Changing tastes: learning hunger and fullness after gastric bypass surgery

Introduction

A gastric bypass is a specific medical technology that alters the body in ways that radically change both how a person eats and how hunger and fullness are experienced. After surgery, the person's stomach is reduced to one-tenth of its original size, and the first part of the intestine is bypassed (Sjöström et al. 2012). Because of these physical changes, patients alter their eating practices in several ways. That is to say, the surgical transformation of stomach size and intestinal length, together with changes in food absorption, result in new sensations, and hence feelings, related to eating; these in turn lead to changes in eating practices. Patients are advised to eat small meals up to six times a day, and told to chew their food thoroughly. Some find they have to learn to eat all over again. The empirical focus of this article is on the processes involved in the resumption of eating after gastric bypass surgery. In the article, we analyse the practices and meanings attached to food and eating in the transition from before to after obesity surgery and explore the way eating shifts from a habitual routine to a distinct, conscientious engagement in relation to an altered body and new sensory experiences. ‘Eating again’ is understood here as the constant and minute adjustments made by the eater in response to the requirements of the body, informed by the nutritional expertise of dieticians and recommended meal plans on the one hand, and the personal, moral and social dimensions of the mundane practices of preparing, serving and consuming foods on the other.

Gastric bypass is considered an effective treatment for severe obesity by physicians and surgeons (O'Brien 2015), but the subjective experience of the changes it produces and their long-term impact are not well researched (Natvik et al. 2014, Throsby 2009). In the transition from before to after surgery, the existing role played by eating is challenged, and eating acquires a new role. The experience of uncertainty in patients’ lives becomes central to the way they relate to food and eating. We explore ways in which our eating seems to coalesce around experiences of personal integrity – experiences that extend beyond our bodies and comprise numerous social and material relations – by asking how patients relate to their bodies, to food and to eating during both bodily and dietary change.

Lived experience of eating, dietary change and the body

The fields of anthropology and sociology have a long history of engaging with social and cultural aspects of food and eating (for extensive reviews, see Beardsworth and Keil 1997, Mennel et al. 1992, Mintz and Du Bois 2002), but less scholarship has been devoted to the sensory aspects of eating and the lived experience of the eating body. When incorporating sensory experience into the analysis of eating, we can draw potentially on vast literature of the anthropology or sociology of the senses. But whereas most of this literature has dealt with comparative studies of ‘sensory cultures’ (Classen 1993, Howes 1991, 2003, Korsmeyer 2005), few have focused on the interconnectedness of food and the eater, as exemplified by the exploration of sensory practices (notable exceptions are Nichter 2008, Seremetakis 1996, Sutton 2001, 2010). In her seminal work on sensory memory, The Senses Still (1996) Greek anthropologist C. Nadia Seremetakis is interested in how memory and a sense of one's self is tied to the sensory experience of particular material artefacts such as food. In this way everyday experience, and thus the historicity of the self, are linked to our sensory memory of the concrete, tangible qualities of food and eating. One example she uses is the memory of tasting a particular Greek peach (rodhákino), which is no longer available. Seremetakis thus links the disappearance of sensory practices of eating particular foods or of handling other material artefacts to changes in our life world (1996: 8). A similar question arises in the case of gastric bypass patients, for what exactly happens when one can no longer experience hunger, eating, or feeling full in the ways one is accustomed to? With Seremetakis, we propose an understanding of eating as an embodied sensory practice tied to the wider material, symbolic and social formation of the self. As we shall show in the case of gastric bypass patients, disconnection from these practices can result in experiences of ‘sensory displacement’ (1996: 3) from one's self but also from others, leading in turn to experiences of social displacement. Seremetakis's work developed alongside early theories of embodied experience in the social sciences (see for example, Csodas 1990, Leder 1990, Scheper-Hughes and Lock 1987). Perspectives on the body that arise from these phenomenologically inspired studies perceive the body as the prime locus of experience. What we find particularly interesting in this strand of phenomenology is a dynamic definition of embodied experience, which conceptualises the body as a subject/object, and which highlights the tension between having and being a body. The lived body denotes a body that is somehow always being made; it is unfinished and therefore always in an intimate relationship with the world in which it finds itself (Csodas 1990). According to Leder (1990), our bodies are not acknowledgeable to us as objects in the world, because we live and act through them. He terms this the ‘disappearing body’ (Leder 1990: 25). This changes however, when, like the gastric bypass patients, we experience change or pain. The body is no longer ‘hidden’, but becomes an object in itself, demanding attention. The body's status changes from ‘disappearing’ to ‘dys-appearing’ and hence ‘it can come to appear “Other” and opposed to the self’ (Leder 1990: 70). The paradoxical way the ambiguous body becomes both an object of measurement and control in dietetic counselling and a subject (but ‘someone not quite me’) will be used as a lens here, guiding the analysis of the patients’ changing eating practices.

