A symptom diary to assess severe premenstrual syndrome and premenstrual dysphoric disorder

The differentiation between premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) has been widely discussed. PMDD is listed as a mental disorder in the DSM-5, whereas PMS is not considered as a mental disorder in any diagnostic manual. Consequently, PMS is operationalized in different ways. Keeping a symptom diary is required to diagnose PMDD but is also recommended for PMS. The aim of our study was, therefore, to operationalize PMS and PMDD within a DSM-5-based symptom diary. We developed a symptom-intensity-score (SI-score) and an interference-score (INT-score) to evaluate the symptom diary. Ninety-eight women (aged 20–45 years) completed a symptom diary over two menstrual cycles, a retrospective screening for premenstrual symptoms, and answered additional impairment questionnaires from August 2013 to August 2015. The scores revealed moderate to good reliability (Cronbach’s α = 0.83–0.96). Convergent validity was shown by significant correlations with a retrospective screening, the Pain Disability Index, and the German PMS-Impact Questionnaire. Discriminant validity was indicated by low correlations with the Big Five Inventory-10. These scores may facilitate the evaluation of prospective symptom ratings in research and clinical practice. Future research should focus on continuing to validate the scores (e.g., in an ambulatory setting).     

The diversity of opinion among general practitioners regarding the threat and measures against COVID-19 – Cross-sectional survey

BackgroundAfter the ‘first wave’ in spring 2020, opinions regarding the threat and measures against COVID-19 seemed to vary among German general practitioners (GPs).ObjectivesTo systematically investigate opinions and to identify subgroups of GPs sharing similar views.MethodsA questionnaire was sent to all 210 practices accredited for undergraduate teaching of family medicine at the Medical Faculty of the Technical University of Munich. Questions addressed personal opinions regarding risks, dilemmas, restrictions and their relaxation associated with COVID-19, and personal fears, symptoms of depression and anxiety. Patterns of strong opinions (‘archetypes’) were identified using archetypal analysis, a statistical method seeking extremal points in the multidimensional data.ResultsOne hundred and sixty-one GPs sent back a questionnaire (response rate 77%); 143 (68%) with complete data for all 38 relevant variables could be included in the analysis. We identified four archetypes with subgroups of GPs tending in the direction of these archetypes: a small group of ‘Sceptics’ (n = 12/8%) considering threats of COVID-19 as overrated and measures taken as exaggerated; ‘Hardliners’ (n = 34/24%) considering threats high and supporting strong measures; ‘Balancers’ (n = 77/54%) who also rated the threats high but were more critical about potentially impairing the quality of life of elderly people and children; and ‘Anxious’ GPs (n = 20/14%) tending to report more fear, depressive and anxiety symptoms.ConclusionAmong the participants in this survey, opinions regarding the threat and the measures taken against COVID-19 during the ‘first wave’ in Germany in spring 2020 varied greatly.     

Exploring the diverse career trajectories of general practice graduates in the French-speaking part of Belgium: An interview study

BackgroundSeveral European countries face a shortage of general practitioners (GPs), in part due to GP attrition. Most studies of GP attrition have focussed on why GPs decide to leave. Yet understanding why GPs decide to remain may also elicit potential interventions to reduce attrition.ObjectivesThis study examined GP graduates’ career trajectories and underlying decisions to elucidate the factors influencing GP attrition.MethodsWe conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant’s career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants’ trajectories. We compared and contrasted trajectories to develop a typology of career trajectories.ResultsWe identified six types of career trajectories: ‘stable’ (never considered leaving general practice), ‘reaffirmed’ (had considered leaving but made substantial changes whilst remaining), ‘reactional reorientations’ (had left to escape the challenges of general practice), ‘inspired reorientations’ (had left to pursue a different job), ‘reorientations out of loyalty’ (had never wanted to practice as GPs and had remained true to their original professional aspirations) and ‘mobiles’ (valued change and did not want to set-up practice).ConclusionReasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.     

