Når fedmekirurgi vurderes som «siste sjanse»

Bakgrunn: Fedmekirurgi har i løpet av de siste årene etablert seg som en medisinsk metode i eksplosiv vekst. Stadig flere får tilbud om denne behandlingsmetoden, og av disse er over 70 % kvinner. Hensikt: Å undersøke kvinners begrunnelser for å velge fedmekirurgisk behandling. Metode: Empirien baserer seg på individuelle dybdeintervju med 22 norske kvinner som alle hadde gjennomgått en gastric-bypass operasjon. Funnene er analysert tematisk. Resultater: Mye står på spill når kvinner velger fedmekirurgisk behandling, både helsemessig og sosialt. De risikerte alvorlig sykdom og tidlig død om de ikke gikk betydelig ned i vekt. På den andre siden risikerte de å få alvorlige og livstruende komplikasjoner, samt plagsomme bivirkninger som følge av selve operasjonen. Stilt overfor dette dilemmaet ble et annet aspekt vurdert som betydningsfullt, nemlig ønsket om å få en sosialt akseptert kropp. Konklusjon: Kvinnenes tiltro til kirurgi som deres siste sjanse var særlig relatert til frykten for hva som kunne skje om de lot være å benytte seg av denne behandlingen. Det var vanskelig å ta innover seg at behandlingen i seg selv kunne resultere i problematiske bivirkninger og livstruende komplikasjoner. Denne troen på at det kun finnes et alternativ må sees i lys av fedmekirurgiens framvekst som medisinsk behandlingsmetode, hvordan det er blitt et kommersielt felt, samt tidens sterke idealisering av slanke og faste kropper

Teenage girlhood and bodily agency: on power, weight, dys-appearance and eu-appearance in a Norwegian lifestyle programme

Despite the growing literature on childhood obesity and lifestyle intervention programmes focusing on weight loss, few studies have examined young persons’ experiences of being identified as candidates for such programmes and of participating in them. This paper does so. Juxtaposing insights from phenomenology with an approach inspired by Foucault, the paper shows how teenage girls’ bodily self-perception and bodily self-awareness are shaped in intercorporeal assemblages comprising other people and specific features or elements of the lifestyle programme.Inspired by van Manen’s hermeneutic-phenomenological approach, with its point of departure in lived experience, this paper draws on interviews with Norwegian teenage girls participating in the same lifestyle programme and identifies three core thematic aspects of the girls’ experiences: being identified as a candidate for a lifestyle programme and not wanting this; negotiating the lack of weight loss and the scales; and bodily situated agency – feeling good and being able. Permeating all three themes are two central, interrelated phenomena: agency and resistance. Furthermore, the paper shows how a combination of Foucauldian insights and a phenomenological understanding of intercorporeality can help to shed light on the power, affective, material and temporal dimensions of dys-appearance (i.e., when one’s body appears as bad or wrong), as well as those of eu-appearance (i.e., when one’s body appears as healthy or strong), and thus contribute to the understanding of the girls’ narrated lived experiences.On the basis of these findings, we argue that weight-related treatment goals are not necessarily compatible with the strengthening of adolescents’ body images and self-esteem. However, whilst being obliged to attend to their bodies while in the programme, the girls also encountered unexpected, positive bodily feelings and experiences. Such events, we suggest, offer a means of resisting the more troubling dys-appearing bodily situations our participants described so powerfully

