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University of Southampton Research Repository Eprints Soton University of Southampton Research Repository ePrints Soton Copyright © and Moral Rights for this thesis are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder/s. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given e.g. AUTHOR (year of submission) "Full thesis title", University of Southampton, name of the University School or Department, PhD Thesis, pagination http://eprints.soton.ac.uk UNIVERSITY OF SOUTHAMPTON FACULTY OF LAW, ARTS AND SOCIAL SCIENCES School of Education Being Connected: An exploration of women’s weight loss experience and the implications for health education By Teresa Marion Burdett Thesis for the degree of Doctor of Philosophy February 2010 UNIVERSITY OF SOUTHAMPTON ABSTRACT FACULTY OF LAW, ARTS AND SOCIAL SCIENCES SCHOOL OF EDUCATION Doctor of Philosophy BEING CONNECTED: AN EXPLORATION OF WOMEN’S WEIGHT LOSS EXPERIENCE AND THE IMPLICATIONS FOR HEALTH EDUCATION By Teresa Marion Burdett The focus of this thesis is the experience of intentional weight loss. There is a growing recognition that the rising levels of obesity are contributing to a global health problem. Although the costs and consequences of obesity for both individuals and societies are many; research in the field of obesity has so far failed to offer successful solutions to these problems. This thesis argues that the reason for this failure is that research has focused primarily on finding the causes of obesity and has ignored to a large extent the experiences of obesity and intentional weight loss. Furthermore, what little qualitative research that has been conducted into obesity and intentional weight loss tends to be short term and fails to follow participants for extended periods of time. In order to address the perceived gaps in knowledge, this thesis adopts a qualitative approach, informed by phenomenology, to explore the experience of intentional weight loss. This thesis intends to explore the following research questions: • What feelings or beliefs motivate individuals to start trying to lose weight and to continue trying to lose weight? • What strategies do individuals employ to try to lose weight and what decisions, feelings or beliefs underpin or influence these strategies? • What factors help or hinder individuals in their attempts to lose weight? Ten overweight or obese women in the South of England were interviewed four times over the period of a year about their experiences of trying to lose weight. Semi structured interviews were used to explore weight loss goals and strategies; feelings and beliefs about losing weight and factors that help and hinder weight loss. The interview transcripts were analysed using Hycner’s (1985) framework and an overarching theme of connectedness was identified linked to four key themes of self- sabotage, internal conflict, control and choice. The results reveal wide variations across the ten participants in their motivations for losing weight, many of which are different to the reasons that health educators give for losing weight. The strategies that participants used to lose weight seemed to have less influence on weight loss than participants’ beliefs regarding their chosen strategy and in their own ability. The majority of participants experienced a weight loss relapse. Explanations for these results are sought using two theories of mindfulness and intuitive eating. Implications for weight loss focused health education are considered and recommendations are made both for future health education practice and future research. ii LIST OF CONTENTS ii … Abstract iii … List of contents viii … List of figures ix … List of tables x … Declaration of authorship xi … Acknowledgements 1 … CHAPTER ONE: INTRODUCTION 1 … Personal motivation for research into obesity and weight loss 1 … The definitions and measurements of obesity and overweight 3 … The research problem 4 … Obesity demographics 6 … Multi factorial causes of obesity 9 … The costs of obesity 17 … The rationale for the study 19 … The purpose of the study and the overarching research objectives 20 … Conclusion and overview of thesis 22 … CHAPTER TWO: LITERATURE REVIEW 22 … Introduction 23 … Approaches to weight loss 25 … Personal self help approaches 36 … Primary care focused strategies 44 … Surgical and specialist care focused strategies 45 … Summary 46 … Researching the experience of obesity and intended weight loss 46 … The psychological aspects of being overweight 52 … Overview and reflection on the reviewed lived experience literature 54 … A potential conceptual