A summary of themes and subthemes derived from thematic analysis of interview transcripts
| Theme | Subtheme | Direct quotes |
| Desire to achieve rapid weight loss to improve liver health | An opportunity to lose weight quickly was a significant motivator to uptake Knowledge that weight loss could improve liver-related and diabetes-related health was important | ‘The idea of quick weight loss…that appealed’ (male, aged 60 years. Weight loss achieved: 14 kg) ‘I think it was the fact that it was short term—quick and fast’ (female, aged 64 years. Weight loss achieved: 8 kg) ‘It wasn’t about vanity, you know? I just want to be healthier and live longer—that is what I am doing this for’ (female, aged 64 years. Weight loss achieved: 11 kg) ‘If I have eaten rich food you can feel a reaction almost from your liver. And I just wanted to feel better about that, I just wanted to feel healthier around that’ (male, aged 54 years. Weight loss achieved: 24 kg) |
| Accountability to staff providing support facilitated adherence | Regular appointments with personalised feedback promoted continued engagement The desire to receive positive reinforcement from a consultant or clinical team member promoted adherence | ‘The fact that I am coming to see you on a weekly basis, or a fortnightly basis, it has kept me focussed’ (male, aged 41 years. Weight loss achieved: 15 kg) ‘Definitely, I think the main thing is the visits’ (male, aged 31 years. Weight loss achieved: 4 kg) ‘I suppose it’s a bit like being at school, isn’t it, and sort of saying, ‘when I go back and get weighed I want them to be pleased with me’’ (female, aged 55 years. Weight loss achieved: 11 kg) ‘I would have cheated without the support’ (male, aged 68 years. Weight loss achieved: 16 kg) ‘I like to come in every couple of weeks, just to, the talking is helping’ (male, aged 56 years. Weight loss achieved: 20 kg) ‘Seeing the surgeons face with a big smile. I walked in and he said ‘you’ve made my afternoon’’ (male, aged 56 years. Weight loss achieved: 20 kg) |
| The structured nature of the LED made it easier to adhere Practical and emotional support from friends, colleagues and family members promoted adherence | ‘Not having to think about what to eat or what to cook. It made it so much easier because I’ve got such an erratic lifestyle’ (female, aged 55 years. Weight loss achieved: 11 kg) ‘It is more regimental. It is laid out clearly for me, and I can follow it easily. And with the advice I have been given as to what other bits of recipes I can do I found it very, very easy’ (male, aged 72 years. Weight loss achieved: 17 kg) ‘You do need a bit of your family to help you… if I was on my own, it would have been really, really hard’ (male, aged 61 years. Weight loss achieved: 12 kg) ‘The people I work with… they were really good, and they would bring food in, but they would eat it when I was away from the desk’ (female, aged 54 years. Weight loss achieved: 23 kg) | |
| Early and significant weight loss promoted continued engagement and adherence | ‘I didn’t think I would last in the first week… I got weighed, and then I’d lost all that weight in the first week, it gave me an incentive to continue with it’ (female, aged 54 years. Weight loss achieved: 23 kg) ‘In the first few weeks the motivation was seeing that I had lost a reasonable amount of weight pretty rapidly’ (male, aged 60 years. Weight loss achieved: 3 kg) ‘After the first initial five days, when I had lost all that weight, I was like, ‘Yes, this, this is working I can really do this’’ (female, aged 55 years. Weight loss achieved: 11 kg) | |
| Working patterns make adherence to the LED difficult | ‘If I was in a position where I could work nine till five or you know regular hours, same hours day after day, if I was in a good pattern I’d have no problem’ (male, aged 60 years’. Weight loss achieved: 14 kg) ‘I am really quite good during the week, unless I am having to work away and that makes it more difficult… I suffered where it was really difficult in work situations’ (male, aged 60 years. Weight loss achieved: 3 kg) |
LED, low-energy diet.