The medicalization of obesity, bariatric surgery, and population health

Abstract

This article examines how the medicalization of obesity validates the use of bariatric surgery to treat obesity in the United States and how expansions in access to bariatric surgery normalize surgical procedures as disease treatment and prevention tools. Building on this discussion, the article poses two questions for population health regarding health technology: (1) to what extent does bariatric surgery treat obesity in the United States while diverting attention away from the ultimate drivers of the epidemic and (2) to what extent does bariatric surgery improve outcomes for some groups in the US population while simultaneously generating disparities? We conduct a brief, historical analysis of the American Medical Association's decision to reclassify obesity as a disease through internal documents, peer-reviewed expert reports, and major media coverage. We use medicalization theory to show how this decision by the American Medical Association channels increased focus on obesity into the realm of medical intervention, particularly bariatric surgery, and use this evidence to review research trends on bariatric surgery. We propose research questions that investigate the population health dimensions of bariatric surgery in the United States and note key areas of future research. Our objective is to generate a discourse that considers bariatric surgery beyond the medical realm to better understand how technological interventions might work collectively with population-level obesity prevention efforts and how, in turn, population health approaches may improve bariatric surgery outcomes.

Representations of mental health and arts participation in the national and local British press, 2007–2015

“…'combating' and 'conquering'), but recovery as the heroic journey of individuals is a rather narrow view, given that the capacity to recover may often be relational, requiring a mix of personal, social and economic resources -from housing to connections and friendships (Jacobson and Greenley, 2001;Tew, 2013). This medicalised and individualised framing of recovery is, however, compatible with wider trends in the ways in which various health and health-related issues from sleep to obesity have been framed (Meadows, 2008;Ortiz et al, 2017).…”

Bringing disgust in through the backdoor in healthy food promotion: a phenomenological perspective

“…10 For example, during the nineteenth century signs of overweight were being framed as indicators of a lack of control and indicators of an uncivilized society which established them as new disgust elicitors. This is further contributed to by the systematic framing of obesity as an indicator of disease (e.g., Ortiz et al 2017 ).…”

Partnering Support Interventions with Bariatric Surgery to Maximize Health Outcomes in Adolescents with Severe Obesity

“…Specifically, Lewis et al noted “a striking lack of research focused on potential disparities” in bariatric surgery outcomes. They further stated, “Given the array of new options available to physicians for treating obesity, this would be a very informative line of work to pursue moving forward, and could help to optimize patient selection for different treatments, as has been the case for hypertension.” Furthermore, Miller‐Motero et al recommended that “future research should continue to investigate reasons why demographic disparities in severe obesity exist and develop strategies for intervening to decrease them...[W]e may need to learn ways of encouraging younger patients, males, and ethnic minorities to pursue bariatric surgery to increase weight loss success and decrease medical comorbidities.” Finally, Ortiz et al stated, “To better understand the dynamic role of bariatric surgery within the landscape of obesity prevention and treatment efforts, we recommend that a population‐focused research agenda be developed. We particularly note the causal pathways that link successful bariatric surgery outcomes to certain populations such as racial/ethnic minorities as a key area of future research and that applying ecological approaches to examine bariatric surgery outcomes among racial/ethnic minorities, such as using mixed methods to understand how support systems influence postoperative adherence, is highly recommended.” Even less is known about these identified gaps in adolescents with severe obesity and the interplay between developmental level and puberty, among those from ethnically and socioeconomically diverse backgrounds in particular.…”

“…Furthermore, Miller-Motero et al (23) recommended that "future research should continue to investigate reasons why demographic disparities in severe obesity exist and develop strategies for intervening to decrease them...[W]e may need to learn ways of encouraging younger patients, males, and ethnic minorities to pursue bariatric surgery to increase weight loss success and decrease medical comorbidities." Finally, Ortiz et al (24) stated, "To better understand the dynamic role of bariatric surgery within the landscape of obesity prevention and treatment efforts, we recommend that a populationfocused research agenda be developed. We particularly note the causal pathways that link successful bariatric surgery outcomes to certain populations such as racial/ethnic minorities as a key area of future research and that applying ecological approaches to examine bariatric surgery outcomes among racial/ethnic minorities, such as using mixed methods to understand how support systems influence postoperative adherence, is highly recommended."…”