A qualitative exploration of Men’s Uptake of Specialist Treatment for Obesity (MUSTO) within the UK national health service: what men say about what helps and hinders them to engage

Abstract Background Men referred to specialist weight management services are less likely to engage with these services. There is currently limited research exploring their experiences and what may affect engagement. Men are both under-represented in weight management services and in weight management research. This study qualitatively explores the perspectives of men who have been through a National Health Service (NHS) Tier 3 Programme to gain a detailed understanding of the barriers and drivers to joining and elicit patient-generated recommendations on how to engage more men. Methods Semi-structured interviews were conducted with patients ( n = 9) who had or were more than halfway through completing the Programme and buddies ( n = 3), who are previous users of the service, subsequently supporting others going through it. Peer buddies provide lived-experience, encouragement, social connection and practical accountability to help participants on the Programme with making long-term lifestyle changes. They were included as they have been through the Programme as patients themselves and offer additional insight from their work supporting other patients. The interviews were inductively analysed using Reflexive Thematic Analysis to identify patterns in engagement, barriers and drivers. Results Four themes were identified. The first two indicate psychological barriers to engagement, the second two denote drivers. The themes were: It’s culturally more acceptable for men to be overweight/obese (Theme 1), with larger size associated with strength and male identity. A male identity which encourages self-reliance and guarded vulnerability means Being vulnerable is uncomfortable for men (Theme 2) and discourages them from seeking help. But Men do need help when obesity becomes a health worry (Theme 3) and Being invited for specialist treatment is helpful for men (Theme 4). This last theme offers new insight in this field for healthcare practitioners, based on what men living with obesity who participated reported. Conclusions Findings indicate a paradigm shift is needed for male obesity to be understood not as an aesthetic and identity issue for men, but as a threat to their health and for men’s healthcare help-seeking behaviour to be normalised. The findings provide learning for healthcare practitioners, including those in primary care, in the way they frame conversations with men about obesity and insight for NHS weight management leads around service promotion.