Photovoice as a Methodology in Obesity Research: A Scoping Review

ABSTRACT

Introduction

Photovoice is a community‐based participatory research methodology that empowers participants to document and reflect on their lived experiences through photography. This scoping review examines the use of Photovoice in obesity research to explore the contexts in which it has been used, its application, and key themes in the literature to date.

Methods

Eligible studies were peer‐reviewed primary research published since 1997 that used Photovoice (with the process described) to collect empirical data from people with lived experience of obesity as the primary focus and were available in English, French, or Portuguese. Following the Joanna Briggs Institute guidelines, a systematic search was conducted in six databases, yielding 387 records, with 32 studies meeting the inclusion criteria. Key data, including study location, participant demographics, Photovoice methodology, and findings, were extracted and synthesized.

Results

Most studies were conducted in North America within community settings, predominantly with minority populations. Four key themes emerged: environmental influences, facilitators and barriers to healthy living, mental health and well‐being, and perceptions of obesity. Although findings align with other research methodologies, Photovoice uniquely highlights participant voices and fosters critical community engagement.

Conclusion

Photovoice is a valuable tool for obesity research, amplifying participant perspectives and contextual insights in ways more traditional methods may overlook. Future research should expand geographic and demographic diversity and adapt Photovoice for virtual formats to broaden its accessibility and explore its impact on participants, policy, and practice change.

1. Introduction

Obesity has emerged as a critical public health concern, with substantial evidence highlighting its widespread impact on individuals and societies. Recent studies point to the global rise in obesity rates, emphasizing its link to increased risk of chronic diseases such as type 2 diabetes, cardiovascular disorders, and certain cancers [1, 2]. The economic consequences of obesity are also significant, with rising healthcare costs driven by obesity‐related illnesses and a corresponding decline in productivity [3, 4].

The perceptions and preferences of people with obesity are underrepresented in global literature [5, 6]. For example, although research demonstrates variations in how interventions affect people with obesity compared to those with a normal BMI [7, 8], clinical trials continue to lack adequate representation of individuals with obesity [9], resulting in limited inclusivity. This exclusionary trend restricts the generalizability of findings and hampers the development of evidence‐based interventions tailored to the diverse needs of those with obesity. Stigmatization and discrimination linked to obesity often discourage individuals from participating in studies due to fear of judgment or biased treatment [10, 11], contributing to experiences of societal exclusion, external judgment, and environmental stigma [12]. This social stigma is further reinforced by pervasive stereotypes and negative attitudes within society and healthcare settings [11, 13] and is experienced across multiple domains in daily life [12]. Additionally, research infrastructure and recruitment methods may inadvertently contribute to the underrepresentation of individuals with obesity.

Obesity stigma and discrimination are prevalent in many areas of life, including healthcare, employment, education, and social relationships [14, 15]. Photovoice is a participatory action research method in which participants use photographs and accompanying narratives to document and reflect on their lived experiences, foster critical dialogue about community issues, and advocate for change with decision‐makers [16], which has been widely used to explore lived experiences and decision‐making in obesity contexts [17, 18]. Photovoice is well‐suited to this cohort because it aligns with participatory, equity‐oriented approaches that treat lived experience as expertise and seek to translate community insights into action [16, 19], including addressing gaps in the design and implementation of obesity prevention and treatment interventions [20]. Rather than framing people living with obesity through a deficit lens, Photovoice engages them as partners who can articulate social, environmental, and systemic contexts and help set research priorities [16].

This aligns with growing evidence that participatory approaches are critical to addressing gaps in obesity research and intervention design [20]. Methodologically, participant‐generated images and photo‐elicited dialogue allow participants to ground accounts in context, surface meanings that are harder to express verbally, and support movement from reflection to action (praxis) [21, 22]. Together, these features make Photovoice a strong choice when the goal is to co‐produce insights and inform responsive policy and service design in obesity contexts [19].

1.1. Photovoice Method

Photovoice was first conceptualized in the mid‐1990s as a community‐based, participatory action research methodology [16, 17, 18]. It is centered around photographs taken by participants [16] while also incorporating narrative elements [1, 2]. In their seminal article introducing Photovoice, Wang and Burris outlined three primary goals: (1) enabling people to document and reflect their community's strengths and concerns, (2) fostering critical dialogue and knowledge sharing about significant community issues through group discussions of the photographs, and (3) reaching policymakers to advocate for change” [16] (pp. 370). In practice, Photovoice typically begins with the identification of a target audience of decision‐makers, followed by the recruitment and orientation of participant co‐researchers, development of photo prompts, participant photo taking, photo elicited dialogue using frameworks such as SHOWeD, and finally, planned dissemination to policymakers (e.g., exhibits/briefings) [21].

While semistructured interviews can elicit nuanced, rich data, Photovoice offers a complementary, multimodal pathway to different ways of knowing, which accesses deeper insight into lived experiences, treatment preferences, and contextual factors [17, 18]. Rooted in empowerment education and problem posing pedagogy, Photovoice positions participants as knowledge‐holders and uses images and narratives to prompt critical dialogue and supports movement from reflection and dialogue, to action (conscientisation and praxis) [16, 22]. Drawing on traditions of documentary and visual inquiry, participant generated images ground accounts in tangible contexts and prompt memory, metaphor, and meaning making that can be difficult to access during verbal interviews [23]. Informed by feminist and participatory scholarship, Photovoice also seeks to rebalance researcher–participant power by privileging lived experience, amplifying often unheard voices, and creating spaces where participants set the agenda and interpret their own images [16, 24]. In practice, these features often produce different, possibly more diverse, insights than interviews alone, as part of photo‐elicited interviews and group dialogue [16, 25]. Prior reviews in public health also describe these advantages and their implications for design and reporting [19].

This method was originally designed for use with marginalized and underrepresented groups and has been used to explore lived experiences of stigma, social exclusion, and everyday challenges associated with obesity [12]. It is believed that using visual artifacts, Photovoice can reveal emotional and metaphoric insights that are not easily accessible through other qualitative methods [26, 27]. Photovoice may also produce more nuanced and richer data than traditional interviews [28], because it does not rely solely on verbal and written data [29]. The visual images become symbolic representations of participants' lived experience, prompting them to critically reflect on the barriers they face, both individually and within their broader community, in ways that transcend the limitations of narrative alone [16, 30, 31].

Photovoice aims to enable critical conversations about the challenges or barriers faced by marginalized and underrepresented communities and serves as a foundation for active change. Its participatory approach involves participants at every stage of the research process, reflecting a democratic approach that seeks to capture both individual priorities and broader community dynamics [32, 33]. This begins at study conceptualization (co‐defining the focus, research questions and relevance) and includes governance structures (advisory roles and decision‐making on procedures/ethics). Participants are also involved in recruitment processes (shaping inclusion, consent, safety and photo‐tasks), data collection (participant‐led image making and storying), analysis/interpretation (group dialogue, participant‐led coding/meaning making, e.g., SHOWeD), and dissemination/action (co‐curating exhibitions, briefing leaders, co‐authoring outputs, and follow‐up advocacy).

There have been no comprehensive reviews of its use with people living with obesity to understand its implementation and identify opportunities for further development, particularly across emerging contexts and delivery formats [20]. Photovoice studies do not typically address questions of effectiveness, causality, or prevalence, which are the focus of systematic reviews. However, scoping reviews are well‐suited to synthesizing diverse research, mapping existing evidence, clarifying concepts, and identifying knowledge gaps [34]. This scoping review aims to comprehensively examine the existing literature on the use of Photovoice methodology in studies involving people with obesity. It aims to describe the available studies, the contexts in which Photovoice is used, and the key study findings.

