Ambivalence and obesity stigma in decisions about weight management: A qualitative study

Abstract

Background: Many adults do not take up weight\rmanagement interventions even after apparently deciding to do so. Further\rresearch about decision making prior to the intervention would be useful.\rThis paper presents a qualitative study exploring\rthe process of decision making and the influences of obesity stigma. Methods:\rA pragmatic qualitative methodology, conducting indepth interviews with 52\rparticipants all with BMI > 30 kg/m2 and experience of efforts at\rweight management. Equal numbers of men and women with mean age 56.9 years\rcompleted interviews. Inductive analyses\rproceeded through systematic steps over a series of iterations. Findings:\rDecision making is difficult in the context of\ron-going mixed feelings over a long time. Thoughts and feelings become ingrained with habits and it is\rhard to separate out what is needed to think\rthrough a good decision. Thinking about weight brings a large volume of\rthoughts and feelings and apparent options or action choices. The volume of\rthoughts makes decisions difficult but, in the context of obesity stigma,\rmany of the thoughts are negative. A variable sensitivity to these stigma-related\rthoughts adds further ambivalence and inhibition for taking deciions. The\rneed for further thinking does not stand out in the context of the emotional resolving of thoughts about personal responsibility arising from obesity stigma.\rConclusions: Obesity stigma contributes to a deeper ambivalence in the decision\rprocess and hence difficulty in decision making about weight management. Decision\raid interventions and training of health care staff in communication skills for\rshared decision making are needed.