Int J Qualitative Stud Health Well-being
EMPIRICAL STUDY
Understanding everyday life of morbidly obese adults-habits and
body image
BJØRG CHRISTIANSEN, Associate Professor1, LISBET BORGE, Associate Professor2, &
MAY SOLVEIG FAGERMOEN, Associate Professor3,4
1
Health Faculty, Institute of Nursing, Oslo and Akershus University College, Oslo, Norway, 2Institute of Nursing and Health,
Diakonhjemmet University College, Oslo, Norway, 3Department of Gastroenterology, Oslo University Hospital, Oslo, Norway,
and 4Institute of Health and Society, University of Oslo, Oslo, Norway
Abstract
Background: Morbid obesity is a progressive, chronic condition associated with failed attempts at change and repeated
relapses.
Aim: There seems to be little previous research into the understanding of the everyday life of morbidly obese adults.
We wanted to gain more knowledge about characteristics of eating habits and body image as well as motivational forces
for change.
Methods: A qualitative approach was chosen in order to gain insight into how morbidly obese adults experience everyday
life. Qualitative interviews are well suited to provide insight into themes from the interviewee’s life story from the subjects’
own perspectives. To gain insight into such processes, a narrative approach that allowed the informants to give voice to their
ways of doing, thinking and feeling in daily life, was adopted. The informants comprised seven women and four men aged
of 2656 years, recruited from a population of obese individuals who had participated in a weight reduction course.
A hermeneutic approach was used where the research question was the basis for a reflective interpretation.
Results: The following meaning-units were identified: to be perceived as overweight; and to see oneself as overweight.
Ingrained habits: the struggle between knowing and doing; acting without knowing; and eating is soothing.
Conclusions: Seeing oneself as an obese person is a gradual process that implied experiencing oneself as different from
significant others, such as (slim) siblings and friends. To experience a gap between knowing and doing concerning food
habits in everyday life indicates that informants value they have a choice. This is an important insight to consider when
framing interventions to support this vulnerable group.
Key words: Morbid obesity, food-habits, body, shame, qualitative study, life style, routine behaviour, weight-related problems
(Accepted: 29 June 2012; Published: 31 July 2012)
This paper focuses on characteristics of eating
habits and body image among adults suffering from
morbid obesity. Overweight and obesity is an increasing public health problem both in Norway and
internationally (Helse-og omsorgsdepartementet,
2007). Morbid obesity is a progressive, chronic
condition associated with failed attempts at change
and repeated relapses (Rippe, McInnis, & Melason,
2001). The medical criteria for morbid obesity
is a BMI 40 kg/m2, or 35 kg/m2 with one comorbidity (Hjelmesæth, Hofsø, Handeland, Johnson,
& Sandbu, 2007). A combination of genetic dispositions and social factors seems to have a causal
connection (Sosial-og helsedirektoratet, 2004). Overweight and obesity are generally conceived as results
of sedentary lifestyle with too little physical activity
and too much food.
Everyday life is a generic term that, among other
things, relates to daily activities of an individual
as typified by living habits, e.g., eating, physical
activities and social life. Eating habits is a term
that covers what and how people eat. The meaning and organization of everyday life has been
a topic of investigation (Håkanson, Sahlberg-Blom,
Ternestedt, & Nyhlin, 2011; Halkier & Jensen,
2011; Svidèn, Tham, & Borell, 2010).
Correspondence: B. Christiansen, Institute of Nursing, Health Faculty, Oslo and Akershus University College, Post-box 4, St. Olavs pl, NO-0130 Oslo,
Norway. Tel: 4722453738. Fax: 4722453855. E-mail: bjorg.christiansen@hioa.no
#2012 B. Christian et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0
Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Citation: Int J Qualitative Stud Health Well-being 2012, 7: 17255 - http://dx.doi.org/10.3402/qhw.v7i0.17255
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B. Christian et al.
