Discussion
Participants in this research described weight loss and weight-loss maintenance as an omnipresent and on-going challenge. Weight loss appeared to be punctuated with successes and failures, and problems and difficulties were balanced and combated with behaviours and strategies that fostered adherence. The thematic framework (Fig.
1) demonstrates that the issues identified: dichotomous thinking, environments, social pressures and weight centeredness, were experienced as barriers to the participants’ weight-loss efforts, which at times stunted progress. By contrast, the facilitators: mindfulness, knowledge, exercise, structure, readiness to change, social support and self-monitoring, all assisted the participants’ weight-loss efforts, antagonistically. Some of these facilitators were meta-cognitive strategies (mindfulness), cognitive behavioural techniques (self-monitoring), motivational states (readiness to change), and environmental (social support) and educational (knowledge) strategies that participants experienced, developed or adapted to achieve their goals.
According to the theory of planned behaviour [
19], if the balance between perceived barriers and facilitators of a behaviour change is biased towards facilitators, then the likelihood of lasting behaviour change is greater than if more barriers are perceived than facilitators. The participants in this study identified more facilitators than barriers, possibly because four of the participants were in a weight-maintenance phase having already achieved and experienced weight loss, and that the rest of the participants were experiencing weight losses at the time of the interviews. Participants in this research, therefore, had or were achieving weight-loss success at the time of the interviews. According to social cognitive theory (SCT) [
20], the participant’s perceived/actual successes are likely to have increased their weight-loss self-efficacy, influencing the findings of this study [
20,
21]; within SCT a person with high self-efficacy for lifestyle change is more likely to identify facilitators of change than barriers to change [
20,
21]. Interestingly, Burke et al. [
22] and Hammarström et al. [
23] found strong emphases on barriers in their research (these studies explored the experiences of a self-monitoring intervention and the experiences of obese females aligned to an intervention study), perhaps because participants had failed in previous weight-loss attempts and possessed a lack of self-efficacy to achieve their weight-loss goals [
21]. Indeed, high self-efficacy appears to be associated with long-term, successful weight management [
1,
6], and has been linked to successful weight-loss and weight-loss maintenance in empirical research elsewhere [
24].
It is interesting to note that participants here articulated a mostly positive weight-loss experience, especially considering that large proportions of dieters are unsuccessful in achieving their weight-management goals [
5], and that the participants were not obtained from intervention research. Indeed, participants in this study self-initiated their weight loss endeavours, and so the experiences discussed in this research represent those obtained outside of an artificial research framework. It is possible, therefore, because participants self-initiated their weight management, that these participants possessed sufficient self-efficacy to develop the behaviours necessary to experience positive weight changes [
21]. Within SCT behaviours are learnt through observational learning and modelling [
20,
21]. Self-efficacy therefore can be enhanced by helping individuals learn and model new behaviours, or, by modifying unwanted behaviours by changing the reinforcements of that behaviour [
21]. Strategies that enhance an individual’s weight-loss self-efficacy, such as those highlighted above, might be an effective weight-loss treatment [
24].
Dichotomous/polarised thinking and behavioural patterns were an important experience encountered by each participant in this research. The literature recognises dichotomous/polarised thinking as a cognitive distortion where individuals view stark contrasts with no middle-ground, and is a thinking style linked to perfectionism and anxiety [
25]. Individuals with dichotomous thinking might interpret not achieving a weight-loss goal as evidence of absolute failure, and are less likely to maintain weight-loss-related behaviours due to a perceived lack of success [
25]. Rigid restraint is the concept that individuals possess overly restrictive eating habits and is an example of dichotomous/polarised thinking common to dieters [
1,
6,
25‐
27]. When self-imposed eating restrictions become compromised, rigid restraint might then promote disinhibited eating, negative emotions, feelings of failure and the desertion of weight-loss dieting [
27]. Participants in this research reported incidences of dichotomous thinking and rigid restraint, reflecting findings of similar research aligned to intervention studies [
8,
22,
23]. Participants in this research, however, suggested that mitigating rigid restraint (achieved via metacognitive strategies such as mindfulness) reduced dichotomous thinking and disinhibited eating episodes, and improved emotional wellbeing and adherence. Indeed, participants in this research articulated that successful weight loss could be a transformative experience, where newfound behaviours and lifestyles are developed and reinforced by changes to cognitions (mindfulness), behaviour (self-monitoring), and environments (social support), synergistically. Treatment strategies such as cognitive-behavioural therapy [
28] and mindfulness-based interventions [
29] might be useful tools to assist with the development of similar cognitive-behavioural changes, and foster improved weight loss for some individuals.
