The weight management practices and support needs of young adults living with excess weight in the UK and Australia: A mixed methods cross-sectional study using data from the YOUTH cohort

The weight management practices and support needs of young adults living with excess weight in the UK and Australia: A mixed methods cross-sectional study using data from the YOUTH cohort | 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 The weight management practices and support needs of young adults living with excess weight in the UK and Australia: A mixed methods cross-sectional study using data from the YOUTH cohort Tamla S. Evans, Jordan Marwood, Katerina Z Kolokotroni, Therese Fozard, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4594068/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 Young adulthood is a critical period where there is an increased weight gain trajectory. Understanding the weight management support needs of young adults with excess weight is essential to enable the delivery of appropriate and tailored services and prevent the development of comorbidities. This study sought to determine the current health service usage, weight management practices and support needs, in young adults with excess weight. Methods A mixed-methods convergent parallel design was employed. A cohort of community-dwelling young adults (18–35 years), with excess weight (BMI ≥ 25), residing in the UK and Australia participated in an online, longitudinal survey. Cross-sectional data was analysed descriptively, including quantitative measures of health service usage and weight management practices. Responses to an open-ended question asking what support participants would find most helpful were analysed using Thematic Template Analysis. Convergence and divergence across sociodemographic characteristics were explored. Results The sample (n = 410) included 204 women, 201 men and five non-binary people with a mean age of 28.3 and BMI of 35.8. Most participants reported a white ethnicity (80%) and resided in the UK (83%). Half reported a below median gross household income (49%). Most (73%) reported currently trying to manage their weight and 63% were using commercial weight management products or self-directed diets. Only 12% of participants reported accessing healthcare services for weight management support or treatment, yet qualitative responses indicated a desire for support from a dietitian or psychologist. Five themes indicated a need for structured but tailored resources, simplicity, addressing internal and external barriers, access to holistic professional support, and access to networks vs a preference for self-reliance. Conclusions Young adults with excess weight are using commercial products and self-led diets but many desire specialist healthcare professionals to support their weight management. Young adults appear to prefer online resources and support that are simplistic, structured and individually tailored to their diverse cultural preferences, routines, environments, and comorbidities. Furthermore, findings indicate unmet psychological support needs amongst young adults with excess weight in the UK and Australia. Protocol Whatnall, M., Fozard, T., Kolokotroni, K.Z., Marwood, J., Evans, T., Ells, L.J. and Burrows, T., 2022. Understanding eating behaviours, mental health and weight change in young adults: protocol paper for an international longitudinal study. BMJ open, 12(9), p.e064963. weight management prolific survey cohort study UK Australia young adults 1. Introduction 1.1 Background Over 52% of adults live with overweight or obesity worldwide ( 1 ). Obesity can lead to significant implications for physical ( 2 ) and mental health ( 3 ), including cardiovascular disease – the leading cause of death globally ( 4 ). Young adulthood is a critical period for weight gain, with evidence suggesting that most individuals living with obesity experience gradual weight gain before the age of 35 ( 5 ). Young adults (YA) are acknowledged to have the worst health trajectory when compared to other age groups. They are a heterogenous group with unique needs. They often experience a range of life stressors ( 6 , 7 ) such as moving out of home, low income, starting a family, high levels of lifestyle risk behaviours such as poor diet ( 8 , 9 ), low physical activity ( 10 ), and poor sleep which often cluster together ( 11 ). Engagement with healthcare services, weight management support, and some weight management behaviours may be helpful in reducing weight gain in YA living with obesity ( 12 – 14 ). Indeed, the SNAP trial found that in a YA sample, weight loss attempts acted as a buffer to future weight gain ( 14 ). However, it is difficult to engage young adults with health services given their unique needs ( 6 ). Despite findings suggesting that weight management interventions for YA should be appropriately tailored ( 15 ), the evidence base for weight management interventions targeting YA remains limited ( 16 ). In YA, perceived overweight is associated with more weight loss attempts, but increased weight gain over time ( 17 , 18 ), suggesting that weight loss attempts are not necessarily successful. This may be because YA are less likely to access appropriate formal support to enable them to successfully manage their weight ( 19 ). Limited engagement could be due to their unique needs or services not being tailored to YA. Therefore, understanding YA’s engagement with and support needs is important to inform service development and prevention strategies. However, given the complex health and social inequalities that underpin obesity ( 20 ), it is likely that weight management support needs will differ by social determinants. Obesity, Type 2 Diabetes, and poorer health outcomes are more common in people of a lower socioeconomic status (SES) and some minority ethnic groups ( 21 – 23 ), and those who are more deprived often require greater healthcare support ( 24 ). Furthermore, engagement with health services is known to differ by gender, ethnicity, and SES. For example, men appear to access healthcare less frequently than women ( 25 ) and report lower willingness to join weight management support groups or programmes, when compared to women ( 26 ). Research in adult samples have found that weight loss attempts are significantly more common in higher SES groups ( 27 – 29 ). Some research also suggests that people of an ethnic minority background may be more likely to use over-the-counter weight loss supplements, and less likely to use commercial weight loss programmes ( 29 ). Despite the relationships between ethnicity, SES, and excess weight, a systematic review indicated that there is a lack of high-quality trial evidence on the efficacy of weight management modifications in deprived and ethnically diverse YA samples ( 30 ). Therefore, it is essential that individual differences in weight management support needs are explored to support service modifications. 1.2 The present study Given the importance of intervention in managing weight in YA, it is crucial to understand health service usage, weight management attempts, and the weight management support needs of YA, to inform effective and equitable early intervention for obesity. This study therefore sought to: 1) descriptively report health service usage and weight management practices amongst YA with excess weight in the UK and Australia, 2) explore the perceived weight management support needs of YA, to understand the potential differences between current weight management engagement and what YA say they need. 2 Methods 2.1 Research questions What health/weight management support services and products are used by YA who live with excess weight? What are the weight management support needs of YA with excess weight? Do weight management support needs differ in relation to social determinants including BMI, gender, SES, and ethnicity? 2.2 Design A mixed methods convergent parallel design was used. Research questions and subsequent methods were informed by a critical realism research paradigm using a contextualism epistemology. 2.3 Data collection Baseline data collection was analysed from an online international longitudinal survey examining the temporal relationship between eating behaviours, mental health, and weight change, in a cohort of YA residing in the UK or Australia ( 31 ): YOUTH: Young people's Outlook on Understanding Mental health, Eating Behaviours, and Lifestyle in the UK and Australia. Ethical approval was granted by Leeds Beckett University, UK (reference number 86004) and the University of Newcastle, Australia (reference number H-2022–0110). Informed consent was obtained from all participants. 2.4 Quantitative data collection Demographic and anthropomorphic measures BMI was assessed via participant self-reported height and weight (kg/m 2 ) (validated in a subset of participants, using image-captured weight ( 32 ). Participants were asked to report their gender (options: female, male, non-binary, another gender) and ethnicity, using questions sourced/adapted from the UK and Australian census questionnaires. Household income was used as a proxy for SES; data for median gross income for each nation was used to determine whether a participant’s reported income was greater than/equal to, or below the median income for each country. Current healthcare use and weight management engagement Participants were asked whether they had used any health care services from a pre-defined list (see Table 2 ) in the past three months (in person or online). Participants were also asked if they are currently trying to manage their weight. If they answered yes, they were asked if they are currently receiving any support/treatment for weight management from a list of professionals, and if they were currently using any products or diets for weight management. Quantitative data analysis Descriptive statistics were analysed using IBM SPSS 27. The types of healthcare use, weight management attempts and weight management support used by the two cohorts were summarised and compared. 2.5 Qualitative data collection and analysis Qualitative data was collected through an optional open-ended question “What support would you find most helpful in managing your weight or eating behaviours in the future?” Responses were imported into NVivo12 software and analysed by TE and JM using inductive Template Thematic Analysis ( 33 , 34 ). Queries were run in Nvivo12 to explore convergences and divergences in the data across participant characteristics and sociodemographic characteristics (BMI category, gender, ethnicity, SES). Subsequent meetings were held to establish initial themes and their organisation into a hierarchical structure, followed by successive refinement and development of the template with input from LE. An inductive approach was taken to devising the template following analysis of all participant responses. 2.6 Reflexivity and methods to enhance rigor Authors TE and JM undertook independent coding, critical reflexive discussion, and documentation of emergent thinking throughout refinement of codes and theme development. Contextualism requires reflexivity to consider how meaning is shaped by the researcher and does not serve to minimise bias ( 35 ). Meetings were held to merge codes and to discuss and reflect on interpretations. Our stance as researchers were acknowledged, critically evaluated, and valued. For example, the behaviour change expertise of TE and disordered eating expertise of JM informed our interpretations of survey responses that implied psychological support needs (e.g., “improve my mood and not use food to cheer myself up”), whilst reflective discussions ensured interpretations were challenged to ensure we were not imposing our stances on the data. Furthermore, by returning to the data, we ensured analysis was grounded in participants’ responses ( 36 ). Coding reliability is discouraged when using Template Analysis ( 37 ). 3. Results 3.1 Participant characteristics Of the 512 people participating in the survey, 410 met the BMI ≥ 25 criteria and provided responses to the open-ended question. The sample included 204 women, 201 men and five non-binary people. The mean age was 28.3 (SD = 4.4). The mean BMI of the sample was 35.8kg/m2 (SD = 7.3, range 25.3–59.6); there were no significant differences in BMI between Australian (34.7 (SD = 6.4) and UK (36 (SD = 7.4) residents ( t (408) = -1.19, p = .23). Other participant characteristics are reported in Table 1 . Table 1 Participant Characteristics N (%) Country of residence Australia 16.8% United Kingdom 83.2% Ethnicity White Mixed Asian Black African/Caribbean Aboriginal or Torres Strait Islander Other 80.7% 5.6% 8.1% 3.4% 0.5% 1.2% Gross household income At or above national average (median) 47.6% Below national average (median) 49.3% Student status Student 22.7% Non-student 77.3% Just over half (54.4%, n = 232) of the sample reported having used any form of healthcare in the past three months and 73% of the sample (n = 302) were currently trying to manage their weight. 