Obesity is an epidemic with a dire need for public health solutions (1–3). Efforts to decrease the rates of obesity have focused on interventions at multiple levels of influence including policy, environment, community and individual (4, 5). Although there are a variety of weight management interventions available, the success of participants is contingent on several factors including program completion, social support, and motivation for behavior change (6–8). It is important to study motivation at the individual level because motivation for weight loss has been shown to be a predictor for controlling weight successfully (6, 9, 10).

Motivation for diet and exercise has mostly been studied using quantitative approaches (11) such as the Treatment Self-Regulation Questionnaire (TSRQ) which assesses levels of motivation (12). A qualitative approach allows for further exploration of both motivational factors for weight loss (outcome) and associated behaviors (process) such as following a healthy diet or engaging regularly in physical activity. The investigation of the quality of motivation and its regulators can inform the understanding of effective weight loss efforts and interventions (13, 14). Further, theories such as the Self-Determination Theory expand on fundamental mechanisms for behavior change and may inform the development of more successful interventions (15).

Understanding motivational factors can help inform the improvement of weight loss programs especially as they pertain to an understudied population with an increased burden of overweight and obesity. A review of the literature revealed a dearth of information and published studies on motivational factors for weight loss among Hispanics, racial/ethnic minorities, and low-income populations. This is a problem as cultural attitudes and norms among minority racial and ethnic groups impact health behaviors in distinct ways and warrant study in their own right (16, 17). For example, Tamers et al. (18) completed a study assessing the relationship between worry of developing diseases associated with obesity and its role in motivating behavior change for physical activity and weight management among mostly Hispanic and non-Hispanic Black participants, with an average age of 44 years, high school education or less and living below the poverty line. Findings showed that individuals who were more concerned about the medical implications of being overweight or obese have a higher intention to change and are more likely to participate in health promotion programs (18). Research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity is lacking (19, 20), particularly for Hispanics in lifestyle interventions (21).

Self-Determination Theory (SDT) was developed to inform social science and was first applied in the context of education and the effect of rewards systems on intrinsic motivation. Applications of SDT have since included physical and mental health outcomes, such as physical activity, tobacco cessation, medication adherence, weight loss, quality of life, depression, and anxiety (22). SDT has been applied to weight loss program for patients with morbid obesity (23) and showed that participants with greater autonomous self-regulation had increased reductions in their BMI as well as increased program attendance.

Other studies have explored the motivation for weight loss (6, 9, 24–27). Motivators for weight loss vary greatly across studies and may include health, physical appearance, social life, mood (24, 26, 27), desire to be a better parent/spouse, serving as a positive role model (19) and the desire to improve self-esteem and confidence through weight loss (26). Other weight loss motivations were identified in a latent class analysis conducted by Lemon et al. (19). Review articles have shown that predictors of successful weight control include self-motivation and internal motivation to lose weight (6, 9). On the other hand, an intervention conducted among rural adults of Nebraska found that while autonomous self-regulation was not a significant predictor of weight loss, controlled regulation was a significant predictor. While authors stated the finding could be partly explained by the provision of an incentive to program participants, findings still call to question whether intrinsic or extrinsic motivation is more significant and what this means for long-term sustainable change (28).

Reasons for weight loss may also vary by age and sex. The most extensive prospective study investigating successful weight loss maintenance among men in the National Weight Control Registry found that a health or a medical concern was the most common motivator for starting the weight loss journey (25). A web-based weight loss intervention among 301 women found that when physical appearance was a pre-intervention motivator it was actually associated with losing weight at a slower pace and gaining weight at 30-month post intervention (29).

A systematic review examining predictors of weight loss amongst participants of lifestyle interventions found predictors across four categories being sociodemographic, anthropometric, psychological/behavior, and intervention characteristic factors (30). Among psychological factors identified in studies of the review, physical appearance was found to be a significant predictor for women while autonomous self-regulation, self-efficacy, and social support were significant predictors of treatment outcomes among both sexes (30). As stated previously, there are conflicting results found across interventions, but not many of these studies have been conducted among predominantly underserved minority populations. Thus, this study aims to explore the perceptions and motivation for weight loss of participants who completed a free community-based weight loss program in a predominantly Hispanic and low-income region along the US-Mexico border.

