{"paper_id":"1349bc23-65cc-4a02-bc2d-190215fd6c92","body_text":"“We go hunting…too”: Experiences of people living with obesity and food insecurity in an ethnically diverse community when shopping for supermarket foods | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “We go hunting…too”: Experiences of people living with obesity and food insecurity in an ethnically diverse community when shopping for supermarket foods Hannah C Greatwood, Emma Hunter, Flora Douglas, Thomas Sawzcuk, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6697876/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The United Kingdom faces complex economic and structural challenges that have disrupted food pricing, contributing to widespread food insecurity. These fluctuations diminish the affordability and accessibility of healthy, nutrient-dense foods among vulnerable groups. In high-income countries, food insecurity is associated with higher levels of obesity, and in the UK specifically, the cost of living crisis, where the cost of food has increased quicker than wages, is likely to have exacerbated existing dietary inequalities. This qualitative paper explores insights of people living with obesity and food insecurity, in an ethnically diverse community, to develop further understanding on their food shopping experiences. Methods A secondary analysis of qualitative data from four focus groups (8–11 participants per group; 92% female) was undertaken with participants who self-reported as living with obesity and food insecurity (n = 39) and were attempting to reduce their weight. Results Three themes and eight subthemes were generated using deductive and reflexive thematic analysis: ( 1 ) the Conscious Consumer , reflects the preparation and planning participants undertook by participants to maximise their limited resources. Subthemes include advanced meal planning, and price-comparison shopping. Despite these efforts, participants frequently encountered barriers to being able to purchase nutritionally balanced foods. ( 2 ) the Restricted Consumer highlights how structural and systemic limitations, including time pressures due to work or caregiving responsibilities, further constrained participants’ food purchasing choices. and ( 3 ) Mitigating the rising cost of food , describes the actions required to manage the challenges in purchasing foods with rising costs. Subthemes include substituting affordable, less-healthy products for costlier fresh produce and bulk buying of staple items. Conclusions Findings challenge societal beliefs that people living on low incomes need to budget more carefully to afford a healthy diet. People living with obesity and food insecurity often report experiencing cognitive dissonance. In this context, participants faced difficult and emotive trade-offs, as they recognised the suboptimal nutritional value of their food purchases but felt compelled by necessity to buy unhealthier food that matched their budget. Findings provide further insights to support healthy, sustainable food purchasing, as part of transforming the UK food system. Living with Obesity Food Insecurity Focus Groups Supermarkets Qualitative Research Cost-of-living Health inequalities 1. Introduction Food insecurity (FI) occurs when people do not have the economic, social, and physical resources to shop, cook, or eat adequate food to meet nutritional requirements ( 1 ). Once considered to be a problem only in low- and middle-income countries, FI is now reported to affect 8–20% of households within more affluent countries ( 2 ) such as the UK. In June 2024, 13.6% of UK households, representing approximately 7 million adults and 3 million children, reported living with FI ( 3 ). There are clear ethnic disparities in FI, with one in four (24%) people from an ethnic minority group experiencing FI, almost twice the rate (13%) for white people ( 4 ). FI is more likely to be experienced by people living with obesity (PLWO) ( 5 – 7 ). In England, the prevalence of overweight and obesity is highest among those living in the most deprived areas (71.5% and 35.9%, respectively) and lowest in those living in the least deprived areas (59.6% and 20.5%, respectively) ( 8 ). Between May 2021 and May 2024, UK food prices rose by 30.6% ( 9 ). The Food Foundation ( 10 ) reported that the lowest-income fifth of households would need to spend 45% of their disposable income on food to meet UK government dietary recommendations, compared to only 11% for higher-income groups. They also reported that healthier foods in the UK are more than twice as expensive per calorie as unhealthy foods. Furthermore, in a longitudinal study to assess food price developments by food group and healthiness category during the UK’s inflationary period (from 2013 to 2023), ‘more healthy’ foods had a greater absolute price increase and remained more expensive, potentially exacerbating dietary inequalities ( 11 ). For people living on a low income, calorie-dense and higher in saturated fat, sugar, or salt foods and drinks have become more affordable and, in some cases, the only option ( 12 ). Therefore, rising costs of healthier foods may result in increased levels of obesity as families on low incomes purchase less expensive and less nutritious alternatives to maximise their limited funds ( 5 , 13 ). The economic challenges of FI underscore the urgency of adopting dietary recommendations that are not only nutritionally sound but also sustainable and accessible. Sustainable dietary patterns promote all dimensions of individuals’ health and wellbeing; they have low environmental pressure, i.e., reduced greenhouse gas emissions, water consumption, and land use; are accessible, affordable, safe, and equitable; and culturally acceptable ( 14 ). Moreover, adherence to government guidelines such as the Eatwell Guide has been associated with improved health outcomes as well as reduced environmental footprints, suggesting that well-designed interventions could simultaneously address dietary inequalities and environmental sustainability challenges exacerbated by rising food costs ( 15 , 16 ). Policies targeting obesity have been criticised for focusing on individual responsibility while overlooking broader environmental and social factors ( 17 , 18 ). Individual responsibility assumes that individuals have the necessary material resources, such as an adequate food budget and access to facilities and equipment for cooking, as well as psychological resources, including motivation and mental well-being, to make the appropriate changes to their diet. However, these assumptions often do not align with empirical evidence ( 12 , 18 , 19 ). Food purchasing reflects the upstream dietary behaviours before consumption ( 20 , 21 ). With 83% of UK household food shopping currently undertaken within supermarkets ( 22 ), this environment could provide a context within the wider food system through which healthier, sustainable eating could be supported ( 23 ). Hunter et al. ( 12 ) qualitatively investigated influences surrounding healthy, sustainable purchasing decisions of people living with obesity and FI, living in England and Scotland, when shopping for healthy, environmentally sustainable food in the supermarket. In interviews (n = 25) and focus groups (n = 8) participants described navigating the supermarket space in the face of restrictions imposed upon them by their limited budget for food. These restrictions often prevented the purchase of healthy food, determined where participants were able to shop, and led them to make trade-offs in sustainability and dietary preferences, inflicting an emotional toll on individuals. Participants also detailed conscious, effortful shopping practices, including meticulous planning, price monitoring, and engagement with nutritional labels, though the ability for this information to guide purchasing behaviours was often constrained by budgets. To mitigate costs, participants sacrificed food quality, made purchases that ensured shelf life was maximised, and adopted energy-efficient cooking methods. Stigma, both weight- and poverty-related, also featured prominently, influencing behaviours such as shopping at specific stores or online to avoid judgment. This study aims to enhance our understanding of the influences of purchasing environmentally sustainable food in the supermarket of PLWO and FI within an ethnically diverse population. The study uses secondary data from focus groups in an area of high FI to undertake deductive thematic analysis using prior themes identified by Hunter et al. ( 12 ). The collective dialogue from focus groups can reveal community-specific insights into how socio-economic restrictions, stigma, and emotional tolls shape food purchasing decisions. 2. Methods A secondary analysis of qualitative data was carried out to explore the influences of food purchasing behaviours in PLWO and FI. The study is part of the FIO Food project ( 23 ), which aims to combine knowledge from large-scale population data with an understanding of the lived experience of FI and obesity to support environmentally sustainable and healthier food choices in the retail environment. The research builds upon previously published findings from the FIO Food project ( 12 , 13 , 24 ) to help verify insights from an ethnically diverse population of PLWO living in an area of high FI. Using Heaton’s five categories of secondary analysis ( 25 ), this paper is a supplementary analysis, involving the in-depth investigation of an aspect of the data that was only partly covered in the original research ( 26 ). The current study is based on a constructivist epistemology, which asserts that reality is socially constructed and highlights the collaborative creation of knowledge between the researcher and participants ( 27 ). This approach aims to explore lived experiences and the fundamental nature of phenomena. Ontologically, we recognise the presence of real-world structures and mechanisms that influence food shopping experiences. Our comprehension of these influences is shaped by interpretative processes when applying deductive thematic principles. The authors in this paper take a position that acknowledges our desire to incorporate the individual food shopping experiences of the participants and the meanings they attach to them. However, we also wish to consider the impact of the wider social context on these meanings ( 28 ). This study was approved by Leeds Beckett University Local Research Ethics Committee (Reference 135671). Participants all gave written, informed consent and received a £25 voucher to reimburse their time. 2.3 Design The design of the study has previously been described ( 26 ). In summary, data collection took place between April and June 2024, and the study was conducted in a town in Northern England, which encompasses neighbourhoods classified as having the highest risk for FI prevalence in the UK ( 29 ). The town has an ethnically diverse population, with 48.0% of people identifying as Pakistani and 36.3% identifying as white ( 30 ). In-person focus groups with people who self-identified as living with obesity and FI were hosted in locations identified by relevant gatekeepers (Community Nutritionist and Family Centre Manager) as appropriate, including a community centre and a community family unit. Within the primary study, data collection continued until data saturation was reached ( 31 ). 2.3.1 Participants A detailed account of recruitment and participant backgrounds is reported by Greatwood et al. ( 26 ). Participants (n = 39, with 8–11 participants per group; 92% female) (Table 1 ) were recruited using purposeful convenience sampling methods ( 32 ). One focus group (FG1) comprised individuals enrolled in a locally operated community weight management program, while participants in the other three focus groups (FG2, FG3, and FG4) were parents and carers of children attending a local primary school. To be eligible, participants had to be residents of the town, aged 18 years or older, self-identify as living with obesity, and be looking to reduce their weight, as well as report difficulties in affording healthy food. Individual demographic data, for example, BMI and age, were not collected to encourage participation from this hard-to-reach population ( 33 ). Table 1 provides a summary of participants' ethnic backgrounds across the focus groups, as well as the health co-morbidities mentioned during the discussions. Table 1 Summary of focus groups of PLWO and FI Focus group Setting Number of participants (n) Participant details Ethnicity as described through focus group discussions Participant self-reported co-morbidities identified through focus group discussions FG1 Community Centre – weight management group 8 Female n = 8 Male n = 0 White Diverticulitis Allergies Anxiety Diabetes Arthritis High cholesterol FG2 Family Centre 11 Female n = 11 Male n = 0 Pakistani, Bangladeshi Other Asian None mentioned FG3 Family Centre 10 Female n = 10 Male n = 1 Pakistani, Bangladeshi White High cholesterol Diabetes Asthma High blood pressure FG4 Family Centre 9 Female n = 7 Male n = 2 Pakistani, Bangladeshi White Physical disability Autism High blood pressure 2.4 Procedure The development of the topic guide has previously been reported ( 26 ) (Supplementary Material 1). A FIO Food project Patient and Public Involvement (PPI) partner, with lived experience of obesity and FI, helped inform the development of focus group materials, including reviewing participant documents (invitation letter, information sheet, consent forms) and the content and phrasing of the questions within the topic guide. The semi-structured nature of the topic guide allowed specific questions relating to participants' experiences of shopping to be asked, while also providing flexibility for follow-up questions on topics of interest. 2.4.1 Data Collection All focus groups were undertaken by the lead author (HG) and audio recorded using a digital audio recorder (Olympus VN-541PC Digital Voice Recorder), during April and June 2024, and each took approximately 1 hour. All data were transcribed verbatim, and any identifiable information was removed. Field notes were also generated as the focus groups took place, which were based on the researcher’s observations and other notable and relevant information. NVivo 12 ( 34 ) software was used to manage and support data analyses as a password-protected project. 2.5 Data Analysis All transcripts involved in the parent study were read to confirm which were relevant to the secondary data analysis. A qualitative synthesis using a deductive thematic analysis ( 28 , 35 , 36 ) of themes generated by Hunter et al. ( 12 ) was used to analyse the data. In conducting the deductive thematic analysis, the transcripts and field notes were thematically analysed (HG and EH) following the steps outlined by Braun and Clarke ( 28 , 36 ). This process involved re-reading the transcripts to assist familiarisation and reflection on potential codes (HG), and initial coding of the data using the predefined coding framework (supplementary material 2) derived from Hunter et al. ( 12 ) (HG), reviewing (EH) and discussing this coding (HG and EH). Following this initial coding, themes and subthemes were then reviewed and discussed through an iterative process and further refined (HG, TS, MSG, RAS, CG). This iterative process involved multiple discussions and exchanges to resolve discrepancies, ensure consistency, and reach a consensus. When disagreements arose, the authors reviewed the data and the coding framework, and through discussion, adjusted this framework as needed to align coding with appropriate themes and subthemes. 