How do overweight people dropout of a weight loss diet? A qualitative study | BMC Nutrition

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This study was conducted on 27 obese participants, including 25 females (92.6%) and two males (7.4%). The participants’ ages ranged from 18 to 56 years, with a mean age of 33.4 ± 8.4 years. Based on the results, 18 participants (66.7%) had a history of dropout of one weight-loss diet, and nine participants (33.3%) had a history of dropout of more weight-loss diets. Accordingly, four participants (14.8%) had a history of dropout of two diets, and five participants (18.5%) had a history of dropout of weight-loss diets three times. Furthermore, nine participants (33%) were single, and 18 (66.7%) were married. The reasons for going on weight-loss diets included dissatisfaction with body shape (66.6%), suffering from diseases (14.8%), and improvement of health status (18.5%) (Table 1).

Table 1 Demographic characteristics of participants

Tables 2 and 3 describe quantitative interview information, such as who prescribed or recommended the diet for them. And what their diet included and the number of themes, and their repetition. (Tables 2,3).

Table 2 Sources of received diet among the participants and type of diet
Table 3 Frequency distribution of each theme for dropout of diet

After completing 27 interviews, 391 initial codes on dietary problems and reasons for dropout were extracted. Eventually, 181 codes were obtained, which were in the first ten categories. Subsequently, by merging the codes with similar concepts, approximately 28 final codes were extracted that were classified into 15 categories and three general themes (Tables 4,5,6).

Table 4 Individual reasons for dropout of diet
Table 5 Family and social reasons for dropout of diet
Table 6 Diet characteristics reasons for dropout of diet

*Since some participants mentioned several reasons for diet dropout, some of them were put in separate categories that were concurrently relevant to two different themes

The first theme for diet dropout included personal reasons, categorized into six parts: diet misunderstanding, lack of motivation, stress and hormonal impairment, having the feel of “being harmful to health”, lack of mental and psychological preparation, and personal taste. Then, 17 codes were generated from the categorized subsets. Further details on the codes and examples have been presented in Table 4.

The second theme included familial and social reasons divided into two categories and two codes. In this context, two crucial codes were “being busy and having problems at work and school” and “lack of cooperation on the part of family and friends”. Further details on the codes and examples have been shown in Table 5.

The third theme was related to diet characteristics categorized into six parts: the diet’s ineffectiveness, expensiveness of diet food and dietary supplements, unavailability of food, unscientific and unconventional diets, feeling bad about the diet, and unpalatable diet food. Further details on the codes and examples have been presented in Table 6.

Theme 1. Personal reasons for dropout of diet

The first theme was personal reasons for diet dropout, categorized into six parts: diet misunderstanding, lack of motivation, stress and hormonal impairment, feeling of “being harmful to health”, lack of mental and psychological preparation, and personal taste. Then, 17 codes were generated from the categorized subsets. What follows includes the details of the codes and examples.

Among the participants, the term “dropout” was used to describe withdrawal from dieting, such that overeating might occur. In other words, “premature termination of diet and gradual overeating” was often used to describe this phenomenon. In this theme, the reasons for the dropout of diet were explained.

Misunderstanding of diet: In this sub-theme, there were several concepts such as “the idea that we can maintain weight without going on a diet” and “imagination of quick weight loss”. Regarding the maintenance of weight without going on a diet, one of the participants stated:

After losing weight, I thought I no longer needed to be on a diet” (participant No. 3).

Not having enough motivation

In this sub-theme, one crucial concept was “lack of motivation”. One of the participants said:

I didn’t adhere to my diet at a party. We always had a party. Repeating this made me lose my diet, and my appetite increased again. So, I could no longer continue my diet program. The most important factor in my diet dropout was not motivated” (participant No. 8).

Stress and hormonal disorder

In this sub-theme, there were several concepts such as “stress and hormonal disorder” and “taking hormonal drugs”. In this context, two participants maintained:

I experienced hormonal imbalance and weight gain a few years ago. I was offered a diet. I adhered to the diet for seven or eight months, and I went to a gym, as well. I experienced a good weight loss, and I was delighted. However, due to stress conditions and thyroid hormone problems, I regained my weight. This was repeated two or three years later … ” (Participant No. 11).

“ … After my weight was fixed, the doctor gave me a maintenance diet, but I neglected it. Besides, because of hormonal problems, my weight increased rapidly. I did not go to the doctor again to pursue this problem. I was also involved in depression. My appetite increased because of the hormonal disturbance and consumption of anti-depression drugs … ’ (Participant No. 5).

Having the feeling of “being harmful to health

In this sub-theme, there were several concepts such as “having headaches,” “having stomach burning,” and “having brittle nails.” In this regard, eight participants said:

“ … The problem was that I was weak in the early days, and it was hard for me. I became very thin during the diet, but I had severe headaches, and my face had deteriorated. So, I dropped out of my diet. The problem with my diet was that it had some effects on my skin, and it didn’t affect my body because I exercised. Because of my stubborn diet, my face and skin were flaky. I had hair loss and stomach burning. As a result of this diet, I had severe hair loss and had a lot of physical weakness, and my nails were broken. I called them and said I had hair loss, but they said it was OK … ” (Participant No. 1).

