Barriers and facilitators to weight-loss in patients with overweight/obesity and cardiac disease: a realist qualitative synthesis.

Purpose: Lifestyle advice for cardiac patients with overweight/obesity includes weight management, yet few achieve significant weight loss. People with heart disease may require different support to the general population. We synthesized evidence that reported cardiac patients' weight management experiences to identify barriers and facilitators to weight loss.

Methods: Our realist review identified five manuscripts reporting four studies of weight management experiences of people with heart disease. The capability, opportunity, motivation behaviour change model (COM-B) provided the framework for thematic synthesis.

Results: The studies included qualitative data from 117 participants and revealed factors favouring or impeding effective weight management during cardiac rehabilitation (CR) and in participants' daily lives. We identified four major themes illustrating participants' wish to change harmful health behaviours, adopting exercise and psychological strategies to facilitate change, social and professional support, and regaining control after a cardiac event. These themes broadly aligned with the COM-B categories of capability, opportunity, and motivation.

Conclusions: Most cardiac patients with overweight/obesity express a desire to lose weight. Participants preferred personalized services that could adapt to meet their individual needs, but struggled to make sustainable changes for interconnecting psychological, social, cultural, and financial reasons. Consideration of these complexities when designing programmes may help to support successful weight management.