Eating and the body are inherently social. Hence the work of Judith Farquhar in her book Appetites – Food and Sex in Post-Socialist China (2002) offers a point of entry into combining a focus on lived experience with a focus on the political, cultural and historical contingency of embodiment. Farquhar links eating, materiality and ideology by pointing to the often-naturalised but diverse embodied and social practices that make up the practices of eating, and calls for further investigation of what she terms ‘the political phenomenology of eating’ (Farquhar 2002, 28, 47). Using Farquhar's insights, we suggest that change (in body, diet and self) should be viewed as an interrelation between politics and eating that necessarily involves negotiation of what constitutes bodies, hunger and fullness in lived everyday experience, and that experiences of diverse modes of embodiment are part of the difficulties patients have when they adopt a new diet.

Weight-loss surgery

Weight-loss surgery has gained popularity in recent years as an alternative or supplement to weight-loss diets. There are several different weight-loss surgeries, but a common bariatric procedure is the so-called Roux-en-Y gastric bypass. The procedure affects eating practices immediately because of the physiological changes it makes to the digestive tract (Moshiri et al. 2013). By creating a small gastric pouch, the procedure ensures that the new stomach can hold only a small amount of food, approximately 1.5 dl at most. In addition, the food that is eaten is not absorbed the way it was prior to surgery, since part of the small intestine is bypassed, leading to fewer calories being absorbed. Central here is the fact that regulation of eating is achieved by a radical change of the physical body rather than by interventions directed at dietary habits and practices. In Denmark the operation is offered mainly on the basis of a person's body mass index (BMI).1 Candidates are further required to lose 8 per cent of their body weight before surgery.2 At the time of fieldwork (2010–2012), a person without health problems other than obesity could be referred for surgery with a BMI of 40. For people with related health problems, the minimum BMI level was 35. Most healthcare services in Denmark are free of charge and based on the welfare state principle of equal access for all citizens. The cost of obesity surgery is high, and until recently Denmark had the world's highest number of operations per capita (550 per million citizens).3 However, Denmark has a relatively low obesity rate, at 10–15 per cent of the population. Obesity is socially differentiated in Denmark, as it is throughout the world.

Following surgery, patients can expect to lose approximately 60 per cent of their overweight, which can lead to better overall health. Weight has come to dominate health concerns, and overweight has been shown to be a risk factor, but there is in fact no guaranteed health benefit associated with losing weight (Wright 2009). Another characteristic of the operation is that it seems to ameliorate type 2 diabetes overnight in most cases (Christou et al. 2006). This remission of diabetes can be ascribed not to weight loss but to a combination of decreased food intake and changes in gut hormones as a result of the bypassed intestine (Rubino et al. 2010). Patients cannot expect to attain normal weight, and there is also a risk of re-gaining weight after a few years (see Magro et al. 2008). Furthermore, the procedure is irreversible and has both social and personal consequences. Making the stomach smaller solves the problem of eating too much at the level of ‘mechanics’, so to speak – ‘fullness’ here is understood as a consequence of physical registration of fullness in the stomach – but limiting the physical capacity of the stomach does not address other concerns or motivations, which, according to patients’ experiences, make them eat. Hunger is often described and dealt with as a merely biological drive, although we are well aware that there is much more involved in ‘wanting to eat’ than securing and satisfying physiological needs. In a social reality characterised by an abundance of food, hunger relates to many other social and normative arenas as well.

Methodology

This article builds on empirical findings from ethnographic fieldwork undertaken by the first two authors among individuals undergoing gastric bypass surgery between 2010 and 2012 in Denmark. Participant observation was carried out at a major public hospital,4 in settings such as information meetings, dietetic counselling meetings, clinical trials and examinations. Interviews were conducted with 32 individuals going through surgery (both pre-operatively and post-operatively). Most patients were interviewed in their homes. Additionally, we participated in a few meetings of the local Gastric Bypass Association in Copenhagen, which took place in the private homes of members. The Gastric Bypass Association organises voluntary support groups for people who have had surgery, or who are awaiting or considering treatment.

