“This cage that I’m stuck inside”: Autistic adults’ perceptions of weight management, body weight, and body image
Authors: Healy Sean , Pacanowski Carly , Kennedy Lauren , Obrusnikova Iva 
Published: April 2021

Personal beliefs and attitudes about body weight and body image are important determinants of weight management practices. To inform efforts to prevent and treat obesity among autistic adults, this study examined how autistic adults perceive weight management, body weight, and body image. Eleven adults participated in semi-structured interviews. Consistent with an interpretive paradigm, an interpretative phenomenological analysis methodology was employed, resulting in four themes: (a) Mental and physical health: direct and indirect interactions, (b) ASD traits and health-related behaviors, (c) Body dissatisfaction: Unrealistic ideals and misperceptions, and (d) Sources of information. This study’s findings have several implications for research and practice. First, participants viewed overweight and obesity as just one component of a holistic perspective of health. A dynamic, bidirectional relationship between mental health and physical health, including overweight/obesity was described, leading us to posit that the promotion of mental health is crucial for the promotion of overall health among autistic adults. Second, body dissatisfaction was pervasive among participants in this sample. This finding requires future research as it may be an important target for intervention, with relevance for mental health and weight management practices. Finally, interactions with medical professionals regarding weight management were perceived to be inadequate. Lay abstract Our beliefs and feelings about our bodies and our body weight influence our weight management behaviors, such as physical activity and eating behaviors. These beliefs and feelings are largely shaped by how we interact with, and compare ourselves to, people in our lives. Due to the social traits associated with autism, autistic adults may have different perceptions of body weight, body image, and weight management than neurotypical adults. To explore this, for the first time, we interviewed 11 autistic adults. The participants’ perceptions can be summarized in four findings. First, the participants viewed overweight and obesity as just one part of their overall health. Participants described how their mental health and physical health, including overweight/obesity, were closely connected. Second, some traits related to autism made weight management difficult; for example, eating and physical activity were negatively impacted by social anxiety, sensory sensitivity, obsessiveness, and a strong desire for routine. Third, participants were generally dissatisfied with how they looked. This was primarily due to a disconnect between how they felt their body looked and how it actually looked in real life. Other people, including on social media, also negatively influenced how they perceived themselves. Fourth, and finally, participants described how they got most of their weight management-related information online. Medical professionals were frequently described as being unprepared to provide them assistance related to weight management.