The War on Obesity as a Moral Project: Weight Loss Drugs, Obesity Surgery and Negotiating Failure

Abstract

Anti-obesity interventions are configured within British biomedicine as a hierarchy of condoned practices, with access to those further up the hierarchy made contingent on documented failure with interventions further down. The unsuccessful use of weight loss drugs, for example, is a condition of access to surgery, which is positioned at the top of the hierarchy. This configuration of interventions, I argue, exposes surgery patients to the risk of the moral censure of others: the failure to lose weight is attributed to a lack of self-discipline rather than to the inefficacy of any particular intervention. This risk is particularly pronounced in the case of weight loss drugs and surgery, which are commonly (mis)conceptualised as attempts to ‘cheat’ at weight loss and avoid the bodily work of diet and exercise. This paper argues that those undergoing surgery have to account for their unsuccessful use of weight loss drugs in a way that resists these negative characterisations. This is achieved through the strategic mobilisation of three key discursive resources in relation to the drugs: discourses of degradation, danger and inefficacy. These discursive resources, and their strategic mobilisation, highlight the profoundly moral context of the ‘war on obesity’ within which the escalating hierarchy of anti-obesity interventions operates.

Keywords:

• Weight loss drugs
• obesity surgery
• obesity
• failure
• morality

Notes

It is important to note that in practice, many people move back and forth across interventions, particularly at the lower end of the hierarchy, although access to interventions higher up the hierarchy remains dependent on having already tried those further down.

This previously well-established condition of surgery is potentially disrupted in the 2006 NICE Guidance by the recommendation that surgery should be a first-line option in the case of adults with a Body Mass Index (BMI) of over 50 kg/m2 (NICE, 2006, p. 11). However, in spite of this proposal, at the time of writing, access to funded surgery remains dependent upon a documented history of previous weight loss attempts.

The gastric band is a silicone band that fits around the top of the stomach, creating a small pouch with a restricted entrance to the rest of the stomach. The degree of restriction provided by the band can be adjusted by adding or withdrawing saline from the band via a port under the skin.

Now, 15 February 2006.

See http://emc.medicines.org.uk/ (accessed 26 March 2007).

See http://emc.medicines.org.uk/ (accessed 26 March 2007).

Summary of Product Characteristics, http://emc.medicines.org.uk/ (accessed 26 March 2007).

Several of the participants in my study pointed out the ironies of having to prove the ability to lose weight in order to gain access to a drug designed to help people who have difficulty in losing weight.

See http://emc.medicines.org.uk/ (accessed 26 March 2007).

See www.managingyourweight.com (copyrighted to the drug's manufacturer, L. Hoffmann-La Roche Ltd) (accessed 26 March 2007).