ST1 Impressions of dieting.

Collated findings from the FGIs outlined that on the whole men perceived dieting, and associated connotations including weight loss, in a generally negative manner associated to the short-term perception of dieting, particularly the restrictive nature of the approach. This was expressed by participants with the following examples:

• “I think diets are often a short-term crash programme and it’s very difficult to sustain those” (FGI 2)
• “I associate diet with dieting as having negative connotations…my perception is that diets are not successful” (FGI 3)

This essentially implied that strategies to support men should not emphasise or focus on terminology associated with diet or restriction. In addition, the negative connotations perceived by men around diets and dieting, may inadvertently lead them to be automatically put off by a weight loss programme (which was noted as being associated with denial of foods or a lifestyle they enjoy), potentially resulting in a rebellious approach to such initiatives. Expressed consistently across all focus groups, this was portrayed by participants as follows:

• “I think diet is a very negative word because as soon as you mention the word diet everybody automatically thinks restriction, restriction, restriction” (FGI 2)
• “When I’m looking at doing any kind of restrictions or dieting a part of me kind of rebels against it as it were” (FGI 3)
• [Diets involve] “Denying yourself certain things” (FGI 4)

Despite these negative perceptions, across the focus groups participants alluded to (with a degree of self-pride) the number of diets they had attempted. It was therefore noteworthy that whilst diets were perceived as wholly negative, there appeared to be perceived merit in accumulating dietary attempts as a need for personal challenge. This was expressed as follows:

• “I’ve pretty much been yo-yo dieting since I’m 18 up and down up and down, so I’ve been in that situation many times” (FGI 2)
• “I’ve done south beach…I tried Lighter Life, that gave me stomach aches, so did SlimFast… I did Slimming world, but I don’t like the Americanised, yeeha meetings…” (FGI 4)
• “I’ve done the 5:2 intermittent 500 calories in a day isn’t really good, I was thinking about doing the 16:8…I’ve tried vegetarian diet but I gained on that one” (FGI 4)

Fundamentally these insights highlighted the often-poor efficacy associated with generic, commercial programmes, which participants appeared to perceive as a type of challenge. If that challenge was achieved this equated to weight loss (sustainable or not); however, if unsuccessful, could reinforce their negative views of dieting. Furthermore, opinions suggested that diets are cyclic in nature consisting of sustained periods of weight gain intermitted with periods of dieting, further reinforcing the negative connotations associated with dieting and weight loss. Therefore, for weight loss initiatives to be both successful and sustainable, terminology should target away from “diets” and “dieting” and positively phrased towards a form of personal challenge.

ST2 Perceived effort and willpower.

Following thematic analysis, it was evident that there was pertinent discussion surrounding the self-discipline and effort required as well as the motivation to engage in such programmes, supporting ST1. The perceived effort required to undertake weight loss initiatives was raised across all focus groups and acknowledged by the majority of participants. It was therefore evident that this was a regular factor impacting programme engagement, as noted below:

• “It’s finding that motivation to actually get on and do it. And I need to be really focused on something to be able to do it on my own” (FGI 1)
• “The issue with a diet. Over the years I’ve actually struggled” (FGI 3)
• “There has to be that willpower, whatever it is as soon as I start to fail I just give up mentally and then it all falls apart and then a year later I try and gain and it’s just a cycle” (FGI 4)

Furthermore, the men demonstrated that even the smallest of perceived negative encounters when undertaking a weight loss programme such as food temptations or tasks requiring effort, could act to disproportionately demotivate male participants in future attempts.

• “Temptation is normally the thing that breaks you” (FGI 1)
• “Even the slightest set back can bring the whole thing crashing down” (FGI 1)
• “Now calorie counting, I’m not going to do it just because I can’t be arsed” (FGI 2)

It was therefore observed that the perceived effort, willpower or motivation needed to engage in traditional weight loss or dieting programmes was considered a central factor in poor success in the men interviewed, in some cases aligned with perceived failure. This highlighted that longer term initiatives need to consider factors which are both easy and achievable, whilst building in appropriate coping strategies to offset the potential for relapses or failure.

