Table 1. Quotes from the 30 interviews with health professionals to illustrate the three themes and subsequent sub-themes highlighted in these interviews.
Theme / Subtheme / Example quote (participant code)Obesity as a conversation stopper
Perceptions of obesity and the impact on communication / “...to try and broach the subject with some women, it can be difficult because they are vulnerable and obviously it can be embarrassing and hurtful…” (HP17)
“It would be really difficult to justify not talking to women about the risks… about anything that puts them at risk of anything in pregnancy…that you know about from the start…Booking someone with twins and failing to tell them about the risks of pre-term labour” (HP15)
Delivery of information / “…but I think you have to judge it a little bit to their attention span, you know, we can all only take so much…I think one of our drawbacks is that we give so much information to people they do switch off…” (HP28)
“…you don’t want to upset them by saying they’re overweight or fat and you don’t really know what words to use sometimes...” (HP13)
“…you can give out patient information leaflets but whether they read them is another thing – they’ve got so many” (HP10)
“…I think because on the questionnaire it addresses the smoking…that seems easier…because they’ve got the question in front of them…I just think it’ll take a while for that to be as acceptable [for obesity] as asking those other questions…[obesity] isn’t a question anywhere… (HP5)
Lack of information / “…we should be able to offer things for obese ladies but it’s about us knowing what there is out there and what we can signpost these ladies off to” (HP5)
“…I don’t think there’s any good patient resources…obesity literature is fairly complicated and always gets into the science bit which will turn people off straight away” (HP15)
Knowledge and/or need for training / “When we first started tackling HIV, oh we can’t possibly do that…I mean now we do it all and it’s a matter of course and nobody even thinks about it” (HP13)
“…we’re always striving to give better advice to pregnant women…it would be nice to have a bit more knowledge around you to be able to advise people that way…it’s knowing sometimes what’s the right advice to give…only by going and researching yourself…” (HP19)
“…prior to…doing the study, we identify these women with a raised BMI and other than getting an anaesthetic referral that was it…it was good to know that for the women who wanted to, there was something where we could guide them” (HP20)
Obesity as a maternity issue
Something is needed / “…they [women they cared for who attended the antenatal lifestyle programme] were quite positive about the programme…had learnt a lot about healthy eating…would actually continue with their lifestyle change even after the baby was born” (HP3)
“…I think people just want the knowledge or they want to know where to go to be able to get that sort of information…I also think that people, when they see …it’s an actual in-place course or programme they take it more seriously” (HP19)
“…lifestyle programme as in diet, exercise…they [women] weren’t aware of a lot of things they are now aware of so I think it’s a good start…” (HP3)
“If you teach a mother about a healthy lifestyle intervention she’s going to take that home and share it with the rest of the family…” (HP26)
“…they [women who they care for who attended the antenatal lifestyle programme] think it’s great. It’s a social type of thing for them, they enjoy it, it gets them to meet other mums as well and I know they’ve all got a common theme going on but they’re all in the same situation, they’re all pregnant…they swap recipes and things like that…” (HP7)
“I think it should be embedded in the health service but also across the community services. It should be a joint venture. And education. I think the opportunities are there everywhere for us all to be delivering on that package and it should be integral to all services so that it’s seen to be the norm … that’s how it becomes acceptable…” (HP26)
Continuous care / “Whoever reviews them, the booking midwife…whoever reviews them in the…reviews like let it be obstetricians and midwives, all levels of doctors…then they go to the GP and the booking midwives, that should be a good start and that should be continued at every visit” (HP11)
Impact on clinical practice / “…looking at it practically and realistically it’s just another role [providing information about maternal obesity]…that you’re expected to fill and I just don’t think practically on a day to day basis you would have time to do it...” (HP18)
“Main issue with obesity is…shoulder problems…it hurts your shoulder and some people have back problems as well” (HP6)
“It’s hard if they’re bigger if you’re having to move them around…we have beds that help us ... with slip mats and mattresses and stuff, but you have to get them in…so if you know they’re coming it’s fine but if they’re not actually…you’ve got to ring round and ask...it’s a bit more time consuming” (HP21)
Obesity as a public health issue
Addressing obesity at a public health level / “... they should be educated from a very early age and then as they grow up you know again in schools important, probably the media, advertising and then hopefully antenatally they get it” (HP25)
“…small things can make big life changes…nobody walks anywhere do they anymore?…People are sat at home watching TV, playing on games…they’re not getting out like they used to do…and the takeaways…it’s just so easy and accessibly, ready meals. Nobody makes anything from scratch much do they anymore? And that’s probably because they’ve never been taught by their own parents.” (HP23)
“…the cycle has to be broken somewhere and it’s finding the right balance of where to break that circle and how to do it effectively” (HP2)
The long term effects of obesity / “Healthy eating plans, weight management programmes, exercise programmes…are relevant not just for pregnancy but pre-conceptually and postnatally so that women even if they’ve a problem in this pregnancy can improve their health and well-being for the next pregnancy. I think that’s really important we don’t…ignore what we can see in front of us, we do something about it” (HP26)
“…there’s nobody to explore the psychological cause of why they have obesity in the first place…” (HP9)