2. Methods

This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodological guidance for scoping reviews [35], which builds upon and operationalizes the seminal framework developed by Arksey and O′Malley [36]. Consistent with this combined approach, the review followed the five key stages proposed by Arksey and O'Malley—(1) identifying the research question, (2) identifying relevant studies, (3) studying selection, (4) charting the data, and (5) collating, summarizing, and reporting results—while aligning reporting and methodological decisions with the updated JBI recommendations [35]. The Preferred Reporting Items for Systematic Reviews (PRISMA) Scoping Reviews extension (PRISMA‐ScR) [37] was utilized. Consistent with the JBI recommendation, we used the population–concept–context (PCC) framework to define scope, eligibility, and search parameters. Specifically, our Population was people living with obesity; the Concept was the use of Photovoice as a research method; and the Context included any health, community, or policy relevant setting in which Photovoice was applied. This scoping review protocol was registered at Open Science Framework on April 19, 2024 (https://doi.org/10.17605/OSF.IO/P4RXM).

2.1. Stage 1: Identification of the Research Question and the Objectives

The primary question guiding this inquiry, analysis, and evidence consolidation was: ‘What are the characteristics of Photovoice studies involving people with obesity, and what key themes emerge from their findings?’ The objective of this review was to guide future use of this research methodology in obesity research.

2.2. Stage 2: Identifying Relevant Studies

2.2.1. Data Sources

The initial database search was conducted on February 4, 2024 and updated on May 1, 2026 to ensure inclusion of recently published Photovoice studies in obesity research. We developed a search strategy in conjunction with a university librarian specializing in health research to ensure its quality and rigor. Our search terms included keywords such as photovoice, photojournalism, photonarrative, photo elicitation, obes*, “weight loss”, “weight gain”, overweight, and “over weight” to capture the range of visual participatory approaches used in obesity research [17, 18]. From these keywords, we identified MeSH terms for database searches. The following databases were searched: Medline Complete, CINAHL, Global Health, Psycinfo, Social Work Abstracts, SocINDEX, and Web of Science. Bibliographic software (EndNote) was used to store, organize, and manage all references. A draft search strategy for MEDLINE was completed to demonstrate its application to this database (S1).

2.2.2. Review Eligibility

Studies were assessed for eligibility according to the inclusion and exclusion criteria summarized in Table 1, which were developed using the PCC framework to ensure consistency and transparency in study selection. Only data from the qualitative components of mixed studies (i.e., findings directly related to the Photovoice process, participant narratives, and visual data interpretation) were extracted and analyzed, in alignment with the qualitative foundations of this methodology. Quantitative results presented within mixed‐method studies were summarized narratively where relevant to the implementation or outcomes of Photovoice but were not included in the thematic synthesis. This approach aligns with the participatory and lived experience focus of Photovoice studies in obesity research [20].

TABLE 1.

Scoping review inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
1. Primary research using Photovoice as a research method	1. Secondary research only (e.g., reviews)
2. Description of the Photovoice process provided (phases of data collection and analysis)	2. Photovoice used solely for pedagogy/health promotion rather than data collection
3. Obesity is the primary focus of the aim/research question	3. Includes people with obesity but does not explicitly address obesity in aims/research questions
4. Data collected from people with lived experience of obesity, with or without additional comorbid conditions (such as diabetes or cardiac conditions)	4. No direct data collected from people with lived experience of obesity
5. English, French, or Portuguese publication (languages spoken by the research team)	5. Languages other than English, French, or Portuguese
6. Peer‐reviewed publication	6. Not peer‐reviewed (e.g., dissertations, reports, and preprints where applicable)
7. Qualitative and/or quantitative empirical evidence reported	7. Non‐empirical formats (e.g., theoretical articles, opinion pieces, and editorials)
8. Published after January 1, 1997 (year Photovoice was first introduced)	8. Published before January 1, 1997

2.3. Stage 3: Study Selection

All studies identified by the search strategy were downloaded into the Covidence platform [38] for screening and selection. Two reviewers (OO and DH) independently screened all titles and abstracts for relevance, followed by full‐text screening of potentially eligible studies. Interrater reliability was calculated using Cohen's kappa statistic, which demonstrated substantial agreement for title/abstract screening (κ = 0.85) and almost perfect agreement for full‐text screening (κ = 0.90). Discrepancies were resolved through discussion, with no need to refer to a third reviewer as consensus was achieved.

The reference lists of all studies included after the full‐text review were screened for additional studies. To supplement this process, the Connected Papers platform [39] was used to visually map and identify potentially relevant articles that had not appeared in database searches. However, no further studies were identified through this method.

2.4. Stage 4: Data Extraction and Charting

Data from articles meeting the inclusion criteria were extracted through Covidence based upon the JBI manual for data extraction [38, 40] (S2), to enable systematic comparison of methodological approaches and study characteristics across Photovoice research. The initial version of the form was created by the first author and then shared with the broader research team for consultation and revision. The form systematically captures essential information from the included studies, such as authors, study year, objectives, geographic location, study population characteristics, sample size, study design, results, and key findings.

For each included study, we extracted key findings that directly addressed the review question and objectives, including the following: participant‐reported themes and outcomes; methodological insights related to the design, facilitation, analysis, and dissemination of Photovoice projects; and how Photovoice was applied to explore lived experiences, environmental influences, and participant perspectives [12, 17, 18]. This included (i) methodological characteristics (e.g., number and format of data collection sessions, analytic approach, and use of frameworks such as SHOWeD); (ii) participatory characteristics (e.g., stages of the research process in which participants were involved and the presence of co‐research or advisory roles); and (iii) contextual characteristics (e.g., setting, target population, and dissemination strategies). These characteristics were extracted to enable cross‐study comparison and synthesis of methodological trends.

2.5. Stage 5: Collating, Summarizing, and Reporting

The characteristics of included articles were summarized using descriptive statistics, primarily frequencies. Key themes from the findings were identified and synthesized using a conventional content analysis approach [41], consistent with established approaches to synthesizing heterogeneous qualitative evidence.

Two reviewers (OO and DH) independently read all extracted result texts to become familiar with their content. They then generated inductive codes capturing manifest meanings, and related codes were grouped and categorized into data‐driven themes. Through iterative review team discussions, these categories were refined and synthesized how Photovoice has been used, reported, and interpreted in studies involving people living with obesity. This process ensured that the synthesis remained grounded in the data while capturing overarching patterns across the literature.

To assess theoretical and methodological coherence, we applied a bespoke rubric (S3) that classified each study by its level of adherence to Photovoice's stated aims, the principles of Patient and Public Involvement (PPI), and the extent to which studies reflected the participatory and advocacy aims of Photovoice [16, 20, 42]. The rubric included detailed criteria to support this classification, and two researchers (OO, DH) independently reviewed 30% of the studies to confirm its reliability. We also considered commonly reported Photovoice steps (e.g., participant orientation, image‐making, participatory analysis, and dissemination) when appraising PPI across research stages.

