Views and Experiences of Adults who are Overweight and Obese on the Barriers and Facilitators to Weight Loss in Southeast Brazil: A Qualitative Study

ABSTRACT

Background: Obesity in Brazil is increasing with 54% of the Brazilian population being overweight, of which 20% is obese. Obesity is a risk factor for non-communicable diseases such as cardiovascular disease: the leading cause of mortality in Brazil. This study aims to identify the barriers and facilitators to weight loss as perceived by patients with a view to reducing the burden of obesity-related diseases on patients and healthcare services.

Methods: Fifteen qualitative, semi-structured, in-depth interviews were conducted in the preventive medicine department in a private health clinic in Bauru, Southeast Brazil. Inductive thematic analysis was conducted.

Results: The barriers and facilitators were classified into three themes: lifestyle, motivation and education.

Barriers include cost of a healthy lifestyle, time management, personal safety, mobility, junk food advertising, sustaining weight loss, mental health, lack of support and health education.

Facilitators include change in eating habits, sleep quality, cooperative food networks, access to the multidisciplinary team and expert patients as health educators.

Conclusion: Expert patients should be utilized as an education method, as they increase motivation, promote the facilitators and provide realistic expectations of the weight loss process. Barriers such as junk food advertising and accessibility to treatment need to be addressed.

Abbreviations:

BMI: Body Mass Index; NCD: Non-Communicable Disease; SUS: Sistema Único de Saúde; WHO: World Health Organization

KEYWORDS:

• Barriers
• Brazil
• facilitators
• obesity
• qualitative
• weight loss

Acknowledgments

The interpreters provided crucial help in translation of the interviews and transcripts from Brazilian Portuguese to English, the multidisciplinary team at the health center helped in the recruitment of participants.

Authors’ contributions

CM conceived the study question, designed the study, conducted interviews and data analysis and wrote and revised the manuscript. GdW helped to conceive the study question, research plan, provided global and national health and socio-economic contexts and reviewed drafts. MV helped to design the study, provide local context on the study question and helped with data collection. RR helped in the study design, provided guidance on data analysis and reviewed drafts. NT helped with analysis by conducting analysis triangulation. RP helped with the study design and data collection. All authors read and approved the final manuscript.

Availability of data and material

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Consent for publication

The participants signed an informed consent form which included consent for the publication of data.

Disclosure statement

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The research was approved by the BMedSci Population Sciences and Humanities Internal Ethics Review Committee at the University of Birmingham, Scientific Committee and Ethics Committee at Instituto Lauro de Souza Lima. All participants signed an informed consent form before the interviews.

Geolocation information

Key words: Barriers, Brazil, facilitators, obesity, qualitative, weight loss

Additional information

Funding

The University of Birmingham BMedSci Population Sciences and Humanities programme provided funding for the expenses of the study. The University of Birmingham had no role in the design, collection, analysis and interpretation of data in the study.

Notes on contributors

Caroline Morgan

Caroline Morgan holds a degree in International Health BMedSc from the University of Birmingham (2019) and she is currently a medical student at the University of Birmingham due to graduate in 2021. Her interests are public health and preventive medicine.

Gilles de Wildt

Gilles de Wildt is a General Practitioner with a particular interest in health and healthcare inequalities and mental health. His current interests include global aspects of commercialisation of health care including use of NHS and other health care data and access to medicines, pharmaceutical R&D, intellectual property rights and global justice.

Renata Billion Ruiz Prado

Renata Bilion Ruiz Prado has a degree in Psychology, improvement in Clinical Psychology, Master in Psychology and Society and is currently a scientific researcher of the technical rehabilitation team and research and teaching division at the Instituto Lauro de Souza Lima.

Nisha Thanikachalam

Nisha Thanikachalam holds a degree in International Health BMedSc from the University of Birmingham (2019) and she is currently a medical student at the University of Birmingham due to graduate in 2021. Her interests are infectious diseases.

Marcos Virmond

Marcos Virmond holds a degree in Medicine from the Federal University of Rio Grande do Sul (1974) and a doctorate in General Bases of Surgery from the Universidade Estadual Paulista Julio de Mesquita Filho (1999). He was a researcher at the Instituto Lauro de Souza Lima. He has experience in the field of Hensenology, acting mainly on the following themes: leprosy, rehabilitation, public health, reparative surgery, epidemiology and disabilities.

Ruth Riley

Ruth Riley is an applied social scientist and qualitative methodologist as applied to health. Her main research interest focuses on the health and wellbeing of healthcare professionals.