title: A qualitative evidence synthesis on the management of male obesity.
abstract: OBJECTIVE
  To investigate what weight management interventions work for men, with which men, and under what circumstances.
  
  
  METHODS
  Realist synthesis of qualitative studies.
  
  
  METHODS
  Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches.
  
  
  METHODS
  Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m(2) in all settings.
  
  
  RESULTS
  22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had 'worked' for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled 'obese'; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design.
  
  
  CONCLUSIONS
  Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition.
authors.affiliation: Scottish Collaboration for Public Health Research & Policy (SCPHRP), University of Edinburgh, Edinburgh, Lothian, UK.
authors.forename: Daryll
authors.initials: D
authors.lastname: Archibald
authors.affiliation: Rowett Institute of Health and Nutrition, University of Aberdeen, Medical School, Aberdeen, UK.
authors.forename: Flora
authors.initials: F
authors.lastname: Douglas
authors.affiliation: NMAHP Research Unit, Unit 13 Scion House, University of Stirling, Stirling University Innovation Park, Stirling, UK.
authors.forename: Pat
authors.identifier: http://orcid.org/0000-0002-4372-9681
authors.initials: P
authors.lastname: Hoddinott
authors.affiliation: Maternal & Perinatal Health Faculty of Health & Social Sciences, Centre for Midwifery, Christchurch Road Bournemouth University, Bournemouth, UK.
authors.forename: Edwin
authors.initials: E
authors.lastname: van Teijlingen
authors.affiliation: Cochrane Incontinence Review Group, University of Aberdeen, Aberdeen, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Stewart
authors.affiliation: Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Health Economics Research Unit (HERU) and Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK.
authors.forename: Dwayne
authors.initials: D
authors.lastname: Boyers
authors.affiliation: Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Avenell
mesh_terms: D015992:Body Mass Index; D019468:Disease Management; D006801:Humans; D008019:Life Style; D008297:Male; D009765:Obesity / Q000628:therapy*; D010349:Patient Compliance; D036301:Qualitative Research
keywords: Behavioural Change; Men; Systematic Reviews; Weight management