11.9% (n = 36) of participants were currently receiving support or treatment to manage their weight, and 62.9% (n = 190) were using weight management products or diets. Table 2 shows the current health care use, weight management engagement and support in the cohort. Although a very similar percentage of participants across Australia and the UK reported trying to manage their weight (72.5–73.9%), the samples differed in their health care and weight management techniques. A higher proportion of the Australian sample had accessed healthcare in the last 3 months and were also more likely than the UK cohort to be receiving expert support to manage their weight (26% vs 9.1%). Comparatively, a higher proportion of the UK participants were using products or diets to manage their weight (64.3% vs 56%). Similarly, weight management attempts were comparable across men and women (74.5% vs 73.2%). Despite this, more women reported having accessed healthcare in the past 3 months (63.2% vs 43.4%) and weight management support (38% vs 29.4%). Table 2 Types of healthcare use, weight management attempts and weight management support used by the cohort Number of responses Australian cohort UK cohort Men Women Non-binary In the past 3 months have you used any of the following health care services including online/over the phone? * General Practitioner 187 38 149 71 113 4 Psychologist 31 15 16 10 19 2 Psychiatrist 17 7 10 4 12 1 Dietitian 11 4 11 1 10 0 Medical Specialist 38 8 30 15 22 1 Exercise Physiologist 2 1 1 0 2 0 Physiotherapist 17 6 11 7 10 0 Other 28 8 20 12 15 1 Total n who endorsed any healthcare use 223 45 (65.2%) 178 (52.2%) 87 (43.4%) 129 (63.2%) 5 (100%) Are you currently trying to manage your weight? Yes 302 50 (72.5%) 252 (73.9%) 152 (74.5%) 150 (73.2%) 3 (60%) No 108 19 (27.5%) 89 (26.1%) 52 (25.5%) 55 (26.8%) 2 (40%) Are you currently receiving support/treatment for weight management from any of the following? * General Practitioner 13 9 4 2 11 0 Dietitian 8 2 8 2 6 0 Pharmacy 0 0 0 0 0 0 Exercise Physiologist 1 1 0 0 1 0 Physiotherapist 2 1 1 1 1 0 Personal Trainer 11 3 8 4 7 1 Health Coach 2 1 1 2 1 0 Other 8 2 6 3 4 1 Total n who endorsed receipt of weight management support 36 13 (26.00%) 23 (9.13%) 60 (29.4%) 78 (38%) 4 (80%) Are you currently using any of the following products or diets for weight management? * Over the counter supplements 7 1 6 6 2 0 Meal replacements (shakes, bars etc) 31 9 22 20 12 0 Meal delivery services 4 3 1 2 2 Weight management support group 12 0 12 4 8 0 Weight management online service or app 60 9 51 22 37 1 Very low-calorie diet (< 800kcal) 11 1 10 7 4 0 Low calorie diet 85 15 70 40 46 0 Low carbohydrate diet 28 5 23 16 13 0 Fasting diet 38 5 33 20 18 0 Other 20 3 17 5 15 0 Total n who endorsed product/diet use 190 28 (56.00%) I am not currently using any products or diets to manage my weight 112 22 (44.00%) 90 (35.71%) 65 (31.9%) 46 (22.4%) 2 (40%) *Participants could select as many responses as applied 3.3 Template Analysis results Five themes were identified across participant responses to the open-ended question. A template that illustrates the hierarchal mapping is shown in Supplementary Fig. 1. 1) Structured but tailored education, resources, and tools for the enactment of energy balance behaviours Many participant responses expressed a need for structured and credible resources such as meal and exercise plans, and some participants desired having meals boxed or delivered (see Supplementary Table 2 for example quotes). This illustrates a need for convenience but also a lack of confidence in making food decisions, as these young adults would prefer to remove this need for thoughtful decision making around food and exercise choices. In addition, responses illustrated a need for individual tailoring, particularly in the context of diet/meal plans. Although structured plans were cited, such plans would be more acceptable and easier to adhere to, if these are tailored to an individual’s food preferences, routine, and family circumstances. Moreover, some participants cited a desire for adjustable plans to allow “off-plan foods” to be taken into consideration, enabling unrestrictive eating. Equally, many participants desired plans tailored to affordability and access factors, as well as the skill level and convenience required. Meal plans were most frequently cited by men overall and participants of a white ethnic background, with some citations across men of other ethnicities. Similarly, exercise plans were more frequently cited by white men, with some citations by women and other ethnic groups. On the other hand, nutrition advice and education were frequently cited by both white men and women but remained less so across other ethnic groups. 2) Time poor: Simplicity, ease, and convenience for busy lives Many young adults described a preference for digital tools to support weight management including: smartphone apps that provide calorie and macronutrient calculators, food diaries, progress tracking, and incentivised rewards; adjustable online meal plans; virtual consultations; and wearable physical activity monitors. However, it’s important to note that digital tools were most frequently cited by white men and women. Regardless of the methods reported as potentially useful (e.g., diet plans, recipes, smartphone applications etc.), the need for simplicity, ease and convenience was a pattern across many responses. For example, digital monitoring tools that are simple to use, recipes that are easy to follow, and meal delivery services. 3) Addressing Barriers (two levels) 3.1) Those that are population/systemic issues (codes: structural and environmental barriers, financial barriers and facilitators) Many participants described how systemic changes would support the management of their weight, such as locally accessible exercise facilities, cheap and healthy food, and cheaper exercise facilities. Whilst young adults desire structured support, a personal trainer, meal plans, box meals or food delivery services, these tend to be costly and are therefore inaccessible to many young adults. This theme highlights the structural and environmental influences necessary to promote health and complement the busy lifestyles of young adults in the UK and Australia. Access to cheap and healthy food was most frequently cited by white below median SES participants. Similarly, cheaper exercise facilities were cited by only white participants but were somewhat more frequent in the above median SES group. This suggests that some systemic barriers are not unique to more deprived groups. Some survey responses also described how structural and environmental changes could support management of behavioural antecedents, ideas included more green spaces and banking functionalities such as individually set spending limits for certain food purchases or eating out. In contrast to access to cheap and healthy food, both white and mixed ethnic origin participants (in the below median SES group) most frequently desired greater access to exercise facilities (both physically and financially). 3.2) Those that can be targeted through the individual (codes: internal and external antecedents) Many participants expressed a need for support with individual level barriers to weight management, these included internal and external antecedents of unwanted eating behaviours. Participants referred to a range of internal cues that interfere with their weight management, such as emotions, sources of stress, habits, cravings, and appetite regulation. Support with motivation and “will power” was also frequently cited. Both support with motivation and managing internal cues were most frequently cited across white men and women, with only few citations across other ethnic groups. To address these individual level barriers, many participants perceived external accountability as a requirement to initiate and sustain behavioural changes. A range of potential sources of external accountability were described, including professional support (e.g., a personal trainer or dietitian), family, accountability buddies, and support groups. Some of these participants expressed a desire for high intensity support and monitoring, such as “someone constantly watching me”, “constant monitoring” and wanting “somebody to query what” they’ve “eaten each day”. This signifies various levels of external accountability that YA perceive as being helpful and illustrates how some YA have a low self-efficacy in their ability to sustain behavioural changes. The need for external accountability was frequently cited across survey responses and was common across all BMI categories and genders including males, females, and non-binary. Although these were most frequently cited in white participants. 4) Accessing professional services that are person-centred, compassionate, and holistic 4.1) General (nutrition, dietetics, GP) Professional support from a dietitian or nutritionist was the most frequently cited weight management support need across all survey responses, followed by a personal trainer, and psychological support. The desire for nutritional support was common across women of all BMI categories, whilst citations appeared to increase by BMI category in men. Furthermore, citations were most frequent across participants of a white ethnicity, with only a few participants from other ethnic backgrounds expressing a desire for nutritional support. Similarly, the desire for a personal trainer was expressed most frequently by white men and women, with only a few citations across other ethnicities. 4.2) Specialist (psychological, bariatric, pharmacological) Of the participant responses that were coded for psychological support, some explicitly referred to psychological services (e.g., counselling, therapy, mental health support, a doctor specialised in eating disorders, a psychologist), whilst others were more implicit (e.g., support with emotions, mindset, self-esteem, disordered eating, and a preoccupation with food). Furthermore, psychological support was coded most frequently across white women’s responses; although there appeared to be an increase by BMI category across both men and women, with few responses from men and participants from other ethnicities. Although less frequently cited in survey responses, some participants described biomedical interventions, such as medication or weight loss surgery, as an important weight management support need. Unlike the other forms of professional support described above, men (particularly those in the BMI ≥ 40 category) more frequently expressed a desire for pharmacological support. Some participants also cited bariatric surgery. Together this demonstrates the diversity of preference for professional support services across young adults in the UK and Australia, particularly in relation to ethnicity, gender, and BMI category. 5) Accessing networks vs self-reliance/responsibility Some participants exhibited a preference for accessing or improving social support whilst others described a preference for self-reliance. Those who did cite social support described a range of sources including family, friends, spouses, workout buddies, sport and exercise groups, peer support groups, and having shared goals with others. Support groups were the most frequently cited source of social support, cited exclusively by participants aged 22 years and over, and most frequently by those aged 28 years and over. Preference for groups was similar across men and women, and although in women this was exclusive to those of a white ethnicity, men from a range of ethnic backgrounds cited groups as a tool for weight management. Many responses described how peer support groups are useful for motivation and accountability, importantly some participants expressed a desire for groups that do not enforce a fixed plan but rather bring together like-minded individuals with the shared goal of healthy living. Social support from a partner, spouse or friends were most frequently cited by white men and women, although more so in men. Furthermore, white men most frequently cited social support from family, whilst men across ethnic groups cited workout buddies or sport/exercise groups. Many young adult women noted a preference for peer support groups but did not cite support inside the home. Male participants that described familial support mentioned the household food environment as a barrier to weight management and expressed a desire for encouragement. Similarly, men who cited friends expressed a desire for encouragement, motivation, someone to talk to, and having shared goals, whereas women were more likely to express a desire for emotional support but were not specific about the preferred source for this support. Many participants, particularly men in the overweight BMI category, described weight management as being their own responsibility. Outliers illustrating an unmet need: Nothing works / Unsure / None A subgroup of participant's responses fell outside of the general pattern of responses; these expressed either no desire for weight management support, uncertainty about what support could help them, or the belief that no support would be successful. These responses indicate a subgroup of YA who are potentially less likely to access or seek out weight management resources or support due to low self-efficacy, lack of awareness of support tools and service, and potentially negative experiences of weight loss attempts. 