Pre-return to work consultation and therapeutic part-time work: Cross-sectional study on level of knowledge and use by general practitioners in France

BackgroundIn France, general practitioners (GPs) may use two tools specifically designed to help employees who experience difficulties in returning to work after sick leave: the pre-return-to-work (PRW) medical consultation and therapeutic part-time (TPT) work.ObjectivesThe objective was to investigate the level of knowledge and use of these two tools by GPs in Maine-et-Loire, France.MethodsThis cross-sectional study was performed using a telephone questionnaire to evaluate the level of knowledge of GPs and the use of these two tools in patients having difficulties returning to work.ResultsAmong the 200 randomly selected GPs, 122 responded (response rate: 61%). More than half of the interviewed GPs declared they ‘often’ (46%) or ‘always’ (14%) contacted the occupational physician in these situations. Moreover, 62.2% and 32.7% believed that they had a ‘vague’ or ‘very good’ level of knowledge, and 41% and 51% declared either ‘frequent’ or ‘regular’ level of use of the PRW medical consultation, respectively. Regarding TPT work, 47% and 53% reported a ‘very good’ or ‘vague’ level of knowledge, and 41% and 51% a ‘frequent’ or ‘regular’ level of use, respectively. GPs who had a better level of knowledge of this tool reported a higher level of use (p < 0.001).ConclusionThis study shows that while the level of knowledge and use of the PRW medical consultation and TPT work is good, it is not optimal. This could be improved by organising training courses for GPs. Obstacles to their wider use could be investigated further in a qualitative study.     

General practitioners’ perspectives on discontinuation of long-term antidepressants in nursing homes

BackgroundLong-term use of antidepressant drugs (AD), much longer than recommended by guidelines, in nursing homes (NH) is common. NH home residents may have a relatively higher risk of adverse events. Moreover, in an NH setting nursing staff and relatives are intensively involved in the decision-making process. In many countries, General Practitioners’ (GPs) provide care for residents in NHs. Little is known about GPs’ perspectives on discontinuation of long-term AD in NH residents.ObjectivesTo explore GPs’ views of discontinuing long-term AD in NH residents.MethodsAn exploratory qualitative study, with semi-structured interviews, was conducted with a purposive sample of 20 Belgian GPs. Interviews, conducted over six months in 2019, were analysed by thematic analysis.ResultsTwenty interviews were conducted until data saturation. The first theme, ‘reluctance to rock the boat: not worth taking the risk’, describes that GPs perceive discontinuation as an unpredictable risk without clear benefits. GPs’ main concern was the risk of destabilising the fragile balance in an older patient. Second, ‘it takes at least three to tango’, captures the unspoken alliance between GPs, nursing staff and relatives and suggests that agreement of at least these three partners is required. The third, ‘Opening the door: triggers to discontinue’, points to severe health problems and dementia as strong facilitators for discontinuation.ConclusionDiscontinuation of long-term AD in NHs is a complex process for GPs. More evidence and attention to the role nursing staff and relatives play are needed to better guide the discontinuation of AD in older NH patients.     

A Complex Negotiation: Women's Experiences of Naming and Not Naming Premenstrual Distress in Couple Relationships

ABSTRACT

Recent research has demonstrated the importance of family relationships in women's experience of premenstrual changes, their construction of these changes as “PMS.” However, the discursive process by which women take up the subject position of “PMS” sufferer through the explicit naming of “PMS” to an intimate partner has received little research attention. Drawing on 60 individual interviews with Australian women, conducted between 2004 and 2006, we examined accounts of naming “PMS” in intimate relationships, women's explanations for naming or not naming, their experiences of their partner naming them as premenstrual. The analysis process identified an overarching theme of naming “PMS,” which was made up of three themes: naming to explain; “PMS” becoming the only explanation for distress; “PMS” as not a legitimate explanation for distress. The findings suggest that clinicians need to be aware of women's complex, often ambivalent, experiences of naming “PMS” within their relationships, when working with women, couples, seeking treatment or support for premenstrual distress.     

