Skip to main content
Erschienen in:

27.01.2022 | Original Contributions

Understanding Racially Diverse Community Member Views of Obesity Stigma and Bariatric Surgery

verfasst von: Grace F. Chao, Adrian Diaz, Amir A. Ghaferi, Justin B. Dimick, Mary E. Byrnes

Erschienen in: Obesity Surgery | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The obesity epidemic poses serious challenges to health equity. Despite bariatric surgery being one of the most effective obesity treatments, utilization remains low. In this context, we explored public perceptions of bariatric surgery, centering voices of Black individuals.

Materials and Methods

Semi-structured interviews with individuals who have never considered bariatric surgery with purposive sampling to ensure the majority of participants were Black. Transcripts were iteratively analyzed. We employed an Interpretive Description framework to arrive at a collective description of perceptions of bariatric surgery.

Results

Thirty-two participants self-identified as 88% female, 72% Black, 3% Hispanic, 3% Pacific Islander, 3% Mixed Race, and 19% White. Participants reported a complex interplay of deeply held, stigmatized beliefs about identity. According to the stigma, persons with obesity lacked willpower and thus were considered devalued. Participants internalized this stigma, describing themselves with words like “glutton,” “lazy,” and “slack off.” Because stigma caused participants to view obesity as resulting from personal failings alone, socially acceptable ways to lose weight were discipline through diet and exercise. Working for weight loss was “self-love, self-discipline, and determination.” Thus, bariatric surgery was illegitimate, a “shortcut to weight loss” or “easy way out,” since it was outside acceptable methods of effort.

Conclusion

This qualitative study of community members who qualify for bariatric surgery shows obesity stigma was the main reason individuals rejected bariatric surgery. Obesity was stigmatizing, but undergoing bariatric surgery would further stigmatize individuals. Thus, healthcare providers may be instrumental in increasing bariatric surgery uptake by shifting social discourse from stigmatized notions of obesity towards one focusing on health.

