Abstract
BackgroundEvidence-based behavioral weight loss interventions are under-utilized. To inform efforts to increase uptake of these interventions, it is important to understand the perspectives of adults with obesity regarding barriers and facilitators of weight loss intervention initiation.MethodsWe conducted a qualitative study in adults with obesity who had recently attempted weight loss either with assistance from an evidence-based behavioral intervention (intervention initiators) or without use of a formal intervention (intervention non-initiators). We recruited primary care patients, members of a commercial weight loss program, and members of a Veterans Affairs weight loss program. Intervention initiators and non-initiators were interviewed separately using a semi-structured interview guide that asked participants about barriers and facilitators of weight loss intervention initiation. Conversations were audio-recorded and transcribed. Data were analyzed with qualitative content analysis. Two researchers used open coding to generate the code book on a subset of transcripts and a single researcher coded remaining transcripts. Codes were combined into subthemes, which were combined in to higher order themes. Intervention initiators and non-initiators were compared.ResultsWe conducted three focus groups with participants who had initiated interventions (n = 26) and three focus groups (n = 24) and 8 individual interviews with participants who had not initiated interventions. Intervention initiators and non-initiators were, respectively, 65% and 37.5% white, 62% and 63% female, mean age of 55 and 54 years old, and mean BMI of 34 kg/m2. Three themes were identified. One theme was practical factors, with subthemes of reasonable cost and scheduling compatibility. A second theme was anticipated effectiveness of intervention, with subthemes of intervention content addressing individual needs; social aspects influencing effectiveness; and evaluating evidence of effectiveness. A third theme was anticipated pleasantness of intervention, with subthemes of social aspects influencing enjoyment; anticipated dietary and tracking prescriptions; and identity and self-reliance factors. Different perspectives were identified from intervention initiators and non-initiators.ConclusionsStrategies to engage individuals in evidence-based weight loss interventions can be developed using these results. Strategies could target individuals’ perceived barriers and benefits to initiating interventions, or could focus on refining interventions to appeal to more individuals.
Highlights
Evidence-based behavioral weight loss interventions are under-utilized
There is substantial literature focused on attrition from weight loss interventions [11, 12], this literature is of limited value for addressing intervention initiation because the factors that lead to intervention initiation may be different from those that lead to discontinuation
Participants Three intervention initiator groups were conducted with 24 total participants
Summary
Evidence-based behavioral weight loss interventions are under-utilized. To inform efforts to increase uptake of these interventions, it is important to understand the perspectives of adults with obesity regarding barriers and facilitators of weight loss intervention initiation. To increase initiation of evidence-based weight loss interventions among adults with obesity, facilitators of and barriers to initiating interventions must be identified. Rothman suggests that initiation of a health behavior is determined primarily by favorable expectations about outcomes of behavior change, whereas maintenance of behavior is determined by satisfaction with achieved outcomes [13] Another body of literature focuses on the facilitators of and barriers to engaging in the weight loss behaviors of dietary change and exercise (independent of intervention use). This literature is limited in its ability to address reasons for initiating weight loss interventions; joining a weight loss intervention involves many elements in addition to dietary change and exercise (e.g., group meetings, prescriptions to track food) and likely has distinctive barriers and benefits
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