Perceived barriers and facilitators of initiation of behavioral weight loss interventions among adults with obesity: a qualitative study

Megan A McVay, William S Yancy Jr, Gary G Bennett, Seung-Hye Jung, Corrine I Voils, Megan A McVay, William S Yancy Jr, Gary G Bennett, Seung-Hye Jung, Corrine I Voils

Abstract

Background: 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.

Methods: We 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.

Results: We 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.

Conclusions: Strategies 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.

Keywords: Behavioral weight loss intervention; Intervention engagement; Intervention initiation; Qualitative research.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Duke University School of Medicine Institutional Review Board and Durham VA Institutional Review Board. All participants were ensured confidentiality and provided written consent to be in the study.

Consent for publication

Not applicable.

Competing interests

Gary Bennett holds equity in Scale Down, LLC and Coeus Health, LLC, serves on the scientific advisory board of Nutrisystem, is a member of the board of directors at Girl Trek, and is past president and a member of the board of directors at the Society of Behavioral Medicine. No other authors have conflicts to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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