Environmental issues created problems for the group, and these ranged from work-related and lifestyle constraints, to the exposure to appetite-promoting stimuli in the home. Environmental stability appears to be important for long-term weight management [
6,
30], and participants suggested that when stability became compromised, through issues such as erratic working hours, travel, poor food availability and scheduling problems, that consistency to weight-loss behaviours became challenging. This reflects the theory of planned behaviour (TPB) [
19], where life circumstances outside of an individual’s perceived behavioural control might create difficulty achieving or maintaining a behaviour (such as weight-loss dieting), despite the presence of the intention to engage with the behaviour [
19]. Stressful life events were revealed to be particularly problematic by participants in this research, and stress-related and emotional eating episodes manifested from difficult life circumstances. Research elsewhere highlights similar findings [
10], and multiple sources of evidence indicate that successful dieters develop coping strategies that accommodate for difficult life circumstances [
1,
6‐
8,
10,
22,
23]. The ability to cope and successfully navigate difficult life events might therefore be an important factor in successful weight loss, regardless of the research context underpinning its observation [
6].
Social difficulties were encountered by all participants in this research. Losing weight fostered alienation for some, where newfound weight-loss behaviours alienated individuals from valued peer and friendship groups, particularly during social activities, reflecting research elsewhere [
7,
31]. Eating out led to the perception that participants needed to make eating decisions that lead to the consumption of non-diet foods, or risk alienation from their social groups. This led to some participants’ self-imposed social exclusion, which might be a common occurrence for some dieting individuals [
7,
31,
32]. Social eating and drinking also exposed participants to stigma, where participants felt judged while eating out, which then led to feelings of self-consciousness, exacerbating the (perceived) need for isolation further. Participants were vocal of the need to obtain social support to accommodate such issues and eliminate feelings of alienation, provide stability, and engender the perception of moral support. Social support was therefore sought from friends, family and spouses, and from work colleagues and slimming clubs, which reflects evidence elsewhere [
1,
6,
7,
26]. The perception of being supported appeared to be more important than the mode of support experienced however, which is complicit with evidence elsewhere [
7,
33]. However, spouses and family could also act as saboteurs to participants’ efforts, tempting them with forbidden foods, or eating forbidden foods in their presence, with little consideration to the participants’ challenges, emotions and motivations. Interestingly, these findings have also been reported elsewhere [
7,
34], and highlight that while significant others appear to play an important, facilitative role in dieting [
1,
6,
7], they can be destructive also. Further research might be needed to corroborate some of the findings of this study and further investigate social difficulties experienced while dieting, in particular the motives and mechanisms of conscious/unconscious spousal sabotage, which appeared to be particularly challenging for participants in this study, but might also be understated in the literature at this time [
7,
34].
Mindfulness was revealed to be a key facilitator of the participant’s efforts, which was a meta-cognitive transformation that engendered participants’ self-awareness, flexible restraint and self-regulation. Mindfulness, in this research, reflects Newman’s health as expanding consciousness theory, which suggests that lifestyle transformations occur through critical self-reflection and self-discovery, leading to an expanded consciousness, improved self-awareness, and greater self-control [
35]. Mindfulness might also reflect the heightened vigilance articulated by participants in similar research aligned to intervention studies [
7,
10,
36], where individuals experienced an intensified awareness of internal and external influences which challenge weight-loss consistency. While mindfulness was beneficial to participants’ efforts in this research, attentiveness to weight-loss behaviours could also be perceived negatively: careful decisions about eating and lifestyle had to be made and evaluated constantly, creating the perception of a weight-centred existence. The need to be constantly mindful and recommit to weight loss was therefore revealed to be emotionally challenging by some participants, especially in the presence of negative life events and difficult life circumstances. This is perhaps a novel and important finding of this research, and highlights that while attentiveness to weight loss was an important facilitator of success, this metacognitive strategy might be emotionally difficult to maintain, divorced from participants’ habituated cognitions and behaviours, and in some instances, promotes weight centeredness and obsessive behaviour towards achieving weight-loss goals. Indeed, weight centeredness reflected, and was the consequence of, an all-encompassing and difficult weight-loss journey.
