Within the three groups some interesting differences emerged in terms of attitudes, behaviours, strategies, resilience, emotional control, levels of family/social support and will power. The one thing which was consistent between the three groups was the desire or motivation to be slim, however only those in groups one and two had been able to fulfil this desire/motivation.
In our primary weight maintainers group weight maintenance was cited as an “absolute priority” in their lives driven by vanity and health in equal amounts. The size of their waist band was the main monitoring device for weight control. In other words if they felt the waist band on clothing getting tighter this signalled a time for action, prompted them to lower their calorie intake and increase their exercise regime for a few weeks until they were back fitting comfortably into their waist bands again. They would never allow themselves to buy a bigger clothes size. Neither fad diets, nor weighing scales were a feature in this group. They were passionate about food and seemed to have a very good relationship with food. Being slim was an integral part of their lives, and was driven by vanity, health and wanting to be a good parental role model. Willpower, balance, regulation, good emotional control, and resilience were strong themes emerging within this group. Organisation and planning were key to success. Food shopping had to be done regularly ensuring well stored cupboards, fridges and freezers. At home and at work almost all meals were planned in advance. Dining out was kept to an occasional treat rather than a routine. A pattern of strict dietary intake during week days emerged with more relaxed patterns of eating allowed at weekends with an acknowledgement that “treats” were necessary. Calories from alcohol were low with intakes during the week typically at zero with some intake allowed at weekends. Moderate and regular exercise featured strongly both for weight maintenance but also for the feel good factor and mental health. There was a good awareness of portion sizes and nutrient contents across the range of foodstuffs. Low fat foods did not feature amongst this group. Good family supports seemed to be an important element in facilitating these factors to come together.
In the group who had managed to sustain weight loss (group two) the participants identified a personalised approach that had worked for them and felt strongly regarding a “no one fit for all approach”. They spoke of having to find their own route that fitted with their particular lifestyle which illustrates the need for personalised support and advice tailored to the individual. Exercise had increased in frequency and intensity and portions sizes, planning and organisation had improved. In some cases support groups such as weight watchers had worked while others had make the transition alone. Family and peers at work were identified as being important in motivating and encouraging change and hence success. In this group there was an acknowledgement that the “battle was on-going” that there was pain involved and that a lifelong effort would be required. There would be no reverting to old habits. Reasons cited for being able to make the change included also vanity and health/health scares as well as landmark events such as getting married and having children. Perseverance was cited as key to success.
In group three there was an air of despondency with weight loss being almost a pre-occupation which never materialised. Most worried about their health long term but still could not change their behaviours. Vanity featured here also with the desire to fit into nicer clothes expressed. The cost implication of larger clothes was also alluded to. Some described self-loathing and low self esteem. Fluctuations in weight status were a lifelong feature. Disarray featured strongly in their lives as a whole and not just in relation to food. Lives were described as unstructured and lacking routine. Exercise was ad hoc and not sustained. Alcohol intakes were higher and seemed to be used as a comfort during times of despondency. Family support structures around childrearing was notably absent in this group making it harder to get time out to do shopping, prepare meals ahead or get space to exercise. Secret and guilt eating were a feature. Fad diets featured strongly with only short term weight loss achieved. Support groups such as weight watchers and slimming world featured strongly. Only one participant had ever consulted a dietician. Planning around food was absent, this seemed to result in this group skipping meals and eating later in the day and hence being more hungry and therefore consuming more than they would have done if they had planned ahead and had a meal to hand when they needed it. Skipping breakfast was also a feature. Participants reported binge eating and secret eating. Lack of will power and impulsivity were identified as problematic issues. Everybody in this group acknowledged that they eat too much, and that they didn’t exercise enough so a knowledge deficit does not seem to be a major issue. Critical time points when significant weight gain had occurred included pregnancy, marriage and times of emotional stress such as moving house, jobs and relationship breakups. The notion of rowing-back evident in group one did not feature in any sense in group three and there was a sense of their weight being totally out of control, as if there was nothing they could do about it. One subject likened it as to addiction similar to alcoholism. The idea of balance between calories consumed and expended did not emerge in any of the participants in group three. While all participants in this group cited weight loss as extremely important and desirable it was not prioritised in reality, nor in practice in their lives.
These results are discussed in more details in the next section under the main categories which emerged from the data.
