A synthesis of qualitative research on overweight and obese people's views and experiences of weight management

Abstract

The effectiveness of existing weight management programmes may be improved by understanding overweight and obese people's perceptions of the reasons for successful and unsuccessful weight management. Many qualitative studies have investigated overweight and obese adults' experiences with weight management. This paper presents findings of a meta-ethnography that synthesized 17 qualitative studies of overweight and obese adults' weight management experiences, principally in the context of behavioural weight management programmes. Twelve themes were derived describing factors that overweight and obese people identify as relevant to weight management: health concerns, expectations towards weight management, attributions for weight gain, psychological barriers, psychological facilitators, self-perception and body image, stigmatization, socio-cultural factors, environmental barriers, environmental facilitators, experiences with weight management programmes and positive outcomes of programme participation. Interventions that address all of the modifiable factors identified in this review are likely to appear credible to participants and will engage with the intra- and extra-individual factors that they perceive as affecting their weight management efforts.

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Review Articlecob_21 110..126
A synthesis of qualitative research on overweight
and obese people’s views and experiences of
weight management
G. Garip and L. Yardley
School of Psychology, University of
Southampton, Southampton, UK
Received 20 May 2011; revised 29 July 2011;
accepted 1 August 2011
Address for correspondence: Gulcan Garip,
School of Psychology, University of
Southampton, Southampton SO17 1BJ, UK.
E-mail: gg1g09@soton.ac.uk
Summary
The effectiveness of existing weight management programmes may be improved
by understanding overweight and obese people’s perceptions of the reasons for
successful and unsuccessful weight management. Many qualitative studies have
investigated overweight and obese adults’ experiences with weight management.
This paper presents findings of a meta-ethnography that synthesized 17 qualitative
studies of overweight and obese adults’ weight management experiences, princi-
pally in the context of behavioural weight management programmes. Twelve
themes were derived describing factors that overweight and obese people identify
as relevant to weight management: health concerns, expectations towards weight
management, attributions for weight gain, psychological barriers, psychological
facilitators, self-perception and body image, stigmatization, socio-cultural factors,
environmental barriers, environmental facilitators, experiences with weight man-
agement programmes and positive outcomes of programme participation. Inter-
ventions that address all of the modifiable factors identified in this review are
likely to appear credible to participants and will engage with the intra- and
extra-individual factors that they perceive as affecting their weight management
efforts.
Keywords:Obesity,overweight,qualitative studies,weight management.
Introduction
The International Association for the Study of Obesity (1)
reports that around 1.5 billion adults worldwide are either
obese or overweight. Obesity is associated with many
adverse outcomes, including morbidity, disability, prema-
ture death (2), poor mental health (3), stigma and discrimi-
nation (4). Sustained weight loss of 5–10% of initial body
weight in overweight and obese people has been associated
with benefits to physical and psychosocial health, func-
tional ability and quality of life (5). Despite the wide variety
of individual and population based interventions that have
been developed to address obesity, the rise in obesity rates
suggests that the long-term results of such interventions
have generally been poor (6).
Systematic reviews have been conducted to evaluate the
effectiveness of weight management interventions in order
to establish which types of interventions, or components
of interventions, are most effective for supporting over-
weight and obese people to adopt dietary and physical
activity behaviours associated with weight management
(7,8). Meta-analyses indicate that lifestyle interventions
appear to be more effective than interventions focusing on
immediate weight loss (7,8). Previous reviews of the
factors associated with weight management have tended
to focus on quantitative studies and has been useful for
identifying determinants of weight management (9). The
potential contribution of the perspectives of people
who attempt to manage their weight has received less
attention.
clinical obesity doi: 10.1111/j.1758-8111.2011.00021.x
110 © 2011 The Authors
Clinical Obesity © 2011 International Association for the Study of Obesity. clinical obesity 1, 110–126

Quantitative research typically provides limited informa-
tion about how and why adults adopt, maintain or cease to
engage in behaviours associated with weight management
in the long-term. The effectiveness of weight management
interventions may be improved by a better understanding
of how and why successful and unsuccessful weight man-
agement occurs. Hence, one way of improving weight man-
agement programmes may be to learn from the views of the
target users regarding its acceptability and feasibility.
Numerous qualitative studies have investigated overweight
and obese people’s views of weight loss and their experi-
ences with weight management programmes. Such studies
are valuable for identifying limitations of existing pro-
grammes and offering suggestions for improvements from
overweight and obese people’s viewpoint. However, most
have focused on people’s views regarding a single pro-
gramme, in a single context, and their generalizability to
other programmes is therefore unclear.
Qualitative studies are increasingly recognized as an
important source of evidence for public health (10). The
feasibility and usefulness of using meta-ethnography (11)
to synthesize qualitative research in a defined field of study
has been demonstrated (12,13). However, there are no
existing published syntheses of qualitative research on
overweight and obese people’s experiences with weight
management and weight management programmes.
This systematic review was undertaken to identify and
synthesize published qualitative findings of overweight and
obese adults’ experiences and perceptions of weight man-
agement and behavioural weight management programmes.
The aim was to identify factors perceived by overweight and
obese people as relevant to successful and unsuccessful
weight management and to derive a more comprehensive
understanding of people’s experiences with weight manage-
ment that may inform future research and practice.
Methods
Selection criteria
Qualitative studies were eligible if they explored the
experiences and views of obese and/or overweight adults
regarding weight management and behavioural weight
management interventions in North American, European
and Australian settings. Studies involving medical popula-
tions undergoing surgery or pharmacological weight man-
agement interventions were excluded as these experiences
were considered to be very different from behavioural
weight management. The perspectives of health profes-
sionals and relatives were excluded. Only studies written
in English were included in this study. Unpublished theses
and dissertations were not considered for this meta-
ethnography as they may not have been subject to the
rigorous reviewing that published studies have undergone.
The search strategy
A systematic literature search was conducted from
October–November 2010 utilizing a range of electronic
databases. Databases searched and the search terms used
are detailed in Table 1. The search terms overweight/obese
and qualitative/qualitative research were searched as key
terms, while the remaining terms were entered into the
databases using MeSH explode where this was possible. In
databases where it was possible to specify the participants’
age range, studies using adult samples were selected.
The searches initially identified 943 references that
were imported into an EndNote bibliographic database.
Following a process of electronic and manual elimination
of duplicates, the number was reduced to 596 records.
Titles and abstracts were searched to identify papers of
potential relevance. There were few papers published
before 1990, and overweight and obese people’s experi-
ences with weight management were qualitatively differ-
ent in studies published post-1990. We attributed this
difference to changes in the prevalence of obesity. There-
fore, for the meta-ethnography, a 20-year period, from
1990 to 2010, was considered adequate to cover the most
recent research on overweight and obese adults’ views on
weight management. Five hundred seventy-eight studies
did not meet the inclusion criteria in terms of the aims of
the study, study setting, language, year of publication and
characteristics of the sample, which resulted in 18 studies
that were selected for further screening.
