Abstract

Background

Obesity is defined as having a body mass index (BMI) that exceeds 30 kg/m². The etiology of obesity is often presented as produced by a simple imbalance in caloric intake versus expenditure. This depiction can lead to the value-laden presumption of larger individuals as necessarily over-indulgent and inactive [1], and this personal attribution can exacerbate already widespread stigma [2–5]. However, obesity need not preclude the development of an athletic identity or enjoyment in physical activity; cardiorespiratory fitness can be a more powerful predictor of mortality risk than BMI; and physical activity can reduce morbidity risks independent of weight loss [6–15]. Such findings have helped support and sustain the Health-at-Every-Size (HAES) movement that argues for a focus on promoting self-care behaviors for individuals of all sizes, such as enjoyable physical activity and healthful eating, rather than weight loss outcomes [6, 7]. Importantly, while the independent benefits of physical activity among obese individuals are well documented [16–21], little is known concerning what motivates and hinders activity in obese individuals, how fat corporeality may impact on activity, and how positive or negative experiences in activity contexts may influence these issues [22]. While many studies focus on activity with an explicit focus on weight loss outcomes, most weight loss is transitory [23], and obesity is increasingly recognized as a chronic state [24]. A greater understanding of obese persons’ motivations and experiences respecting physical activity is required, in order to produce messaging and interventions that are resonant with the target population. This study provides these insights among obese persons with diverse weight trajectories and perspectives on weight loss, rather than presenting obese persons as necessarily characterized by the same weight histories and goals. Data were collected over a year to generate insight into change, rather than treating obesity as a stagnant condition. Findings from this study may facilitate programs and messaging that appeals to, and meets the needs of, a broad spectrum of obese persons. The ethnography from which this study derived was designed with a focus on health and quality of life. The importance of physical activity, experiences with physical activity, and motivations underlying participation or non-engagement in physical activity spontaneously emerged in every interview and during participant observation. These data were subject to a focused secondary analysis for this paper. Therefore, the purpose of this paper is to describe obese and formerly obese persons’ experiences with physical activity and motivators of physical activity that emerged when discussing health and quality of life over one year.

Methods

Participants

Recruitment occurred via online mailing lists and posters at multiple sites, following ethics approval from the researcher’s institutional Health Research Ethics Board. Study participants (n=15) were self-identified obese and formerly obese adults, males (n=2) and females (n=13), 18 years of age or older. Maximum variation was sought on perspectives of obesity, health, and weight loss. Purposive sampling ensured that participants hoping for weight loss, fat acceptance advocates, and HAES proponents were all recruited by probing for attitudes during screening contacts and initial interviews. Recruitment proceeded until the sample included individuals holding all these views. Approximately 80 % of participants were Caucasian. However, a wide array of participants’ socioeconomic status, living conditions, and ages (range: 30s-60s) were included. Because of the hospital-based nature of one of the electronic mailing lists used in recruitment, many participants were affiliated with the broader medical community or had been prior to retirement or other alteration in employment status. A diverse range of occupations was still present even among those participants broadly affiliated with healthcare including: individuals who worked from home on medical records, accountants, administrators, home care aides, social workers, and providers. Participant characteristics are summarized in Table 1. However, to ensure participants’ confidentiality, detailed demographic data is not reported; the recruitment pool is small and some noticeable body transformations and narratives may reveal participant identities, if linkable to demographic details. Most important to the aims of the study, a wide variation was achieved in participants’ weight trajectories, perspectives on obesity, and health behaviors. Such categories are necessarily arbitrary, contingent, and fluctuating. However, at the start of the study, approximately two-thirds were hoping to lose weight or maintain a weight loss, while a third of participants were striving to achieve a state of body acceptance. Individuals described losing weight prior to the study or lost weight throughout data collection, however; only two individuals would be considered formerly obese. To ensure confidentiality all participants were assigned participant numbers and pseudonyms upon enrolment in the study. Those pseudonyms are used in this article.

Table 1

Participant Characteristics

Age (Range)	Sex (n)	Household	Ethnicity	Occupation	Weight goals
30s-60s	Female=13	Partner=8	Caucasian	HC=6	WL=7
		No Partner=7	(n=12)	HC–U=2	ML=3
	Male=2	Has children=8	Other (n=3)	HC–P=5	A=5
				Other=2

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HC Healthcare employee, U Unemployed, P Healthcare Peripheral

WL Weight loss, ML Maintain weight loss, A Accept current weight

Results

Participants’ accounts of engaging in physical activity were multifaceted and complex. Most participants discussed numerous reasons for their often extensive engagement in physical activity. Participants expressed a desire to protect their bodies, engagement, and identities; pressure to adhere to standards or meet goals; and the pleasure derived from activity, involvement, or a sense of achievement. The major inter-related themes respecting physical activity motivators, inhibitors, and experiences described by participants are summarized in Fig. 1.