Codes were inductively clustered into categories when they described a common phenomenon across multiple studies, with particular attention to recurring patterns related to environmental, social, and psychosocial influences on obesity [12, 43]. Categories were then synthesized into four cross‐study themes through iterative team discussion, prioritizing labels that reflected participants' own phrasing where possible. Two reviewers (OO and DH) independently proposed candidate theme labels and inclusion criteria, which were then finalized by consensus through discussion with the review team.

3. Results

3.1. Study Selection

The reviewers found 387 records from database searches. Following the elimination of duplicates and screening of titles, abstracts, and full texts, 32 records were included in this scoping review. Detailed information regarding the selection process and reasons for excluding articles are outlined in Figure 1.

FIGURE 1.

Study selection process.

3.2. Study Characteristics

Few Photovoice studies involving people with obesity were published prior to 2016, as shown in Figure 2.

FIGURE 2.

Number of Photovoice studies involving people with obesity.

3.2.1. Geographical Location

All included studies were conducted in the Global North, with the majority completed in the United States of America (USA) (n = 24) (see Table 2). The remaining studies were conducted in Canada (n = 2), Ireland (n = 2), United Kingdom (UK) (n = 2), Australia (n = 1), and Poland (n = 1).

TABLE 2.

Study characteristics.

First author year	Study location and setting	Study aims and /or objectives	Sample size majority gender	Sample a characteristic [39]	Findings
Balvanz [40] 2016	USA, rural community	To assess contextual determinants of childhood obesity, create a community action plan, and report actions taken with a community‐based organization and a university.	n = 7 Female 100%	Adolescents (specific age n/r) African American (n = 7)	Three themes: access to healthy food, social support, and community disorder. Youth were effective collaborators in identifying obesity factors and significantly contributed to developing and implementing obesity strategies with adult community stakeholders.
Banik [41] 2023	Poland, rural and urban communities	To investigate adolescents' critical awareness of local community policies for obesity prevention.	n = 41 Female 90%	16–18 years (M 17, SD 0.8). Polish (n = 41)	Obesity prevention policies focused on food environments and healthy diets. Adolescents were three times more likely to perceive a lack of such policies than notice existing, active policies.
Bateman [42] 2019	USA, urban community	To explore social determinants of obesity as perceived by residents in two segregated, low‐income communities. To understand residents' views on obesity‐contributing factors and effective interventions in their communities.	n = 59 Female 73%	21–90 years old (M 53, SD 16) Location A: African American (n = 3), American (n = 3) Location B: African American (n = 3), American (n = 1)	Root determinants: Equity and social justice, linked to racial segregation and unmet market needs. Underlying determinants: Neighborhood conditions, community development, employment, social cohesion. Proximal determinants: Convenience, cost, time, cooking skills and cultural norms.
Breland [43] 2024	USA, community (unspecified location)	To understand the factors influencing variable weight loss outcomes for veterans.	n = 9 Male 78%	42–69 years (M 58) Nine veterans who self‐identified as Black or African American	Three key themes: Food in our lives and health care, body image, and healthcare bias and discrimination.
Corty [44] 2022	USA, urban community	To explore community factors that influence healthy childhood weight and understand participant insights on the photovoice process.	n = 8 Female 88%	Aged ≥ 16 years Hispanic North American (n = 8).	Community barriers and facilitators to healthy weight: Including family habits, cultural influences on food, built environment and food marketing Participant motivations for Photovoice: Including desire to learn about health, personal growth from group sharing, pride in representing their community and empowerment as role models
Craig [17] 2024	United Kingdom, community health	To explore the application of Photovoice as a participatory methodology in obesity research, with a focus on participant engagement, meaning‐making, and the generation of lived‐experience insights.	n/r Gender n/r	Age n/r Ethnicity n/r	Photovoice supports participant engagement, reflection, and meaning making. Visual and narrative methods enhance understanding of contextual and environmental influences on health behaviors. Photovoice may facilitate advocacy and empowerment, by positioning participants as active contributors to knowledge generation and potential agents of change.
Cueva [45] 2020	USA, urban community	To explore youth perspectives on community‐based obesity prevention, emphasizing cultural connectedness and traditional foods revival.	n = 44 Male 52%	9–11 years old Native North American Indian (n = 44)	Traditional foods are cultivated through farming or gardening and are perceived as healthy. Stores offering less nutrient dense food are considered unhealthy. The theme “Feast for the Future” fosters positive cultural connections and a hope for increased farming and gardening for future generations.
Farrell [46] 2022	Ireland, community (unspecified location)	To examine the impact of the COVID‐19 pandemic and associated stay‐at‐home orders on adults with obesity.	n = 15 Female 53%	Age n/r Irish (n = 15)	The pandemic and stay‐at‐home orders had varying health and well‐being effects, which changed over time. Some experienced positive outcomes while others faced negative consequences. Felt stigmatized and isolated after being labeled “at risk” and marginalized by social attitudes from public health messaging about obesity.
Findholt [47] 2010	USA, rural community	To gathering insights on community assets and barriers impacting rural youths' physical activity and dietary habits.	n = 6 Female 67%	15–18 years American (n = 6)	Environmental influences on activity and diet included structural features, natural surroundings, economic conditions, community norms, and obesity‐related policies. These factors acted as either barriers or enablers.
Hackett [48] 2015	USA, urban community	To explore assets and barriers to nutrition and physical activity in an underserved, majority‐minority suburban community.	n = 9 Female 56%	15–17 years African American (n = 8), Hispanic North American (n = 1).	Key challenges: Limited access to fresh, nutritious food and safe spaces for physical activity. Recognized need for policy reform and active civic involvement in change.
Hollmann [12] 2024	USA, community	To explore the lived experiences of people with obesity, with a focus on how weight stigma and social environments shape daily life, identity, and well‐being.	n/r Gender n/r	Age n/r Ethnicity n/r	Pervasive weight stigma across multiple domains, including social interactions, public spaces, and healthcare contexts. Stigma contributed to emotional distress, reduced self‐worth, and social withdrawal, shaping identity and well‐being. Weight stigma is both socially constructed and structurally reinforced.
Homer [49] 2016	UK, urban community	To explore experiences of individuals seeking bariatric surgery and identify implications for behavioral and self‐management interventions.	n = 18 Female 78%	30–61 years Ethnicity n/r	Three themes: Negative experiences of obesity, Experience of weight management services, and expectations of normality.
Jennings [50] 2020	USA, urban community	To explore cultural health perspectives of food‐insecure, transitionally housed Indigenous children	n = 18 (n = 10 completed project) Male 60% (completed project)	8–12 years old n = 6 boys, 4 girls Native North American Indian (n = 10)	Healthy themes: Nutrition, gardening, relationships, food sovereignty, water quality, natural and built environments. Unhealthy themes: Cumulative stress, food insecurity, access and cost issues, screen time, smoking, violence.
Johnson [51] 2018	USA, hospital (unspecified location)	To explore bariatric patients' journeys, from pre‐surgery to post‐surgery experiences	n = 15 Female 73%	37–65 years Hispanic or Latino (n = 5) Not Hispanic or Latino (n = 10)	Key themes: perceptions of beauty based on race/ethnicity; adherence to gender norms; dealing with comorbidities; depression/disordered eating; discrimination due to obesity; and financial challenges to adherence.
Khalesi [20] 2025	Australia, maternity/online environment	To evaluate the feasibility and acceptability of an online Photovoice approach and explore the experiences of larger‐bodied women in maternity care, including barriers, stigma, and healthcare interactions.	n = 8 Female 100%	Age n/r Ethnicity n/r	Identified barriers to equitable care, including unmet needs and lack of tailored, person‐centered support for larger‐bodied women. Demonstrated that online Photovoice is feasible and acceptable, enabling participants to share lived experiences and inform improvements in maternity services.
Maley [52] 2010	USA, rural community	To understand rural community perspectives on how built, natural, and social environments influence food choices and physical activity behaviors.	n = 27 Gender % n/r	20–80 years n = 2 female, 3 male (others unreported) African American (n = 2), American (n = 3), Other participants were American women (n = 25)	Obesity is both an individual and collective issue Participants observed conflicts between desired behaviors and community values/environmental conditions. Existing models do not address the relationship between social, built, and natural environments.