Self-esteem and body image are influenced by
obesity (Cooper, Fairburn, & Hawker, 2003;
Friedman & Brownell, 1995; Grilo, Masheb,
Brody, Burke-Martindale, & Roth, 2005). Stigmatizing experiences among people suffering from
obesity occur frequently in the context of personal relationships with family, friends, and coworkers (Puhl & Brownell, 2006). Rugseth (2011)
claims living with obesity may be perceived as an
individually experienced phenomenon, which is
contextually conditioned by mutual exchange with
other people, cultural stigma, times and places.
She found that the obese body was at the forefront
of all experience (Rugseth, 2011).
Individuals suffering from morbid obesity
who make decisions about changing habits to promote weight-loss, often perceive this action as a
continuous endeavour that requires external support
(Borge, Christiansen, & Fagermoen, 2012; Dansinger,
Gleason, Griffith, Selker, & Schaefer, 2005).
In order to improve our understanding of everyday life of morbidly obese adults we conducted a
qualitative study. An understanding of everyday life
from the viewpoint of morbidly obese adults may
shed light on why changing habits to create healthier
and weight-reducing way of life seems to be such a
Sisyphean task. This is important to consider when
framing preventive and therapeutic interventions for
this major public health problem.
Background
Despite the efforts of individuals and public and
private services aimed at weight reduction, the
population keeps getting heavier. This suggests a
need to ask what factors, other than rational choice,
may be influencing living habits? Habits may be
defined as non-reflective, repetitive behaviour, a
basic necessity for making daily life manageable.
Preferences and habits are often intimately connected. Habitual behaviour is also often associated with addiction (Lindbladh & Lyttkens, 2002).
Habits can often seem like an intimate and connected part of the self, and are particularly visible
when judged as bad habits, e.g., smoking, ‘‘I am a
smoker’’ (Connerton, 1989). According to MerleauPonty (2002) the lived body is a habitual body.
It is in action that the habitual body is accomplished.
Within a sociological frame of reference, a goaloriented version of rational behaviour is distinguished from routine everyday practices that do not
require reflection about aims, motives and means
(Berger & Luckmann, 1966; Connerton, 1989).
Nevertheless, in the context of everyday life the
demarcation between reflective and habitual behaviours is normally fluid and contains elements
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of both. It is also obvious that there are important differences in the ways in which individuals
relate themselves to habits (Lindbladh & Lyttkens,
2002). These researchers found that people in lower
social positions are more inclined to rely on their
habits and are accordingly less likely to change their
behaviour.
Some studies conducted among obese adults seem
to address underlying aspects of eating habits. In a
Danish qualitative study it appeared that informants
had considerable knowledge of food and its energy
composition, but in spite of this they made choices
contrary to that knowledge (Overgaard, 2002). In a
qualitative study with 11 obese adults, Grant and
Boersma (2005) found strong connections between
eating and various emotional and social needs.
Preferences for particular foods were linked to foods
the informants had known as children. Cycles of
control, where food was a tool used by parents to
maintain control, were also transmitted intergenerationally. These lessons are particularly powerful
because they are tacit and learned by experience
(Grant & Boersma, 2005). Exploring obesity as a life
experience among 20 Norwegian adults, Rugseth
(2011) found that food and meals formed patterns
of living that informants were reluctant to give up.
They perceived the choices of food and eating
regimen recommended on the basis of nutritional
and medical perspectives as turning their world
‘‘upside down’’ (Rugseth, 2011). A qualitative study
from Scotland with mostly women over 50 years
old, reported that many obese patients felt apathetic,
that there was no room for change and that they
were unable to help themselves (Jones, Furlanetto,
Jackson, & Kinn, 2007). Lindelof, Nielsen, and
Pedersen (2010) reported from a qualitative study
exploring Danish obese adolescents’ and their parents’ views on the former’s obesity. They found
that the adolescents were fully aware that their
diet was unhealthy and they wished they were able
to alter this behaviour. Besides the food served at
home, obese adolescents consumed large quantities
of unhealthy food when alone, feeling sad, bored,
hungry or with peers (Lindelof et al., 2010). It appears that habits may be a powerful force to deal
with when being obese, which inspired us to do
further research into how morbidly obese adults experience these aspects of everyday life.
Body shame, body image and quality of life in
relation to obesity have been addressed in studies.
