Analizando la unidad didáctica y su defensa

suggested a variety of weight loss solutions including WLS options. Rosie recalled her brother-in-law’s promptings:

I’ve got this choice. Shall I have this or not?” And he said to me, “Rosie, you haven’t got a choice.” And I said, “Why do you say that for?” And he said… “If you don’t do something about your weight now, by the time you’re 60 you won’t only have diabetes and heart problems, but no one in the medical profession will want to touch you because you’ll have this myriad of medical problems which are all connected to each other caused one way or another through weight.

The fact that her brother-in-law, a doctor, recommended the surgeon, “made me feel I

can trust the guy. He’s a good surgeon...He wouldn’t put me crook.”

Rosie’s medical “at risk” status was used to support WLS in a persuasive, clearly rhetorical and generalised medical language. As her brother-in-law and friend, his advice was ethically compromised. The surgeon was recommended on the basis of a successful appendix operation for his son, an operation he had been invited to attend. The invitation had raised the surgeon’s standing with Rosie’s brother-in-law and may have blurred his vision in relation to the greater complexity of the surgery he was

recommending for Rosie. Rosie was not encouraged to consider aspects of new surgeries such as the surgeon’s experience or success rates. Her brother-in-law focused on Rosie’s weight.

Scrapper and her friend chose WLS and had surgery on the same day. Pinky’s mother attended a WLS lecture, informed Pinky about the surgery and paid for her lapbanding. SusieB’s sister-in-law suggested lapbanding following a cousin’s procedure. Meryl’s friend advised her about surgery following another friend’s WLS in Australia.

Lapbanding came to the market as the use of the Internet for research purposes by the general public was burgeoning. Pinky accessed academic databases available within her institution; Karlie had become used to researching her health options and had access to medical researchers employed by her brother, a breast cancer specialist. Karlie and her doctor/daughter researched options for weight control to assist her continued mobility:

I went to Dr M2 and he said that because I wasn’t obese enough, it wasn’t something that he would just do and also because I had cancer and MS I had to prove to him that it would be worthwhile to do. So then we got on and my brother found a surgeon that had done it, in America, for someone with MS and it had made a big difference to their lifestyle.

Michelle used her Internet research skills to investigate lapbanding: “I didn’t need a doctor to tell me whether it was good bad or indifferent. I wasn’t looking to a doctor for that.” Michelle’s research included contacting the company producing the lapbands. When a friend suggested WLS to Meryl, she investigated the New Zealand Health and Disability Commissioner’s website. Although one complaint was essentially anonymous, Meryl referred to the surgeon by name: “(He) was very dismissive of her and I got the sense that he was really derogatory to her.” Meryl decided against the surgeon and the lapband. She then discovered the New Zealand bypassers’ website, read the postings and placed her own question: “How could it be that a woman who’s been so successful in all these other areas of her life can fail so spectacularly at weight- loss?”

WLS for Shona began on Atkins-diet Internet sites which led her to “before and after” photos of people on WLS support-group websites. Shona discussed potential

and what is public have been obscured in this Internet environment (Eysenbach & Till, 2001). Sharing the bond of being involved in WLS allowed intensely meaningful relationships to develop and decisions about proceeding to WLS were influenced within this environment. Their significance was underlined by the presence on these sites of company representatives who might act to “cut off any problems as soon as someone posts a problem” (Michelle, email). Surgery practices/doctors’ receptionists were also tracing the postings. “We are not alone” (Michelle, email) and “We need a place to vent and be open” (Michelle, email).

Three participants developed websites referencing information amassed in their own searching. Information on these websites ranged from personal experiences of WLS, societal attitudes to thinness and weight-loss, dieting, comparisons between different surgical procedures, information about surgeons, and the geographical availability of particular surgeries. Michelle also summarised the FDA transcripts involved in the application for registration of gastric lapbanding procedures in the United States.

These were resourceful women, attempting to improve their lives. They developed relationships that supported their choices and most did considerable research into the proposed WLS. Davis (2003) has argued that choosing cosmetic surgery procedures may be both agental and reasonable options for women who wish to improve their lives. I suggest that WLS choices may be described as agental within the limits of choices shaped by the type of information that participants were able to access and the cultural lure for thinned bodies that was difficult to resist (Bourdieu, 1984; Fields, 2004). The internalisation of thinned body norms, the assumption of personal responsibility for weightfullness and the medical sanctioning of WLS impelled participation in these radical procedures.

7.4.2.3 The “hailed” WLS patient.16Some participants were introduced to WLS

in a medical consultation. In her late twenties, Michelle consulted an endocrinologist about her weight and gastric bypass was recommended. Initially grief-stricken and overwhelmed by this medical opinion, Michelle recalled asking herself, “Why do I have to? I really felt sorry for myself then” (laugh). The laugh contained her grief at living large for much of her adult life and the possibility that radical interventions would be required to control her weight. Having dismissed the open gastric bypass in the early

16_{This refers to Bourdieu’s conception of citizens being interpellated or hailed into subject positions} which we are already primed to accept through their availability within the ideology or belief systems in which we are absorbed (Butler, 1999a).

1990s, she was primed for less radical surgery options: “It softened me towards the idea” (Michelle). Her concerns were ostensibly addressed by this new WLS:

(The endocrinologist) kind of opened the door in a way and then this one seemed that that cost-benefit analysis worked a bit better for me… the fact that it wasn’t permanent, the fact that it didn’t interfere with my normal, the way things worked, and that kind of stuff that yeah.

The endocrinologist’s opinion acted as the proverbial thin end of the wedge for Michelle. Already interpellated through the myriad of ways in which modern citizen/patients may be hailed, in the absence of words or alongside the words without conscious awareness of being continuously hailed, Michelle consults the designated expert. Citizens enact patienthood in seeking consultations. Within consultations, patients are exposed to medical dicta reinforced by the intimidatory power of non- verbal cues (Bourdieu, 1991). Michelle, patient-ed17 in relation to weight, accepted that WLS options were medically indicated for her. As a rational consumer, Michelle determined that she was making the best decision possible.

Patients are continually hailed into their patient-hood: The person called from the waiting room responds, more or less, as a patient, an “enabling vulnerability” (Butler, 1997, p.2) in a process of interpellation. The patient/doctor consultation opens up possibilities for positive health interventions as it also opens patients to the subtle coercions implied in the symbolic positioning of the doctor as expert. When gastric bypass was first suggested to Susie B by her GP, she turned it down because, “I’m not ready to die (and) because I didn’t know enough about it.” When an apparently safer, less radical option of lapbanding became available, she approached her GP for a referral even though she was “terrified at the thought of surgery, because everything I’ve ever had done in my life has always gone wrong and this terrified me.”

Doctors and specialists suggested WLS both in reaction to their own concerns about risky weight and to those of their patients, alerted to new technologies by surgeons and technology companies. Doctors described such ‘suggestions’ as casual or reactive but participants interpreted them as serious medical pronouncements about their health. The objectivity of these opinions tended not to be questioned. Even when suggestions were “lightly given” (SusieB), they were taken seriously. Encultured thinned weight preferences and weightfull-body discourses interspersed with injunctions to lose weight

within consultations are framed as the words of an expert. They are uttered when people are vulnerable in being a patient (Roter & Hall, 2006). Even seemingly insignificant but persistent persuasions, such as those being experienced by Hine, may eventually lead to WLS. When women had been advised to consider WLS, choosing not to have such a surgery became less possible.

7.4.2.4 Framing slim as healthy. Most participants just wanted to be slim. This