key: cord-0902535-m5u1ghq8
authors: Budden, Timothy; Dimmock, James A.; Smith, Brett; Beauchamp, Mark; Rosenberg, Michael; Jackson, Ben
title: Overweight and obese men’s experiences in a sport-based weight loss intervention for men
date: 2020-06-30
journal: Psychol Sport Exerc
DOI: 10.1016/j.psychsport.2020.101750
sha: b80236b2a045ba83e375f81bcdc813eab9a0c568
doc_id: 902535
cord_uid: m5u1ghq8

In Western countries, such as Australia and the UK, a significantly greater proportion of men (relative to women) are overweight and obese, yet relatively few weight loss interventions have been developed that sufficiently target men. This lack of male-focused programming may be in part because ‘traditional’ weight loss programs are unappealing for what is considered a ‘hard-to-reach’ population. One program that appears to have such appeal for men is the MAN v FAT Football (MVFF) program, based out of the United Kingdom, which is designed for men with a body mass index of (or greater than) 27.5. MVFF encourages men’s participation in a community-based weight loss program that incentivizes weight loss through participation in a football league, and since 2016 MVFF has supported the weight loss efforts of several thousand men. Using MVFF as an exemplar, our aim was to derive insight into how men experience a male-only competitive, sport-based weight loss program. We recruited twenty-seven players (Mage = 41.13, SD = 9.93), and ten coaches (Mage = 31.8, SD = 11.55) from program locations throughout the United Kingdom. Using semi-structured interviews and thematic analysis, we identified several appraisal aspects of the program that players and coaches considered important, including the appeal of sport, competition on a level playing field, being part of a team, camaraderie, accountability, men sharing issues with other men, gender-sensitized environment, likeminded and similar men, and perceptions that traditional weight loss programs are tailored towards women. Player experiences (i.e., competence and enjoyment) and functional supports in the program (e.g., player handbook, weight loss coach) were reported to drive outcomes of effective weight loss and program retention. Interventions aiming to target men may be more successful working with rather than against formulations of identity such as masculinities, and this can be achieved by tailoring program content (e.g., messaging), settings (e.g., among men sharing similar characteristics such as body-type or goals), and mode of delivery (e.g., through organized sports, and leveraging competition to drive healthy behaviours).

Introduction 1 further off-field goals for reaching various other weight loss milestones throughout the season. The 1 majority of players join the program as individuals and are placed into teams with people they did 2 not know before joining the program. There are a number of program elements-outside of the 3 structured physical activity-that are designed to support weight loss, including weekly brief 4 consultations with a league weight loss coach, the use of player handbooks, and web-based and 5 mobile communication forums. The MVFF program appears to satisfy several of the components 6 that have been highlighted as potentially supporting the uptake and effectiveness of male health 7 promotion (and weight loss) programs (Bottorff et al., 2015; George et al., 2012) . Specifically, the 8 program incorporates, among other things, sport-based physical activity, social support, contact with 9 other men, gender-specific advice, access to self-monitoring tools, and an element of competition. 10

The popularity of the program attests to this assertion; at December 2019, prior to the COVID- 19 11 outbreak and the temporary cessation of the program, four thousand men were participating in sixty-12 three MVFF locations throughout the UK, and the cumulative amount of weight loss recorded in the 13 program stood at over 230,000lbs (or 104,000kgs). 14 As noted previously, it is unclear whether men are simply 'hard-to-reach' (i.e., due to lack of 15 motivation to lose weight, reflecting societal pressures that disproportionately affect women) or are 16 poorly targeted in weight loss interventions in particular, and health promotion interventions more 17 broadly. As Pagoto and colleagues (2012) suggest, qualitative research methods may be particularly 18 helpful in generating insight into intervention features that men find attractive and effective. For 19 instance, previous qualitative research by Lozano-Sufrategui and colleagues (2016) indicates that 20 while the experience of weight stigma may undermine men's senses of self-concept and masculine 21 values, participation in men-only weight management programs provides a safe environment for men 22 to repair this damaged self-concept. Similarly, qualitative insight into older men's experiences of a 23 men-only, football-led weight management program suggests that men value playing sports and competition and caring interpersonal relationships. This football-led program provided participants 1 with an opportunity to 'do' things together, facilitating a strong bond between men, promoting a 2 sense of an inclusive environment (Lozano-Sufrategui, Pringle, Carless, & McKenna, 2017). The aim 3 of this study, then, was to derive insight into how men experienced MVFF as a competitive sport-4

Sampling procedure and participants 1

The Human Research Ethics Committee at the first author's institution granted ethical 2 approval for this study. Twenty-seven players (Mage = 41.13, SD = 9.93) and 10 coaches (Mage = 3 31.8, SD = 11.55) participated in the study. Three coaches had previous experience as players in the 4 program, and two coaches were women. Three players were no longer involved in the program. The 5 mean starting BMI for players and coaches who had participated in the program was 37.16 (SD = 6 5.77), mean end BMI 31.89 (SD = 6.35), with an average weight loss of 18.48kg (SD = 12.39). 7