McFatrich [53] 2013	USA, urban community	To use photovoice, a community‐based participatory research tool to gain insights into the perspectives of African American faith leaders regarding the factors influencing childhood obesity within their communities.	n = 5 Female 100%	African American	Faith leaders focused on modeling positive behaviors and meeting family needs. However, parenting demands often led to a cycle of stress, which in turn contributed to unhealthy behaviors. External opinions on parenting created pressure to meet ideal standards, and their fear of appearing vulnerable led faith leaders hesitant to seek help.
Mondoh [18] 2026	UK, community	To explore the lived experiences of people with obesity using Photovoice, with a focus on how social, environmental, and structural factors influence health behaviors and everyday life.	n/r Gender n/r	Age n/r Ethnicity n/r	Highlighted the influence of social and environmental contexts on health behaviors. Weight stigma and social judgment are key influences on everyday experiences and engagement in health behaviors. Photovoice captures contextual and lived realities, including structural and environmental influences on obesity.
Nabors [54] 2020	USA, community (unspecified location)	This study aimed to evaluate the effectiveness of a healthy eating intervention in after‐school programs and document observed changes in eating behavior.	n = 42 Study 1 (n = 30) Male 63% Study 2 (n = 12) Female 50%	Study 1: 8 –11 years (M 9, SD 0.8) African American (n = 4), American (n = 22), Asian American (n = 1), Native North American Indian (n = 2), Hispanic North American (n = 1). Study 2 8–10 years old (M 9, SD 0.8) African American (n = 1), American (n = 11)	Two key themes: Changing or improving diet for healthy eating and helping my family to eat more healthy foods.
Necheles [55] 2007	USA, urban community	To identify factors influencing youth health behaviors and support the development of health advocacy projects.	n = 13 Female 85%	13–17 years African American (n = 9), Asian American (n = 1), Mexican (n = 3)	Key themes: unhealthy eating, stress, friendships, emotions, environment, health, positive family dynamics. Advocacy targeted unhealthy eating and stress through social marketing. Obesity focus initiated a new community based participatory research project within the local school district.
Nichols [56] 2016	USA, community (unspecified location)	To identify social ecological barriers and supports for healthy weight management in an underserved community of the parents of adolescents with obesity in a weight management program	n = 24 Female 54%	Adolescent/parent dyads (n = 12) Adolescents: 12–16 years (M 13.5) African American (n = 11) American (n‐1) Parental age and ethnicity n/r	Individual: Influenced by knowledge, beliefs, values, genetics, race, ethnicity, SES. Personal temptation and food or activity choices were barriers. Interpersonal: Parents (positive and negative influence), time with grandparents, and dynamics in divorced or single parent homes. Community: Neighborhood safety levels (including urban decay, gangs and crime) Organizational: Limited free public programs; private programs are costly.
Nieuwendyk [57] 2016	Canada, rural and urban communities	To explore perceptions of how micro‐ and macro‐level community environmental factors impact physical activity and healthy eating, identifying key elements of obesogenic environments and suitable local interventions.	n = 35 Female 74%	Majority aged ≥ 35 years Ethnicity n/r	Participants viewed health in a broad context, including “community social health.” Microenvironment influences were frequently discussed, but macroenvironment was mentioned less Photovoice visually showed community partners and decision‐makers how macroenvironmental forces can limit healthy choices.
Oates [58] 2018	USA, urban community	To explore community perspectives on obesity in two urban areas and investigating grassroots solutions to address obesity.	n = 59 Location A: African American Female 70.6% While Female 66.7% Location B: African American Female 76.5% White Female 71.4%	Age Location A: African American (M 49, SD 12), American (M 53, SD 18). Location B: African American (M 55, SD 11), American (M 57, SD 25) African American (n = 34), American (n = 25)	Main barriers to healthy weight were restaurants, physical activity limitations and food store access. Recommended solutions included individual efforts, peer support, education for children and adults, and community advocacy.
Rosado [59] 2020	USA, rural community	To explore environmental and social determinants of childhood obesity as perceived by rural migrant farm workers.	n = 13 Female 85%	M 40 years. Hispanic North American (n = 13). Parents of 30 children (M 10 years)	Themes addressed the impact of built and social environments on diet, physical activity, and consequently, health and weight status.
Sackett [60] 2016	USA, urban community	To explore adolescent girls' views on environmental factors in childhood obesity and outline implications for counselor advocacy	n = 7 Female 100%	14–17 years American (n = 7) Divided into two groups based on location	Shared Themes: ease and convenience, money and SES, freedom and pride. Two groups also had unique themes suggesting influence of local context ‐ Ignorance, addiction, will and motivation, time (Location A); advertisement (Location B)
Stewart [43] 2024	USA, university	To explore how ‘fat’ students experience and navigate university campus environments, focusing particularly on the role of built environments and institutional structures on experiences of sizeism, exclusion, and ‘body terrorism’.	n = 6 Gender % n/r	Age n/r Ethnicity n/r	Campus environments reinforce size‐based exclusion through noninclusive physical design (e.g., seating and desks), contributing to discomfort, anxiety, and avoidance. Sizeism operates structurally and socially, intersecting with other identities and highlighting the need for system‐level, inclusive design and policy change.
Torres [61] 2013	USA, urban community	To identify barriers and opportunities influencing physical activity for Latino children and propose policy changes, from the perspective of mothers.	n = 12 Female 100%	25–30 years Guatemalan (n = 1) Mexican (n = 11) 7‐year USA residency (mean)	Generally positive perceptions of neighborhoods Barriers to physical activity: transportation limitations, language barriers, lack of awareness of school programs, and anti‐immigration discrimination. Suggested improvements: healthier family diets, better public park equipment, community sidewalks, and increased police presence.
Van Oss [62] 2014	USA, urban community	To raise adolescent awareness of positive and negative influences on dietary and physical activity behaviors and explore perceptions of physicians' roles in shaping these behaviors.	n = 7 Female 86%	13–19 years (M 16) African American (n = 4), Asian American (n = 1), Hispanic North American (n = 2).	Barriers to healthy eating: Family influences on food choices and high cost of healthy foods Barriers to physical activity: Academic pressures and unsafe neighborhoods Healthy eating strategies: Portion control and moderation Physical activity strategies: Enjoyable activities and social supports Other influences: Role of physicians and physical education teachers, along with a desire for more personalized and culturally aware healthcare Study participation increased their awareness of health behaviors, with some making positive behavior changes.
Watts [63] 2015	Canada, urban community	To explore factors perceived to hinder or support healthy eating in the home environment among overweight/obese adolescents.	n  = 22 Female 77%	M 14 years (SD 1.9) Parental ethnicity: White (n = 12) Nonwhite (n = 10)	Six themes in order of frequency: home cooking; availability and accessibility of foods/beverages; parenting practices; family modeling, celebrations; and screen use and studying
Weinstein [64] 2019	USA, urban community	To investigate social and structural factors influencing weight loss in collaboration with people with serious mental illness and overweight/obesity involved in a lifestyle program in supported housing.	n = 8 Male 75%	M 56 years (SD 6.8) African American (n = 5), American (n = 3)	Structural barriers included prevalence of low‐quality food, costly transportation, financial limitations, food pantry constraints, easy availability of tobacco and alcohol products, and limited exercise opportunities.
Woolford [65] 2012	USA, community (unspecified location)	To explore images that adolescents with obesity find supportive for their weight loss efforts	n = 23 Female 78%	13–19 years (M 14) Arab American (n = 3), African American (n = 7), American (n = 10), Hispanic North American (n = 2), Native North American Indian (n = 1)	Participants rated Photovoice highly, noting that selecting pictures encouraged reflection on their weight loss journey. They believed a mobile intervention with personal images would enhance adherence. Photos often featured family and friends, highlighting their essential role in motivation and support.
Xiao [66] 2021	USA, community (unspecified location)	To explore perceptions of obesity and overweight conditions among African American women and identify influencing factors.	n = 18 Female 100%	M 35 years (SD 7) African American (n = 18)	“The Weight of a Black Neighborhood” referred to challenges in maintaining healthy habits in their neighborhoods. “Cultural Ties” described preferences for high‐carbohydrate, salty, and fatty foods and difficulties changing cultural dietary habits. “Weight is Just a Number” referred to their personal views on the significance of weight.

