Being active when living within a large body: experiences during lifestyle intervention

Abstract

Background: In-depth understanding of the experiences of both well-being and suffering in relation to being severely obese and becoming active through lifestyle intervention is lacking. Aim: to explore and describe adults' existential experiences of being active, when living within a large body-before and during a lifestyle intervention. Methods: A longitudinal design of repeated individual interviews with 16 adults with BMI ≥40, based on hermeneutic phenomenology, existential philosophy and a theory of wellbeing was performed. The study was approved by the Danish health authorities. Results: Two dimensions of experiences were found; "Living within a downward spiral" and "Striving for enjoyment and settlement". The themes describing suffering were: 'Sense of being thwarted and defeated ' and "Tackling energy depletion and impact of sense of self". The themes describing well-being were: "Hoping for renewal and energised resoluteness" and "Enduring discomfort and feeling safe". Conclusions: Interacting existential experiences can be facilitators or barriers for physical activity. It seems relevant for health care providers to address the individual's lifeworld experiences of well-being, lack of well-being and suffering. Well-being as a sense of feeling "at home" when physically active may break down an inactivity spiral. Promoting well-being is a legitimate aim of lifestyle intervention. ARTICLE HISTORY

Balancing one's mood: experiences of physical activity in adults with severe obesity 18 months after lifestyle intervention

“…This study is a part of a longitudinal study of multiple individual interviews conducted by the same interviewer (first author). The interviews are the last of a series of three individual interviews with the same participants [6]. Previous interviews were conducted before intervention and at the end of the intervention six months later.…”

“…The interview guides presented open-ended questions and served mainly as preparation prior to the interviews in order to structure and guide questions and enable active listening in an informal way. Moreover, the interview guide included a briefing and a de-briefing [21] and consisted of questions inspired by a conceptual framework of different lifeworld domains [11] in combination with personal questions reflecting previously gained understanding [6]. Being curious about the participant's present situation the initial questions of the interview were: How are you?…”

“…Clarifying questions were posed with the readiness to be told something by the participant relevant for the research questions and process of lifestyle change with openness towards their answers [19]. The first author had developed two figures presenting the preliminary findings identified in previous interviews [6] (Figure 1). The participants were asked to critique the interpretation by commenting on whether or not they could relate to the figures.…”

“…Additionally, an empirical study found that experiences of well-being, lack of well-being and suffering in relation to PA were interacting and counterbalancing each other during lifestyle intervention. The participants' negative sense of self and their body reduced well-being in the domain of mood and drained their energy [6]. Moreover, negative moods have been found to influence the maintenance of lifestyle changes [7] and to be a barrier to PA in adults with obesity [8].…”

“…Hence, physical health cannot be addressed without addressing the individual's existential experiences of PA, which must be understood as an entity by patients and healthcare providers (HCP), when aiming for increased health and well-being. Well-being may be a barrier to PA among individuals with severe obesity and promoting well-being seems a legitimate aim for interdisciplinary interventions in both the hospital and in the home setting [6]. It has been argued that normative body ideals are gendered and influence health behaviour in a way that result in men being less engaged with health and well-being than women due to their masculine identity [9].…”