Dr. Heather Howard spent the semester as a Visiting Scholar with the School of Anthropology and Museum Ethnography at the University of Oxford, where she gave a paper titled, “What’s in a name? ‘Metabolic surgery,’ Curing Diabetes, and the Transformation of Weight Loss Procedures and Patients,” as part of the seminar series of the Unit for Biocultural Variation and Obesity (UBVO). She also presented her research at the Institute of Preventative Medicine at Frederiksberg Hospital and Governing Obesity group at the University of Copenhagen, Denmark, this past March. These papers draw on findings from NIH-funded research carried out with Dr. Linda Hunt, and describe the social transformations of patients with diabetes who undergo bariatric surgery. The larger study focuses on diabetes and explores risk status, treatment responsibility, and clinical care choices, especially as these may differentially impact diverse patient groups. Her work illustrates how strongly diabetes is a motivation for patients to pursue surgery, and raises questions about the broader socio-political and ethical implications of surgical treatment for diabetes, as well as the implications for group identity and concepts of racial and ethnic difference.
The UBVO at Oxford is an interdisciplinary research unit whose academic work focuses on the various dimensions of obesity, especially the social, cultural and political aspects of the emergence of obesity among many of the world’s populations. It is one of several thematic research interest groups in the Institute of Social and Cultural Anthropology (ISCA) which organizes weekly seminars given by visiting scholars from throughout the UK and abroad. Dr. Howard attended seminars on medical anthropology, material culture and museum studies, as well as the department’s weekly seminar. During her time there she also had the opportunity to engage with Professor Stanley Ulijaszek, Director of the UBVO, and with other Oxford medical anthropologists with biocultural and ecological perspectives on health, the materiality of biomedicine, identity, and the body. “The intellectually stimulating environment was particularly productive for me in thinking through some of my analysis,” Dr. Howard explains more:
A significant preliminary outcome of the research is that it has brought into relief the complexity of transformations in patient identity compelled by rapidly changing scientific and technological approaches to the treatment of diabetes. These include surgical (bariatric) and health information technological imperatives which are re-conceptualizing patient responsibility and choice in important ways. Of particular interest to me is the extent to which an increased representation of bariatric surgery as a “cure” for diabetes has shifted the landscape of the clinical management of obesity, and dominates the decision-making of patients to pursue surgery. It also presents a valuable case study to highlight the processes by which the political determinants of disease and health unfold, and raises important ethical and policy questions. For instance, how are the lines between patient educational information and marketing blurred in the translation of scientific knowledge production about this approach to diabetes? What issues may arise around access and targeting particular populations? Will a surgical cure for diabetes be a right; a first resort? Might the surgical treatment of diabetes sustain, or even increase inequalities? And, relating back to the genomic focus of our research, how are constructions of metabolic disorder and “faulty” hormones displacing or extending genomic explanatory narratives about diabetes and obesity?
Dr. Howard was also awarded funding from the Provost Undergraduate Research Initiative to support anthropology undergraduate major, Kailyn Williams, who developed analysis of the multiple ways in which insurance coverage impacts bariatric surgery patient experience. She presented this work as a poster at the Undergraduate Research and Arts Forum in April.
Photograph of Dr. Heather Howard (above), taken by Stanley Ulijaszek
This article appears in our Spring 2016 newsletter. Read the entire newsletter here.