Journal of Human Nutrition and Dietetics
PUBLIC HEALTH NUTRITION AND EPIDEMILOGY Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration C. J. Metzgar,1 A. G. Preston,2 D. L. Miller2 & S. M. Nickols-Richardson1 1
Department of Food Science and Human Nutrition, The University of Illinois, Urbana-Champaign, Urbana, IL, USA, The Hershey Company, Hershey, PA, USA
2
Keywords qualitative study, weight loss, weight loss maintenance, women. Correspondence S. M. Nickols-Richardson, Department of Food Science and Human Nutrition, The University of Illinois, 260A Bevier Hall, 905 S. Goodwin, Urbana, IL 61801, USA. Tel.: +1 217 244 4498 Fax: +1 217 265 0925 E-mail: [email protected] How to cite this article Metzgar C.J., Preston A.G., Miller D.L. & Nickols-Richardson S.M. (2015) Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration. J Hum Nutr Diet. 28, 593–603 doi:10.1111/jhn.12273 This is an open access article under the terms of the Creative Commons AttributionNonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is noncommercial and no modifications or adaptations are made.
Abstract Background: The present study aimed to explore facilitators and barriers to weight loss (WL) and weight loss maintenance (WLM) in women who participated in a primary, 18-week comparative trial that promoted WL with an energy-restricted diet. Methods: Twenty-three women participated in seven focus groups conducted by a moderator and co-facilitator using open-ended questions and probes. Focus groups were held in a private room and audio tape-recorded. Tapes were transcribed verbatim and thematic analysis was used to evaluate transcripts for common themes. Results: Accountability to others, social support, planning ahead, awareness and mindfulness of food choices, basic nutrition education, portion control, exercise, and self-motivation were perceived as key facilitators for WL and WLM by women. Identified barriers included life transitions, health status changes, internal factors, environmental pressures, lack of accountability and an absence of social support. Conclusions: Future interventions should address these salient facilitators and barriers to promote sustainable changes in women across their WL and WLM journeys.
Introduction Following weight loss (WL) success, weight loss maintenance (WLM) remains a challenge (Stunkard & McLarenHume, 1959; Lyznicki et al., 2001; Stevens et al., 2006). Dietary programmes and related interventions that produce WL in the short term rarely promote WLM over the long term (Jeffery et al., 2000). Indeed, approximately half of any weight lost is regained within 1 year, and most individuals return to their baseline weight within 3–5 years (Goodrick et al., 1996; Jeffery et al., 2000; Byrne et al., 2003). Although interventions and programmes provide strategies for short-term WL, few include WLM strategies, which may differ from those used to achieve WL (Byrne et al.,
2003; Reyes et al., 2012). Additionally, studies examining effective long-term WL strategies (Klem et al., 1997; Jeffery et al., 2000; Ogden, 2000; Elfhag & Rossner, 2005; Wing & Phelan, 2005; Wing et al., 2006; Svetkey et al., 2008; Burke et al., 2011) have not always captured the subtleties of WLM that can only be uniquely described by individuals engaging in such efforts (Kayman et al., 1990; Byrne et al., 2003; Barnes et al., 2007; Reyes et al., 2012). The National Weight Control Registry, with over 10 000 members, is the largest database of individuals successful at long-term WLM (Wing & Phelan, 2005). To be eligible to join the National Weight Control Registry, individuals must have maintained a WL of ≥13.6 kg (≥30 lbs) for ≥1 year. Behavioural and psychological characteristics as well as
ª 2014 Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association
593
C. J. Metzgar et al.
Weight loss and maintenance: a qualitative study
WLM strategies of National Weight Control Registry members have been prospectively investigated using detailed questionnaires and follow-up surveys. Six key strategies for WLM have been identified and include: engaging in high levels of physical activity; consuming a diet low in energy and fat; eating breakfast; maintaining a consistent eating pattern; self-monitoring of weight on a frequent basis; and reversing slight weight regains quickly (Wing & Phelan, 2005). These behaviours do not fully reflect the cognitive and emotional aspects of WLM strategies or real and perceived structural support systems that influence WLM success. Additionally, National Weight Control Registry members each have their own WL journey to long-term WLM. Strategies for and barriers and facilitators to WL and WLM need to be examined further in groups of individuals who have undergone the same WL intervention. The purpose of the present qualitative study was to use focus groups to explore facilitators and barriers to WL and WLM in women who previously participated in a randomised comparative trial that promoted WL using an energy-restricted diet (Nickols-Richardson et al., 2014) and to capture insights into their perceptions regarding WL during and WLM following completion of a single intervention. No hypotheses were established a priori because an inductive approach was used to analyse data.
