Experiences of barriers and facilitators to weight-loss in a diet intervention – a qualitative study of women in Northern … – BioMed Central
Commercial
BMC Women's Health quantity 14, Article quantity: 59 (2014)
8066
43
2
Metrics details
There’s a lack of analysis in regards to the experiences of collaborating in weight-reducing interventions. The goal of this research was to discover limitations and facilitators to weight-loss skilled by individuals in a weight loss plan intervention for middle-aged to older girls within the basic inhabitants in Northern Sweden.
Within the intervention the ladies have been randomised to eat both a Palaeolithic-type weight loss plan or a weight loss plan in keeping with Nordic Diet suggestions for twenty-four months. A strategic choice was made of girls from the 2 intervention teams in addition to from the drop-outs in relation to social class, civil standing and age. Thematic structured interviews have been carried out with twelve girls and analysed with qualitative content material analyses.
The outcomes confirmed that the ladies within the dietary intervention skilled two fundamental limitations – fighting self (associated to difficulties in altering meals habits, well being issues, lack of self-control and insecurity) and fighting implementing the weight loss plan (associated to social relations and project-related difficulties) – and two fundamental facilitators– striving for self-determination (associated to having clear targets) and receiving assist (from household/pals in addition to from the undertaking) – for weight-loss. There was a better emphasis on limitations than on facilitators.
You will need to additionally embrace drop-outs from weight loss plan interventions with a view to totally perceive limitations to weight-loss. A gender-relational strategy can deliver new insights into understanding experiences of limitations to weight-loss.
ClinicalTrials gov NCT00692536.
Peer Review reports
Weight problems is quickly growing world wide and is taken into account to be one of the vital necessary threats to public well being worldwide [1]. Due to this fact, each prevention of weight problems and environment friendly programmes for weight-loss in numerous contexts have to be in focus in well being promotion. But though there are a lot of therapy regimens for weight problems, profitable weight-loss and upkeep have been proven to be suboptimal [2, 3]. Many of the dietary intervention research have targeted on evaluating the impact of the intervention concerning anthropometric or metabolic variables [2, 4]. However with a view to perceive why a majority of the intervention programmes have proven suboptimal long-term outcomes, and to acquire data of how future programmes should be designed, it’s essential to analyse the experiences of the individuals. Of important significance for designing profitable weight-loss programmes is an understanding of how the individuals expertise limitations and facilitators to shedding pounds. Surprisingly, regardless of the excessive quantity of quantitative research about weight discount, qualitative analysis in regards to the experiences of collaborating in weight-reducing interventions is sparse [4, 5]. There are some qualitative research about weight loss plan interventions aimed toward sufferers with particular diagnoses (corresponding to diabetes, coronary coronary heart illness, knee issues). For instance, a qualitative analysis of an intervention was carried out with excessive cardiovascular danger individuals [6]. The research confirmed that the method of weight-loss was skilled as advanced and difficult, as a consequence of their continual well being circumstances, the professionals and cons of social assist (which means that members of the family may both assist or hinder their new weight loss plan) in addition to because of the time constraints of adjusting the weight loss plan. One other qualitative research was carried out with individuals in (business) weight-loss programmes in a patient-based cohort research [7]. The research discovered that motivation was skilled as an enabler whereas low self-efficacy was a recurrent barrier to weight-loss makes an attempt. An analogous research, primarily based on an intervention amongst primary-health care sufferers, recognized customized messages and social assist (from professionals and others) as facilitators to profitable weight administration [4].
Nevertheless, there’s a lack of research and thus little data in regards to the perceived experiences, attitudes and emotions of individuals from the overall inhabitants in dietary interventions. Due to this fact, the goal of this research was to discover limitations and facilitators to weight-loss skilled by individuals in a weight loss plan intervention for middle-aged to older girls within the basic inhabitants in Northern Sweden.
The research was performed in an space round a middle-sized city in Northern Sweden. The intervention was primarily based on the hospital.
Center-aged to older girls have been invited by announcement to a weight-loss programme, designed as a two-year randomised medical trial (ClinicalTrials.gov, NCT00692536). In all 70 girls with a imply age of 60 years (vary 49 to 71 years) with obese/weight problems (BMI > 27 kg/m2) have been included. For sensible causes, the individuals have been included on three completely different events (24 individuals on every event equally divided into two completely different dietary teams). After baseline measurements, half of the individuals have been randomised to eat a Palaeolithic-type weight loss plan (PD) aiming at an vitality consumption from protein, fats and carbohydrates of 30, 40 and 30 E% respectively. The opposite half was prescribed to eat a weight loss plan in keeping with the Nordic Diet Suggestions (NNR), aiming at an vitality consumption from protein, fats and carbohydrates of 15, 25 and 60 E% respectively. Vitality consumption was not restricted and solely basic recommendation was given about bodily exercise. To attain adherence to the meals consumption, individuals in every dietary group took half in a complete of 12 group classes held by a educated research dietician (one dietician per weight loss plan) all through the 24-months research interval. The group classes consisted of data on and cooking of the intervention diets, dietary results on well being, behavioural adjustments, and group discussions. The topics got recipes and written directions to facilitate the preparation of meals at dwelling. Eight group classes (4 cooking courses and 4 follow-up classes) have been held throughout the first 6 months of the intervention. Extra group conferences have been held at 9, 12, 18, and 24 months. Adherence to the weight loss plan was adopted by repeated meals diaries and goal measurement of vitality and protein consumption. The intervention research began in August 2007 and was carried out till March 2010 with a drop-out of 13% after 6 months and 30% in whole after 24 months. There was no vital distinction between the intervention teams in drop-out fee (eight girls within the PD group, 13 within the NNR group) calculated because the distinction of proportions between teams (p = 0.19) [8].
