Hospitalised patients with extreme obesity have poorer healthcare outcomes compared to normal weight patients. How hospital services are coordinated and delivered to meet the care needs of patients with extreme obesity is not well understood. The aim of the proposed evidence gap map (EGM) is to identify and assess the available evidence on healthcare interventions to improve healthcare outcomes for hospitalised patients with extreme obesity. This research will use standardised evidence gap map methods to undertake a five-stage process to develop an intervention–outcome framework; identify the current evidence; critically appraise the quality of the evidence, extract, code, and summarise the data in relation to the EGM objectives; and create a visualisation map to present findings. This EGM will provide a means of determining the nature and quality of health service initiatives available, identify the components of the services delivered and the outcome measures used for evaluation, and will identify areas where there is a lack of research that validates the funding of new research studies.

<p>Young people appear to be under extreme pressure to live up to complicated, unrealistic expectations to ‘achieve’ across the domains of their lives. These expectations include achieving academically, gaining employment, volunteering their time, participating in their culture and community, as well as carefully maintaining the self physically and mentally. The pursuit of all these goals together may be a stressful, failure-prone task that can encourage feelings of distress, anxiety, depression, and, in extreme cases suicidality, amongst young people. Instagram is a key pedagogic tool for young people to understand who and how they should be in the world. Importantly, this platform may reflect and reinforce expectations of achievement by, and to, young people. Prefects are considered role models for their peers and as such may be under exacerbated pressure to meet these achievement demands. As such, their experiences may be particularly valuable to understand achievement imperatives. Expectations are gendered; achieving as a young woman, or successful femininity, is defined separately to standards of achievement for young men. As such, this thesis explores how young women negotiate complex and competing gendered achievement expectations through Instagram. Nine young women were recruited from a local, single-sex secondary school in Pōneke, Aotearoa to participate in a three-stage study. The first stage included an initial focus group exploring expectations these young women negotiated in their day-to-day lives. Following this, the participants were followed on Instagram for a period of six weeks during which time the interviewer engaged them in discussion around their posted Instagram content. A final focus group was conducted to explore these young women’s management of Instagram norms. Social constructionist thematic analysis was used to analyse focus group transcripts, online discussions, and Instagram content. Through Instagram, the participants negotiated three key achievement imperatives with their followers: control, authenticity and intimacy. These imperatives are explored through circumstances in which the participants achieve or struggle to achieve these in ways they prefer. At times the platform presented the achievement of these imperatives as a possibility, at other times the platform limited the participants’ capacity to manage these imperatives. The implications for the participants as they negotiate themselves and their lives through Instagram are discussed. This research has implications for the way that Instagram is understood, in research and in the public sphere, to impact young people’s health and wellbeing. Young people are critical, capable users of the Instagram platform, that aim to manage complex achievement imperatives within a constantly evolving social world.</p>