The methodological approach was deliberately intimate. The researchers used semi-structured interviews with open-ended questions, allowing participants to describe their days, their meals, their bodies and their frustrations in their own words. Interviews, which lasted between 25 and 47 minutes, mostly took place in residents’ own living rooms and were audio-recorded and transcribed verbatim. The team then applied a phenomenological analysis method developed by Amedeo Giorgi, a framework designed to distil the essential structure of lived experience from first-person accounts. The analysis moved iteratively through four steps, from an initial holistic reading to coding with participants’ own phrases, such as the study’s evocative title phrase about swapping cake for crispbread, and finally to consensus themes agreed between two researchers.

The eleven participants, six men and five women aged 69 to 87, had body mass indices ranging from 31 to 61. Their marital histories varied widely: one was married, three widowed, three divorced and four had never married. From the transcripts, three themes emerged that the researchers say encapsulate the essence of daily life with obesity in an institutional setting: living and coping with an oversized body, wanting to keep going, and navigating the possibilities and barriers of the nursing home’s social and institutional environment.

The first theme reveals how profoundly body and self are intertwined. Every participant described being intensely aware of their body, and that awareness shaped their actions throughout the day. Some used gentle euphemisms such as being well-fed or horizontally challenged, while others were blunter. Crucially, residents tended to describe their bodies not in abstract terms but through function: what they could do and what they could not. One participant, given the fictional name Richard, framed his bodily experience entirely through mobility. How do I see my body? Well, one part of it is that I cannot walk, you know, I’m just sitting in this chair, he told the researchers. In contrast, Adam described himself as overweight but said his body felt good because it did not restrict him from being physically active.

Weight loss emerged as a powerful lens through which residents re-experienced their bodies. Paul, who lost 40 kilograms around the time he moved into the nursing home, described the change in purely physical terms: you can feel it in the legs, you can feel that there is less to drag along. Helen, who cared about dressing neatly, felt her size acutely when her clothes grew tight, saying she did not feel comfortable in clothes she otherwise liked. For several residents, the move into the nursing home itself triggered weight loss and improved function, which in turn became an incentive to continue the positive changes. All eleven participants expressed a desire to lose or maintain weight, and each had developed personal strategies: replacing cake with crispbread or fruit, arranging controlled portions with staff, monitoring what went onto their plates, or, in one case, skipping lunch entirely. Peter, who lost 30 kilograms after moving in, even traded one of his two daily slices of rye bread for a hot dish when meatballs appeared on the lunch trolley, a kind of informal calorie arithmetic conducted meal by meal.

The second theme, wanting to keep going, captures a strikingly energetic stance toward life. Rather than resigning themselves to decline, residents expressed a strong desire for continuity, renewal and doing as much as possible, with or without assistance. Lis, who received help with personal hygiene but insisted on doing as much as she could herself, arranged with the night staff to have breakfast and medication delivered before dawn so she could begin crocheting at five in the morning. That craft, she explained, fills up her entire day. Henry, meanwhile, refused the easier option of using a bottle beside his bed, choosing instead to shuffle to the toilet three, four or five times a night, a decision he framed as refusing to take the easy way out.

Exercise was another expression of this drive. Peter, who uses a walker, took four walks a day around the nursing home, saying it keeps him in shape. Others used wall bars and double-pedal trainers. The desire for change extended beyond fitness: residents longed for more outdoor trips, with one, Mary, willing to leave at nine in the morning to visit a newly opened amusement park. Others wanted changes to the food selection, from traditional Danish dishes to ethnic cuisine, or the removal of ingredients they disliked. The researchers note that this keep-going attitude was not simply a byproduct of weight-loss efforts but seemed to be an inherent characteristic of the group, an eagerness to reshape their immediate circumstances rather than stagnate.

The third theme maps the institutional terrain on which these personal battles are fought, and it cuts both ways. On the positive side, the physical environment offered exercise opportunities residents had lacked in their previous homes, and supportive staff proved invaluable for weight management. Paul praised a staff member as the best at making him low-fat food, and others described staff serving oatmeal without raisins, helping with finances and encouraging outings. For residents who built such relationships, the staff became a lever for influencing the institutional framework itself, shaping when and what food was provided.

But the institutional setting also imposed barriers. Staff busyness and shortages meant some residents could not get the help they needed, one could not go to bed at her preferred time, and several could not go outdoors because the assistance required was unavailable. Social dynamics added another layer of difficulty. Participants described feeling different from residents with cognitive impairments, keeping to themselves, and in some cases using starkly distancing language, referring to other residents as them. Helen avoided communal cake touched by wandering residents with dementia. The researchers observe a painful paradox: being in the nursing home was partly a consequence of their oversized bodies, since they needed daily help, yet placement meant living among people from whom they felt estranged. Volunteers, by contrast, opened doors that routine staffing could not, taking residents rickshaw cycling, shopping and visiting, restoring access to the outdoors and to companionship.

The findings carry practical weight for occupational therapy and nursing care. Because routines, habit change and environmental adaptation are central to successful weight management, the authors argue that occupational therapists are well positioned to design interventions that support residents’ self-reliance, preserve preferred routines and embed physical and social cues that encourage weight loss where it is beneficial. They also caution that nutritional risk and malnutrition, including low protein intake, can be overlooked in older adults with overweight or obesity, underscoring the need for staff education. The study has limitations: participants were recruited by convenience sampling and were relatively well-functioning and articulate, so the findings may not transfer to all residents, and further research is needed on residents unable to verbally express their preferences. Still, as the first study of its kind, it replaces a one-dimensional picture of decline with something more nuanced: older people actively calculating, negotiating and striving, one slice of bread and one early-morning crochet session at a time, to keep going on their own terms.

Subject of Research: Everyday life experiences of nursing home residents living with obesity

Article Title: From cake to crispbread – giving voice to nursing home residents with obesity and their experiences of everyday life

Article References: Holt Bentz, H., Maersk, J. L., Dynesen, A. W., & Lindahl-Jacobsen, L. E. (2025). From cake to crispbread – giving voice to nursing home residents with obesity and their experiences of everyday life. Scandinavian Journal of Occupational Therapy, 32(1), Article 2577287. https://doi.org/10.1080/11038128.2025.2577287

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2577287

Keywords: obesity, nursing homes, older adults, occupational therapy, qualitative research, phenomenology, weight management, everyday life, geriatrics, Denmark, institutional care, staff support