Sub-theme: being prepared
Being prepared and organised in relation to food and exercise was cited as important by participants in group one. Significant time was devoted to preparing lunches, having the fridge full, preparing dinners and having the gym bag packed and in the car. Planning was described by group one as ‘essential’. Improved planning, organization and dietary changes in order to encourage and maintain weight loss were reported by group two. Increased planning and better organisation included bringing in lunch, better use of freezer, However, for group three there was little or no planning around meals and meal times with other family members were sporadic.
“I know I should plan and I want to plan but I never actually seem to succeed in tying it down”
The lack of planning and organization around food often lead to skipped meals and hunger reaching levels which resulted in double portions being consumed at the next sitting, or grabbing take away food or ready to eat meals on the way home in the car.
“..... if I haven’t planned which with the kids like they’re 8 and 10 and it’s mam this ma that, there’s hurling here and GAA there, and I’ve football there, and I’m dancing here, and I’m swimming there, and I’m everywhere. I’m working and I’m doing their homework and it’s all that tumbling down on top of you and you see you just grab whatever”
Sub-theme: implementing techniques
Quick fix strategies were implemented by group one if they felt they had put on a small amount of weight by cutting back on treats and increasing exercise.
“I decide OK cut back on the ice cream, the chocolate and the biscuits and maybe exercise a bit more”
Group two also cited several strategies that were put in place to encourage and promote weight loss. Strategies implemented by participants included: calorie counting applications on phones, checking portion sizes on a digital scales.
“and the only thing I really did was use an app on my iPhone, a calorie counter and I found it absolutely fantastic because it’s very easy to track what you eat”
Others spoke of reducing portion sizes, reducing meats, increasing fish, veg, fruit and brown foods, reducing alcohol intake and keeping an eye on weight after socializing in order to ‘row back’ quickly. The aspect of strategizing was not seen in group three.
New behaviours such as steering clear of certain aisles in supermarkets was mentioned by those in group two such as and realizing that the majority of food in supermarkets are not needed. One respondent spoke of now avoiding the majority of the aisles in a supermarket
‘I suddenly realized that 85 % of the stuff on the supermarket shelves you don’t actually need so I don’t go there’
Participants in group one discussed how healthy food choices are often automatic and poor food choices are not selected routinely. For some rules are put in place regarding food choices with fish and nuts high on the list of must have foods and foods high in fat kept to a minimum. Picking the healthy dish would be because of choice rather than because it was expected.
Participant’s ability to persevere with weight loss efforts in group two was referred to as a lifelong struggle and one that was painful at times. Poor eating habits were replaced with better choices and alcohol consumption reduced. Development of discipline and determination were cited as necessary leading to improved confidence.
“....determination, confidence and things become easier. Not sure why it’s easier, maybe because clothes start to fit better. It’s not a drama going out. Life is easier without the weight”
Although ‘set-backs’ were experienced amongst those in group two, there was a recognition of continuous, conscious effort was required to sustain change.
For some participants in group three however, there was a sense of being stuck and an inability to control actions around food intake. Comparisons were drawn with alcoholism for one participant, with secret and binge eating a common theme that occurred throughout the group.
“In a way I associate this almost similar to alcoholism it’s em.. sure now I don’t know but I would guess like an alcoholic in some part of their brains they know they shouldn’t be doing that or whatever somebody’s addicted to drugs it’s a another addiction as far as I’m concerned in some ways”
Some specifically described behaviours of hiding food packaging from partners to avoid detection of over eating or fear of recrimination for their food choices.
“I’d eat a bar of chocolate in secret and then hide the wrapper down the side of the sofa”
Willpower was strong in both groups one and two that included refusing food offered by others and weighing foods to ensure portion sizes are adhered. Being tired was cited as a reason for lack of willpower in group three, particularly in the evening times. For some not knowing why they could not restrict themselves was a source of frustration.
“I buy a bar of chocolate - I don't know why I do it. I have these conversations in my head - can't seem to stop”
Food is often seen as a reward, a treat for hard work or immediate gratification. Most participants advised that food was often consumed in excess due to lack of structure while poorer food choices were also made if a participant’s mood was low.
‘At the end of the day the ‘willpower is gone to pot’.
Sub-theme: regular exercise
All participants in group one reported undertaking exercise in a sustained and systematic way often exercising three to four times per week. Early mornings and afternoon breaks were utilized frequently in order to fit exercise in during the day. Group one participants reported an interest in exercise, considering it as something that makes you feel good, is important for mental health and is challenging.