Participants (MVFF players and weight loss coaches) were recruited through a combination of 8 criterion-based, maximum-variation, and snowball sampling methods (Sparkes & Smith, 2013) . 9

Players were eligible to participate if they were adult males (aged 18 or over) and were a current or 10 former participant in a MVFF league. Maximum-variation in the sample was sought by recruiting 11 players from a variety of locations (n = 8) throughout the UK, and were primarily recruited using a 12 flyer distributed through a messaging platform (i.e., league WhatsApp groups). Potential participants 13 were invited to contact the lead author, and prior to all interviews, participants were provided with 14 information about their rights and the purpose of the study. The first author also attended a number 15 of league match nights, where players were approached in person and invited to participate in 16 interviews. Snowball methods were used (i.e., through discussions with league coaches, and during 17 interviews with players) to identify and contact information-rich cases (i.e., players who had 18 experienced substantive weight loss, had been involved in the program for an extended period of 19 time, or were vocal and likely to share their experiences in the program). Coaches were approached 20 and invited to participate in interviews via a member of the organization itself (i.e., MVFF). Coach 21 eligibility criteria were adult male or female, and a current or former coach in a MVFF league. All 22 players and coaches provided their informed consent at the beginning of their interview.

A semi-structured interview guide was developed with two faculty members (XX and XX) 1 who have prior experience conducting semi-structured interviews. Semi-structured interviews, as co-2 construction (process co-constructing finite knowledge). No a priori theoretical or analytical 3 framework informed the development of the interview guide; instead, the final interview guide 4 included open-ended questions developed to gain an understanding of participant motives for joining 5 the program (e.g., "Can you give me a back story for why you joined the program?) participant 6 experiences within the program (e.g., "Can you tell me about your experiences participating in MAN 7 v FAT Football?"), experiences of the various aspects of the program (e.g., "What was it about the 8 program that worked, or didn't work, for you?", "How did you experience the aspect of competition 9 in the program?") and factors related to program retention and attrition (e.g., "What works / doesn't 10 work about this program compared to other weight loss programs?"). Semi-structured interviews 11 provide researchers with the flexibility to pursue lines of inquiry that are of interest, while entering 12 into the interview with a certain degree of structure. The majority of interviews were held over the 13 phone (n = 30), with the remainder conducted in person at a setting the interviewee selected (e.g., 14 cafes, local pubs; n = 7). All interviews (except two) were conducted with one participant and one 15 interviewer (the first author). One face-to-face interview was conducted with two players, and in one 16 phone interview, two co-authors (who contributed to the interview guide) were present. The data 17 collection period was conducted during a research trip to the UK. At the time of data collection, the 18 notion of data saturation guided the lead author's approach to qualitative research. Data saturation 19 refers to the point at which the information collected begins to repeat itself, and as such conducting 20 additional interviews is relatively unlikely to yield novel information relevant to the research 21 question (Sparkes & Smith, 2013) . It should be noted that the consistency between this approach and 22 a reflexive thematic analytic approach has been questioned (Braun & Clarke, 2019; O'Reilly & 23 'finalizing' the range of men's experiences in the MVFF program. Being reflexive about saturation, it 1 is possible that conducting more interviews, or conducting follow-up interviews with participants, 2 would yield potentially novel findings; rather, we were guided by pragmatic concerns -data were 3 conducted during a relatively brief (i.e., three week) window, and it became evident during data 4 collection that interviews began repeating themselves. 5

Data analysis was led by the first author. All audio-recordings were transcribed verbatim by 7 the first author, and an inductive, reflexive thematic analysis approach was adopted, following Clarke 8 and Braun's (2016) guidelines. This approach included an initial stage of familiarization with the 9 interview transcripts, listening to audio-recordings, and generating an initial code guide. Initial codes 10 were created by identifying units of text that referred to the same or very similar semantic (i.e., a unit 11 of text directly expressed an idea or experience) content. Following this initial familiarization, the 12 entire dataset was then systematically coded by the lead author, and a tentative framework of themes 13 were identified. Themes were developed by primarily identifying the semantic meaning of 14 participant responses during interviews, although this was supplemented by exploring, in some cases, 15 the latent meaning (i.e., coding for implicit ideas or meaning behind what was explicitly stated) of 16 participant responses. This tentative thematic framework was then subsequently refined and re-17 ordered in a series of 'critical friends' (Sparkes & Smith, 2013) meetings, wherein the lead author 18 met with one, two, or three of the co-authors to discuss their critical interpretations of the initial 19 findings. Themes were re-ordered, re-defined, re-categorized, re-structured and represented, and in 20 several cases abandoned, based on discussions around how themes fit with the aims of this research 21 project, and the guiding research question: what was it about the program that worked (or didn't 22 work) for the men involved? The original framework consisted of many isolated themes, and the 23 restructuring process allowed us to identify three distinct higher-order categories of themes presented 24 in the results below. These higher-order themes were (1) appraisal aspects of the program, which refers to elements of the program that players and coaches appraised as driving positive (or negative) 1 outcomes within the program, (2) perceived experiences within the program, referring to internal 2 perceptions regarding experiences during the program, and (3) functional supports within the 3 program, perceptions regarding specific functional aspects of the program that supported players' 4 weight loss efforts. The approach informed by the philosophical and epistemological assumptions 5 above is evident (a) in the open-ended nature of the research questions, and (b) the process used in 6 refining themes, namely the adoption of a 'critical friends' approach (Sparkes & Smith, 2013) , 7

