The type of surgery20 was significantly determined by geographical availability, costs, and, notions of relative radicalism.
7.5.1 Availability. WLS was chosen largely on the basis of it geographical availability. While most of the women and all of the doctors knew of gastric bypass surgery through the 1990s, much of that surgery was performed as private surgery in only one major New Zealand city. From the late 1990s, GPs and specialists who did not practice in the upper North Island21 were unaware of lapbanding procedures and did not suggest them to their patients (Doctors’ research transcripts). Although lapbanding received television and magazine coverage throughout New Zealand in the late 1990s, only surgeons in the northern New Zealand cities actively promoted it. Clover, Pammy and Janice opted for bypass, a decision framed by personal referral and geographical availability.
For Scrapper, Susie B and Michelle, lapbanding was their preferred surgery and it was available locally. They chose between two surgeons within a two-hour radius of their homes. Scrapper and her friend were patients 5 and 6 to have their lapbanding
19Pammy’s BMI was significantly lower than that usually required for acceptance.
20The research period was extended when it became obvious that WLS for these participants was not a one-off definitive cure for weight loss. At a number of junctures during their WLS journeys, participants faced deteriorating health, poor weight loss or regained weight and these required new decisions to be made about WLS.
operations: They both had young families and wished to avoid travel for surgery and follow-up appointments. Susie B was originally referred to a surgeon over two hours away: Unable to be fitted in for a surgery consultation “because it was Christmas time,” she was referred back to a less experienced, local surgeon. Michelle was also encouraged to use her local though relatively inexperienced surgeon. The referring surgeon suggested that this was about the risks of travelling to appointments.
Shona chose lapbanding with a surgeon who was operating in the town closest to her home. Turned down for the procedure, she was referred on for a laparoscopic gastric bypass in a city some hours away: “I’d proven by going to Pitona that I’d had no problem with travelling for the surgery. So he sort of said to me “Well, Pauataha is not that terrible a deal.” She had shown that she was prepared to travel for a form of WLS acceptable to her.
7.5.2 Intrusiveness, reversibility and costs. Shona was initially upset and rather shocked that “a surgeon would turn somebody away who was obviously quite desperate to seek that sort of help.” She refused to consider an open bypass in her local area because of its costs and long recuperation period. She spoke of “really hurt(ing) financially” in choosing WLS. Funding for these operations came from a variety of personal resources: Participants had increased mortgages on their homes, relied on some funding from medical insurance,22 sold property, or borrowed from friends and family. As Michelle wrote: “I had to decide whether I was happy continuing life as a larger person or trying a fairly non-invasive and reversible procedure which had the potential to free me from all that (Michelle, email). Clover’s original WLS cost her “an enormous amount of money” and she borrowed money for the second operation. In the revision consultation she focused on costs and negotiated a flat rate for her surgery to include any complications.
There were certainly people working in the aircraft industry, that knew I was having it done, suggested that it should be a warranty claim, because it would have been subject to a warranty claim if it had been a plane.
Clover paid $15,000 for her first bypass and her revision operation, by the same surgeon, was $21,000 at a time when first procedures were being charged at $18,000.23 WLS tended to be described on a continuum from more to less radical. Open bypass
considered less radical compared to an open bypass though more invasive than a lapband. Karlie’s previous cancer ruled out an invasive open procedure and she chose a laparoscopic bypass. Topsy described the bypass as “invasive.” Scrapper who originally investigated the Gastric Bypass decided that it was “just too invasive, you know, total open-up.” When Michelle’s lapband failed to produce long-term weight loss, she researched laparoscopic bypass as a “crappy option.” Its potential rested on the fact that she had not “heard of anyone not losing weight after the more invasive surgery”(Michelle, email). Michelle was lured to more radical bypass options by her knowledge and experience of the appearance and reported weight loss of those patients (cf. Blum, 2005).
Describing the open bypass operation as “the big cut,” Shona chose the laparoscopic version. She placed the surgeon “under orders not to go open. If he can’t do it, he’ll just close me up on the spot.” Her surgeon had described open bypass procedures as “basically butchery versus very, very technical surgery.” Shona pointed to the longer and more painful recovery times involved in open bypass as a major reason for choosing laparoscopy: As a single mother, she needed to be return to work as quickly as possible. Having originally sought the lapband for its reversibility, Shona resolved the dissonance of choosing bypass because of its laparoscopic method. She wondered aloud why she would have opted for reversibility if she were serious about weight loss: “Now that’s an interesting thing isn’t it? Why on earth would you want to reverse it?” What are discounted here are the very serious side effects that involve reversal of any form of WLS.