ST3 Gendered perspectives.

It was evident that men identified with a male gendered narrative when it comes to dieting and/or weight loss. A proposition raised initially by one participant in FGI 2, but subsequently endorsed across other participants, posited a gendered-binary perspective suggesting that women utilise “dieting” as a lifestyle factor, which contrasts with male-centric competitive sporting approaches. He did accept that not all men prefer sport or exercise to lose weight and highlighted the need for alternative approaches:

• “I think a lot of men, if you like sport, because this is okay if you’re doing it with people who are active….. I’ve done a lot of sport but there’s an awful lot of blokes out there that don’t do sport so you need to try and find another way to challenge them to realise yes, it’s not a diet you’re not a woman just accept the fact you’re a bit overweight and this is the way to do it” (FGI 2)

Clarification as to what the participant meant when suggesting that women diet, led to an open discussion exploring how men perceive weight and dieting in comparison with women. It was noted that some participants felt that dieting was a common approach for women and often discussed by them, particularly around weight and aesthetics, amplified by social media pressure. The negativity expressed by the men inferred that they were less inclined to be drawn into the dieting culture. This view was shared across the majority of participants, demonstrated as example:

• “I believe that women to look at dieting a bit differently from men and potentially different reasons” (FGI 2)
• “I feel women pay more attention to their body, the size of their body, the shape of their body compared to men” (FGI 2)
• “When we go down to the pub or socialise, we’re not necessarily talking about our weight or our appearance as such” (FGI 3)

The role of social media and advertising in reinforcing this perception were also noted as part of this theme:

• “When you look at articles if you go online and they used to have slimming stuff on TV would always have women so there was always an ad there that women need to look slim” (FGI 2)
• “Women it’s part of that conversation because now it’s social media pressure. And it’s there in the magazines and stuff, whereas it’s not the topic of conversation primarily for men. And I think it’s that whole culture change” (FGI 3)

These insights highlighted that for weight loss initiatives to be successful for men, a male gendered narrative should be employed, potentially focusing away from connotations of “diet” and being “slim” and more towards a positive challenge, which for some could involve sport or exercise.

ST4 The weight gain journey.

Throughout the focus group discussions there was also reference to the men’s relationships with food, particularly the cyclic nature of dieting. Men outlined a pervasive draw towards prior dietary habits and their relationship with food as a key issue with weight loss initiatives; as example this was expressed by one participant as:

• “The problem is me; the problem is the background. My relationship to food, the way I’m eating when I’m not dieting” (FGI 1)

Another participant, who mentioned that both “culture” and the “root cause” requires tackling, provides further clarity as to the superficial nature of dieting (as well as reaffirming that diets are a temporary approach), which in turn leaves the dieter susceptible to relapse.

• “So, if I lose weight and become not big. I then go, right my diet over I’ll return to my normal way of eating. But my normal way of eating made me big. So, I’m going to be big again aren’t I. So, you really have to tackle the culture, the root cause and not the symptoms” (FGI 1)

This weight gain journey was consistently expressed across all four groups, with the majority of participants describing a cyclic return to prior habits, as follows:

• “I’d lost my weight and then I thought I’ll have a doughnut today. And then one doughnut became two... and before you know where you are, you’re back at the other end of where you want to be” (FGI 1)
• “So, you can do that for a certain amount of time, but eventually, something will trigger it, or it will creep back and you will end up on the same kind of weight I’ve always been” (FGI 1)
• “I got down to 12 stone with that and as soon as I stopped I went all the way back up” (FGI 4)
• “Everything I’ve tried as soon as you stop doing it and go back to where you were it has to be a lifestyle change not a diet” (FGI 4)

It was therefore felt that men’s prior experiences had often led to the fundamental belief that diets are unlikely to be successful based on the negative weight-loss-weight-gain journey, and that having a better relationship with food could likely be a more sustainable strategy.