In a meta-analysis, Friedman and Brownell (1995)
found body image distortion and disparagement in
obese individuals, while Cooper et al. (2003) underlined the need to address body image concerns in
the treatment of obesity. Grilo et al. (2005) found
that among bariatric surgery candidates, women
Citation: Int J Qualitative Stud Health Well-being 2012; 7: 17255 - http://dx.doi.org/10.3402/qhw.v7i0.17255
Understanding everyday life of morbidly obese adults-habits
reported significantly higher body image dissatisfaction than men. An Australian qualitative study
reported several stigmatizing experiences among
mostly female obese adults: e.g., being abused
when using public transport, and not being able to
fit into seats on planes. Participants often blamed
themselves for stigmatizing experiences (Lewis et al.,
2011). In a recent Norwegian cross-sectional study
among morbidly obese adults on treatment waiting
lists, the participants were found to have lower
health related quality of life (HRQoL) on all subdimensions compared with the norms (Lerdal et al.,
2011).
Although themes such as emotional eating, body
image disturbance, self-esteem, obesity stigma, quality of life and life experience have been addressed in
studies concerning obesity, there seems to be little
previous research into the understanding of the
everyday life of morbidly obese adults. The aim of
the study was two-sided: we wanted to gain more
knowledge about characteristics of eating habits
and body image as well as motivational forces for
change. The paper focuses on the following research
question: How do the participants describe their
everyday life experiences as morbidly obese adults?
Method
A qualitative approach was chosen in order to gain
insight into how morbidly obese adults experience
everyday life. Qualitative interviews are well suited
to provide insight into themes from the interviewee’s
life story from the subjects’ own perspectives
(Kvale & Brinkmann, 2009). To gain insight into
such processes, a narrative approach that allowed the
informants to give voice to their ways of doing,
thinking and feeling in daily life, was adopted. A way
of viewing narrative is, according to Polkinghorne
(1988), that experience itself is storied, or it has a
narrative pattern. The narrative approach enabled a
focus on the participant’s own understanding, recall
and interpretation of their experiences (Riessman,
2008).
Participants
In Norway a Patient Education Resource Centre
(PERC) offers a 40-hour course that covers major
subjects related to necessary lifestyle changes. The
course is mandatory for patients on waiting lists for
treatment of their morbid obesity, and emphasizes
an increased awareness of lifestyle choices (Lerdal
et al. 2011). The study was conducted among a
group of participants who had attended PERC.
Having completed the course we expected that the
participants had raised consciousness of lifestyle
choices, enabling them to review their everyday life
even before attending PERC. Thus, they might also
contribute with valuable insight into the characteristics of eating habits and body image of morbidly
obese adults.
A letter of invitation to participate in this study was
sent from the PERC to all course attendees (n 44)
46 months after course completion. The researchers
had no prior relation to the interviews, but we have a
genuine interest in the problem area we approached
in this study.
The informants comprised seven women and four
men aged 2656 years. Nine of the participants were
waiting for surgery, while two had chosen to reduce
weight without surgery.
Interviews
Narrative interviews centre on the stories the subjects
tell which may come up spontaneously during the
interview or may be elicited by the interviewer (Kvale
& Brinkmann, 2009). Inspired by the ‘‘open narrative
interview’’ as described by these authors, we used an
interview guide as a framework allowing informants
to describe their everyday life practices in their own
terms. The interview guide included questions about
eating habits, physical activities and other everyday
activities and experiences related to obesity. Informants were encouraged to talk about what their daily
lives were like before attending the course. The ways
in which they expressed themselves may have been
influenced by their participation at PERC, which
probably raised their awareness of habits. A general
impression was that they spoke more or less without
restraint about their daily life experiences. To promote a realistic, detailed narrative, the informants
were encouraged to describe a typical day, starting
from morning rising (Haavind, 1987; Ulvik, 2007).
We also asked them to look back on their history as
obese. Interviews were conducted by two of the
authors (BC and LB) between June and August
2009. Each informant decided where the interview
should be carried out; at his or her home or at the
researcher’s office. All interviews were tape recorded
and transcribed verbatim.
Analysis
Narratives can be analyzed in many different ways.
