ArticleBMC primary care2026
Negotiating energy, fear, and control: a qualitative study of nutrition and exercise experiences among middle-aged adults with obesity and diabetes-related cardiomyopathy.
Article in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMiddle-aged adults with obesity and diabetes-related cardiomyopathy (DRCM) face competing demands when attempting to implement dietary and physical-activity recommendations. However, little is known about how day-to-day decisions are negotiated under fluctuating energy, symptom-related fear, and competing role responsibilities.
objectiveTo explore experiences of nutrition and physical-activity management among middle-aged adults with obesity and DRCM, and to develop an explanatory framework to inform individualised lifestyle counselling in general practice.
methodsWe conducted a qualitative study in the Department of General Practice, Zhongda Hospital, Southeast University (Nanjing, China), between August 2024 and August 2025. Seventeen adults aged 40–60 years with obesity (body mass index ≥ 28 kg/m²) and clinician-diagnosed DRCM participated in semi-structured, in-depth interviews. Data were analysed using reflexive thematic analysis, theoretically informed by self-regulation theory and the Capability–Opportunity–Motivation–Behaviour (COM-B) framework.
resultsFour interrelated themes described how participants managed nutrition and physical activity in everyday life: (1) negotiating between energy and fear; (2) confronting the limits of rigid self-control; (3) integrating family involvement into routines; and (4) reconstructing control through flexible pacing. Synthesising these themes, we propose the Energy–Fear–Control (EFC) cycle—a novel explanatory model in which perceived energy availability shapes feasibility, symptom-related fear constrains action, rigid control strategies contribute to fatigue and rebound, and family-enabled co-regulation supports flexible adaptation and sustained engagement.
conclusionsThe EFC cycle extends existing accounts of lifestyle management by specifying a cyclical mechanism rather than a linear “adherence” pathway, and by highlighting actionable leverage points for general practice—assessing “energy reality,” eliciting fear triggers, involving family early, and negotiating small, repeatable adjustments that remain feasible under midlife constraints.
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