2.6 Data Analysis The first author (HG) (a white, female, with extensive experience in dietary behaviour research and a familiarity with the literature on food systems) was primarily responsible for original data collection and both primary ( 26 ) and secondary analysis. EH and RAS (white, female, research fellows in FI and Obesity), TS (a white, male, post-doctoral research fellow in sport and computer sciences), MSG (a white, male, Professor of Statistical Epidemiology) and CG (a white, female, Reader in Systems Approaches to Population Obesity) supported the analytic process during the deductive application of themes. Themes were presented to the wider interdisciplinary FIO Food team, who have extensive experience in qualitative research design, data collection, analysis, interpretation, and reporting. 3. Results While the coding process primarily involved mapping the data to the predefined themes (Supplementary material 2, four main themes and 13 associated sub-themes) ( 12 ) the authors remained open to nuances within the data that necessitated refinement or expansion of the subthemes. This ensured that the coding framework was sufficiently flexible to accommodate the complexity of the data while remaining consistent with the deductive approach. The resulting three themes and eight subthemes reflect both the theoretical expectations, and the specific patterns observed in the data (Table 2 ). Three main themes remained as reported by Hunter et al. ( 12 ), with the exception of “Stigma: In-store experiences” theme, which was not replicated within this study. The inclusion of an additional subtheme, “unconscious sustainable shopping practices” , was generated as part of the thematic analysis process. Each theme is defined and described in turn, using quotes from participants to illustrate findings. The themes and subthemes are organised under separate subheadings to aid interpretation; however, it is essential to acknowledge their interconnectedness. Table 2 Summary of themes and sub-themes Theme Sub theme Example Quote Conscious Consumer Searching, planning and preparing “I go monthly shopping because I find it easier. I've got a big chest freezer and what I tend to do is go to the reduced place first and see what I can find from that and then I plan the rest of my meals…..So then I go to the bread bit and I freeze whatever bread I can get and then I go to the fresh bits and get what I can.” (FG1) In-depth knowledge of food prices “Like nuts now, they're like ridiculous prices when you go for like just nuts packets, little packets of them. They're three times the price than what they were. And the prices, like they're now trying to like, before it used to be like just say £2.50, no, or £2.49. But now they've got 79p and 69p [at the end of the price], it's that extra 20p, 30p... The prices are going up. And then the discount [store] as well, it's like … only 10, 20p difference. Yeah. It's not like major how you used to get half price or 20% off.” (FG4) Restricted Consumer Healthy options are off the table “ Especially like healthy food, like salad bar or something. Basically, like healthy food has gone really expensive. Yeah. And it's cheaper to buy fatty food or junk food and take-outs are cheaper, so rather than cooking at home, it adds up. All the ingredients. ” (FG4) Shop where you can, not where you want “So, I've gone from [supermarket] to [discount store]. I've changed from branded stuff to non-branded stuff. I think it's about changing a lot of stuff to non-branded things. I just can't afford it.” (FG3) Unconscious sustainable shopping practices* “We used to buy meat from [discount store], but because of the prices, we haven't bought meat now, at least in four months.” (FG3) The emotional toll of restriction “Especially when you've got kids, because you want to get them the things that, you know, like even for instance yogurts, you know that the cheaper one might not be the actual fulfilling one. The one that's got the best of the, you know, vitamin D's or whatever you want to call it. To get the expensive one, it's like you have to pay another two pounds for it. But that's got the full ingredients that you want your kids to have, but you don't know. You're paying for something that might not be artificial. So, you know that you have to sacrifice that just to give them, you know, the cheap option, basically…we're having to, like, you know, feed the kids the more unhealthier versions.” (FG3) Mitigating the Rising Cost of Food Sacrificing quality, quantity and taste “You have to buy crap cheese because the healthy cheese is so expensive….. So, you're going for the cheaper [food option], but you don't know what's inside it. You're just eating chemicals anyway; it's all made of processed stuff. That's what you get to eat.”. (FG4) Maximising food shelf life “The fresh tomatoes are more expensive than the tinned ones, …. They have got preservatives and chemicals, and the fresh ones are more expensive than that. So, people usually have to go for the cheaper ones, the tinned products.” (FG2) *Whilst this subtheme is additional to those reported in Hunter et al. ( 12 ), it has been identified in work undertaken but not yet published by the same author. 3.3 Theme 1: Conscious Consumer Throughout the focus groups, participants consistently discussed the preparation and planning they engaged in before food shopping to maximise their limited time and budget. This process often included researching deals and promotions through websites or in-store communications to identify cost-effective options for essential and healthy foods, often under financial and health-related constraints. 3.3.1 Searching, planning, and preparing Budgeting and meal planning were central strategies discussed by participants when planning and preparing to shop for food. The following quote illustrates how one participant searched and navigated the supermarket environment to shop within their budgetary constraints whilst meeting their families' food needs. I go monthly shopping because I find it easier. I've got a big chest freezer and what I tend to do is go to the reduced place first and see what I can find from that and then I plan the rest of my meals…..So then I go to the bread bit and I freeze whatever bread I can get and then I go to the fresh bits and get what I can. (FG1) Participants also explained how they compared prices across different food stores to determine the most economical shopping destination. This participant describes how they visited multiple supermarkets to search for the best deals and prices. They talked about how searching across different stores was time-consuming as well as taking immense effort. I don't buy everything in one shop. I have to jump from shop to shop to buy what I need. When I want to do full shopping, like everything, food and stuff like that, then I'm all day in town because I must go to [multiple supermarkets and discount stores], different shops and things like that. Then I have full shopping at home. (FG4) 3.3.2 In-depth knowledge of food prices The elevated cost of food emerged as a dominant theme across all four focus groups. Many participants displayed a detailed, in-depth knowledge of food prices across multiple stores, as illustrated by this quote, “some stuff is, you know, cheaper in [Supermarket 1]. Some is in [Discount store]. [Supermarket 2] is a bit expensive. [Supermarket 3] is a bit expensive. Sugar is cheaper in [Discount store]” (FG2). Participants expressed frustration over recent increases in food prices, noting that even discount supermarkets were unable to provide significantly cheaper alternatives. This was highlighted in the following quote, which discusses the rising cost of nuts: Like nuts now, they're like ridiculous prices when you go for like just nuts packets, little packets of them. They're three times the price than what they were. And the prices, like they're now trying to like, before it used to be like just say £2.50, no, or £2.49. But now they've got 79p and 69p [at the end of the price], it's that extra 20p, 30p... The prices are going up. And then the discount [store] as well, it's like…only 10, 20p difference. Yeah. It's not like major how you used to get half price or 20% off. (FG4) In the next example, a participant not only demonstrates the knowledge of prices but their approach to minimising the amount of money they spend when cooking by making a conscious decision to change the recipe to use tinned instead of fresh tomatoes: if we're making like a biryani or something like that, we use like a kilo of fresh tomatoes. But yeah, I've got to now think when I'm doing that because I'm thinking that's costing me how much. Whereas I can buy a tin for 30-something p [pence], I'm going to go for the 30-something p [pence] now, aren't I?... I've got to now think when I'm doing that, because I think that's costing me a lot. (FG2) 3.4 Theme 2: The Restricted Consumer Participants consistently described the practices they used to purchase and prepare food within their financial constraints and the emotions they experienced resulting from these restrictions. Participants reported experiencing substantial additional limitations on their ability to buy healthy food, often describing certain options as off the table . These restrictions included constraints on food shopping where individuals describe being forced to shop where you can and not where you want . Outcomes of the constraint led to unconscious sustainable shopping habits , and a pervasive sense of the emotional toll of restriction . 3.4.1 Healthy options are off the table Participants shared experiences of being constrained by the affordability of certain foods, frequently noting that healthy options were beyond their financial reach, for example, one participant explained “Fruits become a luxury.” (FG3). To cope, some substituted healthier foods and ingredients with perceived less nutritious alternatives that were within their budget. This approach is exemplified by the following quote. Especially like healthy food, like salad bar or something. Basically, like healthy food has gone really expensive. Yeah. And it's cheaper to buy fatty food or junk food and take-outs are cheaper, so rather than cooking at home, it adds up. All the ingredients. (FG4) The following example highlights the apparent cognitive dissonance, in living with FI, expressed by participants. They acknowledged that, out of necessity, they engaged in what they considered ‘suboptimal’ purchasing habits, specifically buying foods they deemed less healthy. This participant prioritised feeding her family over choosing healthy food options. In fact, I'm a single parent. I'm on benefits as well, so it depends if I can afford it or not. If not, then I have to choose the more unhealthy option, just, because we need to eat. (FG1) 3.4.2 Shop where you can, not where you want Participants also faced limitations regarding the supermarkets they frequented, highlighting the structural and financial constraints that shape shopping habits. Participants explained how they shopped at stores where they could stretch their budget the furthest, rather than selecting supermarkets based on preference. The following quote illustrates how a participant has not only changed the store that they shop at due to the increasing cost of food, but also how they now choose non-branded food products instead of preferred branded items within the discount store. So, I've gone from [supermarket] to [discount store]. I've changed from branded stuff to non-branded stuff. I think it's about changing a lot of stuff to non-branded things. I just can't afford it. (FG3) 3.4.3 Unconscious sustainable practices We asked participants about their understanding of shopping for environmentally sustainable food. In all four focus groups, participants consistently reported that they were not familiar with the concept. Despite their uncertainty, participants tentatively suggested this concept was related to the need for reduced Carbon Dioxide emissions and less plastic waste. No participant reported using environmentally sustainable food practices when purchasing food. In Hunter et al. (2025)’s work, participants reported the presence of the theme “ shopping sustainability: past and present practices” ; however, in the current deductive analysis, it was felt that this theme name did not accurately reflect participants' responses. Participants talked about prioritising long-life shelf items to reduce food waste as well as purchasing less meat, for example, “we used to buy meat from [discount store], but because of the prices, we haven't bought meat now, at least in four months.” (FG3). These practices could be viewed as being beneficial for the environment despite occurring due to the price rises, i.e., “unconscious sustainable” . Another example is where a participant talked about creative cooking practices they had implemented, including red lentils, freeze-able fish, and other pulses as sources of protein instead of meat: “I've cut out, or I'm trying to cut out having as much red meat. We've actually been learning what to do with red lentils because I've never used them before. So, we made a sweet potato dahl thing the other week and the thing of red lentils don't cost hardly anything. So, I'm trying to look at ways to substitute things and do away with red meat out of my diet. You go more towards fish, but then fish is more expensive. So then like you say about the reduced thing, I always go to the reduced thing and I'm always looking to see if they've got fish and if they've got fish and it's freezable, then I'll get a few of them, and put them in my freezer. But yeah, it depends on your recipes as to what they are. But if you're trying to go a bit more vegetarian with pulses and stuff”. (FG1) To reduce waste and extend the usability of their purchases, participants talked about how they prioritised items with “ longer shelf lives ”, such as tinned or frozen foods. While nutritional considerations play a role, compromises are often necessary due to financial limitations. Additionally, participants reported selecting foods that required minimal cooking time or energy to mitigate rising energy costs. 