Exploring the lived experience of obesity with people who have accessed NHS weight loss services

Abstract

Background: Weight stigma poses a significant risk to the physical and psychological health of obese people (Puhl et al., 2018). A range of literature highlights that people regularly experience shame, humiliation, and rejection because of their weight. People defined as obese (BMI 30kg/m²) see impacts on their identity, self-esteem, and mental health because of the internalisation of pervasive negative attitude to people classified as obese. Over the past number of years, we have seen increasing medicalisation of obesity. Currently, there is an on-going debate in the United Kingdom regarding whether obesity should be designated as a disease. While some argue that disease designation will reduce stigma and increase access to services (Widling, 2019), the British Psychological Society (BPS) suggest that obesity should be considered as arising as a result of a complex interplay of social, biological and psychological factors (BPS, 2019). People living with obesity must navigate these sometimes-conflicting ideas. This study seeks to explore the lived experience of obesity and the ways in which people who have accessed NHS weight loss services internalise and embody the dominant social ideas regarding obesity. Method: This study adopted a phenomenological epistemological position. Eight semi-structured interviews were completed (eight women aged 38-71) with people who had accessed NHS weight loss services. Results: Data was analysed using interpretative phenomenological analysis with a focus on the phenomenology of Merleau-Ponty and concepts of embodiment. Four key themes and eight sub-themes were identified. These include: The experience of a large body and the embodiment of the social construct of weight, making sense of weight gain, the social function of weight, and making sense of weight-based difficulties through dominant conceptualisations. Conclusion: Weight stigma can become internalised to an extent that it significantly influences obese peoples’ self-image and relationships. Obese people are acutely aware of the judgments that others make of them. They can feel that they fulfil a role in social groups, often holding others’ anxieties about control and body size. People with obesity make sense of their weight through life experiences and events, however, it can be difficult to express nuance in a society that sees obesity as a moral or medical issue. Different perspectives on the issue of obesity as a disease were expressed, however, there was a sense that disease designation could not adequately address the issue of weight stigma, which is the issue of utmost importance for participants in this study.