Background: There is a shortage of public hospital weight management programs (WMPs) that provide comprehensive, multidisciplinary care for people with class 3 obesity (BMI ≥ 40kg/m2). Given that over 75% of participants in most WMPs are women, this study aimed to identify the barriers to accessing a WMP for women with class 3 obesity.
Methods: This qualitative study was conducted in a Sydney Hospital WMP where one-to-one, semi-structured interviews with female participants were conducted between January and May of 2024. These interviews explored participants’ reasons for and barriers to accessing the clinic, and were recorded, transcribed and analysed thematically using Quirkos software once data saturation was reached.
Results: Seven women were interviewed in the study, with a median age of 49 years (IQR 17), weight of 133kg (25.8), and BMI of 49.8kg/m² (8.5). Five major themes emerged: logistical barriers, clinic resource/service availability, the pre-clinic journey of participants, health barriers, and psychosocial determinants. Logistical barriers included work schedules, family responsibilities, transportation issues and physical accessibility. Clinic resource limitations involved long wait times and restricted service availability. Participants’ pre-clinic journeys were marked by repeated, unsuccessful weight loss attempts leading to a sense of hopelessness and scepticism about new interventions. Health barriers included physical comorbidities which caused chronic pain and mobility issues, as well as mental health struggles which reduced motivation to attend the program. Psychosocial determinants encompassed stigma and judgment, both from healthcare providers and society, which further discouraged clinic attendance.
Conclusion: This study demonstrated the need to implement system-level strategies to address the barriers to accessing WMPs for women with class 3 obesity. These strategies should be centred around improving infrastructure, such as expanding clinic hours and locations, providing integrated support for mental and physical health, and increasing service accessibility by reducing wait times, increasing resource availability and improving transport options.