How does the food environment influence people engaged in weight management? A systematic review and thematic synthesis of the qualitative literature

People engaged in weight loss or weight loss maintenance (weight management) often regain weight longterm. Unsupportive food environments are one of the myriad challenges people face when working towards a healthier weight. This systematic review explores how the food environment influences people engaged in weight management and the policy implications. Nine electronic databases (CINAHL, Medline, PsycINFO, Academic Search Complete, Embase, Ovid Emcare, PubMed, Open Grey and BASE) were searched systematically in May 2020 to synthesize the qualitative evidence. Eligible studies were conducted with adults (18+) in high-income countries, available in English and published 2010-2020 with a substantial qualitative element and reference to food environments. Data was analysed using a thematic synthesis approach. Quality assessment using the Critical Appraisal Skills Programme was undertaken. We identified 26 studies of 679 individuals reporting on weight management experiences with reference to the food environment. Limitations of the included studies included a lack of detail regarding socioeconomic status and ethnicity in many studies. The analysis revealed that food environments undermine efforts at weight management, consistently making purchasing and consumption of healthier food more difficult, particularly for those on a low income. For weight management to be more successful, concurrent actions to reshape food environments are necessary