Fat Disorders

Contrasting Approaches Towards Dealing With Corpulence: A Comparison Between Eating and Weight Disorders and Obesity Surgery: Stories of Altered Lives

Upon first examination, there would appear to be several areas of similarity between Carlos Grilo’s Eating and Weight Disorders and Obesity Surgery: Stories of Altered Lives, which is co-authored by Marta Meana and Lindsey Ricciardi. Both literary works detail the finer points of cautionary measures regarding complications of eating, as well as the many hazards which may accompany this seemingly innocuous, vital act. However, thorough analysis of each book reveals a departure in the methodology and purposes presented in the manuscripts. Eating and Weight Disorders takes a decidedly more academic approach in presenting a comprehensive overview of the various types of disorders associated with eating including specific symptoms, potential treatments, and the overall prevalence in which such conditions can occur. Obesity Surgery: Stories of Altered Lives, on the other hand, is concerned with the several nuances influencing and affecting the causes and procedures of surgery to correct obesity, and is more sociological in focus in determining the psychological processes involved with this medical action.

The point of commonality between the books, however, is in their treatment of the all-too frequent occurrence of obesity and its influence on the perception of self-image and overall health in contemporary Western society. While Meana and Ricciardi’s manuscript deals solely with this particular condition, obesity is one of the many disorders detailed in Grilo’s work, which is primarily focused on eating disorders of all varieties. Interestingly enough, Grilo contrasts the polemics of obesity with those of typical eating disorders, and even stratifies the former from the latter as being primarily a physical medical condition, while denoting that the root causes of eating disorders are primarily psychological in nature (Grilo, 2006, p.14). The contrast between obesity and eating disorders continues with the author’s assertion that obesity is an extremely common occurrence in Western society, while eating disorders are significantly rarer. Furthermore, Grilo cites obesity as one of the leading causes of morbidity and mortality, and alludes to the fact that its prevalence is steadily increasing (Grilo, 2006, p.4).

The premise of Meana and Ricciardi’s book certainly seems to agree with many of Grilo’s assertions regarding obesity, for the simple fact that the pair of authors has devoted the vast majority of the pages of their work to factors involved in what is commonly perceived as a correction to such an issue: a surgical procedure which inherently reduces the ability of the human body to become corpulent. Yet the authors’ approach in deconstructing the nature of obesity greatly varies from Grilo’s removed, academic analysis of qualitative statistics and citations of previous sources, and is focused on the social, psychological, and decidedly more human aspect of such a condition which would drive people to consider and actually undergo gastric intestinal surgery. The following quotation, in which the authors attend a prospective-patient seminar for the surgical procedure, elucidates the fact that this approach is one of the principle themes in Obesity Surgery: Stories of Altered Lives. “Sitting among the audiences of severely obese individuals and a smattering of significant others, we found ourselves humbled by the challenges these individuals had faced in the past and were about to confront in their near future…We didn’t discuss whether this surgery was really necessary or whether these folks would be better served by a good lifestyle-modification program. We wondered what their lives were like and the ways in which these lives would be changed by weight loss (Meana and Ricciardi, 2008, p. 1).”

The preceding passage underscores a degree of compassion and highlights the authors’ concerns for the specific, individual social and psychological ramifications of people’s attempts to cope with the presence of obesity in a way which Grilo’s work does not address. What makes this comparison all the more noteworthy is that Eating and Food Disorders addresses similar issues that Surgical Procedures does, albeit it from a distanced, academic standpoint that rarely (if ever) considers the human nature of the subjects or statistical data (which represent subjects) of those who experience obesity. The following quotation, in which the author presents information about individuals essaying to lose weight, indicates Grilo’s disaffected academician approach which is typical of his work on the whole. “The prevalence of attempting to lose weight in the U.S. has been studied in several large and ongoing national studies. Serdula, Mokdad, Williamson, Galuska, Mendleinm and Heath (1999), based on data for 107,804 adults obtained by a random telephone survey as part of the Behavioral Risk Factor Surveillance System, estimated the prevalence of attempting to lose weight was 28.8% in men and 43.6% in women. Interestingly, among those who reported that they were attempting to lose weight, a common strategy (34.9% of men and 40% of women) was to eat less fat but not fewer calories (Grilo, 2006, p. 32).

