The decision to undergo bariatric surgery remains contentious. Despite high demand, patients face long waits and requirements focused primarily on biomedical parameters (high BMI, diabetes, hypertension), ignoring factors such as social stigma and negative body image that impair mental health. The present study draws on interviews with 23 patients undergoing bariatric surgery to examine the significance of living in a fat body and how this shaped their decision-making. Employing reflexive thematic analysis within a critical realist framework, the findings show a prolonged trajectory of suffering marked by a paradox of hyper-(in)visibility. Participants reported feeling constantly scrutinized yet simultaneously dismissed due to their stigmatized bodies. For them, bariatric surgery was more than a medical intervention; it was a means to reassert agency and reconstruct a damaged identity in a society marginalizing fat bodies. This underscores the importance of integrating identity, agency, and social context into discussions about bariatric surgery.
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