Each weight loss plan teams had a major weight-loss over time. The most important weight-loss was measured on the 12-months follow-up with −8.7 kg within the PD group and −4.4 kg within the NNR group. On the 24-months, the weight-loss was −6.2 kg and −3.7 kg, respectively. There was a considerably increased weight discount within the PD group in comparison with the NNR group on the 12-months follow-up however not on the 24-months follow-up [8].
A strategic choice of girls from the entire sampling base of the intervention research was carried out after its completion in Autumn 2010. A pattern of fourteen girls was drawn from three teams: the 2 weight loss plan teams (PD and NNR) in addition to from the drop-outs from the intervention. We strived for getting as a lot variation as potential among the many chosen girls in relation to social class/schooling, civil standing, residing in rural or city areas and age (working age or retired). The strategic choice supplied a different group of individuals in every of those three teams – together with each girls in working life and pensioners, those that have been married and single, girls residing within the metropolis in addition to within the surrounding rural areas and ladies of various instructional background (middle-class and working-class). Two girls refused to take part in our interview research and thus, twelve participated within the research. Total, the individuals have been fairly extremely educated and all of them have been Swedish-born. In whole, 4 of the twelve girls have been drop-outs whereas eight girls had fulfilled the undertaking, with 4 collaborating within the PD and 4 within the NNR dietary intervention.
Particular person thematic structured interviews have been carried out with assistance from an interview information with open questions concerning limitations and facilitators to weight discount. Instance of questions for this paper was: Please inform me about limitations/facilitators to attain your purpose of weight-loss. What have you ever executed with a view to overcome the limitations? Did you expertise disadvantages with the brand new weight loss plan. If sure, which? Please inform me in regards to the stipulations for reaching your weight purpose. What has made you succeed/not reach reaching your weight purpose? Minor changes have been made to the questions between interviews in order that info supplied in a single interview could possibly be considered in a subsequent interview. A sociologist interviewed ten of the ladies, whereas two of the authors (CA, AFW) interviewed the opposite two girls. We carried out the interviews at our office, within the dwelling or on the office of the individuals. The interviews lasted about one hour every, and have been tape-recorded and transcribed verbatim.
The interviewer and all authors besides BL and CL have been by no means concerned within the intervention research.
The analyses have been carried out in keeping with qualitative content material analyses [9]. The evaluation began with a naïve studying to get an understanding of the content material of the interviews after which the open coding was carried out. Throughout all steps of the evaluation two or three of the authors (AFW, AH, CA) coded every interview independently, adopted by a mutual comparability and a closing negotiated consequence between all authors. On this course of, we discovered solely minor disagreements between us and, when that occurred, we went again to the unique textual content and mentioned the coding till settlement was reached. This technique of methodological triangulation was carried out with a view to enhance the trustworthiness of the info and its interpretation [10].
The info evaluation was carried out within the following approach. First, sentences describing obstacles and facilitators have been extracted from the textual content as which means models (i.e., phrases or sentences that convey the identical central which means). Thereafter, the which means models have been condensed and abstracted into codes. Examples of which means models and codes are given in Desk 1.
The codes have been then interpreted and in contrast concerning variations and similarities for the 2 content material areas – limitations and facilitators to weight-loss. After that the codes have been introduced collectively on a extra summary stage into preliminary subcategories which have been then sorted and abstracted into preliminary subcategories and classes. Lastly, these preliminary subcategories and classes have been mentioned, mirrored on and condensed into closing subcategories and classes. A class refers primarily to a descriptive stage of content material and solutions the query “What?” and may thus be seen as an expression of the manifest content material of the textual content. A class usually consists of a variety of subcategories or sub-subcategories at various ranges of abstraction. The subcategories and classes for the 2 content material areas are introduced in Tables 2 and 3. Ultimately all rising subcategories and classes have been mentioned, mirrored on and condensed into closing subcategories and classes.
The research has been authorised by the Regional Ethics Vetting Board in Umeå. Written knowledgeable consent was obtained from all individuals.
The recognized classes and subcategories for limitations and facilitators to weight-loss are described under. The codes, subcategories and classes associated to limitations to weight-loss are described in Desk 2. The outcomes for every class are described under.
4 subcategories – difficulties in altering meals habits, well being issues, lack of self-control and insecurity – have been recognized in relation to Battling self.
The ladies, particularly these on the PD weight loss plan, mentioned that it was tough to alter meals habits. They discovered the primary interval within the undertaking rewarding as a consequence of heavy weight-loss and thus they thought the brand new weight loss plan was acceptable. Nevertheless, after a while (corresponding to after the primary yr) the ladies may lengthy for forbidden meals (like cheese, bread, potatoes and wine) and thus discovered the brand new weight loss plan extraordinarily tough to maintain. They mentioned that the problem was to keep away from falling again into previous habits as time went on, and so they longed for excluded meals. In the long term, it could possibly be tough to do with out meals they appreciated so much.
It was even tougher if they didn’t just like the meals within the weight loss plan intervention, for instance fruit and greens. One participant described how she acquired very indignant when she pressured herself to eat the greens, which she didn’t like. However she continued to eat them anyway.
One other barrier to conserving the weight loss plan was well being issues. New or exacerbated well being issues may destroy the ambition to drop some weight, as a result of these issues may make it tougher for them to carry out every day actions, corresponding to bodily exercise. For instance, one participant broke her leg, and the persistent ache after the operation made it onerous for her to be bodily energetic. The elevated inactivity made it tough for her to drop some weight and due to this fact she dropped out of the undertaking. One other participant broke her arm, which made it very tough to prepare dinner. Ladies with different illnesses, corresponding to bile issues or intolerance to e.g., fruit, skilled much more restricted diets after the exclusion of such meals merchandise. As well as, girls who underwent extreme life occasions corresponding to well being issues amongst companions/family members mentioned that the demanding scenario prevented them from conserving their weight loss plan.