Participants suggested that improving knowledge enhanced autonomy and led to informed decision making, assisting weight-loss efforts. Research elsewhere has found similar findings [
37], and increasing practical knowledge of food and recipes, and theoretical knowledge such as energy balance and nutrition, might assist weight-loss efforts, reflecting SCT and TPB [
19‐
21]. Within TPB, perceived behavioural control (which along with intention to engage with behaviour leads to the development of that behaviour) is analogous to self-efficacy [
19‐
21], is an individual’s confidence in their ability to perform/achieve a desired behaviour, and is influenced by resources and opportunities [
19]. Improving knowledge might enhance an individual’s perceived behavioural control by engendering the perception that they have greater knowledge to successfully undertake/complete the behaviour [
19]. Interestingly, one participant in this research articulated reservations about furthering their understanding of nutrition science as an aide to weight loss however. For this participant, understanding the scientific underpinning of nutrition depersonalised eating and led to confusion and exposure to conflicting information about appropriate dietary choices, conflicting with the hypothesis above.
Exercise was also found to play an important, beneficial and multi-faceted role in this research. Regular exercise reinforced dietary behaviours, was used as a tool to promote and enhance flexible restraint, and was a potent modifier of mood and self-esteem. Importantly, exercise appeared to enhance self-regulatory behaviours, which appears to be consistent with empirical data [
10]. Exercise also provided structure and routine, and becoming organised and developing structure was a formative experience that led to the perception of a greater internal locus of control, which was clearly articulated by participants here, and has been discussed in literature elsewhere [
1,
6,
26,
38,
39]. While exercise was discussed as being unequivocally beneficial by participants, exercise was also revealed to have appetite-promoting effects by some, making dietary compliance challenging at times. Indeed, empirical data indicates that exercise might have appetite-promoting or appetite-reducing effects depending on its mode and intensity [
40], supporting this observation. This is perhaps the first qualitative study that highlights exercise’s appetite-modifying effects within a naturalistic sample of participants engaged with weight-loss dieting, and might indicate that the prescription of exercise interventions within weight-loss contexts might need to be tailored towards its appetite-reducing effects for some individuals.
Self-monitoring appears to be widely associated with successful weight management [
1,
6,
22], was reported to be a facilitator of weight loss by participants in this research, and those in intervention-based experiential research elsewhere [
8,
22,
23]. Participants tracked dietary intakes using electronic tools and devices, but also monitored exercise data and valued qualitative assessments of wellbeing. Participants explained that they used smart phone apps to complete food and exercise diaries to collect and tabulate data that they could use to monitor and assess their progress. Monitoring and feedback appear to be important behaviour-change techniques [
41], and participants in this research made use of mobile technology and online tools to assist their utilisation for weight-loss purposes. For participants in this research, and those in similar studies elsewhere [
8,
22,
23], consistent self-monitoring appeared to be important aspect of a successful weight-loss experience. However, despite the broadly positive role articulated, some participants also explained that self-monitoring might also promote obsessiveness (about maintaining the behaviour), exacerbate dichotomous thinking (if results are not achieved in-line with expectations), and lead to weight-centeredness (if regular weighing and body measurements are the self-monitoring activities of choice), which were all unanimously described to be damaging by participants. Indeed, an important finding of this research is the need to mitigate the detrimental effects of the preceding factors, and that some of the techniques and strategies employed/developed by participants, such as self-monitoring and mindfulness, might exacerbate their effects in some contexts. This offers an important counterargument to the utilisation of such techniques as weight-loss interventions in some dieting individuals, and partially reflects Burke and colleagues findings that self-monitoring interventions might not be universally agreeable [
22], despite its widespread acclaim within literature [
1,
6‐
8,
36].
Study limitations
While weight loss was revealed to be a complex problem, where physical, environmental, social and behavioural factors disrupt and assist weight loss, the homogeneity of the sample necessitates that further research might be needed to gain a broader insight into the weight-loss experience. Indeed, participants were recruited to this study from local slimming clubs, gyms and health clubs, and through colleagues’ networks, using iterative sampling techniques. This mode of recruitment might have been insufficient to recruit participants from disadvantaged and black and minority ethnic backgrounds, who might not have access to these establishments. A lack of diversity within the sample might mean that information relevant to the experiences of all social and ethnic groups is not fully-represented in this study. The sample of this research was, however, sufficient to achieve data saturation, and this study therefore provides useful, in-depth information about living weight-loss experiences. Further research is required to explore the issues identified within this study in depth, and within wider social contexts.
Study strengths
This study explored real-life weight-loss experiences, as opposed to experiences captured within research environments. This study, therefore, offers information about the experiences of individuals who initiated and undertook weight loss in real-life contexts outside of a research framework, highlighting the barriers and facilitators that they experienced. The findings of this study offer new information about the weight-loss experience, and should serve as a catalyst for further investigation.