Weight maintenance as a tightrope walk
A model representing the main findings was constructed based on the informants' stories and the descriptions of attitudes, behaviors and strategies important for weight maintenance, (Figure 3). Weight maintenance was interpreted as a balancing act between different things in life that can be illustrated as a "tightrope walk". How well individuals manage the tightrope walk, i.e. how easy or difficult it is for them to maintain their weight, is influenced by three factors:
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1)
Their prerequisites for maintaining weight.
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2)
Their mental preparedness to maintain or change weight.
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3)
The actions needed on their side to maintain weight.
Factor 1 and 2 are in the model illustrated as four types of ropes that differ in length, width and tightness. The shorter, wider and tighter the rope is, the easier it is to keep the balance, i.e. to maintain weight.
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a)
The length of the rope symbolizes an individual's hereditary prerequisites for weight maintenance. The prerequisites could be inherited either biologically or socially.
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b)
The width of the rope symbolizes prerequisites in terms of the support an individual needs or can access in order to maintain weight.
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c)
The tightness of the rope symbolizes the mental preparedness an individual needs or has to maintain or change weight. This could be linked to the satisfaction individuals have with their weights. The lower the satisfaction, the higher the preparedness is to do something about their weight.
Factor 3 in the model is illustrated as four main strategies that are each needed to be able to walk along the rope (one for each rope), e.g. "to rely on heritage" (Figure 3). Connected to each main strategy are two or three ideal types that illustrate the way and extent to which the main strategies are being used. Grey boxes in the model represent ideal types mainly using food habits in connection to the main strategy as a way to maintain weight. Black boxes represent ideal types that mainly use physical activity. The extent to which the ideal type is using the main strategy is described by the ideal types being put on axes, falling from partly to fully.
The findings are presented below with headings and sub-headings indicating the main strategies and their connected ideal types as described by the model (Figure 3). Quotations from the interviews are given to illustrate how the interpretations are grounded in data.
To rely on heritage
This main strategy is implemented when walking along on a short, wide, and tight rope. This makes it easy for the individuals walking along this rope to maintain their weight. The rope is short since the individuals have strong hereditary prerequisites for weight maintenance and wide since they need almost no support to do so. The rope is tight because little mental preparedness is needed since they are satisfied with their weight and able to rely on their heritage to maintain weight. This main strategy is captured in two ideal types.
The unstructured eater
The main strategy "to rely on heritage" is used to a full extent by "the unstructured eater", because it is able to lean on the genetic factors for weight maintenance and has almost no need for mental preparedness or actions.
The informants who contributed to this ideal type described living a hectic life. They ate differently from day to day, without thinking about nutritional value or meal pattern, according to their own needs, and without being affected by the family's food habits. They described themselves as having "strong genes" for weight maintenance that enabled them to have this kind of eating pattern without gaining or losing weight.
"Food habits...well that varies quite a lot...It is not the same at all...How does it look? Where am I? Will I be home in time for dinner with them (the family), or do I have to eat at a restaurant?...If I eat breakfast, then I have to have lunch. If I do not have any breakfast then I can be without food until ten in the evening."
Man, aged 40
The habitual eater
This ideal type relies mainly on a social heritage. A heritage of solid food habits that are grounded in childhood facilitates the tightrope walk. However, this ideal type does not only lean on hereditary factors but also takes responsibility by using mental preparedness to change habits if necessary. The main strategy is therefore only partially used and the balancing act to maintain weight demands some effort.
The informants associated with this ideal type described eating similar food and having approximately the same amount of food every day. They were comfortable with consistent food habits and did not feel any need for weekend treats. They did not like too much sweet or fat food and would rather reward themselves by reading a book or taking a walk than by eating food. These individuals felt directly if a meal had been missed by getting symptoms of tiredness or irritation.
To find the joy
This main strategy is implemented when walking along a relatively short rope since the individuals neither have strong heredity for weight gain, nor strong hereditary prerequisites for weight maintenance. The rope is relatively wide since they need rather little social support. When they need support, they most often obtain it by meeting friends and family when doing weight maintaining activities. The rope is relatively tight since the individuals using this main strategy both need and have a mental preparedness to maintain weight. The way to maintain weight is to find and keep joy in different life choices.