Lack of self-control was additionally recognized as a significant interior impediment to weight-loss. Following a weight loss plan requires excessive self-control; it was thought-about too simple to present solution to temptation.
The individuals talked about dishonest, i.e. consuming what was not allowed in keeping with the weight loss plan regimes. Throughout sure durations of the weight loss plan intervention the individuals saved an in depth diary of every part they ate, which they obtained feed-back on from the undertaking leaders. In the course of the meals diary week, the ladies mentioned that they tried their finest to maintain the weight loss plan, however after that week their dietary regime could not have been so excellent any longer.
Dishonest was skilled as a significant downside for the individuals. The undertaking was described as a assist to construction their consuming so as to not yield to temptation. Alternatively, it was tempting to return to previous, most well-liked meals habits if the undertaking didn’t result in the specified weight discount. The dishonest was associated to difficulties to find motivation to alter meals habits. And thru time, this dishonest could possibly be the explanation why the ladies dropped out of the undertaking. For many who didn’t succeed with the undertaking the forbidden meals was skilled as a consolation. Consoling oneself by consuming was recognized as a barrier to weight-loss.
One more reason for dishonest was that the ladies had reached their targets for weight-loss and have been in a position to have a extra relaxed relationship to meals. The undertaking nonetheless anticipated the individuals to maintain the weight loss plan, regardless of weight-loss. As one participant mentioned, after a sure time within the undertaking with fascinating weight discount she may lean again, chill out and eat among the meals she had given up due to the weight loss plan regime. A structural purpose for dishonest was taking retirement and spending extra time at dwelling, thus being nearer to meals, so to talk.
Being hooked on sweets was skilled as lack of self-control over consuming. This sugar habit gave the impression to be a significant downside for the interviewed girls. For instance, one participant described herself as a sweet-alcoholic; she simply needed to eat sweets:
“I can not purchase sweets, which is why I name myself an alcoholic as a result of I’m like them in that they will’t purchase themselves a bottle of alcohol. And I’ve to eat all sweets without delay. Nothing else is feasible. I want the sweets have been as distant within the store as potential.”
One other lady talked a few related habit to sweets. She thought that her habit was triggered by bread, or possibly by “one thing in her head” and likewise that the issue was inherited, as a result of her daughter was additionally hooked on sweets:
“after which I need that candy. And afterwards when I’ve eaten it I really feel sick and I feel– hell, why did I eat it … after I know that I mustn’t and that I really feel dangerous afterwards. ”
The ladies may additionally expertise a roughly whole lack of management over consuming. As one participant mentioned:
“my weight solely will increase and will increase and by no means goes down once more”.
In her description of herself, she isn’t in management over her consuming or her weight. The sandwich (or a bit later within the interview – the chocolate) “simply goes down”.
Insecurity was the final subcategory in relation to the class Battling self. The ladies within the weight loss plan intervention had long-term expertise of unsuccessful weight-reduction plan and due to this fact they mentioned they have been usually insecure about whether or not or not they’d succeed this time. Particularly these on the PD weight loss plan skilled the meals as sophisticated and due to this fact a query was: What is true to eat? The ladies described how the PD weight loss plan may result in too massive a change in comparison with their traditional meals consumption, which added to the emotions of insecurity.
A proof for not succeeding in weight discount was lack of interior power, which additionally elevated the emotions of insecurity. Good urge for food together with difficulties in resisting consuming was described as a foul mixture for weight-loss. As one participant mentioned:
“So I attempted … however no, I couldn’t mobilise the interior power which is a pity”.
Battling implementing was associated to social relations and project-related difficulties. Limitations related to social relations embrace difficulties in combining dietary adjustments with being along with the household, pals or workmates. The ladies mentioned that their associate could possibly be a significant impediment to weight-loss. He could possibly be an impediment by tempting them with forbidden meals, as described by one of many drop-outs. Her new associate introduced sweets or baked muffins to her on a regular basis. Throughout their time collectively he elevated his weight so much. When requested how she managed the burden discount she answered:
“It’s onerous. You’ll be able to see how he actually drowns his meals in cream and sugar after which he appears at me like – he is aware of, he’s acutely aware that this isn’t good”.
In different instances, the ladies advised us that their associate didn’t care about their new weight loss plan, though he didn’t settle for consuming it himself. Nearly all of individuals mentioned that they lived with a husband/associate who didn’t prepare dinner. He nonetheless anticipated her to make his meals within the conventional approach; this meant that the spouse needed to prepare dinner two completely different dishes for each meal:
“My husband had no opinion besides that he … needed to have the same old meals with sauce and so forth”.
So these girls ended up conserving two households – the standard one for the husband and the brand new weight loss plan for themselves. Solely one of many interviewed girls talked in regards to the husband/associate sharing the cooking along with her. One other impediment skilled was when their grown-up youngsters with households came over them, particularly after they anticipated to be served conventional meals relatively than the brand new weight loss plan.
Friendships have been additionally recognized by the ladies as a potential impediment to weight-loss. Having espresso collectively was described as a central a part of social relations, and this espresso at all times included buns and muffins. The individuals described emotions of isolation after they had their fruit whereas everybody else was having buns and muffins. And being invited to a celebration at all times meant being supplied sweets, which have been discovered tough to withstand. The ladies talked about their concern of injuring the hostesses who had made the meals and due to this fact they may eat of every part relatively than hold to their weight loss plan. In addition to, the ladies have been afraid that an excessive amount of emphasis on their new weight loss plan may impose calls for on their pals to begin weight-reduction plan too. These social issues have been recognized as a purpose why the individuals didn’t inform others about their new weight loss plan. A technique among the many individuals was to ask pals to their properties for dinner relatively than go to their dwelling, as a result of it was simpler to maintain the weight loss plan once you made the meals your self.
