Background: Many adults do not take up weight
management interventions even after apparently deciding to do so. Further
research about decision making prior to the intervention would be useful.
This paper presents a qualitative study exploring
the process of decision making and the influences of obesity stigma. Methods:
A pragmatic qualitative methodology, conducting indepth interviews with 52
participants all with BMI > 30 kg/m2 and experience of efforts at
weight management. Equal numbers of men and women with mean age 56.9 years
completed interviews. Inductive analyses
proceeded through systematic steps over a series of iterations. Findings:
Decision making is difficult in the context of
on-going mixed feelings over a long time. Thoughts and feelings become ingrained with habits and it is
hard to separate out what is needed to think
through a good decision. Thinking about weight brings a large volume of
thoughts and feelings and apparent options or action choices. The volume of
thoughts makes decisions difficult but, in the context of obesity stigma,
many of the thoughts are negative. A variable sensitivity to these stigma-related
thoughts adds further ambivalence and inhibition for taking deciions. The
need for further thinking does not stand out in the context of the emotional resolving of thoughts about personal responsibility arising from obesity stigma.
Conclusions: Obesity stigma contributes to a deeper ambivalence in the decision
process and hence difficulty in decision making about weight management. Decision
aid interventions and training of health care staff in communication skills for
shared decision making are needed.
National Institutes of Health & NHLBI (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults—The evidence report. Obesity Research, 6, 1-209.
NICE (2006) Obesity: Guidance on the prevention, iden- tification, assessment and management of overweight and obesity in adults and children. National Institute for Hea- lth and Clinical Excellence, London.
Douketis, J., Macie, C., Thabane, L. and Williamson, D. (2005) Systematic review of long-term weight loss stud- ies in obese adults: Clinical significance and applicability to clinical practice. International Journal of Obesity, 29, 1153-1167. doi:10.1038/sj.ijo.0802982
Loveman, E., Frampton, G., Shepherd, J.P., Cooper, K., Bryant, J. and Welch, K. (2011) The clinical effectiveness and cost effectiveness of long-term weight management schemes for adults: A systematic review. Health Techno- logy Assessment, 15, 1-182.
Sabin, J., Marini, M. and No-sek, B. (2012) Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One, 7, e48448. doi:10.1371/journal.pone.0048448
Relton, C., Bissell, P. and Smith, C. (2011) South York- shire Cohort: A “cohort trials facility” study of health and weight—Protocol for the recruitment phase. BMC Public Health, 11, 640. doi:10.1186/1471-2458-11-640
Psarou, K. and Brown, I. (2010) Patients’ experiences of prescribed anti-obesity drugs and perceptions of support from primary care: A qualitative study. Primary Health Care Research and Devel-opment, 11, 250-259.
Brown, I., Thompson, J., Tod, A. and Jones, G. (2006) Pri- mary care support for tackling obesity: qualitative study of the perceptions of obese patients. British Journal of Ge- neral Practice, 56, 666-672.
Thomas, S.L., Hyde, J., Karunaratne, A., Herbert, D. and Komesaroff, P.A. (2008) Being “fat” in today’s world: A qualitative study of the lived experiences of people with obesity in Australia. Health Expectations, 11, 321-330.
Blixen, C., Singh, A. and Thacker, H. (2006) Values and beliefs about obesity and weight reduction among Afri- can-American and Caucasian women. Journal of Trans- cultural Nursing, 17, 290-297.
Crocker, J., Cornwell, B. and Major, B. (1993) The stig- ma of overweight—Affective consequences of attributio- nal ambiguity. Journal of Personality and Social Psycho- logy, 64, 60-70. doi:10.1037/0022-35188.8.131.52
Smith, E., Hay, P., Campbell, L. and Trollor, J. (2011) A review of the association between obesity and cognitive function across the lifespan: implications for novel ap- proaches to prevention and treatment. Obesity Reviews, 12, 740-755.
Baronowski, T., Cullen, W., Nicklas, T., Thompson, D. and Baronowski, J. (2003) Are cur-rent health behavioural change models helpful in guiding pre-vention of weight gain efforts? Obesity Research, 11, S23-S43.
Ogden, J., Ban-dara, I., Cohen, H., Farmer, D., Hardie, J. and Minas, H. (2001) General practitioners’ and patients’ models of obesity: Whose problem is it? Patient Educa- tion & Counselling, 44, 227-233.
Wadden, T.A., An-derson, D.A., Foster, G.D., Bennett, A., Steinberg, C. and Sarwer, D.B. (2000) Obese women’s perceptions of their phy-sicians' weight management atti- tudes and practices. Archives of Family Medicine, 9, 854- 860. doi:10.1001/archfami.9.9.854
Greiner, K.A., Born, W., Hall, S., Hou, Q., Kimminau, K.S. and Ahluwalia, J.S. (2008) Discussing weight with obese primary care patients: Physician and patient per- ceptions. Journal of General Intern Medicine, 23, 581- 587. doi:10.1007/s11606-008-0553-9
Malterud, K. and Ulriksen, K. (2011) Obesity, stigma and responsibility in health care: A synthesis of qualitative studies. International Journal of Qualitative Stud Health Well-being, 6, e8404. doi:10.3402/qhw.v6i4.8404
Brown, I. and Thompson, J. (2007) Primary care nurses’ attitudes, beliefs and own body size in relation to obesity management. Journal of Advanced Nursing, 60, 535-543.
Huisman, S., Maes, S., de Gucht, V., Chatrou, M. and Haak, H. (2010) Low goal ownership predicts drop-out from a weight intervention study in overweight patients with type 2 diabetes. International Journal of Behavioural Medicine, 17, 176-181. doi:10.1007/s12529-009-9071-3
Stacy, D., Bennett, C., Barry, M., Col, N., Eden, K.B., Holmes-Rovner, M. and Llewellyn-Thomas, H. (2011) Decision aids for people facing health treatment or scree- ning decisions. Cochrane Database of Systematic Reviews, 3.