One of the 18 articles was excluded as its aims were
incompatible with this paper. Seventeen papers met the
inclusion criteria (see Table 2 for study characteristics), a
sample size that is compatible with Sandelowski and Bar-
roso’s (14) recommendation of including at least 10–12
studies in a meta-synthesis. The reference lists of potentially
relevant papers were searched but no further articles were
identified. Figure 1 shows the study selection process.
Table 1 Databases searched and search terms used
Databases
searched
Interface Coverage
PsycINFO EBSCO 1806 to November 2010
MEDLINE Ovid SP 1966 to November 2010
EMBASE Ovid SP 1980 to November 2010
Web of Science ISI WoKnowledge
Platform
1981 to November 2010
OR AND
OR
AND
OR
Overweight ‘weight loss’ ‘qualitative research’
obese ‘weight control’ Qualitative
‘weight reduction’ interview*
‘weight management’ ‘focus groups’
‘weight maintenance’ narrative*
‘weight perception’ ‘grounded theory’
clinical obesity Overweight and obese people’s views G. Garip & L. Yardley 111
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Table 2 Study characteristics
Authors Aims Setting Participants, sample selection
and socioeconomic (SE)
factors
Data collection Data analysis
Davis et al. (36) Examined obese women’s experiences with
weight loss methods
Maryland, USA Purposive volunteer sample of
obese African–American
and white women (n=27)
Focus groups (n=4) Grounded theory approach
Visram et al. (33) Explored the views and experiences of patients
who recently completed a primary care-based
weight management intervention
Newcastle, UK Purposive volunteer sample of
overweight and obese
patients (n=20) recently
completing a weight
management programme
Semi-structured interviews
(n=20)
Subject coding and thematic
representations (Miles and Huberman
(42))
Fogel et al. (32) Described the experience of weight loss efforts
among lesbians participating in a
predominantly lesbian weight loss group
USA Self-identified overweight
lesbians (n=14)
Focus groups (n=2) Template analysis (Crabtree and Miller
(43))
Bidgood and
Buckroyd (34)
Explored obese adults’ accounts of their
experiences and feelings during their attempts
to lose weight and to maintain a reduced
weight
Hertfordshire, UK Volunteer sample of obese
men and women (n=18)
Semi-structured interview
(n=8); focus groups
(n=2)
Thematic analysis
Lopez (1997) (19) Described women’s experiences of weight
treatment and how they integrated the
requirements of the programme into their daily
life activities
USA Purposive volunteer sample of
women (n=6) attending
one of three weight
treatment programmes
Series of three in-depth
interviews (n=6)
Feminist framework was used to focus
the inquiry on women’s daily
experiences with their chosen weight
treatment programmes within the
context of American culture. No
information on data analysis given
Adolfsson et al. (31) Identified the circumstances considered to be
important for obese individuals participating in
a lifestyle intervention programme for weight
reduction
Stockholm,
Sweden
Volunteer sample of
overweight and obese
attendees (n=15) in a
weight reduction
programme
Series of four
semi-structured
interviews (n=15)
Transcripts coded according to topic
using a vertical and horizontal coding
system
Johnson (28) Described and analysed the experience of the
weight loss process among participants
attending a weight loss programme
USA Purposive volunteer sample of
attendees (n=13) of a
weight loss programme
Series of in-depth
interviews (n=13)
Grounded theory
van Zandvoort
et al. (27)
Explored obese female university students’ views
on their experience of a co-active life
coaching intervention
Ontario, Canada Obese female university
students (n=5)
Semi-structured interviews
(n=5) conducted pre-
and post-participation
in the coaching
intervention
Inductive content analysis
Groven and
Engelsrud (30)
Explored how women experience training as a
means of losing weight
Norway Purposive volunteer sample of
obese women (n=5)
participating in an exercise
programme
In-depth interviews (n=5) ‘Bricolage’ Several analytic techniques
and concepts based on systematic of
the transcripts
112 Overweight and obese people’s views G. Garip & L. Yardley clinical obesity
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Barberia et al. (29) Explored obese and overweight women’s beliefs
and attitudes related to eating behaviours
Spain Overweight and obese female
(n=17) outpatients
participating in a weight
loss programme
In-depth interviews
(n=17)
Grounded theory
Miles and Panton (18) Assessed the ways in which the perceived
quality of community environments affects
low-income women’s efforts to increase
physical activity
USA Overweight and obese
women (n=25)
participating in an
intervention to increase
number of daily steps taken
In-depth interview (n=25) Content analysis
Herriot et al. (26) Investigated obese adults’ reasons for
volunteering for a weight loss programme and
their experiences in a commercial weight loss
programme
Surrey, UK Obese adults (n=32)
participating in one of four
commercial weight loss
programmes
Baseline focus groups
(n=6); follow-up focus
groups (n=4)
Classical long table approach
Jones et al. (23) Investigated obese adults’ views on attending
community dietetic clinics, on dietetic service,
the outcomes of dietary treatment in terms of
lifestyle change and the impact of the dietician
Ayrshire, West of
Scotland
Obese patients (n=24)
attending dietetic clinics for
weight management
Semi-structured interviews
(n=24)
Content analysis
Burke et al. (24) Explored participants’ experience of
self-monitoring and described their feelings,
attitudes and behaviours while using a diary to
self-monitor their diet and exercise
USA Purposive volunteer sample of
overweight adults (n=15)
participating in a
behavioural weight loss
intervention
Semi-structured interviews
(n=15)
Inductive content analysis
Sabiston et al. (25) Explored the experiences of overweight women
participating in a physical activity intervention
Canada Overweight, inactive women
volunteering in the physical
activity intervention (n=8)
In-depth interviews (n=8) Interpretative phenomenological analysis
Greener et al. (35) Investigated the perspectives of lay overweight
people about their beliefs of the causes of
obesity and effective interventions to manage
their weight
UK Purposive volunteer sample of
self-identified overweight
men and women (n=34)
Interviews (n=34) Framework approach
Cioffi (22) Explored factors that influence participants’
transition from a weight management
programme
Australia Purposive volunteer sample
(n=12)
Interviews (n=12) Thematic analysis
clinical obesity Overweight and obese people’s views G. Garip & L. Yardley 113
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Quality assessment
A structured appraisal tool was used to evaluate the quality
of the studies included in the meta-ethnography (15); a
modified version of the critical appraisal skills programme
(CASP) for qualitative research (16) by Campbell and col-
leagues (12) was used for this purpose to evaluate 18 papers
prior to conducting the synthesis. The authors discussed the
evaluation of each paper in light of the modified CASP
criteria. Two screening questions were used to eliminate
papers that were inappropriate for the purposes of the
synthesis: ‘is this paper a qualitative study and did it involve
qualitative methods of data collection and analysis?’ and ‘is
the research relevant to the synthesis topic?’. One study was
excluded at this stage. All the remaining 17 studies were
considered of sufficient quality to be included in the synthe-
sis. Ratings for each paper can be found in Appendix 1.