wherein all co-authors were invited to interrogate, question, and provide alternate interpretations of 8 the codes and themes generated by the analysis completed by the first author. The process of writing 9 the manuscript also served as part of the process of analysis, and this is captured in the attempt at 10 presenting our findings in a 'narrative' fashion, as opposed to attempting to describe themes in 11 isolation -what became evident in the process of data analysis and writing is the interconnection 12 between various elements of the program. 13

The aims of this study were to-using MVFF as an exemplar of a male-only weight loss 15 program-derive an understanding of how men experience a competitive sport-based weight loss 16 program. Interviews generated 245 pages of 12-point, single spaced text. Themes were grouped 17 together in higher-order categories reflecting participants' perceptions of appraisal aspects of the 18 program, perceived experiences in the program, and functional supports of the program. Participants 19 were provided with pseudonyms to protect anonymity. Each of the aforementioned higher-order 20 categories are interrelated, and rather than attempting to create or magnify (artificial) distinctions 21 between themes, it is our hope that readers will gain some sense of how they combine to form a complete 'whole'. That being the case, the accounts below follow a narrative structure to illustrate 23 the interconnections between themes. The frequency of meaning units are not reported, which is 24 consistent with the philosophical assumptions underpinning this research (Sparkes & Smith, 2013) .

Players and coaches described aspects of the program as drivers of (a) recruitment, (b) 2 program effectiveness, and (c) retention. These aspects included the appeal of sport, competition, and 3 playing on a level playing field. Sport was closely linked to being part of a team, wherein a sense of 4 camaraderie and accountability was fostered with likeminded and similar men. These concepts 5 collectively created a space where men shared issues with other men-contrasted against a 6 perception that traditional weight loss programs were tailored towards women-in a gender-7 sensitized environment. 8

Players and coaches described the importance of the appeal of sport, competition, and playing 10 on a level playing field as crucial drivers of men's recruitment, retention, and effectiveness in weight 11 loss programs. For coach Talib (C3), a key attractor for enrolment for many players was sport: 12 I think it's sport itself, I think that's the key word I think, just sport. Because the only reason 13 this is working in football here, is because these guys love football. But if you had a bunch of 14 guys that love cricket, you could apply it. You could apply this to virtually any sport. 15

Players and coaches alike attributed the popularity of the program throughout the UK to 16 football, "…because men love football in England, it's just like, the perfect thing to lose weight to be 17 honest." (Coach Ryan, C4). For former player Conrad (P19), football is an activity in which men are 18 often socialized, typically play with other men, and are more prone to think about: 19 I think because it's football, it's generally something that men think about more than other 20 activities. It was something that you are kind of geared at, geared towards from when you 21 were little. The whole thought process of football as a young boy, you're playing football 22 with boys. Most of the time. You hardly ever play football with girls. Something to attract 23 men, for me would be quite good. 24

For Talib, structuring the program around football allowed players to address weight loss, but 1 they "don't have to face it in a really serious way. It's a sporting environment and [players] know 2 they're there to lose weight and they know…the off-pitch results make a massive difference to the 3 league tables, and the league table is everything." Closely linked to the notion of participation in 4 sport is the prospect of engaging in competition, and the multi-layered (i.e., on-and off-pitch) 5 competition was appealing to men because "Men thrive on competition, so having the element 6 of…[playing] against other teams in a football environment…for a man, it's always going to be 7 competitive…" Talib continued, stating that "although the football is kind of the main attraction, it's 8 not the main focus, because you're there to lose weight". 9

The multiple layers of competition motivated enrolment in the program, affording players the 10 flexibility to endorse one element over the other. Some players placed a primary emphasis on the 11 football element of competition in the program, whereas others, such as Carl (P11), placed greater 12 emphasis on the weight loss side, as "[the] weight loss part…I cottoned onto and focused on. I didn't 13 really have any football skills, so I knew that was a way that I could contribute to the team." Carl 14 compensated for a perceived lack of ability by contributing to the team score on the scales. Some 15 tensions existed between the two approaches outlined above. Some players perceived that the 16 emphasis on the football competition could "go too far", leading to negative experiences, as "some 17 people…[forget] that it is a weight loss program and take the football side a bit too serious" (Charles, 18