The enjoyment seeker
The main strategy "to find the joy" is used to a full extent by "the enjoyment seeker". Only activities that provide joy and lust are chosen, instead of feeling pressured to be active in a certain way or to a certain extent. Balance between having no concerns and major concerns about weight are kept by constantly making choices that aim at weight maintenance rather than weight loss.
The informants resembling this ideal type described themselves as being able to maintain weight by resting and rewarding themselves with physical activity. Outdoor activities and physical activity had been a part of their lives since childhood and came naturally. Exercise for them was a spur to keep the body on the right path and not something primarily needed to obtain a certain weight.
The competing athlete
This ideal type uses the main strategy to a full extent since testing limits is seen as a joyful way to be physically active and not as a must. Weight is maintained by balancing, not pushing the body at all, but constantly testing the limits of the body with regards to physical capacity. This ideal type finds joy by balancing time being physically active and time being with friends and family. Physical activity is seen as a social event where one can do both.
The informants contributing to this ideal type described themselves as experiencing joy, curiosity, interest and having an urge for physical activity. New sports and extreme sport were mixed with team sports. Physical activity was seen as an engine for social relationships, even if they did not necessarily need company to be physically active.
The holistic eater
This ideal type partially uses the main strategy. Food and other pleasures are chosen to provide lust and joy, but not to an extent that is harmful for the body. The food that is chosen should provide something good for the body, both in terms of pleasure and nutrition. This means that you are allowed to have one glass of wine or to eat food high in calories at some occasions but not in excessive amounts.
The informants contributing to this ideal type described themselves as gourmets wanting food to be well prepared, tasteful, but also healthy in order to be worth to be eaten. They often chose fair-trade and locally produced products and preferred to cook food based from unprocessed products without too many additives. They were well aware of different food alarms discussed in society such as media's focus on the risk of having Mad Cow's disease when eating meat. These individuals had a holistic rather than a biomedical view on health.
"And I think about what is good for the body, and I like the feeling when I am able to give the body something that I know is good for it... And I like to... even when I eat a lot, I enjoy it because then I am giving the body something that it needs. I would not be able to drink very much alcohol, because then I would feel that I harmed my body."
Woman, aged 50
The balance between having no concerns and major concerns about the weight was for the individuals contributing to this ideal type kept by being reflective without being worried about their weight and aiming at body acceptance. With regards to appearance, many of the women in this study expressed a view of body acceptance similar to "the holistic eater" and were generally proud of how they looked, being more concerned with their well-being than their appearance. Men more often expressed developing an increased concern about both appearance and health.
To find the routine
This main strategy is implemented as walking along a relatively long rope representing rather weak hereditary prerequisites for weight maintenance. Those who use this strategy may have distanced themselves from the habits of their social heritage. The rope is relatively thin because those using this strategy focus more on support of their significant others than that they themselves have support. They also want and have their significant others relying on them for support. The rope is not too thin since they have some support to lean on when it is needed. The rope is relatively loose since more mental preparedness is needed and used to maintain weight. These individuals have a lower satisfaction with their weight and they put a lot of effort into making their wish to maintain weight applicable in everyday life.
The family pleaser
This ideal type balances taking care of oneself and taking care of significant others. The main strategy is used partially by having a routine of choosing the same food as the significant others but constantly eating smaller portions. Eating traditional food from childhood but using low fat and low sugar products is also an important characteristic. This ideal type has a routine of planning food intake by making weekly menus and doing weekly grocery shopping.
The informants contributing to this ideal type described that it was important for them to balance the needs of family members with their own aspiration to eat healthy and maintain weight. They expressed that having children is helpful in finding routines. Food, especially dinner, was seen as something more than nutrition and something that gathers and keeps the family together. They were cautious not to let their own efforts to maintain weight create food anxiety or pressure for weight maintenance among their children. Instead they tried to be good role models by eating healthy.
The daily exerciser
This ideal type also balances between personal needs and those of significant others, but instead balances between time to be with significant others and time to be physically active. The balance is kept by finding time for daily exercise. Weight maintenance is obtained by continuing present levels of physical activity but being reflexive enough to change the activity if weight gain occurs.
An example of finding time for daily exercise without taking time away from significant others was to be physically active when traveling to and from work, during lunch breaks, when the children were at activities, and to always use the stairs instead of elevators. The informants associated with this ideal type were used to working with their bodies from early childhood and therefore also enjoyed physical household work. The goal for them was to maintain mobility as long as possible rather than to have a certain weight.