A total of 20 participants were interviewed between April and early June 2019, with interviews lasting between 20 to 50 min. The demographic characteristics of the interviewees are presented in Table 1. The majority of participants interviewed (80%, n = 16) were women and ranged in age from 28 to 60 years, with an average age of 41.5 (SD 10.5). Similarly, to the demographic makeup of the region, 95% of interviewees (n = 19) identified as Hispanic. Most of the participants had participated in “The Challenge” more than once (70%, n = 14), and an equal percentage were overweight and obese (45%, n = 9) at the beginning of “The Challenge.” Of the respondents, 95% lost weight and 30% (n = 6) were able to lose 5% or more of their initial weight. Average weight loss among all participants was 3.4 kg. Eight themes that were in accordance with SDT emerged from the participants' experiences. The themes were related to competence, relatedness, and six types of motivation represented in SDT (Table 2).

Competence refers to the belief in one's ability to accomplish a goal or intended behavior change. “The Challenge” started in 2010, and participants can repeatedly enroll throughout the years. Of the participants interviewed, 70% had previously participated. Participants also had the option of participating in a small group of 2-10 people (45%, n = 9) or a large group of 11–20 people (15%, n = 3). Previous participation in “The Challenge” and being part of a group helped some individuals to feel more confident, “I was confident because not only had I done it before I knew I had a team to support me.” (Female, 42 years old).

Participation in “The Challenge” in prior years or previous experiences with weight loss could both boost and diminish competence based on the results of previous attempts. Not all of the participants who complete or participate in “The Challenge” or other weight loss attempts are able to meet their weight loss goals. Not being able to lose weight in previous years successfully became a source of doubt for some of the participants: “I didn't know if I was going to be able to lose weight because I've been going through several years that I have not been able to.” (Female, 51 years old). Thus, prior experiences could affect competence, both positively and negatively.

Along with free exercise and nutrition classes, “The Challenge” offers a Mid-Point Weigh-In along with a 5K run. This event serves to provide encouragement, a family-friendly activity, and an opportunity to assess progress. One participant shared how she was able to complete the 5K run.

This participant used an affirmation rooted in her sense of competence. Earlier in her interview, she had mentioned that she was feeling ill but that she had been looking forward to the run, especially since she participated with her whole family, and her team was going to be there. She stated her goal was to at least walk, but after encouraging herself with affirmations of competence, she ran the entire 5K. In sum, there were various factors that influenced participants' sense of competence and included support from family and team members, participation in previous years, completion of milestones, and words of affirmation. These factors contribute to satisfying the need for competence, a core component of SDT.

Relatedness refers to the need for social support, connectedness, and a sense of belonging. Participants found motivation through the support provided to them by their friends and families. Support was provided through verbal encouragement and providing accountability as well as through accompaniment in being physically active. One participant described, “My husband. He wouldn't let me quit. He would say, “you're going.” And my niece goes with me [to exercise] too, so that's another motivation.” (Female, 43 years old).

Participating in “The Challenge” as part of a group helped participants find encouragement and support to continue with their healthy behaviors. Having a group was especially important for participants during the more difficult times of their weight-loss journey. A participant describes the mutual support provided through her group, “When I had downfalls, my friends would pick me up. And when they had discouragement, I would pick them up. We would take turns, so it was very important for them to be part of the group.” (Female, 31 years old).

“The Challenge” and its pervasiveness in the city helped participants recognize that becoming healthier and losing weight is a common goal. For example, participants discussed how “The Challenge” brings many people together to lose weight, and that action was motivating to see.

A sense of connectedness through sharing a common goal can contribute to the need for relatedness. Other participants also talked about the “hype” of “The Challenge” and how it was exciting to see others also making an effort to improve their lives. Many of the participants expressed the importance of social support and relatedness in their weight loss attempts. The prevalence of this theme is consistent with the SDT identification of relatedness as an innate psychological need.