4 Discussion 4.1 Summary This study sought to determine health service usage, weight management practices, and support needs, amongst YA with excess weight in the UK and Australia. Although a very similar percentage of participants across countries and genders reported trying to manage their weight, a greater proportion of women and Australians had accessed healthcare in the last 3 months and were also more likely to be receiving professional support to manage their weight. Services from a general practitioner were the most accessed across both cohorts, whilst the Australian cohort were more likely to report accessing a psychologist. Comparatively, a slightly higher proportion of the UK participants were using products or diets to manage their weight. Template analysis identified five themes across participants’ perceived weight management support needs: 1) structured but tailored resources; 2) simplicity, ease, and convenience; 3) addressing barriers; 4) person-centred services; 5) accessing networks vs self-reliance. An additional cluster of responses were categorised to represent a subset of participants who reported either no support needs or uncertainty around what their needs were. 4.2 Relation to existing research Of those who were attempting to manage their weight, the majority were using diets/products as a weight management method, while strikingly few individuals were receiving support/treatment from a healthcare professional. It may be that YA are less able to access appropriate formal support, which results in increased weight gain, despite weight loss attempts in this age group ( 17 , 18 ). Our qualitive findings suggest that low uptake is not due to a lack of want for professional support, as the most frequently cited support needs were access to a dietitian, personal trainer, or psychologist. The reliance on commercial products and self-led diets is problematic from a social inequity perspective, as there might be a greater financial requirement to access diet products and services. Whilst the difficulty accessing publicly funded dietetic and psychological services might also explain their poor uptake. This notion was reflected by our qualitative findings, where many participants described how systemic changes, such as increased availability of exercise facilities and green spaces, access to cheap and healthy food, and cheaper and/or subsidised exercise facilities would support their weight management. Additional research is needed to understand the reasons behind low uptake of healthcare services for weight management support and whether this is due to limited awareness or accessibility and availability of services. Further unmet psychological support needs were also indicated. Many participants described their psychological support needs qualitatively, ranging from higher intensity support (e.g., mental health and disordered eating) to low intensity support (e.g., managing internal and external antecedents of their behaviours, and habit change). Our qualitative findings suggested YA lack the confidence and skills to manage their weight and habitual responses to internal and external antecedents of eating behaviours, generating a need for external accountability. This finding aligns with a qualitative study of UK-based study of women participant in Slimming World ( 38 ), and suggests the importance of developing interventions that build skills in self-managing behavioural antecedents and self-efficacy. Although psychological support (including disordered eating support) was one of the most cited weight management support needs, the lack of support being received, and highly cited desire for psychological support, illustrate a significant unmet need for YA in the UK and Australia. Future studies from our group will examine the prevalence and changes in disordered eating in the YOUTH cohort. Disordered eating is increasingly recognised as an important factor in person-centred weight management support ( 39 ). However, participation of people with disordered eating in weight management programmes is controversial, as restricted eating and eating beliefs can influence the development and maintenance of disordered eating ( 40 ). However, the preoccupation with weight, shape, and food ( 41 ) means that people with disordered eating may be more likely to be engaging in weight management attempts. Furthermore, eating disorders are commonly associated with secrecy and shame ( 42 ) suggesting people may be engaging in weight management attempts in private, without professional support. Our finding that the majority of YA were currently managing their weight and using commercial products or self-led diets to do so, alongside reports of disordered eating, suggests YA might be accessing products and diets that might exacerbate their disordered eating. A finding that potentially substantiates the argument for public health campaigns to promote both the harms of unhealthy weight management practices in addition to the benefits of healthy practices ( 43 ). In contrast, people of minority ethnic backgrounds were less likely to cite traditional sources of support such as personal training, nutritional education and resources, or support from a dietitian. Another study found minority ethnic groups more likely to report using over-the-counter weight loss supplements, and less likely to report use of commercial weight loss programmes ( 29 ), when compared to white participants. This implies that traditional nutritional education and support are not perceived as useful or acceptable to minority ethnic groups, which might speak to the lack of cultural tailoring, as these typically reflect a westernised culture. Given that people from minoritized ethnic backgrounds are more likely to live with obesity ( 23 ), it is critical that culturally competent resources are developed for these communities. The gender and ethnic differences also observed in terms of the need for psychological support (which predominated in white women) may also reflect the impact of culture and gender on mental health awareness, literacy, and acceptability of requesting psychological support. This is substantiated by research identifying stigmatisation of mental illness and help-seeking behaviour in Black and South Asian groups, and particularly young men ( 44 , 45 ). The weight management support needs identified in this study are supported by other research in YA. For example, we identified a need for multi-component weight management support that is tailored to need, a finding that correlated with data from young women living with excess weight in Australia ( 46 ). Interestingly, the qualitative results indicated group-based weight management support to be equally cited across men and women, which does not reflect the poorer uptake of support groups by men ( 47 ). This suggests that group-based support services might not be tailored towards men's preferences, rather than men having no desire to receive group-based support; this is corroborated by findings of the WRAP trial, where male participants viewed commercial weight loss programmes as women’s groups ( 48 ). Some men in our study described a preference for sport and exercise groups, which have been found to effectively engage middle aged men (35–65 years old) with excess weight (e.g., Football Fans in Training ( 49 )), suggesting similar groups could be a viable intervention for young men. In addition, YA men described a strong preference for weight management support from family, friends, and their spouses, particularly with managing the household food environment and receiving encouragement and praise. Responses relating to the food environment in the home potentially reflect traditional gender household responsibilities, whereby men are less involved with food decision making and preparation, resulting in less autonomy over their eating behaviours. Many young adult women noted a preference for peer support groups but did not cite support inside the home, and women were more likely than men to express a desire for emotional support but were not specific about the preferred source for this support. Perhaps, men are more likely than women to find benefit from family members providing praise or affirmation of their weight management efforts. These findings reiterate the need for tailored support, which is consistent with other studies exploring weight management in YA ( 15 ). Finally, our findings indicated a preference for use of online and digital resources and tools in line with other research in young people. Although these methods show potential for increasing physical activity and reducing weight ( 50 ), they should be used as an adjunct or to support communication with a healthcare professional, rather than as a replacement for human contact. Especially given the limited evidence base for the effectiveness of digital weight management support for YA ( 16 ), and the frequently cited desire for specialist health professional support in our sample. A 12-week m-health intervention that delivered non-personalised behaviour change information with limited contact with peers and a dietitian found no significant difference in weight loss in YA in Australia ( 51 ). Feedback received on this intervention revealed that YA prefer personal weight loss targets with regular weight monitoring, contact, and support with planning meals and activity schedules. Participants also expressed a desire for content tailored to individuals and their commitment levels, and meal plans with more options across various dietary needs and preferences (e.g., vegan, gluten-free) ( 51 ). This is in line with other research finding young women to prefer multicomponent digital interventions alongside support from a credible health professional that are delivered flexibly ( 46 ). 4.3 Strengths and limitations The strengths of this paper include the use of a validated BMI measure ( 32 ) and the stringent processes used to collect survey data through validation processes embedded within both the survey and the Prolific delivery platform [ https://www.prolific.co/ ]. The mixed-method approach also facilitated the exploration of both current practice vs self-reported need. Furthermore, stratification of participant characteristics resulted in an even split of men and women and above and below median national income. The spread of ethnicity in the sample is also representative of the population in the UK and Australia (e.g., 82% of people in England Wales are White and 2.9% of Australian’s are Aboriginal) ( 52 , 53 ). Although a limitation was the comparatively small Australian cohort, due to a higher uptake of the Prolific platform in the UK. Further, since participants were sampled using the Prolific platform, those using this digital platform may favour digital tools to a greater extent than the general population. 4.4 Recommendations for practice There is a need for structured resources or support that are individually tailored and flexible to the diverse preferences, routines, environments, cultures, finances, and physical/psychological comorbidities that reflect the 21st century lifestyles of YA in high-income countries. The unmet psychological support needs identified in this study illustrate the importance of psychological support for YA with excess weight. This support must cover a spectrum of needs, from managing internal and external antecedents of eating behaviours, to mental health and eating disorder management. Resources, education and support should include psychological education and training in the development of cognitive strategies to build and sustain confidence in dietary and physical activity habits. Increased public awareness, literacy and education on the psychological underpinnings of obesity is necessary to address stigma and help YA to identify and communicate their psychological support needs, especially amongst young men and minority ethnic groups. Systemic changes to structural and environmental influences such as access to green areas locally, food affordability, and subsidised exercise facility memberships are necessary to promote health and complement the busy lifestyles of YAs. Primary care should offer referrals to a personal trainer and/or a dietitian where this is perceived as helpful. Dietetic and weight management services should provide easy to follow healthy recipes and individual meal plans that are adjustable and tailored to an individual’s cultural traditions, dietary and taste preferences, affordability, family care roles and routine. These should be in an accessible easy to use format (e.g., online or app-based) alongside app-based self-monitoring tools to support individuals' self-regulation. Men should be encouraged and guided on how to elicit support from their family, friends, and spouses, particularly with managing barriers within the household food environment. 