Most of our informants were women employed as unskilled workers in the healthcare sector or in similar service industries. Our male informants typically worked in public transport or manufacturing companies. Four times more women than men undergo this operation, which points to a gendered normativity in the way bodies are perceived and regulated.5 The questions guiding the fieldwork were how patients use or relate to instructions on how to eat, and how they experienced food and eating after the operation. In order to obtain insight into the longer-term experience of living with gastric bypass, we also included interviews with patients who had undergone surgery 1 to 2 years previously, which proved critical in determining how the analysis developed around the themes of eating, bodily change and sense of self. Doing fieldwork in a clinical setting with a vulnerable group of people was challenging. But the intimacy of interviewing and passing time together gave patients an opportunity to voice their concerns in ways that many called a relief. We interviewed each informant twice and were able to let the conversation develop and to explore themes that arose.

Before surgery: the dietician's advice

The dieticians at the hospital help patients deal with changes in eating patterns. At a hospital information meeting, Line met Fred, who let her accompany him to his first meeting with the dietician. Fred weighed 147 kg, and the dietician started out by telling him he needed to lose 12 kg before surgery. ‘It sounds impossible’, Fred replied, explaining that he had never lost more than 10 kg. Since giving up smoking 3 years previously, his weight had only gone up, he said, whistling and pointing his finger to the ceiling. Then they began to talk about his diet, asking how many meals he would eat on an average day. The dietician quickly concluded, ‘This all sounds quite sensible. Maybe we should discuss quantity?’ But the dietician then changed the subject to vegetables: ‘What about vegetables? Are you getting any of those?’ To which Fred replied, ‘I like vegetables. Yes, we do eat them. My wife isn't keen on them, but I like them’. Then, moving on to the subject of fat, they discussed Fred's breakfast. He prefers yoghurt with a fat content of 3.5 per cent. The dietician declared this too fatty: ‘We recommend 0.1 per cent’, she said. Fred was resigned: ‘Not much spark in that’. She asked a last question, ‘How about exercise?’ Fred just shook his head. Time ran out and the meeting was over, and shaking Fred's hand the dietician said, ‘It's difficult. The operation alone will not do the job. One's psyche has to be up to it as well’.

In the work of dieticians, a cultural understanding of ‘the eater’ and ‘the body’ surface in the clinical encounter. Learning through counselling is a social process, and as new eating skills are learned, so too are the social values within which the skill is practiced (see Lave and Wenger 1991). The question is whether the normative or cultural level in the dieticians’ work resonates with the way each patient practices eating. Fred had tried to go on diets previously. During his short meeting with the dietician, Fred's daily practical ways of handling food and eating were not addressed. Fred told Line that he had worked as a carpenter for many years, but that several years previously he had been retrained as a bus driver. His occupation had therefore changed from one requiring physical labour to one that was more sedentary. His wife was a healthcare assistant. They both worked variable hours, so sharing meals was not something they would do on an average day. Asked about the dietician's tip to eat dark chocolate, Fred said he was not interested. He never could stand the taste of dark chocolate.

The value of feeling perfectly satisfied by a nibble of dark chocolate, or of underlining the importance of sensing, are examples of specific ways of dealing with eating that recall values and trends linked to mindful eating and the Slow Food Movement, which appear to have spread to new areas like dietetic counselling (Vogel and Mol 2014). It is clear that in the dialogue between dieticians and patients, standard medical guidelines were communicated. These dealt with weighing bodies, measuring calories and defining nutrients. But in their seemingly more intuitive conversation around food and eating, as they reference either psychological motivation or ways of using the senses to direct or develop one's eating, dieticians express an understanding of food and eating that relates to their own personal preferences. This suggests that the values expressed by the dieticians are linked as much to issues of class and gender as they are to the relevant professional guidelines and, as we have seen, they did not apply to Fred.