Non-regulation refers to the lack of motivation or intention to act. This program was voluntary, and only people who completed “The Challenge” participated in this study; thus, the frequency of expressed non-regulation is less than might be expected from the general population or from those that register for “The Challenge” but do not complete it. Only one interviewed participant expressed thoughts that are consistent with non-regulation. From the beginning he stated that he had felt a sense of obligation to participate, saying, “Ugh, my wife kind of pressured me to do it.” (Male, 28 years old).

He reported that following setbacks in team progress with weight loss and feeling that his team would not win the competition that it was no longer worthwhile to continue with the program, their behavioral change attempts, or their intention to lose weight.

This same participant also mentioned that this sentiment was shared at his workplace among other team members. The participant's employer organized a smaller competition within the larger program. He mentioned that one of the other teams was performing much better and that the chances of his team winning were minimal, so this made him feel that it was not worth continuing to try to win through losing more weight.

Non-regulation was not a prevalent theme and was primarily attributed to feeling pressured to participate, setbacks in team progress, and the perception that winning the competition portion of “The Challenge” was unlikely.

Many participants mentioned an external source as their motivation for participating in the program and for wanting to lose weight and pursue a healthier lifestyle. External sources of motivation included: Improving physical appearance and receiving compliments, not disappointing others, and a desire to win the competition and prizes.

Participants were motivated not just by how losing weight made them look better; they also liked that others started to notice and compliment them on their physique. One participant put it as “I started looking thinner and looking better. People were saying, “Oh, you look good.” So that kind of kept me going. The results. So the results after 2 weeks. I kept going, and I was feeling stronger” (Female, 34 years old). Another participant mentioned that her main motive for wanting to lose weight, “Had to be cosmetic at first and I think especially because I was younger at the time. I was pretty young, and there weren't any health issues. Health was not the first thing on my mind, so it was all cosmetic. Trying to get into certain sizes, look a certain way.” (Female, 28 years old) This quote exemplifies wanting to lose weight to improve personal appearance and fit in with society's standards of beauty.

The group winners of “The Challenge” were determined by calculating the cumulative team progress. Participants expressed that they were motivated by their desire to be dependable and not let their teammates down. A participant who had previously participated as an individual indicated that it was an essential part of her success to be on a team because of the accountability it provided. She stated, “But this time around [entering “The Challenge”] because it was other coworkers, I didn't want to let them down either. And I didn't want to be the one who didn't lose any weight or didn't attempt to make a difference.” (Female, 44 years old).

There was a strong sense of being accountable to other members of the team. If you registered as part of a team, then it was important to take it seriously because your performance affected the group as a whole: “If you're part of a team you know like you're not just letting yourself down you're letting the team down. I think that's worse than you not doing it.” (Male, 28 years old) Thus the perception of the importance of dependability and accountability was a motivation source for participants.

“The Challenge” also had an incentive component. The participants that had the highest weight loss percentage qualified for cash prizes. Some participants mentioned that their motivation was winning the competition, “We are in it to win it. We didn't win it, but that was our motivation” (Female, 44 years old). Another participant mentioned that she was excited at the prospect of winning prizes.

Gift cards were awarded to everybody who reported a 5% body weight loss from their initial body weight or who had been involved in program activities such as exercise classes. Involvement in activities was measured using stickers that were provided by partnering gyms and organizations. Other participants found it motivating to see the progress they were making through the stickers they had collected.

External motivators were highly cited as influencers to be involved in “The Challenge.” Participants mentioned their desire to improve their physical appearance and the associated compliments, the importance of accountability from their team, and the prizes associated with successfully losing weight. External motivators are one component of motivation in SDT and the extent and depth of comments around this influencer suggest this is a primary motivation for the participants in this study related to weight loss and completion of “The Challenge.”

Introjected regulation is rooted in enhancing self-worth or avoiding guilt. Improving self-worth was consistent with mental health benefits and improved self-esteem. Participants found that after exercising and eating well, they also started to feel better about themselves, thus positively contributing toward their mental health. A participant who began regularly exercising during “The Challenge” stated,

In contrast, a few participants were more concerned with avoiding guilt as one participant stated she would, “feel guilty on days that I didn't exercise” (Female, 44 years old).