4.5 Recommendations for future research Gender-sensitised group-based interventions for young men should continue to be developed and evaluated, including but not limited to sport and exercise groups. Further research should explore whether the lack of preference for nutritional resources and support across minoritised ethnic communities is due to a lack of cultural tailoring. Co-developed culturally competent interventions for ethnic minority YA should be developed and evaluated. Hybrid interventions, for example Smartphone Applications that are tailored to the holistic needs of young people, alongside conveniently scheduled one-to-one sessions with a healthcare professional should be developed and evaluated. Interventions might also benefit from offering group-based in-person or virtual sessions, as many participants desired group-based social support. Community-based interventions could implement and evaluate group-based, gender sensitised exercise sessions to further facilitate group support and the desire for work out buddies whilst being a cheaper alternative to personal training – implementing these as a collaborative initiative with local gym and exercise facilities could enhance feasibility. There is an urgent need for further research to explore the appropriateness of diet products and approaches in people living with disordered eating. 5. Conclusion Despite young adults attempting to manage their weight, few are accessing support from a healthcare professional. On the contrary, young adults expressed a desire for dietetic and psychological support to support weight management, suggesting limited accessibility as opposed to no desire to access support. Generally, young adults require access to structured resources or support that are individually tailored and flexible to the diverse cultural preferences, routines, environments, finances, and physical/psychological comorbidities that reflect the 21st century lifestyles of young adults in high-income countries. More specifically, findings indicate unmet disordered eating and mental health needs. It is essential that referral pathways to weight management services and psychological support are strengthened. The findings will inform the co-production of an online intervention for disordered eating with young adults. Declarations Ethics approval and consent to participate : Ethical approval was granted by Leeds Beckett University, UK (reference number 86004) and the University of Newcastle, Australia (reference number H-2022–0110). All participants provided informed consent. Availability of data and materials : Data are available upon reasonable request. Example qualitative data supporting the conclusions of this article are available in Supplementary Table 2. Competing interests : None to declare Funding : This work was supported by a grant from the Centre for Psychological Research, Leeds Beckett University, UK (grant number N/A), and a School of Health Sciences grant from the University of Newcastle, Australia (grant number N/A). Authors' contributions : TB, LE, TF, MW, KK, JM and TE were involved in conceiving and designing the study. TF, MW and KK are primarily responsible for data acquisition and data organisation. TE and JM analysed the data and prepared the written manuscript. All authors approved the final manuscript. Acknowledgements : The authors thank public involvement participants Elysa Ioannou, Rachel Bolton, and Rosie Horton for helping to co-develop this programme of study. We also thank BSc Nutrition & Dietetics students, Kaydee Shepherd, for supporting a literature review. 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Jackson SE, Wardle J, Johnson F, Finer N, Beeken RJ. The impact of a health professional recommendation on weight loss attempts in overweight and obese British adults: a cross-sectional analysis. BMJ open. 2013;3(11):e003693. Bärebring L, Winkvist A, Augustin H. Sociodemographic factors associated with reported attempts at weight loss and specific dietary regimens in Sweden: the SWEDIET-2017 study. PLoS ONE. 2018;13(5):e0197099. Tsai AG, Wadden TA, Pillitteri JL, Sembower MA, Gerlach KK, Kyle TK, et al. Disparities by ethnicity and socioeconomic status in the use of weight loss treatments. J Natl Med Assoc. 2009;101(1):62–70. Hayba N, Partridge SR, Nour MM, Grech A, Allman Farinelli M. Effectiveness of lifestyle interventions for preventing harmful weight gain among young adults from lower socioeconomic status and ethnically diverse backgrounds: a systematic review. Obes Rev. 2018;19(3):333–46. Whatnall M, Fozard T, Kolokotroni KZ, Marwood J, Evans T, Ells LJ, et al. Understanding eating behaviours, mental health and weight change in young adults: protocol paper for an international longitudinal study. BMJ open. 2022;12(9):e064963. Whatnall MC, Kolokotroni KZ, Fozard TE, Evans TS, Marwood JR, Ells LJ, et al. How is online self-reported weight compared with image-captured weight? A comparative study using data from an online longitudinal study of young adults. Am J Clin Nutr. 2023;118(2):452–8. King N, in Organizational Research. Essential Guide to Qualitative Methods. 2004 2024/05/10. London: SAGE Publications Ltd. https://sk.sagepub.com/books/essential-guide-to-qualitative-methods-in-organizational-research . Brooks J, McCluskey S, Turley E, King N. The utility of template analysis in qualitative psychology research. Qualitative Res Psychol. 2015;12(2):202–22. Gough B, Madill A. Subjectivity in psychological science: from problem to prospect. Psychol Methods. 2012;17(3):374. Madill A, Jordan A, Shirley C. Objectivity and reliability in qualitative analysis: Realist, contextualist and radical constructionist epistemologies. Br J Psychol. 2000;91(1):1–20. King N, Brooks JM. Template analysis for business and management students. Sage; 2016. Hugh-Jones S, Burke S, Stubbs J. I didn't want to do it on my own: A qualitative study of women's perceptions of facilitating and risk factors for weight control on a UK commercial community program. Appetite. 2021;165:105308. Marwood J, Brown T, Kaiseler M, Clare K, Feeley A, Blackshaw J, et al. Psychological support within tier 2 adult weight management services, are we doing enough for people with mental health needs? A mixed-methods survey. Clin Obes. 2023;13(4):e12580. Da Luz FQ, Hay P, Touyz S, Sainsbury A. Obesity with comorbid eating disorders: associated health risks and treatment approaches. Nutrients. 2018;10(7):829. Fairburn CG, Beglin SJ. Assessment of eating disorders: Interview or self-report questionnaire? Int J Eat Disord. 1994;16(4):363–70. Fassino S, Abbate-Daga G. Resistance to treatment in eating disorders: a critical challenge. Springer; 2013. pp. 1–4. Mulgrew KE, Prichard I, Stalley N, Lim MSC. Effectiveness of a multi-session positive self, appearance, and functionality program on women’s body satisfaction and response to media. Body Image. 2019;31:102–11. Arora PG, Metz K, Carlson CI. Attitudes toward professional psychological help seeking in South Asian students: Role of stigma and gender. J multicultural Couns Dev. 2016;44(4):263–84. Memon A, Taylor K, Mohebati LM, Sundin J, Cooper M, Scanlon T, et al. Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ open. 2016;6(11):e012337. Crino ND, Parker HM, Gifford JA, Lau KYK, Greenfield EM, Donges CE, et al. What do young women with obesity want from a weight management program? Eating and Weight Disorders-Studies on Anorexia. Bulimia Obes. 2020;25:1303–9. Ashton LM, Morgan PJ, Hutchesson MJ, Rollo ME, Young MD, Collins CE. A systematic review of SNAPO (Smoking, Nutrition, Alcohol, Physical activity and Obesity) randomized controlled trials in young adult men. Prev Med. 2015;81:221–31. Allen JT, Cohn SR, Ahern AL. Experiences of a commercial weight-loss programme after primary care referral: a qualitative study. Br J Gen Pract. 2015;65(633):e248–55. Wyke S, Hunt K, Gray C, Fenwick E, Bunn C, Donnan P et al. Football fans in training (FFIT): a randomised controlled trial of a gender-sensitised weight loss and healthy living programme for men. Public Health Res. 2015. Kim H-N, Seo K. Smartphone-based health program for improving physical activity and tackling obesity for young adults: a systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17(1):15. Hebden L, Cook A, Van Der Ploeg HP, King L, Bauman A, Allman-Farinelli M. A mobile health intervention for weight management among young adults: a pilot randomised controlled trial. J Hum Nutr dietetics. 2014;27(4):322–32. Office for National Statistics. Ethnicity facts and figures. 2022. Accessed January 2024 [ https://www.ethnicity-facts-figures.service.gov.uk/ ]. The Central Intelligence Agency. Australia: Ethnic groups as of 2021. 2024. Accessed March 2024 [ https://www.statista.com/statistics/260502/ethnic-groups-in-australia/] . Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable1..docx SupplementaryTable2.docx Supplementaryfigure1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4594068","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":315696677,"identity":"0385da5d-7388-4823-9b0e-6825c67caf29","order_by":0,"name":"Tamla S. 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Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Background\u003c/h2\u003e \u003cp\u003eOver 52% of adults live with overweight or obesity worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Obesity can lead to significant implications for physical (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and mental health (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), including cardiovascular disease \u0026ndash; the leading cause of death globally (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Young adulthood is a critical period for weight gain, with evidence suggesting that most individuals living with obesity experience gradual weight gain before the age of 35 (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Young adults (YA) are acknowledged to have the worst health trajectory when compared to other age groups. They are a heterogenous group with unique needs. They often experience a range of life stressors (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) such as moving out of home, low income, starting a family, high levels of lifestyle risk behaviours such as poor diet (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), low physical activity (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), and poor sleep which often cluster together (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Engagement with healthcare services, weight management support, and some weight management behaviours may be helpful in reducing weight gain in YA living with obesity (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Indeed, the SNAP trial found that in a YA sample, weight loss attempts acted as a buffer to future weight gain (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, it is difficult to engage young adults with health services given their unique needs (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Despite findings suggesting that weight management interventions for YA should be appropriately tailored (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), the evidence base for weight management interventions targeting YA remains limited (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn YA, perceived overweight is associated with more weight loss attempts, but increased weight gain over time (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), suggesting that weight loss attempts are not necessarily successful. This may be because YA are less likely to access appropriate formal support to enable them to successfully manage their weight (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Limited engagement could be due to their unique needs or services not being tailored to YA. Therefore, understanding YA\u0026rsquo;s engagement with and support needs is important to inform service development and prevention strategies.\u003c/p\u003e \u003cp\u003eHowever, given the complex health and social inequalities that underpin obesity (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), it is likely that weight management support needs will differ by social determinants. Obesity, Type 2 Diabetes, and poorer health outcomes are more common in people of a lower socioeconomic status (SES) and some minority ethnic groups (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), and those who are more deprived often require greater healthcare support (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Furthermore, engagement with health services is known to differ by gender, ethnicity, and SES. For example, men appear to access healthcare less frequently than women (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and report lower willingness to join weight management support groups or programmes, when compared to women (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Research in adult samples have found that weight loss attempts are significantly more common in higher SES groups (\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Some research also suggests that people of an ethnic minority background may be more likely to use over-the-counter weight loss supplements, and less likely to use commercial weight loss programmes (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Despite the relationships between ethnicity, SES, and excess weight, a systematic review indicated that there is a lack of high-quality trial evidence on the efficacy of weight management modifications in deprived and ethnically diverse YA samples (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Therefore, it is essential that individual differences in weight management support needs are explored to support service modifications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 The present study\u003c/h2\u003e \u003cp\u003eGiven the importance of intervention in managing weight in YA, it is crucial to understand health service usage, weight management attempts, and the weight management support needs of YA, to inform effective and equitable early intervention for obesity.