active, eumenorrheic, with a self-reported stable body weight, who scored
PUBLIC HEALTH NUTRITION AND EPIDEMILOGY Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration C. J. Metzgar,1 A. G. Preston,2 D. L. Miller2 & S. M. Nickols-Richardson1 1
Department of Food Science and Human Nutrition, The University of Illinois, Urbana-Champaign, Urbana, IL, USA, The Hershey Company, Hershey, PA, USA
2
Keywords qualitative study, weight loss, weight loss maintenance, women. Correspondence S. M. Nickols-Richardson, Department of Food Science and Human Nutrition, The University of Illinois, 260A Bevier Hall, 905 S. Goodwin, Urbana, IL 61801, USA. Tel.: +1 217 244 4498 Fax: +1 217 265 0925 E-mail: [email protected] How to cite this article Metzgar C.J., Preston A.G., Miller D.L. & Nickols-Richardson S.M. (2015) Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration. J Hum Nutr Diet. 28, 593–603 doi:10.1111/jhn.12273 This is an open access article under the terms of the Creative Commons AttributionNonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is noncommercial and no modifications or adaptations are made.
Abstract Background: The present study aimed to explore facilitators and barriers to weight loss (WL) and weight loss maintenance (WLM) in women who participated in a primary, 18-week comparative trial that promoted WL with an energy-restricted diet. Methods: Twenty-three women participated in seven focus groups conducted by a moderator and co-facilitator using open-ended questions and probes. Focus groups were held in a private room and audio tape-recorded. Tapes were transcribed verbatim and thematic analysis was used to evaluate transcripts for common themes. Results: Accountability to others, social support, planning ahead, awareness and mindfulness of food choices, basic nutrition education, portion control, exercise, and self-motivation were perceived as key facilitators for WL and WLM by women. Identified barriers included life transitions, health status changes, internal factors, environmental pressures, lack of accountability and an absence of social support. Conclusions: Future interventions should address these salient facilitators and barriers to promote sustainable changes in women across their WL and WLM journeys.
Introduction Following weight loss (WL) success, weight loss maintenance (WLM) remains a challenge (Stunkard & McLarenHume, 1959; Lyznicki et al., 2001; Stevens et al., 2006). Dietary programmes and related interventions that produce WL in the short term rarely promote WLM over the long term (Jeffery et al., 2000). Indeed, approximately half of any weight lost is regained within 1 year, and most individuals return to their baseline weight within 3–5 years (Goodrick et al., 1996; Jeffery et al., 2000; Byrne et al., 2003). Although interventions and programmes provide strategies for short-term WL, few include WLM strategies, which may differ from those used to achieve WL (Byrne et al.,
2003; Reyes et al., 2012). Additionally, studies examining effective long-term WL strategies (Klem et al., 1997; Jeffery et al., 2000; Ogden, 2000; Elfhag & Rossner, 2005; Wing & Phelan, 2005; Wing et al., 2006; Svetkey et al., 2008; Burke et al., 2011) have not always captured the subtleties of WLM that can only be uniquely described by individuals engaging in such efforts (Kayman et al., 1990; Byrne et al., 2003; Barnes et al., 2007; Reyes et al., 2012). The National Weight Control Registry, with over 10 000 members, is the largest database of individuals successful at long-term WLM (Wing & Phelan, 2005). To be eligible to join the National Weight Control Registry, individuals must have maintained a WL of ≥13.6 kg (≥30 lbs) for ≥1 year. Behavioural and psychological characteristics as well as
ª 2014 Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association
593
C. J. Metzgar et al.
Weight loss and maintenance: a qualitative study
WLM strategies of National Weight Control Registry members have been prospectively investigated using detailed questionnaires and follow-up surveys. Six key strategies for WLM have been identified and include: engaging in high levels of physical activity; consuming a diet low in energy and fat; eating breakfast; maintaining a consistent eating pattern; self-monitoring of weight on a frequent basis; and reversing slight weight regains quickly (Wing & Phelan, 2005). These behaviours do not fully reflect the cognitive and emotional aspects of WLM strategies or real and perceived structural support systems that influence WLM success. Additionally, National Weight Control Registry members each have their own WL journey to long-term WLM. Strategies for and barriers and facilitators to WL and WLM need to be examined further in groups of individuals who have undergone the same WL intervention. The purpose of the present qualitative study was to use focus groups to explore facilitators and barriers to WL and WLM in women who previously participated in a randomised comparative trial that promoted WL using an energy-restricted diet (Nickols-Richardson et al., 2014) and to capture insights into their perceptions regarding WL during and WLM following completion of a single intervention. No hypotheses were established a priori because an inductive approach was used to analyse data.
active, eumenorrheic, with a self-reported stable body weight, who scored