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Fig. 1

Inter-related motivators and inhibitors to obese persons’ physical activity. WL=weight loss; PA=physical activity; ED=disordered eating; HAES=Health-at-Every-Size; ↓=decreased; ↑=increased; = contributes to

Discussion

This ethnographic study explored the physical activity experiences of self-identified obese and formerly obese persons. Participants engaged in physical activity to protect their future health, for the sake of pleasure, and because they felt pressured to pursue health and weight aims in a stigmatizing environment. These priorities shifted over time, weight fluctuations, and activity engagement, but they remained in some iteration as the primary activity-related foci of most participants.

Obese persons’ concerns with physical functioning have been found in other studies [35–37]. Older obese African-American women, much like some participants in the present study, were more concerned with maintaining functional independence via physical activity, rather than solely weight-based goals [35]. Low income, obese mothers in Michigan expressed related priorities. Similar to participants in the present study, these mothers described health behavior motivators including concerns regarding future health issues, physical limitations, and an inability to interact with children [36]. Post-bariatric surgery patients also highlighted that the benefits of physical activity included a higher level of functioning that facilitated familial interactions [38]. While awaiting bariatric surgery, however, patients discussed how they needed to lose weight in order to engage in further physical activity [37]. Given high rates of weight loss recidivism [23] and still limited capacity for bariatric surgery, this is unfortunate; physical activity may be protective of functional status, even in the presence of weight gain [21]. Greater health promotion efforts encouraging physical fitness’s benefits on functioning, even irrespective of weight changes, may align with obese individuals’ own concerns and have profoundly beneficial wellness benefits.

Participants experienced a significant amount of stigma, and this affected their fitness identities and pursuits. This is similar to other studies, in which obese individuals felt judged for their sizes in activity contexts and this could de-incentivize health behaviors [36, 37]. Derogatory treatment and histories of disordered eating left some participants unwilling to pursue weight loss per se. By enhancing their fitness, speaking to these pursuits, and highlighting the injustice of obesity stigma, participants were able to protect their identities and unsettle some of the stigma directed upon them. Furthermore by focusing on fitness over weight loss, participants could work to protect their future functional capacity, derive pleasure from activity, and adhere to perfomative pressures, without feeling hopeless concerning static, cycling, or escalating weight.

Participants described enjoyment in physical activity that was not necessarily contingent on weight loss, regardless of whether their fitness endeavors were ultimately intended to achieve this end. Engagement and achievement in exercise may serve as its own motivator for ongoing activity [39]. Among adolescents, for example, personal fulfillment was the only independent motivator of activity, and, in fact, weight-based motivation was negatively associated with physical activity [40]. The pleasure-based activity motivations of participants in the present study strengthens the appeal for a greater focus on affect in body and physical activity related research [41, 42] and echoes findings from other studies on activity among obese persons [37, 38]. For some previously inactive participants in the present study, whole social relations, identities, and communities could emerge from physical activity.

The evident pleasure in activity demonstrated by participants reinforces the findings of other authors that athletic identities and material fatness are not mutually exclusive. Provided the opportunity, activity can be mastered and pleasurable regardless of size and despite previous stigmatization, as long as individual preferences concerning activity are taken into account, activities are appropriate, and environments are inviting [10, 12–15, 37, 43]. One aspect of making activity venues safe for obese participants frequently reiterated by participants in this, and other studies, is increasing bodily diversity in terms of gender, size, age, and ability [17, 37, 38, 44].

For some participants, pleasure related to physical activity was directly tied to making and recording progress. Heyes discusses the potentially enabling factors that may accrue from dieting in a commercial weight loss group [45]. The group offered a socially-approved and supportive venue in which women could be preoccupied with better knowing and enhancing themselves, even while trying to ‘correct’ non-normative bodies [45]. Many participants in the present study referenced the value of goal setting, rewards, and social supports as sources of motivation for activity.

Some participants expressed concerns that a focus on self-monitoring was dangerous to their overall wellbeing, based on prior disordered eating experiences. These participants struggled to balance pressures to be active, the pleasure they derived from activity and measuring their progress, and the worry this would lead to pathological behaviors. Similarly, patients waiting for bariatric surgery similarly asserted an” all or nothing approach” to physical activity and a need to meet potentially unrealistic standards of social contacts [37]. Overwhelming expectations and goals may ultimately discourage activity among obese persons. When weight goals are not met for overweight or obese women, despite beliefs in other benefits of physical activity, this can de-motivate exercise behaviors [17].

