Understanding Participant Experiences During the Very Low-Calorie Diet Phase of a Diabetes Remission Trial in Singapore: A Reflexive Thematic Analysis

Background/ObjectiveResearch in the past decade has shown that targeting obesity in patients with type 2 diabetes mellitus (T2DM) can bring about multiple health benefits, including diabetes remission.This study explores the barriers and facilitators affecting behaviour changes for weight loss in obese individuals with early Type 2 diabetes who completed a Very Low Calorie Diet (VLCD) intervention in diabetes remission clinical trial.Methods A qualitative study embedded within the clinical trial conducted in four public primary care clinics located in central north region of Singapore.Semi-structured in-depth interviews, guided by the Capability Opportunity Motivation and Behaviour (COM-B) model of behavioural change, was conducted after participants had completed 12 weeks of VLCD.Transcribed narratives were analysed using a thematic approach. ResultsSix themes emerged from participants' experiences during VLCD: 1) Integral support framework for weight management, 2) Improved Sense of Well-Being through weight loss, 3) Psychological barriers to adhering to a calorie-restricted diet, 4) the Unique Singaporean way of life, 5) Seeking tasty food options during VLCD and 6) Retaining knowledge, not the weight.These themes were inter-related, reflecting a dynamic process where personal motivations, environmental and cultural factors collectively influenced behaviour change.