Differences and commonalities in barriers and facilitators experienced by participants enrolled in an online...

Online behavioral weight management programs offer a scalable solution to address overweight and obesity but often face high dropout rates and variable success. Understanding the barriers and facilitators experienced by participants who achieve weight loss targets versus those who do not is critical for optimizing programs. This study compared the barriers and facilitators reported by participants achieving ≥5% weight loss with those achieving <5%, using a social-ecological framework to capture influences across individual, interpersonal, and environmental levels. The framework was chosen to reflect the complex, interacting factors beyond the individual that shape behavior. Forty-eight participants completed semi-structured telephone interviews exploring factors affecting their weight loss journey. Interviews were analyzed using a thematic framework approach. Across both groups, key facilitators included willpower, knowledge, social support, and perceived safety in the local environment, with their absence acting as barriers. Food availability at home and in the workplace was also reported as a barrier due to temptation. Social roles could challenge behavior change, though perceiving themselves as role models provided motivation. Program-specific factors, such as group dynamics and difficulty using the platform, were barriers for both groups. Notable differences emerged between groups in responding to challenges. The ≥ 5% weight loss group proactively addressed stressors and sought solutions, while the < 5% weight loss group reported greater difficulty overcoming barriers, more interpersonal stressors, and dissatisfaction with their weight targets. This is the first study to compare qualitative experiences across social-ecological domains between participants achieving ≥5% and <5% weight loss during program participation. Findings highlight the need to address environmental infrastructure, interpersonal skills, and communication of weight targets to improve program effectiveness. Future research should examine how these factors can identify individuals at risk of not achieving 5% weight loss and inform tailored interventions.