framework for understanding obesity and weight loss 54 … Motivation 57 … Rationality and linked concepts of control and choice iii 60 … Coping and self-efficacy 61 … Intuitive eating 62 … Mindfulness 63 … Conclusion 65 … CHAPTER THREE: METHODOLOGY 65 … Introduction 65 … A rationale for the use of a qualitative paradigm in this thesis 67 … A justification for the use of the qualitative paradigm in this thesis 70 … A phenomenologically informed approach 72 … Semi-structured interviews 76 … Longitudinal studies 79 … The Hycner (1985) data analysis framework 81 … Adaptations to the Hycner framework 82 … Strengths and weaknesses of the Hycner framework 84 … Alternative frameworks used in weight related studies 84 … Rationale for utilising the Hycner (1985) framework in this study 86 … Identifying the participants 86 … Sample size 87 … Transferability 90 … Sampling 90 … Purposeful sampling 91 … Snowballing 92 … Credibility and trustworthiness 94 … Researcher and subject bias 95 … Pilot studies 96 … The interview schedule 96 … Interview one 99 … Interview two 102 … Interviews three and four 104 … Recruitment and data collection 110 … The researcher’s ethical position 111 … Informed consent iv 112 … Confidentiality 113 … Anonymity 113 … Transparency and ethics 114 … Professional ethics 115 … Transcribing and analysing the semi-structured interviews 117 … The researcher’s position 118 … The importance of reflexivity 120 … Conclusion 121 … CHAPTER FOUR: RESULTS 121 … Introduction 122 … Vignettes 125 … Emerging themes 126 … Self-sabotage 130 … Internal conflict 135 … Control 138 … Choice 140 … Connectedness and disconnectedness 144 … Case studies 144 … Code Red: an illustration of disconnectedness 149 … Molly: an illustration of partial connectedness 152 … Pat: an illustration of connectedness 155 … Discussion 156 … Weight loss experience 161 … Motivation for losing weight 166 … Weight loss strategies 174 … Conclusion 176 … CHAPTER FIVE: DISCUSSION AND CONCLUSIONS 176 … Introduction 176 … Overview of the findings 176 … What feelings or beliefs motivate individuals to start trying to lose weight and continue trying to lose weight? v 178 … What strategies do individuals employ to try to lose weight and what decisions, feelings or beliefs underpin or influence these strategies? 181 … What factors help or hinder individuals in their attempts to lose weight? 182 … A discussion of the results in relation to the models and theories previously discussed in the literature review 205 … A reflection of the usefulness of the models and the theories previously discussed to explain the results of this study 206 … Implications of this study 207 ... Implications for the clinical and weight loss practice arena 208 ... Intuitive eating 210 ... Mindfulness 214 ... Implications for health promotion and health education strategies 220 ... Implications for future research 221 ... Contribution of research 223 ... Reflection on methods utilised 226 ... Personal reflections on the PhD/research journey 228 ... Conclusion 230 … APPENDICES 230 … Appendix 1: Body Mass Index 231 … Appendix 2: Hycner (1985) Data Analysis Framework 232 … Appendix 3: Interview Schedule 1 234 … Appendix 4: Interview Schedule 2 236 … Appendix 5: Interview Schedule 3 238 … Appendix 6: Interview Schedule 4 240 … Appendix 7: Covering Letter 242 … Appendix 8: Recruitment Poster 243 … Appendix 9: Echo Advertisement 244 ... Appendix 10: Information Letter 247 … Appendix 11: Participants Consent Form 249 … Appendix 12: Examples of how the interview data was explored utilising the Hycner’s (1985) Data Analysis Framework 258 … Appendix 13: Ethical guidelines by Reynolds (1979) vi 260 … Appendix 14: Code Red’s Fourth Interview Transcript 264 … REFERENCES vii LIST OF FIGURES Figure 1: Emergent Themes……………………………………………….126 viii LIST OF TABLES Table 1: Detail of the demographic background of each participant ….89 Table 2: Alignment between interview one questions and the overall research questions………………………………………………………98 Table 3: Alignment between interview two questions and the overall research questions………………………………………………………101 Table 4: Alignment between interview three and four questions and the overall research questions…………………………………………..104 ix DECLARATION OF AUTHORSHIP I, …………………………………………………. {please print name} declare that the thesis entitled {enter title} ………………………………………………………………………………………… …………………………………………………………………………………….. and the work presented in the thesis are both my own, and have been generated by me as the result of my own original research. I confirm that: • this work
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