Table 2.

Summary of reciprocal translation synthesis

Responder	Theme	Description	Second order lines of arguments
Patient	Knowledge/education	The provision of lifestyle education influences patients’ beliefs about roles	Obesity services delivered without sufficient support may limit the degree to which patients engage with health services
	Medicalisation	Understanding of the causes of obesity relate to patients’ beliefs about roles	Patients maintain the view that obesity is an individual, medical issue, but their psychological and social experiences of obesity leads them to seek ‘personal’ help from primary care
	Uncertainty	The doubt and confusion apparent in patient understanding of roles	Uncertainty of practitioners’ roles and available options confuses patient understanding of what the roles are to be, and may lead to a limited engagement with health services
	Communication	The patient–practitioner interface shapes patient perception of roles	Patients respond to the content and style of communication received from practitioners in determining what role they will take when interacting with services
	Blame/stigma	The focus of responsibility on to patients influences patients’ perspectives of roles	Blame can cause practitioners to stigmatise patients, leading to negative effects on psychological health and wellbeing, and ultimately diminished engagement
Practitioner	Knowledge/education	Evidence for obesity interventions influences the roles practitioners take	Practitioners believe that obesity services should be delivered in primary care only if their effectiveness is supported by the evidence base, which currently is limited
	Medicalisation	Beliefs about the causes of obesity, the conflict as to whether it is a medical or social issue, influence practitioners’ perspectives of roles	Practitioners believe that they should only take a strong role when obesity is considered a medical issue, and do not have a role to play in ‘personal’ issues
	Uncertainty	Practitioners’ lack of confidence in the evidence and in patients influences their conceptions of roles	Uncertainty over responsibilities can lead practitioners to take a limited or inconsistent role in delivering obesity services
	Communication	The patient–practitioner interface, in particular issues of uncertainty, shapes practitioners’ beliefs about roles	Practitioners can feel uncomfortable or unprepared talking about obesity, believing obesity to be a sensitive, personal issue, and as a result take a limited role in discussing it
	Blame/stigma	The assignment of blame influences practitioners’ perspectives of roles	Practitioners who hold patients entirely responsible for obesity, without recognising other factors involved, are in danger of stigmatising patients