Paper short abstract:

This paper examines the lived experiences of patients who have turned to bariatric surgery to resolve diabetes. It focuses on shifting states of responsibility and choice as these are embedded in and extend relations of care, and are animated by moral economies of biocitizenship.

Paper long abstract:

People with type 2 diabetes who are also obese are doubly marked as "bad biocitizens" (Greenhalgh and Carney 2014). Intervening on conditions that involve self-management and so-called lifestyle change by individuals, bariatric surgery is appealing for its power to both circumvent and boost individual agency, aligning with a variety of perspectives on control, responsibility, and choice in chronic disease prevention and management. Based on ethnographic research with the diabetic patients of a weight management clinic in the United States, this paper explores bariatric surgery as a treatment for diabetes in the context of moralistic neoliberal rhetorics of fear that predominate healthcare ideologies in which chronic illness sufferers imperil society with an escalating epidemic. Now readily conducted through a laparoscopic procedure, the surgery is framed as quick, safe and cost-effective. It offers not only the potential to heroically slay major public health threats, saving many from affliction. It also promises to slash the substantial "burden on society" of the billions of dollars in annual costs measured in healthcare consumption and lost productivity. Patients and their providers are morally responsiblized to pursue the surgery in order to unburden patients as well as the public from the liability they place on the health care system. This paper examines the lived experiences of these shifting states of responsibility and choice as they are embedded in and extend relations of care, and are animated by and with the politics of healthcare systems and the moral economies of biocitizenship.