Level playing field 20 For many players, prior re-entry into social football leagues had become (apparently) 21 unattainable. Gradual weight gain and shifting priorities due to work or family, perceptions that 22 players would be unable to keep up with "18, 19, 20 year-olds who are all in fantastic shape", and 23

perceptions that gyms or other traditional exercise settings would be "full of guys that have been 24 going for years", "built like Hercules and you're out of breath just removing his weight…it's really intimidating for some" (Patrick, P5). The program provided an attractive alternative for players who 1 perceived barriers to entering such traditional spaces, as they were able to engage in competition on a 2 level playing field, or as Cory (P16) put it, "I like playing football against guys like my weight or 3 heavier…it's good to play against your peer group because sometimes you're with younger, faster 4 guys and smaller guys…if you're with guys your own size you realize you're still a good player." 5

Posters and website advertisements for MVFF showed overweight or obese men playing football, 6 supporting player perceptions of a level playing field, given "the fact that they're actually 7 advertising, they're clearly able to participate" (Damian, P26). Players would not be "up against real 8 sportsmen", they would be "able to play with a load of fat blokes" (Rob, P21). 9

Being part of a team was an integral aspect of the program motivating enrolment, retention, 11 and effectiveness in the program. Players "form really thick fast bonds with their teammates which I 12 think inspires them to keep on going" (Coach Leah, C6). The team was reported to serve multiple 13 functions in the program such as driving accountability, adherence, and interpersonal support as 14

Derek (P25) happen, weighed in, joined the team and straight way, everyone is there for some reason and 18 everyone's also there to play football. So you get a massive kick as a team and you don't 19 want to let that team down, but the first couple of weeks, you're not too sure, but after that, 20 you realise you're letting 9 other blokes down, if you don't lose weight, so that is the massive 21 push that keeps you going, keeps you coming back.

Knowing that their team player is there to support them, knowing that there's a team player to 1 talk to and just having a group of male friends. For some of these guys that can be an issue 2 especially if you're married and you don't get to socialise with your friends anymore. 3

Although teams were randomized, strong bonds, or a sense of camaraderie, were reported to 5 quickly develop. The "team ethic" and "support network" that developed in the program, meant that 6 some teammates took a softer "arm around" the shoulder approach, whereas others were "straight 7 talkers" (Coach and former Player Liam, C8). Camaraderie was often likened to 'pub-talk'. Through 8 the development of trust and a feeling of being in a 'safe environment', men were able to support 9 each other, as Grant (P10) elaborated: "When you get a load of blokes down at the pub, they quite 10 openly talk about stuff like this…once you get that camaraderie, that's how it happens. You support 11 each other, don't you?" The camaraderie that developed between teammates was reported to support 12 retention in the program, as Carl (P11) explained, "Everyone was quite social about it…it was 13 something that I definitely enjoyed, I think it was the main part that kept me staying there." 14

The notion of camaraderie closely linked to a feeling of accountability to lose weight for 16 one's team. Losing weight can be a "lonely" process of abstaining from enjoyable activities. The 17 program appeared to raise awareness about healthy behaviour; players were members of a team with 18 a shared purpose as Paul (P14) stated, "if you put weight on, you're letting the guys down…it's 19 psychological probably, how much that affects you…you're conscious of that team responsibility". 20

Feelings of accountability did not necessarily develop instantly. Coach and former player Brian (C9) 21 elaborated, "some players will turn up and just literally want to be held accountable", whereas for 22 others, it appeared to take a process of getting to know players until the "smallest click", based on 23 "common ground and I think a friendship or a partnership that they're more accountable to". Grant 24 (P11) noted that accountability to oneself was insufficient to drive weight loss behaviour, as "…I know if I stop MAN v FAT Football, the weight would go back on." Feelings of accountability were 1 not universally positive for all players. Accountability could be interpreted as external pressure to 2 lose weight, leading to maladaptive, avoidant strategies, as "…that pressure sometimes can lead to 3 people not turning up some weeks because they know they've gained weight and stuff" (Coach Ryan, 4 C4). 5