Our analysis can be described as ‘‘bricolage’’, which
refers to an eclectic form of generating meaning,
moving freely between analytic techniques and concepts based on systematic readings of the material
(Kvale & Brinkmann, 2009). A hermeneutic approach was used where the research question was
the basis for a reflective interpretation. Inspired by
Citation: Int J Qualitative Stud Health Well-being 2012; 7: 17255 - http://dx.doi.org/10.3402/qhw.v7i0.17255
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B. Christian et al.
Kvale and Brinkmann’s (2009) three contexts of
interpretations, two researchers analyzed the verbatim transcripts manually.
ingrained habits: the struggle between knowing and
doing; (4) ingrained habits: acting without knowing;
and (5) ingrained habits: eating is soothing.
Self-understanding
Theoretical understanding
The interpreter here formulates in a condensed
form what the subjects themselves understand to be
the meaning of their statements, and the interpretation is more or less confined to the subjects’ selfunderstanding (Kvale & Brinkmann, 2009). After
separate, in-depth readings of the transcripts to gain
a sense of the whole, meaning units that derived from
the data (social life, food and eating patterns, work,
physical activity, etc.), were identified by colourcoding in order to structure the informants’ utterances. This process involved searching the entire
material for similar and contrasting utterances.
A theoretical frame for interpreting the meaning of
a statement is applied, and thus exceeds a commonsense understanding (Kvale & Brinkmann, 2009).
This more comprehensive interpretation involved
contextualizing the critical commonsense understanding by using theoretical frameworks and previous research moving our analysis to a higher level
of abstraction. This third context of interpretation
is reflected in the discussion (Table I).
Critical commonsense understanding
The interpretation here goes beyond reformulating
the subjects’ self-understanding, and may thus be
critical of what is said. By including general knowledge about the content of the statement it is possible
to amplify and enrich the interpretation of a statement (Kvale & Brinkmann, 2009, p. 215). Further
attentive reading and discussions uncovered nuanced
meanings related to the initial meaning units. This
interpretation included a wider frame of understanding than that of the informants themselves.
The meaning units were subsequently condensed
by identifying patterns and variations, underpinned
by illustrative excerpts and quotes from the material.
Thus, the analysis moved from units of meaning
and generated preliminary themes. To enhance the
rigour of the research process, a third researcher
was involved in discussing the analysis. The discussions opened up a more nuanced meaning, and
through this process five themes eventually emerged.
Verbatim quotations from the transcribed material
underpinned and exemplified our interpretations.
This second context of interpretation is reflected in
the presentation of findings: (1) to be perceived as
overweight; (2) to see oneself as overweight; (3)
Ethics
The study was approved by the Regional Norwegian
Committees for Medical Research Ethics (6.2009.
194). The informants were contacted by mail,
distributed by PERC. Those who agreed to participate in the study sent their names in an envelope
directly to one of the researchers. They were
informed that participation was voluntary, and that
they had the right to withdraw at any time. Written
informed consent was obtained from each of them
prior to the interviews, including their consent to the
use of audio recordings. Assurances were also made
that anonymity would be preserved when the results
were published.
Findings
To be perceived as overweight
All informants had been more or less overweight
since childhood or adolescence. They seemed, however, to have had varied experiences concerning
what attention their overweight caused while growing up. One informant told how others in the family
were overweight, and her mother urged her to eat.
In her childhood, food was connected to cosines
and reward. Another found that plenty of attention
was given to weight, food and slimming: ‘‘Mom
nagged’’ about the weight*while the nurse focused
Table I. Examples of three contexts of interpretations.
1. Self-understanding
‘‘I don’t like to see myself in a photo’’
‘‘I dislike myself, and don’t want to be seen’’
2. Critical common-sense understanding To see oneself as overweight: Seeing oneself as an overweight person was
connected with displeasure, particular for female informants. Data indicated
that they were dissatisfied and avoided images of themselves. Looking in the
mirror or seeing oneself in a photograph or on video was often difficult
3. Theoretical understanding
To view oneself in mirrors, etc., reflects an outward glance at the physical body.