Trening i endringens tegn : Noen overvektiges erfaringer

Oppgaven omhandler overvektige personers erfaringer med trening. Det sees nærmere på hvordan trening foregår og gis betydning i et konkret behandlingsopplegg. Opplegget ledes av en fysioterapeut som tar utgangspunkt i det rådende kunnskapsgrunnlaget innenfor overvektsfeltet. Det innebærer at vektreduksjon er det sentrale effektmålet for alle deltakerne. Ved å anvende både fenomenologisk teori og kjønnsteori som sentrale fortolkningsrammer, er hensikten å få frem kunnskap som handler om mer enn målbare ”effekter” av treningen. Undersøkelsen er forankret i en kvalitativ metodetradisjon. Dybdeintervjuer med fem kvinnelige og to mannlige gruppedeltakere utgjør forskningsmaterialet. Analysen er tematisk og organiseres i to hovedkapitler. Resultatene viser at trening ikke erfares som noe som kan isoleres fra deltagernes øvrige erfaring med å være overvektige. Både forholdet til andre og tidligere erfaringer får betydning for hvordan treningen gjøres og oppleves. Erfaringene er individuelle i betydningen at den enkeltes livshistorie preger det som gir treningen mening. Samtidig er erfaringene med å gå ned i vekt vevd inn i kulturelle og kjønnede relasjoner. Både fysioterapeuten og de andre gruppedeltakerne bidrar til å skape en treningskultur der det å presse seg og oppnå resultater kommer i forgrunnen. Kvinnene opplever dette presset som slitsomt og ubehagelig. Enkelte får også smerter i kroppen i forbindelse med treningen, mens andre føler skyld og skam når de ikke innfrir forventningene. I tillegg uttrykker kvinnene at de har blitt avhengige av fysioterapeutens oppfølging når de trener. Til sammenligning, gir mennene uttrykk for å ha en mer selvstendig rolle i gruppen. De justerer både progresjonen og øvelsesutvalget på egenhånd, og hevder at fysioterapeutens tilstedeværelse ikke lenger har noen betydning for deres innsats. Kvinnene utrykker engasjement, tilhørighet og tilfredsstillelse ved å trene sammen med andre tykke, mens mennene inntar en slags ”ekspertposisjon” i gruppen og uttrykker uavhengighet til de andre. Mennene fremhever sine resultater som ”gode” og betegner flere av kvinnene som ”sutrekjærringer”. Kvinnene, på sin side, inntar ikke en kommenterende rolle overfor mennene. Funnene viser at det er mange typer erfaringer som inngår i det å delta på trening. At treningen både innebærer avhengighet til fysioterapeuten, ubehag, smerter så vel som følelsen av tilhørighet og felleskap viser at det både kan være godt og vondt. Slike tvetydige erfaringer kan bidra inn i en diskusjon om vektreduksjon bør være det sentrale ”effektmålet” for alle deltakerne. Når de ”målbare” resultatene kommer i forgrunnen, bidrar det til å skape et ekstra stress og press for mange av deltakerne, noe som på sikt kan bidra til at de mister lyst og motivasjon til å fortsette treningen og derfor velger å slutte. Oppgavens oppsummering er at vektlegging av ”effekt” når treningstiltaket skal vurderes må kompletteres med undersøkelser av overvektige trenedes egen meningsproduksjon i, og erfaringer med trening, samt de institusjonelle rammer og kjønnede forståelser som skapes og brukes

Practising physical activity following weight-loss surgery: The significance of joy, satisfaction, and well-being

While health care professionals advise those who have undergone weight loss  surgery (WLS) to increase their levels of physical activity, research suggests that  often this is not achieved. This paper explores the experiences of ten Norwegian women as they engaged in physical activity several years after weight loss surgery (WLS). In contrast to the existing literature, which explores physical activity post-WLS largely in terms of quantitative data and measurable outcomes, the present study sought to explore women’s lived experiences of physical activity, including the meanings they ascribed to different forms of activity and how such meanings changed over time. The research participants, all of whom had undergone WLS more than five years earlier, described (during individual interviews) the meanings they attached to becoming physically active, as well as the different  activities and movement practices they engaged in, from interval training to  mountain hiking and yoga. For all the women, maintaining and increasing their level of physical activity was challenging. On the one hand, engaging in exercise after weight loss improved their sense of joy and well-being and expanded their  opportunities to move and act. On the other hand, during physical activity they needed to be constantly alert to symptoms of post-surgical side-effects, including variable energy levels, digestive problems and acute illness episodes. As the women explored their new capacities, it seemed to be important for them to explore various forms of physical activity in order to find the form of exercise which best suited them or which they most enjoyed. In some cases, they constructed new meanings around activities which, prior to surgery, had seemed onerous and bereft of pleasure. We argue that such insights will benefit health professionals who provide advice on physical activity at different post-surgical stages, sometimes to persons seriously concerned about regaining weight