ST1 Lack of knowledge.

It was evident from discussions that men perceived that having the right knowledge and information was important in creating the environment required for successful weight loss. This was noted as follows:

• “Knowledge is the biggest one, because there is so much misinformation out there about what makes a successful diet” (FGI 1)
• “I think knowledge is the key here. Knowing processed food is especially bad for you” (FGI 1)
• “One of the things which is a typical male way of living is we know everything we don’t like being told what to do, we don’t like to admit that we don’t know what we’re talking about” (FGI 2)
• “I did MyFitnessPal …. and that was an absolute pain... for me because I’ve got no idea about what calories are or anything… I completely rely on [my wife] so what she used to do was cook the dinner, tell me what was in it and then half the time as I’m trying to find everything and put it in …my phone” (FGI 4)

The last comment, aside from outlining a lack of knowledge with calories, suggested a dependency on the spouse to both prepare food and support the participant’s dieting attempts. Spousal support is further outlined in Theme 4, ST3. This sub-theme highlights the need for accurate dietary information which needs to be easy to understand and follow. Whilst partly expressed by participants (via spousal support), other forms of authoritarian or expert opinion may be important in reducing the negative connotations of misinformation.

ST2 Lifestyle barriers.

Following on from the prior discussion, we also uncovered how lifestyle factors, in particular working patterns, can be disruptive and could eventually undermine adherence to a dietary regime. Occupational and lifestyle demands were raised as significant barriers across three of the four groups, particularly among full-time workers.

• “You come home from work when you sit down because I’ve been working for eight or nine hours doing a physical job... and I don’t want to go out and do stuff, so you want to eat the simplest things which is kind of pasta or whatever without realising the effect” (FGI 2)
• “So I use to do long 12-hour shifts where you would struggle to be able to eat on the shift regardless of what you were trying to eat. And then at home, you’re exhausted afterwards. You don’t want to cook particularly good things. I’ve never found salads and fruit items particularly filling. There might be a psychological factor with that. But I would try and eat something healthy like baked potatoes, beans and a huge salad with it. Build up on the good bits with it. Half an hour afterwards I’d be sitting there going I’m starving” (FGI 3)
• “Other complications of life come into that, such as what my wife eats” (FGI 4)
• “That’s partly what my lifestyle issue is I’m out coaching tonight and I’m not going to get back until half eight and then we’re going to eat then” (FGI 4)

These insights highlight the need for weight loss initiatives to focus on “simplistic opportunity”; that is, tasks requiring minimal effort and time, which can be easily accommodated as part of a busy lifestyle. Based on participant discussions this not only needed to involve clear and correct information, but easy to manage and practical strategies built within typical habitual lifestyles (not as additional requirements).

ST1 Perception of body/self-image.

Negative body image was expressed with persistent emotional intensity across the focus groups, with most participants able to recall a specific triggering moment where realisation or self-awareness acted as a key component for personal change. Early on it was made clear to the researchers that the men regularly observed themselves and were overwhelmingly shameful in nature, outlining a negative aesthetic perception of themselves, which in turn impacted self-confidence. The majority of the men were able to clearly recall, often in detail, these negative feelings prior to attempting weight loss.

• “It’s an embarrassment because I’m thinking, people are looking at me thinking I’m fat again I can’t believe I’m the size I am” (FGI 2)
• “Looking in the mirror and just feeling absolutely disgusted with myself” (FGI 3)
• “I actually do like to wear suits and the suits I wear now it’s not flattering anymore” (FGI 3)
• “I walked past a mirror and thought, you’re a fat bastard to be perfectly blunt. A mirror, no T-shirt on and I just thought, Jesus that’s the biggest I’ve ever been” (FGI 4)

ST2 Motivation for change.