Thorough deconstruction of this passage is necessary to understand a fundamental difference in Grilo’s writing and treatment of obesity in his work with that of the authors of Obesity Surgery: Stories of Altered Lives. The author is obviously concerned with his subject, as his interest in the particular strategy for weight loss for the men and women mentioned in the passage readily indicates. Yet the tone of voice in which he employs in this quotation, as well as throughout the duration of the book, is authoritarian and well removed from whatever crises, circumstances, and negligible occurrences the subjects of his statistics may have endured. It may be implied or assumed that the author has undertaken a book on eating disorders and obesity because he has a concern for the discomfort associated with these particular syndromes, but this concern is never made manifest in his writing, which is altogether formal and impersonal, cold and calculating in its conviction.

Yet as the previous passage from Meana and Ricciardi’s work alludes to, it is just such an interest in the human aspect of psychological and social despair, pain, and humiliation which drives their entire book and adorns it, in ways both large and small. The entire first half of Obesity Surgery: Stories of Altered Lives, details the mundane, minute occurrences which greatly affects obese people, and propels several of them (at least the ones mentioned in the book) to seriously consider the undertaking of gastro-intestinal surgery. As the title of this work suggests, the individual anecdotes and personal emotions represented in them are presented to give the general public a greater understanding for the reasons behind corrective surgery for obesity. This emotional appeal for understanding is extremely apparent in the following quotation, in which an obese subject recounts her feelings of despair regarding her weight.

“Daphne: I remembered I had stepped on the scale, and I saw how heavy I was [350 pounds]. I was taking a shower with my kids who were toddlers at the time. Now this is a small square shower, and I pretty much took up the whole space. I remember crying hard and looking up and crunching my fists and saying, “Why? God, why are you letting me die? I’m a good person (Meana and Ricciardi, 2008, p. 14). The emotional appeal of such a passage is fairly apparent from the subject’s tone and actions. Her cries to a divine force regarding her dissatisfaction with her weight and the imagery of her girth encompassing an entire shower and dwarfing those of her toddlers, are used by the authors to portray feelings about this particular subject (Daphne), as well as about the general subject which the book is being written for (obesity), to both engage the reader and illicit his or her understanding for the development of and willing participants of gastro-intestinal surgery. Furthermore, this passage illustrates the authors’ concerns with the human aspects behind the raw figures and statistical data which Grilo’s work relies on. The passage shows a more complete story behind the phenomenon of obesity in a way which the best of Grilo’s writing does not.

This difference in the scope and focus of the writing of the two books becomes magnified when one examines one of Grilo’s more in-depth examples of a specific eating disorder highlighted in his manuscript. The following quotation, in which he proffers an analysis of symptoms of anorexia nervosa, typifies the clinical nature of the impersonal treatment of his subjects. “A.J.’s preoccupation with weight and exercise soon become obsessional. She constantly thought about food while managing to eat less and less. There were many days that she ate little more than egg whites and a few vegetables. On days that she ate other foods she counted (and recounted) calories and made sure to exercise longer to burn off the “extra” calories (Grilo, 2006, p.69).” Despite recounting the personal story of someone battling with anorexia nervosa, Grilo keeps this account decidedly impersonal and academic by offering no more details than are necessary to understand the story. Whereas Meana and Ricciardi employed imagery to effectively “show,” the sentiments and predicaments of their subject, Grilo simply “tells” the facts while offering little more intimacy of details other than what food his subject ate. The overall effect removes any trace of feeling or compassion for the subject, and keeps the reader emotionally removed from the author’s academic discourse.