Papers from journals with generous word limits (mainly
papers from the field of nursing) were easier to evaluate
because the length of articles allowed the research process to
be more fully described. Papers published in medical jour-
nals (e.g. Davis et al. (17)) and a study that used mixed
methods (18) were often poorly rated using the CASP tool
due to lack of space to provide methodological details. Most
papers (n=16) reported the type of qualitative data analysis
used in the study, with the exception of Lopez (19).
However, only Lopez reported the theoretical framework
from which the study was conducted. However, it became
evident that study quality as assessed by the CASP criteria
did not affect the contribution of a paper to the synthesis.
Descriptive studies with a well-described and satisfactory
methodology offered few insights, while conceptual studies
with rigorous analysis made substantial contributions to the
development of the themes and findings of this study even if
their method was less comprehensively described (20).
The synthesis
Meta-ethnography is an interpretive approach that was
initially developed for synthesizing ethnographic research
in the field of education (11) and was selected for the
purpose of this review because it is now one of the most
well-developed methods for synthesizing qualitative data
(21). Noblit and Hare suggest that concepts from indi-
vidual studies can be synthesized to develop a broader
interpretation of the written interpretive accounts by a
process called ‘reciprocal translational analysis’. The
process of ‘translation’ involves identifying common and
recurring concepts across the individual papers to derive
‘third-order constructs’. According to Noblit and Hare,
‘second-order constructs’ are concepts developed by the
authors of the individual papers, which are based on the
‘first-order constructs’ (i.e. participants’ accounts). Noblit
and Hare use the term ‘constructs’, but in this paper, we
will use the term ‘themes’ as it conveys a similar meaning
and is more widely recognized.
For this meta-ethnography, the selected articles were read
in full several times, noting the main themes, descriptions
and quotes representative of each of the themes. Fourteen
(18,19,22–33) of the 17 selected papers focused on people’s
experiences with weight management programmes, while
three papers (17,34,35) explored people’s experiences with
weight management outside the context of weight manage-
ment programmes. A grid was created to aid the ‘translation’
of studies into one another. Each paper was entered into a
separate column and the themes from each paper entered
into the grid. The grid was explored to identify related
themes that could be grouped together across studies. A
coding manual was developed using the second-order
themes to derive third-order themes (see Appendix 2). The
second-order themes in each paper were compared with
those from other studies. Similar themes were grouped
together and through an iterative process of review and
discussion translations of the themes were developed to
create third-order themes, which are the authors’ interpre-
tations of the findings from the studies reviewed.
Results
Seventeen studies were reviewed in this paper. Eight were
conducted in the USA and in Canada, five in the UK, three
in Europe and one study was undertaken in Australia.
Participants’ demographic characteristics were diverse in
terms of age, socioeconomic status, sexuality and ethnicity.
The total number of participants was 290; at least 224
943 study records identified from databases listed in Table 1
596 study records as the starting point for screening
18 full-text records selected for further screening
Reviewed by GG and discussed with LY
17 studies included in the synthesis
347 duplicate records omitted
578 studies failed to meet required study inclusion criteria:
•Language/location = 7
•Participants not at least 18 years old = 31
•Participants from a medical population= 189
•Study did not focus on overweight and obese people’s
experiences with weight management = 119
•Quantitative study = 206
•Views of health professionals and parents = 26
17 studies assessed for eligibility
1 article excluded based on aims of the study
Figure 1 Flow chart for selecting studies.
114 Overweight and obese people’s views G. Garip & L. Yardley clinical obesity
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participants were women, but one study (35) did not report
the number of participants by gender. Eight studies
involved mixed samples, while nine studies reported
female-only samples from diverse backgrounds.
Twelve third-order themes were derived from the papers
that were reviewed and are presented in Table 3. Participa-
tion in weight management programmes was not common
in all the selected studies. Table 4 illustrates participants’
quotes that are representative of the third-order themes.
Health concerns related to excess weight
Many studies found that the existence of health problems
(18) and the desire to prevent future health problems
(23,26,29,32,33,35) were the main reasons reported why
some people engaged in weight management. Visram et al.
(33) found that 20 overweight and obese people, with ages
ranging from 21 to 70, viewed health professionals as a
legitimate source informing them of the consequences of
excess weight on their health, which motivated them to
manage their weight.
Expectations of weight management
Studies revealed that people’s expectations of the weight
management process varied, which may influence their
weight management attempts. Groven and Engelsrud (30)
conducted in-depth interviews with obese women between
the ages of 35 and 63 and found that participants had
ambivalent attitudes towards weight management, which
were related to fluctuations in their weight. Some studies
revealed unrealistic expectations of weight management
(23,26), which led to disappointment and negative atti-
tudes towards the weight management programme and/or
towards themselves (23).
Some people had more realistic expectations (26),
which may have facilitated the development of effective
strategies to deal with potential relapses. For example,
one study found that five obese women attending a
weight management intervention aiming to increase physi-
cal activity levels expected to experience physical discom-
fort during the sessions and attributed this to their excess
weight (30). It was reported that participants believed
that by persevering with the programme, engaging in
physical activity would cause less physical discomfort as
they lost weight.
Attributions for weight gain and the maintenance
of excess weight
A variety of attributions were made for weight gain and the
maintenance of excess weight when people were not trying
Table 3 Summary of themes derived from the studies reviewed
Third-order themes Second-order themes Papers from which themes were derived
Health concerns Motivation to improve health; existing health problems; legitimization
from health professionals
(33) (26) (35) (32) (29) (23) (18)
Expectations towards weight
management
Weight management processes; unrealistic expectations; realistic
expectations
(30) (26) (23)
Attributions for weight gain and the
maintenance of excess weight
Unhealthy behaviours and eating habits; lack of physical activity;
physical and psychological problems
(35) (28) (18)
Psychological factors
Facilitators Internal changes; understanding one’s eating and dieting patterns (24) (28)
Barriers Previous weight loss attempts; eating for reasons other than hunger;
feeling unable to manage weight
(26) (24) (35) (32) (29) (27) (31) (22) (34)
(18)
Self-perception and body image Feelings related to excess weight; motivation to improve body
image; weight management as a personal responsibility
(19) (26) (24) (35) (32) (29) (27) (28) (25)
Stigmatizing experiences Experiences of stigma; stigma as a barrier and motivator to weight
loss
(33) (30) (26) (34)
Socio-cultural factors Competing daily responsibilities; influences of family and friends;
societal and cultural influences
(33) (19) (26) (24) (35) (29) (27) (31) (34)
(23) (17)
Environmental factors
Facilitator Reorganizing the environment (28)
Barriers Availability of tempting food; costs; safety and security concerns;
services and facilities
(26) (35) (29) (27) (23) (18)
Experiences with the programme Support from peers and health professionals; obligations to attend;
intervention environment liked; conflict between structure and
participant’s desire to be in control; dependence
(33) (19) (30) (26) (24) (35) (32) (29) (27)
(31) (22) (34)
Positive outcomes of programme
participation
Knowledge and skills; weight loss; weight loss-related
psychological benefits; weight loss-related physical benefits;
improved lifestyle
(33) (24) (32) (27) (31) (22) (23)
clinical obesity Overweight and obese people’s views G. Garip & L. Yardley 115
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to manage their weight. Many overweight and obese people
between the ages of 18 and 50 commonly attributed their
excess weight to unhealthy behaviours (35) and dietary
(18,35) and physical activity patterns (18,35) that were
incompatible with weight management. These people
attributed their excess weight to modifiable behaviours,
suggesting they were knowledgeable about how to success-
fully manage weight and viewed weight maintenance as a
personal responsibility.