Lack of mental and psychological preparation

In this sub-theme, there were several concepts such as “spouse’s lack of cooperation for adherence to the diet,” “friends’ comments about facial aging,” and “lack of companionship to maintain a diet.” In this respect, six participants mentioned:

“ … I dropped out of the diet because my wife said that my face was shrinking and that I was getting old and broken. I lost a little weight, but weight loss affected my face a lot, and people around me kept saying that I looked too old. My diet didn’t cause any problems, and it was perfect. Most troubles were related to those around us who insisted on eating wherever we went…” (Participant No. 19).

Personal taste

In this sub-theme, there were several concepts such as “dislike for diet food,” “great interest in certain food items,” “high tendency towards sweets,” “lack of diet based on one’s interests and appetite,” and “too many restrictions in the diet.” In this regard, five participants said:

“ … The problem with my diet was that there were lots of food items that I didn’t like. I was fond of pizza and soda and couldn’t remove them from my diet. During the diet, I found myself craving a lot of sweets. All my favorite food items were eliminated from the diet, and the amount of food was insufficient for my appetite. It was challenging for me to restrict starchy food and fat in the diet, and I didn’t feel good about it…” (Participant No. 2).

Theme 2. Familial and social reasons for dropout of diet

The study findings reflected the relationship between personals as well as their backgrounds and social and familial factors. This theme included two categories and two codes. The details of the codes and examples have been presented below.

Social problems

This sub-theme consisted of one concept; i.e., “being busy and having problems at work and school.” In this regard, two participants said:

“ … My main problem was my work. I became hungry during the nights because I was on shift work and had woken up in the morning. I didn’t know what to do, and I was starving. Due to the cramped university classes and lack of time, I couldn’t adhere to my diet schedule. Besides, I couldn’t exercise … ” (Participant No. 6).

Familial problems

This sub-theme consisted of one concept; i.e., “lack of cooperation on the part of family and friends.” In this context, three participants maintained:

“ … My daughter got married. We had lots of parties. My son-in-law’s family insisted on eating every time. After that, I gradually dropped out of my diet that was going on well … ” (Participant No. 7).

Theme 3. Reasons related to diet characteristics

The third theme included the reasons related to diet characteristics and was categorized into six parts: the ineffectiveness of diet, the expensiveness of diet food and dietary supplements, unavailability of food, unscientific and unconventional diets, and feeling bad about the diet, and unpalatable diet food. Further details about the codes and examples have been provided below:

Ineffectiveness of diet

This sub-theme consisted of one concept; i.e., “no weight loss.” Two participants said:

“ … I was very motivated for the first couple of months. However, when my weight didn’t change, I lost my motivation … ” (Participant No. 5).

Expensive diet food and dietary supplements

This sub-theme included two concepts, namely “expensive diet food” and “expensive weight loss supplements.” In this regard, two participants stated:

“ … The problem with my diet was that it wasn’t economical, and it was very difficult to get diet food. So, I couldn’t adapt to the diet, and I lost my motivation gradually. Weight-loss supplements are generally expensive, and they are not worthy for long-term usage … ” (Participant No. 13).

Unavailability of food

This sub-theme consisted of two concepts, namely “unavailability of certain food items” and “unavailability of food in different situations.” In this respect, two participants said:

“ … The problem with my diet was that it was challenging to get food. So, I couldn’t adapt to the diet, gradually left, and did not attend the therapy sessions. My lunch and dinner meals were almost just meat, poultry, and grilled fish in my diet. Normally, this type of food was not always available to me since I was at work or because of attending parties and family gatherings or some other restrictions … ” (Participant No. 18).

Unscientific and unconventional diets

This sub-theme consisted of two concepts, namely “unavailability of certain food items” and “unavailability of food in different situations.” In this regard, five participants maintained:

“ … I used different diets. Some were simple diets that had everything, and some were starchy and sugar-free. However, some were special diets that only had coffee or bananas. I tried different diets with temporary effects. I had no rice in my diet for the first month. I only had lentils or egg white for breakfast. Lunch and dinner included chicken breast or steamed fish and vegetables … ” (Participant No. 22).

Feeling bad about the diet

This sub-theme included one concept; i.e., “not paying attention to the strong tendency towards certain food items.” In this regard, two participants mentioned:

“ … At that time, I had a strong tendency towards chocolate and cocoa, which was limited, and my blood pressure dropped. In addition, I had headaches and felt weak almost all the time. I was very bothered and did not feel well … ” (Participant No. 24).

Unpalatable diet food

This sub-theme consisted of one concept; i.e., “not paying attention to personal unpalatable food items.” In this context, two participants said:

“ … My previous diet consistently made me eat beans or lentils, cooked vegetables, coconut, chicken, and boiled fish, which I didn’t like at all. There were lots of food items in my diet that I didn’t like … ” (Participants No. 14 and 10).

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