Likeminded and similar men surrounding players supported notions of camaraderie, 7 accountability, and being part of a team. Players were able to connect over common issues, as Grant 8 (P11) indicated, "…you're ultimately among other blokes who, even if they do not have those issues 9 themselves, they can personally sympathize with how it might happen because you are ultimate 10 dealing with people that had had weight problems." Two salient aspects of identity, gender and body-11 type, appeared to promote perceptions of similarity, as Rob (P21) intimated: "There was just fat 12 blokes having a kick around. There is nothing else that you can get involved in that's anywhere close 13 to that." One coach (Leah, C6) identified the process of self-identification as "fat", and the direct, 14 honest approach (or 'language') of the program as a positive: "everyone turns up and they are in 15 accord so they already all self-identified as fat, like they already realize that they are fat. It is not like 16 someone has sprung it on them like 'Surprise! We think you're fat!'" Matt (P2) described his feelings 17 attending the initial registration session at the beginning of his first season as "quite refreshing" 18 entering a room with a range of men of different sizes, reassuring him that there was nothing to be 19 embarrassed about, as "some of the guys [were] significantly bigger than me…You feel less self-20 conscious as a result almost immediately. Everybody there is there for the same reason, there is 21 nothing to be embarrassed about." This created a supportive environment, where "people...do praise 22 each other…That is important". Matt expressed ambivalence over whether the same result could be 23 achieved with a mixed-gender group: "I'm not saying you couldn't do that in an environment of men and women, you could, but I think it would feel different. I would just mean they would feel more 1 self-conscious". 2

The combination of camaraderie, gender-sensitization, and perceptions of like-mindedness 4 and similarity between players in the program fostered an environment where men share issues with 5 other men, including weight loss, body-image, or mental health. Coach Ben (C1) explained that 6 MVFF created an environment where "blokes…see that they've got somewhere that is for them": that the other guys come up with, and I think that is crucial to the way we work. 14

Players and coaches frequently highlighted the contrast between the approach men and 16 women adopt to weight loss, lamenting that traditional weight loss programs are tailored towards 17 women. Cory elaborated on his experience attending such a program, finding "success on and off, 18 but I felt that it was mainly a group for women, and I think it was mainly recipes and it's mainly 19 mothers…I couldn't relate much to them" whereas, in contrast, MVFF better suited his needs, as it 20

was "more positive, more competitive, more dynamic, and more aggressive." Traditional weight loss 21 programs are typically tailored, intentionally or not, towards the expectations and demands of 22 women. This was described by the participants as due to the content of group meetings (e.g., 23

discussing "fitting in bikinis", "wedding dresses", "slimming down", or "eating salads"), 24 demographics (i.e., majority women), and nature of meetings (i.e., sedentary).

Gender-sensitized environment 1 MVFF was described as allowing men to engage in weight loss in a stigma-free, gender-2 sensitized environment, instead of feeling "completely alienated". Ben (C1) described the social 3 environment in his leagues, run "very much on the fact that they are men", and his "changing room 4 was full of blokes' banter". Players would make jokes at each other expense, but "there's no 5 judgement about that at all". For Lorne (C5), the program creates a comfortable yet fun environment 6 for men: 7

For me, the spirit of MANvFAT is it's a comfortable but fun environment for blokes to come 8 along and speak freely about any health issues and speak freely about weight loss issues as 9 well, without feeling stigmatised and everything like that as well, and it just offers men an 10 opportunity where they can feel comfortable, where they might not feel comfortable in other 11 commercial programs such as [commercial weight loss programs] which are much more 12 designed for a female audience as opposed to a male audience. 13 Leah (C6) had a unique perspective working as a female coach in a male-dominated 14 environment. She adopted a male online pseudonym for her correspondence with new players, to 15 which she attributes the "attraction" and rapport developed with players when they initially express 16 interest in joining the program: 17

probably make the guys a bit more comfortable. I have a male name which I think sometimes 19

can help a little bit before they come along because the attraction they've had with someone 20 called [male pseudonym], so they do come in a little bit shocked that I'm a girl but like it's 21 not a problem that I am but I feel it works a lot better being a male only program. 22

For coach and former player Liam (C8), the environment in MVFF starkly contrasted with 23 previous experiences in female-dominated weight loss programs, leading to him feeling more 24 comfortable being weighed in front of a group of men, instead of a group of women:

Yeah it was good, I found it better than going into weighing rooms previously, and they're 1 dominated by ladies talking about things that you can't necessarily relate to, talking about 2 wedding dresses and baby weight that they've gained and things like that and you know it's 3 very relevant to them, buts it's just something where you feel a little bit excluded because you 4 know you couldn't relate to it directly. So to be with a group of guys, I think guys just feel a 5 little bit more comfortable. For me I felt very self-conscious so in that kind of environment, 6 so being surrounded by a group of guys I certainly felt more comfortable in the room. I didn't 7 shy away from standing on the scales as much as I would if maybe I was standing next to 8 ladies all round me. 9

Players and coaches provided accounts of two broad experiences within the program, 11 competence and enjoyment. 12

Related to notions of competition, sport appeal, and level playing field, players described 14 perceptions of competence regarding weight loss, football ability, and fitness improvements over the 15 course of participation in the program. For Brian (C9), "the easiest part for me to sticking to [the 16 program] is because I had success with it so quickly". Amit (P1) found his early success surprising, 17 in contrast with his previous failures at losing weight, which "is a big deal, because I've never had 18 this sort of change in my life…this is certainly something that's worked for me, so in that sense, very 19 positive with achieving weight loss." Carl (P11), who went from playing a few minutes to a whole 20 game found that he "had a lot more fitness and was able to out-run people on the pitch…[which] was 21 something that was good". 22

Weight loss was described as leading to a change in body image. For Sam (P27), "…that 23 makes a big difference…with clothes and things like that…the last time I was this weight was 24 probably before I started university." These changes were a source of enjoyment for Sam: "the reason why I'm doing it again is because I've really enjoyed it and we've got a great team and I want to be 1 able to lose some more weight." 2

Players often attributed perceptions of enjoyment or fun to playing sport and engaging 4 socially (i.e., in banter) with other players. For Lyle, (P3) the football was a "nice add on" to the 5 weight loss aspect of the program, providing an additional reason to attend game nights every week, 6 because making it "enjoyable gives you the reason to go". Martin (P4) echoed this sentiment, 7 comparing his experiences in gyms-wherein his motivation would gradually fade over time-with 8 his "love of the game", his love of "being out on that field…I actually look forward to going to MAN 9 v FAT; I get excited about the football." For Orson (P2), being able to enjoy the football in the 10 program allowed players to integrate physical activity into their lifestyle, "…almost like a ritual…it 11 has that sort of ritual element, which I find very powerful…I love the football." 12

Players and coaches described various functional elements in the program that supported 14 player experiences and weight loss, including the player handbook, weight loss coach, captains, team 15

WhatsApp groups, and the online forums. 16

The player handbook allowed players to monitor and draw awareness to salient weight loss 18 behaviours such as physical activity and dietary intake, and served as a tool for the weight loss coach 19 to provide feedback on player progress. As Orson (P2) elaborated: "I've religiously recorded all my 20 meals. I've found that really helpful to be able to look back and review exactly what you ate that 21

week, and where I went wrong, where I ate what I shouldn't have and patterns emerging." For Lyle 22 (P3), feedback was "more about changing your lifestyle rather than criticizing it, and the 23 understanding that it doesn't happen overnight and you do have bad weeks."

The player handbook was closely linked to the relationship between player and weight loss 1 coach. For some coaches, the role was an active one; they were in a position of leadership within the 2 league, and had a responsibility to "set the tone for the league. If you can be positive and outline 3 what the league's trying to achieve and what players are expected [to do] and what help you can give 4 them…it's really key to the success" (Coach Brian, C9). "The best coaches always keep the players 5 focused for as long as possible." Not every player is "reachable", and not every player "wants to chat 6 all the time". Nonetheless, as long as the coach placed the primary focus on losing weight, then 7 players were reported to benefit from the coaches' leadership. The players also emphasized the 8 importance of coaches promoting camaraderie and accountability. According to John (P23) "if you 9 put on one [week], [coach]'d be like "What happened, what did you do wrong? If you're going to 10 have to explain yourself, it was another reason to lose that weight." 11

Teams nominated captains, a liaison between coach and teams, with some captains taking the 13 role seriously. As Ben (C1), a player-/ captain-turned-coach, elaborated that as he lost weight, he 14 began to think about "helping the other guys in my team", which is "one of the massive things about 15

MAN v FAT…that kind of camaraderie and collaboration amongst the players to help each other." 16

The captain was reported to be a source of motivation for some players, rallying the team around 17 "the 5% and 10% weight loss" targets (Paul, P14). 18

Players were encouraged to engage during the week in team WhatsApp groups. These groups 20 contained all members of each team, accentuating camaraderie, accountability, and men sharing 21 issues with other men. Whatsapp groups allowed for open communication because, "although it's not 22 private, it is in a way because it's all people [players] know and people they can trust and then build 23 friendships with and that is a go-to group for people that struggle" (Coach Brian, C9). A wide variety 24 of issues were raised, and support provided for, in these chats, from "people losing weight" to "people going through divorce". In light of perceptions that men rarely disclose personal issues, 1

Brian highlighted that the added social connectivity provided by the league supported the 2 development of an environment where men feel able to disclose personal issues, which is "not a very 3 'Man thing' to do, to reach out when a guy's divorced…to have this group of guys that understand 4

and are now ready to talk to you…just puts them in a better state of mind." The WhatsApp groups 5 facilitated this disclosure, as Brian continued: "…you can be open and honest. With the WhatsApp 6 groups, there's no criticism, and whatever you've been through, someone else has been through as 7 well." Further, the WhatsApp groups served to remind players of the outcome of the league, as Alex 8 (P17) explained: "…when it gets to Friday night, which would normally be take away night, but then 9 they would see 20 messages on their phones from their team members…They would almost go "I 10 can't eat take away when the rest of the team are doing so well". So that really helped." 11