Abbreviations: M, mean; n/r, not reported; SD, standard deviation; SES, socioeconomic status; UK, United Kingdom. USA, United States of America.

^a Based upon the Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG) [39] as per reported ethnicity.

3.2.2. Setting

Most studies were conducted in community settings, with a small number in hospital, university, and maternity contexts [20, 43, 44] (see Table 3). Community studies were conducted in urban [45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56], rural [57, 58, 59, 60, 61], and suburban areas [62]. Two spanned both rural and urban settings [63, 64]; however, six studies [65, 66, 67, 68, 69, 70] did not describe their service setting.

TABLE 3.

Photovoice methodologies of included studies.

First author Year	Format and analysis method	Session number and duration per session	SHOWeD utilized	Equipment a	Number of photos (instructed, taken and analyzed)	Photos published
Balvanz [40] 2016	Standalone Photovoice study Applied thematic analysis	4 sessions 90 min	Yes	Camera (type of camera n/r)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	Yes
Banik [41] 2023	Standalone Photovoice study Descriptive qualitative coding	4 sessions Duration n/r	N	Smartphone or camera (type of camera n/r)	Instructions: Up to 6 photos showing either the presence (n = 3) or absence (n = 3) of healthy eating or physical activity initiatives Photos taken (n = 222) Photos analyzed (n = 213)	Yes
Bateman [42] 2019	Standalone Photovoice study Theoretical thematic analysis	10 sessions 90 min	Yes	Camera (disposable)	Instructions: 3–4 pictures per day for 7 days Photos taken (n/r) Photos analyzed (n = 96)	Yes
Breland [43] 2024	Standalone Photovoice study Rapid qualitative analysis	6 sessions 85 min	No	n/r	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	Yes
Corty [44] 2022	Standalone Photovoice study Unspecified thematic analysis	7 sessions 90 min	Yes	Smartphones	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	Yes
Craig [17] 2024	Photovoice combined with other methods Unspecified thematic analysis	No of sessions n/r Duration n/r	No	n/r	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	n/r
Cueva [45] 2020	Standalone Photovoice study Unspecified thematic analysis	8–9 sessions per group Duration n/r	Yes (adapted)	Cameras (disposable)	Instructions: At least 3 photos for each of 14 guiding questions Photos taken (n/r) Photos analyzed (n/r)	Yes
Farrell [46] 2022	Photovoice combined with other methods Reflective thematic analysis	1 session Up to 120 min	No	Cameras (disposable)	Instructions: 3–4 pictures per day for 7 days Photos taken (n/r) Photos analyzed (n = 5 per participant)	Yes
Findholt [47] 2010	Photovoice combined with other methods Unspecified thematic analysis	4 sessions 180 min (Sessions 1–3) and 60 min (Session 4)	Yes (adapted)	Cameras (disposable)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	No
Hackett [48] 2015	Standalone Photovoice study Grounded theory	10 sessions 60–120 min	No	Smartphones or flip video cameras	Instructions (n/r) Photos taken (n/r) Photos analyzed (n = 78)	Yes
Hollmann [12] 2024	Standalone Photovoice study Unspecified thematic analysis	No of sessions n/r Duration n/r	No	n/r	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	Yes
Homer [49] 2016	Photovoice combined with other methods Framework analysis	2 sessions Duration n/r	No	n/r	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	No
Jennings [50] 2020	Standalone Photovoice study Qualitative descriptive content analysis	2 sessions (1 interview, 1 group discussion) Duration n/r	No	Camera (type of camera n/r)	Instructions (n/r) Photos taken (n = 400) Photos analyzed (n = 100)	No
Johnson [51] 2018	Standalone Photovoice study Grounded theory	2 sessions Duration n/r	No	Camera (digital)	Instructions (n/r) Photos taken (n = 150 approx) Photos analyzed (n/r)	Yes
Khalesi [20] 2025	Standalone Photovoice study Participatory thematic analysis	Multiple online and interview sessions (no unspecified) Duration n/r	Yes (adapted)	Smartphone/digital camera	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	Yes
Maley [52] 2010	Photovoice combined with other methods Constant comparison analysis	1 interview 60 min 1 focus group 30 min	Yes (adapted)	Cameras (disposable)	Instructions (n/r) Photos taken (n = 113) Photos analyzed (n = 17–34 approx)	No
McFatrich [53] 2013	Standalone Photovoice study Content analysis	3 sessions 90 min	Yes	Cameras (disposable)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	No
Mondoh [18] 2026	Standalone Photovoice study Unspecified thematic analysis	No of sessions n/r Duration n/r	Yes	n/r	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	Yes
Nabors [54] 2020	Photovoice combined with other methods Grounded theory	8 sessions Duration n/r	Yes (adapted)	Cameras (disposable)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	No
Necheles [55] 2007	Photovoice combined with other methods Network analysis	9 sessions 120 min	Yes	Cameras (digital), plus memory card, photo‐editing software, USB cable and photo album	Instructions (n/r) Photos taken (n = 3500) Photos analyzed (n = 130)	Yes
Nichols [56] 2016	Standalone Photovoice study Directed content analysis	1 session per participant Duration n/r	Yes	Camera (digital)	Instructions (n/r) Photos taken (n = 590) Photos analyzed (n = 72–120 approx)	Yes
Nieuwendyk [57] 2016	Standalone Photovoice study Unspecified thematic analysis	2 sessions 60–90 min	No	Camera (digital)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n = average 13 per participant)	Yes
Oates [58] 2018	Standalone Photovoice study Unspecified thematic analysis	4 sessions 90 min	Yes	Camera (disposable)	Instructions: 3 to 4 pictures per day for 7 days Photos taken (n = 1600) Photos analyzed (n = 174 discussion, n = 96 focus group)	Yes
Rosado [59] 2020	Standalone Photovoice study Multistep, successive approximation coding for theme identification	3 sessions Duration n/r	Yes	Camera (disposable)	Instructions (n/r) Photos taken (n = 182) Photos analyzed (n = 49)	Yes
Sackett [60] 2016	Standalone Photovoice study Unspecified thematic analysis	4 sessions Duration n/r	Yes (adapted)	Camera (disposable)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n = 15–25 approx)	No
Stewart [43] 2024	Photovoice combined with other methods Collaborative and participatory ‘Sort and Sift’ approach	1 session 45–78 min (M 59 min)	Yes	n/r	Instructions provided Photos taken (n/r) Photos analyzed (n/r)	Yes
Torres [61] 2013	Standalone Photovoice study Content analysis	3 sessions 90 min	Yes	Camera (type of camera n/r)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n = 24–36 approx)	No
Van Oss [62] 2014	Standalone Photovoice study Unspecified thematic analysis	3 sessions Duration n/r	No	Smartphone or camera (digital)	Instructions: Minimum of 5 photos to be taken Photos taken (n/r) Photos analyzed (n/r)	Yes
Watts [63] 2015	Standalone Photovoice study Constant comparative analysis	1 session 15 min	No	Camera (digital)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n = 105)	Yes
Weinstein [64] 2019	Standalone Photovoice study Unspecified thematic analysis	4–7 sessions Duration n/r	Yes	Camera (digital)	Instructions (n/r) Photos taken (n/r) Photos analyzed (n = 33)	Yes
Woolford [65] 2012	Standalone Photovoice study Constant comparative analysis	1 session 15–25 min	No	Smartphone	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	No
Xiao [66] 2021	Standalone Photovoice study Grounded theory	2 sessions 60 min	Yes	n/r	Instructions (n/r) Photos taken (n/r) Photos analyzed (n/r)	No