According to Merleau-Ponty (2002), to see oneself through the eyes of others,
may evoke a sense of bodily shame
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Citation: Int J Qualitative Stud Health Well-being 2012; 7: 17255 - http://dx.doi.org/10.3402/qhw.v7i0.17255
Understanding everyday life of morbidly obese adults-habits
on weighing: ‘‘To be measured and have one’s weight
checked, and be told you have a fault, that was no
good.’’
Being constantly reminded about weight problems
while growing up seemed to be a common experience among the informants. A man said that his
mother was advised to feed him with plenty of fruit
and vegetables, ‘‘which is why I hardly touch them
today.’’
As adults, they spoke about varied experiences
from their social life. A typical pattern was that
obesity seemed to cause tension in relationships, and
two women told of relationships that ended, in part
because of weight problems, and periods of social
isolation. One of them was extremely depressed for
weeks without any social contact, which she related
to being overweight. One informant said that his
wife did not understand his weight related problems,
and argued with him. Another became annoyed
with her husband when he tried to help her to lose
weight.
Obesity caused job-related problems to a greater
or lesser degree. Two of the informants said they
were unable to perform their work the way they
should because of being overweight. A male informant spoke about going to several job interviews
without ever getting a job.
Even though comments about their obesity were
rare, the informants were sensitive about how other
people react to their obesity: ‘‘You notice a look . . .’’
All informants had experienced feeling uncomfortable with activities that required them to appear in
public, such as the feeling of being stared at in the
grocery-shop, on the beach or in a swimming pool.
They also felt strain when using public transport:
‘‘I feel I take up a lot of space.’’ Another barrier
seems to be a particular focus on chairs when visiting others, at the cinema, meetings, etc., because
they feared that the chair would break or that the
armrests were too narrow. Insufficient mastery of
social life made one informant feel depressed and
slump into passivity: ‘‘I sit down in a chair and go
to sleep.’’
To see oneself as overweight
One informant told how he was about 12 or 13
years old when he ‘‘saw himself as plump and
heavy.’’ He experienced himself as different from
his siblings: ‘‘It has been bothersome that they can
eat what they want.’’ Several informants seemed
not to be aware of their overweight until it came
to their attention because clothes did not fit, or
weight-related problems started to occur: ‘‘When I
noticed that my back hardly managed to carry my
weight, I thought, what’s happening?’’
Seeing oneself as an overweight person was connected with displeasure, particular for female informants. Data indicated that they were dissatisfied
and avoided images of themselves. Looking in the
mirror or seeing oneself in a photograph or on video
was often difficult: ‘‘I don’t like to see myself in a
photo.’’
One woman said that she kept an expressionless
face, but felt different inside, while another felt she
was living inside a box, to protect herself: ‘‘I dislike
myself, and don’t want to be seen.’’
It appears that the men view themselves in a more
positive way. Two men stated that they think they
function normally, but were aware of being overweight when they bought clothes.
Physical activity was a theme in the interviews.
A typical pattern involved explanations about how
they were more or less prevented from undertaking
physical activity because of obesity, which made
them resigned to inactivity. Several informants told
about health problems related to obesity that hindered physical activity. While a few informants said
that they were fond of physical activities such as
walking and participating in sports, particular as
youngsters, there were also examples of a lifelong
story of escape, for instance making up weightrelated excuses so they did not have to participate
in various activities: ‘‘I sneaked away from physical
activity in periods’’ and ‘‘I don’t like to walk outside
during winter because I’m afraid of falling and not
being able to get up.’’
Some of the informants indicated positive experiences with adapted training: ‘‘They (trainers) made
me run on the treadmill for the first time in many
years, and I enjoyed it very much.’’ Even so, several
of the informants seemed to prefer a sedentary lifestyle with activities that did not demand much
movement of the body, such as listening to music,
reading books and handicraft.