\u003c/p\u003e \u003cp\u003eThis study therefore sought to: 1) descriptively report health service usage and weight management practices amongst YA with excess weight in the UK and Australia, 2) explore the perceived weight management support needs of YA, to understand the potential differences between current weight management engagement and what YA say they need.\u003c/p\u003e \u003c/div\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Research questions\u003c/h2\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat health/weight management support services and products are used by YA who live with excess weight?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat are the weight management support needs of YA with excess weight?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDo weight management support needs differ in relation to social determinants including BMI, gender, SES, and ethnicity?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Design\u003c/h2\u003e \u003cp\u003eA mixed methods convergent parallel design was used. Research questions and subsequent methods were informed by a critical realism research paradigm using a contextualism epistemology.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data collection\u003c/h2\u003e \u003cp\u003eBaseline data collection was analysed from an online international longitudinal survey examining the temporal relationship between eating behaviours, mental health, and weight change, in a cohort of YA residing in the UK or Australia (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e): YOUTH: Young people's Outlook on Understanding Mental health, Eating Behaviours, and Lifestyle in the UK and Australia. Ethical approval was granted by Leeds Beckett University, UK (reference number 86004) and the University of Newcastle, Australia (reference number H-2022\u0026ndash;0110). Informed consent was obtained from all participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Quantitative data collection\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eDemographic and anthropomorphic measures\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eBMI was assessed via participant self-reported height and weight (kg/m\u003csup\u003e2\u003c/sup\u003e) (validated in a subset of participants, using image-captured weight (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Participants were asked to report their gender (options: female, male, non-binary, another gender) and ethnicity, using questions sourced/adapted from the UK and Australian census questionnaires. Household income was used as a proxy for SES; data for median gross income for each nation was used to determine whether a participant\u0026rsquo;s reported income was greater than/equal to, or below the median income for each country.\u003c/p\u003e \u003cp\u003e \u003cem\u003eCurrent healthcare use and weight management engagement\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants were asked whether they had used any health care services from a pre-defined list (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) in the past three months (in person or online). Participants were also asked if they are currently trying to manage their weight. If they answered yes, they were asked if they are currently receiving any support/treatment for weight management from a list of professionals, and if they were currently using any products or diets for weight management.\u003c/p\u003e \u003cp\u003e \u003cem\u003eQuantitative data analysis\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDescriptive statistics were analysed using IBM SPSS 27. The types of healthcare use, weight management attempts and weight management support used by the two cohorts were summarised and compared.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Qualitative data collection and analysis\u003c/h2\u003e \u003cp\u003eQualitative data was collected through an optional open-ended question \u003cem\u003e\u0026ldquo;What support would you find most helpful in managing your weight or eating behaviours in the future?\u0026rdquo;\u003c/em\u003e Responses were imported into NVivo12 software and analysed by TE and JM using inductive Template Thematic Analysis (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Queries were run in Nvivo12 to explore convergences and divergences in the data across participant characteristics and sociodemographic characteristics (BMI category, gender, ethnicity, SES). Subsequent meetings were held to establish initial themes and their organisation into a hierarchical structure, followed by successive refinement and development of the template with input from LE.\u003c/p\u003e \u003cp\u003eAn inductive approach was taken to devising the template following analysis of all participant responses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Reflexivity and methods to enhance rigor\u003c/h2\u003e \u003cp\u003eAuthors TE and JM undertook independent coding, critical reflexive discussion, and documentation of emergent thinking throughout refinement of codes and theme development. Contextualism requires reflexivity to consider how meaning is shaped by the researcher and does not serve to minimise bias (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Meetings were held to merge codes and to discuss and reflect on interpretations. Our stance as researchers were acknowledged, critically evaluated, and valued. For example, the behaviour change expertise of TE and disordered eating expertise of JM informed our interpretations of survey responses that implied psychological support needs (e.g., \u0026ldquo;improve my mood and not use food to cheer myself up\u0026rdquo;), whilst reflective discussions ensured interpretations were challenged to ensure we were not imposing our stances on the data. Furthermore, by returning to the data, we ensured analysis was grounded in participants\u0026rsquo; responses (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Coding reliability is discouraged when using Template Analysis (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participant characteristics\u003c/h2\u003e \u003cp\u003eOf the 512 people participating in the survey, 410 met the BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 criteria and provided responses to the open-ended question. The sample included 204 women, 201 men and five non-binary people. The mean age was 28.3 (SD\u0026thinsp;=\u0026thinsp;4.4). The mean BMI of the sample was 35.8kg/m2 (SD\u0026thinsp;=\u0026thinsp;7.3, range 25.3\u0026ndash;59.6); there were no significant differences in BMI between Australian (34.7 (SD\u0026thinsp;=\u0026thinsp;6.4) and UK (36 (SD\u0026thinsp;=\u0026thinsp;7.4) residents (\u003cem\u003et\u003c/em\u003e(408) = -1.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.23). Other participant characteristics are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003e\u003cem\u003eParticipant Characteristics\u003c/em\u003e\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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCountry of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003cp\u003eMixed\u003c/p\u003e \u003cp\u003eAsian\u003c/p\u003e \u003cp\u003eBlack African/Caribbean\u003c/p\u003e \u003cp\u003eAboriginal or Torres Strait Islander\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.7%\u003c/p\u003e \u003cp\u003e5.6%\u003c/p\u003e \u003cp\u003e8.1%\u003c/p\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGross household income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt or above national average (median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow national average (median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStudent status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-student\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.3%\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\u003eJust over half (54.4%, n\u0026thinsp;=\u0026thinsp;232) of the sample reported having used any form of healthcare in the past three months and 73% of the sample (n\u0026thinsp;=\u0026thinsp;302) were currently trying to manage their weight. 11.9% (n\u0026thinsp;=\u0026thinsp;36) of participants were currently receiving support or treatment to manage their weight, and 62.9% (n\u0026thinsp;=\u0026thinsp;190) were using weight management products or diets.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the current health care use, weight management engagement and support in the cohort. Although a very similar percentage of participants across Australia and the UK reported trying to manage their weight (72.5\u0026ndash;73.9%), the samples differed in their health care and weight management techniques. A higher proportion of the Australian sample had accessed healthcare in the last 3 months and were also more likely than the UK cohort to be receiving expert support to manage their weight (26% vs 9.1%). Comparatively, a higher proportion of the UK participants were using products or diets to manage their weight (64.3% vs 56%). Similarly, weight management attempts were comparable across men and women (74.5% vs 73.2%). Despite this, more women reported having accessed healthcare in the past 3 months (63.2% vs 43.4%) and weight management support (38% vs 29.4%).\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\u003e\u003cem\u003eTypes of healthcare use, weight management attempts and weight management support used by the cohort\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of responses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAustralian cohort\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUK cohort\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNon-binary\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIn the past 3 months have you used any of the following health care services including online/over the phone? *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatrist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDietitian\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\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercise Physiologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysiotherapist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal n who endorsed any healthcare use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e223\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e45 (65.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e178 (52.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e87 (43.4%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e129 (63.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e5 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAre you currently trying to manage your weight?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e302\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e50 (72.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e252 (73.9%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e152 (74.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e150 (73.2%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e3 (60%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e108\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e19 (27.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e89 (26.1%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e52 (25.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e55 (26.8%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e2 (40%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAre you currently receiving support/treatment for weight management from any of the following? *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDietitian\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\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercise Physiologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysiotherapist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal Trainer\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\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Coach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\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\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal n who endorsed receipt of weight management support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e36\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e13 (26.00%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e23 (9.13%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e60 (29.4%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e78 (38%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e4 (80%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAre you currently using any of the following products or diets for weight management? *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOver the counter supplements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeal replacements (shakes, bars etc)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeal delivery services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeight management support group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeight management online service or app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery low-calorie diet (\u0026lt;\u0026thinsp;800kcal)\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\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow calorie diet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow carbohydrate diet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFasting diet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal n who endorsed product/diet use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e190\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e28 (56.00%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eI am not currently using any products or diets to manage my weight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e112\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e22 (44.00%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e90 (35.71%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e65 (31.9%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e46 (22.4%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e2 (40%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*Participants could select as many responses as applied\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Template Analysis results\u003c/h2\u003e \u003cp\u003eFive themes were identified across participant responses to the open-ended question. A template that illustrates the hierarchal mapping is shown in Supplementary Fig.