Living With Obesity: Expressions of Longing

Abstract Those who are obese experience complex moral distress. The norm in Western societies is to be slim, and people living with obesity experience challenges under the gaze of society. They feel great vulnerability and the available treatments seldom meet individual needs. New concepts of embodiment need to be developed to include phenomenological investigations. There is limited knowledge about longing among those suffering from obesity. A deeper understanding of longing from an individual perspective is required to improve treatment. The aim of this study was to gain an in-depth understanding of the experiences of longing by those suffering from obesity. The research was approved by the Norwegian Regional Committees for Medical and Health Research Ethics. An explorative phenomenological–hermeneutical design was used. Qualitative interviews were conducted with 18 participants, all with body mass indexes in the range of 30 to 45, which were then analyzed using a phenomenological– hermeneutical approach. Three main dimensions of longing were revealed: longing for normality, longing for what was lost, and longing for simplicity in life. The health service needs to understand better the longings of obese individuals to help them live their lives in greater freedom, based on their own longings and self-care. Focusing on longing may reveal a person’s true desires, and the longing may be a form of resistance to the disciplination of society.publishedVersio

Therapeutic writing in a programme for binge eating disorder - A tool to come closer to clarifying feelings

Introduction Therapeutic writing involving affect consciousness (AC) can be used to put difficult topics into words. In this study, we investigated how patients with binge eating disorder (BED) experienced therapeutic writing and AC in the context of cognitive behavioural therapy. The elements were included in an existing cognitive behavioural therapy group programme and the participants' experiences investigated qualitatively. Aim To investigate therapeutic writing as experienced by patients in the context of a BED group programme focusing on AC. Method A phenomenological, hermeneutic design with semi-structured interviews was employed. Eight participants were recruited after completing the BED programme at a Community Mental Health Centre on the West Coast of Norway. Findings Four sub-themes emerged: Struggling to achieve a flow in the writing process, Deeper understanding of eating patterns through writing, Moving specific feelings towards the surface by writing and Greater insight into oneself as a human being by shared writing. Based on the sub-themes, one main theme was developed: Therapeutic writing in a binge eating disorder programme means focusing on oneself as a human being by becoming closer to one's feelings. Conclusion Therapeutic writing offered in treatment for BED involves individual movements at different levels, including processes of awareness of feelings, cognitions and oneself as a human being.publishedVersio

Health professionals' reflections on existential concerns among people with obesity

Abstract Purpose This study aimed to describe health professionals' reflections on existential concerns among people with obesity when attempting to support them in their lifestyle change processes. For many of those affected by obesity, the condition becomes lifelong and causes existential concerns. The health professionals' reflections on existential concerns among people with obesity may influence central aspects of their practice and their patients' well-being. Methods Eighteen health professionals with relevant health education working in three different treatment programmes for people with obesity were recruited for three focus group interviews. The interviews were analysed and interpreted using a model for interpretation of meaning at three levels with a phenomenological–hermeneutical approach. Findings The analysis identified three themes. The health professionals reflected on existential concerns among people with obesity in terms of patients' repressed emotional difficulties and lack of self-respect. In addition, they reflected on their own experiences of powerlessness when presented with people with obesity's existential concerns. Conclusion The present study provides valuable insights into reflections on existential concerns among people with obesity, based on health professionals' descriptions. We believe that these insights add to the existing literature and have consequences for how people with obesity are met and cared for.publishedVersio

Binge Eating Disorders – Experience of Change in the Relationship with Food and the Body during Treatment

Background: Binge eating disorder is a multidimensional mental health condition associated with a complicated relationship to food and the body. Non-pharmacological treatments such as psychoeducation are common, but there is a lack of knowledge regarding patients’ experience of completing a treatment programme. To our knowledge, no study has been conducted exploring the lifeworld of patients with binge eating disorder regarding changes in their relationship with food and the body during treatment. Aim: The aim was to develop a deeper understanding of how changes related to food and the body are experienced by patients with binge eating disorder during psychological treatment. Method: A qualitative approach was employed to explore the lifeworld of the participants. Eight patients were purposely sampled and interviewed, after which the interviews were transcribed verbatim and analysed using systematic text condensation. Results: Four categories emerged: Transition from senseless towards sensible handling of feelings, Transition from body-hatred towards body-benevolence, Transition from anxiety towards confidence in relation to others and Transition from mindless towards conscious eating. Conclusion: Patients suffering from binge eating disorder experience a disruption in their lifeworld, which creates a sense of distance between themselves and the world. Several transition processes emerged after treatment, which were experienced as unifying in the patients’ lifeworld and enhanced their sense of closeness to themselves.publishedVersio

Living with obesity — existential experiences

Aims and objectives: The aim was to gain in-depth understanding about individuals’ existential experiences of living with obesity. Background: People living with obesity face great vulnerability and existential challenges. The different treatments offered do not seem to meet the individual needs of persons with obesity. A deeper understanding of existential experiences from an individual perspective is needed to individualize treatment. Design: An exploratory phenomenological–hermeneutical design was used to gain a greater understanding of the existential experiences involved in living with obesity. Methods: The participants represented a convenient sample. 18 qualitative interviews were conducted and subjected to phenomenological–hermeneutical analysis. Results: Four themes emerged: shaped by childhood; captured by food; depressed by the culture; and judged by oneself. Conclusions: The burden of being obese can be experienced as being objectified and alienated as a human being. We need to turn towards a life-world perspective, seeing each human being as a living body to overcome objectification and alienation, and then move them towards becoming subjects in their own lives, through giving space for self-love. Health care workers need to assist persons living with obesity to reduce objectification and alienation. It is important to develop intervention that has an individual, holistic approach.publishedVersio