It has been observed that professionals may draw on several rationalities of treatment or care (Mol 2008) that interact or fuse in practice, and although intentions are good, they do not necessarily lead to the right outcomes. Some patients, like Fred, are not that familiar with counting calories, and others have always done it. In the faces of the audience members listening to the dietician, there was doubt, frustration and raised eyebrows. At the information meetings where patients were told by dieticians to always eat proteins first to ensure a high nutritional value, the patients joked that it sounded like their favourite diet. The patients learn from dieticians to work with ‘healthier’ strategies of eating, but the different strategies formulated by the dieticians show how eating is not explored in terms of patients’ lived experience. Patients are advised to eat foods like whole grains and dark chocolate, which are conceptualised as having an effect on the way hunger or fullness is experienced. The patients work on using their senses, developing a taste for specific foods, and replacing quantity with quality or taste as a recommended way of managing hunger. The latter can be seen in the example of managing a ‘sweet tooth’ with dark chocolate. But eating dark chocolate or whole grains will not necessarily have the effect the dietician has in mind on someone like Fred. Thus there are multiple modes of hunger and fullness in play among both the patients and the dieticians; this was humorously illustrated by the patients’ joke about protein, which also points to the different cultural norms embedded in eating. The dieticians’ promotion of a healthy diet and the individual eating experiences of both patients and dieticians intersect, and diverse ways of eating are negotiated. In the following, the diet induced by the surgical procedure adds yet another layer to the diversity in eating.

After surgery: new stomach – new sensations

Karen summed up by saying, ‘Now everything is about food, and I am not used to this. Before, it was instinctive – I'll just made something and it tasted good’ (Karen, 18 months after the operation). Karen's juxtaposition of the idea that ‘food has controlled my life’ and the notion that ‘now everything is about food, and I'm not used to it’ is striking. It is clear that she experiences a dramatic change in how she handles her eating. The role of food has changed. Now, she is forced to be conscious of when and what she eats, when she is not eating, and when she feels the urge to eat. Before, she did not experience hunger the way she does now. Experiencing hunger now evokes sadness in her, insanity even. Before, hunger was about reacting to a craving: she made something and it tasted good, as she says. She mentioned buttered toast as an example of something that would make her eat; hence a craving for a certain food can be, we suggest, what determines, or is experienced as, the ‘right’ kind of hunger. Karen continues to talk about herself as a host, a role she is fond of. What Karen's story underlines is how profoundly eating relates to a person's sense of self, and how changes around eating might develop into disruptions, not only in the way she experiences her body, but also in the way she relates to herself and acts in the world. This is something we shall return to shortly.

After surgery: experimenting with eating again

Surely Anne was well aware of how to follow ‘the right’ habits. She has what she terms ‘drawer food’ in the kitchen, like popcorn, dark chocolate and nuts – small snacks to prevent herself from eating more unhealthy stuff – but in the end she never ate it. Some begin to follow the dieticians’ advice about using the senses to replace quantity with quality or taste. Miriam, for example, spoke about her supermarket budget: she described how she now chooses to buy better-quality products, and enjoys new experiences like squeezing an organic lemon, appreciating the smell and freshness of the fruit. One couple described the alteration in their eating preferences as follows: ‘Before, we would go for an “all you can eat” kind of place, now it's homemade sushi’. John, meanwhile, talked about having ‘begun to eat properly’ – that is, ‘chew extra and think’, as he summed it up. Most of the patients develop new eating practices and habits out of need, but nevertheless, the slow tempo, the tiny meals, and the focus on every bite are challenging. Cutting food into the tiniest bits was strange and left them with the feeling of actually not sensing the food in the mouth. Some felt it was like ‘chewing air’ and had developed the practice of putting down their cutlery between each bite as a way of prolonging the meal and of avoiding having nothing to chew on too soon, both in terms of eating socially with others and in terms of time (according to dieticians, a meal ought to last around 30 minutes).

In our analysis of the above, we found that the patients’ practices bear a resemblance to mimicry. Mimicry is a practice of close imitation characterised by ‘likeness’ between the imitator and the imitated (Taussig 1993). From this perspective, one might suggest that, through their practices, patients connect to new eating practices by mimetically representing them. Thus, Anne could be said to be experimenting with adapting to a healthy lifestyle by strolling with her wicker shopping basket, which she understands to be an iconic image of ‘the gourmet’ – that is, a person with the ‘right’ kind of eating habits. It might help to pursue a mimetic strategy, but when those who do so are unsuccessful, we suggest this is because the new practices cannot fulfil the eater's needs. John still hungered for rib-eye steak, and not being able to change that, mimicked ‘normal’ eating through his ‘sham-eating’ practice. Sham eating is an example of mimetic eating. One might also argue that eating ‘light’ products, as patients are advised by their dieticians, could be considered mimetic eating. Here, for example, what Fred considers ‘real’ yoghurt is substituted by a reduced-fat product, yielding a type of mimetic eating he rejects. These types of mimetic eating are mechanical in nature. By ‘mechanical’ we mean that their tool-like characteristics (for example, reduced fat content) are foregrounded at the expense of emotive associations, memories, sensory pleasure and so on. This tendency is also observed in Gracia-Arnaiz's article on eating disorders, in which she questions the paradoxical way in which those obsessed with eating are advised by counsellors to control their eating even further (2009: 201). In our material, we see that patients’ eating often remains mimetic, because it is not embedded in their lived experience of eating in a meaningful way. One might further suggest that the mechanistic approaches applied by the patients resemble the logic of the intervention practices that they encounter at the hospital, in terms of both the actual operation and the approach to food proposed by the dieticians. It is evident that the patients do not learn healthy eating habits as part of the intervention process. Instead, they find themselves caught between their old eating patterns and not-yet-embodied new practices.

