Caring For Evidence: Research and Care in an Obesity Outpatient Clinic

ABSTRACT

In recent years, there has been a substantial increase in bariatric surgery rates. This form of obesity treatment is often subjected to the critique that it turns patients into passive objects of medical intervention. Similarly, efforts to ‘rationalize’ medicine, as in evidence-based medicine, are sometimes denounced for imposing a ‘one-size-fits-all’ approach that neglects patient diversity. We argue that these critiques fail to do justice to the complexities of actual care situations. In our ethnographic study of a project for bariatric pre- and aftercare, we show how research protocols not only close down but also open up spaces for patient-centered care. Despite professional cautions, experiences of stigma and broader imaginations of biomedical care often lead patients to embrace surgery as a treatment conceptualized as a technological fix. We argue that investigations of how research and clinical practice intertwine need to be both empirically grounded and sensitive to wider societal contexts.

KEYWORDS:

• Bariatric surgery
• evidence-based medicine
• objectification
• patient-centered medicine
• standardization

Acknowledgments

We thank the editors and three anonymous reviewers for their extensive comments on previous drafts that have much helped to sharpen the argument. We further thank the health professionals and patients at the outpatient clinic for so generously participating in our study. We have received clearance from the ethics committee of the clinic in which we conducted the study.

Funding

This research was conducted as part of the project “From Lab to Intervention and Back. Doing and Undoing Diversity in Obesity Research, Treatment and Prevention” (PI: Ulrike Felt), which is funded by the Vienna Science and Technology Fund.

Notes

1. All of the employed surgical procedures involve either a reduction of stomach size or a re-routing of the small intestines to a small stomach pouch, resulting in either a reduction of the amount of possible food intake and/or a lessened capacity to digest food.

2. While we have not pursued this line of questioning further, it would be worthwhile to explore the ways in which gender and class aspects influence the dynamics analyzed in this article, as both the condition of obesity itself and its surrounding discourses appear to be strongly patterned by class and gender relations (Broom and Warin 2011).

Additional information

Funding

This research was conducted as part of the project “From Lab to Intervention and Back. Doing and Undoing Diversity in Obesity Research, Treatment and Prevention” (PI: Ulrike Felt), which is funded by the Vienna Science and Technology Fund.

Notes on contributors

Kay Felder

Kay Felder is lecturer and researcher at the Department of Science and Technology Studies at the University of Vienna. Her current research focuses on public understanding of science and medicine and on how human diversity becomes a matter of concern in health contexts.

Ulrike Felt

Urike Felt is professor of Science and Technology Studies and dean of the Faculty of Social Sciences at the University of Vienna. Her research interests gravitate around issues of governance and public participation in technosciences, science communication, and changing knowledge politics and research cultures. Between 2002 and 2007 she was editor-in-chief of Science, Technology, & Human Values.

Michael Penkler

Michael Penkler is lecturer and researcher at the Department of Science and Technology Studies at the University of Vienna. His current research focuses on questions of subjectivity and embodiment in health issues and on how human diversity becomes a matter of concern in biomedicine.