CONSIDERACIONES CULTURALES BASICAS

Weight loss at 6 months = 22.6 kg Weight loss at 12 months = 34.4 kg Attendance with BOB programme = 76%

On entering the programme, BOB 2 had dropped out of school 2 years ago due to bullying, his weight was continually going up and he had tried all available treatments including lifestyle programmes in the community and medication. BOB 2 attended all sessions of the BOB programme with his Mum and at least always one sibling. From the first appointment with the research team, the whole family attended every appointment as a family and were committed to change together. They appeared ready for the intervention and reported researching details of the intra-gastric balloon on the internet, which had given them an idea of what to expect. All family members were overweight and/or obese but recognised that although the programme was focused on BOB 2, they could all benefit from the education, advice and lifestyle sessions throughout the programme. During the first session Mum arrived in a wheelchair only able to walk 100 m unaided with BOB 2 mute throughout the whole session, hiding behind a long fringe. He looked at the floor and did not respond verbally to any questions. It became apparent at this early stage that this was the last resort for this family, they were in an emotional low and they had acknowledged the need to respond and change to their common issues around weight and weight loss. BOB 2 defined success at the end of programme by drawing his ideal outfit, which we would not only wear, but have brought, from a high street shop.

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about feeling they can move, going out as a family and visiting places, going to Rother Valle a d pla i g ou de s – he does t sit i his ed oo all da , he s o do stai s a d out a d a out ith us .This positive momentum continued into the 12- month interview with a strong appreciation of their involvement with study it as the best thing for him, he was ready, we had a bad time before it, crying all the time, seeing that change f o hi sa i g I do t a t to li e a o e and a totally different young man – he head s up, i stead of alki g looki g at the floo he a tuall looks at people and I see hi e e da , a d I a t elie e its so alki g a ou d i his o e s, he totall ha ged . Recurring themes from conversations were the focus and implementation of lifestyle changes as a family, with less conversation focused on the intra-gastric balloon. There was never a sole reliance on the intra-gastric balloon, BOB 2 invested in making positive lifestyle choices throughout the programme, with a committed attitude to lose weight for him – it as the ight ti e, it just li ked .

Towards the end of the programme, he had started an apprenticeship scheme at college, proposed to his girlfriend and opened a bank account. He also achieved his goal of wearing the outfit he drew in one of the familiarisation sessions to his last BOB session. The family commitment to engage with the programme and the changes at home were stark. BOB 2 and his family believed this programme was the answer and committed to not only attending the sessions from the outset, but also making changes within their home environment. They did a lot as a family and throughout BOB 2 attitude has changed. They described him as more confident, now walking with his head held high, not looking down at the floor all the time. The family saw this programme as a ki k sta t, ha i g the additio al suppo t to help a d guide ut it s still left for us to do the o k. It s just hat e eeded, BOB 2 ould t ha e su i ed othe ise, just illia t .

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wanted, needed and would change it s ee life ha gi g . 5.5.3.2 Case study 2:

BOB participant 3

Weight loss at 6 months = 0.5 kg Weight gain at 12 months = 7.8 kg Attendance with BOB programme = 26%

BOB 3 entered the study during his GCSE year and lived an hour away from the research centre. It was apparent during the early sessions that the mother was protective of her son, talking for her son on numerous occasions, with BOB 3 having to be actively encouraged to contribute to the sessions. At times it was clear his Mum did not listen, as she would say the opposite to what her son had said moments before. BOB 3 explained that he never felt full and ate due to boredom most of the time, whilst admitting he was lazy. Be ause I e got othi g to do a d I o ed I just, I dont know, get something to eat; for something to waste time a bit because nothing else to do he I o ed .

During the 3-month interview, BOB 3 described how he rarely felt the balloon, albeit a fe ei d se satio s, a d that he felt it had t do e u h fo hi . To the extent at times, that it s eas to get de oti ated he I k o I e got the alloo i ecause I k o oh its ot doi g a thi g, hat s the poi t of ha i g it a d that akes e get eall de oti ated . BOB 3 acknowledged he thought it was going to stop him eating a lot more than it actually did inferring he solely relied on the balloon to induce weight loss. His mother spoke openly about her bariatric surgery operation and the large amount of weight lost. It is possible that this influenced family expectations about the degree of weight loss achievable on this study. Once the balloon had been removed BOB 3 described feeling more comfortable. His mother described dietary changes, a

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experience as eah e did sta ith the alloo a d it did t o k. To e ho est, fo those 6 months he did feel bloated, now whether or not he gives it a chance now to do it hi self o a d see ho he gets o ith that .

A theme demonstrating concordance within the data, is the apparent lack of a united approach. The othe s la guage implies that she perceived her sons weight to be entirely his issue, placing the need for change solely on him – a direct contrast from Case study 1. Limited attention within the interviews was given to the lifestyle changes, or the home environment inferring an attitude of sole reliance on the intra- gastric balloon, thereby feeling dissatisfied with the weight outcome.

5.5.3.3 Case study 3: