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Purpose – This chapter explores how discourses of obesity as addiction are taken up by weight loss surgery patients and medical and scientific professionals.

Methodology/approach – Based on 14 semistructured interviews, I discuss the ways in which bariatric patients partially account for their presurgical bodies and contemporary struggles with weight loss and regain by referencing food addiction. This work is part of a larger project involving 35 interviews and participant-observation work and therefore these results should thus be considered preliminary.

Findings – I argue that bariatric patients and bariatric professionals portray weight loss surgery as an extraordinary tool that allows the “out of control” to become controllable. However, bariatric patients also emphasize the hard work that is entailed in both losing weight and maintaining a weight loss even after surgery.

Social implications – I suggest that this portrayal, in addition to being an accurate assessment of the potential for regain following weight loss surgery, is a technology of stigma management.

Originality/value – This work contributes to the sociology of the body and medical sociology literatures by illustrating that, within a neoliberal and anti-fat social context, highlighting the hard work involved in weight loss and weight maintenance allows bariatric patients to demonstrate proper subjectivity and thereby reclaim “proper selves” as they work toward a “proper bodies.”

In this chapter I explore how conflicting discursive claims made by the medical community are consequential for bariatric weight loss surgery patients. Bariatric surgery has become increasingly common in the United States since the 1990s, with over 177,000 Americans undergoing surgery in 2006. Despite the surgery's growing popularity, the US medical community does not wholeheartedly endorse the surgery. Rather, different members of the medical community espouse contradictory evaluations of weight loss surgery. I broadly characterize this intra-medical community controversy and, then, discuss how conflicting claims have helped shape the bariatric surgery industry's discursive conception of an “ideal patient.” Next, I analyze actual patients’ negotiations of the ideal patient archetype, and find that patients’ responses follow three paths: embracing the ideal, having a mixed response to the ideal, and strategically complying with the ideal. As patients are compelled to grapple with the ideal archetype in order to access surgery, I conclude that the ideal archetype acts as a discursive frame connecting individual patients to broad bariatric surgery discourses.

This study examines weight loss surgery patients’ experiences with vanity stigma. First, the research explores if and how vanity stigma occurrences differ for female and male surgery patients. Second, the research interrogates the role of this stigma in shaping patients’ feelings about their bodies.

The data stems from qualitative interviews (n = 44) and surveys (n = 55) with pre-operative and post-operative weight loss surgery patients. The author used narrative interview analysis to inductively identify and analyze prevalent themes.

Participants’ stigma experiences are differentiated by gender. Approximately half of female participants reported perceiving vanity stigma. Women who faced negative accusations were likely to distance themselves from such claims by citing personal disinterest in their bodies, whereas women who did not perceive vanity accusations were likely to express approval and pleasure in their post-weight loss bodies. Men, in contrast, were not accused of vanity. Men frequently characterized their post-surgical, post-weight loss bodies as having utilitarian value.

The study concludes that gender norms play a role in shaping bariatric surgery patients’ experiences with vanity stigma and body-related feelings. Limitations include the small number (n = 9) of male participants and the lack of a representative sampling frame for bariatric surgery patients.

Previous studies have not explored how gender shapes bariatric surgery patients’ experiences with appearance-related social scrutiny. This chapter adds to existing research on gendered body norms and reveals gendered dimensions of vanity stigma.

Evidence suggests high rates of psychiatric disorders in bariatric surgery candidates (e.g. Mitchell et al., 2012), although no rigorous studies have examined the prevalence in a Canadian sample. Improved understanding of the prevalence of psychopathology among female patients is an important area of study, as females comprise approximately 80 percent of surgical candidates (Martin et al., 2010; Padwal, 2005). The purpose of this paper is to assess the prevalence of Axis I disorders and associations with quality of life in a Canadian sample of female bariatric surgery candidates.

Female patients (n=257) were assessed using a structured psychodiagnostic interview and completed a health-related quality of life questionnaire.

Results indicated that 57.2 percent of patients met DSM-IV-TR criteria for a lifetime psychiatric disorder and 18.3 percent met criteria for a current psychiatric disorder. Major depressive disorder was the most common lifetime psychiatric disorder (35.0 percent) and binge eating disorder was the most prevalent current psychiatric disorder (6.6 percent). Patients scored significantly lower than Canadian population norms on all domains of the SF-36 (all p's<0.001). Patients with a current Axis I disorder also reported significantly worse functioning on four mental health domains and one physical health domain (p's<0.01) compared to patients without a current Axis I disorder.

