Putting life on hold: lived experiences of people with obesity

Pain and temporality: a merleau-pontyian approach

Chronic pain is a common disorder with enormous sociomedical importance. A major part of primary and secondary costs of illness is caused by the various pain syndromes. Nociception - the sensory perception of a painful stimulus - is a complex process relying on an intricate system of anatomical, neurophysiological and biochemical networks. This applies even more so to pain - the state of experiencing a nociceptive event, of interpreting it in terms of meaning for the affected individual and of suffering a range of emotions it elicits. This intricacy renders it obvious, that the empirical medical sciences alone cannot explain all aspects of pain. Hence, it has also become a focus of phenomenological research. One aspect of these investigations is the interaction of pain and the perception of the lived body's spatiality. The focus of this article will build on these concepts to develop a construct of the alteration of temporality caused by chronic pain and the effects this spells out for the affected subject. To this end, I will primarily draw on Merleau-Ponty's ideas of the lived body as well as on theories of enactivism and embodiment. I will also point out parallels to neuroscientific data, thereby demonstrating the proximity of phenomenology and neuroscience. A possible partial solution to the pain dilemma may be derived from psychology: techniques relying on cognitive behavioural intervention, awareness training, and existential analysis may provide alleviation to patients suffering from chronic pain.

The experience of living with obesity for adults in Asian countries: A scoping review of qualitative studies

Sociocultural and biological backgrounds significantly influence people's experience of obesity. Yet the experience within the Asian sociocultural context is underexplored. This scoping review aims to summarize the qualitative evidence that explores the lived experience of adults with obesity in Asian countries. Guided by the Joanna Briggs Institute (JBI) approach, we systematically searched five databases (MEDLINE, EMBASE, PsychINFO, CINAHL, and Scopus) for studies exploring the lived experience of adults with obesity in Asian countries. Eligible studies with English full text were screened by two reviewers and analyzed using a descriptive qualitative content analysis. Of the 16,764 articles retrieved, 11 were included. The qualitative data can be summarized into three categories: (1) cultural norms shaped the lived experience with obesity, (2) the influence of obesity on social relationships, and (3) coping with life challenges. Despite the small number of studies, a strong influence of the sociocultural environment on the lived experience of obesity was evident, particularly on social roles and expectations, social relationships, the stigma of obesity, and life challenges. The extent and significance of this sociocultural influence on the Asian population warrant further exploration. Future research should fully report the qualitative methods to provide contextual information about the study.

Psychological considerations for the holistic management of obesity

Psychological presence in multidisciplinary obesity teams has been highlighted as an important component of such teams. Although mentioned in guidelines and recommendations, there is little information regarding the extent to which this is present currently in weight management services, and in what form. Here, we discuss important ways in which psychological aspects of obesity can impact a person living with obesity and how psychology can be incorporated to provide holistic support in weight management services. Recommendations are also made to create clearer guidelines to provide a more robust reference for the inclusion of psychology in multidisciplinary teams.

Women's lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study

OBJECTIVES

The study aimed to explore the lived experiences of women with severe obesity before and after undergoing bariatric surgery with a special focus on possible effects of changed sex hormone levels.

DESIGN

A qualitative interview study with transcribed text analysis based on Gadamer's hermeneutics.

SETTING

Regional hospital and outpatient bariatric clinic in central Sweden.

PARTICIPANTS

Ten women (age 23-38 years) having undergone Roux-en-Y gastric bypass surgery between 2016 and 2019 were interviewed.

RESULTS

The transcribed interviews were analysed according to Gadamer's hermeneutics. Text horizons, interpreter horizons and fact horizons were derived and formed the fusions 'Recognition of unhealthy body weight', 'Dealing with other people's opinions and society's norms', 'Life has changed in a positive way' and 'Accepting inner self and bodily changes'.

