ASU anthropologists consider the challenges of extreme weight loss in new book

April 28, 2021

You may know someone who has undergone bariatric surgery — an intense medical procedure that reduces the size of a person’s stomach to help with rapid weight loss. Doctors performed an estimated 256,000 of these procedures in 2019, according to the American Society for Metabolic and Bariatric Surgery. 

A team of Arizona State University anthropologists set out to better understand extreme weight loss via bariatric surgery by interviewing and surveying Arizona bariatric patients. The findings, published this month in a new book, intimately describe the journey leading up to surgery and life after the procedure.  headshots of three anthropologists, (from left to right) Alexandra Brewis, Amber Wutich and Sarah Trainer, co-authors of "Extreme Weight Loss: Life Before and After Bariatric Surgery" From left to right: Alexandra Brewis, Amber Wutich and Sarah Trainer, co-authors of "Extreme Weight Loss: Life Before and After Bariatric Surgery." Download Full Image

School of Human Evolution and Social Change anthropologists Alexandra Brewis and Amber Wutich co-wrote the book with Sarah Trainer, who was a postdoctoral scholar at ASU during the study and continues to be an affiliated researcher with ASU’s Center for Global Health.

The researchers interviewed patients over several years before and after bariatric surgery, accompanied them to pre- and post-surgery classes and support groups, and spent time talking with clinicians and hospital staff. The study provides a window into the complex experiences of extreme weight loss from the patient point of view.

The book outlines why people get the surgery and some of the short- and long-term challenges, while exploring stigmas and norms around living with high body weights in a society that the authors say harshly judges those with large bodies. 

“Weight discrimination is legal, pervasive and – for those that endure it – soul-destroying,” Brewis said. “By tracing how bariatric patients’ lives changed as they lost large amounts of body weights, we are telling a larger story of how society’s stigma toward large bodies harms and hurts so many.”

Trainer hopes the book will encourage readers to think critically about how they view weight and weight loss. For example, a gastric bypass is considered an elective surgery, but many patients in the study, and their doctors, saw it as a necessary, life-saving intervention. The surgery can successfully treat diabetes and other chronic weight-related diseases.  

While those who have heard of bariatric surgery may already have positive or negative thoughts about it, Trainer hopes the book will help people better understand what the surgery is and why patients have it done. 

Book cover image

Many people interviewed for this research had bariatric surgery to improve their health and quality of life, or to feel more accepted and to “fit in.” 

"I’m an active soul in a large body, and it doesn’t work, you know?” shared one participant. “I want to go hike ... I want to go to the Caribbean and snorkel and scuba dive. I’m going to get emotional. But I want to do those things, and I can’t. I can’t, physically I can’t."

After the surgery, some participants saw a positive transformation, and talked about their postsurgical lives with joy. Others faced new challenges. The book explores some of these challenges of the surgery that people might not initially consider.

In a culture that views weight loss as a success, some patients had internalized the idea that the surgery was “cheating” at weight loss. One participant shared that someone told her getting a bypass was “the easy way” to lose weight and she described how nothing about the process was easy. 

For some patients, there is a worry of regaining weight, and they count calories daily or constantly monitor their weight. 

Months after the surgery, one participant said, “I don’t feel super confident, like I beat this. Every day, every day I have to think about it, every day. I think it’s going to be a lifelong thing.”

Extreme Weight Loss: Life Before and After Bariatric Surgery” was published in April 2021 by New York University Press. 

Taylor Woods

Communications program coordinator, School of Human Evolution and Social Change


Psychology Dean's Medalist setting her own path to health care career

April 28, 2021

Editor's note: This story is part of a series of profiles of notable spring 2021 graduates.

Jasmin Ray, the 2021 Dean’s Medalist for the ASU Department of Psychology, is graduating with a major in psychology and a minor in biology and plans on going into graduate school to become a physician assistant with an emphasis in child behavioral studies.  Jasmin Ray, Dean's Medalist in the ASU Department of Psychology Jasmin Ray is the 2021 Dean’s Medalist for the ASU Department of Psychology. Download Full Image

Ray is personally interested in how intergenerational trauma from war or poverty can impact the lives of children through indirect parenting practices. Her family escaped from the Cambodian genocide and built a life for Ray in the United States, however, she had to figure out much of the college experience for herself, such as applying, gaining research experience and finding her path to graduation. 

“I’m just interested in learning how the families of people who survive trauma, such as the Cambodian genocide or the Armenian genocide are impacted by those events, both in the short and the longer term. While those people are struggling with their own mental health, they are raising their families in spite of that,” said Ray. 

While Ray won’t personally tell you how incredible she is, it was apparent from the very beginning of her time as an undergraduate research assistant in the Arizona Twin Project that she is special. 

“Jasmin has been a trailblazer for her peers and her family," said Leah Doane, associate professor of psychology and area head of the Developmental Psychology PhD program. Doane is also the co-principal investigator of the Arizona Twin Project. "Jasmin is a first-generation college student and a child of Cambodian refugees. Her high levels of tenacity, intelligence and commitment to the well-being of others echo ASU’s missions of inclusion, discovery and responsibility to the communities we serve.” 

Ray is part of the behavioral coding team on the project and helps to transcode data for the longitudinal study. She is particularly curious about the idea of nature versus nurture and how genetics plays in the long-term outcomes of the twins. 

The Twin Project features research by three female faculty leads: Doane, Associate Chair Mary Davis and Professor Kathryn Lemery-Chalfant. 

“It has been so inspiring to see a female-dominated lab where everyone is so inclusive," said Ray. "They made such an outright effort to be inclusive towards their RAs — during the summer during the period of unrest (political and social), they really took the time to make it known that all of their RAs were accepted. It was so amazing to see these three different women come together to make such a huge study and organized group of people. I think as women, we owe it to other women to go into these fields. These female experiences shape how we approach research, study medicine. Having diverse perspectives and bringing forth experiences is super important, especially in health care.”

Ray conducted her honors thesis on research data from the project as well, examining the relationship between the importance of culture and parenting practices on children’s health and adjustment.

“Her thesis examined whether parents’ traditional or mainstream cultural values or qualities of parenting, i.e., warmth, authoritarianism, were associated with children’s diurnal cortisol patterns and whether such associations were different for majority, i.e., European American, as opposed to minority, i.e., Latinx, families,” said Doane. 

While her experience at ASU featured extensive time in the research lab, Ray also found time to work in a neurorehabilitation unit for traumatic brain injury, and as a patient care technician at Phoenix Children’s Hospital. She also served as a teaching assistant within the Department of Psychology, mentoring and tutoring other undergraduate students. 

Immediately after graduation, she is taking a gap year to get patient experience while working at Phoenix Children’s Hospital. She then plans on applying to PA school, with an emphasis in child behavioral studies. 

Robert Ewing

Marketing and Communications Manager, Department of Psychology