Table 3.

Examples of participants’ narratives related to barriers and facilitators of adherence with the very‐low‐energy diet

Main theme	Sub‐theme	Example quote
Barriers to adherence	Hunger	‘The first week or so I was probably feeling hungry but after that, absolutely fine…I did think Christ, how am I going to manage on three drinks a day, but absolutely fine.’ (Man, aged 69 years, diabetes duration 3.5 years).
	Emotional distress	I had some news on Friday which at the weekend, I got it on Friday but Saturday it hit us like a brick wall and I was like ‘oh, and I really wanted comfort food’ (Woman, aged 47 years, diabetes duration 2.5 years)
	Environment	Seeing cold meat hanging around sometimes, a leg of chicken or a breast and it would be on a plate in the kitchen … At times I would twitch and go oh Sylvia [wife] ‘you've got to move that damn chicken before I go in there’ (Man, aged 67 years, diabetes duration 3.5 years).
Facilitators of adherence	Rapid outcomes	I found it very easy and I got results very quickly. I started to see weight loss fairly quickly and that's encouragement in itself’ (Man, aged 69 years, diabetes duration 18 years).
	Social support	The major support that I had, I knew my family were behind me with regards to it and I could do and ask them anything. My boss has given me a tremendous level of support by giving me the time off work to come here today and stuff like that and just to give me little words of encouragement’ (Man, aged 49 years, diabetes duration 9.5 years)
	Involvement in a study	I thought well there's no point I'm coming here, I'm getting support, I'm getting help and if I don't do – I mean people don't know what you're doing in your own house, but I thought if I'm not honest and stick to it then I won't lose the weight and my blood sugar won't go down so it's just trying to be motivated and to be sensible and think well this is a chance that you've taken, an opportunity to lose weight, opportunity to get your blood sugar down so take it, grab it with both hands’ (Woman, aged 70 years, diabetes duration 15 years).