Qualitative themes and sub-themes from the survey, focus groups and interviews and supporting participant quotations
| Themes and sub-themes | Quotations |
|---|---|
| Medication | |
| Anti-psychotic medication associated with weight gain | “I think medication adding weight is a massive issue and I think it reduces some patient quality of life” Staff |
| Lack of early intervention for predictable weight gain | “Yeah, I think I needed to be warned about the side effects of olanzapine and I wasn’t” Former patient |
| Sedentary behaviour | |
| Lack of exercise opportunities, particularly during COVID-19 | “I think it’s challenging for people because they’re locked in. And I think that’s a really good point if you’re on a section you can’t even go out for a walk around the grounds” Former patient |
| Patient motivation and intrinsic factors | |
| Unhealthy food choices influenced by poor self-esteem, emotions, health conditions and prior patterns of behaviour | “Making unhealthy choices such as takeaway food from the shop may be a way of trying to manage emotional states and create a sense of comfort” Staff |
| Low patient motivation to eat healthily and exercise | “Patients’ motivation levels are very poor, they don’t seem to see any incentive to eating healthier foods or doing exercise and as much as staff can provide them with information and encouragement, ultimately it is up to the individual to take the advice on board and engage with sports and the dieticians. There is virtually nothing staff can do to influence this” Staff |
| Lack of capacity around weight and long-term health impact | “If patients lack capacity to make these decisions – then it is unethical and negligent to provide an environment and food that lead to unhealthy weight gain which might be dangerous to their health – it can be a very difficult balance to strike” Staff |
| Catered food and alternatives | |
| Hospital meals not appetising, portion sizes too small, repetitive menu | “So, the food, absolutely disgusting, still is. It hasn’t changed at all in all the years. It’s really poor quality” Former patient |
| Patient leave focussed on unhealthy food, with excess personal funds available | “The outings are a regular occurrence and they are eating bad stuff every time they go out” Staff |
| Cooking therapy sessions, socialising and events involving unhealthy food | “Social activities tend to be hugely food orientated – celebrations on the ward, outings off the ward always seem to include treat food” Staff |
| Environment | |
| Relationships with peers and staff | “They build friendships with other peers and will then order food to socialise with their new friends and acquaintances” Staff |
| Restrictive practice and tension with patient choice | “It’s a delicate balance taking somebody’s right to make their unwise choice away, because that can affect your mental health” Former patient |
| Boredom | “Yeah, I think there just needs to be more to do on the wards because a lot of the rubbish people are eating is literally because there’s nothing to do” Former patient |
| Service delivery | |
| Weight management prioritisation and responsibility | “Weight management is everyone’s responsibility. It doesn’t just fall to one or two people to champion” Staff |
| Need for individualised care planning | “In mental health services we can support our patients to achieve their goals by ensuring inclusion within their own care plan. Give encouragement and praise which will build a new trust and confidence between the patient and care coordinator team” Staff |
| Role of staff | |
| Lack of staff training and education | “Staff training must put a greater emphasis on nutrition – keeping a healthy realistic body weight and education on preventing diabetes, heart disease and cancers – also making exercise fun and enjoyable” Staff |
| Understaffing as a limitation on patient exercise and health promotion | “I think staffing is the biggest issue to patients exercising. There rarely is enough staff to facilitate the sessions that all patients want to do… Likewise there would be enough to do additional health based sessions also. I feel like I have all the tools available to be able to educate and staffing plays a major role in being able to actually do things with the patients” Staff |
| Themes and sub-themes | Quotations |
|---|---|
| Anti-psychotic medication associated with weight gain | “I think medication adding weight is a massive issue and I think it reduces some patient quality of life” Staff |
| Lack of early intervention for predictable weight gain | “Yeah, I think I needed to be warned about the side effects of olanzapine and I wasn’t” Former patient |
| Lack of exercise opportunities, particularly during COVID-19 | “I think it’s challenging for people because they’re locked in. And I think that’s a really good point if you’re on a section you can’t even go out for a walk around the grounds” Former patient |
| Unhealthy food choices influenced by poor self-esteem, emotions, health conditions and prior patterns of behaviour | “Making unhealthy choices such as takeaway food from the shop may be a way of trying to manage emotional states and create a sense of comfort” Staff |
| Low patient motivation to eat healthily and exercise | “Patients’ motivation levels are very poor, they don’t seem to see any incentive to eating healthier foods or doing exercise and as much as staff can provide them with information and encouragement, ultimately it is up to the individual to take the advice on board and engage with sports and the dieticians. There is virtually nothing staff can do to influence this” Staff |
| Lack of capacity around weight and long-term health impact | “If patients lack capacity to make these decisions – then it is unethical and negligent to provide an environment and food that lead to unhealthy weight gain which might be dangerous to their health – it can be a very difficult balance to strike” Staff |
| Hospital meals not appetising, portion sizes too small, repetitive menu | “So, the food, absolutely disgusting, still is. It hasn’t changed at all in all the years. It’s really poor quality” Former patient |
| Patient leave focussed on unhealthy food, with excess personal funds available | “The outings are a regular occurrence and they are eating bad stuff every time they go out” Staff |
| Cooking therapy sessions, socialising and events involving unhealthy food | “Social activities tend to be hugely food orientated – celebrations on the ward, outings off the ward always seem to include treat food” Staff |
| Relationships with peers and staff | “They build friendships with other peers and will then order food to socialise with their new friends and acquaintances” Staff |
| Restrictive practice and tension with patient choice | “It’s a delicate balance taking somebody’s right to make their unwise choice away, because that can affect your mental health” Former patient |
| Boredom | “Yeah, I think there just needs to be more to do on the wards because a lot of the rubbish people are eating is literally because there’s nothing to do” Former patient |
| Weight management prioritisation and responsibility | “Weight management is everyone’s responsibility. It doesn’t just fall to one or two people to champion” Staff |
| Need for individualised care planning | “In mental health services we can support our patients to achieve their goals by ensuring inclusion within their own care plan. Give encouragement and praise which will build a new trust and confidence between the patient and care coordinator team” Staff |
| Lack of staff training and education | “Staff training must put a greater emphasis on nutrition – keeping a healthy realistic body weight and education on preventing diabetes, heart disease and cancers – also making exercise fun and enjoyable” Staff |
| Understaffing as a limitation on patient exercise and health promotion | “I think staffing is the biggest issue to patients exercising. There rarely is enough staff to facilitate the sessions that all patients want to do… Likewise there would be enough to do additional health based sessions also. I feel like I have all the tools available to be able to educate and staffing plays a major role in being able to actually do things with the patients” Staff |
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