The ladies who have been nonetheless working discovered it simpler to maintain the weight loss plan at work with restricted entry to sweets, in comparison with being at dwelling or invited to pals. Alternatively, it could possibly be very tough to maintain the weight loss plan when travelling. Travelling so much additionally made it tough to maintain up with the undertaking conferences and with the info assortment for the undertaking. Additionally, night time work may disturb any meals habits, particularly if you happen to have been on a brand new weight loss plan.
The individuals additionally recognized project-related difficulties. A barrier skilled with the PD meals was that it was fairly restricted. As one participant who had left the research upfront acknowledged:
“There was too little variation for me to maintain the weight loss plan over an extended time … Every part you longed for, cheese is one instance.”
The citation additionally signifies that it could possibly be boring to have too little variation within the weight loss plan. One participant described how tedious it was to peel one kilogram of shrimps to present 300 grams of shrimps for breakfast each Saturday morning, whereas her husband may eat something. It additionally felt boring to eat fruit when everybody else (at work, at dwelling or with pals) had buns and muffins, or to observe their weight loss plan generally, due to lack of variation within the meals consumption. With the ability to eat sweets as an alternative of fruit was seen as including that little further to life.
For among the girls, particularly these on the PD weight loss plan, the brand new meals was very costly:
“Proteins are very costly to purchase … greens are seasonally costly in order that made about 100 euro further per 30 days which is an excessive amount of. I wouldn’t have the economic system”.
The excessive prices could possibly be a purpose for leaving the undertaking. As one participant advised us, beforehand she may develop potatoes with none price or purchase low-cost pasta, whereas now she had to purchase costly greens and proteins. The prices additionally relied on their place of residing – the prices have been particularly excessive if you happen to had no massive grocery store near your property. Contributors residing within the rural space advised us that they needed to pay far more for his or her new weight loss plan as in comparison with city individuals who had massive supermarkets close by.
The PD weight loss plan was additionally discovered to be costlier to eat in a restaurant than the standard weight loss plan. The ladies claimed that proteins along with greens price far more than, for instance, a pizza or pasta.
Participation within the undertaking was skilled by among the girls as very time-consuming. This was particularly the case for these residing outdoors the principle metropolis in addition to for these with shift work (together with the well being care employees) who usually labored throughout evenings/nights. For them it was tough to mix the group conferences and the opposite undertaking actions (together with taking specimens for the undertaking) with their very own work, or with lengthy distances to journey from dwelling. The additional time wanted for collaborating within the undertaking along with the additional time wanted for making ready the brand new weight loss plan (particularly the PD weight loss plan) could possibly be an especially demanding expertise and a purpose for leaving the undertaking.
Additionally, among the individuals needed extra assist and training from the undertaking for his or her weight loss plan change. They mentioned that throughout the undertaking they’d needed to prepare dinner extra collectively in addition to to have extra group conferences or some sort of contact with the group individuals in between the group conferences. Additionally, one lady expressed a want for the undertaking to manage the quantity of meals she ate.
One other project-related downside was disappointment in regards to the group to which the ladies have been randomised. The PD group was hottest as a result of the opposite weight loss plan could possibly be skilled as consuming the identical as their bizarre meals.
The codes, subcategories and classes associated to facilitators for weight-loss are described in Desk 3. Two fundamental classes have been recognized – striving for self-determination and receiving assist. Total, the interviews weren’t as wealthy in relation to “facilitators” as they have been in relation to “limitations for weight-loss”.
One subcategory – self-determination – was recognized as a facilitator of weight-loss. Those that succeeded in reaching the targets of their weight-loss mentioned that they have been very motivated and had clear targets. Additionally, they simply accepted their new weight loss plan. Their self-determination helped them to chorus from undesirable consuming. One technique was to drink much less espresso, as a result of espresso ingesting was related to consuming buns and muffins. One other technique was to purchase cheese (which many liked) with decrease fats and to chorus from shopping for sweets. The self-control was expressed as “I don’t allow myself to eat” or “I forbid myself to eat”. The ladies may additionally use their self-control and chorus from dinner invites to stay to their weight loss plan extra simply.
Two subcategories have been recognized in relation to this class – assist from household/pals and project-related assist. As acknowledged above in relation to “limitations for weight-loss”, the associate could possibly be an impediment. However there have been additionally girls whose husbands/companions have been supportive. One in every of these girls mentioned that her husband thought the brand new weight loss plan was tremendous. However she stopped him from consuming her weight loss plan as a result of she believed that he was too bodily energetic to really feel good with that meals. As a substitute he needed to repair his personal meals.
Buddies – identical to husbands/companions – may both be supportive or make weight-loss tougher. When supportive, the chums didn’t tempt the individuals to eat forbidden meals. When inviting them for dinner, the chums would prepare dinner the weight loss plan meals too. Additionally, good pals could possibly be actually supportive in serving to the individuals to maintain their weight loss plan.
The project-related assist was described as both direct assist or inspiration to weight loss plan change. The individuals felt that they obtained assist in sticking to their weight loss plan from the group conferences in addition to from the dieticians and the nurses. The undertaking was additionally skilled as not directly supportive for the reason that individuals may seek advice from and use the undertaking in relation to others as an excuse for refraining from sure meals.