It is also interesting how tasting, as opposed to eating, gains importance for the patients, which indicates the close relationship between eating, the materiality of the food and the senses, a relationship that turns taste into an embodied ‘act; sitting and listening, feeling, tasting, touching. This “doing” engages the body entering into contact with a material and having an impression that is difficult to qualify’ (Hennion 2005: 676). In what follows, it is not only uncertainty about the usefulness of the instructions, but also uncertainty about the taste of food after the operation that plays a significant role.

Uncertain tastes: beyond stomach sensibilities

After the operation, patients react to their food in often unexpected ways. Taste change following gastric bypass is recognised biomedically as an adverse side-effect of the surgery. Some patients experience dramatic food aversions, or changes in tastes and preferences, but so far a clear cause of this phenomenon has not been established (Benson-Davies and Quigley 2008). In conversation, the doctors at the hospital said that taste change is experienced by approximately two-thirds of patients. In spite of this, this theme was not incorporated as a topic in itself at the hospital meetings, but was mentioned instead along with other side effects of the operation. In Jane's case it seemed quite clear that she was choosing food she used to like, and that she then found out through experimentation that foods that used to give her pleasure were no longer tasty. Many of the patients feel disgust when confronted with certain foods. For some, this can be foods they used to like, and for others, it can be a whole group of foods: salty, sweet, fatty and so forth. The patients experience uncertainty when they discover that their taste for things has changed: they experience anxiety (fright, even) about doing something wrong, but also a more existential anxiety as new sensitivities are activated. Disgust has been described as ‘a sentiment that unites physical experience with emotional force and moral evaluation’ (Durham 2011: 133). In anthropological scholarship on dietary taboos and transgressions, food and consumption play important roles in establishing social order and physical and social boundaries. Disgusting objects are often those that violate boundaries (Douglas 1966). Following this line of thinking, disgust might be understood as something related to social rupture. Thus, disgust is not only linked to ‘boundaries of the self’, but ‘extends beyond the self’ (Douglas 1966: 144). In a recent study, Mol uses the example of patients who have been tube-fed. She finds that the patients experience a lack of taste to the food the way they used to. Mol argues that in the case of eating despite sickness, it is possible to come back to eating because taste ‘can be made to have a function’. We as eaters have an attachment to tasting and to the pleasures of taste, and therein lie taste's therapeutic possibilities (Mol 2011: 9). The idea we propose to extract from Mol's analysis is that of an ‘attachment’ to taste, and thus the ‘drive’ to taste (in the usual way). The way that uncertainty unfolds in patients’ eating practices relates, we suggest, to a similar drive to taste – which, has to be viewed as something related in complex ways to the interconnectedness of modes of being and modes of sensing. When they express uncertainty in eating, patients are experiencing what we suggest should be understood as a lack of both former sensory practices and of the specific foods they used to cherish. In that respect, the patients become ‘sensory-displaced’ (Seremetakis 1994: 3). As a consequence, their experience of uncertainty when becoming accustomed to new dietary practices ruptures their own (indigenous) modes of sensory investment and reception (Seremetakis 1994).

‘Foods are distinct from other objects that people may use to derive comfort’, writes Locher et al. about comfort foods. This is because foods are ‘incorporated’, and thus have both physical and emotional effects (2005: 275). The new uncertainty in the way a person deals with food and eating thus becomes an issue of personal integrity and identity. Returning to Leder and to the experience of ‘dys-appearance’, we find in Jane's case that the sensory displacement is a displacement from herself. Once the surgery had happened she lost what one might call ‘bodily access’ to herself, as she was no longer able to act upon cravings that used to be a familiar signal from her body; hence her way of caring for herself is obstructed.