Finally, an optional resource players reported making use of were the online forums, 13 primarily as a tool for finding information, and connection to a broader online community, as coach 14 and previous player Liam (C8) explained: "The forum is really useful, it has guys from all walks of 15 life, and it's great to read their stories. It's another way of supporting guys when they're going 16 through struggles to look at what other people are doing. Not just from the UK but from all over the 17 world". 18

The purpose of this study was to use MVFF to provide insight into how men experience a 20 sport-based, male-only weight loss program. By examining player and coach experiences in the 21 program, our results shed light on the factors that may motivate men to engage in weight loss efforts 22 and with their health more broadly. More specifically, the results provided insight into how salient 23 issues such as identity, gender-sensitization, and male communication make MVFF an attractive spaces, self-monitoring strategies, and leadership roles (e.g., team captains, coaches) are intervention 1 characteristics that can be opted-in-to, and accentuate other intervention characteristics. In the 2 material that follows, and without wishing to 'finalize' the participants in this study (i.e., by claiming 3 to have the 'final word' on their or others' experiences in the program) we present what we consider 4 to be the most salient overarching conclusions that can be drawn from these results. 5

Our results indicate that the popularity of MVFF stems from the pragmatic, competitive 7 approach toward weight loss. Dieting and weight loss are typically seen as feminized activities 8 (Gough, Seymour-Smith, & Matthews, 2016), and for many men in the program, the prospect of 9 joining traditional weight loss programs was unattractive, due to expectations or prior experiences 10 that the conversations and settings (and demographics) would tend toward 'feminine' issues. Further, 11 many players had previous experience playing football or other sports during their youth, and the 12 appeal of sport and team membership were common factors attracting these men to join MVFF. Sport 13 is a common socializing force in the lives of many men: preadolescent boys are often embedded in a 14 sporting culture by the age of 8, and performance (i.e., in sport) is important in the display and 15 maintenance of masculine identities (Tatangelo & Ricciardelli, 2013) . For men who have, over the 16 years, allowed a process of bodily inattention (Malik, Grogan, Cole, & Gough, 2019) to lead to 17 gradual weight gain and fitness loss, re-entering into exercise environments can be daunting. Gyms 18 are unappealing for many, and the prospect of joining social sport leagues can also be unattractive 19 due to the perceived need to be fit to keep up. These two broad issues pose a problem for men 20 seeking to lose weight. 21

These concerns around the feminine nature of weight loss and the daunting prospect of reengaging in sport reflect the way men often appear to approach health; men appear to view their 23 bodies as 'machines or tools' for getting work done (Gough et al., 2016) , reflecting pragmatic and practice (Robertson, Sheikh, & Moore, 2010; Watson, 2000) . Experiences in health-related contexts 1 that undermine men's feelings of physical competence (i.e., being able to keep up), or fail to address 2 how men often view their bodies (i.e., as functional tools) present a dilemma for men seeking to re-3 engage with healthful behaviours. MVFF, by allowing men to participate in sport on a level playing 4 field, circumvents this problem. Men (and women) exist in social contexts that reflect certain norms 5 regarding the expression of gender identity -in other words, how they ought and ought not to 6 behave. Certain expressions of masculinity are more desirable or idealized over others (Connell, 7 1995; Connell & Messerschmidt, 2005) , and the link between masculinities and health practices 8 appears complex. Traditional researchers in sport and health psychology, leveraging Connell's (1995) 9 model of hegemonic masculinity, for instance, proposed a negative relationship between subscription 10 to masculine ideals and health (e.g., those who endorse such masculine ideals are more likely to 11 engage in excessive alcohol consumption). This model may be too simplistic, however; recent masculine behaviours (i.e., demonstrating skill on the pitch, or scoring points by losing weight) to 20 compensate for other non-masculine behaviours required to succeed in the program, that may 21 undermine masculinity (e.g., abstaining from drinking, eating healthy, low-calorie foods). We suggest 22 that the reason for the success of the program, with this particular population of men, is in its ability 23 to circumvent the 'masculinity' problem certain men face when attempting to lose weight, through target men may be more successful working with, rather than against, formulations of identity such 1 as masculinities. results also indicate that group identification processes contribute to the success of the MVFF 5 program. Namely, players described perceptions of homogeneity (i.e., body-type and gender), like-6 mindedness (i.e., purpose for joining, goals), social support (i.e., camaraderie, men sharing issues 7 with other men), and homo-sociality (i.e., gender-sensitization) as appraisal aspects of the program 8 that drove retention and effectiveness within the program. Evidence for the management of obesity 9 among men suggests men may benefit from group-based weight loss programs (Robertson et of being in a 'shared safe place', encompassed by feelings that everybody in the program was 'in the same boat'. In our study, players experiencing settings with men of a similar body type and gender 23 offset expectations of negative social comparison, on the basis of shared ground. One area of tension 24 in the MVFF program is reconciling mindsets prioritizing football or weight loss. Teams that 25 internalize weight loss goals appear to adopt clearer group roles and discuss weight loss more 1 frequently. When these mindsets clash, as evident in accounts of excessive competition, this may 2 undermine some players' motivation to stay enrolled in the program. 3

