Qualitative studies of obesity: A review of methodology

Ian Brown, Jill Gould

Centre for Health & Social Care Research, Sheffield Hallam University, Sheffield, UK;.

DOI: 10.4236/health.2013.58A3010                

Abstract

BACKGROUND: There is a developing interest in qualitative research to understand the perspectives and experiences of people living with obesity. However, obesity is a stigmatised condition associated with negative stereotypes. Social contexts emphasizing large body size as a problem, including research interviews, may amplify obesity stigma. This study reviews the methodology employed by qualitative studies in which study participants were obese and data collection involved face-to-face interviews. METHODS: Database searches identified qualitative studies meeting inclusion criteria from 1995 to 2012. Following screening and appraisal data were systematically extracted and analyzed from 31 studies. RESULTS: The studies included 1206 participants with a mean age of 44 years and mean BMI of37 kg/m². Women (78.8%) outnumbered men (21.2%) by four to one. Socio-economic background was not consistently reported. The studies employed similar, typically pragmatic, qualitative methodologies, providing rich textual data on the experience of obesity derived from face-to-face interviews. The majority considered quality issues in data collection, analyses and generalizability of findings. However, the studies were weak as regards researcher reflexivity in relation to interviewer characteristics and obesity stigma. CONCLUSIONS: The impact of obesity stigma has not been attended to in the qualitative research. Clear information about study participants is essential, but studies involving face-to-face interviews should also report on interviewer characteristics including body size.

