Decisions about weight management: a synthesis of qualitative studies of obesity

Abstract

There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions.

A Decision Aid Intervention to Improve Decisions about Weight Management Referral in Primary Care: Development and Feasibility Study

“…Other studies suggest nurses in particular may overstate the health risks of obesity and may have beliefs that it is readily tackled by weight loss [43]. The findings about patient difficulties in decision making are also supported by other research of decision making more generally [17][18][19][20][21][22].…”

“…Even well designed programmes find that a quarter or more of patients do not even make it to the start after referral [15,16]. Improving the involvement of patients in decision making in primary care prior to referral is a key area for research and development [17,18].…”

Weight Bias and the Training of Health Professionals to Better Manage Obesity: What Do We Know and What Should We Do?

“…Recent systematic syntheses of qualitative studies are useful for confirming and illuminating this picture. Brown and Gould [42] reviewed 29 qualitative studies of patient experiences of obesity. The majority of studies found participants were affected by obesity stigma with heightened awareness of negative stereotypes and internalisation of negative thoughts about self.…”

Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care

“…The authors identified a range of factors that would influence the decision to undertake weight loss, including cultural identity, responses to obesity stigma, previous weight-loss experiences, personal motivators and barriers, social support and practical resources. 40 Another review 41 described similar motivators for weight-management programs (e.g., health concerns, mental preparedness, self-perception and body image, and past positive experiences). Sociocultural factors could be facilitators or barriers, depending on the individual and culture, and weight-management attempts were influenced by expectations of weight management.…”

“…22,40,41 Patients who have tried behavioural interventions without success may benefit from a greater focus on positive lifestyle changes, such as promotion of physical activity and weight-gain prevention. 16,22 The most effective interventions were highly heterogeneous with respect to provider discipline, length and format.…”