Self-disclosure, humour, and camaraderie 4

Self-disclosure is risky, because it opens the self to external negative judgement, but may also 5 be rewarding -group members may validate and affirm one's issues or challenges by acknowledging 6 their similar beliefs, problems, or experiences (Jourard, 1971 ). These are validating experiences-7 potentially for both the receiver and giver of social support (Liang, Finally, coaches and captains in MVFF can act as 'ambassadors' of healthy attitudes, taking a hands-20 on approach, emphasizing self-monitoring, providing social support, and setting team challenges. 21 Alternatively, they can take a more hands-off approach, setting the direction and tone of the league to 22 players. In future, researchers might investigate the characteristics of effective leadership in such a 23 male health environment, by observing in situ interactions and discourse exchanged between players, 24 captains, and coaches.

There are certain influences that we were not able to consider in this study, such as how 2 socio-cultural, socio-economic, or cultural influences affected men's experiences in the program. 3

Future research could explore in depth how such influences (e.g., ethnicity, cultural background, and 4 social class) impact overweight and obese men's experiences in competitive, sport-based weight loss 5 programs. 6

Further, a growing body of literature suggests that utilizing sport as a weight loss strategy 7 may incur certain psychological detriments, such as undermining enjoyment or intrinsic motivation 8 for, and adherence to, physical activity (e.g., Pickett & Cunningham, 2017 ). Tylka and colleagues 9

(2014), for instance, question the use of weight-normative approaches (i.e., prescribing weight loss), 10 favouring weight-neutral approaches. Placing an emphasis on weight loss may lead to weight 11 cycling, and Tylka and colleagues draw a link between weight stigma associated with such weight-12 normative approaches and adverse health and well-being outcomes. Although many players cited the 13 appeal of sport as a lure for joining the program, and one of the programs' strengths, tensions arose 14 around the emphasis on competition -particularly when players personally focus on one element of 15 competition (e.g., weight loss) but feel that others place too much emphasis on the other (e.g., 16

performance on the pitch). Future research ought to examine the perspectives, in further depth, of 17 players who have negative or disconfirming experiences in the program. How do they experience 18 self-identifying as fat, or do they position themselves in opposition to fat (as the name of the program 19 would suggest)? Do either of these processes of self-identification drive positive or negative 20 outcomes for health and well-being, long-term adherence to physical activity, or weight loss? Future 21 research should also examine how inclusive these kinds of competitive, sport-based programs are. This is not to suggest that they are not (or do not have the potential to be) inclusive: for instance, are 23 men who relate to masculinity in non-traditional ways comfortable in, or attracted to this type of A limitation that affected our potential sample reflects the BMI cut-off criterion for the 1 program. The criterion for joining the MVFF program requires that participants have a BMI equal to, 2 or greater than 27.5. This cut-off restricts entry into the program for men who qualify as overweight 3 (i.e., BMI of 25+) but do not meet this (what might be considered arbitrary) criterion. This places 4 limits on the conclusions we can reach in terms of the efficacy of the program for overweight men. It 5 is notable that the average starting and end BMI of our recruited sample is markedly higher than the 6 cut-off, suggesting our results speak more predominantly to a sample of obese (rather than 7 overweight) men. Finally, researchers may in the future want to consider the naturalistic 8 generalizability of this program. The 'active ingredients' of the program are relatively 9 straightforward: leveraging competition to drive health behaviours by 'rewarding' weigh loss. In 10 terms of naturalistic generalizability, future research could explore instances where this mechanism 11 has emerged 'naturally' in local exercise groups (e.g., group fitness classes), in other communities, or 12 other countries. 13

In this study, we explored player and coach experiences in a case study exemplar of a male-15 only, sport-based weight loss program that is attractive to men, with the aim of deriving broader 16 insights into intervention characteristics that may be appealing to this population. Interventions that 17 aim to target this population may be more successful attracting and retaining this population by 18 working with, rather than against, formulations of identity such as masculinities; this can be achieved 19 by tailoring program content (e.g., messaging), settings (e.g., among men who share similar 20 characteristics such as body type, goals, or intentions), mode of delivery (e.g., through organized activities), and leveraging competition to drive healthy behaviours. Overweight and obese men's experiences in a sport-based weight loss intervention for men Highlights:

• We explored men's experiences of a male-only competitive sport-based weight loss program • Men highlighted competition, accountability, and camaraderie as driving positive outcomes • Being around likeminded and similar men makes the program attractive to overweight and obese men • Sport and competition allows men to offset 'un-masculine' behaviours (e.g., nondrinking)

• Highlights the potential of leveraging competition / masculinity to drive healthy behaviour

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