Body image and aesthetic dissatisfaction were clearly noted as dominant motivators raised spontaneously by most participants. However, throughout the open discussions, participant responses also focussed more towards the triggers to action and uncovered two core areas of interest invoking motivation for change: aesthetic appeal and personal identity. Although a different perspective and acknowledging the overlap with the previous sub-theme (referring to the level of dissatisfaction with oneself), the following sub-theme related more to self and external perceptions of image and personal identity. Responses were overwhelmingly related to negative body/image, and it was made apparent that these perceptions, induced a point in which “enough was enough” and culminated in positive action, albeit often impulsive or sudden.

• “I think for me if I’m completely honest I needed the shame, if that makes sense” (FGI 1)
• “It was an identity thing… I didn’t want to be like this” (FGI 2)
• “So, for me personally it wasn’t about weight, I never look at weight it’s how aesthetically you look that’s what I go on which is why this is massive for me... it’s not about weight I could weigh 100 kilos, 80 kilos it’s how I think I should aesthetically look” (FGI 2)
• “I hated photos of myself” (FGI 3)
• “So, there’s a kind of mismatch between your identity and who you think you are and who you actually are” (FGI 4)

Whilst aesthetic concerns dominated, the second largest motivator to change related to health and usually triggered meaningful action, due a prior health scare or concerns associated with health risk.

• “And then when they said I was diabetic type 2 or whatever it was. They wanted to put me on medication, and I said no” (FGI 1)
• “I had to have emergency open heart surgery. That was a big wake up call. But even more so, the photo was the more, bigger prompt” (FGI 1)
• “I could feel something was not right, and that triggered me to start my exercises” (FGI 2)
• “I had no awareness of how things were [in relation to a routine health check-up]” (FGI 2)
• “At home I happened to read a few cases of heart attack of people who are the same age as me and then I really started thinking about it, I still don’t know whether that was a fear of heart attack or something that triggered me” (FGI 2)

These insights highlighted that men were more governed by aesthetic appeal and personal identity (moving away from negative body image and aesthetic dissatisfaction) how they thought they should be looking. However, it appeared that a significant prompt (visual image of their physical self) or a potential health scare acted more directly as a “wake up call” to take meaningful action. These factors if utilised effectively could act to create acute awareness around their current circumstances and positively incentivize pro-action.

ST1 “The buddy”.

The buddying system was the most frequently cited support structure, raised spontaneously across all focus groups and endorsed by the majority of participants. “The buddy” was commonly acknowledged as being an important approach to long-term engagement to change for men specifically. The idea of “competitive socialisation” was proposed as being central to sustained engagement in weight management programmes and focussed on male-centric social structures. This level of social accountability coupled with a sport or competitive element was highly noted across the FGIs.

• “Having a check in buddy, somebody on the diet who is motivated enough and says “Okay, do you want to check in buddy, do you want somebody you could talk to?” (FGI 2)
• “Surround yourself with people who are on the same mission” (FGI 2)
• “That would be certainly much easier if you were collaborating or even competing with someone, I think that would be an easier thing to do” (FGI 4)
• “But if I knew I was going to meet a bunch of people and run around the park together I’d probably commit more to that” (FGI 4)

ST2 “The mentor”.

Following on from the above sub-theme, in contrast to the need for social companionship (or a “buddy”) some interviewees suggested that direct mentorship would likely enhance accountability and therefore success. Depending upon the individual, some men preferred the need for a knowledgeable “mentor” to check on progress, provide advice and motivate; accordingly, differing slightly in context to a “buddy” system by re-positioning themselves into a subordinated role.

• “If you have a coach, if you hired a coach and contact them regularly and they motivate you, give you things to do and you are always checking in with them so some sort of mentor” (FGI 2)
• “I think having an accountability partner is key to weight loss” (FGI 2)
• “Because it’s always nice for someone to check in on you and make sure you are sticking to what you say you are going to stick to” (FGI 2)
• “Or just have a professional check-in. Have someone external who can see the progress in some way. I think that would probably be a good push” (FGI 3)

In part, this aligned with Theme 2 (ST1 Lack of knowledge) highlighting the need for guided support, monitoring or tracking potentially from a mentor with professional expertise (i.e., coach, healthcare professional) which could invoke a degree of trust and/or accountability.