Overall, participants’ experiences of activity-derived pleasure were multidimensional, varied, and social. Innate experiences of enjoyment were always in danger of being overshadowed by the fear that their efforts were insufficient to achieve ‘wellbeing’ ([46]:23). This could lead to altered, ceased, or disordered activity patterns. That some participants were able to focus on overarching fitness and health goals, irrespective of weight fluctuations and plateaus suggests they are well-positioned to achieve the independent benefits of physical activity and fitness [16–21].

This study was characterized by strengths and limitations. The long-term engagement, participant observation, and repeated interviews helped enhance the trustworthiness of findings and their theoretical validity. Repeated interviews helped enhance rapport, produced more and richer data, allowed for organic member checking, and facilitated researcher and participant reflexivity while reflecting on past interviews. Furthermore, this research design provides greater focus on change than qualitative studies that only include one interview and therefore can present only a snapshot view of necessarily mutable bodily and attitudinal phenomena. Findings such as participants’ increasing sense of mastery, greater body acceptance, and shifting approaches to caloric vigilance were only apparent in the long term and highlight the advantages of using repeated interviews. During the larger study from which this data was derived, analysis was iterative and ongoing during repeated interviews. This allowed for member checking and clarification of issues from previous interviews during data collection, increasing descriptive and interpretive validity. Analysis was subject to ongoing external auditing, enhancing theoretical validity. Variability was sought in weight loss, health, and obesity attitudes. However, the sample was mostly Caucasian, middle-aged, presently obese women, many of whom were affiliated with the healthcare system. This is a major limitation of the study. Given the small and homogenous sample, the findings cannot be generalized. However, the findings largely align with studies conducted in other samples (reviewed above). Furthermore, the themes identified can be investigated in other samples to test their transferability, particularly as more research is needed exploring physical activity experiences and motivations among obese persons of different ages, ability statuses, races, sexualities, genders, ethnicities, and weight trajectories.

Conclusions

In an ethnographic study on obese persons’ experiences and health perceptions, most participants were active. The study was novel in its inclusion of participant observation and focus on change over time, and inclusion of individuals characterized by diverse weight attitudes and trajectories. To the existing literature, this study provides insights into what motivates obese and formerly obese persons to be physically active and how relevant experiences shape their perception of physical activity and its relationship to health, quality of life, and obesity. Findings from this study may help inform physical activity programs and messaging for obese persons. In addition to weight loss, motivators for physical activity included maintenance of functioning and mobility; feelings of weight-based stigma and pressure to be active; and pleasure derived from activity. Finding an environment in which participants felt safe and encouraged to be active was extremely important, and instances of such inclusion had major ramifications on social wellbeing. Ultimately, most participants invoked all of protective, pressure, and pleasure-based motives for physical activity involvement. Some participants cycled through these motivations depending on material changes in their bodies. While participants had pleasure-related reasons for engaging in physical activity, this enjoyment could be overshadowed by the grip of caloric fear or dread of a demobilized future; a need for performative achievement or a thinner body; or the need to be a conspicuous exception to potentially stigmatizing anti-obesity messaging. Focusing on their health and fitness achievements and behaviors may have helped participants cope with their sizes in a stigmatizing climate. However, participants could still be overwhelmed by pressures to always be healthier or more active, and many participants had histories of disordered eating and activity practices.

These findings imply that to encourage physical activity among individuals with diverse weight histories and attitudes, physical activity messaging and programming may benefit from moving beyond a weight loss focus. Many participants in the present study found physical activity rewarding in itself. Disappointment in weight loss aims could be a disincentive to physical activity. Furthermore, physical activity messaging should feature a variety of bodies and abilities, as should activity venues and classes. Discrimination in such settings should be strictly disallowed, and pacing and goal-setting should be moderate and at the participant’s discretion. An inclusive model of physical activity for people of all sizes would focus on enjoyment, pleasurable accomplishment, and social belonging emergent during physical activity, rather than focusing on possibly unachievable or ultimately exclusionary endpoints. This study also highlighted areas requiring greater research. Few men participated in the present study and similar research; therefore, more in-depth, long-term research is needed in exploring men’s experiences of physical activity while obese. The experiences of physical activity following significant weight loss or gain also must be explored.

Ethics, consent and permissions

Study was approved by the University of Manitoba Health Research Ethics Board.

Acknowledgements

Footnotes

References