Graphical Abstract

Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Hales CM, Carroll MD, Fryar CD, et al. NCHS Data Brief, No 360: Prevalence of obesity and severe obesity among adults: United States, 2017–2018. National Center for Health Statistics. 2020. Hales CM, Carroll MD, Fryar CD, et al. NCHS Data Brief, No 360: Prevalence of obesity and severe obesity among adults: United States, 2017–2018. National Center for Health Statistics. 2020.
2.
Zurück zum Zitat Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020;324(9):879–87.CrossRef Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020;324(9):879–87.CrossRef
3.
Zurück zum Zitat Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55.CrossRef Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55.CrossRef
4.
Zurück zum Zitat Campos GM, Khoraki J, Browning MG, et al. Changes in utilization of bariatric surgery in the United States from 1993 to 2016. Ann Surg. 2020;271(2):201–9.CrossRef Campos GM, Khoraki J, Browning MG, et al. Changes in utilization of bariatric surgery in the United States from 1993 to 2016. Ann Surg. 2020;271(2):201–9.CrossRef
7.
Zurück zum Zitat Moore D, Cooper C, Davis-Smith YM. African American obese men’s attitudes and perceptions of bariatric surgery: a phenomenological study. Spectrum: J Black Men. 2016;4(2):43–60. Moore D, Cooper C, Davis-Smith YM. African American obese men’s attitudes and perceptions of bariatric surgery: a phenomenological study. Spectrum: J Black Men. 2016;4(2):43–60.
8.
Zurück zum Zitat Moore DD, Taylor C, Holland J, et al. African American obese women’s perspectives regarding barriers to the utilization of bariatric surgery: a phenomenological study. J Black Stud. 2017;48(5):484–500.CrossRef Moore DD, Taylor C, Holland J, et al. African American obese women’s perspectives regarding barriers to the utilization of bariatric surgery: a phenomenological study. J Black Stud. 2017;48(5):484–500.CrossRef
9.
Zurück zum Zitat Lynch CS, Chang JC, Ford AF, et al. Obese African-American women’s perspectives on weight loss and bariatric surgery. J Gen Intern Med. 2007;22(7):908–14.CrossRef Lynch CS, Chang JC, Ford AF, et al. Obese African-American women’s perspectives on weight loss and bariatric surgery. J Gen Intern Med. 2007;22(7):908–14.CrossRef
10.
Zurück zum Zitat Imbus JR, Voils CI, Funk LM. Bariatric surgery barriers: a review using Andersen’s Model of Health Services Use. Surg Obes Relat Dis. 2018;14(3):404–12.CrossRef Imbus JR, Voils CI, Funk LM. Bariatric surgery barriers: a review using Andersen’s Model of Health Services Use. Surg Obes Relat Dis. 2018;14(3):404–12.CrossRef
11.
Zurück zum Zitat Stanford FC, Jones DB, Schneider BE, et al. Patient race and the likelihood of undergoing bariatric surgery among patients seeking surgery. Surg Endosc. 2015;29(9):2794–9.CrossRef Stanford FC, Jones DB, Schneider BE, et al. Patient race and the likelihood of undergoing bariatric surgery among patients seeking surgery. Surg Endosc. 2015;29(9):2794–9.CrossRef
12.
Zurück zum Zitat Funk LM, Jolles S, Fischer LE, et al. Patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery: a systematic review. JAMA Surg. 2015;150(10):999–1005.CrossRef Funk LM, Jolles S, Fischer LE, et al. Patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery: a systematic review. JAMA Surg. 2015;150(10):999–1005.CrossRef
13.
Zurück zum Zitat Wee CC, Hamel MB, Apovian CM, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg. 2013;148(3):264–71.CrossRef Wee CC, Hamel MB, Apovian CM, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg. 2013;148(3):264–71.CrossRef
14.
Zurück zum Zitat Munoz DJ, Lal M, Chen EY, et al. Why patients seek bariatric surgery: a qualitative and quantitative analysis of patient motivation. Obes Surg. 2007;17(11):1487–91.CrossRef Munoz DJ, Lal M, Chen EY, et al. Why patients seek bariatric surgery: a qualitative and quantitative analysis of patient motivation. Obes Surg. 2007;17(11):1487–91.CrossRef
15.
Zurück zum Zitat Wee CC, Huskey KW, Bolcic-Jankovic D, et al. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med. 2014;29(1):68–75.CrossRef Wee CC, Huskey KW, Bolcic-Jankovic D, et al. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med. 2014;29(1):68–75.CrossRef
16.
Zurück zum Zitat Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.CrossRef Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.CrossRef
18.
Zurück zum Zitat Holstein JA, Gubrium JF. The active interview. Thousand Oaks: SAGE Publications; 1995.CrossRef Holstein JA, Gubrium JF. The active interview. Thousand Oaks: SAGE Publications; 1995.CrossRef
19.
Zurück zum Zitat Saldaña J. The coding manual for qualitative researchers. 3E [Third edition]. ed. Saldaña J. The coding manual for qualitative researchers. 3E [Third edition]. ed.
20.
Zurück zum Zitat Miles MB, Huberman AM, Saldaña J. Qualitative data analysis: a methods sourcebook. Edition 3. ed. Miles MB, Huberman AM, Saldaña J. Qualitative data analysis: a methods sourcebook. Edition 3. ed.
21.
Zurück zum Zitat Thorne SE. Interpretive Description : qualitative research for applied practice. Second edition. ed. Thorne SE. Interpretive Description : qualitative research for applied practice. Second edition. ed.
23.
Zurück zum Zitat Goffman E. Stigma; notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963. Goffman E. Stigma; notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963.