Miles and Panton (18) reported that overweight and
obese women from low socioeconomic backgrounds
viewed physical and psychological problems as the main
cause of weight gain and the maintenance of excess weight.
In a few studies (18,28,35), some people attributed their
excess weight to genetic factors, life events and having
children. For these people, excess weight was attributed to
uncontrollable factors, which may have implications for
their attitudes towards weight management.
Psychological factors
Studies identified a variety of psychological factors that
may hinder or facilitate people’s weight management
attempts. Previous experiences of unsuccessful weight
management were described as potentially influencing peo-
ple’s confidence to successfully manage weight in the future
(26,32,34,35). The majority of studies reported that many
people felt they were unsuccessful with weight management
because they lacked the will-power (24,29,35) or knowl-
edge and skills (24) for successful weight management, had
psychological problems (18,24,27) or reverted back to old
dietary habits (22,24). Another explanation for unsuccess-
ful weight management was people eating for reasons other
than hunger, such as emotional and habitual eating
(24,26,31).
According to one study in which 13 overweight and
obese women were interviewed, understanding one’s eating
and dieting patterns was helpful for the identification of
unhelpful behaviours, which guided the development of a
plan for weight management (28). Other studies suggested
that successful weight management was associated with
achieving a psychological preparedness to integrate weight
management strategies into everyday life and to be com-
mitted to self-management (24,28).
In sum, it may be necessary to help overweight and obese
people identify and address psychological barriers to
weight management such as maladaptive habits, poor self-
regulation skills, low motivation or emotional problems.
Table 4 Quotes illustrating the third-order themes
Theme Representative quotes
Health concerns ‘The doctor telling you you’re not well. [...]when somebody says “you’ve got seriously high blood pressure and it’s
your life” type of thing, you get off your backside and you try to do something about it’. (Male) (33)
Expectations towards weight
management
‘. . . I’m really trying to get [the weight] off. I’m eating better, but it’s not coming off – it’s not getting off as fast as I
hoped it would’. (Female, obese) (27)
Attributions for weight gain
and the maintenance of
excess weight
‘I live a stressful life during the day and love eating at night. I lie in bed, watch TV and eat cheese, crackers, fruit,
and sandwiches ...Idon’t want to deprive myself. I have a right to enjoy something’. (Female, 38, obese) (31)
Psychological facilitators ‘...withtheotherdiets thatI’ve done before, you get so far then the line and you give up. But because I can still
say I’m losing weight, it’s an incentive to continue to be careful’. (Female) (33)
Psychological barriers When I get depressed I feel anxious and I go directly to the fridge [...]myway ofescape is the food (Alicia, 27,
obese) (29)
Self-perceptions and body
image
‘When no one else is around I look in the mirror at myself – I look good. If someone else comes into the room, I look
fat. I see myself differently when someone else is around’. (28)
Stigmatizing experiences ‘If you’re waiting to be served, you can be overlooked ...bigasyouare,youcanbeinvisible.People make snide
comments to each other in lifts. In passing they will stare’. (34)
Socio-cultural factors ‘It is very hard if I have to cook for my children. Say that I am preparing 3 sandwiches of Nutella, come on! You have
to have loads of willpower! And you always try a bit . . .’ (Lucia, 40, overweight) (29)
Environmental facilitators ‘I’m getting all of the things out of the way that I could for an excuse. I’m not even watching TV very much ...TVis
loaded with commercials about eating all the wrong things . . . I’ve tried to surround myself with things that are
going to be positive’. (28)
Environmental barriers ‘It’s impossible to eat healthily at work due to a lack of healthy eating facilities’. (23)
Experiences with the
programme
‘I walked into the first meeting; it just felt like I had found a home, and every week has been successful so far. I
cannot imagine not doing it [coming to the meetings] on Saturday mornings. So – I am very grateful for this
meeting’. (32)
Positive outcomes of
programme participation
‘She is my motivator. She weighs and measures me. And she makes me keep a record of my diet. I fill out a form
and then she gives me advice as to how I can eat healthier meals....HowIcandoeven better. So I think it is
really nice to participate in her treatment program’ (30)
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Self-perception and body image
Findings suggest that self-perception and body image are
related to weight management in various ways. A few
studies identified overweight and obese women having
positive self-perceptions (25,27,28) and Sabiston et al. (25)
found that four out of eight white women reported benefits
of excess weight. On the other hand, some studies found
that overweight and obese people had negative feelings
towards their weight status, such as shame (32,35) and
feeling self-conscious (27). van Zandvoort et al. (27)
revealed that five female obese university students felt
remorse about their weight and lifestyle choices, which
may have motivated them to engage in weight manage-
ment. Indeed, in some studies, improving self-perception
and body image were motivations to manage weight
(19,25,26,29,35). Where weight management was reported
as being perceived as a personal responsibility (24,25,35),
successes and failures related to weight management
may influence self-perception. In summary, negative self-
perceptions can motivate weight management, which then
may improve self-perceptions.
Stigmatizing experiences related to excess weight
Some studies found that people with excess weight experi-
enced stigma, which had varied influences on people’s
weight management efforts. Stigmatizing experiences hin-
dered obese people’s attempts to manage their weight by
deterring them from taking up activities in public spaces
(30,33,34). One study found that negative comments from
partners could lead to negative feelings, which were
described as a motivation to engage in weight management
for some overweight and obese women (26).
Socio-cultural factors
Socio-cultural factors could either support or obstruct
weight management efforts. Three studies (17,24,33)
reported that family and friends facilitated overweight and
obese people’s weight management efforts by encouraging
them to engage in weight management and engaging in
weight management behaviours. Spouses and co-workers
were particularly identified as an invaluable source of
support (24).