\u0026nbsp;1.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1) Structured but tailored education, resources, and tools for the enactment of energy balance behaviours\u003c/h3\u003e\n\u003cp\u003eMany participant responses expressed a need for structured and credible resources such as meal and exercise plans, and some participants desired having meals boxed or delivered (see Supplementary Table\u0026nbsp;2 for example quotes). This illustrates a need for convenience but also a lack of confidence in making food decisions, as these young adults would prefer to remove this need for thoughtful decision making around food and exercise choices.\u003c/p\u003e \u003cp\u003eIn addition, responses illustrated a need for individual tailoring, particularly in the context of diet/meal plans. Although structured plans were cited, such plans would be more acceptable and easier to adhere to, if these are tailored to an individual\u0026rsquo;s food preferences, routine, and family circumstances. Moreover, some participants cited a desire for adjustable plans to allow \u0026ldquo;off-plan foods\u0026rdquo; to be taken into consideration, enabling unrestrictive eating. Equally, many participants desired plans tailored to affordability and access factors, as well as the skill level and convenience required.\u003c/p\u003e \u003cp\u003e Meal plans were most frequently cited by men overall and participants of a white ethnic background, with some citations across men of other ethnicities. Similarly, exercise plans were more frequently cited by white men, with some citations by women and other ethnic groups. On the other hand, nutrition advice and education were frequently cited by both white men and women but remained less so across other ethnic groups.\u003c/p\u003e\n\u003ch3\u003e2) Time poor: Simplicity, ease, and convenience for busy lives\u003c/h3\u003e\n\u003cp\u003eMany young adults described a preference for digital tools to support weight management including: smartphone apps that provide calorie and macronutrient calculators, food diaries, progress tracking, and incentivised rewards; adjustable online meal plans; virtual consultations; and wearable physical activity monitors. However, it\u0026rsquo;s important to note that digital tools were most frequently cited by white men and women.\u003c/p\u003e \u003cp\u003eRegardless of the methods reported as potentially useful (e.g., diet plans, recipes, smartphone applications etc.), the need for simplicity, ease and convenience was a pattern across many responses. For example, digital monitoring tools that are simple to use, recipes that are easy to follow, and meal delivery services.\u003c/p\u003e\n\u003ch3\u003e3) Addressing Barriers (two levels)\u003c/h3\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.1) Those that are population/systemic issues (codes: structural and environmental barriers, financial barriers and facilitators)\u003c/h2\u003e \u003cp\u003eMany participants described how systemic changes would support the management of their weight, such as locally accessible exercise facilities, cheap and healthy food, and cheaper exercise facilities. Whilst young adults desire structured support, a personal trainer, meal plans, box meals or food delivery services, these tend to be costly and are therefore inaccessible to many young adults. This theme highlights the structural and environmental influences necessary to promote health and complement the busy lifestyles of young adults in the UK and Australia.\u003c/p\u003e \u003cp\u003eAccess to cheap and healthy food was most frequently cited by white below median SES participants. Similarly, cheaper exercise facilities were cited by only white participants but were somewhat more frequent in the above median SES group. This suggests that some systemic barriers are not unique to more deprived groups.\u003c/p\u003e \u003cp\u003eSome survey responses also described how structural and environmental changes could support management of behavioural antecedents, ideas included more green spaces and banking functionalities such as individually set spending limits for certain food purchases or eating out. In contrast to access to cheap and healthy food, both white and mixed ethnic origin participants (in the below median SES group) most frequently desired greater access to exercise facilities (both physically and financially).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.2) Those that can be targeted through the individual (codes: internal and external antecedents)\u003c/h2\u003e \u003cp\u003eMany participants expressed a need for support with individual level barriers to weight management, these included internal and external antecedents of unwanted eating behaviours. Participants referred to a range of internal cues that interfere with their weight management, such as emotions, sources of stress, habits, cravings, and appetite regulation. Support with motivation and \u0026ldquo;will power\u0026rdquo; was also frequently cited. Both support with motivation and managing internal cues were most frequently cited across white men and women, with only few citations across other ethnic groups.\u003c/p\u003e \u003cp\u003eTo address these individual level barriers, many participants perceived external accountability as a requirement to initiate and sustain behavioural changes. A range of potential sources of external accountability were described, including professional support (e.g., a personal trainer or dietitian), family, accountability buddies, and support groups. Some of these participants expressed a desire for high intensity support and monitoring, such as \u0026ldquo;someone constantly watching me\u0026rdquo;, \u0026ldquo;constant monitoring\u0026rdquo; and wanting \u0026ldquo;somebody to query what\u0026rdquo; they\u0026rsquo;ve \u0026ldquo;eaten each day\u0026rdquo;. This signifies various levels of external accountability that YA perceive as being helpful and illustrates how some YA have a low self-efficacy in their ability to sustain behavioural changes. The need for external accountability was frequently cited across survey responses and was common across all BMI categories and genders including males, females, and non-binary. Although these were most frequently cited in white participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e4) Accessing professional services that are person-centred, compassionate, and holistic\u003c/h3\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1) General (nutrition, dietetics, GP)\u003c/h2\u003e \u003cp\u003eProfessional support from a dietitian or nutritionist was the most frequently cited weight management support need across all survey responses, followed by a personal trainer, and psychological support. The desire for nutritional support was common across women of all BMI categories, whilst citations appeared to increase by BMI category in men. Furthermore, citations were most frequent across participants of a white ethnicity, with only a few participants from other ethnic backgrounds expressing a desire for nutritional support. Similarly, the desire for a personal trainer was expressed most frequently by white men and women, with only a few citations across other ethnicities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.2) Specialist (psychological, bariatric, pharmacological)\u003c/h2\u003e \u003cp\u003e Of the participant responses that were coded for psychological support, some explicitly referred to psychological services (e.g., counselling, therapy, mental health support, a doctor specialised in eating disorders, a psychologist), whilst others were more implicit (e.g., support with emotions, mindset, self-esteem, disordered eating, and a preoccupation with food). Furthermore, psychological support was coded most frequently across white women\u0026rsquo;s responses; although there appeared to be an increase by BMI category across both men and women, with few responses from men and participants from other ethnicities. Although less frequently cited in survey responses, some participants described biomedical interventions, such as medication or weight loss surgery, as an important weight management support need. Unlike the other forms of professional support described above, men (particularly those in the BMI\u0026thinsp;\u0026ge;\u0026thinsp;40 category) more frequently expressed a desire for pharmacological support. Some participants also cited bariatric surgery. Together this demonstrates the diversity of preference for professional support services across young adults in the UK and Australia, particularly in relation to ethnicity, gender, and BMI category.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e5) Accessing networks vs self-reliance/responsibility\u003c/h3\u003e\n\u003cp\u003eSome participants exhibited a preference for accessing or improving social support whilst others described a preference for self-reliance. Those who did cite social support described a range of sources including family, friends, spouses, workout buddies, sport and exercise groups, peer support groups, and having shared goals with others.\u003c/p\u003e \u003cp\u003eSupport groups were the most frequently cited source of social support, cited exclusively by participants aged 22 years and over, and most frequently by those aged 28 years and over. Preference for groups was similar across men and women, and although in women this was exclusive to those of a white ethnicity, men from a range of ethnic backgrounds cited groups as a tool for weight management. Many responses described how peer support groups are useful for motivation and accountability, importantly some participants expressed a desire for groups that do not enforce a fixed plan but rather bring together like-minded individuals with the shared goal of healthy living.\u003c/p\u003e \u003cp\u003eSocial support from a partner, spouse or friends were most frequently cited by white men and women, although more so in men. Furthermore, white men most frequently cited social support from family, whilst men across ethnic groups cited workout buddies or sport/exercise groups. Many young adult women noted a preference for peer support groups but did not cite support inside the home. Male participants that described familial support mentioned the household food environment as a barrier to weight management and expressed a desire for encouragement. Similarly, men who cited friends expressed a desire for encouragement, motivation, someone to talk to, and having shared goals, whereas women were more likely to express a desire for emotional support but were not specific about the preferred source for this support. Many participants, particularly men in the overweight BMI category, described weight management as being their own responsibility.\u003c/p\u003e \u003cp\u003e \u003cb\u003eOutliers illustrating an unmet need: Nothing works / Unsure / None\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA subgroup of participant's responses fell outside of the general pattern of responses; these expressed either no desire for weight management support, uncertainty about what support could help them, or the belief that no support would be successful. These responses indicate a subgroup of YA who are potentially less likely to access or seek out weight management resources or support due to low self-efficacy, lack of awareness of support tools and service, and potentially negative experiences of weight loss attempts.