Homeworld/Alienworld: a qualitative study about existential experiences after cancer treatment

Background As a group, cancer survivors experience significant vulnerability and existential challenges. The biomedical approach dominating health care is insufficient to meet such existential challenges in an individualistic, holistic way. Objective This study aimed to explore the existential experiences of those treated for different cancers. Methods An exploratory phenomenological–hermeneutical design was used to obtain an understanding of existential experiences after cancer treatment. Data were collected through in‐depth interviews with 21 individuals who represented a purposive sample and were recruited from a cancer organisation. Results Three overriding themes emerged from the phenomenological–hermeneutical analysis are as follows: Experiencing an unfamiliar tiredness; Experiencing not being fully oneself; and Experiencing a feeling of being alone. Conclusions Existential suffering after cancer treatment involves living on the edge of the old homeworld and the experience of a new alienworld. Individuals undergoing such suffering need a transformational process, from the alienworld to the homeworld, which must be supported by the healthcare system.publishedVersio

Aspects of well-being when struggling with obesity

Purpose: We aimed to gain deeper insight into how people struggling with obesity handle their life situation by addressing how well-being might unfold. For many people, obesity becomes a lifelong condition characterized by repeated weight fluctuations while their weight increases gradually. From an existential perspective, constantly waiting for weight loss can cause an experience of not reaching one’s full potential. How people with obesity experience well-being, within their perceived limitations, is less reflected in previous research. Methods: We established a qualitative study using in-depth interviews with seven men and 14 women with obesity (body mass index 335 kg/m2) aged 18–59 years. The study had an exploratory design including a phenomenological–hermeneutic perspective, with a lifeworld approach. Results: Three themes describing aspects of well-being were developed: coming to terms with the body, restoring the broken relational balance and reorienting the pivot in life. The thematic findings were abstracted into a main theme: striving to make living bearable. The movement towards well-being can be seen as a struggle towards an experience of balance to make bearable living. Conclusions: We suggest that well-being as a dialectic between vulnerability and freedom might become a health-facilitating experience for people struggling with obesity.publishedVersio

Organizational structures influencing timely recognition and acknowledgment of end-of-life in hospitals – A qualitative study of nurses' and doctors’ experiences

Healthcare personnel's timely recognition and acknowledgment of end-of-life (EOL) is fundamental for reducing futile treatment, enabling informed decisions regarding the last days or weeks of life, and focusing on high-quality palliative care. The aim of this study is to explore and describe nurses' and doctors' experiences of how organizational structures in hospitals influence timely recognition and acknowledgment of EOL. A qualitative explorative design was applied, with data collected through 12 individual in-depth interviews using a semi-structured interview guide. A total of 6 nurses and 6 doctors were strategically recruited from medical and surgical wards in a Norwegian hospital. Qualitative content analysis was used. The analysis revealed the theme The importance of hospital organizational structures in timely recognition and acknowledgment of EOL and a subtheme comprising three areas of organizational structures influencing timely recognition and acknowledgment of EOL; Challenges to and demands of continuity, collaboration, and time. The study's results show challenges in identifying when cancer patients approach the last weeks and days of life within hospital wards. For nurses and doctors to be able to recognize and acknowledge EOL, continuity of care, collaboration, and time is needed. A fragmented healthcare system, with a predominant focus on treatment and cure, may prevent cancer patients from receiving timely palliative, care causing unnecessary suffering.publishedVersio

How elderly residents in nursing homes handle loneliness – from the nurses’ perspective

Introduction: Elderly people who leave their home environment and move to a nursing home enter a phase in life with diminishing contact with family and friends. This situation often results in a feeling of loneliness with a concomitant deterioration in physical and mental health. By exploring the topic through the lens of the nurses, this study takes a novel approach to address an under-researched area in the nursing field. Objective: The objective of the study was to identify, based on the nurses’ experience, how elderly residents handle loneliness in the nursing home. Methods: This study used a qualitative explorative approach with data collected through two focus group interviews with nine nurses at two elderly care facilities in Norway. The resulting transcripts were examined using an approach based on inductive content analysis. Results: Three main categories emerged as crucial to help lonely nursing home residents cope with day-to-day life: (i) maintaining ties to one’s earlier life; (ii) engaging in recreational pursuits; and (iii) building new networks. Conclusion: Analysing the findings based on sense of coherence (SOC) and person-centred care (PCC) theories illustrates the importance of maintaining a connection with both family and friends. To that point, having access to familiar objects from their earlier life seemingly provides meaning to the residents by bridging the past and the present. Recreational activities, ideally adapted to each person’s needs and ability, have a positive impact by providing structure and meaning that help overtake feelings of loneliness. Building a new network with fellow residents and staff imparts a sense of meaningful community belonging and projects both dignity and self-worth.publishedVersio

Life after cancer treatment – existential experiences of longing

Purpose: The study aimed to gain insight into existential longing as experienced by people treated for cancer. Method: An exploratory phenomenological–hermeneutical design was used, and data were collected through in-depth interviews with 21 people recruited from a cancer organization. Results: Three themes emerged: longing to be oneself, longing for relief from suffering, and longing for rootedness. The theoretical understanding of well-being developed by Todres and Galvin was used to illuminate how the life-fulfilling power of longing is inherent in dwelling–mobility. Conclusions: During the theoretical interpretation and discussion of these findings, a new analytic step revealed a state of uncertainty that can influence longing. The findings of this study may help fill the gap in the current health-care approach to cancer survivors by highlighting the importance of a new professional perspective of listening to patients describe their existential burden. Such an approach may create greater clarity and thereby allow longing to flow more freely towards future possibilities and well-being.publishedVersio