However, a larger proportion of studies described how
socio-cultural factors hindered weight management
attempts. Pressure from family and friends for overweight
and obese people to manage their weight actually left
some women less inclined to manage their weight
(17,23,27,29). Family and friends were identified as unin-
tentional saboteurs of weight management efforts by
making unhealthy palatable foods available (24) and dis-
rupting time that had been set aside for physical activity
(19). Six studies (23,24,26,29,31,35) suggested that daily
family and work routines and responsibilities competed
with and hindered weight management attempts. Accord-
ing to these studies, overweight and obese people lacked
the time to plan and engage in weight management due to
family and/or work commitments, and life events. One
study revealed that obese people felt unsupported at a
societal level because society generally did not take into
account obese people’s weight management-related con-
cerns (34). Davis et al. (36) reported that food had a
central focus in the African–American culture, which
encouraged dietary patterns that were incompatible with
successful weight management.
In summary, involving family and friends in weight man-
agement attempts may help people persevere with weight
management behaviours as long as family and friends
support overweight and obese people sensitively in order to
avoid provoking negative responses.
Environmental factors
Studies identified environmental barriers to weight man-
agement, such as the ease of access to unhealthy food (29),
the financial costs of healthy eating and participation in
some weight management programmes (23,26,35) and the
difficulty of accessing services and facilities for weight man-
agement (23,27). A major barrier to increase physical activ-
ity, such as walking in one’s neighbourhood, was related to
people’s safety and security concerns in their communities
(18,35). On a more positive note, some overweight and
obese middle-class women found that reorganizing their
own environment, e.g. by not buying unhealthy food, facili-
tated weight management efforts (28).
In summary, findings suggest that there are a variety of
environmental barriers to weight management, but by
developing ways to reorganize one’s environment, such
obstacles may be eliminated.
Experiences of weight management programme
The social context of weight management programmes
appears to be an important source of motivation and
support. A prominent theme in seven studies related to
people’s positive views of support from contact with peers
and health professionals in weight management pro-
grammes (19,24,26,30,32,33,35). Participants liked the
tailored, face-to-face support provided by health pro-
fessionals in the weight management programmes
(27,32,33,35). Contact with peers afforded people with
a safe, affirming and supportive environment for sharing
experiences related to weight management (19,24,26,
30,32,33,35). This was especially highlighted in two focus
groups with 14 overweight and obese lesbians, who stated
they had rarely felt supported in their weight management
clinical obesity Overweight and obese people’s views G. Garip & L. Yardley 117
© 2011 The Authors
Clinical Obesity © 2011 International Association for the Study of Obesity. clinical obesity 1, 110–126

attempts (32). Two studies reported that people attended
weight management programmes due to perceived pressure
from health professionals (29) and because of an awareness
of being part of a research study (24).
The extent to which control is imposed by the weight
management programme can be problematic. Lopez (19)
reported that six overweight and obese women desired to
make personal choices regarding their weight management
behaviours. Conversely, in one study (31), participants felt
the weight management programme failed to provide
adequate structure to support their needs. In addition, a
few studies found that some overweight and obese people
indicated they relied on continued attendance at the weight
management programme to successfully manage their
weight (22,30,34).
In summary, weight management programmes can
provide structure and support for people attempting to
manage their weight but need to foster individuals who can
make autonomous weight management decisions in and
out of the context of the programmes.
Positive outcomes of participating in a weight
management programme
A wide variety of benefits of participating in weight man-
agement programmes were identified, including weight loss
(22), weight loss-related physical improvements (23),
weight loss-related psychosocial benefits (22,23,27,32),
gaining knowledge and skills to manage weight
(23,24,31,33) and improvements in lifestyle (27). Partici-
pation in the weight management programmes often
increased eating-related knowledge and afforded partici-
pants the skills to self-monitor their eating habits. Partici-
pants who acquired such knowledge and skills were then
able to achieve their target weight loss (22).
Many studies reported improvements in physical and
psychosocial functioning that were not necessarily linked to
weight loss, such as improved mobility (23), mood (23),
self-acceptance (27) and relationships with others (23).
For fourteen overweight and obese lesbians, the weight
management programme afforded participants a sense of
belongingness that was described as a benefit irrespective of
weight loss (32). Weight management interventions that
highlight the physical and psychosocial benefits of weight
loss may encourage participants to persist with weight
management efforts.
Figure 2 represents the relationships between the themes
identified in this review. Six of the 12 third-order themes
derived from the papers were grouped together as ‘intra-
individual’ factors related to people’s weight management
experiences, four themes were grouped together as ‘extra-
individual’ factors related to weight management experi-
ences and two themes related to people’s experiences in the
context of a weight management programme.
Discussion
Summary of findings
Overweight and obese people’s experiences with weight
management were influenced by intra- and extra-individual
factors and by their evaluations of their experiences in
weight management interventions (see Fig. 2). Various
intra-individual factors may influence weight management,
including self-perceptions and body image, health concerns
related to excess weight, attributions for weight gain and
the maintenance of excess weight and expectations about
weight management. For some younger females, negative
self-perception was attributed to excess weight. Improving
health as a motivation for managing weight was commonly
described by overweight and obese participants in some
studies. Unrealistic expectations and unhelpful beliefs may
hinder weight management attempts, while realistic expec-
tations and constructive beliefs could allow people to
manage weight effectively.
Several extra-individual factors, including stigmatiza-
tion, socio-cultural factors and environmental factors, were
also related to weight management. Stigmatizing experi-
ences negatively influenced weight management for some
participants while motivating some female participants to
manage their weight. Socio-cultural factors were a promi-
nent theme in the papers and highlighted how people’s
community, home and work settings and culture could
facilitate or support weight management. For some people,
the food culture was incompatible with weight manage-
ment. Many uncontrollable environmental barriers were
reported, but reorganizing one’s surroundings to eliminate
some environmental barriers (e.g. restricting the availabil-
ity of unhealthy food) was described as facilitating weight
management.
Our review suggests that the overweight and obese
people included in the studies reviewed generally had posi-
tive attitudes towards the structure and content of weight
management interventions and relationships with health
professionals and peers. Many physical and psychosocial
benefits associated with participation in weight manage-
ment programmes were reported. In one study of over-
weight and obese lesbians, the support received from the
intervention was described as providing a sense of belong-
ingness, which was valued regardless of whether they lost
any weight. Nevertheless, in some other interventions, a
tension could be discerned between the need for structure
provided by weight management programmes and partici-
pants’ desire and need for autonomy.
Implications for weight management
The themes identified have implications for improving
current interventions for weight management for over-
118 Overweight and obese people’s views G. Garip & L. Yardley clinical obesity
© 2011 The Authors
Clinical Obesity © 2011 International Association for the Study of Obesity. clinical obesity 1, 110–126

weight and obese adults. Assessing overweight and obese
people’s weight management-related expectations may
help identify unrealistic expectations in order to prevent
disappointment and negative attitudes towards weight
management and themselves. It may be necessary to chal-
lenge unrealistic expectations about weight management
and unhelpful beliefs regarding the reasons for weight
gain and maintenance of obesity in order to provide a
convincing rationale that the adoption of healthy dietary
and physical activity behaviours can lead to successful
weight management.