In part, Ricciardi and Meana are afforded the privilege of taking such liberty with the personalized depiction of their examples because their entire manuscript is based on the subject of obesity, while Grilo’s work is effectively more comprehensive in its depiction of several eating disorders in addition to its analysis of obesity. Yet Obesity Surgery: Stories of Altered Lives, offers no such solutions for obesity, and makes it quite clear early on in the text that its authors do not advocate nor oppose gastrointestinal surgery as a corrective measure for this problem, as the following quote from its preface makes abundantly clear. “This book has no agenda other than to provide the reader with a collective account of life before and after obesity surgery from the perspective of a group of individuals who are likely to be representative of many people opting for this surgery. This is neither a pro- nor an anti- obesity surgery book (Meana and Ricciardi, 2008, p. iX).”

Eating and Weight Disorders, however, is decidedly more partisan in the fact that its author takes great pains to present a plethora of solutions to the afflictions described within its pages. After systematically defining the various conditions he details (including anorexia nervosa, bulimia nervosa, Eating Disorder Not Otherwise Specified, binge eating disorder as well as obesity), he outlines the prevalence of each occurrence before devoting the latter half of the book to solutions to these related conditions. Grilo’s curative process includes a detailed procedure of assessment for each disorder (stratified by instruments of provision, physical medical symptoms as well as psychological effects) before offering a variety of methods of treatment encompassing a physical aspect of weight restoration and nutritional rehabilitation, a psychological component of therapy, as well as pharmacotherapy which includes applicable pharmaceutical treatment. The author also devotes several pages to circumstances and surrounding ramifications of patients who undergo involuntary treatment.

Although there are no similar solutions to the several issues that arise from obesity in Obesity Surgery: Stories of Altered Lives, the book does offer a form of assistance for corpulent patients who are considering or who have considered undergoing gastro-intestinal surgery. In many ways, such assistance can be thought of as the final boon of Ricciardi and Meana’s monitoring of the disparate lives in their book. Although not nearly as widespread in form and approach as Grilo’s specific measures for ameliorating victims of eating disorders, the measures outlined in Obesity Surgery are extremely pragmatic and definitely utilitarian in their scope of focus for those considering gastro-intestinal surgery. The authors offer a pair of models, both pre- and post-surgical, which give potential surgery patients a path to follow to successfully transition from the personal, psychological and societal effects of such a procedure. The models identify common areas of tension for one’s self, social relations, and the acquisition of skills related to the procedure (such as eating and dealing with newfound emotions regarding body image) and specifies fundamental changes in areas such as appearance, mental health and physical health. In all, the authors rationalize a 14-step process for effectively dealing with the myriad dramatic changes associated with gastro-intestinal surgery.

The fact that these steps were garnered from a personal approach to the stories and livelihoods of the various subjects depicted in Obesity Surgery: Stories of Altered Lives, is evidenced in the following quotation which the authors of the book present as a concluding note. “Six years ago, thirty-three people sat down with us and graced us with their stories of how severe obesity and then weight loss had affected their lives. Their rich stories and impressions were about so much more than diets and pounds lost. They told a universal story of the complexity of human experience and how any attempt to reduce a life down to one component is no story at all (Meana and Ricciardi, 2008, p. 233).” The reference of the authors to the “complexity” of “human experience” indicates just how influential this degree of humanity is both on the author’s work and their conveyance of it through their writing. It is this degree of humanity in the anecdotes and tales of common people that primarily differentiates Obesity Stories: Tales of Altered Lives, from Eating and Weight Disorders.

However, the personalized touch in the writing and depiction of the subject of obesity prevalent in this work which is largely absent from that of Grilo in Eating and Weight Disorders should not be taken as an indication that Grilo is indifferent to the plight of his subjects, many of whom have issues with other eating disorders not involving obesity. Grilo’s heavy reliance on statistical data and impersonal accounts of the various eating afflictions presented in his text merely help him codify a number of useful methods to combat such afflictions. His book also helps to illustrate the complications of obesity as made manifest in other food disorders such as binge-eating and bulimia. Both works, then, are vital commentaries on the state of eating habits and their complications for residents of contemporary Western society, and offer cautionary tales, in decidedly different forms, to help prevent and succor those undergoing such problems in their lives.

References

Grilo, C.M. (2006). Eating and Weight Disorders. New York: Pschology Press.

Meana, M. Ricciardi, L. (2008) Obesity Surgery: Stories of Altered Lives. Reno: University of Nevada.