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

Patient perspectives on personalised medicine for obesity: An IMI2 SOPHIA Study

OBJECTIVE

Personalised medicine is seen as an exciting opportunity to improve the health outcomes of people with obesity. As research on phenotyping and personalised treatment for obesity rapidly advances, this study sought to understand patient preferences and perspectives on personalised medicine for obesity.

METHODS

A participatory world café methodology was used to garner the perspectives of people living with obesity on the potential opportunities and limitations associated with a personalised approach to obesity risk identification and treatment. Data were recorded by participants on tablemats and analysed thematically using thematic analysis.

RESULTS

Patients expressed the hope that personalised medicine for obesity would reduce stigma, support understanding of obesity as a disease, and improve treatment outcomes and acceptance. They also expressed concern about the accuracy of personalised medicine for obesity, its implications for insurance and that further advances in individual, personalised medicine, would detract attention from social, environmental, economic and psychological drivers of obesity.

CONCLUSIONS

This study highlights how patients are generally very optimistic about the potential for personalised obesity medicine but also raise a number of legitimate concerns that will be of interest to clinicians, industry, and policy makers.

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.

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.

Recruiting and Engaging Women of Reproductive Age with Obesity: Insights from A Mixed-Methods Study within A Trial

Engaging women with obesity in health-related studies during preconception is challenging. Limited data exists relating to their participation. The aim of this study is to explore the experiences and opinions of women participating in a weight-related, preconception trial. This is an explanatory sequential (quan-QUAL) mixed-methods Study Within A Trial, embedded in the GetGutsy randomized controlled trial (ISRCTN11295995). Screened participants completed an online survey of eight questions (single or multiple choice and Likert scale) on recruitment, motivations and opinions on study activities. Participants with abdominal obesity (waist circumference ≥ 80 cm) were invited to a subsequent semi-structured, online focus group (n = 2, 9 participants) that was transcribed and analyzed using inductive thematic analysis, with a pragmatic epistemological approach. The survey (n = 102) showed the main research participation motivations were supporting health research (n = 38, 37.3%) and wanting health screening (n = 30, 29.4%). Most participants were recruited via email (n = 35, 34.7%) or social media (n = 15, 14.7%). In the FGs, participants valued flexibility, convenience and. research methods that aligned with their lifestyles. Participants had an expanded view of health that considered emotional well-being and balance alongside more traditional medical assessments. Clinical trialists should consider well-being, addressing the interconnectedness of health and incorporate a variety of research activities to engage women of reproductive age with obesity.

Assessment and Management of Obesity and Self-Maintenance (AMOS): An Evaluation of a Rural, Regional Multidisciplinary Program

Obesity is common in rural areas, and reduced specialist healthcare access impedes its management. A pilot nurse-practitioner-led Assessment and Management of Obesity and Self-Maintenance (AMOS) Clinic focused on individualised obesity care in people living with type 2 diabetes delivered in a rural setting. This study aimed to explore participant and staff experiences of the multidisciplinary obesity clinic to identify barriers and facilitators to self-care, health, and well-being. A two-stage, mixed-method design was used. Initially, three focus groups involving a sample of AMOS participants and semi-structured staff interviews helped identify key barriers/facilitators. These findings informed a survey delivered to all AMOS participants. Qualitative data were analysed using an inductive two-step thematic networks technique to identify themes. Quantitative data were summarised using descriptive statistics. A total of 54 AMOS participants and 4 staff participated in the study. Four themes were identified to describe AMOS participant experiences': 1. affordability; 2. multidisciplinary care; 3. person-centred care; and 4. motivation. Specialised, multidisciplinary and individualised obesity care available through one clinic facilitated self-care and improved health and well-being. Dedicated multidisciplinary obesity clinics are recommended in rural and remote areas.

Interaction between patient and general practitioner according to the patient body weight: a cross-sectional survey

OBJECTIVE

To analyse whether patient-general practitioner (GP) interaction, measured by their disagreement, varies among overweight or obese patients compared with normal-weight patients.

METHODS

Twenty-seven GPs and 585 patients participated in the quantitative phase of the multidisciplinary INTERMEDE project and answered "mirrored" questionnaires collecting both GPs and patients' perceptions on information and advice given at the end of the consultation. Multilevel logistic regressions were performed to explore associations between patient body mass index (BMI) and patient-GP disagreement on information and advice given during the consultation.

