Ambivalence and obesity stigma in decisions about weight management: A qualitative study


Background: Many adults do not take up weight management interventions even after apparently deciding to do so. Further research about decision making prior to the intervention would be useful. This paper presents a qualitative study exploring the process of decision making and the influences of obesity stigma. Methods: A pragmatic qualitative methodology, conducting indepth interviews with 52 participants all with BMI > 30 kg/m2 and experience of efforts at weight management. Equal numbers of men and women with mean age 56.9 years completed interviews. Inductive analyses proceeded through systematic steps over a series of iterations. Findings: Decision making is difficult in the context of on-going mixed feelings over a long time. Thoughts and feelings become ingrained with habits and it is hard to separate out what is needed to think through a good decision. Thinking about weight brings a large volume of thoughts and feelings and apparent options or action choices. The volume of thoughts makes decisions difficult but, in the context of obesity stigma, many of the thoughts are negative. A variable sensitivity to these stigma-related thoughts adds further ambivalence and inhibition for taking deciions. The need for further thinking does not stand out in the context of the emotional resolving of thoughts about personal responsibility arising from obesity stigma. Conclusions: Obesity stigma contributes to a deeper ambivalence in the decision process and hence difficulty in decision making about weight management. Decision aid interventions and training of health care staff in communication skills for shared decision making are needed.

Share and Cite:

Brown, I. and McClimens, A. (2012) Ambivalence and obesity stigma in decisions about weight management: A qualitative study. Health, 4, 1562-1569. doi: 10.4236/health.2012.412A224.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organisation (2000) Obesity: Preventing and managing the global epidemic. WHO, Geneva.
[2] Hu, J. (2008) Obesity epidemiology. Oxford University Press, New York. doi:10.1093/acprof:oso/9780195312911.001.0001
[3] Foresight (2007) Tackling obesities: Future choices. Gov- ernment Of-fice for Science, London.
[4] US Department of Health and Human Services (2001) The surgeon-general’s call to action to prevent and de- crease overweight and obesity. US GPO, Washington.
[5] National Institutes of Health & NHLBI (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults—The evidence report. Obesity Research, 6, 1-209. doi:10.1002/j.1550-8528.1998.tb00681.x
[6] NHMRC (2003) Clinical practice guidelines for the ma- nagement of overweight and obesity in adults. National Health and Medical Research Council, Canberra.
[7] NICE (2006) Obesity: Guidance on the prevention, iden- tification, assessment and management of overweight and obesity in adults and children. National Institute for Hea- lth and Clinical Excellence, London.
[8] SIGN (2010) Management of obesity: A national clinical guideline. Scottish Intercollegiate Guidelines Network; Edinburgh.
[9] Douketis, J., Macie, C., Thabane, L. and Williamson, D. (2005) Systematic review of long-term weight loss stud- ies in obese adults: Clinical significance and applicability to clinical practice. International Journal of Obesity, 29, 1153-1167. doi:10.1038/sj.ijo.0802982
[10] Loveman, E., Frampton, G., Shepherd, J.P., Cooper, K., Bryant, J. and Welch, K. (2011) The clinical effectiveness and cost effectiveness of long-term weight management schemes for adults: A systematic review. Health Techno- logy Assessment, 15, 1-182.
[11] Karasu, S. and Karasu, T. (2010) The gravity of weight: A clinical guide to weight loss and maintenance. American Psychiatric Publishing, Washington.
[12] TOS Obesity as a Disease Writing Group (2008) Obesity as a disease. Obesity, 16, 161-177.
[13] Akabas, S., Lederman, S. and Moore, B. (2012) Textbook of obesity: Biological, psychological and cultural influ- ences. John Wiley & Sons, Chichester.
[14] Brownell, K., Puhl, R., Schwartz, M. and Rudd, L. (2005) Weight bias: Nature, consequences and remedies. Guil- ford Press, New York.