A Community Jury on initiating weight management conversations in primary care

BackgroundCurrent guidelines recommend that patients attending general practice should be screened for excess weight, and provided with weight management advice.ObjectiveThis study sought to elicit the views of people with overweight and obesity about the role of GPs in initiating conversations about weight management.MethodsParticipants with a body mass index ≥25 were recruited from a region in Australia to take part in a Community Jury. Over 2 days, participants (n = 11) deliberated on two interconnected questions: ‘Should GPs initiate discussions about weight management?’ And ‘if so, when: (a) opportunistically, (b) in the context of disease prevention, (c) in the context of disease management or (d) other?’ The jury deliberations were analysed qualitatively to elicit their views and recommendations.ResultsThe jury concluded GPs should be discussing weight management, but within the broader context of general health. The jury were divided about the utility of screening. Jurors felt GPs should initiate the conversation if directly relevant for disease prevention or management, otherwise GPs should provide opportunities for patients to consent to the issue being raised.ConclusionThe jury''s verdict suggests informed people affected by overweight and obesity believe GPs should discuss weight management with their patients. GPs should feel reassured that discussions are likely to be welcomed by patients, particularly if embedded within a more holistic focus on person‐centred care.Public contributionMembers of the public took part in the conduct of this study as jurors, but were not involved in the design, analysis or write‐up.     

Premenstrual symptom severity: impact on social functioning and treatment-seeking behaviors

Our purpose was to understand premenstrual symptomatology and treatment-seeking behaviors by examining three subjective measurement approaches for premenstrual syndrome (PMS), their relationship to social functioning interference, and the role of symptom severity in a broader model of help seeking for PMS. Cross-sectional data were obtained from 1022 mail survey respondents who were derived from a nationally representative random sample of women, aged 18-49, experiencing regular menstrual cycles. Statistical analyses included Pearson correlations, chi-square tests, t tests, and logistic regression. The three symptom severity measures (a global self-appraisal, summative symptom counting, and categorical-configural) were strongly intercorrelated, ranging from. 60 to.78 (p < 0.001), and were correlated with interference in social and occupational functioning domains, ranging from.44 to.77 (all p < 0.001). A global self-report measure identified 4.9% of women with severe symptoms, whereas a DSM-IV-adapted approach identified 11.3% with premenstrual dysphoric disorder (PMDD) symptoms (of whom 92% also reported social interference). PMS treatment seeking was predicted by older age, PMS symptoms experienced in most cycles, greater self-reported symptom severity, greater overall use of healthcare services, and less negative attitudes toward PMS (all p < 0.05). These findings support the feasibility of clinician's use of brief screening approaches for PMDD, especially using short summative symptom rating scales. Women underidentify the severity of their PMS difficulties despite the reported difficulties associated with consistent social and occupational interference in most life domains. They are also reluctant to seek help for treatable PMS symptoms because of attitudinal barriers regardless of the severity of their PMS symptoms.     

The Association Between Vitamin D and Premenstrual Syndrome: A Systematic Review and Meta-Analysis of Current Literature

Abstract

A number of studies have assessed the association between vitamin D and premenstrual syndrome (PMS) in different populations, but the findings have been inconclusive. Herein, we systematically reviewed available observational and interventional evidence to elucidate the overall relationship between vitamin D and PMS. PubMed, Cochrane Library, ScienceDirect, Scopus, Google Scholar, and ISI Web of Science databases were searched for all available articles until September 2018. The Newcastle-Ottawa quality assessment scale and Jadad scale were used to assess the quality of the observational and interventional studies, respectively. A total of 16 studies out of 196 met our inclusion criteria and were included in the final analysis. Although no significant association between serum 25(OH)D and PMS (weighted mean difference (WMD)?=?3.35; 95% confidence interval, ?7.80 to 1.11; p?=?0.14) was indicated in observational studies, vitamin D supplementation was effective in ameliorating PMS symptoms based upon findings from interventional studies. These results add to the existing literature supporting the fact that nutrition, especially vitamin D, plays an important role in women’s health. Additional well-designed clinical trials should be considered in future research to develop firm conclusions on the efficacy of vitamin D on PMS.

• KEY TEACHING POINTS

• 5–8% of women experience severe PMS.

• Nutrition especially vitamin D plays an important role in the women's health.

• Vitamin D could exert significant clinical effects on PMS symptoms.

• This is a systematic review and meta-analysis in this regard.

     

Associations of Education With Overall Diet Quality Are Explained by Different Food Groups in Middle-aged and Old Japanese Women

BackgroundThe disparity of overall diet quality by personal educational attainment has been a public issue. However, it remains unknown which food groups contribute to the disparity. This cross-sectional study assesses which food groups explain associations between education and overall diet quality in Japanese women.MethodsA total of 3,788 middle-aged (mean age, 47.7 years) and 2,188 older women (mean age, 74.4 years), who lived in 47 prefectures in Japan, provided data on their education (low, middle, and high) and dietary intakes from a diet history questionnaire. A diet quality score (possible score 0–70) was calculated based on seven food components. Mean diet quality scores, with adjustment for lifestyle and neighborhood variables, were estimated by education using a general linear model, and Dunnett’s multiple comparison was conducted. Additionally, mean scores of each food component were estimated by education and compared using the same manner.ResultsAfter adjustment for lifestyle and neighborhood variables, mean diet quality score of high or middle education was higher than low education for both generations. Middle-aged women with high and middle education had higher scores of ‘milk’, ‘snacks, confection, and beverages’, ‘fruits’, and ‘vegetable dishes’ than those with low education. Older women with high and middle education had higher scores of ‘sodium from seasonings’ and ‘fruits’ than those with low education.ConclusionsThis study suggests that positive associations between education and diet quality are explained by different food groups in middle-aged and older Japanese women, which are independent of lifestyle and neighborhood variables.Key words: education, diet quality, Japanese     

Understanding young adults’ reasons for seeking ‘clinically unnecessary’ urgent and emergency care: A qualitative interview study

BackgroundStudies have identified young adults as more likely to use emergency departments for ‘clinically unnecessary’ problems, with limited similar evidence for emergency ambulance use. Media portrayals depict young adults as motivated by ‘convenience’, but little research has explored the reasons for their help‐seeking behaviour.MethodsQualitative interviews with 16 young adults (18‐30) considered by clinicians to have made unnecessary use of emergency ambulance, emergency department or an urgent GP appointment. Data analysis was informed by interpretive phenomenological analysis.FindingsA number of interrelated factors contributed to participants’ decisions. They were anxious about the seriousness of their symptoms, sometimes exacerbated by reduced coping capacity due to poor mental health or life stresses. They looked to others to facilitate their decision making, who sometimes encouraged urgent contact. They wanted to avoid impact on existing day‐to‐day commitments including work or study. They had strong views about different health services, sometimes based on frustration with lack of resolution of on‐going health problems. Convenience was not identified as a significant factor, although some actions could be interpreted in this light if the context was not considered.ConclusionsYoung adults make ‘clinically unnecessary’ use of urgent and emergency care for more than convenience. Their decisions need to be understood in relation to the complexity of their experience, including lack of confidence in making health‐related decisions, lowered coping capacity and concern to maintain normal daily life.     

The relative importance of information items and preferred mode of delivery when disseminating results from trials to participants: A mixed‐methods study

BackgroundParticipants want to receive the results of trials that they have participated in. Dissemination practices are disparate, and there is limited guidance available on what information to provide to participants and how to deliver it.ObjectivesThis study aimed to establish what trial participants believe should be included in a results summary and how this information should be delivered.MethodsA mixed‐methods design was used with focus groups and interviews involving women convenience‐sampled from two host randomized‐controlled trials. Participants ranked information items in order of their importance for inclusion in a trial results summary and potential modes of delivery by preference. All participants provided written informed consent.ResultsSixteen women (mean age [SD] = 71.6 [9.7] years) participated. Participants ranked ‘individual results from the study’ and ‘summary of overall trial results’ as most important. Themes such as reassurance and setting results in context were identified as contributing to participants'' decisions around ranking. ‘A thank you for your contribution to the study’ was ranked the least important. Delivery by post was the preferred mode of receiving results, with receiving a hard copy of results cited as helpful to refer back to.ConclusionOur findings provide insight into what information trial participants deem as important when receiving trial results and how they would like results delivered. Involving patients during development of trial results to be communicated to participants could help to ensure that the right information is delivered in the right way.Patient or Public ContributionPublic partners were involved in focussed aspects of study conduct.     

Plasma Carotenoids and Premenstrual Symptoms in a Multi-Ethnic Population of Young Women

Premenstrual symptoms are experienced by most women of reproductive age, but effective therapies are limited. Carotenoids may have an attenuating effect on premenstrual symptoms; however, studies to date are equivocal. The objective of the present study was to examine the association between plasma concentrations of seven carotenoids and premenstrual symptom severity in 553 women from the Toronto Nutrigenomics and Health study. Participants provided information on fifteen common premenstrual symptoms and severities. Each participant completed a General Health and Lifestyle Questionnaire and provided a fasting blood sample from which plasma carotenoid concentrations were measured. Multinomial logistic regressions were used to determine associations between plasma carotenoid concentrations and premenstrual symptom severity. Beta-cryptoxanthin was associated with moderate/severe increased appetite for women in the highest compared to the lowest tertile (OR: 2.33; 95% CI: 1.39, 3.89). This association remained significant after adjusting for multiple comparisons. There were no observed associations between other plasma carotenoids and any premenstrual symptoms. In summary, higher concentrations of beta-cryptoxanthin were associated with an increased appetite as a premenstrual symptom, but no associations were observed for any other carotenoid and for any other symptom.     

Prescribing patterns in premenstrual syndrome

Background  

Over 300 therapies have been proposed for premenstrual syndrome. To date there has been only one survey conducted in the UK of PMS treatments prescribed by GPs, a questionnaire-based study by the National Association of Premenstrual Syndrome in 1989. Since then, selective serotonin re-uptake inhibitors have been licensed for severe PMS/PMDD, and governmental recommendations to reduce the dosage of vitamin B6 (the first choice over-the-counter treatment for many women with PMS) have been made. This study investigates the annual rates of diagnoses and prescribing patterns for premenstrual syndrome (1993–1998) within a computerised general practitioner database.     

UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender,ethnicity and disability

Objectives

To seek doctors’ views about the NHS as an employer, our surveys about doctors’ career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good ‘equal opportunities’ employer for women doctors, doctors from ethnic minority groups and doctors with disabilities.

Design and Setting

Surveys undertaken in the UK by mail and Internet.

Participants

UK medical graduates in selected graduation years between 1993 and 2012.

Main outcome measures

Respondents were asked to rate their level of agreement with three statements starting ‘The NHS is a good equal opportunities employer for…’ and ending ‘women doctors’, ‘doctors from ethnic minorities’ and ‘doctors with disabilities’.

Results

Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000–2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities.

Conclusions

Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern.     

