Carnie Wilson, who had her first Roux en Y gastric bypass surgery broadcast live on the internet in 1999 and produced two books about her experiences, recently announced that she’s now had a lap-band procedure because she regained weight. Several surgery centers immediately began using Wilson’s choice to undergo a lap band procedure as a means of promoting their own practices. Bariatric surgery centers weren’t, however, the only ones talking about Wilson’s latest effort to lose weight. Immediately, cyberspace lit up with comments about Wilson taking the “easy way out.”
I’ve read both of Wilson’s books and many other personal and medical accounts of bariatric surgeries, and there’s nothing easy about the results of these procedures. The list of short term and long term side effects can include everything from frequent bouts of nausea and diarrhea to cases of Beriberi. And let’s not forget that the intended side effect of bariatric procedures is that one must carefully monitor one’s food intake in order to have any chance at avoiding these and other side effects. Then there’s the fact that bariatric surgeries, like most surgeries, carry a risk of death, infection, and other complications from the procedure itself. None of this sounds easy to me.
Yet, American culture seems to hold fast to the notion that weight loss needs to be the direct result of traditional diet and exercise (aka “the hard way”). The truth is, however, that even those who work hard at weight loss via traditional diet and exercise don’t always have success. In fact, many medical experts acknowledge that they still don't have meaningful data to suggest that traditional diets have good success rates over time, and even the most optimistic findings suggest a relatively small percentage of people maintain weight loss over time.
The failure rate of traditional diet and exercise programs is one of the reasons that many doctors now recommend bariatric surgeries. According to clinical guidelines, one of the litmus tests for qualifying for bariatric surgery is to have already tried and failed to lose weight by diet and exercise. In short, patients who qualify for weight loss surgeries have already tried “the hard way” and are living proof that diet and exercise don't work for everyone.
The moralizing about how weight ought to be lost, which is via willpower and hard work, has become part of a larger cultural narrative about who is and isn’t worthy. In general, our culture constructs large people as lazy, slovenly and unworthy. One of the few ways large people seem to be able to redeem themselves is by showing their devotion to cultural norms by losing weight. The more grueling and public their performance of devotion the better, which might explain the popularity of shows like The Biggest Loser, where contestants often exercise to the point of collapse.
Don’t misunderstand. I’m not necessarily saying that Wilson ought to have as many weight loss surgeries as she wants or that we shouldn’t question what it means that people need such “revision” surgeries. There are serious ethical questions about bariatric surgeries to be discussed, such as whether these surgeries are appropriate for anyone, when enough surgery is enough (for both patients and surgeons), and whether or not weight should be considered a primary indicator of health.
What I am saying is that Wilson and others who undergo weight loss surgeries needn’t be characterized as people who haven’t made sacrifices or who could have lost weight by other means but instead chose the “easy way out.” Rather, we should think carefully about what it means to judge people like Wilson in such ways and to demand a specific kind of sacrifice.
Apparently, having a weight loss surgery like Roux en Y, a procedure that sections off a portion of stomach and prompts food restriction and malabsorption, isn’t the “right” kind of sacrifice—even when that surgery has been publicly broadcast--and neither is having a lap-band as a second procedure.
That Wilson's choices are understood and talked about as “the easy way out” says as much about our culture's troublesome constructions of large people and our misunderstandings about weight loss and weight loss surgeries as it does about Wilson.