“I would be interested in exercise, exercising itself and I suppose the competiveness side of it would attract so that would motivate me as well and then you’re challenging yourself to lose a bit of weight if you put it on”
Regular sustained exercise was introduced by all participants in group two to assist weight loss. However it was noted as important by all participants that each must find their own way to keep an interest and ensure its sustainability.
“finding your own way with regards to sport, for example a lot of people think oh I have to run or I have to gym no you have to find the thing that works your way”
In groups one and two, exercise was preferred if it was undertaken as a normal part of the day i.e. cycling to work or as a social activity. However in group three, exercise was sporadic, ad hoc and was not carried out in a sustained way.
“Never enjoyed exercise for its own sake - only as part of club or part of a normal day/social thing”
Theme: behavioural control
Weekday and weekend behaviours were implemented in group one who reported allowing themselves stricter guidelines during the week in order to have more relaxed rules at the weekend. Most participants in group one never allowed themselves to gain more than a small amount of weight before taking action to reverse it. This occurred in response to waist bands on clothes getting tighter and seeing themselves in photos looking heavier than they wanted to. This would lead to cutting out all junk foods and items such as butter, bread and cheese for a couple of weeks until they had lost the pounds gained. Weighing scales were not considered important for weight maintenance amongst most participants in group one who judged instead using clothing.
“I judge by my clothes, my waist which is what usually happens to me is that I put on my waistband and I say oh now ease off on some of my favourite creams and butter and desserts”.
Weekday and weekend behaviour also featured in group two with behaviours around food and alcohol considered good during the week allowing for slightly more relaxed rules at the weekend.
“another very big behavioural change was you mentioned alcohol and I told myself I’m not going to drink alcohol from Sunday to Thursday................. there’s no way I’m not going to have a drink you know. I was conscious of it and I knew that I was going to have some alcohol Friday and Saturday but I would try to make up for it for the rest of the week”
Keeping things in balance was important for weight loss according to group two also, who advised small ‘tweaks’ to the diet rather than big changes were undertaken by participants and it was agreed that this was necessary to keep things as normal as possible.
“Once life stays the same you can do it – trying to change too much would make you miserable”
In group three alcohol intakes were high and appeared to be used as a short term comfort. Trying to implement changes to immediately counteract excesses in diet or alcohol consumption did not feature in this group.
Theme: motivational influences
The motivations to maintain weight control in group one were diverse across the group with vanity considered a strong motivator.
“Vanity is definitely something with me too I don’t like when I see photographs of myself and I think oh, that does motivate me”
Vanity was also a motivational factor for participants in group two to make the changes necessary for weight loss often prompted by seeing themselves in photographs.
“I saw a couple of photographs of myself in my around then in the middle late 40’s and I was unhappy with that and eh that’s my memory”
Self-image featured in a very negative way amongst those in group three who had expressed feelings of disgust about how they looked and exhibited low self-esteem.
“I feel disgusted when I look in the mirror”
Being able to shop for and buy nice clothes was cited as a motivating factor for being slim amongst those in group one and two. Those in group three expressed dismay at not being able to fit into nice, inexpensive clothes and spoke of shopping and going out as a “drama”.
Sub-theme: major life events
Major life events such as getting married and having children were cited as strong motivational influences in group two which triggered weight loss
“so I was getting married so I wanted to get a few lbs down so I actually lost the weight”
Sub-theme: to maintain health
Health was considered on various grounds for all groups as a motivator. While for group one and two these factors often initiated change, for group three it remained a difficulty in turning this motivation into action.
“I think what motivates me primarily is I want to be a healthy person em…… I don’t want to suffer any illnesses now or later and there’s so many illnesses that are related to inactivity”
Other motivators amongst all groups included wanting to have energy and be able to play with their children, health scares/worries/family risk factors such as diabetes.
Sub-theme: support from family/colleagues/friends
Participants in group two particularly noted the psychological aspects of support as being key. Support was indicated by others undergoing weight loss or remarks made about appearance by colleagues/family and were regarded as having strong psychological aspects to weight loss success. Reading was also noted as an important support.
“Being around others going through something similar is such a key thing”
“the support from colleagues and friends this is kind of you know when people see you let’s say every week or every two weeks and they say you look great, you lost some weight you know and that’s very motivating as well”
Group three noted that lack of family support caused some difficulties for participants who were unable to make commitments to clubs or maintain schedules. For some lack of support made fitting meals around children difficult.