CONCLUSION

Women highlighted weight and body size in their responses. The study provided a deeper understanding of the situation of women living with obesity and pros and cons of having undergone bariatric surgery. Experiences of changes in sex hormones and fertility were discussed but not central to the informants. Participants emphasised the need to be prepared and properly supported in dealing with changes in life after bariatric surgery and subsequent weight loss.

A lifelong struggle for a lighter tomorrow: A qualitative study on experiences of obesity in primary healthcare patients

AIM

To describe experiences of living with obesity before the start of a group-based lifestyle intervention.

BACKGROUND

Obesity is a chronic disease that affects a person's physical and psychological health. Increased knowledge of experiences of living with obesity is required.

DESIGN

A qualitative study with a descriptive design.

METHODS

Semi-structured individual interviews with 17 participants living with obesity (Body Mass Index 32-49) were conducted between October and November 2019. The interviews were analysed using qualitative content analysis. The COREQ checklist was followed.

RESULTS

The analysis resulted in one main theme: Struggling for a lighter tomorrow and three subthemes: Suffering, Resilience and Need for support in making changes. For the majority of the participants, living with obesity was a lifelong struggle involving suffering on different levels. Yet despite this, the participants had not given up and hoped for a better life. They showed a degree of resilience and motivation, and a perceived ability to achieve lifestyle changes. However, there was a pronounced need for support to help them achieve this.

CONCLUSION

Living with obesity is complex and carries a risk of medical complications as well as psychosocial suffering. Healthy lifestyle habits to achieve better health and to lose weight should be encouraged, taking patient resources into account. Patients also need help in handling weight stigmatisation, and both healthcare professionals and society must engage with this.

RELEVANCE TO CLINICAL PRACTICE

Obesity is a chronic disease, and patients need ongoing support. Therefore, care for patients with obesity in primary health care must be further developed. Patient resources and strengths have to be acknowledged and encouraged in the process of helping them adopt healthy lifestyle habits. The findings of this study can contribute to ending weight stigmatisation by increasing the knowledge of living with obesity.

Health professionals' reflections on existential concerns among people with obesity

PURPOSE

This study aimed to describe health professionals' reflections on existential concerns among people with obesity when attempting to support them in their lifestyle change processes. For many of those affected by obesity, the condition becomes lifelong and causes existential concerns. The health professionals' reflections on existential concerns among people with obesity may influence central aspects of their practice and their patients' well-being.

METHODS

Eighteen health professionals with relevant health education working in three different treatment programmes for people with obesity were recruited for three focus group interviews. The interviews were analysed and interpreted using a model for interpretation of meaning at three levels with a phenomenological-hermeneutical approach.

FINDINGS

The analysis identified three themes. The health professionals reflected on existential concerns among people with obesity in terms of patients' repressed emotional difficulties and lack of self-respect. In addition, they reflected on their own experiences of powerlessness when presented with people with obesity's existential concerns.

CONCLUSION

The present study provides valuable insights into reflections on existential concerns among people with obesity, based on health professionals' descriptions. We believe that these insights add to the existing literature and have consequences for how people with obesity are met and cared for.

Elements behind sedentary lifestyles and unhealthy eating habits in individuals with severe obesity

Purpose

This study examines elements behind sedentary lifestyles and unhealthy eating habits in individuals who lived with severe obesity during many years of their lives.

Methods

Ten post-bariatric surgery patients participated in semi-structured interviews 7 months after surgery. A year later, a second round of interviews was also conducted to address some knowledge gaps related to the study purpose. The qualitative data collected were analysed through content analysis.

Results

Embarrassment about showing their body publicly, pain and poor physical condition, and bad experiences in non-inclusive physical activity contexts were found as potential elements that contributed to their adherence to sedentary lifestyles. Poor family food education, loss of a loved one, family problems, arguments or disputes, and past traumatic events (e.g., childhood sexual abuses) could be related to their development of unhealthy eating behaviours. Findings also pointed out that participants’ failed attempts to lose weight provoked them anxiety, feelings of failure and rebellion, and influenced their return to an unhealthy diet and a sedentary lifestyle.

