Table 3.

Themes from interviews about obesity, body image, and healthy lifestyles with Hispanics living with HIV in South Texas.

Theme	Representative Quotes	Interpretation
Non-HIV specific
Dominant food culture	I know there’s healthy Mexican food somewhere. But um, for the most part…it’s just the food. It’s all the tortillas. It’s like a cultural thing. It’s absolutely true um, you know. In San Antonio you can find tacos anywhere.	• Cultural foods are obesity-inducing and cannot be changed • Unlimited access to unhealthy foods
Food and family	You’re going to make enough in case someone knocks on the door, and they also have enough food to offer to someone else. ‘Are you coming over?’ [My family has] so much food. That’s how they show that they care about each other.	• Culture of large family gatherings with excess food showing generosity, community • Food equated to familial love
Obesity as community norm	It’s just kind of a cycle. You know, your parents are raised that way, and they don’t do anything to kind of change it. I think that a lot of people have seen themselves like their parents and their uncles. Or whoever have diabetes. So it’s kind of like. Instead of thinking, what can I do to not have it, they kind of feel like they’re going to get it.	• Obesity and diabetes are community norms and inevitable
Childhood food access	My up bring was never any fruits or vegetables, because I pretty much. Or healthy eating. I’d pretty much learned that on my own. [as children] …we would eat once in a day. I wouldn’t fit into clothes for my age. So yeah, I was always aware of that.	• Unhealthy habits from childhood must be overcome, self-taught healthy eating • Food insecurity as children led to overeating when food is available • Childhood obesity carrying into adulthood
Knowledge base	On portion size: “They say, if it fills in your hand or something.” On salads: “I tried eating like more salads and stuff, but then I just end up hungry all the time.”	• Most participants had clear understanding of portion sizes • Some equated healthy eating to a bland or boring diet
Work environment	You know they are working all the time. Parents are just working all the time. It’s just snacking, cause, there’s no time to leave to go get food or anything like that, because I’m stuck at work A lot of [drug] reps go into the office … I realize that’s just a decision on my part, whether I’m actually going to partake in the food … because it’s never anything healthy.	• Working long hours does not leave time for healthy food prep • Work environment leads to snacking
Cost of healthy food	If you look at it now, it’s expensive to eat healthy.	• Cost prohibits healthy eating for low income families
Lack of time	I really don’t have time to like set up and prepare a whole meal. It’s more fast food places, because I’m always in a rush. I need to get in and out.	• Healthy eating and dieting require time for meal prep
HIV-specific
Thin = ill	When I left the hospital, I weighed 89lbs. So I looked terrible. Then after 6 months, finally I started bouncing back. Little by little. And ever since then I just ah, obsessed with gaining weight. Because when I get Histoplasmosis, I get my, my bones was to the skin…. Because I seen myself as skinny, and I don’t want to be skinny any more… Not as skinny, but like sick skinny. No, that’s why I always prefer to have a little weight. Just my mentality I guess… I just think that if I’m losing weight, I’m getting sick. Even though I’m taking all my medications, like I’m supposed to and everything. I’m afraid of not be hungry, because that’s the way I get sick. I stop getting hungry. And I start losing [weight].	• Thinness and weight loss is associated with illness, particularly HIV-related wasting, and therefore negative. • Being overweight looks healthier
Weight as a buffer against future illness	I guess because of my HIV. And, you know I’m going to end up in the hospital again, or something like that. So that’s why, you know what I mean. I start to try to eat more, and more. You know what I mean? … It’s just like something you know, when you go through something, and experience like that. 46 days on the bed you know. And you’re bone skinny. I was thinking, you know the bigger, on, on my sickness. You know, the bigger … You know, the more nutrition I get... More protein I get … It’ll do better to my sickness.	• Being overweight is protective if you are likely to get sick again
Weight hides HIV-related body changes	My cheeks got sucked in and I know that’s part of the HIV and stuff. But you can never see. You can never tell on me, but when, when I’m that thin you sure can. It was a combination, because my cheeks got sucked in and I know that’s part of the HIV and stuff…that’s such and ugly look. I read in the articles when you get…HIV, you get like a gut stomach.	• Increased weight hides lipodystrophy (or other HIV-related body changes)