A “messy ball of wool”: a qualitative study of the dimensions of the lived experience of obesity

BACKGROUND: Obesity is a multi-dimensional condition with causal factors beyond the physiological into the behavioural, dietetic and psychological. Understanding the lived experience of those who are overweight and obese and self-perceived barriers to access and engagement in intervention are imperative to formulating a systemic response to the complex problem of obesity. This study aims to identify the social, psychological and systemic factors impeding engagement with weight-loss behaviour and interventions, and to formulate a framework for responding to these. METHODS: We conducted an exploratory qualitative study using focus groups and interviews with people who have lived experienced of being overweight or obese. Data were analysed using an inductive thematic approach. Following the thematic analysis, further interpretation of the data was achieved by applying the epistemological foundations of the Lifeworld Led Care paradigm, recognising its philosophy of the person and of care based on the individual’s experiences. Eight men and 17 women participated. RESULTS: Three overarching themes were identified: Complexity and Battle, Impediments, and Positive Re-orientation. The subthemes of these were found to represent the dimensions of the Lifeworld: Identify, Inter-subjectivity, Mood and Embodiment. Further interpretation of the themed data identified six polarised dichotomies representing the opposing lived dimensions of the obesity experience: Failure Double-Bind; Think-Feel Conflict; Negative-Positive Orientation; Impeding-Facilitating Health Professional; Knowledge as Deficit-Insight; and Internal-External Orientation. CONCLUSION: Obesity manifests as constraints and challenges across six polarised dichotomies, active in the lived experience of obesity. This study provides a unique way of conceptualising and understanding the complex and interacting meanings of the lived experience of obesity through the construction of polarised dichotomies. The polarities signify the oscillating experiences that people with obesity encounter, which may be either helpful or destructive in both their lifeworld experience and their capacity to address obesity towards improved social, psychological and physical outcomes. Understanding the dichotomies allows a reconceptualisation of obesity from a quantification of the individual to a more respectful, humane, compassionate and utilitarian conceptualisation of the experiencing person and the phenomenon itself. Further, these lived polarised dichotomies of obesity present the opportunity for health professionals to reconceptualise obesity in care and interventions.