24.
Zurück zum Zitat Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367(9509):528–9.CrossRef Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367(9509):528–9.CrossRef
25.
Zurück zum Zitat Wilson K, Luker KA. At home in hospital? Interaction and stigma in people affected by cancer. Soc Sci Med. 2006;62(7):1616–27.CrossRef Wilson K, Luker KA. At home in hospital? Interaction and stigma in people affected by cancer. Soc Sci Med. 2006;62(7):1616–27.CrossRef
26.
Zurück zum Zitat Cruz ML, Bastos FI, Darmont M, et al. The, “moral career” of perinatally HIV-infected children: revisiting Goffman’s concept. AIDS Care. 2015;27(1):6–9.CrossRef Cruz ML, Bastos FI, Darmont M, et al. The, “moral career” of perinatally HIV-infected children: revisiting Goffman’s concept. AIDS Care. 2015;27(1):6–9.CrossRef
27.
Zurück zum Zitat Pescosolido BA. Erving Goffman: the moral career of stigma and mental illness. Palgrave Handbook of Social Theory in Health, Illness and Medicine. 2015:273–286. Pescosolido BA. Erving Goffman: the moral career of stigma and mental illness. Palgrave Handbook of Social Theory in Health, Illness and Medicine. 2015:273–286.
28.
Zurück zum Zitat Cahnman WJ. The stigma of obesity. Sociological Quarterly. 1968;9:293–9.CrossRef Cahnman WJ. The stigma of obesity. Sociological Quarterly. 1968;9:293–9.CrossRef
29.
Zurück zum Zitat Pause C. Borderline: the ethics of fat stigma in public health. J Law Med Ethics. 2017;45(4):510–7.CrossRef Pause C. Borderline: the ethics of fat stigma in public health. J Law Med Ethics. 2017;45(4):510–7.CrossRef
30.
Zurück zum Zitat Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485–97.CrossRef Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485–97.CrossRef
31.
Zurück zum Zitat Kuehn BM. Put an end to obesity stigma, International Panel Urges. JAMA. 2020;323(15):1435.PubMed Kuehn BM. Put an end to obesity stigma, International Panel Urges. JAMA. 2020;323(15):1435.PubMed
32.
Zurück zum Zitat Berry EM. The obesity pandemic-whose responsibility? No blame, no shame, not more of the same. Front Nutr. 2020;7:2.CrossRef Berry EM. The obesity pandemic-whose responsibility? No blame, no shame, not more of the same. Front Nutr. 2020;7:2.CrossRef
33.
Zurück zum Zitat Rubin R. Addressing medicine’s bias against patients who are overweight. JAMA. 2019;321(10):925–7.CrossRef Rubin R. Addressing medicine’s bias against patients who are overweight. JAMA. 2019;321(10):925–7.CrossRef
34.
Zurück zum Zitat Kyle TK, Puhl RM. Putting people first in obesity. Obesity (Silver Spring). 2014;22(5):1211.CrossRef Kyle TK, Puhl RM. Putting people first in obesity. Obesity (Silver Spring). 2014;22(5):1211.CrossRef
35.
Zurück zum Zitat Sogg S, Grupski A, Dixon JB. Bad words: why language counts in our work with bariatric patients. Surg Obes Relat Dis. 2018;14(5):682–92.CrossRef Sogg S, Grupski A, Dixon JB. Bad words: why language counts in our work with bariatric patients. Surg Obes Relat Dis. 2018;14(5):682–92.CrossRef
36.
Zurück zum Zitat Wallace AE, Young-Xu Y, Hartley D, et al. Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg. 2010;20(10):1354–60.CrossRef Wallace AE, Young-Xu Y, Hartley D, et al. Racial, socioeconomic, and rural-urban disparities in obesity-related bariatric surgery. Obes Surg. 2010;20(10):1354–60.CrossRef
37.
Zurück zum Zitat Salant T, Santry HP. Internet marketing of bariatric surgery: contemporary trends in the medicalization of obesity. Soc Sci Med. 2006;62(10):2445–57.CrossRef Salant T, Santry HP. Internet marketing of bariatric surgery: contemporary trends in the medicalization of obesity. Soc Sci Med. 2006;62(10):2445–57.CrossRef
38.
Zurück zum Zitat Meleo-Erwin ZC. ‘No one is as invested in your continued good health as you should be’: an exploration of the post-surgical relationships between weight-loss surgery patients and their home bariatric clinics. Sociol Health Illn. 2019;41(2):285–302.CrossRef Meleo-Erwin ZC. ‘No one is as invested in your continued good health as you should be’: an exploration of the post-surgical relationships between weight-loss surgery patients and their home bariatric clinics. Sociol Health Illn. 2019;41(2):285–302.CrossRef
Metadaten
Titel
Understanding Racially Diverse Community Member Views of Obesity Stigma and Bariatric Surgery
verfasst von
Grace F. Chao
Adrian Diaz
Amir A. Ghaferi
Justin B. Dimick
Mary E. Byrnes
Publikationsdatum
27.01.2022
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 4/2022
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-022-05928-x

Neu im Fachgebiet Chirurgie

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

US-Team empfiehlt Gastropexie nach Hiatushernien-Op.

Zur Vermeidung von Rezidiven nach Reparatur einer paraösophagealen Hiatushernie sollte einem US-Team zufolge der Magen bei der Op. routinemäßig an der Bauchwand fixiert werden. Das Ergebnis einer randomisierten Studie scheint dafür zu sprechen.

Mit Lidocain kommt der Darm nicht schneller in Schwung

Verzögertes Wiederanspringen der Darmfunktion ist ein Hauptfaktor dafür, wenn Patientinnen und Patienten nach einer Kolonresektion länger als geplant im Krankenhaus bleiben müssen. Ob man diesem Problem mit Lidocain vorbeugen kann, war Thema einer Studie.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.