The undertaking was described as an inspiration to attempt a brand new weight loss plan and to find out about new components. This was very true for many who had no monetary issues getting maintain of the brand new weight loss plan. And among the individuals continued to eat their new weight loss plan, particularly the breakfast, even after ending the undertaking.
In abstract, we recognized that the ladies within the dietary intervention skilled two fundamental limitations–fighting self (associated to difficulties in altering meals habits, well being issues, lack of self-control and insecurity) and fighting implementing the brand new weight loss plan (associated to social relations and project-related difficulties) – and two fundamental facilitators– striving for self-determination (associated to having clear targets) and receiving assist (from household/pals in addition to from the undertaking) – for weight-loss. There was a better emphasis on limitations than on facilitators.
The stability between limitations and enablers is strongly related to precise behaviour change in keeping with most theories of behaviour change. The Well being Perception Mannequin states that if the perceived limitations to a change in behaviour outweigh the perceived advantages, then the chance of such a change in behaviour shall be severely decreased [11]. From Social Cognitive Principle, working with the idea of self-efficacy, one can simply perceive a scenario the place a person with low self-efficacy for dietary change concurrently finds the next frequency of limitations than enablers in every day life when appraising the likelihood to make dietary change [12]. In medical weight-loss programmes (simply as on this research) most overweight people have a historical past of earlier weight-loss makes an attempt and unsuccessful previous experiences regarding weight-loss. A consequence of it is a low stage of self-efficacy for reaching weight-loss, particularly on a long-term foundation. A majority of this group of overweight folks additionally report main obstacles or perceived limitations to adherence to weight-loss therapy or wholesome consuming intervention [13]. The truth that one third of the individuals have been drop-outs could also be one rationalization for the sturdy emphasis on limitations as in comparison with facilitators.
As well as, qualitative analysis has proven that overweight folks usually expertise their weight in profoundly detrimental methods as a consequence of residing in a social context which stigmatises obese and particularly weight problems [14]. So as to develop profitable interventions, well being professionals want to grasp particular person experiences of being overweight and the detrimental impression of weight problems on self-identity. Additionally, interventions should be conscious that detrimental particular person responses to at least one’s weight problems could also be a barrier for weight-loss [14]. In a scientific evaluation, Mildew and Forbes [15] examined the experiences of overweight individuals in relation to their health-care provision and health-care professionals in offering look after overweight sufferers. The evaluation included 30 research printed 1990–2010, confirmed that weight problems has a robust impact on how overweight people view themselves. Overweight sufferers have usually in on a regular basis life at quite a few events been subjected to weight-based stigma and discrimination, which reduces their standing, will increase their self-blame and their detrimental self-image in addition to their sense of powerlessness. The stigmatisation can also be associated to detrimental psychobehavioural responses corresponding to maladaptation and low vanity, which can impede the flexibility to undertake optimistic behaviours with a view to overcome limitations for weight-loss [15]. Experiences of stigmatisation even have impact on how they entry and work together with health-care suppliers. The evaluation means that there exist many types of discriminatory practices amongst health-care suppliers in the direction of overweight sufferers [15].
As there’s a restricted quantity of qualitative analysis about private experiences of limitations and facilitators to weight-loss in weight loss plan interventions, our findings are novel inside the medical literature. Just a few qualitative research inside the area of weight loss plan interventions have been carried out. One article a few US research made a qualitative evaluation of limitations and facilitators to reaching behaviour targets amongst overweight inner-city adolescents in a weight administration programme [16]. Due to the completely different context and ages the outcomes of that research are tough to check with ours. Limitations to reaching bodily exercise targets amongst ladies on this US research included unsafe neighbourhoods and a detrimental physique picture. Sustaining unrealistic behaviour and weight targets hindered weight-loss in each women and men. What was much like our outcomes was the optimistic impression of teaching inside the intervention. It helped the teenagers really feel extra profitable within the goal-setting course of and addressed points associated to their disruptive environments.
When evaluating our outcomes with an article primarily based on a qualitative research of Arab girls susceptible to sort 2 diabetes [17] we discover not solely similarities (associated to the significance of social assist) but in addition contextual variations corresponding to socio-cultural norms that limit outside bodily actions among the many Arab girls.
When evaluating our findings with quantitative population-based research we discover a related barrier associated to excessive prices of wholesome meals in an Australian research of younger girls [18]. Lack of motivation and lack of time have been further main limitations in that research. The choice of motivated individuals in our research may clarify the completely different findings.
A qualitative research of US faculty college students [19] discovered related limitations to weight administration among the many younger women and men to these we present in our chosen group of older Swedish girls: intrapersonal (corresponding to temptation and lack of self-discipline); interpersonal (social conditions); and environmental (e.g., time constraints, prepared entry to unhealthy meals). Facilitators much like these in our research have been additionally recognized among the many younger women and men within the US research–intrapersonal (e.g., regulating meals consumption, being bodily energetic) and interpersonal (social assist) [19]. Whereas our research targeted on an intervention, the US research targeted on making a supportive setting for bodily exercise. As in our research, extra limitations than enablers got, indicating that the individuals in these research are extra delicate to the limitations than the enablers of weight administration.
One other US research [20] – on this case quantitative – of sufferers and suppliers in major care confirmed that the sufferers and GPs had very completely different views of limitations and facilitators to weight-loss. As in our research, lack of self-control and want for assist to remain on a weight loss plan was emphasised by the GPs whereas the sufferers needed to handle their weight issues on their very own.
Lack of self-control in relation to sweets was described by some individuals as sugar habit and equated with alcoholism. This idea has obtained a lot consideration in widespread life-style magazines, however the scientific proof is contradictory. Animal fashions discover that rats underneath sure circumstances can grow to be depending on sugar [21]. Nevertheless, sugar as a substance inflicting bodily habit in people is rejected in a evaluation research [22].
