Technological discipline, obese bodies and gender: A sociological analysis of gastric banding
Borello, Lisa Joy
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America's obesity ̒epidemic̕, coupled with increasing use of biomedical technologies in healthcare, has helped usher in new technoscientific methods to medically manage the bodies of overweight and obese individuals. Potential patients now have several surgical options to choose from in efforts to lose weight and (potentially) improve health outcomes, including gastric bypass, sleeve gastrectomy, and gastric banding; this research focuses on the gastric band, an implantable and adjustable silicone device designed to restrict the amount of food consumed. This study involves: in-depth interviews with predominantly female gastric banding patients, medical practitioners, bariatric surgeons, and representatives from the two U.S.-based biomedical firms that manufacture the gastric band; a multi-site ethnography examining the patient experience and the clinical encounter; and content analysis of scientific and non-scientific texts. Through this mixed methodological approach, this study charts the band's evolution and the complex forces guiding its design, development and adoption, and draws attention to the ways in which gendered assumptions enter into the pre- and post-surgical space with repercussions for patient care. Findings suggest that patients̕ decision-making process is shaped by - and shapes - multiple social, political, economic, and regulatory contexts. As a contested and unstable technology, the band's efficacy and ̒foreignness̕ is continually both challenged and reaffirmed by a diverse arena of social actors with a vested interest in the bariatric surgical space. These actors construct the band's role in the obesity epidemic in oppositional ways, affecting its use and perceived misuse: the depiction of the band as a safe, less invasive and - most significantly - removable technology helps drive its use, directing some patients away from other options - specifically, the anatomically changing gastric bypass procedure - portrayed as unnatural and extreme, though simultaneously more effective. While the band's reversibility represents freedom over technology and control over their bodies, it also reflects patients̕ struggle for both autonomy and desire for technological assistance in managing their weight. However, despite patients̕ attempt to assert themselves as active agents, the gastric band emerges as a disciplinary weight loss technology which serves to reinforce the perceived need for clinical intervention in the care and treatment of obesity. This study contributes to our understanding of the possibilities and limitations offered by biomedical technologies, and the ways in which humans resist, comply or are ambivalent toward their adoption and use.