^a Smartphones were participant provided, while cameras were researcher provided.

Abbreviations: approx. = approximately; min, minutes; n/r, not reported.

3.2.3. Participants

In four studies [12, 17, 18, 58], the gender of participants was not fully reported. However, 75% of the remaining studies had female majority samples, and around half were completed with children or adolescents. Included studies were primarily conducted among ethnic minority groups; however, seven [12, 17, 18, 20, 43, 51, 64] provided no information about the ethnicity profile of their sample (see Table 3). Four studies [49, 59, 65, 70] focused solely on Black or African Americans, three studies [50, 56, 60] with Latino participants, and two studies on Indigenous populations in America [55, 61]. Five studies [46, 48, 49, 58, 68] recruited participants from two or more ethnic groups.

Participant ages ranged from 9 to 90 years, with 12 (38%) studies reporting mean ages (from 9 to 58 years) [46, 47, 52, 53, 54, 60, 63, 65, 66, 67, 68, 70]. All but one of the studies that reported mean age were with young people aged between 8 and 19 years.

3.2.4. Study Aims and Objectives

The aims and or objectives of included studies (Table 2) covered a wide range of topics related to obesity research. Youth and adolescent engagement were a common focus, which involved identifying factors influencing health behaviors, promoting health advocacy, and exploring adolescents' perceptions and experiences with obesity [45, 46, 48, 57, 61, 63, 66]. Community perspectives were also investigated, like local development, build and natural environments, neighborhood safety, food marketing, and cultural attitudes and norms toward obesity [43, 49, 50, 52, 54, 55, 56, 58, 60, 62, 64, 67]. Cultural, social, and economic determinants of obesity [54, 60, 65, 70]; the development and evaluation of health interventions and policy [51, 53, 56, 68, 69]; and the use of Photovoice as a methodology were also the focus of multiple studies [48, 49, 55, 56, 59, 62, 66, 68].

3.3. Photovoice Methodology

Digital [20, 44, 47, 48, 53, 64, 67] and disposable cameras [45, 49, 52, 54, 57, 58, 60, 61, 68, 69] were most commonly utilized, and 13 (40%) studies [44, 47, 48, 52, 53, 54, 55, 58, 60, 62, 63, 64, 69] specified the number of photographs collected and analyzed. Smartphone cameras were used relatively infrequently [20, 46, 56, 62, 63, 66] and seven (22%) studies gave no information about cameras in their Photovoice research [12, 17, 18, 43, 51, 65, 70]. The number of data collection sessions including both photography and interviews ranged from 2 to 8. Session durations of 15 to 120 min were reported in 18 (56%) studies, whilst others omitted this information [12, 18, 20, 43, 44, 45, 46, 51, 53, 60, 61, 63, 67, 68].

To facilitate photo discussions, 14 studies [17, 18, 43, 48, 49, 50, 52, 53, 54, 56, 59, 60, 65, 67] employed the SHOWeD framework. This framework asks five questions: What do you See here? What is really Happening? How does this relate to Our lives? Why does this situation exist? What can we Do about it? Six other studies [20, 45, 57, 58, 61, 68] adapted the SHOWeD framework. Most (n = 21, 66%) of the studies included participant photographs in their subsequent publications [12, 18, 20, 43, 44, 46, 47, 48, 52, 53, 54, 56, 59, 60, 61, 62, 63, 64, 67, 69, 70].

Across included studies, thematic analysis (n = 15, 47%) and content analysis (n = 6, 19%) were the most frequently used approaches to interpret Photovoice data, with several studies combining these with participatory or inductive coding strategies [20, 43]. A smaller number of studies used grounded theory, narrative, or phenomenological approaches.

3.4. Thematic Synthesis of Findings

Four key themes were identified in the findings of included studies: environmental influences on obesity, facilitators and barriers to healthy eating and physical activity, mental health and well‐being, and perceptions of obesity. Findings related to multiple themes were evident in many studies, indicating their close and interconnected relationships.

3.4.1. Environmental Influences on Healthy Eating and Physical Activity

The impact of features in built, natural, and economic environments were explored across studies with children, adolescents, and adults [12, 18, 43, 45, 48, 50, 52, 53, 54, 55, 57, 58, 60, 61, 64, 67]. Built and natural environments were described as having the potential to both help and hinder physical activity, depending on factors such as available green spaces, transportation limitations, perceived safety, and the presence of fast‐food outlets. However, economic environments were consistently considered a barrier to healthy eating, with some disadvantaged communities living in “food deserts” with limited access to affordable nutritious food. Their presence in Photovoice studies suggests that obesogenic (and health promoting) environments are perceived as an important issue by marginalized communities but may also reflect the visual nature of the research methodology.

3.4.2. Other Influences on Healthy Eating and Physical Activity

Several studies explored other facilitators and barriers to healthy eating and physical activity, including social, cultural, and political influences. Relationships with parents, family, friends and peers were all identified as potential facilitators through the modeling of good habits and opportunities for communal activity [46, 47, 48, 49, 50, 67]. However, these social influences (or social isolation) could also lead people to unhealthy eating and sedentary habits and therefore contribute to obesity. More broadly, experiencing a sense of community and access to community‐based programs provided structured opportunities for guidance, physical activities, and shared experiences. These communal aspects of the study findings are also closely related to the built and natural environmental theme.

