Archibald Daryll, Douglas Flora, Hoddinott Pat, van Teijlingen Edwin, Stewart Fiona, Robertson Clare, Boyers Dwayne, Avenell Alison
Scottish Collaboration for Public Health Research & Policy (SCPHRP), University of Edinburgh, Edinburgh, Lothian, UK.
Rowett Institute of Health and Nutrition, University of Aberdeen, Medical School, Aberdeen, UK.
BMJ Open. 2015 Oct 12;5(10):e008372. doi: 10.1136/bmjopen-2015-008372.
To investigate what weight management interventions work for men, with which men, and under what circumstances.
Realist synthesis of qualitative studies.
Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches.
Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m(2) in all settings.
22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had 'worked' for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled 'obese'; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design.
Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and strategies to minimise attrition.
探讨哪些体重管理干预措施对男性有效，适用于哪些男性，以及在何种情况下有效。
对定性研究进行实在论综合分析。
对1990年至2012年期间的11个电子数据库进行全面检索，并辅以灰色文献检索。
纳入1990年至2012年期间发表的报告对肥胖男性进行定性研究的文献，或与肥胖女性对比的肥胖男性以及生活方式或药物体重管理方面的研究。这些研究纳入了16岁及以上的男性，无年龄上限，所有研究对象的平均或中位数体重指数均为30kg/m²。
共识别出22项研究，包括5项与体重维持干预随机对照试验相关的定性研究、8项与非随机干预研究相关的定性研究，以及9项与任何干预均无关联的英国相关定性研究。健康问题以及认为某些项目对其他男性“有效”的观念是促使男性参与体重管理项目的关键因素。参与和坚持项目的障碍包括：男性在被贴上“肥胖”标签之前未将自己的体重视为问题；朋友和家人对新食物选择缺乏支持，以及不愿进行极端节食。在饮食方面保留一定自主权；对零食和酒精保持灵活性，并注重体育活动是项目的吸引人之处。小组干预、幽默和社会支持有助于提高参与度和坚持度。男性更愿意在方便、无威胁且符合其男性身份的环境中参加项目，但男性很少参与项目设计。
在设计体重管理服务时，应考虑男性在家庭、工作和娱乐等更广泛背景下的观点和偏好。需要对男性进行定性研究，为干预设计的各个方面提供信息，包括场所、最佳招募流程以及减少流失的策略。
