy: “For many people, the experience of weight loss is one of feeling like they can be themselves” (2016:12). In these ways, Galchen’s portrayal of weight loss is similar to Saris’ exploration of medically acceptable drug consumption. However, Saris challenges the hegemonic idea that medical intervention is unrelated to the implication of choice, problematizing Galchen’s portrayal of free will in different weight loss methods.
Saris implies that medical intervention to achieve a particular mental state implicates individual free will: “Entangled with this sense of effective psychopharmacology, however, is a rejected identity of the compound bound up with both recreation and dependence” (Saris 2013: 274). This concept can be applied to obesity patients, who pursue methods to achieve a particular physical state. Galchen implies that bariatric surgery is unrelated to free will by contrasting its success to the ineffectiveness of dieting, a method she suggests directly compromises individual choice. Galchen recounts an example of a patient who, after following a no-carb diet, allowed himself one bite of a waffle. As soon as he left for work, the man, “…literally pulled back into his driveway, went back inside, and ate three waffles.” (2016:8). In contrast, Galchen highlights an example of a man who underwent a surgical lap-band procedure. Quoting the man, she writes: “I know now that when I walk by the ice-cream aisle it’s not a problem for me anymore. I’m not even tempted – I really don’t want it” (2016:10). With this juxtaposition, Galchen presents non-surgical weight loss methods as having unexplained consequences for free will, and attributes bariatric surgery’s success to the fact that it does not produce the same side effects. However, Saris reveals the dichotomy of medical intervention to achieve a “normal” state, challenging the idea that dependency on bariatric surgery to achieve weight loss has no implications for free will.
Misconceptions of Individual Behavior With Conflicting Societal Interests
Analyzing the Italian government’s population management ideology in the 20th century in David Horn’s “The Power of Numbers,” reveals connections between America’s growing obesity problem and the perceptions surrounding the condition as described in “Bariatric Surgery.” In “The Power of Numbers,” Horn recounts how Italian leadership in the early 20th century designed population management programs to enhance the, “physical wellbeing of the social body” (Horn 1994:46). This so-called wellbeing was largely manifested in the objective of a growing population that could sustain a productive workforce and strong defense force. However, Horn reveals that Italian leaders were largely ignorant to the interests of individual citizens, despite the fact that these interests sometimes conflicted with leadership’s demographic ideals. For example, faced with the issue of low birth rates, leaders attributed the problem to the biological deterioration of reproductive instinct, rather than recognizing sociocultural factors like the individual benefit received from having a smaller family (Horn 1994:52-53). Horn’s analysis of the Italian government’s inability to understand the reasoning behind individual behaviors that conflicted with their goals for society is paralleled in Galchen’s description of individualized stigma surrounding obesity in the midst of a problem with societal implications.
In her article, Galchen presents metrics that indicate obesity is a population-wide epidemic. One third of the American adult population is obese, and two thirds are overweight (Galchen 2016:6). However, though these statistics indicate the existence of external influences with far reaching consequences, Galchen explains that the stigma surrounding obesity is attributed to a lack of individual discipline. Quoting William Dietz, Galchen explains: “Embedded in the stigmatization of obesity is the idea that this is something that people have done to themselves” (Galchen 2016:8). This attribution to the individual is reminiscent of the ways Italian leaders categorized low birth rates as a problem of, “biological rather than sociocultural origin” (Horn 1994:52). American society similarly fails to intuitively recognize the sociocultural factors that influence the population, revealing a similar misinterpretation of individual behaviors in the context of a population-wide epidemic.
The Influence of Institutional Interest on Health Program Development
Galchen’s exploration of the institutional influence in obesity treatment in the United States draws parallels to Monica J. Casper and Adele E. Clarke’s examination of organizational interests in relation to the popularization of the Pap smear in, “Making the Pap Smear into the ‘Right Tool for the Job.’” In their article, Casper and Clarke highlight the American Cancer Society (ACS) and the National Cancer Institute’s (NCI) avid support of the Pap smear, despite the fact that characterization of the screening as, “fast, cheap and accurate…has always been highly contentious” (Casper and Clarke 1998: 262). Casper and Clarke assert that the ACS and NCI supported the Pap smear for the purposes of furthering their reputations as prestigious research organizations. They also suggest that the support received from other medical agencies was the result of a desire to, “share in the newfound largesse” (Casper and Clarke 1998:262) of the increasingly distinguished ACS and NCI. In “Bariatric Surgery,” Galchen highlights institutional stakeholders that may similarly interfere with the population’s health, working against the proliferation of both preventionist and interventionist obesity treatments.
Galchen asserts that the institutions that profit from the growing obesity problem may hinder the proliferation of weight loss surgery and preventative efforts. Questioning why few obesity patients take advantage of bariatric surgery, Galchen writes: “Peddling new approaches to dieting is a multibillion-dollar industry. In one sense, bariatric surgeries are an addition to this market; in another, they are counter to it” (2016:3). Here, she suggests that the financial interests of the dieting industry contribute to weight loss surgery’s lack of popularization. Galchen also anticipates responses of companies that would be financially implicated by obesity prevention efforts, using the example of a sugar tax to reduce sugar consumption. Quoting a clinical psychologist, Galchen writes: “‘The sugary-drink companies will say, “But it’s salty snacks! Why are you targeting us?”” (2016:12). In their article, Casper and Clarke similarly support the idea that institutional interest has the ability to compromise popular and far reaching health treatments. When translated to the context of obesity and Galchen’s article, Casper and Clarkes’s arguments support the idea that effective obesity treatments and population-wide prevention efforts may be compromised by the power of corporations with conflicting interests.
Examining “Bariatric Surgery” through the lens of anthropological concepts detailed by A. Jaime Saris, David Horn, and Monica J. Casper and Adele E. Clarke allows us to further explore the concepts of free will, stigma, and institutional influence described in the article. Concepts from Saris’ “Committed to Will” challenge Galchen’s notion that surgical weight loss intervention is unrelated to the implication of free will. Horn’s analysis of the failure of Italian leaders to attribute sociocultural influences to behaviors of the population explains the disconnect between statistics about obesity and the stigma surrounding it. Finally, Casper and Clarke’s analysis of the ways institutional interest influences health program proliferation supports Galchen’s position that corporate financial interest may hinder the popularization of effective obesity treatment and impede the growth of large-scale preventative efforts.
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Works Cited
Casper, Monica J., and Adele E. Clarke. "Making the Pap Smear into the "Right Tool" for the Job: Cervical Cancer Screening in the USA circa
1940-95." Social Studies of Science 28, no. 2 (April 1998): 255-90. Accessed November 8, 2016.
Galchen, Rivka. "Bariatric Surgery: The Solution to Obesity?" The New Yorker, September 26, 2016. Accessed November 8, 2016.
Horn, David. "The Power of Numbers." Social Bodies, Science, Reproduction, Italian Modernity, 1994, 46-65.
Saris, A. Jamie. "Committed to Will." Compiled by Eugene Raikhel. Addiction Trajectories, 2013, 265-83. Accessed November 8, 2016.