Eating and being

Changing the way we eat also changes who we are in our fundamentally embodied experience. The body becomes an object when patients experience changes in their ways of eating. What is perhaps more surprising is that the body appears as a subject. The body suddenly acts on its own, producing new sensations, such as sudden fullness or aversion to once-cherished food. In this sense, the body acts unaccountably, almost like an actor with its own will. Experiences like this can, for some, result in uncertainty and in the feeling that the body is different. The person affected in this way may say things like, ‘I'm not myself’, or ‘My body doesn't want what I want’. We find that ruptures in a person's way of eating are closely connected to ruptures in a person's sense of self, and ruptures on the level of the patient's personal eating seem to spill over to the social realm and have important consequences for the social lives of these patients. These patients will not come to eat more normally (if such normality exists). Despite the surgery, they are still moving around the periphery of meals. They prepare special meals to eat in parallel with family meals, or they tend to eat before or after. One of the women had a private day-care service where she had worked for 31 years. This was meant to be something she would do while her son was little, but it continued. She reasons that her overweight developed because she was always cooking and caring for the children. But it struck us that she said she never shared a meal with the children. It was not until they had left her home at 3:00 PM that she would eat. The same was true when she left the house: she would not eat for a whole day when out shopping. Upon returning, late in the afternoon, she would eat. We met her again later, and she felt energetic: ‘I lost my joy in eating, but it doesn't matter because I have so much more in my life now’, she said, telling me how she had started to redecorate her kitchen. But she herself did not eat in her new kitchen, as she had stopped taking ordinary meals and no longer ate together with the family. She still enjoyed watching the family eat, however. This paradox suggests that her eating has changed even more after the surgery. Before, she did not eat when at work or out, but now her pleasure in food was also displaced – to the kitchen décor, or to watching the rest of family eat. Not only was she ‘sensory-displaced’ and therefore unable to pursue her usual eating habits and pleasures, but her sensory displacement had also turned into social displacement.

Conclusion

In a Western society whose social reality is characterised by an abundance of food, feelings of hunger and fullness relate to many other social, normative arenas. Focusing on eating and dietary change in practice, as this study has done, helps situate phenomena like hunger and fullness and requires us to look beyond the idea that these are merely natural needs. When we ground peoples’ changing sense of themselves in their everyday sensory experience, we find that eating and the range of sense-making practices related to eating are embodied modes of presence and engagement in the world. Gastric bypass surgery alters the body in ways that force patients to change their eating habits. This alteration produces new sensory experiences that cause not only a displacement from the patients’ sense of self, but also ruptures in their social life. Though many of the patients have attempted to diet periodically for most of their lives, and therefore tend to eat very differently from the rest of their families, the patients did not feel that their dieting had affected their families in the same way as the surgery. They cherished their role as food providers and enjoyed eating with their family, and would always prioritise a hot meal with the family. After the operation, some lost the joy of eating, or had bouts of nausea or other side-effects, and some found it difficult to hold on to their usual routines. Post-operatively, patients lost a lot of weight, but they also found their lives had changed in ways they were not prepared for. What we want to highlight are the consequences of this sensory displacement for patients. Although doctors and dieticians facilitate treatment to overcome obesity – a condition that causes patients to suffer – the consequences of treatment are complicated. The patients hoped to attain ‘normality’, and health personnel shared this objective, but as we have shown, the process entails unforeseen existential uncertainty. When patients tried to change their eating, we found that they developed ‘mimetic eating’ practices: that is, they adopted practices they associate with healthy eating, such as keeping healthy snacks like popcorn in a drawer. Mimicry is part of most social learning as a first step to acquire new competences (Lave and Wenger 1991), but some gastric bypass patients seem stuck in their mimetic practices. Tangible and sensory qualities of food are crucial in these respects, and are part of the reason that popcorn is not interchangeable with buttered toast. Foodstuffs like those in the drawer and the ways of eating that are recommended to patients are neither the right kind of satisfaction nor are they the true object of their hunger. Furthermore, gastric bypass patients’ ways of handling and expressing the uncertainty that arose from these changes are analysable as expressions of the moralities involved in changing and adjusting their subjective experience of eating. The adoption of ‘healthy eating’ that the patients encounter at the hospital might potentially be analysed as a ‘politics of the senses’ (Farquhar 2002: 89). The radical changes in the patients’ former modes of sensing, along with the new sensations themselves, do not allow patients to access their bodies the way they used to. However disturbing these changes may be to patients, they are naturalised in the hospital setting and thus not questioned.