ST3 “The spouse”.

The requirement for male-specific tailored support strategies, whether from a knowledgeable mentor or peer was a common suggestion and yet interestingly, most men also outlined how spousal support was pivotal for sustained success and adaptation to lifestyle change. The men were vocal when expressing how favourable spousal support had been and would often expand to the point of suggesting that the diet was largely orchestrated by the partner which inadvertently suggested that the male, again, acted in a subordinated role by having the spouse prepare meals and provide advice. This was expressed as follows:

• “My wife structures our meal plan, but she does like 10 days shopping in a row. And she’ll say to me, what do you want to eat on these days?” (FGI 1)
• “The snacks she buys me are apples rather than chocolates and stuff like that. That’s half the battle” (FGI 1)
• “My wife helps me now a hell of a lot because she kicks me in the arse when I start to go for the doughnuts again” (FGI 1)
• “For me, it was having the support of my wife. Without that, I wouldn’t have done it because she buys the food, she does the cooking in the evenings because I’m not home till late. If it wasn’t for her doing that then I wouldn’t have got as far as I did” (FGI 1)
• “(Use of a dietary app) because my wife uses it too which is motivationally extremely helpful” (FGI 2)
• “Because my wife made me a packed lunch” (FGI 4)

These insights also suggested that the men may not have fully immersed themselves within the dietary mindset (or did not feel a need to) and instead capitalised on the availability of spousal support to relinquish almost full control, including behavioural aspects, such as goal setting, self-motivation and self-control. As such, spousal support was deemed a key factor in sustainable practices which could be additionally beneficial in offsetting perceived setbacks.

ST4 Additional supportive factors.

Whist recognising the importance the men placed on peer support, this did not disregard other factors deemed important for dietary success, which varied amongst participants. The following views were raised across multiple groups, albeit with less consistency than the three primary support structures, and therefore grouped as additional supportive factors, including: clear and translatable knowledge; motivation through regular measurements; being realistic with goal setting; identifying root causes associated with weight gain; and keeping initiatives simple. Knowledge was a recognised as primary skill when embarking and engaging with a diet (including when attending group meetings) but also outlined the importance of social interaction, despite being initially dismissed by one recipient, as example:

• “Whilst I didn’t get much from the group aspect, one of the things I did appreciate from going to the groups was the knowledge I got. Even people that were doing their diet just like I was learning new things. And they were saying by the way, if you make your own sauces, it’s really easy to do. You just throw this, this and this in. Oh, that’s a good idea. You would get a little bit of knowledge, and you’d get that from like this little messenger group” (FGI 1)

Additional comments further outlined the array of opinions as to what could also be deemed as important when embarking on and sustaining a weight loss initiative for men:

• Motivation: “It’s all psychological as well, knowing that I’ve got to weigh. I don’t know, there’s something about it. It’s acknowledgement that you’ve got to weigh in” (FGI 1)
• Setting realistic achievable goals: “In 2019 I was 14 and a half stone in January. Then I got married 2020 January the second I was 10 and a half, so I’ve lost four stone. And for my frame and my height, I think 10 and a half stone wasn’t really realistic. But I managed to maintain that until COVID hit and had to stop going but I don’t think my target weight which I hit was realistic” (FGI 1)
• Identifying the root cause: “It’s knowing it’s a long journey and knowing that lesson I learned. You’re only tackling the symptoms; you need to tackle the root cause” (FGI 1)
• Simplicity: “It needs to be simple; it can’t be something that you have to think about and takes up too much time because I wouldn’t bother, I would go, “Oh yes this is fun” and three days later it’s no longer fun it’s a drag” (FGI 4)