[15] Puhl, R. and Heuer, C. (2009) The stigma of obesity: A review and update. Obesity, 17, 941-964. doi:10.1038/oby.2008.636
[16] Sabin, J., Marini, M. and No-sek, B. (2012) Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One, 7, e48448. doi:10.1371/journal.pone.0048448
[17] Finley, C., Barlow, C. and Greenway, F. (2007) Retention rates and weight loss in a commercial weight loss pro- gram. International Journal of Obesity, 31, 292-298. doi:10.1038/sj.ijo.0803395
[18] Green, J. and Thorogood, N. (2009) Qualitative methods for health research. Sage, Lon-don.
[19] Ritchie, J. and Lewis, J. (2003) Qualitative research prac- tice. Sage, London.
[20] Mays, N. and Pope, C. (2000) Assessing quality in quail- tative research. British Medical Journal, 320, 50-52. doi:10.1136/bmj.320.7226.50
[21] The PLoS Medicine Editors (2007) Qualitative research: Understanding patients’ needs and experiences. PLoS Me- dicine, 4, 1283-1284.
[22] Relton, C., Bissell, P. and Smith, C. (2011) South York- shire Cohort: A “cohort trials facility” study of health and weight—Protocol for the recruitment phase. BMC Public Health, 11, 640. doi:10.1186/1471-2458-11-640
[23] Brown, I. and Gould, G. (2011) Decisions about weight management: A synthesis of qualitative studies of obesity. Clinical Obesity, 1, 99-109. doi:10.1111/j.1758-8111.2011.00020.x
[24] Psarou, K. and Brown, I. (2010) Patients’ experiences of prescribed anti-obesity drugs and perceptions of support from primary care: A qualitative study. Primary Health Care Research and Devel-opment, 11, 250-259. doi:10.1017/S1463423610000083
[25] Brown, I., Thompson, J., Tod, A. and Jones, G. (2006) Pri- mary care support for tackling obesity: qualitative study of the perceptions of obese patients. British Journal of Ge- neral Practice, 56, 666-672.
[26] Gibbs, G. (2002) Qualitative data analysis: Explorations with NVivo. Open University Press, Buckingham.
[27] Richie, J., Spencer, L. and O’Connor, W. (2003) Carrying out qualitative analysis. In: Richie, J. and Lewis, J. Eds., Qualitative Research Practice, Sage, London.
[28] Thomas, S.L., Hyde, J., Karunaratne, A., Herbert, D. and Komesaroff, P.A. (2008) Being “fat” in today’s world: A qualitative study of the lived experiences of people with obesity in Australia. Health Expectations, 11, 321-330. doi:10.1111/j.1369-7625.2008.00490.x
[29] Brown, I., Thompson, J. and Jones G. (2006) Obesity, sti- gma and quality of life. International Journal of Interdis- ciplinary Social Sciences, 1, 169-178.
[30] Granberg, E. (2006) “Is that all there is?” possible selves, self-change, and weight loss. Social Psychology Quar- terly, 69,109-126. doi:10.1177/019027250606900201
[31] Blixen, C., Singh, A. and Thacker, H. (2006) Values and beliefs about obesity and weight reduction among Afri- can-American and Caucasian women. Journal of Trans- cultural Nursing, 17, 290-297. doi:10.1177/1043659606288375
[32] Crocker, J., Cornwell, B. and Major, B. (1993) The stig- ma of overweight—Affective consequences of attributio- nal ambiguity. Journal of Personality and Social Psycho- logy, 64, 60-70. doi:10.1037/0022-3514.64.1.60
[33] Crandall, C. and Martinez, R. (1996) Culture, ideology and anti-fat attitudes. Personality and Social Psychology Bul- letin, 22, 1165-1176. doi:10.1177/01461672962211007
[34] Smith, E., Hay, P., Campbell, L. and Trollor, J. (2011) A review of the association between obesity and cognitive function across the lifespan: implications for novel ap- proaches to prevention and treatment. Obesity Reviews, 12, 740-755.