3.4.4 The emotional toll of restriction During the focus groups, it was apparent that restrictions relating to participants’ ability to afford healthy, sustainable foods and shop in the way they would like or where they would like, were challenging for participants. For example, when asked how going to the supermarket made them feel, one participant responded “Upset. Upset. Very angry” (FG3). It was also noted by the researcher leading the focus group, the distress in the participants' tone of voice and body language. In the following illustrative example, the participant was visibly troubled when they explained how they recognised that they were not able to afford the most nutritious option for their children, but that they could only provide them with the cheaper yogurts that were not fortified with vitamins: Especially when you've got kids, because you want to get them the things that, you know, like even for instance yogurts, you know that the cheaper one might not be the actual fulfilling one. The one that's got the best of the, you know, vitamin D's or whatever you want to call it. To get the expensive one, it's like you have to pay another two pounds for it. But that's got the full ingredients that you want your kids to have, but you don't know. You're paying for something that might not be artificial. So, you know that you have to sacrifice that just to give them, you know, the cheap option, basically…we're having to, like, you know, feed the kids the more unhealthier versions. (FG3) While not part of the topic guide, one participant talked about the poverty-related stigma associated with the financial constraints that they had faced in not being able to provide the food they wanted for their children. They used the term \" council tea \" which likely refers to a simple, low-cost meal that is affordable and filling but may lack nutritional balance and is likely associated with negative societal judgment. “And then you get to end up using odds and sods in the bottom of your freezer and it is what people used to say ‘council tea’, so if you're cooking just chips and beans and things like that rather than having a Sunday dinner or having the sausage and mash”. (FG1) 3.5 Theme 3: Mitigating the rising cost of food (actions and agency) Throughout the focus groups, participants described actions they had been taking to manage the challenges in purchasing foods when facing FI, and the individual agency they were using to mitigate the rising food costs. Participants displayed additional cognitive effort to undertake the necessary strategies required to feed themselves and their families including sacrificing on quality, quantity, and food preferences to make ends meet, and maximising food shelf life. 3.5.1 Sacrificing quality, quantity, and food preferences To stretch their food budgets, participants talked about making sacrifices and compromises regarding the quality, quantity, and taste of the food they bought, as shown in the following quotes. In the first example, a participant explains that they are having to reduce their portion size of salad foods because of the associated costs. I do a salad like in the evenings with my main meal, like before, you know, I did stuff like that. But now, I make it last a week, just the cucumber, lettuce and everything. Just, you know, because it's so expensive. So, you're going smaller and smaller in portions. (FG2) In this next example, the participant became animated in describing that, although she would like to consider the healthiness of the food she purchased, the less-healthy options were cheaper and so governed her choices. The participant also highlighted the health dilemmas they faced, explaining that although they were aware cheaper foods may use unknown ingredients or processing methods, affordability took precedence, with sustenance outweighing health concerns. You have to buy crap cheese because the healthy cheese is so expensive….. So, you're going for the cheaper [food option], but you don't know what's inside it. You're just eating chemicals anyway; it's all made of processed stuff. That's what you get to eat. (FG4) 3.5.2 Maximising food shelf life Participants discussed buying and consuming more tinned and frozen food because of its lower cost and longer shelf life. Participants perceived tinned tomatoes to be lower in quality, with added preservatives and chemicals compared to fresh ones. The fresh tomatoes are more expensive than the tinned ones, …. They got preservatives and chemicals, and the fresh ones are more expensive than that. So, people usually have to go for the cheaper ones, the tinned products. (FG2) The participant highlights that maximizing their food resources was a key influence when shopping and cooking. Discussions within focus groups led to participants sharing what fruits and vegetables tasted the best in frozen form as illustrated in the following quote. if you don't keep your berries frozen, they're all squashed and mushed. My kids won't eat that. So, what I do is when I go shopping, I get the frozen stuff for the back end of the month. And then I get the fresh for the beginning of the month. So, then I've got the fresh for the beginning of the month and I've got peas, carrots and sweetcorn. That's fine but anything else tends to go mushy and I don't like the textures of it or how it looks when it's cooked. (FG1) 4. Discussion This secondary data analysis qualitatively presents an in-depth insight into the factors influencing food purchasing decisions for healthy, environmentally sustainable diets in an ethnically diverse population of PLWO and FI. Three themes that mapped onto those initially proposed by Hunter et al. ( 12 ) were identified: 1) participants reported engaging in conscious consumer decision-making processes, both before and during their shopping trips, despite facing numerous constraints and the accompanying emotional strain; 2) participants’ goal was to purchase healthy foods that supported their weight-related objectives, within their restricted budgets; and 3) they explained their use of resourcefulness, skills, and strategies to mitigate the rising cost of foods. The rising food prices, driven by the cost-of-living crisis, appeared to have intensified the challenges participants faced when purchasing food. Participants consistently highlighted the necessity of preparation and planning before food shopping to maximise their limited resources. This often involved researching deals and promotions through websites or in-store communications to identify cost-effective options for essential and healthy foods. Aligning with findings from previous studies from the FIO Food project (Stone 2024; 2025; Hunter 2025), and wider literature ( 37 , 38 ), budgeting and meal planning emerged as central strategies, with participants comparing prices across different stores to determine the most economical shopping destinations. This meticulous approach underscores the significant cognitive effort required to manage food budgets under financial constraints. Similar findings have been reported in studies examining food choices in resource-poor communities, where cost and availability are major factors influencing purchasing decisions ( 19 , 39 ). The elevated cost of food was a dominant theme across all focus groups. Participants demonstrated a detailed, in-depth knowledge of food prices across multiple stores, and often described having to visit several supermarkets to find the best deals and maximise their limited budget. This extensive price awareness reflects the heightened financial vigilance and complex knowledge necessary to cope with rising food costs ( 13 , 24 , 40 ). For instance, participants noted specific price differences between supermarkets and discount stores, illustrating their strategic shopping practices, which align with their families' needs. These results align with those of others, who have reported that people experiencing higher levels of FI were more motivated by food prices when making food choices (relative to those experiencing lower FI) ( 19 , 41 ). Low-income individuals often engage in strategic shopping to maximise their limited budget, which challenges some societal beliefs that people living on low incomes need to budget more carefully to be able to afford a healthy diet. Participants described the emotional and practical challenges of purchasing and preparing food within their financial constraints within The Restricted Consumer theme. The stress of constantly monitoring prices and the limitations of buying healthy food were frequently mentioned. Discussions with participants revealed that they understood what constitutes a healthy diet but felt that healthy options were often beyond their financial reach, leading them to substitute with less nutritious alternatives. This cognitive dissonance, where participants recognised the suboptimal nutrition value of their purchasing habits but felt compelled by necessity to buy unhealthier food that matched their budget, highlights the challenging and emotive trade-offs faced by those living with FI and obesity. Our findings are similar to those reported by others who have documented similar experiences among low-income populations, where financial constraints significantly impact dietary choices and subsequent physical and mental health outcomes as part of different levels within the food system ( 13 , 19 , 42 , 43 ). Future policies aimed at addressing population health must be equitable for all members of society, and the additional struggles faced by those experiencing FI must be considered, as well as the impact on mental health. While participants did not explicitly consider environmental sustainability in their food purchasing decisions, their practices often aligned with sustainable dietary behaviours, often through necessity rather than choice. Motivated by price, including reduced purchasing of meat, participants prioritised items with longer shelf lives, such as tinned or frozen foods, to reduce waste and extend their usability. Additionally, they selected foods requiring minimal cooking time or energy to mitigate rising energy costs. These ‘unconscious sustainable’ strategies were an unanticipated consequence of the resourcefulness and adaptability of PLWO and FI in managing their food budgets, and align with recommendations from the EAT–Lancet Commission’s Planetary Health Diet Report ( 44 ). The EAT-Lancet diet relies on increased consumption of plant-based foods and decreased consumption of unhealthy foods, including red meat, sugar, and refined grains, to promote health benefits, including the incidence of obesity. Kenny et al. ( 45 ) suggests that consumers primarily perceive sustainable diets through a human health lens, overlooking the interconnectedness with environmental health. They call for public health professionals to promote a more holistic understanding by developing evidence-based, interdisciplinary guidance to encourage more sustainable dietary behaviours. The emotional impact of financial constraints on food purchasing was evident throughout the focus groups. Participants expressed feelings of frustration and distress when unable to afford healthy foods or the ability to shop at preferred stores. This emotional toll underscores the broader social and psychological implications of FI and obesity ( 42 ). Participants described various actions and strategies to Mitigate the Rising Cost of Food . These included sacrificing quality, quantity, and food preferences and maximising food shelf life. These findings complement those of Stone et al. (2024), where food-insecure individuals adhering to a strict budget reported reduced diet quality in the foods they purchased. Whilst reduced diet quality has previously been reported to be associated with increased weight ( 46 ), stress, from FI, could also be associated with higher BMI via emotional eating/maladaptive coping (Keenan et al., 2021). FI can widen health inequalities, and future food policies need to recognise the motives and reasoning behind decisions for food purchasing behaviours, to support healthy sustainable dietary behaviours. To limit food waste and reduce costs, participants described purchasing more tinned and frozen foods. Some participants viewed these products as being less healthy than their fresh counterparts. However, Li et al. (2017) reported that the nutrient-loss in fresh produce during storage and cooking may be significant and that the freezing process may help to preserve nutrient values. Therefore, while fresh produce is often preferred for its taste and perceived quality, frozen and tinned options can be equally nutritious and offer the benefits of convenience and longer shelf life and therefore could be promoted within the food retail environment. Research also supports the notion that low-income individuals often employ a range of strategies to cope with FI, demonstrating considerable resourcefulness and adaptability ( 19 , 42 ). The cognitive effort required by PLWO and FI to apply these strategies highlights the resilience and agency required to navigate their food environments. Hunter et al. (2025) outlined how PLWO and FI may modify their shopping habits due to perceived or previously experienced stigma within the supermarket context. Conversely, participants within our focus groups suggested that they felt supported within this environment and talked about how helpful supermarket staff were. This discrepancy in findings may relate to social, or neighbourhood cohesion, i.e., the degree of connectedness and solidarity among the participants living in an area of high FI, and therefore they felt a collectiveness in managing the financial constraints ( 47 ). The supermarket stores participants were visiting were also located in the same community and, therefore, staff may be more cognisant of the demographic of shoppers and are less stigmatising. Participants did, however, discuss the adaptation of shopping practices (i.e., going less frequently to the shops or completing the shopping trip in less time), which may reveal how they have adapted their behaviours to minimise stigma ( 42 , 48 ). Currently, less healthy foods are often the most affordable and convenient choices ( 10 ), which can displace healthier options in people's diets, especially for those experiencing FI. Although obesity is frequently attributed to individual behaviours, it is crucial to acknowledge the influence of the food environment, which shapes the context in which food choices are made and is therefore a social determinant of health. To address this, interventions aimed at improving food security and supporting healthy eating among PLWO and individuals living with FI should consider the financial constraints and trade-offs this group faces. Meaningful systems changes are required that coordinate action across policy domains, including agriculture, social protection, public health, and community development. By addressing the root causes of food unaffordability and creating enabling environments for healthy eating, such change can help ensure that all individuals-regardless of income level or health status-can access healthy sustainable diets ( 49 ). The current study had several strengths, particularly in gathering insights from a hard-to-reach FI, ethnically diverse population group about their shopping experiences during a cost-of-living crisis. Although participants were from a single geographical location in the north of England, experiencing high levels of FI, the goal of this qualitative research was not to achieve representativeness but to explore insights from PLWO and FI. Data saturation was achieved, which helped mitigate the limitation of the sample size. Recognising and addressing the complexity of the food environment is crucial for making meaningful improvements. It should be appreciated that the majority of participants were female, and this should therefore be taken into consideration when interpreting the results. Future studies should aim to gain insights into the factors and mechanisms underlying food retail environments in areas of high FI to identify leverage points for system-based actions to promote equitable access to healthy and sustainable foods for all. 5. Conclusion This study enhances our understanding of the effortful practices and difficult choices driving food purchasing behaviours of PLWO and FI within an ethnically diverse population. The affordability of a healthy, balanced diet remains an issue for consumers, with healthy diets costing significantly more than less healthy diets. Despite the challenges, participants demonstrated resilience and agency, even while grappling with the significant emotional tolls from these experiences. This novel and insightful research provided a platform for voices within society that are generally not heard and gathered insights into their lived experience. This work is critical to guide policymakers and practitioners to develop more targeted and effective interventions, as part of transforming the food system to support healthy, sustainable eating habits in the face of rising food costs. Abbreviations PLWO People Living With Obesity FI Food Insecurity Declarations None Ethics approval and consent to participate The Ethic approval was obtained from the Institutional Review Board at Leeds Beckett University, UK. Written informed consent was obtained from participants. All methods were carried out in accordance with the Declaration of Helsinki. Consent for publication Not applicable Clinical trial number Not applicable. Availability of data and materials The datasets used analysed during the current study available from the corresponding author on reasonable request. Competing Interests MSG is a director of Causal Insights Solutions Ltd, which provides causal inference training and may benefit from any study that demonstrates the value of causal inference methods. AB declares researcher-led grants from the National Institute for Health Research, Rosetrees Trust, MRC, INNOVATE UK, British Dietetic Association, British Association of Parenteral and Enteral Nutrition, BBRSC, the Office of Health Improvement and Disparities and NovoNordisk. AB reports honoraria from Novo Nordisk, Lilly, Office of Health Improvement and Disparity, Johnson and Johnson and Obesity UK outside the submitted work and is on the Medical Advisory Board and shareholder of Reset Health Clinics Ltd. CAH has received research funding from the American Beverage Association (paid to institution), personal honoraria from International Sweeteners Association and International Food Information Council and is primary supervisor on a PhD studentship funded by Coca-Cola, all for work unrelated to the submitted manuscript. CAH reports personal fees for their role on the UK Government’s Food Standards Agency’s Advisory Committee on Social Sciences, and an unpaid role as a trustee of Feeding Liverpool. No other authors declare that they have any competing interests. HG, EH, FD, RAS, TS and CG report no conflicts of interest. Funding This research was funded through the Transforming the UK Food System for Healthy People and a Healthy Environment SPF Programme, delivered by UKRI, in partnership with the Global Food Security Programme, BBSRC, ESRC, MRC, NERC, Defra, DHSC, OHID, Innovate UK and FSA (BB/W018020/1 - FIO Food award). Authors contributions: Hannah C Greatwood : Conceptualisation, Methodology, Formal analysis, Investigation, Writing – Original Draft, Project administration. Emma Hunter : Conceptualisation, Methodology, Formal analysis, Investigation, Writing – Reviewing & editing. Flora Douglas : Conceptualisation, Methodology, Funding Acquisition. Thomas Sawczuk : Methodology, Writing – Review & editing. Mark S Gilthorpe : Methodology, Writing – Review & editing. Rebecca Stone : Methodology, Writing – Review & editing. Adrian Brown : Methodology, Writing – Review & editing. Alex Johnstone , Obtaining funding, Writing – Review & editing. Charlotte Hardman , Writing – Review & editing Claire Griffiths : Conceptualisation, Methodology, Formal analysis, Investigation, Writing – Review & editing, Supervision, Funding Acquisition; Acknowledgements The authors wish to express their gratitude to the FIO Food Patient and Public Involvement (PPI) partners for their input to the co-production in the development of this work and to our interview and focus group participants for giving up their time and sharing their experiences. References Purdam K, Garratt EA, Esmail A. Hungry? Food Insecurity, Social Stigma and Embarrassment in the UK. Sociology. 2016;50(6):1072–88. Pollard CM, Booth S. Food Insecurity and Hunger in Rich Countries-It Is Time for Action against Inequality. Int J Environ Res Public Health. 2019;16(10):1804. Food Foundation. Food Insecurity Tracking [Internet]. 2024 [cited 2025 Jan 30]. Available from: https://foodfoundation.org.uk/initiatives/food-insecurity-tracking Trussell Trust. 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Soc Sci Med. 2022;292:114523. Ellard-Gray A, Jeffrey NK, Choubak M, Crann SE. Finding the Hidden Participant: Solutions for Recruiting Hidden, Hard-to-Reach, and Vulnerable Populations. Int J Qualitative Methods. 2015;14(5):1609406915621420. Hung P, Miciak M, Godziuk K, Gross DP, Forhan M. Reducing weight bias and stigma in qualitative research interviews: Considerations for researchers. Obes Rev. 2024;25(7):e13750. Lumivero. NVivo [Internet]. 2017. Available from: www.lumivero.com. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qualitative Res Sport Exerc Health. 2019;11(4):589–97. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Res Psychol. 2021;18(3):328–52. Nieves C, Dannefer R, Zamula A, Sacks R, Ballesteros Gonzalez D, Zhao F. Come with us for a week, for a month, and see how much food lasts for you:’ A Qualitative Exploration of Food Insecurity in East Harlem, New York City. J Acad Nutr Diet. 2022;122(3):555–64. Shinwell J, Defeyter MA. Food Insecurity: A Constant Factor in the Lives of Low-Income Families in Scotland and England. Front Public Health. 2021;9:588254. Madlala SS, Hill J, Kunneke E, Lopes T, Faber M. Adult food choices in association with the local retail food environment and food access in resource-poor communities: a scoping review. BMC Public Health. 2023;23(1):1083. Beagan BL, Chapman GE, Power E. The visible and invisible occupations of food provisioning in low income families. J Occup Sci. 2018;25(1):100–11. Evans R, Christiansen P, Bateson M, Nettle D, Keenan GS, Hardman CA. Understanding the association between household food insecurity and diet quality: The role of psychological distress, food choice motives and meal patterning. Appetite. 2025;108007. Briggs R, Rowden H, Lagojda L, Robbins T, Randeva HS. The lived experience of food insecurity among adults with obesity: a quantitative and qualitative systematic review. J Public Health. 2024;46(2):230–49. Munialo CD, Mellor DD. A review of the impact of social disruptions on food security and food choice. Food Sci Nutr. 2024;12(1):13–23. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447–92. Kenny TA, Woodside JV, Perry IJ, Harrington JM. Consumer attitudes and behaviors toward more sustainable diets: a scoping review. Nutr Rev. 2023;81(12):1665–79. Zhao Y, Araki T. Diet quality and its associated factors among adults with overweight and obesity: findings from the 2015–2018 National Health and Nutrition Examination Survey. Br J Nutr. 2024;131(1):134–42. Osborn B, Morey BN, Billimek J, Ro A. Food Insecurity and Type 2 Diabetes Among Latinos: Examining Neighborhood Cohesion as a Protective Factor. J Racial Ethnic Health Disparities. 2023;10(4):2061–70. Farrell E, Hollmann E, le Roux CW, Bustillo M, Nadglowski J, McGillicuddy D. The lived experience of patients with obesity: A systematic review and qualitative synthesis. Obes Rev. 2021;22(12):e13334. Loopstra R. Interventions to address household food insecurity in high-income countries. Proc Nutr Soc. 2018;77(3):270–81. Additional Declarations Competing interest reported. MSG is a director of Causal Insights Solutions Ltd, which provides causal inference training and may benefit from any study that demonstrates the value of causal inference methods. AB declares researcher-led grants from the National Institute for Health Research, Rosetrees Trust, MRC, INNOVATE UK, British Dietetic Association, British Association of Parenteral and Enteral Nutrition, BBRSC, the Office of Health Improvement and Disparities and NovoNordisk. AB reports honoraria from Novo Nordisk, Lilly, Office of Health Improvement and Disparity, Johnson and Johnson and Obesity UK outside the submitted work and is on the Medical Advisory Board and shareholder of Reset Health Clinics Ltd. CAH has received research funding from the American Beverage Association (paid to institution), personal honoraria from International Sweeteners Association and International Food Information Council and is primary supervisor on a PhD studentship funded by Coca-Cola, all for work unrelated to the submitted manuscript. CAH reports personal fees for their role on the UK Government’s Food Standards Agency’s Advisory Committee on Social Sciences, and an unpaid role as a trustee of Feeding Liverpool. No other authors declare that they have any competing interests. HG, EH, FD, RAS, TS and CG report no conflicts of interest. 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08:47:14\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":1225481,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"WeGoHuntingTooSupplementaryMaterial1.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6697876/v1/35c2be16949794471fa5f20f.docx\"},{\"id\":86400498,\"identity\":\"f5a2a142-e1d0-4a46-8494-83b2b1871540\",\"added_by\":\"auto\",\"created_at\":\"2025-07-10 08:47:14\",\"extension\":\"docx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":20657,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"WeGoHuntingTooSupplementaryMaterial2.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6697876/v1/fb8f76ca85dd1f653e2615cb.docx\"}],\"financialInterests\":\"Competing interest reported. MSG is a director of Causal Insights Solutions Ltd, which provides causal inference training and may benefit from any study that demonstrates the value of causal inference methods. AB declares researcher-led grants from the National Institute for Health Research, Rosetrees Trust, MRC, INNOVATE UK, British Dietetic Association, British Association of Parenteral and Enteral Nutrition, BBRSC, the Office of Health Improvement and Disparities and NovoNordisk. AB reports honoraria from Novo Nordisk, Lilly, Office of Health Improvement and Disparity, Johnson and Johnson and Obesity UK outside the submitted work and is on the Medical Advisory Board and shareholder of Reset Health Clinics Ltd. CAH has received research funding from the American Beverage Association (paid to institution), personal honoraria from International Sweeteners Association and International Food Information Council and is primary supervisor on a PhD studentship funded by Coca-Cola, all for work unrelated to the submitted manuscript. CAH reports personal fees for their role on the UK Government’s Food Standards Agency’s Advisory Committee on Social Sciences, and an unpaid role as a trustee of Feeding Liverpool. No other authors declare that they have any competing interests. HG, EH, FD, RAS, TS and CG report no conflicts of interest.\",\"formattedTitle\":\"“We go hunting…too”: Experiences of people living with obesity and food insecurity in an ethnically diverse community when shopping for supermarket foods\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eFood insecurity (FI) occurs when people do not have the economic, social, and physical resources to shop, cook, or eat adequate food to meet nutritional requirements (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Once considered to be a problem only in low- and middle-income countries, FI is now reported to affect 8\\u0026ndash;20% of households within more affluent countries (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e) such as the UK. In June 2024, 13.6% of UK households, representing approximately 7\\u0026nbsp;million adults and 3\\u0026nbsp;million children, reported living with FI (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). There are clear ethnic disparities in FI, with one in four (24%) people from an ethnic minority group experiencing FI, almost twice the rate (13%) for white people (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). FI is more likely to be experienced by people living with obesity (PLWO) (\\u003cspan additionalcitationids=\\\"CR6\\\" citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). In England, the prevalence of overweight and obesity is highest among those living in the most deprived areas (71.5% and 35.9%, respectively) and lowest in those living in the least deprived areas (59.6% and 20.5%, respectively) (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eBetween May 2021 and May 2024, UK food prices rose by 30.6% (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). The Food Foundation (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e) reported that the lowest-income fifth of households would need to spend 45% of their disposable income on food to meet UK government dietary recommendations, compared to only 11% for higher-income groups. They also reported that healthier foods in the UK are more than twice as expensive per calorie as unhealthy foods. Furthermore, in a longitudinal study to assess food price developments by food group and healthiness category during the UK\\u0026rsquo;s inflationary period (from 2013 to 2023), \\u0026lsquo;more healthy\\u0026rsquo; foods had a greater absolute price increase and remained more expensive, potentially exacerbating dietary inequalities (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). For people living on a low income, calorie-dense and higher in saturated fat, sugar, or salt foods and drinks have become more affordable and, in some cases, the only option (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). Therefore, rising costs of healthier foods may result in increased levels of obesity as families on low incomes purchase less expensive and less nutritious alternatives to maximise their limited funds (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe economic challenges of FI underscore the urgency of adopting dietary recommendations that are not only nutritionally sound but also sustainable and accessible. Sustainable dietary patterns promote all dimensions of individuals\\u0026rsquo; health and wellbeing; they have low environmental pressure, i.e., reduced greenhouse gas emissions, water consumption, and land use; are accessible, affordable, safe, and equitable; and culturally acceptable (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). Moreover, adherence to government guidelines such as the Eatwell Guide has been associated with improved health outcomes as well as reduced environmental footprints, suggesting that well-designed interventions could simultaneously address dietary inequalities and environmental sustainability challenges exacerbated by rising food costs (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003ePolicies targeting obesity have been criticised for focusing on individual responsibility while overlooking broader environmental and social factors (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). Individual responsibility assumes that individuals have the necessary material resources, such as an adequate food budget and access to facilities and equipment for cooking, as well as psychological resources, including motivation and mental well-being, to make the appropriate changes to their diet. However, these assumptions often do not align with empirical evidence (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Food purchasing reflects the upstream dietary behaviours before consumption (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). With 83% of UK household food shopping currently undertaken within supermarkets (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e), this environment could provide a context within the wider food system through which healthier, sustainable eating could be supported (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eHunter et al. (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) qualitatively investigated influences surrounding healthy, sustainable purchasing decisions of people living with obesity and FI, living in England and Scotland, when shopping for healthy, environmentally sustainable food in the supermarket. In interviews (n\\u0026thinsp;=\\u0026thinsp;25) and focus groups (n\\u0026thinsp;=\\u0026thinsp;8) participants described navigating the supermarket space in the face of restrictions imposed upon them by their limited budget for food. These restrictions often prevented the purchase of healthy food, determined where participants were able to shop, and led them to make trade-offs in sustainability and dietary preferences, inflicting an emotional toll on individuals. Participants also detailed conscious, effortful shopping practices, including meticulous planning, price monitoring, and engagement with nutritional labels, though the ability for this information to guide purchasing behaviours was often constrained by budgets. To mitigate costs, participants sacrificed food quality, made purchases that ensured shelf life was maximised, and adopted energy-efficient cooking methods. Stigma, both weight- and poverty-related, also featured prominently, influencing behaviours such as shopping at specific stores or online to avoid judgment.\\u003c/p\\u003e\\u003cp\\u003eThis study aims to enhance our understanding of the influences of purchasing environmentally sustainable food in the supermarket of PLWO and FI within an ethnically diverse population. The study uses secondary data from focus groups in an area of high FI to undertake deductive thematic analysis using prior themes identified by Hunter et al. (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). The collective dialogue from focus groups can reveal community-specific insights into how socio-economic restrictions, stigma, and emotional tolls shape food purchasing decisions.\\u003c/p\\u003e\"},{\"header\":\"2. Methods\",\"content\":\"\\u003cp\\u003eA secondary analysis of qualitative data was carried out to explore the influences of food purchasing behaviours in PLWO and FI. The study is part of the FIO Food project (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e), which aims to combine knowledge from large-scale population data with an understanding of the lived experience of FI and obesity to support environmentally sustainable and healthier food choices in the retail environment. The research builds upon previously published findings from the FIO Food project (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e) to help verify insights from an ethnically diverse population of PLWO living in an area of high FI. Using Heaton\\u0026rsquo;s five categories of secondary analysis (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e), this paper is a supplementary analysis, involving the in-depth investigation of an aspect of the data that was only partly covered in the original research (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe current study is based on a constructivist epistemology, which asserts that reality is socially constructed and highlights the collaborative creation of knowledge between the researcher and participants (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). This approach aims to explore lived experiences and the fundamental nature of phenomena. Ontologically, we recognise the presence of real-world structures and mechanisms that influence food shopping experiences. Our comprehension of these influences is shaped by interpretative processes when applying deductive thematic principles. The authors in this paper take a position that acknowledges our desire to incorporate the individual food shopping experiences of the participants and the meanings they attach to them. However, we also wish to consider the impact of the wider social context on these meanings (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). This study was approved by Leeds Beckett University Local Research Ethics Committee (Reference 135671). Participants all gave written, informed consent and received a \\u0026pound;25 voucher to reimburse their time.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.3 Design\\u003c/h2\\u003e\\u003cp\\u003eThe design of the study has previously been described (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e). In summary, data collection took place between April and June 2024, and the study was conducted in a town in Northern England, which encompasses neighbourhoods classified as having the highest risk for FI prevalence in the UK (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). The town has an ethnically diverse population, with 48.0% of people identifying as Pakistani and 36.3% identifying as white (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). In-person focus groups with people who self-identified as living with obesity and FI were hosted in locations identified by relevant gatekeepers (Community Nutritionist and Family Centre Manager) as appropriate, including a community centre and a community family unit. Within the primary study, data collection continued until data saturation was reached (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e2.3.1 Participants\\u003c/h2\\u003e\\u003cp\\u003eA detailed account of recruitment and participant backgrounds is reported by Greatwood et al. (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e). Participants (n\\u0026thinsp;=\\u0026thinsp;39, with 8\\u0026ndash;11 participants per group; 92% female) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e) were recruited using purposeful convenience sampling methods (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). One focus group (FG1) comprised individuals enrolled in a locally operated community weight management program, while participants in the other three focus groups (FG2, FG3, and FG4) were parents and carers of children attending a local primary school. To be eligible, participants had to be residents of the town, aged 18 years or older, self-identify as living with obesity, and be looking to reduce their weight, as well as report difficulties in affording healthy food. Individual demographic data, for example, BMI and age, were not collected to encourage participation from this hard-to-reach population (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e provides a summary of participants' ethnic backgrounds across the focus groups, as well as the health co-morbidities mentioned during the discussions.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eSummary of focus groups of PLWO and FI\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFocus group\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSetting\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eNumber of participants (n)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eParticipant details\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eEthnicity as described through focus group discussions\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eParticipant self-reported co-morbidities identified through focus group discussions\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFG1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eCommunity Centre \\u0026ndash; weight management group\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFemale n\\u0026thinsp;=\\u0026thinsp;8\\u003c/p\\u003e\\u003cp\\u003eMale n\\u0026thinsp;=\\u0026thinsp;0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eWhite\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eDiverticulitis\\u003c/p\\u003e\\u003cp\\u003eAllergies\\u003c/p\\u003e\\u003cp\\u003eAnxiety\\u003c/p\\u003e\\u003cp\\u003eDiabetes\\u003c/p\\u003e\\u003cp\\u003eArthritis\\u003c/p\\u003e\\u003cp\\u003eHigh cholesterol\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFG2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFamily Centre\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFemale n\\u0026thinsp;=\\u0026thinsp;11\\u003c/p\\u003e\\u003cp\\u003eMale n\\u0026thinsp;=\\u0026thinsp;0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ePakistani, Bangladeshi\\u003c/p\\u003e\\u003cp\\u003eOther Asian\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eNone mentioned\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFG3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFamily Centre\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFemale n\\u0026thinsp;=\\u0026thinsp;10\\u003c/p\\u003e\\u003cp\\u003eMale n\\u0026thinsp;=\\u0026thinsp;1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ePakistani, Bangladeshi\\u003c/p\\u003e\\u003cp\\u003eWhite\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003eHigh cholesterol\\u003c/p\\u003e\\u003cp\\u003eDiabetes\\u003c/p\\u003e\\u003cp\\u003eAsthma\\u003c/p\\u003e\\u003cp\\u003eHigh blood pressure\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFG4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFamily Centre\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eFemale n\\u0026thinsp;=\\u0026thinsp;7\\u003c/p\\u003e\\u003cp\\u003eMale n\\u0026thinsp;=\\u0026thinsp;2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003ePakistani, Bangladeshi\\u003c/p\\u003e\\u003cp\\u003eWhite\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003ePhysical disability\\u003c/p\\u003e\\u003cp\\u003eAutism\\u003c/p\\u003e\\u003cp\\u003eHigh blood pressure\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.4 Procedure\\u003c/h2\\u003e\\u003cp\\u003eThe development of the topic guide has previously been reported (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e) (Supplementary Material 1). A FIO Food project Patient and Public Involvement (PPI) partner, with lived experience of obesity and FI, helped inform the development of focus group materials, including reviewing participant documents (invitation letter, information sheet, consent forms) and the content and phrasing of the questions within the topic guide. The semi-structured nature of the topic guide allowed specific questions relating to participants' experiences of shopping to be asked, while also providing flexibility for follow-up questions on topics of interest.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e2.4.1 Data Collection\\u003c/h2\\u003e\\u003cp\\u003eAll focus groups were undertaken by the lead author (HG) and audio recorded using a digital audio recorder (Olympus VN-541PC Digital Voice Recorder), during April and June 2024, and each took approximately 1 hour. All data were transcribed verbatim, and any identifiable information was removed. Field notes were also generated as the focus groups took place, which were based on the researcher\\u0026rsquo;s observations and other notable and relevant information. NVivo 12 (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e) software was used to manage and support data analyses as a password-protected project.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.5 Data Analysis\\u003c/h2\\u003e\\u003cp\\u003eAll transcripts involved in the parent study were read to confirm which were relevant to the secondary data analysis. A qualitative synthesis using a deductive thematic analysis (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e) of themes generated by Hunter et al. (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) was used to analyse the data. In conducting the deductive thematic analysis, the transcripts and field notes were thematically analysed (HG and EH) following the steps outlined by Braun and Clarke (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). This process involved re-reading the transcripts to assist familiarisation and reflection on potential codes (HG), and initial coding of the data using the predefined coding framework (supplementary material 2) derived from Hunter et al. (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) (HG), reviewing (EH) and discussing this coding (HG and EH). Following this initial coding, themes and subthemes were then reviewed and discussed through an iterative process and further refined (HG, TS, MSG, RAS, CG). This iterative process involved multiple discussions and exchanges to resolve discrepancies, ensure consistency, and reach a consensus. When disagreements arose, the authors reviewed the data and the coding framework, and through discussion, adjusted this framework as needed to align coding with appropriate themes and subthemes.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.6 Data Analysis\\u003c/h2\\u003e\\u003cp\\u003eThe first author (HG) (a white, female, with extensive experience in dietary behaviour research and a familiarity with the literature on food systems) was primarily responsible for original data collection and both primary (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e) and secondary analysis. EH and RAS (white, female, research fellows in FI and Obesity), TS (a white, male, post-doctoral research fellow in sport and computer sciences), MSG (a white, male, Professor of Statistical Epidemiology) and CG (a white, female, Reader in Systems Approaches to Population Obesity) supported the analytic process during the deductive application of themes. Themes were presented to the wider interdisciplinary FIO Food team, who have extensive experience in qualitative research design, data collection, analysis, interpretation, and reporting.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cp\\u003eWhile the coding process primarily involved mapping the data to the predefined themes (Supplementary material 2, four main themes and 13 associated sub-themes) (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) the authors remained open to nuances within the data that necessitated refinement or expansion of the subthemes. This ensured that the coding framework was sufficiently flexible to accommodate the complexity of the data while remaining consistent with the deductive approach. The resulting three themes and eight subthemes reflect both the theoretical expectations, and the specific patterns observed in the data (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Three main themes remained as reported by Hunter et al. (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e), with the exception of \\u003cem\\u003e\\u0026ldquo;Stigma: In-store experiences\\u0026rdquo;\\u003c/em\\u003e theme, which was not replicated within this study. The inclusion of an additional subtheme, \\u003cem\\u003e\\u0026ldquo;unconscious sustainable shopping practices\\u0026rdquo;\\u003c/em\\u003e, was generated as part of the thematic analysis process. Each theme is defined and described in turn, using quotes from participants to illustrate findings. The themes and subthemes are organised under separate subheadings to aid interpretation; however, it is essential to acknowledge their interconnectedness.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eSummary of themes and sub-themes\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTheme\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSub theme\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eExample Quote\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eConscious Consumer\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSearching, planning and preparing\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I go monthly shopping because I find it easier. I've got a big chest freezer and what I tend to do is go to the reduced place first and see what I can find from that and then I plan the rest of my meals\\u0026hellip;..So then I go to the bread bit and I freeze whatever bread I can get and then I go to the fresh bits and get what I can.\\u0026rdquo;\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eIn-depth knowledge of food prices\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Like nuts now, they're like ridiculous prices when you go for like just nuts packets, little packets of them. They're three times the price than what they were. And the prices, like they're now trying to like, before it used to be like just say \\u0026pound;2.50, no, or \\u0026pound;2.49. But now they've got 79p and 69p [at the end of the price], it's that extra 20p, 30p... The prices are going up. And then the discount [store] as well, it's like \\u0026hellip; only 10, 20p difference. Yeah. It's not like major how you used to get half price or 20% off.\\u0026rdquo;\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e\\u003cp\\u003eRestricted Consumer\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHealthy options are off the table\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;\\u003cem\\u003eEspecially like healthy food, like salad bar or something. Basically, like healthy food has gone really expensive. Yeah. And it's cheaper to buy fatty food or junk food and take-outs are cheaper, so rather than cooking at home, it adds up. All the ingredients.\\u003c/em\\u003e\\u0026rdquo;\\u003c/p\\u003e\\u003cp\\u003e(FG4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eShop where you can, not where you want\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;So, I've gone from [supermarket] to [discount store]. I've changed from branded stuff to non-branded stuff. I think it's about changing a lot of stuff to non-branded things. I just can't afford it.\\u0026rdquo;\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eUnconscious sustainable shopping practices*\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;We used to buy meat from [discount store], but because of the prices, we haven't bought meat now, at least in four months.\\u0026rdquo;\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eThe emotional toll of restriction\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Especially when you've got kids, because you want to get them the things that, you know, like even for instance yogurts, you know that the cheaper one might not be the actual fulfilling one. The one that's got the best of the, you know, vitamin D's or whatever you want to call it. To get the expensive one, it's like you have to pay another two pounds for it. But that's got the full ingredients that you want your kids to have, but you don't know. You're paying for something that might not be artificial. So, you know that you have to sacrifice that just to give them, you know, the cheap option, basically\\u0026hellip;we're having to, like, you know, feed the kids the more unhealthier versions.\\u0026rdquo;\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e(FG3)\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u003cp\\u003eMitigating the Rising Cost of Food\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSacrificing quality, quantity and taste\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;You have to buy crap cheese because the healthy cheese is so expensive\\u0026hellip;.. So, you're going for the cheaper [food option], but you don't know what's inside it. You're just eating chemicals anyway; it's all made of processed stuff. That's what you get to eat.\\u0026rdquo;.\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG4)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eMaximising food shelf life\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;The fresh tomatoes are more expensive than the tinned ones, \\u0026hellip;. They have got preservatives and chemicals, and the fresh ones are more expensive than that. So, people usually have to go for the cheaper ones, the tinned products.\\u0026rdquo;\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG2)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e*Whilst this subtheme is additional to those reported in Hunter et al. (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e), it has been identified in work undertaken but not yet published by the same author.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.3 Theme 1: Conscious Consumer\\u003c/h2\\u003e\\u003cp\\u003e Throughout the focus groups, participants consistently discussed the preparation and planning they engaged in before food shopping to maximise their limited time and budget. This process often included researching deals and promotions through websites or in-store communications to identify cost-effective options for essential and healthy foods, often under financial and health-related constraints.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.3.1 Searching, planning, and preparing\\u003c/h2\\u003e\\u003cp\\u003eBudgeting and meal planning were central strategies discussed by participants when planning and preparing to shop for food. The following quote illustrates how one participant searched and navigated the supermarket environment to shop within their budgetary constraints whilst meeting their families' food needs.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eI go monthly shopping because I find it easier. I've got a big chest freezer and what I tend to do is go to the reduced place first and see what I can find from that and then I plan the rest of my meals\\u0026hellip;..So then I go to the bread bit and I freeze whatever bread I can get and then I go to the fresh bits and get what I can.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG1)\\u003c/p\\u003e\\u003cp\\u003eParticipants also explained how they compared prices across different food stores to determine the most economical shopping destination. This participant describes how they visited multiple supermarkets to search for the best deals and prices. They talked about how searching across different stores was time-consuming as well as taking immense effort.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eI don't buy everything in one shop. I have to jump from shop to shop to buy what I need. When I want to do full shopping, like everything, food and stuff like that, then I'm all day in town because I must go to [multiple supermarkets and discount stores], different shops and things like that. Then I have full shopping at home.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG4)\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.3.2 In-depth knowledge of food prices\\u003c/h2\\u003e\\u003cp\\u003eThe elevated cost of food emerged as a dominant theme across all four focus groups. Many participants displayed a detailed, in-depth knowledge of food prices across multiple stores, as illustrated by this quote, \\u003cem\\u003e\\u0026ldquo;some stuff is, you know, cheaper in [Supermarket 1]. Some is in [Discount store]. [Supermarket 2] is a bit expensive. [Supermarket 3] is a bit expensive. Sugar is cheaper in [Discount store]\\u0026rdquo;\\u003c/em\\u003e (FG2). Participants expressed frustration over recent increases in food prices, noting that even discount supermarkets were unable to provide significantly cheaper alternatives. This was highlighted in the following quote, which discusses the rising cost of nuts:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eLike nuts now, they're like ridiculous prices when you go for like just nuts packets, little packets of them. They're three times the price than what they were. And the prices, like they're now trying to like, before it used to be like just say \\u0026pound;2.50, no, or \\u0026pound;2.49. But now they've got 79p and 69p [at the end of the price], it's that extra 20p, 30p... The prices are going up. And then the discount [store] as well, it's like\\u0026hellip;only 10, 20p difference. Yeah. It's not like major how you used to get half price or 20% off.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG4)\\u003c/p\\u003e\\u003cp\\u003eIn the next example, a participant not only demonstrates the knowledge of prices but their approach to minimising the amount of money they spend when cooking by making a conscious decision to change the recipe to use tinned instead of fresh tomatoes:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eif we're making like a biryani or something like that, we use like a kilo of fresh tomatoes. But yeah, I've got to now think when I'm doing that because I'm thinking that's costing me how much. Whereas I can buy a tin for 30-something p [pence], I'm going to go for the 30-something p [pence] now, aren't I?... I've got to now think when I'm doing that, because I think that's costing me a lot.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG2)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.4 Theme 2: The Restricted Consumer\\u003c/h2\\u003e\\u003cp\\u003e Participants consistently described the practices they used to purchase and prepare food within their financial constraints and the emotions they experienced resulting from these restrictions. Participants reported experiencing substantial additional limitations on their ability to buy healthy food, often describing certain options as \\u003cem\\u003eoff the table\\u003c/em\\u003e. These restrictions included constraints on food shopping where individuals describe being forced to shop \\u003cem\\u003ewhere you can and not where you want\\u003c/em\\u003e. Outcomes of the constraint led to \\u003cem\\u003eunconscious sustainable shopping habits\\u003c/em\\u003e, and a pervasive sense of \\u003cem\\u003ethe emotional toll of restriction\\u003c/em\\u003e.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.4.1 Healthy options are off the table\\u003c/h2\\u003e\\u003cp\\u003eParticipants shared experiences of being constrained by the affordability of certain foods, frequently noting that healthy options were beyond their financial reach, for example, one participant explained \\u003cem\\u003e\\u0026ldquo;Fruits become a luxury.\\u0026rdquo;\\u003c/em\\u003e (FG3). To cope, some substituted healthier foods and ingredients with perceived less nutritious alternatives that were within their budget. This approach is exemplified by the following quote.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eEspecially like healthy food, like salad bar or something. Basically, like healthy food has gone really expensive. Yeah. And it's cheaper to buy fatty food or junk food and take-outs are cheaper, so rather than cooking at home, it adds up. All the ingredients.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG4)\\u003c/p\\u003e\\u003cp\\u003eThe following example highlights the apparent cognitive dissonance, in living with FI, expressed by participants. They acknowledged that, out of necessity, they engaged in what they considered \\u0026lsquo;suboptimal\\u0026rsquo; purchasing habits, specifically buying foods they deemed less healthy. This participant prioritised feeding her family over choosing healthy food options.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eIn fact, I'm a single parent. I'm on benefits as well, so it depends if I can afford it or not. If not, then I have to choose the more unhealthy option, just, because we need to eat.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec15\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.4.2 Shop where you can, not where you want\\u003c/h2\\u003e\\u003cp\\u003eParticipants also faced limitations regarding the supermarkets they frequented, highlighting the structural and financial constraints that shape shopping habits. Participants explained how they shopped at stores where they could stretch their budget the furthest, rather than selecting supermarkets based on preference. The following quote illustrates how a participant has not only changed the store that they shop at due to the increasing cost of food, but also how they now choose non-branded food products instead of preferred branded items within the discount store.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eSo, I've gone from [supermarket] to [discount store]. I've changed from branded stuff to non-branded stuff. I think it's about changing a lot of stuff to non-branded things. I just can't afford it.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG3)\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec16\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.4.3 Unconscious sustainable practices\\u003c/h2\\u003e\\u003cp\\u003eWe asked participants about their understanding of shopping for environmentally sustainable food. In all four focus groups, participants consistently reported that they were not familiar with the concept. Despite their uncertainty, participants tentatively suggested this concept was related to the need for reduced Carbon Dioxide emissions and less plastic waste. No participant reported using environmentally sustainable food practices when purchasing food. In Hunter et al. (2025)\\u0026rsquo;s work, participants reported the presence of the theme \\u0026ldquo;\\u003cem\\u003eshopping sustainability: past and present practices\\u0026rdquo;\\u003c/em\\u003e; however, in the current deductive analysis, it was felt that this theme name did not accurately reflect participants' responses. Participants talked about prioritising long-life shelf items to reduce food waste as well as purchasing less meat, for example, \\u003cem\\u003e\\u0026ldquo;we used to buy meat from [discount store], but because of the prices, we haven't bought meat now, at least in four months.\\u0026rdquo;\\u003c/em\\u003e (FG3). These practices could be viewed as being beneficial for the environment despite occurring due to the price rises, i.e., \\u003cem\\u003e\\u0026ldquo;unconscious sustainable\\u0026rdquo;\\u003c/em\\u003e. Another example is where a participant talked about creative cooking practices they had implemented, including red lentils, freeze-able fish, and other pulses as sources of protein instead of meat:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I've cut out, or I'm trying to cut out having as much red meat. We've actually been learning what to do with red lentils because I've never used them before. So, we made a sweet potato dahl thing the other week and the thing of red lentils don't cost hardly anything. So, I'm trying to look at ways to substitute things and do away with red meat out of my diet. You go more towards fish, but then fish is more expensive. So then like you say about the reduced thing, I always go to the reduced thing and I'm always looking to see if they've got fish and if they've got fish and it's freezable, then I'll get a few of them, and put them in my freezer. But yeah, it depends on your recipes as to what they are. But if you're trying to go a bit more vegetarian with pulses and stuff\\u0026rdquo;.\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG1)\\u003c/p\\u003e\\u003cp\\u003eTo reduce waste and extend the usability of their purchases, participants talked about how they prioritised items with \\u0026ldquo;\\u003cem\\u003elonger shelf lives\\u003c/em\\u003e\\u0026rdquo;, such as tinned or frozen foods. While nutritional considerations play a role, compromises are often necessary due to financial limitations. Additionally, participants reported selecting foods that required minimal cooking time or energy to mitigate rising energy costs.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec17\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.4.4 The emotional toll of restriction\\u003c/h2\\u003e\\u003cp\\u003eDuring the focus groups, it was apparent that restrictions relating to participants\\u0026rsquo; ability to afford healthy, sustainable foods and shop in the way they would like or where they would like, were challenging for participants. For example, when asked how going to the supermarket made them feel, one participant responded \\u003cem\\u003e\\u0026ldquo;Upset. Upset. Very angry\\u0026rdquo;\\u003c/em\\u003e (FG3). It was also noted by the researcher leading the focus group, the distress in the participants' tone of voice and body language. In the following illustrative example, the participant was visibly troubled when they explained how they recognised that they were not able to afford the most nutritious option for their children, but that they could only provide them with the cheaper yogurts that were not fortified with vitamins:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eEspecially when you've got kids, because you want to get them the things that, you know, like even for instance yogurts, you know that the cheaper one might not be the actual fulfilling one. The one that's got the best of the, you know, vitamin D's or whatever you want to call it. To get the expensive one, it's like you have to pay another two pounds for it. But that's got the full ingredients that you want your kids to have, but you don't know. You're paying for something that might not be artificial. So, you know that you have to sacrifice that just to give them, you know, the cheap option, basically\\u0026hellip;we're having to, like, you know, feed the kids the more unhealthier versions.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG3)\\u003c/p\\u003e\\u003cp\\u003eWhile not part of the topic guide, one participant talked about the poverty-related stigma associated with the financial constraints that they had faced in not being able to provide the food they wanted for their children. They used the term \\\"\\u003cem\\u003ecouncil tea\\u003c/em\\u003e\\\" which likely refers to a simple, low-cost meal that is affordable and filling but may lack nutritional balance and is likely associated with negative societal judgment.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;And then you get to end up using odds and sods in the bottom of your freezer and it is what people used to say \\u0026lsquo;council tea\\u0026rsquo;, so if you're cooking just chips and beans and things like that rather than having a Sunday dinner or having the sausage and mash\\u0026rdquo;.\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e3.5 Theme 3: Mitigating the rising cost of food (actions and agency)\\u003c/h2\\u003e\\u003cp\\u003eThroughout the focus groups, participants described actions they had been taking to manage the challenges in purchasing foods when facing FI, and the individual agency they were using to mitigate the rising food costs. Participants displayed additional cognitive effort to undertake the necessary strategies required to feed themselves and their families including \\u003cem\\u003esacrificing on quality, quantity, and food preferences\\u003c/em\\u003e to make ends meet, and \\u003cem\\u003emaximising food shelf life.\\u003c/em\\u003e\\u003c/p\\u003e\\u003cdiv id=\\\"Sec19\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.5.1 Sacrificing quality, quantity, and food preferences\\u003c/h2\\u003e\\u003cp\\u003eTo stretch their food budgets, participants talked about making sacrifices and compromises regarding the quality, quantity, and taste of the food they bought, as shown in the following quotes. In the first example, a participant explains that they are having to reduce their portion size of salad foods because of the associated costs.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eI do a salad like in the evenings with my main meal, like before, you know, I did stuff like that. But now, I make it last a week, just the cucumber, lettuce and everything. Just, you know, because it's so expensive. So, you're going smaller and smaller in portions.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG2)\\u003c/p\\u003e\\u003cp\\u003eIn this next example, the participant became animated in describing that, although she would like to consider the healthiness of the food she purchased, the less-healthy options were cheaper and so governed her choices. The participant also highlighted the health dilemmas they faced, explaining that although they were aware cheaper foods may use unknown ingredients or processing methods, affordability took precedence, with sustenance outweighing health concerns.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eYou have to buy crap cheese because the healthy cheese is so expensive\\u0026hellip;.. So, you're going for the cheaper [food option], but you don't know what's inside it. You're just eating chemicals anyway; it's all made of processed stuff. That's what you get to eat.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG4)\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec20\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e3.5.2 Maximising food shelf life\\u003c/h2\\u003e\\u003cp\\u003eParticipants discussed buying and consuming more tinned and frozen food because of its lower cost and longer shelf life. Participants perceived tinned tomatoes to be lower in quality, with added preservatives and chemicals compared to fresh ones.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eThe fresh tomatoes are more expensive than the tinned ones, \\u0026hellip;. They got preservatives and chemicals, and the fresh ones are more expensive than that. So, people usually have to go for the cheaper ones, the tinned products.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG2)\\u003c/p\\u003e\\u003cp\\u003eThe participant highlights that maximizing their food resources was a key influence when shopping and cooking. Discussions within focus groups led to participants sharing what fruits and vegetables tasted the best in frozen form as illustrated in the following quote.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eif you don't keep your berries frozen, they're all squashed and mushed. My kids won't eat that. So, what I do is when I go shopping, I get the frozen stuff for the back end of the month. And then I get the fresh for the beginning of the month. So, then I've got the fresh for the beginning of the month and I've got peas, carrots and sweetcorn. That's fine but anything else tends to go mushy and I don't like the textures of it or how it looks when it's cooked.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e(FG1)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eThis secondary data analysis qualitatively presents an in-depth insight into the factors influencing food purchasing decisions for healthy, environmentally sustainable diets in an ethnically diverse population of PLWO and FI. Three themes that mapped onto those initially proposed by Hunter et al. (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) were identified: 1) participants reported engaging in \\u003cem\\u003econscious consumer\\u003c/em\\u003e decision-making processes, both before and during their shopping trips, despite facing numerous constraints and the accompanying emotional strain; 2) participants\\u0026rsquo; goal was to purchase healthy foods that supported their weight-related objectives, within their \\u003cem\\u003erestricted\\u003c/em\\u003e budgets; and 3) they explained their use of resourcefulness, skills, and strategies to \\u003cem\\u003emitigate\\u003c/em\\u003e the rising cost of foods.\\u003c/p\\u003e\\u003cp\\u003eThe rising food prices, driven by the cost-of-living crisis, appeared to have intensified the challenges participants faced when purchasing food. Participants consistently highlighted the necessity of preparation and planning before food shopping to maximise their limited resources. This often involved researching deals and promotions through websites or in-store communications to identify cost-effective options for essential and healthy foods. Aligning with findings from previous studies from the FIO Food project (Stone 2024; 2025; Hunter 2025), and wider literature (\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e), budgeting and meal planning emerged as central strategies, with participants comparing prices across different stores to determine the most economical shopping destinations. This meticulous approach underscores the significant cognitive effort required to manage food budgets under financial constraints. Similar findings have been reported in studies examining food choices in resource-poor communities, where cost and availability are major factors influencing purchasing decisions (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe elevated cost of food was a dominant theme across all focus groups. Participants demonstrated a detailed, in-depth knowledge of food prices across multiple stores, and often described having to visit several supermarkets to find the best deals and maximise their limited budget. This extensive price awareness reflects the heightened financial vigilance and complex knowledge necessary to cope with rising food costs (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e). For instance, participants noted specific price differences between supermarkets and discount stores, illustrating their strategic shopping practices, which align with their families' needs. These results align with those of others, who have reported that people experiencing higher levels of FI were more motivated by food prices when making food choices (relative to those experiencing lower FI) (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e). Low-income individuals often engage in strategic shopping to maximise their limited budget, which challenges some societal beliefs that people living on low incomes need to budget more carefully to be able to afford a healthy diet.\\u003c/p\\u003e\\u003cp\\u003eParticipants described the emotional and practical challenges of purchasing and preparing food within their financial constraints within \\u003cem\\u003eThe Restricted Consumer\\u003c/em\\u003e theme. The stress of constantly monitoring prices and the limitations of buying healthy food were frequently mentioned. Discussions with participants revealed that they understood what constitutes a healthy diet but felt that healthy options were often beyond their financial reach, leading them to substitute with less nutritious alternatives. This cognitive dissonance, where participants recognised the suboptimal nutrition value of their purchasing habits but felt compelled by necessity to buy unhealthier food that matched their budget, highlights the challenging and emotive trade-offs faced by those living with FI and obesity. Our findings are similar to those reported by others who have documented similar experiences among low-income populations, where financial constraints significantly impact dietary choices and subsequent physical and mental health outcomes as part of different levels within the food system (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e). Future policies aimed at addressing population health must be equitable for all members of society, and the additional struggles faced by those experiencing FI must be considered, as well as the impact on mental health.\\u003c/p\\u003e\\u003cp\\u003e While participants did not explicitly consider environmental sustainability in their food purchasing decisions, their practices often aligned with sustainable dietary behaviours, often through necessity rather than choice. Motivated by price, including reduced purchasing of meat, participants prioritised items with longer shelf lives, such as tinned or frozen foods, to reduce waste and extend their usability. Additionally, they selected foods requiring minimal cooking time or energy to mitigate rising energy costs. These \\u003cem\\u003e\\u0026lsquo;unconscious sustainable\\u0026rsquo;\\u003c/em\\u003e strategies were an unanticipated consequence of the resourcefulness and adaptability of PLWO and FI in managing their food budgets, and align with recommendations from the EAT\\u0026ndash;Lancet Commission\\u0026rsquo;s Planetary Health Diet Report (\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e). The EAT-Lancet diet relies on increased consumption of plant-based foods and decreased consumption of unhealthy foods, including red meat, sugar, and refined grains, to promote health benefits, including the incidence of obesity. Kenny et al. (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e) suggests that consumers primarily perceive sustainable diets through a human health lens, overlooking the interconnectedness with environmental health. They call for public health professionals to promote a more holistic understanding by developing evidence-based, interdisciplinary guidance to encourage more sustainable dietary behaviours.\\u003c/p\\u003e\\u003cp\\u003eThe emotional impact of financial constraints on food purchasing was evident throughout the focus groups. Participants expressed feelings of frustration and distress when unable to afford healthy foods or the ability to shop at preferred stores. This emotional toll underscores the broader social and psychological implications of FI and obesity (\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e). Participants described various actions and strategies to \\u003cem\\u003eMitigate the Rising Cost of Food\\u003c/em\\u003e. These included sacrificing quality, quantity, and food preferences and maximising food shelf life. These findings complement those of Stone et al. (2024), where food-insecure individuals adhering to a strict budget reported reduced diet quality in the foods they purchased. Whilst reduced diet quality has previously been reported to be associated with increased weight (\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e), stress, from FI, could also be associated with higher BMI via emotional eating/maladaptive coping (Keenan et al., 2021). FI can widen health inequalities, and future food policies need to recognise the motives and reasoning behind decisions for food purchasing behaviours, to support healthy sustainable dietary behaviours.\\u003c/p\\u003e\\u003cp\\u003eTo limit food waste and reduce costs, participants described purchasing more tinned and frozen foods. Some participants viewed these products as being less healthy than their fresh counterparts. However, Li et al. (2017) reported that the nutrient-loss in fresh produce during storage and cooking may be significant and that the freezing process may help to preserve nutrient values. Therefore, while fresh produce is often preferred for its taste and perceived quality, frozen and tinned options can be equally nutritious and offer the benefits of convenience and longer shelf life and therefore could be promoted within the food retail environment. Research also supports the notion that low-income individuals often employ a range of strategies to cope with FI, demonstrating considerable resourcefulness and adaptability (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e). The cognitive effort required by PLWO and FI to apply these strategies highlights the resilience and agency required to navigate their food environments.\\u003c/p\\u003e\\u003cp\\u003eHunter et al. (2025) outlined how PLWO and FI may modify their shopping habits due to perceived or previously experienced stigma within the supermarket context. Conversely, participants within our focus groups suggested that they felt supported within this environment and talked about how helpful supermarket staff were. This discrepancy in findings may relate to social, or neighbourhood cohesion, i.e., the degree of connectedness and solidarity among the participants living in an area of high FI, and therefore they felt a collectiveness in managing the financial constraints (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e). The supermarket stores participants were visiting were also located in the same community and, therefore, staff may be more cognisant of the demographic of shoppers and are less stigmatising. Participants did, however, discuss the adaptation of shopping practices (i.e., going less frequently to the shops or completing the shopping trip in less time), which may reveal how they have adapted their behaviours to minimise stigma (\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eCurrently, less healthy foods are often the most affordable and convenient choices (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e), which can displace healthier options in people's diets, especially for those experiencing FI. Although obesity is frequently attributed to individual behaviours, it is crucial to acknowledge the influence of the food environment, which shapes the context in which food choices are made and is therefore a social determinant of health. To address this, interventions aimed at improving food security and supporting healthy eating among PLWO and individuals living with FI should consider the financial constraints and trade-offs this group faces. Meaningful systems changes are required that coordinate action across policy domains, including agriculture, social protection, public health, and community development. By addressing the root causes of food unaffordability and creating enabling environments for healthy eating, such change can help ensure that all individuals-regardless of income level or health status-can access healthy sustainable diets (\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe current study had several strengths, particularly in gathering insights from a hard-to-reach FI, ethnically diverse population group about their shopping experiences during a cost-of-living crisis. Although participants were from a single geographical location in the north of England, experiencing high levels of FI, the goal of this qualitative research was not to achieve representativeness but to explore insights from PLWO and FI. Data saturation was achieved, which helped mitigate the limitation of the sample size. Recognising and addressing the complexity of the food environment is crucial for making meaningful improvements. It should be appreciated that the majority of participants were female, and this should therefore be taken into consideration when interpreting the results. Future studies should aim to gain insights into the factors and mechanisms underlying food retail environments in areas of high FI to identify leverage points for system-based actions to promote equitable access to healthy and sustainable foods for all.\\u003c/p\\u003e\"},{\"header\":\"5. Conclusion\",\"content\":\"\\u003cp\\u003eThis study enhances our understanding of the effortful practices and difficult choices driving food purchasing behaviours of PLWO and FI within an ethnically diverse population. The affordability of a healthy, balanced diet remains an issue for consumers, with healthy diets costing significantly more than less healthy diets. Despite the challenges, participants demonstrated resilience and agency, even while grappling with the significant emotional tolls from these experiences. This novel and insightful research provided a platform for voices within society that are generally not heard and gathered insights into their lived experience. This work is critical to guide policymakers and practitioners to develop more targeted and effective interventions, as part of transforming the food system to support healthy, sustainable eating habits in the face of rising food costs.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003ePLWO\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003ePeople Living With Obesity\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eFI\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eFood Insecurity\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eNone\\u003c/p\\u003e\\n\\u003ch3\\u003eEthics approval and consent to participate\\u003c/h3\\u003e\\n\\u003cp\\u003eThe Ethic approval was obtained from the Institutional Review Board at Leeds Beckett University, UK. Written informed consent was obtained from participants. All methods were carried out in accordance with the Declaration of Helsinki.\\u003c/p\\u003e\\n\\u003ch2\\u003eConsent for publication\\u003c/h2\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003ch2\\u003eClinical trial number\\u003c/h2\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003ch2\\u003eAvailability of data and materials\\u003c/h2\\u003e\\n\\u003cp\\u003eThe datasets used analysed during the current study available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003ch3\\u003e\\u003cstrong\\u003eCompeting Interests\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/h3\\u003e\\n\\u003cp\\u003eMSG is a director of Causal Insights Solutions Ltd, which provides causal inference training and may benefit from any study that demonstrates the value of causal inference methods. AB declares researcher-led grants from the National Institute for Health Research, Rosetrees Trust, MRC, INNOVATE UK, British Dietetic Association, British Association of Parenteral and Enteral Nutrition, BBRSC, the Office of Health Improvement and Disparities and NovoNordisk. AB reports honoraria from Novo Nordisk, Lilly, Office of Health Improvement and Disparity, Johnson and Johnson and Obesity UK outside the submitted work and is on the Medical Advisory Board and shareholder of Reset Health Clinics Ltd.\\u0026nbsp;CAH has received research funding from the American Beverage Association (paid to institution), personal honoraria from International Sweeteners Association and International Food Information Council and is primary supervisor on a PhD studentship funded by Coca-Cola, all for work unrelated to the submitted manuscript. CAH reports personal fees for their role on the UK Government\\u0026rsquo;s Food Standards Agency\\u0026rsquo;s Advisory Committee on Social Sciences, and an unpaid role as a trustee of Feeding Liverpool. No other authors declare that they have any competing interests. HG, EH, FD, RAS, TS and CG report no conflicts of interest.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch3\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/h3\\u003e\\n\\u003cp\\u003eThis research was funded through the Transforming the UK Food System for Healthy People and a Healthy Environment SPF Programme, delivered by UKRI, in partnership with the Global Food Security Programme, BBSRC, ESRC, MRC, NERC, Defra, DHSC, OHID, Innovate UK and FSA (BB/W018020/1 - FIO Food award).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch3\\u003eAuthors contributions:\\u003c/h3\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eHannah C Greatwood\\u003c/strong\\u003e: Conceptualisation, Methodology, Formal analysis, Investigation, Writing \\u0026ndash; Original Draft, Project administration. \\u003cstrong\\u003eEmma Hunter\\u003c/strong\\u003e: Conceptualisation, Methodology, Formal analysis, Investigation, Writing \\u0026ndash; Reviewing \\u0026amp; editing. \\u003cstrong\\u003eFlora Douglas\\u003c/strong\\u003e: Conceptualisation, Methodology, Funding Acquisition. \\u003cstrong\\u003eThomas Sawczuk\\u003c/strong\\u003e: Methodology, Writing \\u0026ndash; Review \\u0026amp; editing. \\u003cstrong\\u003eMark S Gilthorpe\\u003c/strong\\u003e: Methodology, Writing \\u0026ndash; Review \\u0026amp; editing. \\u003cstrong\\u003eRebecca Stone\\u003c/strong\\u003e: Methodology, Writing \\u0026ndash; Review \\u0026amp; editing. \\u003cstrong\\u003eAdrian Brown\\u003c/strong\\u003e: Methodology, Writing \\u0026ndash; Review \\u0026amp; editing. \\u003cstrong\\u003eAlex Johnstone\\u003c/strong\\u003e, Obtaining funding, Writing \\u0026ndash; Review \\u0026amp; editing. \\u003cstrong\\u003eCharlotte Hardman\\u003c/strong\\u003e, Writing \\u0026ndash; Review \\u0026amp; editing \\u003cstrong\\u003eClaire Griffiths\\u003c/strong\\u003e: Conceptualisation, Methodology, Formal analysis, Investigation, Writing \\u0026ndash; Review \\u0026amp; editing, Supervision, Funding Acquisition;\\u003c/p\\u003e\\n\\u003ch3\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/h3\\u003e\\n\\u003cp\\u003eThe authors wish to express their gratitude to the FIO Food Patient and Public Involvement (PPI) partners for their input to the co-production in the development of this work and to our interview and focus group participants for giving up their time and sharing their experiences.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003ePurdam K, Garratt EA, Esmail A. Hungry? Food Insecurity, Social Stigma and Embarrassment in the UK. Sociology. 2016;50(6):1072\\u0026ndash;88.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePollard CM, Booth S. Food Insecurity and Hunger in Rich Countries-It Is Time for Action against Inequality. Int J Environ Res Public Health. 2019;16(10):1804.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFood Foundation. Food Insecurity Tracking [Internet]. 2024 [cited 2025 Jan 30]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://foodfoundation.org.uk/initiatives/food-insecurity-tracking\\u003c/span\\u003e\\u003cspan address=\\\"https://foodfoundation.org.uk/initiatives/food-insecurity-tracking\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eTrussell Trust. 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Diet quality and its associated factors among adults with overweight and obesity: findings from the 2015\\u0026ndash;2018 National Health and Nutrition Examination Survey. Br J Nutr. 2024;131(1):134\\u0026ndash;42.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eOsborn B, Morey BN, Billimek J, Ro A. Food Insecurity and Type 2 Diabetes Among Latinos: Examining Neighborhood Cohesion as a Protective Factor. J Racial Ethnic Health Disparities. 2023;10(4):2061\\u0026ndash;70.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eFarrell E, Hollmann E, le Roux CW, Bustillo M, Nadglowski J, McGillicuddy D. The lived experience of patients with obesity: A systematic review and qualitative synthesis. Obes Rev. 2021;22(12):e13334.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eLoopstra R. Interventions to address household food insecurity in high-income countries. Proc Nutr Soc. 2018;77(3):270\\u0026ndash;81.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Living with Obesity, Food Insecurity, Focus Groups, Supermarkets, Qualitative Research, Cost-of-living, Health inequalities\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6697876/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6697876/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eThe United Kingdom faces complex economic and structural challenges that have disrupted food pricing, contributing to widespread food insecurity. These fluctuations diminish the affordability and accessibility of healthy, nutrient-dense foods among vulnerable groups. In high-income countries, food insecurity is associated with higher levels of obesity, and in the UK specifically, the cost of living crisis, where the cost of food has increased quicker than wages, is likely to have exacerbated existing dietary inequalities. This qualitative paper explores insights of people living with obesity and food insecurity, in an ethnically diverse community, to develop further understanding on their food shopping experiences.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eA secondary analysis of qualitative data from four focus groups (8\\u0026ndash;11 participants per group; 92% female) was undertaken with participants who self-reported as living with obesity and food insecurity (n\\u0026thinsp;=\\u0026thinsp;39) and were attempting to reduce their weight.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eThree themes and eight subthemes were generated using deductive and reflexive thematic analysis: (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e) the \\u003cem\\u003eConscious Consumer\\u003c/em\\u003e, reflects the preparation and planning participants undertook by participants to maximise their limited resources. Subthemes include advanced meal planning, and price-comparison shopping. Despite these efforts, participants frequently encountered barriers to being able to purchase nutritionally balanced foods. (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e) the \\u003cem\\u003eRestricted Consumer\\u003c/em\\u003e highlights how structural and systemic limitations, including time pressures due to work or caregiving responsibilities, further constrained participants\\u0026rsquo; food purchasing choices. and (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e) \\u003cem\\u003eMitigating the rising cost of food\\u003c/em\\u003e, describes the actions required to manage the challenges in purchasing foods with rising costs. Subthemes include substituting affordable, less-healthy products for costlier fresh produce and bulk buying of staple items.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eFindings challenge societal beliefs that people living on low incomes need to budget more carefully to afford a healthy diet. People living with obesity and food insecurity often report experiencing cognitive dissonance. In this context, participants faced difficult and emotive trade-offs, as they recognised the suboptimal nutritional value of their food purchases but felt compelled by necessity to buy unhealthier food that matched their budget. Findings provide further insights to support healthy, sustainable food purchasing, as part of transforming the UK food system.\\u003c/p\\u003e\",\"manuscriptTitle\":\"“We go hunting…too”: Experiences of people living with obesity and food insecurity in an ethnically diverse community when shopping for supermarket foods\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-07-10 08:47:09\",\"doi\":\"10.21203/rs.3.rs-6697876/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"cb12a459-34bc-4316-9cab-9cb0307453ed\",\"owner\":[],\"postedDate\":\"July 10th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-07-23T10:09:01+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-07-10 08:47:09\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6697876\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6697876\",\"identity\":\"rs-6697876\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}