Perceptions and Experiences of People with Obesity and Type 2 Diabetes Around Appetite and Eating Behaviors: A Qualitative Study

Abstract

Introduction: Chronic weight management and treatments for type 2 diabetes (T2D) involve a combination of lifestyle-based (diet, exercise) and pharmaceutical interventions. In people with obesity or T2D, understanding the impact of drivers/triggers on appetite and eating behaviors can be crucial to successful medical management. This study aimed to characterize perceptions and experiences regarding appetite and eating behaviors among people with obesity or T2D and identify drivers/triggers of food choices.

Methods: This non-interventional, cross-sectional, qualitative study utilized semi-structured concept elicitation interviews to explore the perceptions of people with obesity and/or T2D around appetite, eating behaviors and drivers/triggers of food choices. Adult US residents (≥ 18 years) with stable body weight (± 5 kg) in the 3 months preceding participation were included in the study.

Results: Forty-five participants (obesity: n = 15; overweight: n = 10; T2D: n = 20) were interviewed. Interviews were audio-recorded and transcribed verbatim for analysis. A subset of participants described eating behaviors on smartphone-based app tasks over 5 days. Most (> 96%) discussed the influence of hunger, cravings and satiety on food choices. Participants identified 22 drivers/triggers (including health, 95.6%; culture/heritage, 93.3%; location, 91.1%; stress, 88.8%). Participants also discussed associations between drivers/triggers and eating behavior concepts (appetite, hunger, cravings, satiety, motivation/determination). A conceptual model illustrating eating behavior concepts and related drivers/triggers was developed. The concept elicitation interviews identified a multitude of drivers and triggers and characterized the association of such drivers/triggers with seven core patient-reported concepts encompassing eating behaviors.

Conclusion: The findings build upon existing models of factors influencing food choices. Findings confirm prior research regarding impact of drivers/triggers on food choice in people with obesity and T2D and indicate underlying disease state does not appear to influence eating behaviors in people with stable body weight.

Keywords: Chronic weight management; Eating behaviors; Obesity; Overweight; Qualitative study; Type 2 diabetes mellitus.

Fig. 1

Study design. BMI body mass index, n number of participants in a specified subgroup, N total number of participants, T2D type 2 diabetes. Group A: participants with T2D. Group B: participants with BMI ≥ 30.0 kg/m². Group C: participants with BMI 25.0 to < 30 kg/m²

Fig. 2

Participant experience of hunger, cravings and satiety. N number of participants. Note: each concept is stratified by the number of participants who discussed the concept either spontaneously or when probed by the interviewer

Fig. 3

Drivers/triggers of food choice. N number of participants. Note: each driver/trigger is stratified by the number of participants who discussed the concept either spontaneously or when probed by the interviewer

Fig. 4

Conceptual model of eating behaviors and related drivers/triggers in obesity and T2D. n number of participants, N total number of participants, T2D type 2 diabetes. Drivers/triggers endorsed by five or more participants are presented in the conceptual model. Each driver/trigger is presented with the proportion of participants (n/N, %) who reported it to influence eating behaviors. Descriptors of a driver/trigger are provided with the number of participants who reported each during the interviews. Superscript numbers indicate participant-reported relationships/associations between drivers/triggers and eating behavior concepts