“My quality of life is worse compared to my earlier life”: Living with chronic problems after weight loss surgery

Weight loss surgery is commonly regarded as improving individuals' health and social life, and resulting in a happier and more active life for those defined as “morbidly obese.” However, some researchers have started to doubt whether these positive outcomes apply to everyone and this article explores this doubt further. More specifically, we focus on the experiences of women whose life situation became worse after weight loss surgery. The material draws on qualitative interviews of five Norwegian women undergoing the irreversible gastric bypass procedure. Our findings illustrate that the women lived seemingly “normal” lives prior to the surgery with few signs of illness. Worries about future illness as well as social stigma because of their body shape motivated them to undergo weight loss surgery. After the surgery, however, their situation was profoundly changed and their lives were dramatically restricted. Chronic pain, loss of energy, as well as feelings of shame and failure for having these problems not only limited their social lives but it also made them less physically active. In addition, they had difficulties taking care of their children, and functioning satisfactorily at work. Accordingly, the women gradually felt more “disabled,” regarding themselves as “outsiders” whose problems needed to be kept private. The results highlight some “subtle” consequences of weight loss surgery, particularly the shame and stigma experienced by those whose lives became dramatically worse. Living in a society where negative impacts of weight loss surgery are more or less neglected in research as well as in the public debate the women seemed to suffer in silence. Their problems were clearly present and felt in the body but not talked about and shared with others

A critical perspective on stigma in physiotherapy: the example of weight stigma

"Manipulating practices is the first ever collection of critical physiotherapy studies and comes at a time of unprecedented change in the profession. Written as a collaboration between 20 authors, many members of the Critical Physiotherapy Network (CPN), the book uncovers the growing body of critical thinking now emerging in physiotherapy. From topics as diverse as 21st century education, ethics, evidence-based practice, touch, and equine therapy; and approaches as varied as disability and performance studies, feminism, logic, narrative theory, new materialism, and phenomenology, the book explores ways of thinking ‘otherwise’ about physiotherapy. Over 16 chapters written by authors from six different countries, Manipulating practices offers insights from some of physiotherapy’s most radical thinkers. The book is also an innovative venture into open source publishing, making it entirely free to download and read. In keeping with the objectives of the CPN, the chapters expose a range of concepts, ideas and practices to critical scrutiny, and reflect the profession’s growing interest in critiquing taken-for-granted ways of practicing and thinking. Manipulating practices will be of interest to clinicians, lecturers, policy-makers, researchers and students, and will provide new impetus to help physiotherapists imagine how the profession might grow and develop into the future.""«Manipulating practices» er den første vitenskapelige antologien som samler kritiske studier innen fysioterapi, og lanseres i en tid der profesjonen er preget av store forandringer. Antologien representerer et samarbeidsprosjekt mellom 20 forskere, hvor majoriteten er medlemmer av Critical Physiotherapy Network (CNP) – et internasjonalt nettverk av forskere og klinikere fra hele verden. Antologien synliggjør den økende tendensen til kritisk tenkning som er i ferd med å vokse frem innenfor fysioterapi. Gjennom å fokusere på varierte tema som utdanning, etikk, evidensbasert praksis, berøring og terapiridning, samt en bred tilnærming som inkluderer funksjonshemming, performance-studier, feminisme, logikk, narrativ teori, ny materialisme og fenomenologi, utforsker antologien nye og annerledes tanker om fysioterapi som fag og profesjon. Antologiens 16 kapitler er skrevet av forskere fra seks ulike land og gir innsikt i forskningen til noen av de mest radikale forskerne i det internasjonale fysioterapimiljøet. Boken er også innovativ gjennom at den publiseres som open access, hvilket betyr at den kan lastes ned og leses gratis og dermed gjøres allment tilgjengelig. I tråd med ambisjonen for CPN, utforskes en rekke ulike begreper, ideer og praktiske tilnærminger relatert til kritisk tenkning innenfor fysioterapi. Slik gjenspeiles også profesjonens økende interesse for å kritisere etablerte måter å praktisere og tenke på, som tidligere har vært tatt for gitt. «Manipulating practices» vil være av interesse for forskere, klinikere, forelesere, politikere og studenter. Antologien vil forhåpentligvis bidra med nye impulser med henblikk på hvordan fysioterapiprofesjonen vil vokse og utvikle seg fremover.

