Barriers and facilitators to weight loss in patients living with obesity and OSAHS: a qualitative study based on the...

Weight loss represents a cornerstone therapy for individuals living with obesity and obstructive sleep apnea-hypopnea syndrome (OSAHS). However, long-term effectiveness is often limited by complex behavioral barriers, with over 70% of patients experiencing weight regain. This study explored patient-perceived barriers to sustainable weight loss and modifiable facilitators to clarify the interplay among cognitive, behavioral, and environmental factors in this population.

This qualitative study employed the Theoretical Domains Framework (TDF) guided by a critical realist epistemology. Semi-structured interviews were conducted with 26 purposively recruited participants living with obesity and OSAHS (mean age 43.2 ± 9.9 years, 73.1% male) from a tertiary sleep clinic in China. Recruitment continued until information power was achieved. Data were analyzed using abductive thematic analysis following Braun and Clarke's six-phase framework, with coding moving iteratively between deductive TDF domain assignment and inductive theme development.

Analysis mapped barriers and facilitators onto all 14 TDF domains. Key findings included knowledge misconceptions that actively shaped treatment preferences, a lack of behavioral repertoire rather than motivation driving unsuccessful attempts, and passive drift from goals indicating self-regulatory deficits. Environmental disruptions evoked helplessness, while social influences showed dual effects: supportive family enhanced adherence, yet well-intentioned behaviors sometimes undermined efforts. Facilitators included personal experience-grounded knowledge, health-related anxiety as a motivator, and desire for structured professional guidance.

This first application of the TDF to OSAHS weight management identified key intervention targets across capability, opportunity, and motivation dimensions. The findings provide preliminary evidence for developing theory-informed, multidimensional strategies and support a shift toward structured, personalized interventions. Given the exploratory nature of this study, these conclusions warrant further investigation in diverse populations.