An ideal intervention may draw on support from peers to
create a positive and encouraging environment, while
health professionals can provide a valuable source of per-
sonalized advice and a structured environment for success-
ful weight management. However, interventions also need
to foster autonomous individuals who will be able to rec-
ognize and make use of available internal and external
facilitators and to plan for dealing with environmental and
psychological barriers to maintain weight when support
from the intervention is unavailable.
Overweight and obese people who stop engaging in
weight management behaviours after some weight loss are
likely to regain weight, and this experience may negatively
affect future attempts to lose weight (9). Weight manage-
ment interventions that highlight the physical and psycho-
social benefits of weight management, irrespective of
weight loss, may encourage participants to persist with
weight management efforts. It may also be helpful for
interventions to help overweight and obese people deal
with pressure from others to manage weight.
Interventions can help people reorganize their lifestyle to
achieve weight management. Successful weight manage-
ment requires overweight and obese individuals to make
behavioural, psychosocial and environmental changes that
they can maintain in the long-term (7). Weight manage-
ment interventions can be useful for providing overweight
and obese individuals with the knowledge and skills for
managing weight and may also address psychological issues
that may hinder weight management; however, it is unlikely
that environmental and socio-cultural barriers can be
addressed by weight management interventions alone.
Therefore, changes are needed at the socio-cultural level to
establish safe and supportive environments that encourage
overweight and obese people to modify their lifestyle in
ways that will lead to successful weight management.
Experiences with the weight
management programme
Positive outcomes of
programme participation
Intra-individual factors:
Attributions for
weight gain
Self-perception
Body image
Expectations
Health concerns
Psychological
barriers
Psychological
facilitators
Extra-individual factors:
Socio-cultural
factors
Environmental
barriers
Environmental
facilitators
Stigmatising
experiences
Figure 2 Factors perceived by overweight
and obese people as relevant to weight
management.
clinical obesity Overweight and obese people’s views G. Garip & L. Yardley 119
© 2011 The Authors
Clinical Obesity © 2011 International Association for the Study of Obesity. clinical obesity 1, 110–126

Limitations of the synthesis
It is unclear whether the findings from this review are
applicable to contexts other than those included in the
synthesis, i.e. mainly female Caucasian adults from general
population samples participating in various weight man-
agement programmes. Overweight and obese men were
seriously under-represented, and it is clear that more
research into male experiences of weight management is
urgently needed. Moreover, the meta-ethnography included
studies only from Western societies, which limits the trans-
ferability of findings to other societies.
An inevitable limitation of the review is that in the
studies reviewed, the samples were self-selected and may
have over-represented the views of people who attended
and had positive experiences in the weight management
programmes. People who dropped out of the programmes
and/or had negative weight management experiences may
have had different views from those who volunteered for an
interview or focus group.
As with any qualitative work, the meta-ethnography can
not demonstrate causal relationships between the hindering
and facilitating factors and weight management. Partici-
pants’ perceptions of factors influencing the success of
weight management efforts may not always be accurate,
and experimental methods are required to conclusively test
whether each factor impacts on intervention effectiveness.
A meta-ethnography is interpretive by nature and offers
one possible interpretation of overweight and obese peo-
ple’s views and experiences with weight management and
weight management programmes.
Conclusion
Overweight and obese people’s experiences with weight
management need to be comprehensively understood in
order to improve current recommendations and interven-
tions to support people in their weight management efforts.
To our knowledge, this is the first systematic review and
meta-synthesis of published qualitative studies of over-
weight and obese adults’ perceived barriers and facilitators
to weight management in and out of the context of diverse
behavioural weight management programmes. By synthe-
sizing a large number of studies, it was possible to build up
a more complete overview of potentially relevant factors
than could be obtained from the findings from each of the
individual studies.
The themes derived in this study of the factors perceived
by overweight and obese people as relevant to weight man-
agement are consistent with findings from quantitative
studies. Many of the psychological facilitators and barriers
to weight management described in this review have also
been identified in observational quantitative research into
factors predicting weight management and weight regain
(9,37–39). Since observational research can only provide
suggestive and not conclusive evidence of the causal role of
such factors (38), the convergence of qualitative evidence
provides useful triangulation and corroboration of the
probable role of these factors. Our overview of the quali-
tative research can also provide an elaboration of these
factors, which reveals some interesting and potentially
important complexities and dilemmas. For example, the
negative stigmatizing consequences of obesity have been
well established by quantitative research (40), but our
review suggests that stigmatizing experiences may also
motivate some people to lose weight. A particularly inter-
esting finding from the qualitative literature was the tension
between participants’ desire and need for the structure and
social support provided by weight management interven-
tions and the risks this posed in terms of loss of autonomy
and dependence on the programme; finding the right
balance between support and autonomy may be important
for helping people to maintain weight loss independently in
the longer term (41).
The findings of this paper complement and build on
quantitative reviews that have examined psychosocial
factors associated with weight management in overweight
and obese adults (9,37) by identifying and explaining facili-
tators and barriers to weight management from the view-
point of overweight and obese people. Interventions that
address all of the modifiable factors identified in this review
are likely to appear credible to participants and will engage
with the intra- and extra-individual factors that they per-
ceive as affecting their weight management efforts.
Conflict of Interest Statement
No conflict of interest was declared.
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Appendix 1. Quality assessment of included studies
Table A1 Summary quality assessment of included studies
Study Qualitative
research
Purpose Qualitative methods
appropriate
Theoretical
perspective
Ethics Sample Data
collection
Analysis Reliability
validity
Credibility
rigor
Transferability
Davis S S P N S P P P P P P
Visram S S S N S S S S P P P
Fogel S P S N S S S S S P S
Bidgood S S S N S S P P P P P
Lopez S S S S N P S P P N N
Adolfsson S S S P S S P P P P P
Johnson S S S N N P P P S S S
VanS SS N SPS PP P P
Groven S S S P S S P S P S P
Barberia S S S P S S S P P S P
Miles S S P N S S P N N N P
Herriot S S S N S S S P P P N
Jones S S S N S S S P P S P
Burke S S S N S S S S P S P
Sabiston S S S P S S P S S S N
Greener S S S P S P P P P P P
Cioffi S S S N S S S S P P N
N, not at all; P, partly; S, fully or mostly satisfied.
Appendix 2. Coding manual
Experiences of weight management programme
• Inclusion criteria: themes related to the influences of
participants’ interactions with peers and health profession-
als in the weight management programme and participants’
experiences in the programme on their weight management
behaviours.
• Exclusion criteria: themes related to behavioural and
psychological changes as a result of participating in a
weight management programme or interactions with peers
and health professionals in the weight management
programmes.