Weight development history and predisposition to maintain weight or to gain weight appeared to be captured within the groups. Most participants in group one felt they had always maintained their weight throughout their life only putting on a few pounds at any time.
“through my teens twenties I would have always maintained pretty much the same weight so if I gained weight I would be very aware of it”
For group two some recalled always having weight on, for others weight crept up gradually over time.
“I think I started putting on weight in my 20’s probably around 22/23. And it continued until I was eh 28”
Weight gain for group two was attributed to getting married, slipping back into old habits and change of work.
“It was very gradual. I didn’t really notice it. Kind of slipped back into old habits and it sort of crept on over a few years and then sort of escalated”
In group three recollections of never being slim were recalled by most participants with experiences of either always having weight on, born a big baby or putting on in teens or by early adulthood. Some had gained and lost some weight several times and then put it back on later with extra weight added.
“when I look back I would have been always have been a heavier baby and I was very big born I was you know over 10 pound born so I was the bigger baby”
Weight gain later in life for group three was considered attributable to changing habits, getting married and no longer participating in sport. Participants advised getting married involved a more active social life or involved moving further away from family indicating that there were less supports available.
“around when I was 28. Going out for a good while, got married when I was about 34, 33, that age group and I suppose around that stage we probably bought a house, we moved a bit further out of town”
Lack of energy in the evening after a day’s work was also attributable to weight gain diminishing the ability to prepare healthier food and opting for quick fix meals.
In group three being overweight for most participants brought with it lower self-esteem, self-loathing and feelings of disgust. In response to the question “So what would it mean to you then to be a healthy weight?” the response from one participant was as follows:
“Oh god, it would mean everything. Absolutely everything, I can’t stand the sight of myself”
Participants hated seeing photographs, looking in the mirror and having to shop for bigger more expensive clothes.
“I mean I can’t bear going shopping for clothes. I tend to wear black most of the time. Em, not that I’d be particularly colourful anyway. But like I can’t see, you know I mean if it was my daughters Holy Communion and I was getting really worked up and upset about trying to find something to wear for that…”
Theme: cognitive dissonance
Participants in group one were efficient at taking action on what they knew to be favourable behaviours and actions. For most they described the ability to maintain their weight as a way of life.
“So I get used to eating healthy and exercising as well so for me now it’s a way of living”.
Group two reported that improved knowledge leads to a raised awareness and the ability to make better choices and do what you know you is right.
“It’s finding your own way and having the confidence to find your own way. Some people don’t actually have the confidence to do what they think is right it’s facing up to what you think is right”
While the desire to be fit, do more, have more energy and play with the children were noted by respondents in group three, turning knowledge into action was not prioritised in reality or in practice in their lives.
“...... You know I want to be with you mammy where can we play mammy come on out here and play mammy on the floor mammy and mammy can’t even get on the floor in the first place”
Participants were not unaware of the effects of their eating habits and exercise routines on their weight management as knowledge on portion size, calorie and nutrient content was high. Despite this, portion control was poor and binge eating often out of despondency was reported. This was acknowledged by the respondents themselves even though they seemed to be powerless in correcting it. Turning knowledge into action remained a difficulty for group three.
Theme: role of employer
Sub-theme: negative versus positive perspectives
There were notable difference in attitudes to the role of their employer in facilitating healthy weight maintenance across the groups with those is group one and two reporting a campus that promoted healthy behaviours around food and physical activity. They quoted
“Lots of options for exercise and choice of foods across campus”
“you can bring in own food and consume it on the premises”
“The University has a strong culture of sport and a strong emphasis on health”
Participants in group three viewed the University more negatively in the way it facilitated healthy behaviours around food and physical activity and were more likely to blame the environment. They cited
“Lack of availability of healthy foods”
“Lack of availability of exercise”
“Cost of healthy eating options on campus is prohibitive “
Theme : advice to others
Those in groups one and two were asked what advice they would give to those struggling with weight loss. The advice was mainly centered around four main areas, timely rowing back, maintaining balance between calories in and out, and establishing healthy eating and exercise as a way of life, as a routine. Patience and not being too hard on yourself also emerged as important. Acknowledge the need for treats and then row back. Watch calories even those from fruit and especially alcohol.