Our research included girls, and a related query is whether or not or not our outcomes are transferable to males. One main subject was that the ladies in our research did nearly all of the cooking. As a result of males seldom prepare dinner, they’re depending on their wives for getting the brand new weight loss plan. Analysis has proven that if the husband contracts diabetes, the entire household adjustments their weight loss plan, but when the spouse will get diabetes, the household desires to proceed with their conventional meals so she cooks conventional meals for herself and diet-restricted meals for her husband [23]. The reason given was that the husbands wouldn’t settle for a brand new weight loss plan if they don’t want it themselves.
Thus, a gender-relational strategy [24] – through which males’s and ladies’s relations and interactions with one another are analysed in numerous settings, corresponding to household life – appears to be cheap to grasp our findings. With this theoretical framework, the relations between the ladies and their companions/husbands will be understood from a societal perspective of males’s superiority and energy in relation to girls. Ladies – even in a gender-equal society like Sweden – carry out a lot of the home work [25], which within the case of the ladies in our research meant that they have been the meals suppliers of the household. So when their husbands refused to eat their new weight loss plan, they needed to prepare dinner two meals. That in itself could possibly be a significant impediment to weight-loss. Thus, the facility dynamics inside the couple concerning meals preparation put girls in a subordinate place vis-à-vis their husbands. A major instance of this subordinate place was the tales from girls who have been tempted by their companions/husbands to eat forbidden meals. Thus, a gender-relational strategy interprets our findings as exhibiting that ladies’s subordinate place within the couple relationship constituted a significant barrier to weight-loss.
This interpretation is in keeping with a qualitative research specializing in meals practices amongst Finnish males through which the lads described cooking as elective or distinctive [26]. Their masculinities have been seen as constructed from a rejection of female beliefs corresponding to on a regular basis cooking. One other research, with an strategy primarily based on a relational concept of gender, targeted on weight loss plan change amongst males with prostate most cancers [27]. The research emphasised how each wives and husbands mutually restricted males’s engagement in cooking and weight loss plan whereas reinforcing girls’s conventional femininities in nurturing their husbands. The identical interpretation could possibly be utilized in relation to our findings in regards to the lady who described how she stopped her husband from adopting her weight loss plan due to her concerns about his want for vitality. Despite unequal energy relations related to girls’s duty for the home sphere, the ladies may assemble themselves as desirous to have the principle management over conventional female duties corresponding to cooking [28]. Total, there’s a lack of analysis from a gender-relational strategy in regards to the impression on well being of the gender division of cooking [27, 29].
Our findings may also be in comparison with one of many few research on males, on this case a qualitative research of Danish youthful working-class males, motivated for weight-loss [30]. Lack of motivation along with a detrimental notion of the slimming weight loss plan have been the principle limitations. It’s onerous to know what made the end result so completely different from our research however most likely the mixture of age, gender and sophistication in addition to (maybe most significantly) the choice of very well-motivated girls into our research.
The trustworthiness of our outcomes must be thought-about [9]. Trustworthiness contains the 4 ideas credibility, confirmability, dependability and transferability and we focus on them in keeping with Lincoln and Guba [31, 32]. The credibility or reality worth, offers with whether or not our findings have been constructed on devoted circumstances [31, 32]. The interview information was mentioned and determined upon within the group of authors who analysed the interviews (AH, AFW, CA), all three skilled qualitative researchers from completely different disciplines (triangulation between researchers) [31]. The interviews have been carried out with open questions by a talented interviewer, who didn’t participate within the evaluation. After every interview, the interviewer mirrored upon and mentioned any changes within the interview information along with the authors. Total, the interviews have been wealthy and comparatively lengthy. The textual content was analysed by three of the authors (AH, AFW, CA). The method has been open and clear and the analyses have been fastidiously examined and likewise mentioned in depth by the authors with the interviewer participating, in addition to in numerous seminar teams (peer debriefing) [31]. Confirmability offers with to what extent the findings have been affected by private pursuits and biases [31, 32]. The interviewer together with the authors who analysed the info didn’t participate within the RCT-intervention and thus may deliver an outsider perspective on the info. Dependability offers with how steady the info are over time and circumstances throughout the research [31]. Ladies from each dietary teams in addition to drop-outs from the entire 2 -year research interval have been invited to take part within the interviews. Within the Consequence Part, examples of quotes and the entire coding course of are supplied in Tables 1 and 2 (audit path) [31, 32]. The outcomes have been totally mentioned inside the entire group of authors in addition to with different teams of researchers who discovered the end result to be credible. Thus, we contemplate our outcomes reliable.
The transferability of our findings must be mirrored upon in relation to contextualisation and sampling procedures [31, 32]. Our findings are strongly contextualised inside the body of the 2-year RCT weight loss plan intervention amongst motivated middle-aged girls in Northern Sweden. Our inclusion of applicable quotations additionally enhances transferability. It may be questioned whether or not the textual content from 12 interviews was sufficient. The interviewed girls have been strategically chosen concerning their social background, age, civil standing and residing circumstances. The interviews have been wealthy and gave different views on the matters of this paper. Due to this fact, we imagine that our outcomes will be transferred to related teams and contexts to these represented by the ladies in our research.
The primary limitation of our research was the homogeneous pattern of middle-aged white girls in Northern Sweden in a really particular weight loss plan intervention. Despite that, we discovered not solely similarities but in addition variations in relation to the principle findings. Even so, extra analysis is required about experiences of weight-loss interventions in different contexts.