Valued support from contact with peers and health
professionals
– Ongoing professional and peer support (Visram et al.)
(33)
– Support and affirmation in the group sessions (Lopez)
(19)
– A common ground (Groven and Engelsrud) (30)
– Support from peers (Herriot et al.) (26)
– Group support (Burke et al.) (24)
– Support from peers and health professionals (Greener
et al.) (35)
– One-to-one support (Greener et al.) (35)
– The environment of the group meetings (Fogel et al.)
(32)
– The weight loss programme (Fogel et al.) (32)
Feeling obliged to attend weight management
programme
– Pressure from health professionals (Barberia et al.)
(29)
– Being part of a research study (Burke et al.) (24)
Aspects of weight management programmes that are
liked and preferred
– Tailoring interventions to individual needs and prefer-
ences (Visram et al.) (33)
– Client as expert (van Zandvoort et al.) (27)
– Preference for in-person coaching (van Zandvoort
et al.) (27)
– Desire to make personal choices (Lopez) (19)
– Searching for safety (Fogel et al.) (32)
– Safety and acceptance (Fogel et al.) (32)
Experiences that conflicted with attempts to manage
weight in the programmes
– Control imposed by the weight programme sometimes
conflicts with autonomous though and behaviour (Lopez)
(19)
– Lack of support from the weight reduction programme
(Adolfsson et al.) (31)
– Knowing the programme (Cioffi) (22)
Dependence on weight management programme
– Perceived need to attend classes (Cioffi) (22)
122 Overweight and obese people’s views G. Garip & L. Yardley clinical obesity
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– Dependence of close follow-up (Groven and
Engelsrud) (30)
– The lifestyle change needed to overcome obesity can
seldom be maintained without on-going help (Bidgood and
Buckroyd) (34)
– Keeping control of weight management (Cioffi) (22)
Positive outcomes of participating in a weight
management programme
• Inclusion criteria: themes related to the positive out-
comes as an end in itself of participation in weight man-
agement programmes on participants’ physical functioning,
psychological state, behaviours and skills related to weight
management, and knowledge about weight management.
• Exclusion criteria: themes related to participants’
views and experiences regarding participation in the weight
management programmes, their interactions with peers and
health professionals, and the negative effects of participa-
tion in weight management programmes. Perceived support
from peers, health professionals and the programme that
were interpreted by the authors as a mediator of weight
management are coded under the theme ‘experiences of
weight management’.
Knowledge and skills
– Monitoring and reinforcement (Visram et al.) (33)
– Eating habits (Adolfsson et al.) (31)
– How the weight reduction programme affected eating
habits (Adolfsson et al.) (31)
– Improved knowledge and behavioural techniques
regarding weight management (Jones et al.) (23)
– Seeing it in black and white (Burke et al.) (24)
– A tool for staying on track (Burke et al.) (24)
– New knowledge and skills (Burke et al.) (24)
Weight loss
– Reaching the set goal weight (Cioffi) (22)
Weight loss-related psychosocial benefits
– Improved mood (Jones et al.) (23)
– Improved relationships with others (Jones et al.) (23)
– Community and social support in the weight loss
group (Fogel et al.) (32)
– Group involvement (Cioffi) (22)
– Improved self-acceptance (van Zandvoort et al.) (27)
– Making self a priority (van Zandvoort et al.) (27)
Weight loss-related physical improvements
– Improvements in physical functioning (Jones et al.)
(23)
Lifestyle
– Living a healthier lifestyle (van Zandvoort et al.) (27)
Attributions for weight gain and the maintenance
of excess weight
• Inclusion criteria: themes related to participants’ attri-
butions to life events, psychological and environmental
factors for weight gain and the maintenance of partici-
pants’ overweight and obese states when they were not
attempting to manage their weight.
• Exclusion criteria: themes related to psychological,
social and environmental barriers to weight management.
Unhealthy behaviours and eating habits
– Unhelpful learned behaviours (Greener et al.) (35)
– Poor family eating habits (Greener et al.) (35)
– Over-eating (Greener et al.) (35)
– Eating habits (Miles and Panton) (18)
Lack of physical activity
– Lack of exercise (Greener et al.) (35)
– Sedentary job (Miles and Panton) (18)
Psychological problems
– Physical/mental health problems (Miles and Panton)
(18)
Unmodifiable factors
– Genetic predisposition (Greener et al.) (35)
– Illness and disruptive life events (Greener et al.) (35)
– Having children (Miles and Panton) (18)
– Overweight as chronic disease (Johnson) (28)
Socio-cultural factors
• Inclusion criteria: themes related to the influences of
the community, socio-cultural home and work settings and
food culture on weight management, in and out of the
context of weight management interventions.
• Exclusion criteria: themes related to participants’ stig-
matizing experiences that they attribute to their excess
weight, interactions with peers and health professionals in
weight management programmes and socio-cultural factors
that influence weight gain and the maintenance of excess
weight when participants were not attempting to manage
their weight.
Encouragement and support
– Family influence and societal expectations (Davis
et al.) (36)
– Supportive spouses (Burke et al.) (24)
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– The influence of family and friends as triggers to help-
seeking and weight loss (Visram et al.) (33)
Negative influences of family/friends
– Family influence and societal expectations (Davis
et al.) (36)
– Relationships with others (Jones et al.) (23)
– Normative beliefs and their relationship with subjec-
tive norms (Barberia et al.) (29)
– Influence of family members and friends (Lopez) (19)
– Sabotage by others (Burke et al.) (24)
– Familial pressure to lose weight (van Zandvoort et al.)
(27)
Competing responsibilities in everyday life
– Competing family and work responsibilities (Burke
et al.) (24)
– Work environment and day-to-day routines (Greener
et al.) (35)
– Family commitments, social life and work as barriers
(Herriot et al.) (26)
– Lack of time due to home and work commitments
(Barberia et al.) (29)
– Family responsibilities and stressful days affected
eating habits (Adolfsson et al.) (31)
– Day-to-day routines and life events (Jones et al.) (23)
Societal and cultural influences
– Concerns of obese people are not heard by society in
general (Bidgood and Buckroyd) (34)
– African–American subculture hinders weight manage-
ment (Davis et al.) (37)
Self-perception and body image
• Inclusion criteria: themes related to the influence
of weight on participants’ positive and negative self-
perceptions, and acceptance, satisfaction and dissatisfac-
tion related to perceived body image.
• Exclusion criteria: themes related to the influence of
socio-cultural factors or stigmatizing experiences on par-
ticipants’ self-perception and body image.
Feelings related to having excess weight
– Shame (Fogel et al.) (32)
– Remorse about weight and lifestyle choices (van Zand-
voort et al.) (27)
– Self-conscious about weight (van Zandvoort et al.)