Cultural identity and the challenges of changing dietary habits were also examined [46, 49, 50, 59, 64, 67]. Some cultural preferences were for foods high in carbohydrates, salt, or fats, which are at odds with dietary recommendations related to obesity prevention. Social gatherings and celebrations also often center around unhealthy eating, such as large family meals or festive “treats.” Changing these habits may therefore challenge a person's cherished cultural identity and meet with resistance from their family or social circles. Cultural expectations related to physical activity were also identified, which may be inhibited by community values or be encouraged to express identity. Language barriers and discrimination may prevent culturally diverse people with obesity from accessing health programs and community infrastructure which could help them manage their obesity [20]. However, traditional food cultivation practices through farming or gardening can support healthy lifestyles while also maintaining connection to culture [61].

Several changes and improvements were recommended by participants to address the barriers they identified in their communities [52, 53, 59, 60, 64]. Many of the recommendations addressed common themes and structural issues identified in the literature, for example, eliminating “food deserts,” enhancing community recreational infrastructure, improving food and exercise affordability, and increasing green spaces. A collaborative approach using participatory methods such as community action plans was preferred in underserved communities, along with the tailoring of interventions to local cultural and socioeconomic contexts. However, participants acknowledged and desired structural and sustained transformation to tackle the issues they identified.

3.4.3. Mental Health and Well‐Being

A small number of studies explicitly addressed the influence of mental health and well‐being but strongly emphasized the importance of these factors to the experiences of people with obesity. Experiences of physical exclusion within institutional environments were also associated with feelings of embarrassment, anxiety, and reduced sense of safety [12, 43]. Two studies explored the link between stress, family responsibilities, unhealthy eating, and low levels of physical activity. People with obesity experiencing social and familial stress described the challenges these factors posed to maintaining healthy lifestyles. McFatrich et al. [49] found that stress from parenting responsibilities and societal expectations around this role contributed to unhealthy behaviors for African Americans. Similarly, Nichols et al. [67] reported that adolescents and their parents experienced stressful family dynamics and economic challenges, both of which had a negative influence on dietary choices and activity levels. Outside of families, Stewart et al. [43] described how students experienced physical exclusion within university environments, which left them feeling embarrassed, anxious, and feeling unsafe. As such, multiple psychosocial factors were perceived to be a higher priority or demand by people with obesity than prioritizing their personal health.

Two further studies explored the connection between obesity and clinical comorbidities like depression and disordered eating. Structural barriers (such as limited access to healthy food and opportunities to exercise) play a role in exacerbating mental health problems for people with serious psychiatric conditions, consequently increasing their risk of obesity [53]. For people receiving bariatric surgery, Johnson et al. [44] report that depression, disordered eating, and weight stigma also create a cyclical relationship between poor mental health and sustained obesity.

3.4.4. Perceptions and Experiences of Obesity

At both the individual and community level, negative perceptions of obesity interact with (and potentially amplify) other perceptions of disadvantage in the lived experiences of marginalized people with obesity [43]. In a study by Van Oss et al. [46] adolescents described weight as “just a number” but were also aware of societal expectations around being a healthy weight. African American women also perceived community influences and expectations as a key driver of their problems with body image and weight management [65]. People undergoing bariatric surgery also described their experiences of discrimination and societal disapproval, which had a significant impact on their self‐perception and efforts to manage their obesity [12, 18, 43, 44].

Finally, two studies specifically commented on the empowering effects of the Photovoice process when collecting lived experience data. Corty et al. [56] found their participants valued Photovoice as a tool for personal growth, community representation, and motivation for health advocacy. Similarly, Photovoice was appreciated by some participants as a platform for self‐reflection and advocacy [17, 20, 48] and was valued for its ability to foster both individual and collective awareness. In both cases, Photovoice was perceived as a way for marginalized participants to share their experiences and actively contribute to positive change in their community.

3.5. Participatory and Methodological Alignment With Photovoice Principles

This section presents the application of the bespoke rubric described in the methods to evaluate the alignment of included studies with the participatory and advocacy aims of Photovoice (see Table 4 and Supporting Information). Across studies, the majority positioned their participants as contributors rather than co‐researchers at the “Involve” level (n = 22, 69%). Only a small subset reached the “Collaborate” level of involvement with explicit shared decision‐making (n = 5, 16%), although several recent studies demonstrated higher levels of participant involvement [20, 43]. A minority operated at the “Consult” or “Inform” levels of participation. This pattern suggests that although participatory approaches were widely adopted, deeper forms of power‐sharing and co‐production were less frequently realized in practice.

TABLE 4.

Degree of Patient and Public Involvement (PPI) and meeting Photovoice goals.

Author (year)	PPI level	Goal
		1 ‐ Document & reflect strengths/concerns	2 ‐ Group dialogue and knowledge sharing	3 ‐ Reach policymakers/advocacy
Balvanz (2016) [59]	Collaborate	High	High	High
Banik (2023) [63]	Involve	High	Medium	Medium
Bateman (2019) [54]	Involve	Medium	Medium	Low
Breland (2024) [70]	Involve	High	High	Low
Corty (2022) [56]	Involve	High	High	Medium
Craig (2024) [17]	Consult	High	Low	Low
Cueva (2020) [61]	Involve	High	High	Medium
Farrell (2022) [69]	Involve	High	Medium	Low
Findholt (2010) [57]	Involve	High	High	High
Hackett (2015) [62]	Involve	High	High	High
Hollmann (2024) [12]	Inform	High	Low	Low
Homer (2016) [51]	Involve	Medium	Low	Low
Jennings (2020) [55]	Involve	High	High	Medium
Johnson (2018) [44]	Inform	High	Low	Low
Khalesi (2025) [20]	Collaborate	High	Medium	Low
Maley (2010) [58]	Collaborate	High	Medium	Low
McFatrich (2013) [49]	Involve	High	High	High
Mondoh (2025) [18]	Involve	High	Medium	Low
Nabors (2020) [68]	Inform	High	Medium	Low
Necheles (2007) [48]	Involve	High	High	High
Nichols (2016) [67]	Collaborate	High	Medium	High
Nieuwendyk (2016) [64]	Consult	High	Low	High
Oates (2018) [52]	Involve	High	High	Low
Rosado (2020) [60]	Involve	High	High	Medium
Sackett (2016) [45]	Involve	High	High	Medium
Stewart (2024) [43]	Collaborate	High	Low	Moderate
Torres (2013) [50]	Involve	High	High	Medium
Van Oss (2014) [46]	Involve	High	Low	Low
Watts (2015) [47]	Involve	High	Low	Low
Weinstein (2019) [53]	Involve	High	High	Medium
Woolford (2012) [66]	Consult	High	Low	Low
Xiao (2021) [65]	Involve	High	Low	Low

In relation to the aims of Photovoice, most studies successfully enabled participants to document and reflect on their strengths and concerns and to engage in some level of collective discussion and interpretation. However, relatively few translated these insights into formal advocacy or policy influence. Dissemination was often directed toward academic or community audiences rather than decision‐makers and evidence of measurable policy or practice impact was uncommon. Overall, the findings indicate that Photovoice is being used effectively to support reflection and dialogue, but its potential for structural or policy change remains underreported.

4. Discussion

This scoping review synthesized the findings of 32 Photovoice studies conducted with people experiencing obesity, with the majority undertaken in Western countries. This pattern may reflect differences in research infrastructure, funding priorities, and the uptake of participatory methods across settings [71, 72, 73]. Key themes reported included the impact of environmental influences, facilitators, and barriers to healthy eating and physical activity, mental health and well‐being, and perceptions of obesity. Taken together, these findings indicate that Photovoice is well‐placed to surface multilevel determinants of obesity and to inform context‐tailored action at all levels.