"I take the bike to work every day. I have some kind of basic movement, I think at least... I mean, if one would go by car everyday then maybe I would be a bit heavier; that I actually believe. But, it does not feel that that is why I am doing it, but it is more because I feel that it makes me feel well. You get more out of the day... It feels like I have a routine, and I do not feel any resistance just because the rain is pouring down, then you just put on more clothes."
Man, aged 40
The weekend celebrator
This ideal type uses the main strategy to the full extent, and maintains weight by having a weekly routine with very strict and nutritious meals during weekdays but energy dense meals during weekends. This is the only ideal type that has prohibited food items during weekdays (the unhealthy food items) as a strategy for maintaining weight. This ideal type expresses major concerns about weight and is affected by the thin body ideal, a common ideal of beauty for women in Western societies.
The informants contributing to this ideal type carefully reflected on their eating habits on a daily basis. They also monitored their weight frequently. However, they let go of this control during weekends and saw weekend treats as necessary to stay motivated to keep a strict schedule during the weekdays.
As described earlier, the female informants were largely satisfied with their appearance. However, there were also women that contributed to the "weekend celebrator" that were clearly affected by a thin body ideal. They felt that there was a greater demand on them to maintain weight compared to men in general, and also that women are more often disappointed if they are not successful in weight maintenance. They also expressed that the demands on men to take care of their appearance has become stronger and that the gender difference seems to be decreasing. Similarly, men described that the demands on them have become stronger, but that women still have higher demands on their appearance reflected openly in commercials and advertisements and subtly in coffee room talks and among friends. Both women and men believed that the demands on appearance were decreasing as they aged.
To be in control
This main strategy is implemented as walking along a long, thin, and loose rope. The rope is long because of weak hereditary prerequisites. The individuals walking this rope come from families with poor food habits, lack of physical activity, or have a genetic inheritance that is believed to cause overweight, obesity and disease. The rope is thin since social support in earlier years was weak and these individuals take a lot of personal responsibility. They do not want to rely on others to maintain weight. The rope is loose because considerable mental preparedness is needed and used to maintain weight. The main strategy "to be in control" is used to a full extent by all three ideal types even though the control is expressed in different ways.
The emotion releaser
This ideal type keeps control of stress and negative emotions by performing activities that give an outlet to stress and emotions. The wish to have control also applies to weight. The balancing act between having no control and having too much control is sometimes very difficult.
The informants described exercise, preferably running, as a way of releasing emotions. They used exercise to gather their thoughts and to decrease stress levels. Some of the informants described having personal difficulties and seeing physical activity as a therapeutic tool to release tension and anger.
"During the divorce, I danced. I said 'I am going out and dance away all the garbage'... It is much about being able to work things out. Dancing makes me feel good."
Woman, aged 50
The health concerned eater
This ideal type maintains weight by balancing between eating nutritious and/or tasteful food and taking care of oneself versus others. The main strategy aims to take control over food intake in order to improve or maintain health. This control applies to both weight and health. Therefore the balancing is in choosing food that is nutritious and almost never letting go of control of the situation.
These informants described choosing food alternatives that aim to optimize health. The informants contributing to the "the health concerned eater" were very health conscious and well-read. By acquiring knowledge on food and diseases they felt as if they had more control of their own health. For these individuals, the joy of eating and the enjoyable sensations of food were not a priority.
The health concerned exerciser
This ideal type implements the main strategy for the same reason as "the health concerned eater" but uses physical activity to maintain weight and health and makes choices towards the controlling side. The risk of allowing the need for control to take over is that the pressure to maintain weight and health could affect health negatively. Together with "the health concerned eater", this ideal type needs most effort to ensure weight maintenance. Their interest in maintaining health most often arose from having personal or family experiences of a disease caused by unhealthy eating habits or physical activity patterns.
The informants associated with this ideal type had a great knowledge about what is useful exercise and combined daily exercise with other types of physical and specific gym activities.
"My two older siblings have diabetes and that often occurs with weight gain that is its debut. So I try to maintain my weight, partly because I do not want to have diabetes, and we have that with maintaining the bone mass and the mobility."
Woman, aged 50