Conclusions

This study may be helpful to reveal some elements which could be related to the origin and perpetuation of severe obesity, and to design prevention/treatment strategies from a more holistic, sensitive, and respectful perspective.

Obesity: The Fat Tissue Disease Version of Cancer

Obesity is a disease with high potential for fatality. It perfectly fits the disease definition, as cancer does. This is because it damages body structure and functions, both mechanically and biologically, and alters physical, mental, and social health. In addition, it shares many common morbid characteristics with the most feared disease, cancer. For example, it is influenced by a sophisticated interaction between a person’s genetics, the environment, and an increasing number of other backgrounds. Furthermore, it displays abnormal cell growth and proliferation events, only limited to white fat, resulting in adipose tissue taking up an increasing amount of space within the body. This occurs through fat “metastases” and via altered signaling that further aggravates the pathology of obesity by inducing ubiquitous dishomeostasis. These metastases can be made graver by angiogenesis, which might boost diseased tissue growth. More common features with cancer include its progressive escalation through different levels of severity and its possibility of re-onset after recovery. Despite all these similarities with cancer, obesity is substantially less agitating for most people. Thus, the ideas proposed herein could have utility to sensitize the public opinion about the hard reality of obesity. This is increasingly needed, as the obesity pandemic has waged a fierce war against our bodies and society in general, while there is still doubt about whether it is a real disease or not. Hence, raising public consciousness to properly face health issues is crucial to improving our health instead of gaining weight unhealthily. It is obviously illogical to fight cancer extremely seriously on the one hand and to consider dying with obesity as self-inflicted on the other. In fact, obesity merits a top position among the most lethal diseases besides cancer.

The lived experience of patients with obesity: A systematic review and qualitative synthesis

Although the deleterious effects of obesity have been well documented in terms of morbidity and mortality, less is known about what it is like to live with this complex and chronic disease. This study systematically reviewed and synthesized peer-reviewed studies relating to the lived experience of patients with obesity. A total of 12,388 records were screened, resulting in the inclusion of 32 final studies. Meta-ethnographic synthesis of these 32 studies generated five "third-order constructs" or themes: the development of obesity; a life limited; stigma, judgment, shame, and blame; treatment and; experiences of specific or minority groups. These constructs describe, from the patient's perspective, the factors associated with the development and maintenance of obesity; the effects of the disease on their day-to-day lives; the impact of the stigma and judgment many patients are subjected to; and their experience of accessing, or trying to access, treatment for their healthcare needs. This synthesis reveals the dearth of studies that focus solely on the experience of the patient and highlights the tendency for participant-informed, rather than participatory, methods in obesity research. It concludes with a call for further participatory research into the experiences of people living with obesity.

"What if it doesn't unlock?": A qualitative study into the lived experiences of adults with persistent intra-articular temporomandibular disorders

BACKGROUND

Temporomandibular disorders (TMD) are associated with increased self-reported disability and psychosocial issues, although little is known about those who specifically experience mechanical signs and symptoms such as clicking and locking. Understanding the lived experiences of individuals with persistent intra-articular TMD is an important first step to gaining insight into specific domains of self-reported disability associated with these conditions. This information can be helpful to improve clinical management of this subgroup.

OBJECTIVES

To explore the lived experiences of adults with persistent intra-articular TMD, including its impact on activity, participation and psychological wellbeing, and the influence of contextual factors on disability.

DESIGN

Qualitative study.

METHODS

Semi-structured interviews explored the lived experiences of adults with persistent intra-articular TMD, and data were analysed using thematic analysis. Participants were recruited via convenience sampling from private physiotherapy and dental practices, and the community.

