The Lived Experiences of People with Severe Obesity Who Use Community Health and Social Care Services: A Qualitative Interview Study

Abstract

Evidence indicates growing demand on community health and social care services by people with severe obesity (BMI ≥40 kg/m²), often due to functional limitations. The experiences of this population are largely unexplored. As part of a larger mixed-methods study, this qualitative study explored the lived experience of people with severe obesity using community health and social care services. Participants were recruited via community professionals and visited at home. They consented to individual, audio-recorded, semistructured interviews, which were transcribed and analysed using thematic analysis. Nine women and three men (n = 12) participated, aged 40–76 (mean 60) years, BMI ranged from 45 to 74 (mean 59) kg/m², and eight were housebound. Three overarching themes were identified. Firstly, the hidden struggles of living with a larger body affected all participants, including functional limitations affecting mobility and personal care. These contributed to a sense of being stuck physically, socially, and biographically. Secondly, most participants reported implicit weight bias by a system structurally unprepared to care for people with larger bodies. The majority of participants showed strong internalised weight bias, linked to shame and self-blame for their poor function and larger bodies. Thirdly, a day-to-day coping theme highlighted strategies regularly used by participants: resigned acceptance, avoidance and denial, exercising choice, and support from informal carers. These findings demonstrate that participants experienced unmet physical and psychological care needs associated with living with a larger body, leading to poor quality of care and life. Given rising prevalence, changes to care services are needed. Specific recommendations include staff training about the needs of people with severe obesity, ensuring that the physical infrastructure of care services can safely accommodate people with severe obesity, and improving access to effective, person-centred weight management treatments.