Keywords

Obesity; Stigma; Qualitative Methods; Researcher Reflexivity

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Boulton, M. and Fitzpatrick, R. (1994) Qualitative methods for assessing health care. Quality in Health Care, 3, 107-113. doi:10.1136/qshc.3.2.107
[2]	Murphy, E. Dingwall, R. Greatbatch, D. Parker, S. and Watson, P. (1998) Qualitative methods in health technology assessment: A review of the literature. Health Technol Assess, 2, Monograph.
[3]	The PLoS Medicine Editors. (2007) Qualitative research: Understanding patients’ needs and experiences. PLoS Medicine, 4, 1283-1284.
[4]	Neergaard, M. Olesen, F. Andersen, R.A. and Sondergaard, J. (2009) Qualitative description—The poor cousin of health research? BMC Medical Research Methodology, 9, 52-57. doi:10.1186/1471-2288-9-52
[5]	Mays, N. and Pope, C. (2000) Assessing quality in quailtative research. British Medical Journal, 320, 50-52. doi:10.1136/bmj.320.7226.50
[6]	Malterud, K. (2001) Qualitative research: Standards, challenges, and guidelines. Lancet, 358, 483-488. doi:10.1016/S0140-6736(01)05627-6
[7]	Tong, A, Sainsbury, P. and Craig, J. (2007) Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19, 349-357. doi:10.1093/intqhc/mzm042
[8]	Pound, P. Britten, N. Morgan, M. Yardley, L. Pope, C. and Daker-White, G. (2005) Resisting medicines: A synthesis of qualitative studies of medicine taking. Social Science & Medicine, 61, 133-155. doi:10.1016/j.socscimed.2004.11.063
[9]	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
[10]	Green, J. and Thorogood, N. (2009) Qualitative methods for health research. Sage, London.
[11]	Ritchie, J. and Lewis, J. (2003) Qualitative research practice. Sage, London.
[12]	TOS Obesity as a Disease Writing Group. (2008) Obesity as a disease. Obesity, 16,161-177.
[13]	World Health Organization. (2000) Obesity: Preventing and Managing the Global Epidemic. WHO, Geneva.
[14]	Foresight. (2007) Tackling obesities: Future choices. Government Office for Science, London.
[15]	Brownell, K. Puhl, R. Schwartz, M. and Rudd, L. (2005) Weight bias: Nature, consequences and remedies. Guilford Press, New York.
[16]	Puhl, R. Heuer, C. (2009) The stigma of obesity: A review and update. Obesity, 17, 941-964. doi:10.1038/oby.2008.636
[17]	De Brun, C. and Pearce-Smith, N. (2009) Searching skills toolkit: Finding the evidence. Wiley-Blackwell BMJ Books, Chichester.
[18]	Thomas, J. and Harden, A. (2007) Methods for the thematic synthesis of qualitative research in systematic reviews. ESRC National Centre for Research Methods, London.
[19]	PHRU. (2006) Critical appraisal skills programme. Public Health Resource Unit, England. www.phru.nhs.uk
[20]	Ali, H. Baynouna, L. and Bernsen, R. (2010) Barriers and facilitators of weight management: Perspectives of Arab women at risk for type 2 diabetes. Health and Social Care in the Community, 18, 219-228. doi:10.1111/j.1365-2524.2009.00896.x
[21]	Befort, C.A., Thomas, J.L., Daley, C.M., Rhode, P.C. and Ahluwalia, J.S. (2008) Perceptions and beliefs about body size, weight, and weight loss among obese AfricanAmerican women: A qualitative inquiry. Health Education & Behavior, 35, 410-426. doi:10.1177/1090198106290398
[22]	Blixen, C. Singh, A. and Thacker, H. (2006) Values and beliefs about obesity and weight reduction among African-American and Caucasian women. Journal of Transcultural Nursing, 17, 290-297. doi:10.1177/1043659606288375
[23]	Brown, I. Thompson, J. Jones, G. and Tod, A. (2006) Obesity, stigma and quality of life. International Journal of Interdisciplinary Social Sciences, 1, 169-178.
[24]	Brown, I. Thompson, J. Tod, A. and Jones, G. (2006) Primary care support for tackling obesity: A qualitative study of the perceptions of obese patients. British Journal of General Practice, 56, 666-672.
[25]	Byrne, S. Cooper, Z. and Fairburn, C. (2003) Weight maintenance and relapse in obesity: A qualitative study. International Journal of Obesity and Related Metabolic Disorders, 27, 955-962. doi:10.1038/sj.ijo.0802305
[26]	Chan, N. and Gillick, A. (2009) Fatness as a disability: Questions of personal and group identity. Disability & Society, 24, 231-243. doi:10.1080/09687590802652520
[27]	Chang, C.T. Chang, K.H. and Cheah, W.L. (2009) Adults' perceptions of being overweight or obese: A focus group study. Asia Pacific Journal of Clinical Nutrition, 18, 257-264.
[28]	Da Silva, S. and Costa Maia, A. (2012) Obesity and treatment meanings in bariatric surgery candidates: A qualitative study. Obesity Surgery, 22, 1714-1722. doi:10.1007/s11695-012-0716-y
[29]	Diaz, V., Mainous, I. and Pope, C. (2007) Cultural conflicts in the weight loss experience of overweight Latinos. International Journal of Obesity, 31, 328-333. doi:10.1038/sj.ijo.0803387
[30]	Granberg, E. (2006) “Is that all there is?” Possible selves, self-change, and weight loss. Social Psychology Quarterly, 69, 109-126. doi:10.1177/019027250606900201
[31]	Greener, J. Douglas, F. and Van Teijlingen, E. (2010) More of the same? Conflicting perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers. Social Science & Medicine, 70, 1042-1049. doi:10.1016/j.socscimed.2009.11.017
[32]	Heading, G. (2008) Rural obesity, healthy weight and perceptions of risk: Struggles, strategies and motivation for change. Australian Journal of Rural Health, 16, 86-91. doi:10.1111/j.1440-1584.2008.00961.x
