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Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic bypass costs, complication rates, readmission rates, and post-operative care.

Objective. To examine the 6-month costs and outcomes of laparoscopic vs. open bariatric bypass surgery using a national population-based sample.

Design. We use the 1998–2003 Nationwide Inpatient Sample to examine national trends in the rate of laparoscopic bypass. To examine post-operative outcomes, we examine insurance claims for 2,384 bariatric bypass surgeries, at 308 hospitals, among a population of 5.6 million non-elderly people covered by large employers across 49 states in 2001 and 2002. Multivariate logit regression analysis is performed to risk-adjust outcomes.

Main Outcome Measures. 180-day outcomes: 12 complications specific to bariatric surgery and 44 general post-operative conditions, readmission rates, ER rates, and expenditures following bariatric surgery.

Results. Between 1998 and 2003, the national percentage of bariatric bypass surgeries that were laparoscopic grew from 1.5 to 17.1%. There was no significant difference in in-hospital mortality between laparoscopy and open surgery. With the 2001–2002 claims data, we find that of the patients having bypass surgery, men had 48% lower odds of having laparoscopy and that high bariatric volume hospitals were close to four times more likely to use laparoscopy. Laparoscopic bypass, compared with open bypass, had 34% lower odds of a complication during the initial surgical stay, 27% lower odds of a 30-day complication, but no statistically significant difference in 180-day complications. Laparoscopy had 49% higher odds of having the general 44 post-operative conditions, with 45% higher odds of a readmission and 54% higher odds of an ER visit. However, overall, laparoscopy resulted in a 23% lower number of hospital days and 9% lower 180-day expenditures.

Conclusion. The laparoscopic cost-savings during the less invasive initial surgery stay outweigh the increase in post-discharge utilization. Further cost-savings will only emerge from laparoscopy only if its late post-operative complications are reduced. More cost-savings will also emerge as more physicians switch to the use of laparoscopy for bypass surgery.

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.

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.”

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.

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.

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.

This chapter analyzes the tourism industry from national and regional perspectives, in order to understand the past and current trends in Costa Rica’s positioning and branding attributes and strategies for tourism development. The intent here is not to provide an exhaustive comprehensive literature review of academic research on country branding; and so it is by all means a case study as it describes the evolution of the tourism industry in Costa Rica – including the transformative stages the country went through since the 1980s – as planned tourism national management programs evolved toward reaching the target of creating a nature-based tourism brand. The medical industry and then medical tourism industries are analyzed in a global basis and the US market is examined in detail because of its potential to develop a new complementary niche for Costa Rica’s tourism industry. The chapter intends to asses Costa Rica’s potential to become a country brand in medical tourism, leveraged on its natural tourism destination branding status quo.

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.

This paper aims to examine challenges and prospects of the Malaysian Islamic medical tourism sector and suggests strategies to leverage the strengths and opportunities as well as overcome the weaknesses and threats.

A series of semi-structured interviews were conducted with the Islamic hospital managers. Information collected was transcribed and content analysis was used to group the variables into the four SWOT categories.

The SWOT analysis identified several strengths (e.g. great hospitality, country’s characteristics and development of Islamic compliant hospital), weaknesses (e.g. low international certifications), opportunities (e.g. growing Muslim populations, Sept 11 incidence) and threats (e.g. competition from major medical tourism market and non-uniformity of Islamic medical tourism standards).

This paper could provide understanding of the sector and fundamental on the Islamic medical tourism market. Yet the SWOT analysis does not indicate how to achieve competitive advantage and result may become obsolete, with the dynamic environments.

This paper could serve as a guideline for the industry stakeholders to have better understanding in their business environment.

This paper is the first of its kind to integrate SWOT analysis and Islamic medical tourism industry. Hence, the findings could broaden knowledge on Islamic medical tourism industry and facilitate firms in tapping the growing market.