RESULTS

Sixteen participants were interviewed. Four themes emerged from the data: i) The challenge of living with intra-articular TMD, ii) Living with uncertainty, iii) Seeking control, and iv) Learning to live with it. Novel findings included the impact of persistent intra-articular TMD on dreams, work, intimacy and socialising; and the role of non-pain symptoms (e.g. locking) in disability.

CONCLUSIONS

Persistent intra-articular TMD are associated with numerous activity limitations, participation restrictions and psychological issues. Disability is complex and multi-directional, and influenced by various contextual factors including individuals' thoughts, beliefs and support networks. These findings emphasise the need for biopsychosocial and person-centred care in clinical practice.

The ups and downs of lifestyle modification: An existential journey among persons with severe obesity

Background

Maintaining a healthy living after the end of a lifestyle intervention is a challenge for persons with severe obesity. Measurable outcomes are often emphasised, but there is a need for understanding the process of lifestyle change and the long‐term perspectives among persons with severe obesity.

Aim and objective

To describe and deepen the understanding of how persons with severe obesity experience making and maintaining lifestyle changes in everyday life three years after lifestyle intervention.

Methodology and methods

The study used a hermeneutic phenomenological approach. A purposive sample of seven adults with BMI ≥ 40 was recruited from a lifestyle intervention programme. Data were generated through individual follow‐up interviews. The analysis was based on theoretical framework on dwelling and mobility. Ethical approvals were received from the Danish Data Protection Agency and the ethical principles of the Declaration of Helsinki were followed.

Results

One overarching theme emerged: ‘The journey of ups and downs’. Three sub‐themes were: ‘Living with and tackling the demands of life's hassles’, ‘Deliberating the fight for weight loss’ and ‘Needing a trusted person to feel met as a human being’.

Conclusions

Everyday life among persons with severe obesity is experienced as a dynamic process of shifting experiences of dwelling and mobility. Sustained lifestyle changes require ongoing adjustments of action, which healthcare providers can influence in ways that either support or obstruct. Collaboration and a humanised approach across disciplines and sectors are suggested to promote sustained healthy living.

"I am terrified of something happening to me" The lived experience of people with obesity during the COVID-19 pandemic

Obesity is emerging as a risk factor for COVID-19 disease severity. The impact of the pandemic and knowledge of obesity as a risk factor on the lived experience of people with obesity is not fully understood. The aim of this study was to investigate the impact of the COVID-19 pandemic on people living with severe obesity (BMI ≥35 kg/m² ), currently engaged in multi-modal treatment. The primary objectives were to examine the impact of the pandemic on their lived experience from a treatment and psychosocial standpoint and additionally explore their awareness of obesity as a risk factor for COVID-19 disease severity. An in-depth qualitative study was adopted employing semi-structured interviews with open-ended questions. Interpretive thematic analysis was adopted to analyse the data and identify key themes taking a grounded approach. Themes that emerged from the perspective of impact on lived experience were (a) challenge sustaining treatment and (b) psychosocial impact. There was an even split regarding awareness and lack of awareness of obesity as risk factor which itself contributes towards a negative psychosocial impact in most patients. The COVID-19 pandemic is posing a diverse challenge to people with obesity. This has implications for their on-going treatment. From an ethical standpoint, there is a need to fully elucidate the link between obesity and COVID-19, disseminate this information using people friendly language and imagery in a manner that does not exacerbate a harmful psychosocial response or lead to stigmatization.

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

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 well-being 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.

Being with others during physical activity: experiences of well-being among adults with severe obesity

BACKGROUND

The experience of physical activity is influenced by social relations and gendered roles. Group-based lifestyle interventions are considered effective in promoting physical activity, yet the experiences of being active with others are unknown among individuals with severe obesity.

PURPOSE

To explore how individuals with severe obesity experience being with others during physical activity.

METHODS

A qualitative hermeneutic phenomenological study of repeated single-gender focus group interviews was conducted with adults living with severe obesity during group-based lifestyle intervention.

