title: Decisions about weight management: a synthesis of qualitative studies of obesity.
abstract: There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions.
authors.affiliation: The Clover Practice Sheffield and Centre for Health and Social Research, Sheffield Hallam University, Sheffield UK;Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield UK.
authors.forename: I
authors.initials: I
authors.lastname: Brown
authors.forename: J
authors.initials: J
authors.lastname: Gould
keywords: Decision aids; obesity; qualitative research; systematic review