Ingrained habits: the struggle between
knowing and doing
All informants had participated in various weightmanagement programmes that resulted in rapid
weight loss and subsequent gain. While such programmes did not produce long-term changes in
obesity, informants seemed to acknowledge them
as a source of knowledge about weight-reduction
diets. According to the informants it was not lack
of knowledge about food and diet that seemed to
cause their weight problems, as these statements
illustrate: ‘‘I know exactly what to do! I have a plan,
but I can’t go through with it!’’ and ‘‘As an overweight person I know everything about food,
but when I experience things going in the wrong
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B. Christian et al.
direction, I might just as well carry on . . .’’ Even
though she knew she ought to eat several meals
a day, she struggled to make it a habitual routine:
‘‘I am very aware of what I am doing wrong; it’s easy
to talk about, and easy not to go through with.’’
As the data illustrate, informants seemed to have a
common struggle to integrate obtained knowledge
into daily diet and food habits, but when they talked
about their daily food habits, it was not only what
they ate that created problems, but also how they ate.
Ingrained habits: acting without knowing
All informants told about routines and habits concerning food that seem to deviate to some extent
from what is understood as common practice. This
was exemplified either by eating rarely and becoming
‘‘extremely hungry’’, or eating often and therefore
never feeling hungry. Regular meals were the exception for informants, who also told about other
characteristic habits. One informant said he ate in
a greedy way, another that she used to ‘‘put something in the mouth’’ when she stood in the kitchen
making food. A common practice among informants
seemed to be eating large quantities at each meal,
including ‘‘a lot of gravy.’’
There were examples of food habits that seem
to be more or less subconscious: ‘‘I was unaware that
I didn’t eat breakfast,’’ and ‘‘If I drop hot meals for
several days, I often find myself snooping around in
the cupboards for something to eat.’’
Conversely, the data also indicated that informants paid considerable attention to food, and one
informant stated that she had to think about food
continuously. Several informants expressed a weakness for chocolate: ‘‘Very fond of food, chocolate
and everything, forever.’’ The passion for chocolate
could also indicate indifference, or blaming their
body. A typical statement was that it did not seem to
matter if they ate a bar of chocolate, because they
were already fat. In a similar statement, one informant admitted a lack of willpower: ‘‘When I ate a
chocolate bar, it was a big one. When I opened a bar
of chocolate, I couldn’t leave a piece.’’
Ingrained habits: eating is soothing
Some of the female informants explained that they
ate more than they should to compensate for other
problems. They told how food sometimes became
a comfort, and that eating relieved stress: ‘‘I pop
something in my mouth to relieve my troubles.’’
Although data show that the informants suffering
from obesity were facing great challenges concerning
food and meal habits, there were also examples of
how some of them had developed personal strategies
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to manage their weight and change their habits.
One informant said that she complimented herself
when she avoided fattening food, and another that
he instructed himself to go out and eat regularly:
‘‘When I mobilize thought and will in the right
direction it can work well, but I’m often slow . . .’’
Discussion
One pattern that appeared was that seeing oneself
as an obese person is a gradual process that implied
experiencing oneself as different from significant
others, such as (slim) siblings. Female informants
seemed to suffer more from negative social consequences, for instance low self-esteem, poor body
image, and in relationships, illustrated when they
told of how they disliked the view of themselves in
mirrors and photographs. To view oneself in mirrors,
etc., reflects an outward glance at the physical body.
According to Merleau-Ponty (2002), to see oneself
through the eyes of others, may evoke a sense of
bodily shame. The dys-appearing body appears
as alien (Zeiler & Wickström, 2009). However,
male informants did not seem to be so preoccupied
with their bodies, as shown by their awareness of
obesity being evoked only when clothes did not fit.
Overgaard (2002) reported that women in particular wanted to hide their bodies, and four of the five
interviewees were distanced from their physical
bodies. Lewis et al. (2011) found that mostly female
obese adults often blamed themselves for stigmatizing experiences. Grilo et al. (2005) and Friedman
and Brownell (1995) also found poor body image
and body image distortion in obese individuals. Our
findings indicate gender differences in body image,
other studies report no such differences in quality
of life (HRQoL) among obese (Lerdal et al., 2011).
Hence, the gender perspective on everyday life and
body image should be further investigated. Another
interesting question for further research is the
gradual process of seeing oneself as obese.