The fragile process of homecoming - Young women in recovery from severe ME/CFS

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Purpose: To explore the recovery narratives of 13 young women who had fallen ill with severe Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), during childhood and adolescence, with the focus on what they had to say about their past experiences from the perspective of the present. Method: A qualitative narrative approach, informed by a phenomenological theoretical perspective, was adopted to explore what the women found significant and meaningful in their recovery process. Data analysis of in-depth narrative interviews was performed which are presented to readers through the stories of two particular participants. Results: The first story describes how one participant made a recovery by testing her body’s tolerance and working to create a more confident self. The second story describes a complex exploration of possibilities for action in recovery, along with a struggle to make sense of setbacks and hold on to what has been gained. Conclusion: Recovering from ME/CFS emerges as an inter-personal, contextual, fragile and nonlinear process of homecoming, based on gradually rising bodily based self-knowledge. Illness slowly fades away into the background, and there is the prospect of a healthier tomorrow.publishedVersio

Phenomenology of Professional Practices in Education and Health Care: An Empirical Investigation

In this article a group of professionals working in education and health care explore professional practices and interactions from a phenomenological perspective, drawing on Max van Manen’s conceptualization of the phenomenology of practice and his knowledge interest in understanding and furthering sensitive, caring professional practice. Posing the question what is the meaning of interaction in encounters within education and health care, we look at practice experiences drawn from close observations and interviews during research concerning special needs education, physiotherapy and weight loss programs. Three anecdotes are offered as a way to ‘show,’ rather than interpret, the processes involved. Each anecdote is followed by reflections in which we draw on van Manen’s notion of pathic knowledge and Nancy’s ideas about co-existence to develop phenomenological insights about temporal, embodied and relational qualities of the phenomenon of interaction in professional practice. Such interaction seems to involve continuous negotiation. It emerges as a process of exchange, a movement back and forth between supporting and letting oneself be supported; between confronting and being confronted; between pushing and being pushed. Moments of active engagement give way to periods of waiting for the other to act. The experience is one of continuous back and forth movement in the relational space in-between.Phenomenology of Professional Practices in Education and Health Care: An Empirical InvestigationpublishedVersio

Dilemmas in the process of weight reduction: Exploring how women experience training as a means of losing weight

Patients diagnosed with obesity are usually offered group-based behavior interventions which include dietary advice and exercise programs. In particular, high-intensity training—combining weight lifting with aerobic exercising—has been proven effective for losing weight. Moreover, recent studies have shown that persons participating in high-intensity training are more likely to maintain their weight loss compared to persons with lower levels of physical activity. However, most of the research in the field has made use of quantitative methods focusing on the measurable effect of such interventions. Therefore, the aim of this study was to show how the training is experienced from a first-person perspective, namely the patients themselves. Our hope was to shed some new light on the process of weight loss that concerns more than the measurable “impacts” of the training. A qualitative approach was used based on interviews with five women selected from a primary healthcare clinic in Norway. Our results show that experiences of training are connected to the participants' general experience of being overweight. Both relationships to other people and earlier experiences are important for how the training is carried out and perceived. Five themes were identified supporting this line of argument: (1) the gaze of others; (2) a common ground; (3) dependence of close-follow up; (4) bodily discomfort as painful; and (5) aiming for results—an ambivalent experience. The results highlight the importance of finding the proper context and support for each patient's needs