[35] Baronowski, T., Cullen, W., Nicklas, T., Thompson, D. and Baronowski, J. (2003) Are cur-rent health behavioural change models helpful in guiding pre-vention of weight gain efforts? Obesity Research, 11, S23-S43. doi:10.1038/oby.2003.222
[36] Prochaska, J. and Velicer, W. (1997) The transtheoretical model of health behaviour change. American Journal of Health Promotion, 12, 38-48. doi:10.4278/0890-1171-12.1.38
[37] West, R. (2005) Time for a change: Putting the Transtheo- retical (stages of change) model to rest. Addiction, 100, 1036-1039. doi:10.1111/j.1360-0443.2005.01139.x
[38] Ajzen, I. (1991) The theory of planned behaviour. Organi- zational Behavior and Human Decision Processes, 50, 179-211. doi:10.1016/0749-5978(91)90020-T
[39] Armitage, C. and Conner, M. (2001) Efficacy of the the- ory of planned behaviour. A meta-analytic review. British Journal of Social Psychology, 40, 471-499. doi:10.1348/014466601164939
[40] Puhl, R. and Brownell, K. (2006) Confronting and coping with weight stigma: An inves-tigation of overweight and obese adults. Obesity, 14, 1802-1815. doi:10.1038/oby.2006.208
[41] Brown, I. (2006) Nurses’ atti-tudes towards adult patients who are obese: Literature review. Journal of Advanced Nursing, 53, 221-232. doi:10.1111/j.1365-2648.2006.03718.x
[42] Ogden, J., Ban-dara, I., Cohen, H., Farmer, D., Hardie, J. and Minas, H. (2001) General practitioners’ and patients’ models of obesity: Whose problem is it? Patient Educa- tion & Counselling, 44, 227-233. doi:10.1016/S0738-3991(00)00192-0
[43] Wadden, T.A., An-derson, D.A., Foster, G.D., Bennett, A., Steinberg, C. and Sarwer, D.B. (2000) Obese women’s perceptions of their phy-sicians' weight management atti- tudes and practices. Archives of Family Medicine, 9, 854- 860. doi:10.1001/archfami.9.9.854
[44] Greiner, K.A., Born, W., Hall, S., Hou, Q., Kimminau, K.S. and Ahluwalia, J.S. (2008) Discussing weight with obese primary care patients: Physician and patient per- ceptions. Journal of General Intern Medicine, 23, 581- 587. doi:10.1007/s11606-008-0553-9
[45] Malterud, K. and Ulriksen, K. (2011) Obesity, stigma and responsibility in health care: A synthesis of qualitative studies. International Journal of Qualitative Stud Health Well-being, 6, e8404. doi:10.3402/qhw.v6i4.8404
[46] Brown, I. and Thompson, J. (2007) Primary care nurses’ attitudes, beliefs and own body size in relation to obesity management. Journal of Advanced Nursing, 60, 535-543. doi:10.1111/j.1365-2648.2007.04450.x
[47] Huisman, S., Maes, S., de Gucht, V., Chatrou, M. and Haak, H. (2010) Low goal ownership predicts drop-out from a weight intervention study in overweight patients with type 2 diabetes. International Journal of Behavioural Medicine, 17, 176-181. doi:10.1007/s12529-009-9071-3
[48] Edwards, A. and Elwyn, G., Eds. (2009) Shared decision- making in health care: Achieving evidence-based patient choice. 2nd Edition, Oxford University Press, Oxford.
[49] DaSilva, D. (2012) Helping people share decision making. The Health Founda-tion.
[50] Stacy, D., Bennett, C., Barry, M., Col, N., Eden, K.B., Holmes-Rovner, M. and Llewellyn-Thomas, H. (2011) Decision aids for people facing health treatment or scree- ning decisions. Cochrane Database of Systematic Reviews, 3.
[51] Rollnick, S., Miller, W. and Butler, C. (2008) Motivatio- nal interviewing in health care: Helping patients change Behaviour. Guildford Press, London.
[52] Silverman, J., Kurtz, S. and Draper, J. (2004) Skills for communicating with patients. Radcliffe Publishing, Lon- don.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.