A distanced, outward way of experiencing one’s
own body may provide an understanding of the way
our informants were particularly aware of their obese
bodies, in mirrors, photographs or when clothes
did not fit. Leder (1990) described how the body,
at times of dys-appearance, is often experienced
as separate from oneself. Merleau-Ponty (2002)
would describe this in terms of the body as an object
seeming to be in the forefront of our informants’
lived experience. A person’s sense of own physical
appearance, usually in relation to others, can shape
his or her body image, and can be different from
how others actually perceive him or her. This widespread understanding of body image is much in line
with Merleau-Ponty’s (2002) theory of the body as
Citation: Int J Qualitative Stud Health Well-being 2012; 7: 17255 - http://dx.doi.org/10.3402/qhw.v7i0.17255
Understanding everyday life of morbidly obese adults-habits
relational, in the sense that it is inseparably connected to its surroundings. The body is seen as
fundamental to all human experience and is understood as both subject and object, which coexist.
‘‘We must ask why there are two views of me and the
body: my body for me and my body for others, and
how these two systems can exist together’’ (MerleauPonty, 2002, p. 122). According to Merleau-Ponty,
the feeling of shame is closely connected to the gaze
of others: ‘‘ . . . in so far as I have a body, I may be
reduced to the status of an object beneath the gaze
of another person, and no longer count as a person
for him . . .’’ (Merleau-Ponty, 2002, p. 193).
Another pattern that appeared was that the obese
body created obstacles and influenced living habits
in various ways. Although some informants claimed
they had been fond of physical activities, the obese
body had caused restrictions that led to a lifelong
story of escape from physical activities and the
development of more sedentary activities and habits.
Wiklund, Olsén, and Willén (2011) reported from
a Swedish qualitative study with 18 patients suffering from severe obesity how excess weight itself was
considered an obstacle to physical activity, although
physical activity was experienced positively. Findings in a Norwegian qualitative study with five
obese women showed that they felt more comfortable when exercising within a treatment context
organized for patients with obesity problems. In
ordinary fitness gyms they felt the gaze of others
as well as bodily pain (Groven & Engelsrud, 2010).
All our informants had experienced feeling uncomfortable with activities that required them to appear
in public, for instance in the grocery-shop, on the
beach or in a swimming pool. This is consistent
with results from Rugseth’s (2011) study, where
body weight was at the forefront of all experience
and was an impediment to the things they wished
to do.
Our study found that experiences concerning food
and meals while growing up seemed to influence the
informants’ food habits. Understanding the body as
the primary source of experience also implies that a
person’s lived experiences are an integral part of the
body; where present time includes both the past
and future (Merleau-Ponty, 2002). A question that
is also raised by Lindbladh and Lyttkens (2002) is
whether reference to childhood and adolescence for
the grounding of today’s obesity and habits is seen as
‘‘natural’’, and therefore sustained in an unreflective
way? For instance, one of the informants explained
that he seldom ate fruit and vegetables now because
he was more or less forced to eat these foods in
his childhood to lose weight. Furthermore, informants spoke of how attention from significant others
seemed to be related to food and eating patterns
either in positive or negative ways; food used for
cosiness and reward, or in contrast, food as a source
of problems when considerable negative attention
was given to weight, food and slimming. Female
informants in particular described eating patterns
that seemed to compensate for various forms of
emotional distress. Grant and Boersma (2005)
found that food may be used as a tool to numb
emotional pain and regulate emotions. In line with
their findings, people learn by experience in a tacit
way when food is used by parents as a tool to
maintain control, or it is the symbol or substitute for
relationships and well-being. Although informants
in their study were able to reflect on ‘‘bad’’ habits
and showed awareness of them, the symbolic association with food and meals is rendered powerful by
the fact that it operates below the level of consciousness (Grant & Boersma, 2005).
This is a pattern recognized among our informants
when, probably influenced by greater awareness of
their daily lives after attending the PERC course, they
spoke of food habits that seemed to be more or less
subconscious, for example, being unaware of not
eating breakfast, or finding oneself snooping around
in cupboards. A process of reflection is initiated when
everyday routines that have been taken for granted
are, for some reason, interrupted (Lindbladh &
Lyttkens, 2002). Similar patterns are also reported
in the study by Grant and Boersma (2005), where
cycles of emotional overeating became evident in
retrospect, but not consciously in the moment.