Results confirm high rates of psychiatric disorders in Canadian female bariatric surgery candidates and provide evidence for associated functional health impairment. Further study is needed to elucidate how pre-operative psychopathology may impact female patients’ post-operative outcomes.

Patients in secure units are at high risk of obesity because of antipsychotic medication, restrictions on freedom, and poor motivation to eat healthily and exercise. The aim of this paper is to investigate how consultant forensic psychiatrists address weight management, particularly with respect to inpatients.

Based on a review of the literature, a structured questionnaire was developed and piloted locally. After revising the questionnaire, it was sent to all 442 consultant psychiatrists listed by the Royal College of Psychiatrists as having a special interest in forensic psychiatry.

A total of 183 usable questionnaires were returned (response rate 45.9 per cent). Most respondents monitored patients' weight and had some access to a dietitian. Respondents rated a median of 40 per cent of their inpatients as obese. A total of 68.9 per cent said their patients did not have unrestricted access to food. Use of weight loss drugs such as orlistat was infrequent. A few patients had been referred for bariatric surgery but most had been judged unsuitable.

The responses reported in this paper are based on participants' self‐report and have not been confirmed by independent observation. Further research is needed to determine which weight loss measures are effective for psychiatric patients in real‐life situations.

Obesity appears to be common among forensic inpatients despite weight monitoring, dietetic interventions and exercise programmes. Comprehensive and continuing efforts are needed to help patients lose weight and lead healthier lifestyles.

This survey reports on clinicians' views and clinical practice.

Purpose – We study weight loss communities to contribute to the understanding of how gifting, sharing, and the relationship between them allow individuals to pursue status transitions for a social identity.

Methodology – We employed archival netnography to capture emic experiences for a stigmatized circumstance in American society. We analyze data from four communities to obtain a broad range of consumer experiences within fee versus free communities.

Findings – We explain how individuals differentially employ sharing and gifting to create and sustain communities in support of status transitions within a social identity. Further, we describe roles of gifting, sharing, and prosumption, and their contributions to the transformative process of weight loss.

Research limitations/implications – The data comes from communities that may be viewed as stigmatized within the United States, one cultural milieu. Future research should examine these concepts across additional contexts and cultures.

Practical implications – Our analysis reveals the basis for virtual community development in support of status transitions. These results underscore the necessity to examine how consumers co-opt market resources to enact private, albeit life altering, goals.

Originality/value of paper – Most extant literature focuses either on gifting or sharing with little attention to how consumers employ community and membership to achieve personal goals. Our research articulates how individuals employ market resources to enact customized rituals and achieve individual goals within communities.

The purpose of this paper is to assess multidimensional body image concerns in a sample of obese women seeking bariatric surgery at an outpatient hospital clinic in Hamilton, Ontario, Canada.

A sample of obese adult women seeking bariatric surgery at an outpatient medical clinic in Hamilton, Ontario, Canada (n=148) completed various self-report measures of body image concerns, including body image dysphoria, body image quality of life, body image investment, and appearance satisfaction. Participant scores were compared to normative data. Correlations between body image concern measures and body mass index (BMI) were examined.

Participants endorsed more body image dysphoria, more negative body image quality of life, and less appearance satisfaction than normative samples. BMI was not correlated with body image concern scores.

Interventions aimed at reducing body image disturbance in obese women should target multiple components of body image concern. Decisions about who should receive interventions should not be based on BMI status.

The majority of research on body image concerns focuses exclusively on evaluative constructs such as body image dissatisfaction. The current study examined affective, cognitive, and behavioural body image constructs. A better understanding of the multidimensional nature of body image concerns in obese women seeking bariatric surgery informs the development of effective, targeted interventions.

Addresses how flow times and capacity calculations can be made for a service process such as the Bariatric Surgery Center at a clinic. Highlights how these calculations can be made for a service process just as in any manufacturing setting. Discusses the notions of critical paths and bottlenecks and what factors affect both time and capacity. Also, discusses the relative profitability of two types of bariatric surgery, the goal being to link product profitability to the process.