Specialised fitness programs
Over half of participants (81, 57%) thought that tailored fitness programs were effective in supporting obese individuals to address their health and wellbeing. Men in particular thought these programs were effective in encouraging weight loss (24, 67%). Women spoke about the benefits of exercise in a more holistic way, saying that there were many health benefits of being fit and active - regardless of weight or size:
"I love [the gym]. So, for me, it's been very effective. From the point of view of the fact you can go there for three half hours a week, and it will make a difference, even just doing that." (Female, aged 42)
Participants felt that specialised fitness programs for obese adults and safe spaces (such as women only gyms) could help alleviate the stigma that made obese individuals "uncomfortable" and "self-conscious" when engaging in activity. Both women and men spoke about the importance of being in an environment where they felt emotionally secure and supported:
"They help because you feel more secure when you're in a group of women like there's not much judging." (Female, aged 26)
"Most overweight people are conscious about how they look in a gym." (Male, aged 36)
Some stated that current programs were ineffective because they did little to cater for special physical and emotional needs of people who were extremely overweight:
"Not effective for obese or morbidly obese people because often the equipment can't support their weight." (Male, aged 55)
Participants felt that this highlighted the urgent need for specialised programs for overweight individuals who wanted to improve their health and wellbeing.
Gastric banding surgery
Whilst a third of participants thought that gastric banding surgery was a long term, effective strategy for addressing obesity (44, 31%), most participants doubted the positive claims and marketing of the gastric banding industry and were cautious about its long term success. Some participants stating that the procedure had not been around long enough to make widespread claims about its effectiveness:
"I haven't heard of any research that is saying that it does help people to keep it off. I don't know whether it has been around long enough." (Female, aged 53)
Some participants had highly emotive responses to the use of gastric banding surgery. In particular they were concerned about the commercial marketing of the surgery, describing it as the commercial exploitation of an intervention that should only be reserved for individuals in desperate and acute need of medical intervention:
"Absolutely aghast! Somebody is making a lot of money out of this. It's either drug companies or bariatric surgeons." (Female, aged 58)
Individuals were also concerned about both the short and long term risks associated with the surgery:
"I think that's a really bad idea, seriously, seriously bad idea. The things I've been reading about gastric bypass surgery and lap bands and things, it's messing around with a perfectly good digestive system and there are deaths and permanent problems because of it." (Female, aged 36)
"To go into surgery where there was a risk that I could die, as an easy fix, sort of didn't sit well with me." (Female, aged 47)
Others had formed an opinion about the surgery's effectiveness based on the experiences of friends and family members who had had the surgery:
"I've had a friend who has just gone through it and when she explained the surgery and what went on I'm thinking how you can possibly be healthy after you've had that done." (Female, aged 32)
"Don't tell me that weight loss surgery is the way to do it, because I know lots of fat people who have had weight loss surgery and are still fat." (Female, aged 51)
Participants who thought gastric banding surgery was a positive intervention for obesity were generally those who were waiting to have the surgery. One participant described her own personal short term success with surgery - interestingly describing her weight loss achievement in commercial language:
"I've lost 17 kilo's now...I'm a walking advertisement for lap banding these days." (Female, aged 43)
The vast majority of participants were concerned about the mainstream use of this intervention in treating obesity:
"Medical interventions should be a last resort and lap banding it's been done like changing underpants at the moment." (Male, aged 55)
Participants were particularly concerned about the use of surgery for more vulnerable groups - such as teenagers and indigenous communities. Again, many of these opinions were based on their contact with others who had had the surgery:
"A friend of mine's son [had] that... He's seventeen and he lost tons of weight... but he now still eats like a teenager and then just vomits it up. Are they mentally equipped, emotionally equipped for what it means to them? It's the same idea of a quick fix now but what does it really do in the long run?" (Female, aged 39)
"Teenagers are still growing and you're giving them a medically induced eating disorder, and I don't think that that's a particularly good way to go." (Female, aged 36)
Some described the surgery as disempowering by attempting to enforce medical ideals of thinness on a diverse population. Others stated that resorting to this type of intervention meant that we had failed to help and support individuals appropriately:
"I think that the world is going mad, rather than actually looking at the causes... medicine is going mad for plastic surgery." (Female, aged 49)
"If that's what we're having to do for most people, then we've failed society. We haven't really done the right thing by everyone." (Male, aged 50)
Individuals were also concerned about the lack of complete information about the risks and benefits of the surgery. As such, they were cautious about making conclusions about the effectiveness of the surgery. Rather they felt that whilst this information was missing, it should only be considered as a last resort.
Commercial dieting
Only 26 participants (18%) thought that commercial dieting was an effective intervention for obese individuals. Participants' perceptions of the effectiveness of commercial diets were strongly influenced by their own experiences, often using themselves as a 'case study' to explain why dieting was ineffective. They characterised the dieting industry as "greedy", "a scam" and "a money making industry":
"As someone who's been there and done it, I know for a fact that it is a major advertising rip off." (Female, 46 years)
Ironically, many participants still said that they would turn to commercial dieting to help lose weight and improve their health. This was because they had very little other support available to them in trying to change their health and wellbeing.
Only a small number of participants thought that diets were effective for weight loss. Almost all of these individuals were currently on a diet or were a member of a diet club or support group. They tended to describe the effectiveness of the diet in the exact language used in the marketing of the diet: "it's an investment" and "Weight Watchers is not a diet; it's a lifestyle". It appeared that in some cases commercial diets were perceived to be successful because of the ongoing support that they provided - rather than the effectiveness of the diet itself. Participants often stated that whilst they were aware that the diet was ineffective, at least it provided an environment in which they could obtain help and support from other obese people:
"[It] keeps you in touch with people who are sort of going with you and motivating you and I think this is the point, it's the motivation that you need to keep going." (Female, aged 74)
Some participants thought that some commercial diets were better than others. In particular, participants trusted Weight Watchers more than other commercial diet companies due to their approach being more "genuine", "sensible" and health "promoting" than those of other diet companies.
Yet most participants distrusted the commercial marketing techniques of the diet industry, and in particular the seductive way in which they "lured" individuals back for repeat business. Many called for regulation of the diet industry:
"[Diets] will only work if you stay on them forever. They make more money by people returning over and over again, than their actual successful people." (Female, aged 53)
"They're a very short-term, quick fix answer... you put the weight back on and then you go back - that's how those companies make their money, on their repeat offenders." (Male, aged 48)
Some also described commercial diets as 'unsafe' because dieting enforced unhealthy eating behaviours and led to poor emotional health outcomes for some individuals. Some stated that diets - particularly those which provided pre-prepared meals - were disempowering because they did not create long term behaviour change:
"That's not empowering to take hold of your own life, that's giving you a whole heap of frozen crap that I wouldn't eat." (Female, aged 35)
A perceived lack of help and support appeared to encourage participants to turn to commercial dieting even though they seriously questioned their efficacy, safety and motive.