Surprisingly few research have analysed limitations and facilitators to weight-loss. You will need to additionally embrace drop-outs from weight loss plan interventions with a view to totally perceive limitations to weight-loss. A gender-relational strategy can deliver new insights into understanding experiences of limitations to weight-loss.
Haslam DW, James WP: Weight problems. Lancet. 2005, 366 (9492): 1197-1209. 10.1016/S0140-6736(05)67483-1.
Article PubMed Google Scholar
Anderson JW, Konz EC, Frederich RC, Wooden CL: Lengthy-term weight-loss upkeep: a metaanalysis of US research. Am J Clin Nutr. 2001, 74: 579-584.
CAS PubMed Google Scholar
Anderson JW, Luan J, Høie LH: Structured weight-loss applications: meta-analysis of weight-loss at 24 weeks and evaluation of results of intervention depth. Adv Ther. 2004, 21 (2): 61-75. 10.1007/BF02850334. Evaluation
Article PubMed Google Scholar
Visram S, Crosland A, Cording H: Triggers for weight achieve and loss amongst individuals in a major care-based intervention. Br J Neighborhood Nurs. 2009, 14 (11): 495-501.
Article PubMed Google Scholar
Thomas SL, Hyde J, Karunaratne A, Kausman R, Komesaroff PA: All of them work…once you follow them”: a qualitative investigation of weight-reduction plan, weight-loss, and bodily train, in overweight people. Nutr J. 2008, 24 (7): 34-10.1186/1475-2891-7-34
Article Google Scholar
Gallagher R, Kirkness A, Armari E, Davidson PM: Weight administration points and methods for folks with excessive cardiovascular danger endeavor an Australian weight-loss program: a spotlight group research. Nurs Well being Sci. 2012, 14 (1): 18-24. 10.1111/j.1442-2018.2011.00651.x.
Article PubMed Google Scholar
Herriot AM, Thomas DE, Hart KH, Warren J, Truby H: A qualitative investigation of people’ experiences and expectations earlier than and after finishing a trial of economic weight-loss programmes. J Hum Nutr Eating regimen. 2008, 21 (1): 72-80.
Article CAS PubMed Google Scholar
Mellberg C, Sandberg S, Ryberg M, Eriksson M, Brage S, Larsson C, Olsson T, Lindahl B: Lengthy-term results of a palaeolithic-type weight loss plan in overweight postmenopausal girls: a two-year randomized trial. Eur J Clin Nutr. in press
Graneheim UH, Lundman B: Qualitative content material evaluation in nursing analysis: ideas, procedures and measures to attain trustworthiness. Nurse Educ At present. 2004, 24: 105-112. 10.1016/j.nedt.2003.10.001.
Article CAS PubMed Google Scholar
Patton MQ: Qualitative analysis and analysis strategies. 2001, London: Sage
Google Scholar
Janz NK, Champion VL, Strecher VJ: The well being perception mannequin. Well being conduct and well being schooling. Edited by: Glanz Okay, Rimer BK, Lewis FM. 2002, San Francisco: Jossey-Bass, John Wiley & Sons, 45-66. 3
Google Scholar
Baranowski T, Perry CL, Parcel GS: How people, environments, and well being conduct work together: social cognitive concept. Well being conduct and well being schooling. Edited by: Glanz Okay, Rimer BK, Lewis FM. 2002, San Francisco: Jossey-Bass, John Wiley and Sons, 165-184. 3
Google Scholar
Burke LE, Steenkiste A, Styn MA: A descriptive research of previous experiences with weight-loss therapy. J Am Eating regimen Assoc. 2008, 108: 640-647. 10.1016/j.jada.2008.01.012.
Article PubMed Google Scholar
Ogden J, Clementi C: The expertise of being overweight and the numerous penalties of stigma. J Obes. 2010, Article ID 429098, 9 pages, doi:10.1155/2010/
Google Scholar
Mildew F, Forbes A: Sufferers’ and professionals’ experiences and views of weight problems in health-care settings: a synthesis of present analysis. Well being Anticipate. 2011, 16: 119-142.
Article PubMed Google Scholar
Alm M, Soroudi N, Wylie-Rosett J, Isasi CR, Suchday S, Rieder J, Khan U: A qualitative evaluation of limitations and facilitators to reaching conduct targets amongst overweight inner-city adolescents in a weight administration program. Diabetes Educ. 2008, 34 (2): 277-284. 10.1177/0145721708314182.
Article PubMed Google Scholar
Ali HI, Baynouna LM, Bernsen RM: Limitations and facilitators of weight administration: views of Arab girls in danger for sort 2 diabetes. Well being Soc Care Neighborhood. 2010, 18 (2): 219-228. 10.1111/j.1365-2524.2009.00896.x.
Article PubMed Google Scholar
Andajani-Sutjahjo S, Ball Okay, Warren N, Inglis V, Crawford D: Perceived private, social and environmental limitations to weight upkeep amongst younger girls: a neighborhood survey. Int J Behav Nutr Phys Act. 2004, 1 (1): 15-10.1186/1479-5868-1-15.
Article PubMed PubMed Central Google Scholar
Greaney ML, Much less FD, White AA, Dayton SF, Riebe D, Blissmer B, Shoff S, Walsh JR, Greene GW: School college students’ limitations and enablers for healthful weight administration: a qualitative research. J Nutr Educ Behav. 2009, 41 (4): 281-286. 10.1016/j.jneb.2008.04.354.
Article PubMed Google Scholar
Ruelaz AR, Diefenbach P, Simon B, Lanto A, Arterburn D, Shekelle PG: Perceived limitations to weight administration in major care – views of sufferers and suppliers. J Gen Intern Med. 2007, 22 (4): 518-522. 10.1007/s11606-007-0125-4.
