Different and unequal: a qualitative evaluation of salient factors influencing energy intake in adults with overweight and obesity

Authors: DAO, MARIA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; MESSER, ELLEN - Tufts University; CONIGLIARO, TERESA - Tufts University; SAKAIDA, KYLIE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; OUELLETTE, ALEXIS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; HIMARAS, VICTORIA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; THIRON, SOPHIE - Herbier De Guyane, Institut De Recherche Pour Le Développement (IRD); ROBERTS, SUSAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/14/2019
Publication Date: 6/18/2019
Citation: Dao, M.C., Messer, E., Conigliaro, T., Sakaida, K., Ouellette, A.F., Himaras, V., Thiron, S., Roberts, S.B. 2019. Different and unequal: a qualitative evaluation of salient factors influencing energy intake in adults with overweight and obesity. Nutrients. 11(6). https://doi.org/10.3390/nu11061365.
DOI: https://doi.org/10.3390/nu11061365

Interpretive Summary: Environmental factors such as food availability and variety can influence eating behavior and may lead to overeating in individuals with overweight or obesity, but relatively little is known about other types of environmental factors that may also be important. We conducted a qualitative study consisting of interviews and focus groups including 24 participants in the United States with healthy, overweight and obese weight status. The participant ages ranged from 26 to 77 years. Based on participant responses, we compared and contrasted categories of internal and external factors according to weight status. Five categories of external factors influencing food intake were identified: a) environmental cues including food availability and variety; b) normative expectations for dietary intake; c) food palatability; d) overt social pressures to overeat, and e) perceived social expectations around eating. All external factors were considered challenging by participants with overweight or obesity, and solutions to avoid overeating were lacking. Overt social pressures and perceived social expectations appeared to be especially problematic in causing overeating. This new definition of different domains of external factors that challenge healthy eating behaviors and weight regulation sets targets to address with interventions for healthy weight management.

Technical Abstract: Environmental factors such as food availability and variety can function as cues for overeating in individuals susceptible to overweight or obesity, but relatively little is known about other types of environmental factors that may also be important. This qualitative study compared and contrasted categories of internal and external cues through focus groups and key informant interviews with 24 adults (26 to 77 years old) in the United States who had a body mass index within the healthy range (21.6 +/- 2.5 kg/m^2) or had overweight or obesity (29.1 +/- 3.6 kg/m^2). Five domains of external factors influencing food intake were identified: a) environmental cues including food availability and variety; b) normative expectations for dietary intake; c) food palatability; d) overt social pressures to overeat, and e) perceived social expectations around eating. All external domains were noted by participants with overweight or obesity to be challenging, and solutions to avoid overeating were lacking; however, overt social pressures and perceived social expectations appeared to be especially problematic. By explicitly defining different domains of external factors that challenge healthy weight regulation, this study identifies specific targets to address in interventions for healthy weight management.