Table 3:

Selected quotes for theme 2: second-order barriers to change

SubthemeRepresentative quote
Root causes of obesityMy doctor said … “You’ve got to give up everything white.” … Like pasta and rice and bread. And I said “You’re killing me here.” That has always been my diet, growing up and everything. (nonreferred patient 2)
Healthy eating … was actually the hardest for me to do because I am a food addict. I have to be so careful. It is almost like I have to abstain from eating foods that trigger. (referred patient 7)
The thing that I struggle with most is that their root causes of obesity are outside of spirit of control and influence. So, things like access to healthy food, sedentary lifestyle, the built environment … those are all things that have led us to where we are. (family physician 6)
MotivationRecently … I had a patient and she was motivated because she wanted to have [in vitro fertilization] and was told she had to lose 150 to 200 pounds [68–91 kg]. … She has had great success, but again it is because she has a goal that she wants to get to so that she can finally have [in vitro fertilization]. (family physician 2)
I would say that most people don’t want to change, to be honest. It doesn’t matter what resources you have available. If you have this wonderful multidisciplinary team with a dietitian and social workers and everything … a lot of people are just not ready to change yet. (family physician 8)
He’s [physician] pointed me in all the right directions, now it’s just up to me to do it. It’s an everyday battle. (nonreferred patient 5)
Maybe this [bariatric surgery] will make me change the way I eat everything and exercise more and stuff like that. It was the motivation to have that good kick in the butt kind of thing to get you going to lose the weight. (referred patient 5)
I thought that it would be a proactive thing that I could do to lose weight and to control my diabetes. (referred patient 2)
To be healthier and to be able to control the weight areas, because I’m not really sure just with my weight just how many [comorbid conditions] it is controlling, you know. (nonreferred patient 2)
Perceptions of bariatric surgeryOf course, you will lose the weight for sure, but you end up with all sorts of possible complications, plus it’s not reversible. … It has a lot of risks, I think. I’m just not convinced. … Once you’re convinced yourself, then you can recommend, and so until they [patients] have tried nonsurgical measures, I would not recommend surgery. I just feel it’s like suggesting something that I think is harmful. (family physician 13)
I kind of wish my doctor had encouraged me a while back regarding surgery. It is almost like surgery is taboo or it is not something that is encouraged. They make it feel like it is the last resort. (referred patient 6)
I think if I … [changed] my diet and my lifestyle with the exercising and everything, and if I kept gaining weight, then it wouldn’t be just being lazy — then it [bariatric surgery] might be an option for me. But with what I’m doing right now and the improvement I’m seeing, most likely I wouldn’t say yes to it at the very moment. (nonreferred patient 7)