RESULTS

Disagreement increased with the patients' excess weight, and it was particularly pronounced for advice given by GPs on weight and lifestyle issues. Compared with patients with a "normal" BMI, overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio [OR] = 10.7, 95% confidence interval [CI] = 4.1-27.3), advice given on doing more physical activity (OR = 1.9, 95% CI = 1.1-3.4), and nutritional advice (OR = 2.9, 95% CI = 1.5-5.6).

CONCLUSION

These disagreements could degrade the quality of patient-physician relationship. Our study provides an opportunity for GPs to reflect on how they communicate with overweight and obese patients, particularly with regard to lifestyle and weight-related advice and interventions taking into account the patient's representations.

You Are What You Eat… But Do You Eat What You Are? The Role of Identity in Eating Behaviors—A Scoping Review

Background: Identity is a major construct in the fields of psychology and anthropology that can relate to both the maintenance of eating behaviors and cultural sensitivity. However, there has not been any systematic effort to understand the role of identity in eating behaviors and the maintenance of eating behaviors, or to address multiple aspects of identity within an individual across scientific disciplines. This scoping review aims to understand and describe existing research relating identity to eating behaviors and to detail the measurement of identity. Methods: We conducted a systematic search of Ovid, PsychINFO, Embase, and Web of Science for articles on identity and eating behaviors published between January 1946 and March 2022. We utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, and search methods were developed with the assistance of a research librarian. We rated articles from 1 to 5 based on the depth, complexity, and multi-dimensionality of the identity measurement conducted. Scoring criteria included a review of the number of items directly querying or evaluating identity and the extent of measurement of identity domains. Results: In total, 100 articles were included, examining 10 different identities, 8 identity constructs, 11 eating behaviors, and construct contributions from 26 theories. The mean score of all articles was 2.9 on the scale from 1 to 5. A total of 10 studies scored a “1”; 30 scored a “2”, indicating the use of 1–2 basic questions about identity; 31 received a “3” for use of a common but non-complex identity instrument; 19 received a “4”, meaning they contained strong evaluation and included multiple types of identity but were lacking in terms of depth of measure and/or the comparison of identity effects to constructs; and 10 scored a “5” for their strong, in-depth measure of identity and inclusion of multiple types. Identity was found to be significantly related to eating behaviors in all but one study. Conclusion: Identity measurements seldom accounted for complexities such as multiple identities and identity shifting over time. Nonetheless, our findings indicate that multiple aspects of identity reciprocally reinforce behavior and that change maintenance is associated with identity salience and centrality. Identity is underutilized and heterogeneously applied in eating behavior research. The inclusion of identity assessments may lead to better outcomes being obtained within differing cultural, normative, and environmental scenarios.

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.

The lived experience of people with obesity: study protocol for a systematic review and synthesis of qualitative studies

BACKGROUND

Obesity is a prevalent, complex, progressive and relapsing chronic disease characterised by abnormal or excessive body fat that impairs health and quality of life. It affects more than 650 million adults worldwide and is associated with a range of health complications. Qualitative research plays a key role in understanding patient experiences and the factors that facilitate or hinder the effectiveness of health interventions. This review aims to systematically locate, assess and synthesise qualitative studies in order to develop a more comprehensive understanding of the lived experience of people with obesity.

METHODS

This is a protocol for a qualitative evidence synthesis of the lived experience of people with obesity. A defined search strategy will be employed in conducting a comprehensive literature search of the following databases: PubMed, Embase, PsycInfo, PsycArticles and Dimensions (from 2011 onwards). Qualitative studies focusing on the lived experience of adults with obesity (BMI >30) will be included. Two reviewers will independently screen all citations, abstracts and full-text articles and abstract data. The quality of included studies will be appraised using the critical appraisal skills programme (CASP) criteria. Thematic synthesis will be conducted on all of the included studies. Confidence in the review findings will be assessed using GRADE CERQual.

DISCUSSION

The findings from this synthesis will be used to inform the EU Innovative Medicines Initiative (IMI)-funded SOPHIA (Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy) study. The objective of SOPHIA is to optimise future obesity treatment and stimulate a new narrative, understanding and vocabulary around obesity as a set of complex and chronic diseases. The findings will also be useful to health care providers and policy makers who seek to understand the experience of those with obesity.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020214560 .

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.