Speaking of ‘‘bad habits’’ could also suggest that
our informants made a distinction between positive and negative aspects of their daily routine
behaviour. According to Lindbladh and Lyttkens
(2002), to classify habitual behaviour in negative
terms could be assumed to function as a changepromoting mechanism.
However, the habitual and the good are two
dimensions that were mentioned by several informants, for example, when they said that they often
ate ‘‘a lot of gravy.’’ Lindbladh and Lyttkens (2002)
suggest that there is a tendency to equate habits
and preferences. In our study this is particular
prominent when informants described their passion
for chocolate. Eating chocolate was justified as a
deeply rooted pleasurable habit by several informants. The characteristic pattern was that they
simultaneously expressed indifference and lack of
control, blaming their obese bodies. In relation to
the situation of many obese persons, Riva et al.
(2006) have described some similarities to addictive
behaviour, with a strong desire or compulsion,
difficulties in control, and persisting despite clear
evidence of harmful consequences.
Citation: Int J Qualitative Stud Health Well-being 2012; 7: 17255 - http://dx.doi.org/10.3402/qhw.v7i0.17255
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B. Christian et al.
Another typical pattern in the findings was that
there seemed to be much effort and tension between
what informants knew they should eat, and what they
actually ate. Similar findings were also reported by
Overgaard (2002), who found that, in spite of having
knowledge, informants made choices contrary to that
knowledge. Even though our informants claimed
they, as a group, had knowledge about healthy and
weight-reducing food-habits, they seemed to struggle
to translate this knowledge into action and change, a
well-known tension that requires a process of reflection. However, to experience a gap between knowing
and doing concerning food habits in everyday life
indicates that they value they have a choice. This is an
important insight to consider when framing interventions to support this vulnerable group. The experience of such a gap may work as a source of pressure,
which, as argued by Lindbladh and Lyttkens (2002),
may make an energy-demanding change worthwhile.
The least costly way of maintaining a healthy lifestyle,
is to turn healthy living into a habit.
Methodological considerations
Although our material from qualitative interviews
has been valuable in highlighting nuanced and subtle
aspects of everyday life of morbidly obese adults,
it must be noted that our sample is limited, and that
only 25% of those who were invited to participate
in the study did so. As researchers we have reflected
upon the reason for this; it is possible that the stigma
associated with being obese may have been an important barrier for those who did not consent. As
noted earlier, our participants were a diverse sample
in terms of age and gender, which may be considered
a strength of the study because it enriched the data.
In any qualitative interview, interaction between
interviewer and interviewee influences the outcome.
In this study interviews were conducted by either
one of two interviewers, which may have influenced
the course of the interviews to some degree. A third
researcher was involved during the analyses. We do
not, however, consider this a weakness, because
more than one researcher provides a good basis
for the analysis. According to Kvale and Brinkman
(2009), it is not a problem that different interpreters
construct different readings from an interview story,
but it is instead a source fruitfulness and a virtue of
interview research.
The focus on the daily life experiences of the
informants has also left us with new questions that
ought to be further examined. In addition to an indepth study of the gender-perspective on lived experiences that we have already mentioned, it would
be of interest to do further empirical work into what
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constitutes changes in health-related habits among
obese adults.
Conflict of interest and funding
The authors have not received any funding or
benefits from industry or elsewhere to conduct this
study.
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For this Discussion, you will evaluate qualitative research questions in assigned journal
articles in your discipline and consider the alignment of theory, problem, purpose,
research questions, and design. You will also identify the type of qualitative research
design the authors used and explain how it was implemented.
With these thoughts in mind, refer to the Journal Articles document for your assigned
articles for this Discussion. If your last name starts with A through I, use Article A. If
your last name starts with J through R, use Article B. If your last name starts with
S through Z, use Article C.
By Day 4
Post a critique of the research study in which you:
Evaluate the research questions using the Research Questions and Hypotheses
Checklist as a guide
Identify the type of qualitative research approach used and explain how the researchers
implemented the design
Analyze alignment among the theoretical or conceptual framework, problem, purpose,
research questions, and design
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