Building on these findings, the prevalence of urban settings reflects the geographical focus of much public health research, where communities often have greater access to research initiatives [74, 75]. However, Photovoice has been found to be effective in rural and other underserved communities [18]. Extending Photovoice to regional, rural, and remote communities will require partnering with local organizations, budgeting for costs such as travel and childcare, adapting to internet connectivity constraints, and strengthening privacy protocols for small communities where identifiability risks are higher [76].

Only two studies applied Photovoice in noncommunity settings [20, 43], highlighting a substantial gap in the literature. Conducting Photovoice within institutional environments offers opportunities to capture service users' and clinicians' perspectives on care and educational experiences. Studies in these settings should embed ethical safeguards for image use and consent, establish clear pathways for managing sensitive or distressing content, and co‐design dissemination activities with participants and other stakeholders. Integrating Photovoice findings into existing quality improvement or service redesign processes could enable and accelerate translation of data into actionable change within healthcare and educational systems [76].

Across included studies, many Photovoice studies engaged populations experiencing social or structural disadvantage, including people from culturally and linguistically diverse backgrounds, indigenous communities, and those living with socioeconomic hardship [65, 77]. Future research needs to move beyond representation to embed culturally safe and community‐led practices throughout all stages of the project. This might include establishing community advisory or governance groups, employing participatory translation and interpretation processes, supporting participant ownership of images and narratives, and ensuring benefits are reciprocated through accessible dissemination and local action [78]. Researchers should also align projects with frameworks for indigenous data sovereignty and ethical visual research to ensure that participants maintain agency over how images and stories are stored, shared, and re‐used. These strategies can strengthen trust, improve contextual relevance, and enhance the authenticity and impact of Photovoice in obesity research. However, as reflected in the rubric analysis, engagement with these populations did not consistently translate into higher levels of participation, with most studies operating at the “Involve” rather than “Collaborate” level.

Photovoice methodology is intentionally flexible to fit diverse communities; however, the variation in methods and processes we observed has implications for transparency, comparability and replication [20, 25, 43, 79]. To preserve flexibility while improving rigor, future reports should pair the facilitation approach (e.g., SHOWeD or adaptations) with minimum reporting standards that include the following: devices used and any constraints; the number, duration, and sequencing of sessions; whether and how participant photographs were published (and associated consent procedures); and the analysis approach and coding procedures (including the role of participant dialogue in theme development). A stage‐by‐stage map of participant involvement and decision‐making would allow readers to better appraise participatory integrity and alignment with Photovoice's aims across the research process.

These findings highlight the need for greater methodological transparency and more consistent application of participatory principles in Photovoice research. To support this, reporting guidelines for Photovoice studies may promote greater transparency and consistency in how participation is described [80] but appear to have had limited impact on publication quality [81]. Given its distinctive characteristics, the co‐production of reporting and translation guidelines specific to the Photovoice methodology, developed in partnership with marginalized communities, could enhance both their relevance and uptake.

Beyond these issues, the findings of this review indicate that Photovoice is a relevant and appropriate research methodology for exploring the lived experience of obesity. Several of the themes identified reflect findings from previous research, including the influence of obesogenic environments [82, 83], stress and family responsibilities [84], mental health and well‐being [12, 43, 85], weight stigma [15, 86, 87], and the built environment [12, 18, 43, 88, 89, 90] on the lives of people with obesity. The themes within this review also extend earlier work highlighting the role of culture [91] and socioeconomic status [92] in shaping experiences. Collectively, these findings provide obesity‐specific perspectives on established issues and consolidate their relevance to people living with obesity.

Photovoice addresses limitations of text‐dominant methods by making visible the obesogenic contexts that people with obesity navigate. By enabling nonverbal expression and participant‐led meaning‐making, it widens inclusion for groups underrepresented in obesity research and helps shift participants from “subjects” to advocates whose images and narratives can be mobilized to prioritize concrete, local actions, and build authentic pathways for sustained policy and systems change [93].

Active involvement of people living with obesity in data generation and interpretation ensures findings are locally relevant and fosters collaborative (preferably community‐led) problem solving [94]. Policy and environmental interventions are typically more sustainable than programmatic interventions [95], and Photovoice is well‐suited to informing their design by translating lived‐experience insights into actionable, context‐specific changes. Accordingly, the value of Photovoice lies not only in what it reveals but also in how this knowledge can be mobilized for policy and environmental change. However, its potential as an agent of change remains unrealized given current disparities in obesity Photovoice research and the aims of this methodology.

Nevertheless, consistent with prior reviews, policy‐facing activities and concrete impacts are often sparsely reported in published studies. Our appraisal also showed that PPI was the strongest during image generation and group dialogue but weaker at agenda‐setting and dissemination. The reasons for this pattern of engagement are unclear for the included studies but have been attributed in other studies to persistent power imbalances in research processes [96]. Future Photovoice projects should plan policy engagement at the outset, document decision‐maker participation and follow‐up actions, and report resultant practice or policy adjustments to make the “action” dimension visible [97].

4.1. Limitations and Future Directions

While this review highlights the value of Photovoice to obesity research, identified gaps in the literature are limitations to its use. The scarcity of Photovoice studies involving people with obesity published since 2020 likely reflects the impact of COVID‐19, which posed significant barriers to participatory research designs that typically rely on face‐to‐face interaction. Future research should explore virtual or hybrid format adaptations which enable meaningful engagement while maintaining methodological rigor, including across diverse settings and delivery formats [20]. The limited geographical focus of this research limits its generalizability to diverse cultural and environmental settings, and Photovoice methodologies should be applied more broadly to currently underrepresented communities. Future Photovoice studies should also make stage‐by‐stage involvement by participants in the research process explicit, to support appraisal of participatory integrity and reproducibility.

Methodological variability in Photovoice studies, such as differences in camera equipment, session structures, and frameworks used, also limits cross‐study comparability and synthesis. While flexibility is an advantage of Photovoice, standardized reporting guidelines could help improve methodological transparency and ensure rigorous documentation of participant agency and engagement. These steps will solidify Photovoice's role in obesity research, maximizing its potential to capture lived experiences and drive impactful, community‐informed solutions. Greater fidelity to early policymaker engagement and explicit reporting of methodological steps may also improve both participatory integrity and impact in obesity Photovoice studies. Implementation and evaluative research on the policy and practice changes resulting from Photovoice research are also needed to understand how actionable and sustainable their recommendations are and describe the process of moving from participant to advocate. Future research should also explore the application of Photovoice across diverse settings, including institutional environments and digitally mediated formats [20, 43].

5. Conclusions

This scoping review affirms that Photovoice is a valuable methodology in obesity research, due to its capacity to provide deep insights into the lived experiences of people with obesity and fully engage with complex environmental, social, and cultural factors within context. Its participatory nature encourages a shift toward more inclusive, community‐driven research, capable of informing policy and intervention strategies that are relevant, culturally sensitive, and sustainable. Future research leveraging Photovoice's strengths will be critical for advancing equity‐focused approaches to address obesity and empower those most affected by it.

Funding

This review is part of a larger project funded by Impact Obesity (ABN 65649953891). J.A. is funded by the National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT2033338).

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Supporting information.

Data Availability Statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.