\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Summary\u003c/h2\u003e \u003cp\u003eThis study sought to determine health service usage, weight management practices, and support needs, amongst YA with excess weight in the UK and Australia. Although a very similar percentage of participants across countries and genders reported trying to manage their weight, a greater proportion of women and Australians had accessed healthcare in the last 3 months and were also more likely to be receiving professional support to manage their weight. Services from a general practitioner were the most accessed across both cohorts, whilst the Australian cohort were more likely to report accessing a psychologist. Comparatively, a slightly higher proportion of the UK participants were using products or diets to manage their weight.\u003c/p\u003e \u003cp\u003eTemplate analysis identified five themes across participants\u0026rsquo; perceived weight management support needs: 1) structured but tailored resources; 2) simplicity, ease, and convenience; 3) addressing barriers; 4) person-centred services; 5) accessing networks vs self-reliance. An additional cluster of responses were categorised to represent a subset of participants who reported either no support needs or uncertainty around what their needs were.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Relation to existing research\u003c/h2\u003e \u003cp\u003eOf those who were attempting to manage their weight, the majority were using diets/products as a weight management method, while strikingly few individuals were receiving support/treatment from a healthcare professional. It may be that YA are less able to access appropriate formal support, which results in increased weight gain, despite weight loss attempts in this age group (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Our qualitive findings suggest that low uptake is not due to a lack of want for professional support, as the most frequently cited support needs were access to a dietitian, personal trainer, or psychologist. The reliance on commercial products and self-led diets is problematic from a social inequity perspective, as there might be a greater financial requirement to access diet products and services. Whilst the difficulty accessing publicly funded dietetic and psychological services might also explain their poor uptake. This notion was reflected by our qualitative findings, where many participants described how systemic changes, such as increased availability of exercise facilities and green spaces, access to cheap and healthy food, and cheaper and/or subsidised exercise facilities would support their weight management. Additional research is needed to understand the reasons behind low uptake of healthcare services for weight management support and whether this is due to limited awareness or accessibility and availability of services.\u003c/p\u003e \u003cp\u003eFurther unmet psychological support needs were also indicated. Many participants described their psychological support needs qualitatively, ranging from higher intensity support (e.g., mental health and disordered eating) to low intensity support (e.g., managing internal and external antecedents of their behaviours, and habit change). Our qualitative findings suggested YA lack the confidence and skills to manage their weight and habitual responses to internal and external antecedents of eating behaviours, generating a need for external accountability. This finding aligns with a qualitative study of UK-based study of women participant in Slimming World (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), and suggests the importance of developing interventions that build skills in self-managing behavioural antecedents and self-efficacy. Although psychological support (including disordered eating support) was one of the most cited weight management support needs, the lack of support being received, and highly cited desire for psychological support, illustrate a significant unmet need for YA in the UK and Australia. Future studies from our group will examine the prevalence and changes in disordered eating in the YOUTH cohort.\u003c/p\u003e \u003cp\u003eDisordered eating is increasingly recognised as an important factor in person-centred weight management support (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). However, participation of people with disordered eating in weight management programmes is controversial, as restricted eating and eating beliefs can influence the development and maintenance of disordered eating (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). However, the preoccupation with weight, shape, and food (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) means that people with disordered eating may be more likely to be engaging in weight management attempts. Furthermore, eating disorders are commonly associated with secrecy and shame (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) suggesting people may be engaging in weight management attempts in private, without professional support. Our finding that the majority of YA were currently managing their weight and using commercial products or self-led diets to do so, alongside reports of disordered eating, suggests YA might be accessing products and diets that might exacerbate their disordered eating. A finding that potentially substantiates the argument for public health campaigns to promote both the harms of unhealthy weight management practices in addition to the benefits of healthy practices (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast, people of minority ethnic backgrounds were less likely to cite traditional sources of support such as personal training, nutritional education and resources, or support from a dietitian. Another study found minority ethnic groups more likely to report using over-the-counter weight loss supplements, and less likely to report use of commercial weight loss programmes (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), when compared to white participants. This implies that traditional nutritional education and support are not perceived as useful or acceptable to minority ethnic groups, which might speak to the lack of cultural tailoring, as these typically reflect a westernised culture. Given that people from minoritized ethnic backgrounds are more likely to live with obesity (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), it is critical that culturally competent resources are developed for these communities. The gender and ethnic differences also observed in terms of the need for psychological support (which predominated in white women) may also reflect the impact of culture and gender on mental health awareness, literacy, and acceptability of requesting psychological support. This is substantiated by research identifying stigmatisation of mental illness and help-seeking behaviour in Black and South Asian groups, and particularly young men (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe weight management support needs identified in this study are supported by other research in YA. For example, we identified a need for multi-component weight management support that is tailored to need, a finding that correlated with data from young women living with excess weight in Australia (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Interestingly, the qualitative results indicated group-based weight management support to be equally cited across men and women, which does not reflect the poorer uptake of support groups by men (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). This suggests that group-based support services might not be tailored towards men's preferences, rather than men having no desire to receive group-based support; this is corroborated by findings of the WRAP trial, where male participants viewed commercial weight loss programmes as women\u0026rsquo;s groups (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Some men in our study described a preference for sport and exercise groups, which have been found to effectively engage middle aged men (35\u0026ndash;65 years old) with excess weight (e.g., Football Fans in Training (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)), suggesting similar groups could be a viable intervention for young men. In addition, YA men described a strong preference for weight management support from family, friends, and their spouses, particularly with managing the household food environment and receiving encouragement and praise. Responses relating to the food environment in the home potentially reflect traditional gender household responsibilities, whereby men are less involved with food decision making and preparation, resulting in less autonomy over their eating behaviours. Many young adult women noted a preference for peer support groups but did not cite support inside the home, and women were more likely than men to express a desire for emotional support but were not specific about the preferred source for this support. Perhaps, men are more likely than women to find benefit from family members providing praise or affirmation of their weight management efforts. These findings reiterate the need for tailored support, which is consistent with other studies exploring weight management in YA (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, our findings indicated a preference for use of online and digital resources and tools in line with other research in young people. Although these methods show potential for increasing physical activity and reducing weight (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e), they should be used as an adjunct or to support communication with a healthcare professional, rather than as a replacement for human contact. Especially given the limited evidence base for the effectiveness of digital weight management support for YA (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and the frequently cited desire for specialist health professional support in our sample. A 12-week m-health intervention that delivered non-personalised behaviour change information with limited contact with peers and a dietitian found no significant difference in weight loss in YA in Australia (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). Feedback received on this intervention revealed that YA prefer personal weight loss targets with regular weight monitoring, contact, and support with planning meals and activity schedules. Participants also expressed a desire for content tailored to individuals and their commitment levels, and meal plans with more options across various dietary needs and preferences (e.g., vegan, gluten-free) (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). This is in line with other research finding young women to prefer multicomponent digital interventions alongside support from a credible health professional that are delivered flexibly (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Strengths and limitations\u003c/h2\u003e \u003cp\u003eThe strengths of this paper include the use of a validated BMI measure (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and the stringent processes used to collect survey data through validation processes embedded within both the survey and the Prolific delivery platform [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.prolific.co/\u003c/span\u003e\u003cspan address=\"https://www.prolific.co/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e]. The mixed-method approach also facilitated the exploration of both current practice vs self-reported need. Furthermore, stratification of participant characteristics resulted in an even split of men and women and above and below median national income. The spread of ethnicity in the sample is also representative of the population in the UK and Australia (e.g., 82% of people in England Wales are White and 2.9% of Australian\u0026rsquo;s are Aboriginal) (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Although a limitation was the comparatively small Australian cohort, due to a higher uptake of the Prolific platform in the UK. Further, since participants were sampled using the Prolific platform, those using this digital platform may favour digital tools to a greater extent than the general population.\u003c/p\u003e \u003cp\u003e \u003cem\u003e4.4 Recommendations for practice\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThere is a need for structured resources or support that are individually tailored and flexible to the diverse preferences, routines, environments, cultures, finances, and physical/psychological comorbidities that reflect the 21st century lifestyles of YA in high-income countries.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe unmet psychological support needs identified in this study illustrate the importance of psychological support for YA with excess weight. This support must cover a spectrum of needs, from managing internal and external antecedents of eating behaviours, to mental health and eating disorder management. Resources, education and support should include psychological education and training in the development of cognitive strategies to build and sustain confidence in dietary and physical activity habits.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIncreased public awareness, literacy and education on the psychological underpinnings of obesity is necessary to address stigma and help YA to identify and communicate their psychological support needs, especially amongst young men and minority ethnic groups.