(27)
– Negative self-perception (Greener et al.) (35)
Relationship with self
– Consolidating one’s identity and new way of living as
a thin person (Johnson) (28)
– Coming to terms with self as an overweight/obese
person (Johnson) (28)
– Relationship with self (van Zandvoort et al.) (27)
– Being physically self-accepting: ‘I like my size because
I get to do what I want’ (Sabiston et al.) (25)
Improving body image as a motivation for managing
weight
– Motivations to lose weight to improve perceived body
image (Lopez) (19)
– Motivation to lose weight to improve perceived body
image (Barberia et al.) (29)
– Improving self-image (Herriot et al.) (26)
– Physical self-perception paradox: ‘It would be lovely
to have a better earth suit’ (Sabiston et al.) (25)
– Motivation to improving body image (Greener et al.)
(35)
Seeing weight management as a personal responsibility
– Assuming responsibility for lack of self-monitoring
(Burke et al.) (24)
– The process of self-perception change: ‘I can change
my destiny; I’m not a victim’ (Sabiston et al.) (25)
– Personal responsibility (Greener et al.) (35)
Health concerns related to excess weight
• Inclusion criteria: themes related to health as a moti-
vation for managing excess weight in and out of the context
of weight management programmes.
• Exclusion criteria: themes related to motivators for
weight management other than health.
Desire to improve health as a motivation to manage
weight
– Health as a motivator (Herriot et al.) (26)
– Fear for health motivates weight management (Jones
et al.) (23)
– Health as a motivation to manage weight (Greener
et al.) (35)
– Health concerns (Visram et al.) (33)
– Desire to improve health (Fogel et al.) (32)
– Improving health (Barberia et al.) (29)
Existing health problems motivate weight management
– Having a greater number of health problems (Miles
and Panton) (18)
Health professional’s concern over excess weight on
health is taken seriously
– Legitimization from health professional (Visram et al.)
(33)
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Weight management expectations
• Inclusion criteria: themes related to participants’ real-
istic and unrealistic expectations regarding weight manage-
ment in and out of the context of weight management
programmes.
• Exclusion criteria: themes related to expectations
regarding the role of family members, friends and society in
one’s weight management attempt.
Expectations about the process of weight loss
– Bodily discomfort as painful (Groven and Engelsrud)
(30)
Unrealistic expectations
– Weight loss expectations (Herriot et al.) (26)
– Unrealistic weight loss expectations (Jones et al.) (23)
Aiming for results
– An ambivalent experience (Groven and Engelsrud)
(30)
Stigmatizing experiences related to excess weight
• Inclusion criteria: themes related to stigmatizing and
negative experiences with others that the participant
attributes to their excess weight.
• Exclusion criteria: themes related to negative experi-
ences and interactions with peers and health professionals
in weight management programmes.
Experiences of stigma
– Past experiences of stigmatization (Visram et al.) (33)
– The gaze of others (Groven and Engelsrud) (30)
Stigma hinders weight management
– Prejudice and stigmatization restrict the lifestyle of
obese people and hinder treatment (Bidgood and Buck-
royd) (34)
Stigma motivates weight management
– Negative comments from others as a motivator to
dieting (Herriot et al.) (26)
Environmental barriers
• Inclusion criteria: themes related to participants’ per-
ceived environmental barriers to weight management.
• Exclusion criteria: themes related to perceived socio-
cultural barriers and perceived barriers posed by the weight
management programmes.
Availability of tempting foods
– Tempting foods (Barberia et al.) (29)
Costs
– Costs associated with dieting and exercising (Herriot
et al.) (26)
– Cost implications (Jones et al.) (23)
– Costs of weight management services, leisure facilities,
health food and transport (Greener et al.) (35)
Safety and security concerns
– Safety and security concerns (Miles and Panton) (18)
– Safety concerns (Greener et al.) (35)
Services and facilities
– Appointment availability and flexibility (Jones et al.)
(23)
– Other services and resources (Jones et al.) (23)
– Environmental barriers to losing weight (van Zand-
voort et al.) (27)
Environmental facilitators
• Inclusion criteria: themes related to participants’ per-
ceived environmental facilitators to weight management.
• Exclusion criteria: themes related to perceived socio-
cultural facilitators and perceived facilitators established by
the weight management programmes.
-Reorganizing the environment (Johnson) (28)
Psychological facilitators
• Inclusion criteria: themes related to participants’ per-
ceived psychological facilitators to the uptake or continu-
ation of weight management.
• Exclusion criteria: themes related to health as a moti-
vation for weight management, self-perception and body
image as a facilitator for weight management.
Making internal changes to facilitate weight
management
– Reorganizing the self (Johnson) (28)
– Meeting one’s own needs (Johnson) (28)
– Relabelling the meaning of success and failure in the
context of eating (Johnson) (28)
– Commitment (Burke et al.) (24)
– Integrating self-monitoring into everyday life (Burke
et al.) (24)
Understanding one’s eating and dieting patterns
– Uncovering the origins of eating style and dieting
(Johnson) (28)
clinical obesity Overweight and obese people’s views G. Garip & L. Yardley 125
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– Testing: finding the limit to one’s food intake
(Johnson) (28)
Psychological barriers
• Inclusion criteria: themes related to participants’ per-
ceived psychological barriers to weight management,
including previous unsuccessful weight management
attempts.
• Exclusion criteria: themes related to perceived barriers
related to self-perception and body image and attributions
to weight gain and the maintenance of excess weight when
the participant was not attempting to manage their weight.
Previous weight loss attempts
– History of weight loss attempts (Fogel et al.) (32)
– Dieting, with or without exercise, has limited success
as a treatment for obesity (Bidgood and Buckroyd) (34)
– Previous unsuccessful weight loss attempts (Greener
et al.) (35)
– Previous weight reduction experiences (Herriot et al.)
(26)
Eating for reasons other than satisfying hunger
– Other factors than hunger reported to affect eating
habits (Adolfsson et al.) (31)
– Emotional eating (Burke et al.) (24)
– Emotions, ‘wrong frame of mind’, ingrained habits
(Herriot et al.) (26)
Feeling unable to manage weight
– Lack of will-power (Barberia et al.) (29)
– Organizational deficiencies (Burke et al.) (24)
– Lack of motivation and willpower (Greener et al.) (35)
– Psychological barriers to losing weight (van Zand-
voort et al.) (27)
– Stress made it more challenging (Miles and Panton)
(18)
– Slacking off (Burke et al.) (24)
– Feeling inundated (Burke et al.) (24)
– Tedium (Burke et al.) (24)
– Lack of motivation and willpower (Greener et al.) (35)
– Likelihood to ‘slip back’ (Cioffi) (22)
– Inability to self-nurture (Burke et al.) (24)
126 Overweight and obese people’s views G. Garip & L. Yardley clinical obesity
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Clinical Obesity © 2011 International Association for the Study of Obesity. clinical obesity 1, 110–126