Premenstrual syndrome

Until relatively recently there has been a reluctance to accept premenstrual syndrome as a serious condition. Premenstrual symptoms occur in 95% of all women of reproductive age. Premenstrual syndrome (PMS) occurs in about 5% of those women. PMS patients appear more susceptible to their normal ovarian hormone cycle. The increased sensitivity may be due to neurotransmitter dysfunction (possibly serotonin). However, the definitive aetiology is not known. PMS results from ovulation and appears to be caused directly by the progesterone produced following ovulation in women who have enhanced sensitivity to this progesterone. Treatment can thus be achieved by suppression of ovulation or reducing progesterone sensitivity; the latter seems achievable by the administration of selective serotonin re-uptake inhibitors. Ovulation can be suppressed by a variety of methods, and oestrogen is frequently employed with success. Here, the authors describe an evidence-based approach to the management of PMS.     

Western dietary pattern is associated with higher risk of lower lean muscle mass in Korean postmenopausal women: data from the Korea National Health and Nutrition Examination Survey 2008–2011

BACKGROUND/OBJECTIVESIn a healthy person, from 35 years of age, there is an annual loss of muscle mass at the rate of 1–2% and is associated with a decline in the quality of life. This study aimed to identify the particular dietary patterns associated with the risk of lower lean muscle mass in Korean postmenopausal women.SUBJECTS/METHODSThe Korea National Health and Nutrition Examination Survey (KNHANES) is a population-based, continuous cross-sectional annual survey. The participants of the KNHANES IV (2008–2009) and V (2010–2011) were considered for this study. The study sample consisted of 1548 postmenopausal women, aged 45–86 years. Lower lean muscle mass was defined as having appendicular skeletal muscle mass corrected for body weight less than 1 standard deviation of the young reference group aged 20 to 39 years in KNHANES IV and V. To identify the dietary pattern using factor analysis, 24-h recall data was used.RESULTSThe prevalence of lower lean muscle mass was 31.3% in this study population. Four dietary patterns were identified by factor analysis; ‘Diverse’, ‘Western’, ‘Traditional’, and ‘Snacks and beverages’. The ‘Western’ pattern, highest factor loadings for flour and bread, potatoes, red meat, processed meat, eggs, and cheese, was significantly associated with a high (60%) risk of lower lean muscle mass (odds ratio [95% confidence interval] = 1.60 [1.07–2.39], P for trend = 0.01) after adjustments for potential covariates. The other 3 dietary patterns were not associated with lower lean muscle mass.CONCLUSIONSThe study findings suggest that the ‘Western’ dietary pattern that includes flour and bread, potatoes, red meat, processed meat, eggs, and cheese, may be associated with a higher risk of lower lean muscle mass in Korean postmenopausal women.     

To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study

BackgroundResponsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease.ObjectivesWe aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load.MethodsIn a mixed-method design, Fava’s clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner’s symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO.ResultsData of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, p = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, p = 0.020). 3–4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5–7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility.ConclusionUnder changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.     

Barriers to losing weight for women attending group visits in primary care: A qualitative exploration using in-depth interviews

BackgroundDespite the accumulated evidence suggesting the positive aspects of using group visits in obesity, the number of qualitative studies that examine why and how the effects occur at an individual level is limited.ObjectivesThis qualitative study aimed to explore the experiences and perspectives of women who participated in group visits and had different weight loss outcomes in the programme.MethodPurposive maximum variation sampling was performed. Data collection and analysis were performed iteratively, and the data saturation method was used as a guideline for sample size. All participants who completed the group visits were approached, and finally, 20 individuals were included in the study. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analysed thematically using a phenomenological approach.ResultsThe mean age of the individuals was 38.5 ± 9.8 years, the education level ranged from incomplete-high school to university degree, and the weight changes were between +4.1% and −17.1%. Two main themes emerged from the thematic analysis revealing barriers: weight stigma (two sub-themes: internal and external stigma) and traumatic life events (three sub-themes: ‘loss of relatives,’ ‘childhood traumas,’ and ‘conflicting intimate partner relationships’).ConclusionConsidering the barriers to weight loss efforts in this study, these issues need to be explicitly investigated before and during the group visits in addition to weight loss practices and behavioural changes.