Approaches to obesity among adults with accurate body-size perception: a qualitative thematic analysis

Obesity is commonly framed through biomedical risk, yet it is also lived through functional limitations, emotional burden, and socially mediated experiences. Body-size perception may shape how individuals appraise risk and engage with change, but qualitative work has seldom focused specifically on adults who accurately perceive their body size.

This study explored how adults attending an obesity outpatient clinic with accurate body-size perception conceptualise obesity and describe its implications for everyday life and change efforts.

An interpretivist qualitative design was used. Participants were recruited from the Obesity Outpatient Clinic of Karadeniz Technical University Farabi Hospital using criterion-based purposive sampling with volunteer recruitment (May-August 2025). Accurate body-size perception was defined as concordance between measured BMI and the BMI range of the silhouette selected from BMI-anchored body-size guides. Semi-structured, one-to-one interviews (20-30 min) were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's thematic analysis with NVivo support; reporting followed COREQ.

Twenty-three participants were interviewed (mean age 46.1±10.1 years; mean BMI 35.5±4.6 kg/m²). Four overarching themes were generated: (1) health, functioning, and everyday life; (2) body image and emotional experience; (3) explanatory models and perceived causes of obesity; and (4) the struggle for change and seeking solutions. Across themes, obesity was described as a pervasive "burden" constraining daily activities and roles, emotionally taxing through body-image distress and socially "read" weight, understood through multifactorial causal narratives (lifestyle, stress, biology/medication, household routines, and the food environment), and managed through repeated cycles of attempts, plateaus, and regain alongside a strong desire for sustained professional support.

Among adults with accurate body-size perception, obesity was experienced as an embodied and socially situated burden, with change efforts characterised by fatigue and recurring cycles. Interventions may benefit from stigma-sensitive, person-centred care that addresses functional limitations, emotional drivers of eating, and longer-term behavioural support.