Article PubMed PubMed Central Google Scholar
Avena NM, Rada P, Hoebel BG: Proof for sugar habit: behavioral and neurochemical impacts of intermittent, extreme sugar consumption. Neurosci Biobehav Rev. 2008, 32 (1): 20-39. 10.1016/j.neubiorev.2007.04.019.
Article CAS PubMed Google Scholar
Benton D: The plausibility of sugar habit and its position in weight problems and consuming problems. Clin Nutr. 2010, 29: 288-303. 10.1016/j.clnu.2009.12.001.
Article CAS PubMed Google Scholar
Hepworth J: Gender and the capability of girls with NIDDM to implement medical recommendation. Scand J Public Well being. 1999, 27 (4): 260-266. 10.1177/14034948990270041001.
Article CAS PubMed Google Scholar
Connell RW: Gender. 2002, Polity: Cambridge, England
Google Scholar
Statistics Sweden: Ladies and men in Sweden: details and figures 2010. 2011, Statistics Sweden: Örebro
Google Scholar
Roos G, Prättälä R, Koski Okay: Males, masculinity and meals: interviews with Finnish carpenters and engineers. Urge for food. 2001, 37 (1): 47-56. 10.1006/appe.2001.0409.
Article CAS PubMed Google Scholar
Mróz LW, Chapman GE, Oliffe JL, Bottorff JL: Gender relations, prostate most cancers and weight loss plan: re-inscribing hetero-normative meals practices. Soc Sci Med. 2011, 72 (9): 1499-1506. 10.1016/j.socscimed.2011.03.012.
Article PubMed Google Scholar
Lupton D: ‘The place’s me dinner?’ meals preparation preparations in rural Australian households. J Sociol. 2000, 36 (2): 172-186. 10.1177/144078330003600203.
Article Google Scholar
Schofield T, Connell RW, Walker L, Wooden JF, Butland D: Understanding males’s well being and sickness: a gender-relations strategy to coverage, analysis, and apply. J Am Coll Well being. 2000, 48 (6): 247-256. 10.1080/07448480009596266.
Article CAS PubMed Google Scholar
Sabinsky MS, Toft U, Raben A, Holm L: Obese males’s motivations and perceived limitations in the direction of weight-loss. Eur J Clin Nutr. 2007, 61 (4): 526-531.
CAS PubMed Google Scholar
Lincoln YS, Guba EG: Naturalistic inquiry. 1985, Newbury Park, California: Sage Publications
Google Scholar
Öhman A: Qualitative methodology for rehabilitation analysis. J Rehabil Med. 2005, 37: 273-280. 10.1080/16501970510040056.
Article PubMed Google Scholar
The pre-publication historical past for this paper will be accessed right here:http://www.biomedcentral.com/1472-6874/14/59/prepub
Download references
We thank the individuals within the research. The authors wish to thank David Ekholm for precious assist. This research was supported by grants from the Swedish Council for Working Life and Social Analysis (2006-0699 and 2010-0398), the Swedish Analysis Council (K2011-12237-15-6 and 344-2011-5478), the Swedish Coronary heart and Lung Basis, the County Council of Västerbotten, and Umeå College, Sweden.
Division of Public Well being and Medical Drugs, Umeå College, Umeå, Sweden
Anne Hammarström & Bernt Lindahl
Umeå Centre for Gender Research in Drugs, Umeå College, Umeå, Sweden
Anne Hammarström, Anncristine Fjellman Wiklund & Christina Ahlgren
Division of Neighborhood Drugs and Rehabilitation, Physiotherapy, Umeå College, Umeå, Sweden
Anncristine Fjellman Wiklund & Christina Ahlgren
Division of Meals and Diet, and Sport Science, College of Gothenburg, Sweden, Gothenburg, Sweden
Christel Larsson
Division of Meals and Diet, Umeå College, Umeå, Sweden
Christel Larsson
You can too seek for this writer in PubMed Google Scholar
You can too seek for this writer in PubMed Google Scholar
You can too seek for this writer in PubMed Google Scholar
You can too seek for this writer in PubMed Google Scholar
You can too seek for this writer in PubMed Google Scholar
Correspondence to Anne Hammarström.
The authors declare that they don’t have any competing pursuits.
AH, AFW, BL and CA designed the qualitative research, whereas CL and BL designed the weight loss plan intervention. AFW and CA carried out interviews, which have been analysed by AH, AFW and CA. AH wrote the manuscript which all co-authors commented upon. All authors learn and authorised the ultimate manuscript.
This text is printed underneath license to BioMed Central Ltd. That is an Open Entry article distributed underneath the phrases of the Artistic Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which allows unrestricted use, distribution, and replica in any medium, supplied the unique work is correctly credited.
Reprints and permissions
Hammarström, A., Wiklund, A.F., Lindahl, B. et al. Experiences of limitations and facilitators to weight-loss in a weight loss plan intervention – a qualitative research of girls in Northern Sweden. BMC Ladies’s Well being 14, 59 (2014). https://doi.org/10.1186/1472-6874-14-59
Download citation
Acquired:
Accepted:
Revealed:
DOI: https://doi.org/10.1186/1472-6874-14-59
Anybody you share the next hyperlink with will have the ability to learn this content material:
Sorry, a shareable hyperlink isn’t at the moment accessible for this text.
Supplied by the Springer Nature SharedIt content-sharing initiative
Commercial
ISSN: 1472-6874
Through the use of this web site, you comply with our Terms and Conditions, Your US state privacy rights, Privacy statement and Cookies coverage. Your privacy choices/Manage cookies we use within the desire centre.
© 2024 BioMed Central Ltd until in any other case acknowledged. A part of Springer Nature.
