From Resistance to Belonging: Understanding Youth Experiences in Obesity Interventions

What Can We Learn from Lived Experiences in Obesity Interventions?

A recent phenomenological study conducted in Norway has revealed the complex lived experiences of children and adolescents participating in a community-based, family-centered lifestyle intervention for overweight and obesity. The research, which involved 11 participants aged 10-17 years, provides valuable insights into how these young individuals navigate the emotional journey from initial resistance to finding meaningful connections within such interventions.

The study employed a hermeneutic-phenomenological approach to explore participants' experiences through in-depth interviews and observation. This qualitative methodology allowed researchers to capture the nuanced perspectives of young people as they engaged with the intervention over time. Rather than focusing solely on weight-related outcomes, the research team sought to understand the subjective experiences and meaning-making processes of the participants, offering a deeper understanding of how children and adolescents relate to lifestyle interventions designed to address overweight and obesity. The two-year rolling program included weekly sessions lasting 60-90 minutes and regular family-friendly social activities on weekends, providing multiple touchpoints for data collection and participant engagement.

How Do Overweight Youth Transition from Resistance to Engagement?

One of the most striking findings was the participants' initial resistance to enrollment. Many described feeling objectified and diminished when adults suggested they needed to participate in the intervention. As one 13-year-old participant named Emma explained, "My mother and I sat down one day and talked about it.... My mum had attended a course here (at the clinic) before, and she thought it was not good for me to be overweight.... However, I did not think of myself as overweight; being overweight was not something that bothered me." This disconnect between self-perception and external assessment created significant emotional tension for many participants, who often felt their agency was undermined in the enrollment process. The research revealed how conversations with healthcare providers and parents frequently positioned the children's bodies as objects to be changed rather than respecting their subjective experiences, resulting in feelings of frustration, fear, and anger at the outset of the intervention.

Despite this challenging beginning, the study documented a remarkable transformation in participants' experiences over time. As they engaged with the intervention, many discovered valuable aspects of the clinical environment that contributed to a growing sense of belonging. The specialized equipment and professional atmosphere of the clinic provided affordances that participants came to value. As 14-year-old Morten expressed, "I like it here. For example, they have the things we need at the clinic for a real workout, which we do not have at home. At the clinic, it feels like exercising; then you get tired." This appreciation for the physical space and equipment represented a shift from initial reluctance to active engagement, with participants finding meaning in activities they previously resisted. The phenomenological analysis revealed how the participants' intentionality toward these existential elements allowed them to adapt to the intervention over time through a process the researchers described as "place-making," developing physical and emotional connections to the space and making it their own.

Perhaps the most profound aspect of the findings centered on the social connections formed within the intervention. Participants described how being part of a community of peers with similar bodily experiences created a sense of acceptance and belonging that contrasted sharply with their experiences in other contexts. The title of the study captures this sentiment powerfully: "I'm glad you're fat, just like me." This statement from one participant to another reveals how shared corporeality promoted enjoyment and connection. As 15-year-old Anton explained, "It is nice to be here at the clinic; I meet others... who are overweight... There are not that many overweight people at school... We have become a small family here." This intercorporeality—the shared bodily experience—fostered deep connections that transcended the intervention's original weight management goals, creating what one participant described as a "team" atmosphere where mutual support and understanding flourished.

What If Program Activities Clash With Personal Preferences?

From a phenomenological perspective, the study illuminates how the participants' lived bodies were integral to their place experiences within the intervention. Rather than experiencing their bodies as objects to be modified, many participants came to experience their embodiment as a source of connection and shared understanding. This shift represents a significant departure from typical biomedical approaches to obesity intervention, which often focus primarily on physical changes rather than experiential dimensions. The researchers noted that within the intervention space, participants could engage as embodied subjects rather than objects of evaluation, creating alternative understandings of their corporeality that differed from prevalent societal discourses surrounding body weight.

