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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.

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

  AUTHORS: Ian Brown, Alex McClimens

  KEYWORDS: Obesity; Stigma; Qualitative Research

  JOURNAL NAME: Health, Vol.4 No.12A, December 31, 2012

  ABSTRACT: 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.