Barriers and enabling factors in weight management of patients with nonalcoholic fatty liver disease: A qualitative study using the COM‐B model of behaviour

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is a global public health problem. Lifestyle modifications aimed at promoting weight loss and weight maintenance remain the current first‐line treatments for NAFLD. Objective We aim to identify barriers and enabling factors in weight management among patients with NAFLD using the capability, opportunity, motivation, behaviour (COM‐B) model of behaviour. Design This study adopted a qualitative design using semistructured interviews analysed with content analysis and the COM‐B framework. Setting and Participants Interviews were conducted with 27 patients with NAFLD who experienced successful or unsuccessful weight reduction. Results Our study included 27 participants: 15 participants with successful weight loss (successful weight loss refers to a decrease in body weight ≥7% of the initial body weight for patients with NAFLD) and 12 participants with unsuccessful weight loss. Thirty‐five themes (19 barriers and 16 facilitators) were mapped onto the COM‐B model as barriers and facilitators to weight management among patients with NAFLD. The key barriers were lack of time and energy, lack of awareness of weight, lack of attention to NAFLD, treating food as a reward or compensation and social entertainment. The key facilitators were having basic weight loss knowledge and skills, strong motivation, attention to NAFLD, unsuccessful weight loss experiences and positive feedback from phased success. Conclusion In addition to identifying factors consistent with existing studies, this study identified factors that influence weight management in NAFLD patients, such as basic weight loss skills and rational thinking before weight loss, which were not previously reported. This has clinical implications for clinical healthcare providers and health management services for the improvement of education and support regarding lifestyle improvement and weight management in patients with NAFLD. Patient or Public Contribution We recruited potential participants from the Bariatric Clinic, Hepatology Clinic and Physical Examination Center of hospitals between March 2021 and October 2021. Twenty‐seven patients with NAFLD who had successful or unsuccessful weight loss experiences participated in the study and responded to questions on weight management.

Barriers to lifestyle modification in patients with non-alcoholic fatty liver disease: a scoping review

“…In recent years, qualitative studies have examined barriers to weight management in patients with NAFLD using the COM-B model 40 ) ; the results, such as reactions to hunger, lack of awareness of NAFLD, and lack of time and energy, were consistent with those of the present study. However, the present study revealed differences in other results, such as physical symptoms interfering with the behavior, negative perceptions of the prescribed exercise and diet, life stressors, and inflexible work schedules.…”

Factors influencing adherence to lifestyle prescriptions among patients with nonalcoholic fatty liver disease: A qualitative study using the health action process approach framework

“…In addition, 80.0% of the participants had an undergraduate level of education or higher. While the patients' education level in this study was higher than that reported in previous studies involving patients with NAFLD (7,20,21), it was similar to the findings that higher education levels are usually associated with greater risk awareness and a greater emphasis on disease treatment (22, 23).…”

Mobile App–Based Lifestyle Coaching Intervention for Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial

“…Previous studies have reported the effects of regular exercise practice, associated with various types of diets or not, on weight loss [6][7][8]. However, some factors related to long-term weight loss maintenance and motivation for weight loss remain unclear in clinical practice [9][10][11].…”