The study also revealed that participation occasionally involved uncomfortable experiences. As documented in the researchers' field notes, one participant named Lisa expressed discomfort during dance activities at the clinic, declaring "I hate dancing" when instructed to participate. During her interview, Lisa elaborated: "Oh no, I wouldn't say I like dancing. It's fun to make fun of myself that way—but I'm not fond of dancing. If we danced Hip Hop and had some cool moves to the music, that is okay; then it's, well, you must work on it. However, when we jump those three feet, shake our butts, then jump again... then it's kind of too much for me." This highlights how even within a generally supportive environment, participants sometimes experienced moments where they felt pressured to engage in activities that didn't align with their preferences, creating tension between conformity and self-expression.

Could Phenomenological Insights Transform Clinical Practice?

The findings have important implications for clinical practice. The researchers suggest that healthcare professionals should place greater emphasis on first-person perspectives when designing and implementing interventions for children and adolescents with overweight or obesity. The study highlights the need for more sensitive approaches to initiating conversations about weight management, recognizing that not every child who is clinically defined as overweight identifies with that label. By acknowledging the complexity of lived experiences, practitioners may be better positioned to create interventions that foster positive engagement rather than resistance. The research suggests that the sense of community and belonging that emerged as an "unintended side effect" of the intervention may be just as valuable as traditional weight management outcomes and warrants professional attention in future program development.

The study draws on established theoretical frameworks in phenomenology, including concepts from Merleau-Ponty's work on embodiment and intentionality. The researchers utilized Van Manen's approach to phenomenological analysis, which emphasizes the importance of understanding lived experiences through existential themes of lived space, body, relations, and things. This theoretical grounding provided a robust framework for interpreting participants' accounts beyond surface-level descriptions, allowing for deeper insights into how children and adolescents make meaning of their participation in lifestyle interventions.

In Norway, national guidelines define children and adolescents with an ISO-BMI above 25 as overweight, while those with an ISO-BMI above 30 are classified as obese. The guidelines recommend treatment for children and adolescents with a rising ISO-BMI or an ISO-BMI of 30 or higher. Recent studies indicate that 15% to 21% of children and adolescents in Norway and other Western countries are classified as overweight or obese, highlighting the significance of this public health concern. Treatment strategies primarily emphasize lifestyle changes, including dietary modifications and increased physical activity, with behavioral weight management programs showing small to moderate impacts on reducing ISO-BMI or slowing overall weight gain.

While the study offers rich insights, the researchers acknowledge limitations, including the relatively small sample size. However, the depth of the data collected revealed comparable experiences and sentiments across participants, enhancing the credibility of the results. The researchers suggest several directions for future research, including exploration of gender and age differences in intervention experiences, follow-up studies with the same participants, and investigation of parental perspectives. These avenues could further enhance understanding of how to create more effective and empathetic approaches to addressing childhood obesity.

How might incorporating these phenomenological insights improve the design and implementation of lifestyle interventions for overweight youth? Could a greater emphasis on community-building and peer support enhance outcomes beyond traditional weight metrics? What communication strategies might healthcare providers adopt to minimize feelings of objectification when discussing weight concerns with young people? As childhood obesity continues to present significant public health challenges globally, this study offers valuable perspectives that could inform more holistic and patient-centered approaches to addressing this complex issue.

Summary

A Norwegian phenomenological study examining lived experiences of 11 children and adolescents (aged 10-17) participating in a community-based, family-centered lifestyle intervention for overweight and obesity reveals a complex emotional journey from initial resistance to meaningful engagement. Participants initially felt objectified when enrolled by adults, often not perceiving themselves as overweight. However, through the two-year program featuring weekly sessions and social activities, many developed a sense of belonging through peer connections with others sharing similar bodily experiences. The study highlights how shared corporeality created what participants described as a "small family," with one stating "I'm glad you're fat, just like me." While some activities caused discomfort when misaligned with personal preferences, the intervention's physical space and specialized equipment also contributed to engagement. The research suggests that healthcare professionals should prioritize first-person perspectives in intervention design, recognizing that community-building and peer support may be as valuable as traditional weight management outcomes. Drawing on Merleau-Ponty's phenomenological concepts and Van Manen's analytical approach, the study offers insights for creating more empathetic, patient-centered approaches to addressing childhood obesity, which affects 15-21% of youth in Norway and Western countries. The findings challenge biomedical approaches that focus solely on physical changes, advocating instead for interventions that acknowledge participants as embodied subjects rather than objects requiring modification.