[33]	Heintze, C. Sonntag, S. Brinck, A. Huppertz, M. Niewohner, J. Wiesner, J. and Braun, V. (2012) A qualitative study on patients’ and physicians’ visions for the future management of overweight and obesity. Family Practice, 29, 103-109. doi:10.1093/fampra/cmr051
[34]	Herriot, A.M. Thomas, D.E. Hart, K.H. Warren, J. and Truby, H. (2008) A qualitative investigation of individuals’ experiences and expectations before and after completing a trial of commercial weight loss programmes. Journal of Human Nutrition and Dietetics, 21, 72-80. doi:10.1111/j.1365-277X.2007.00837.x
[35]	Jones, N. Furlanetto, D. Jackson, A. and Kinn, S. (2007) An investigation of obese adults’ views of the outcomes of dietary treatment. Journal of Human Nutrition and Dietetics, 20, 486-494. doi:10.1111/j.1365-277X.2007.00810.x
[36]	Lynch, C., Chang, J., Ford, A. and Ibrahim, S. (2007) Obese African-American women’s perspectives on weight loss and bariatric surgery. Journal of General Internal Medicine, 22, 908-914. doi:10.1007/s11606-007-0218-0
[37]	Ogden, J., Clementi, C. and Aylwin, S. (2006) The impact of obesity surgery and the paradox of control: A qualitative study. Psychology & Health, 21, 273-293. doi:10.1080/14768320500129064
[38]	Ogden, J. and Sidhu, S. (2006) Adherence, behavior change, and visualization: A qualitative study of the experiences of taking an obesity medication. Journal of Psychosomatic Research, 61, 545-552. doi:10.1016/j.jpsychores.2006.04.017
[39]	Ostberg, A., Wikstrand, I. and Bostrom, K. (2011) Group treatment of obesity in primary care practice: A qualitative study of patients’ perspectives. Scandinavian Journal of Public Health, 39, 98-105. doi:10.1177/1403494810391524
[40]	Psarou, A. 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 & Development, 11, 250-259. doi:10.1017/S1463423610000083
[41]	Sabinsky, M., Toft, U., Raben, A. and Holm, L. (2007) Overweight men’s motivations and perceived barriers towards weight loss. European Journal of Clinical Nutrition, 61, 526-531.
[42]	Sarlio-Lahteenkorva, S. (1998) Relapse stories in obesity. European Journal of Public Health, 8, 203-209. doi:10.1093/eurpub/8.3.203
[43]	Smith, E., Sweeting, H. and Wright, C. (2012) ‘Do I Care?’ Young adults’ recalled experiences of early adolescent overweight and obesity: A qualitative study. International Journal of Obesity, 37, 303-308. doi:10.1038/ijo.2012.40
[44]	Thomas, A.M., Moseley, G., Stallings, R., Nichols-English, G. and Wagner, P.J. (2008) Perceptions of obesity: Black and white differences. Journal of Cultural Diversity, 15, 174-180.
[45]	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
[46]	Thomas, S.L., Hyde, J., Karunaratne, A., Kausman, R. and Komesaroff, P.A. (2008) “They all work...when you stick to them”: A qualitative investigation of dieting, weight loss, and physical exercise, in obese individuals. Nutrition Journal, 7, 34-44. doi:10.1186/1475-2891-7-34
[47]	Thomas, S., Karunaratne, A., Lewis, S., Castle, D., Knoesen, N. and Honigman, R. (2010) ‘Just bloody fat!’ A qualitative study of body image, self-esteem and coping in obese adults. International Journal of Mental Health Promotion, 12, 39-49. doi:10.1080/14623730.2010.9721805
[48]	Throsby, K. (2007) ‘How could you let yourself get like that?’: Stories of the origins of obesity in accounts of weight loss surgery. Social Science & Medicine, 65, 1561-1571. doi:10.1016/j.socscimed.2007.06.005
[49]	Tod, A. and Lacey, A. (2004) Overweight and obesity: Helping clients to take action. British Journal of Community Nursing, 9, 59-66.
[50]	Weaver, N.F., Hayes, L., Unwin, N.C. and Murtagh, M.J. (2008) “Obesity” and “clinical obesity” men’s understandings of obesity and its relation to the risk of diabetes: A qualitative study. BMC Public Health, 8, 311-320. doi:10.1186/1471-2458-8-311
[51]	McLaren, L. (2007) Socioeconomic status and obesity. Epidemiologic Reviews, 29, 29-48. doi:10.1093/epirev/mxm001
[52]	Devaux, M. and Sassi, F. (2012) Social inequalities in obesity and overweight in 11 OECD countries. European Journal of Public Health, 23, 464-469. doi:10.1093/eurpub/ckr058
[53]	Stringhini, S., Tabak, A., Akbaraly, T., Sabia, S., Shipley, M., et al. (2012) Contribution of modifiable risk factors to social inequalities in type 2 diabetes: Prospective Whitehall II cohort study. British Medical Journal, 345, e5452. doi:10.1136/bmj.e5452
[54]	King, N. and Horrocks, C. (2010) Interviews in qualitative research. Sage, London.
[55]	Chapple, A. (1999) Issues in research. The use of telephone interviewing for qualitative research. Nurse Researcher, 6, 85-93.
[56]	Burke, L. and Miller, M. (2001) Phone interviewing as a means of data collection: Lessons learned and practical recommendations. Forum: Qualitative Social Research, 2, 7.
[57]	Novick, G. (2008) Is there a bias against telephone interviews in qualitative research? Research in Nursing & Health, 31, 391-398. doi:10.1002/nur.20259
[58]	Lewis, S., Thomas, S.L., Blood, R.W., Hyde, J., Castle, D.J. and Komesaroff, P.A. (2010) Do health beliefs and behaviors differ according to severity of obesity? A qualitative study of Australian adults. International Journal of Environmental Research and Public Health, 7, 443-459. doi:10.3390/ijerph7020443
[59]	Lewis, S., Thomas, S.L., Hyde, J., Castle, D., Blood, R.W. and Komesaroff, P.A. (2010) “I don’t eat a hamburger and large chips every day!” A qualitative study of the impact of public health messages about obesity on obese adults. BMC Public Health, 10, 309-320. doi:10.1186/1471-2458-10-309