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSystemic changes to structural and environmental influences such as access to green areas locally, food affordability, and subsidised exercise facility memberships are necessary to promote health and complement the busy lifestyles of YAs. Primary care should offer referrals to a personal trainer and/or a dietitian where this is perceived as helpful.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDietetic and weight management services should provide easy to follow healthy recipes and individual meal plans that are adjustable and tailored to an individual\u0026rsquo;s cultural traditions, dietary and taste preferences, affordability, family care roles and routine. These should be in an accessible easy to use format (e.g., online or app-based) alongside app-based self-monitoring tools to support individuals' self-regulation.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMen should be encouraged and guided on how to elicit support from their family, friends, and spouses, particularly with managing barriers within the household food environment.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e4.5 Recommendations for future research\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eGender-sensitised group-based interventions for young men should continue to be developed and evaluated, including but not limited to sport and exercise groups.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFurther research should explore whether the lack of preference for nutritional resources and support across minoritised ethnic communities is due to a lack of cultural tailoring. Co-developed culturally competent interventions for ethnic minority YA should be developed and evaluated.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHybrid interventions, for example Smartphone Applications that are tailored to the holistic needs of young people, alongside conveniently scheduled one-to-one sessions with a healthcare professional should be developed and evaluated. Interventions might also benefit from offering group-based in-person or virtual sessions, as many participants desired group-based social support.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCommunity-based interventions could implement and evaluate group-based, gender sensitised exercise sessions to further facilitate group support and the desire for work out buddies whilst being a cheaper alternative to personal training \u0026ndash; implementing these as a collaborative initiative with local gym and exercise facilities could enhance feasibility.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThere is an urgent need for further research to explore the appropriateness of diet products and approaches in people living with disordered eating.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eDespite young adults attempting to manage their weight, few are accessing support from a healthcare professional. On the contrary, young adults expressed a desire for dietetic and psychological support to support weight management, suggesting limited accessibility as opposed to no desire to access support. Generally, young adults require access to structured resources or support that are individually tailored and flexible to the diverse cultural preferences, routines, environments, finances, and physical/psychological comorbidities that reflect the 21st century lifestyles of young adults in high-income countries. More specifically, findings indicate unmet disordered eating and mental health needs. It is essential that referral pathways to weight management services and psychological support are strengthened. The findings will inform the co-production of an online intervention for disordered eating with young adults.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: Ethical approval was granted by Leeds Beckett University, UK (reference number 86004) and the University of Newcastle, Australia (reference number H-2022\u0026ndash;0110). All participants provided informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: Data are available upon reasonable request. Example qualitative data supporting the conclusions of this article are available in Supplementary Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: None to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This work was supported by a grant from the Centre for Psychological Research, Leeds Beckett University, UK (grant number N/A), and a School of Health Sciences grant from the University of Newcastle, Australia (grant number N/A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: TB, LE, TF, MW, KK, JM and TE were involved in conceiving and designing the study. TF, MW and KK are primarily responsible for data acquisition and data organisation. TE and JM analysed the data and prepared the written manuscript. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: The authors thank public involvement participants Elysa Ioannou, Rachel Bolton, and Rosie Horton for helping to co-develop this programme of study. We also thank BSc Nutrition \u0026amp; Dietetics students, Kaydee Shepherd, for supporting a literature review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReporting Checklists\u003c/strong\u003e: Standards for Reporting Qualitative Research (SRGR) Checklist (Supplementary Table 1).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. (2017) P\u003cem\u003erevalence of overweight among adults\u003c/em\u003e. [Online]. 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Fair society, healthy lives. 2013:1\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaldas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005;49(6):616\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaRose JG, Gorin AA, Clarke MM, Wing RR. Beliefs about weight gain among young adults: potential challenges to prevention. Obesity. 2011;19(9):1901\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson SE, Wardle J, Johnson F, Finer N, Beeken RJ. The impact of a health professional recommendation on weight loss attempts in overweight and obese British adults: a cross-sectional analysis. BMJ open. 2013;3(11):e003693.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026auml;rebring L, Winkvist A, Augustin H. 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Clin Obes. 2023;13(4):e12580.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDa Luz FQ, Hay P, Touyz S, Sainsbury A. Obesity with comorbid eating disorders: associated health risks and treatment approaches. Nutrients. 2018;10(7):829.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFairburn CG, Beglin SJ. Assessment of eating disorders: Interview or self-report questionnaire? Int J Eat Disord. 1994;16(4):363\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFassino S, Abbate-Daga G. Resistance to treatment in eating disorders: a critical challenge. Springer; 2013. pp. 1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulgrew KE, Prichard I, Stalley N, Lim MSC. Effectiveness of a multi-session positive self, appearance, and functionality program on women\u0026rsquo;s body satisfaction and response to media. Body Image. 2019;31:102\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArora PG, Metz K, Carlson CI. Attitudes toward professional psychological help seeking in South Asian students: Role of stigma and gender. J multicultural Couns Dev. 2016;44(4):263\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMemon A, Taylor K, Mohebati LM, Sundin J, Cooper M, Scanlon T, et al. Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ open. 2016;6(11):e012337.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrino ND, Parker HM, Gifford JA, Lau KYK, Greenfield EM, Donges CE, et al. What do young women with obesity want from a weight management program? Eating and Weight Disorders-Studies on Anorexia. Bulimia Obes. 2020;25:1303\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshton LM, Morgan PJ, Hutchesson MJ, Rollo ME, Young MD, Collins CE. A systematic review of SNAPO (Smoking, Nutrition, Alcohol, Physical activity and Obesity) randomized controlled trials in young adult men. Prev Med. 2015;81:221\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllen JT, Cohn SR, Ahern AL. Experiences of a commercial weight-loss programme after primary care referral: a qualitative study. Br J Gen Pract. 2015;65(633):e248\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWyke S, Hunt K, Gray C, Fenwick E, Bunn C, Donnan P et al. Football fans in training (FFIT): a randomised controlled trial of a gender-sensitised weight loss and healthy living programme for men. Public Health Res. 2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim H-N, Seo K. 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Accessed January 2024 [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ethnicity-facts-figures.service.gov.uk/\u003c/span\u003e\u003cspan address=\"https://www.ethnicity-facts-figures.service.gov.uk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Central Intelligence Agency. Australia: Ethnic groups as of 2021. 2024. Accessed March 2024 [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.statista.com/statistics/260502/ethnic-groups-in-australia/]\u003c/span\u003e\u003cspan address=\"https://www.statista.com/statistics/260502/ethnic-groups-in-australia/]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\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":"[email protected]","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":"weight management, prolific survey, cohort study, UK, Australia, young adults","lastPublishedDoi":"10.21203/rs.3.rs-4594068/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4594068/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYoung adulthood is a critical period where there is an increased weight gain trajectory. Understanding the weight management support needs of young adults with excess weight is essential to enable the delivery of appropriate and tailored services and prevent the development of comorbidities. This study sought to determine the current health service usage, weight management practices and support needs, in young adults with excess weight.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA mixed-methods convergent parallel design was employed. A cohort of community-dwelling young adults (18–35 years), with excess weight (BMI ≥ 25), residing in the UK and Australia participated in an online, longitudinal survey. Cross-sectional data was analysed descriptively, including quantitative measures of health service usage and weight management practices. Responses to an open-ended question asking what support participants would find most helpful were analysed using Thematic Template Analysis. Convergence and divergence across sociodemographic characteristics were explored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample (n = 410) included 204 women, 201 men and five non-binary people with a mean age of 28.3 and BMI of 35.8. Most participants reported a white ethnicity (80%) and resided in the UK (83%). Half reported a below median gross household income (49%). Most (73%) reported currently trying to manage their weight and 63% were using commercial weight management products or self-directed diets. Only 12% of participants reported accessing healthcare services for weight management support or treatment, yet qualitative responses indicated a desire for support from a dietitian or psychologist. Five themes indicated a need for structured but tailored resources, simplicity, addressing internal and external barriers, access to holistic professional support, and access to networks vs a preference for self-reliance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYoung adults with excess weight are using commercial products and self-led diets but many desire specialist healthcare professionals to support their weight management. Young adults appear to prefer online resources and support that are simplistic, structured and individually tailored to their diverse cultural preferences, routines, environments, and comorbidities. Furthermore, findings indicate unmet psychological support needs amongst young adults with excess weight in the UK and Australia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProtocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhatnall, M., Fozard, T., Kolokotroni, K.Z., Marwood, J., Evans, T., Ells, L.J. and Burrows, T., 2022. Understanding eating behaviours, mental health and weight change in young adults: protocol paper for an international longitudinal study. BMJ open, 12(9), p.e064963.\u003c/p\u003e","manuscriptTitle":"The weight management practices and support needs of young adults living with excess weight in the UK and Australia: A mixed methods cross-sectional study using data from the YOUTH cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 09:01:01","doi":"10.21203/rs.3.rs-4594068/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","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":"b26c8710-3165-4959-b78c-d96d0254d67f","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-06T07:23:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-03 09:01:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4594068","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4594068","identity":"rs-4594068","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}