Table I.

Meta-summary of included studies.

Author (year) country	Aim/objective	Sample (n=212) and design	Data analysis method	Context	Author's conclusions
Baruth (2014) USA	To explore perceptions and experiences with barriers to exercise and healthy eating among women from predominantly African American disadvantaged neighborhoods.	Females (n=28) males (n=0) Mean BMI: 40.4 kg/m2 (range 27.6–57.6) Mean age: 34.3 years (range 25–50.3) Open-ended, qualitative, focus-group interviews.	Transcripts, codes, and identification of key themes.	Disadvantaged neighborhoods, South Carolina.	Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise.
Christiansen (2012) Norway	To gain more knowledge about characteristics of eating habits and body image as well as motivational forces for change.	Females (n=7) males (n=4) (9 of them awaiting bariatric surgery) BMI>40 kg/m2 (or>35 kg/m2 with one comorbidity) Age: range 26–56 years Open, narrative, qualitative interviews.	“Bricolage,” hermeneutic interpretation.	40-h weight reduction course in a patient education resource center.	Seeing oneself as an obese person was a gradual process that implied experiencing oneself as different from others. To experience a gap between knowing and doing concerning food habits in everyday life indicated that informants valued that they had a choice.
Dahl (2014) Norway	To describe how personnel argued for and perceived a residential weight-loss program, to investigate how the participants experienced the program, and to contrast these perspectives.	Females (n=5) males (n=3) BMI: range 40–63 kg/m2 Age: range 22–56 years. Observations, semi-structured focus-group interviews, and individual interviews.	Interview transcripts and field notes were inductive and thematically analysed together.	18-week on-site residential program at a weight-loss center in Denmark.	Participants embraced and adapted to the exercise part of the program. However, the personnel claimed that social training and personal development was necessary to lose weight, and weight to maintenance was not supported by all participants.
Lewis (2011) Australia	To investigate obese men's health behaviors and strategies for change.	Females (n=0) males (n=36) Mean BMI: 37.1 kg/m2 (range 30–60.7) Mean age: 45.5 years (range 21–69) Qualitative interviews by telephone.	Constant comparative methods of analysis. Transcripts, codes, and identification of themes.	Everyday life in community.	Men were found to feel a personal responsibility for weight gain. PA was seen as an empowering option, but difficult to fit into daily lives. Causes of weight gain and barriers to weight loss were sedentary lifestyles, stress, lack of work life balance, and weight-based stigma.
Groven (2010) Norway	To show how high-intensity training was experienced from a first-person perspective.	Females (n=5) males (n=0) Mean BMI: 44.8 kg/m2 (range 40–48) Age: range 35–63 years Face-to-face, semi-structured, in-depth interviews.	Kvale and Brinkman: transcribed, “bricolage,” meaning condensation; thematizing central themes, meaning interpretation.	Group-based treatment program.	Experiences of training were connected to the participants’ general experiences of being overweight. Both relationships to other people and earlier experiences were important for how the training was carried out.
Guess (2012) England	To examine the views and attitudes toward aerobic and resistance exercise among overweight and obese individuals.	Females (n=25) males (n=5) Mean BMI: 33.8 kg/m2 (SD=7.9) Mean age: 40.7 years Qualitative interviews and focus-group interviews and follow-up interviews.	Thematic analysis of transcribed data (NVIVO8).	12-week aerobic or resistance exercise program in a weight management clinic in London.	Weight loss was found as primary motivation for PA participation among women. Existing knowledge need to be reconciled to a successful weight loss and maintenance due to PA as participants had only little awareness or experience of resistance exercise and were fearful of potential risks.
Thomas (2008) Australia	To explore the extent to which people living with obesity have attempted to lose weight; their attitudes toward dieting, physical exercise and weight-loss solutions.	Females (n=63) males (n=13) Mean BMI: 42.5 kg/m2 (range 30–72,1) Mean age: 47 years (range 16–42) Open-ended, qualitative interviews face to face or by telephone.	Constant continuous, comparative method.	Urban and rural areas in Victoria, Australia.	Very few individuals with obesity were given appropriate long-term guidance or support. The positive role of social networks seemed particularly important in engaging individuals in PA.
Wiklund (2011) Sweden	To describe how adults with severe obesity, awaiting gastric bypass surgery experience PA.	Females (n=10) males (n=8) Mean BMI: 47 kg/m2 (range 29–62) Mean age: 47 (range 18–65) In-depth, semi-structured interviews.	7 Steps of Dahlgren and Fallsberg.	Hospital and home setting. Awaiting gastric bypass surgery.	PA was experienced positively, but obstacles exist that influence the capacity or the will of the people living with severe obesity. Support is necessary to maintain PA.