RESULTS

Three themes were developed: 1) 'Enjoying safety, kinship and belonging among peers'; 2) 'Feeling like a failure is shameful: A sense of aversion'; and 3) 'Striving to feel at home in physical activity: Needing distance from others.' The themes were drawn into an overall meaning 'Achieving wellbeing may always be a challenge: not feeling at home in the group or in body.'

CONCLUSION

Intersubjective and spatial dimensions of experiences are central and influence how individuals with severe obesity can feel wellbeing and 'at home' in physical activity. Physiotherapists should be aware of the individuals' vulnerability regarding feelings of failure, aversion, and shame as well as awareness of gendered norms and roles.

A "messy ball of wool": a qualitative study of the dimensions of the lived experience of obesity

Background

Obesity is a multi-dimensional condition with causal factors beyond the physiological into the behavioural, dietetic and psychological. Understanding the lived experience of those who are overweight and obese and self-perceived barriers to access and engagement in intervention are imperative to formulating a systemic response to the complex problem of obesity. This study aims to identify the social, psychological and systemic factors impeding engagement with weight-loss behaviour and interventions, and to formulate a framework for responding to these.

Methods

We conducted an exploratory qualitative study using focus groups and interviews with people who have lived experienced of being overweight or obese. Data were analysed using an inductive thematic approach. Following the thematic analysis, further interpretation of the data was achieved by applying the epistemological foundations of the Lifeworld Led Care paradigm, recognising its philosophy of the person and of care based on the individual’s experiences. Eight men and 17 women participated.

Results

Three overarching themes were identified: Complexity and Battle, Impediments, and Positive Re-orientation. The subthemes of these were found to represent the dimensions of the Lifeworld: Identify, Inter-subjectivity, Mood and Embodiment.

Further interpretation of the themed data identified six polarised dichotomies representing the opposing lived dimensions of the obesity experience: Failure Double-Bind; Think-Feel Conflict; Negative-Positive Orientation; Impeding-Facilitating Health Professional; Knowledge as Deficit-Insight; and Internal-External Orientation.

Conclusion

Obesity manifests as constraints and challenges across six polarised dichotomies, active in the lived experience of obesity. This study provides a unique way of conceptualising and understanding the complex and interacting meanings of the lived experience of obesity through the construction of polarised dichotomies. The polarities signify the oscillating experiences that people with obesity encounter, which may be either helpful or destructive in both their lifeworld experience and their capacity to address obesity towards improved social, psychological and physical outcomes. Understanding the dichotomies allows a reconceptualisation of obesity from a quantification of the individual to a more respectful, humane, compassionate and utilitarian conceptualisation of the experiencing person and the phenomenon itself. Further, these lived polarised dichotomies of obesity present the opportunity for health professionals to reconceptualise obesity in care and interventions.

Aspects of well-being when struggling with obesity

Purpose: We aimed to gain deeper insight into how people struggling with obesity handle their life situation by addressing how well-being might unfold. For many people, obesity becomes a lifelong condition characterized by repeated weight fluctuations while their weight increases gradually. From an existential perspective, constantly waiting for weight loss can cause an experience of not reaching one's full potential. How people with obesity experience well-being, within their perceived limitations, is less reflected in previous research.Methods: We established a qualitative study using in-depth interviews with seven men and 14 women with obesity (body mass index 335 kg/m2) aged 18-59 years. The study had an exploratory design including a phenomenological-hermeneutic perspective, with a lifeworld approach.Results: Three themes describing aspects of well-being were developed: coming to terms with the body, restoring the broken relational balance and reorienting the pivot in life. The thematic findings were abstracted into a main theme: striving to make living bearable. The movement towards well-being can be seen as a struggle towards an experience of balance to make bearable living.Conclusions: We suggest that well-being as a dialectic between vulnerability and freedom might become a health-facilitating experience for people struggling with obesity.