Another participant said that she would tell herself, “Okay, you gotta do this, cause you can't go back. You'll look […] that you didn't lose anything, or you gained.” (Female, 34 years old) So, while participants were aiming to improve their self-esteem, others were acting to avoid more negative self-talk and feeling guilty due to not exercising or losing weight. Introjected regulation and the internalization of improving self-esteem and avoiding guilt as mentioned by participants in this study, is included in the continuum of behavioral regulations and is closer to more self-determined behavior than external regulation.

Identified regulation is behaving in a manner that is consistent with personal values and other goals. Participants found personal value and importance in engaging in healthy behaviors. Participants mentioned that they were engaging in behavior changes not only for the duration of The Challenge but for the rest of their lives. A participant expressed, “One of the motivations was that I was getting results and he [husband] was getting results. So that's an incentive… and we see it short term for The Challenge, but really this is our way of life.” (Female, 57 years old).

One participant mentioned that “After the Challenge is done, there is nothing you are going to win but be healthy” (Female, 44 years old). Another participant elaborated on choosing to participate in The Challenge as something that she values and does for herself. She said, “When I did this Challenge, one of my goals was to eat healthier for myself and to exercise on a regular basis for myself” (Female, 42 years old). These expressions demonstrate identified regulation and that participants find it worthwhile and valuable to engage in healthy behaviors. In congruence with SDT this type of regulation is a more self-determined form of motivation and can be a positive regulator for participants in a weight loss program such as “The Challenge.” Identified regulation has been associated with increased enjoyment and interest in a behavior and a desire to expend more effort to accomplish a goal.

The themes found in this qualitative analysis elucidated how the Self-Determination Theory is reflected in the experiences of participants who completed a free community weight-loss program. The premise of this theory is that autonomy, competence, and relatedness are psychological needs and influence intrinsic and extrinsic motivation for behavior. The types of motivation are part of a continuum that can range from non-self-determined to self-determined.

In line with SDT, relatedness is a psychological need that influences motivation and can facilitate the adoption of health behaviors. This program had built-in social support provided through community events, group participation, social media, and text messaging. Social support and relatedness was an important component of the weight loss and behavior change experience for many of the participants. This is consistent with previous literature that demonstrates group support is conducive to weight loss (35, 36). Participants mentioned that they felt supported by the members in their team and that they would provide encouragement to one another. Other participants expanded on the social support offered by their family members. While social support can be beneficial, loss of self-determination, such as continued pushing by a spouse or significant other to lose weight, may negatively influence the internalization of weight loss as an autonomous health goal (37). For the 43-year-old female participant that stated that her husband “wouldn't let me quit,” she said that she found his support to be helpful. The 28-year-old male that mentioned his wife had pushed him into registering for “The Challenge” had more expressions consistent with amotivation and, thus, less behavior internalization and self-determination.

Our study found many similarities with what has previously been described in the literature regarding reasons for weight loss motivation. Similarly to other studies, motivators identified in this study included both extrinsic and intrinsic motivators such as (1) the prospect of winning financial incentives provided by weight-loss interventions (38, 39) (2) striving for social approval and avoiding feelings of shame (3) physical appearance, (4) health outcomes, and (5) valuing health and healthy behaviors (24, 26). SDT showcases that the forms of regulation and intrinsic and extrinsic motivation are not mutually exclusive but rather may coexist within the same behavior and change over time and in different contexts (31, 32). The motivation for behavior reflected in the experiences of participants in this study displays the continuum and overlap from non-self-determined to self-determined behavior.

Participants in this study endorsed financial incentives as a source of motivation. Evidence supports that weight loss outcomes are improved with the addition of financial rewards (38, 39). In an internet intervention modeled after Diabetes Prevention Program examining the treatment of obesity in lower-income women, women who also received small financial incentives for self-monitoring and losing weight, lost approximately three times more weight, than those completing the program alone. This shows that modest financial incentives can improve weight loss in women from financially disadvantaged backgrounds (40). Participants also mentioned they were motivated by the prizes and financial incentives offered as part of “The Challenge.”

Behavior change motivated by external factors such as feelings of guilt or disappointing others is not self-determined and is more prone to dissuasion following negative experiences and perceived failures (41). Other studies have found that striving for social approval and avoiding feelings of shame do not help improve healthy eating behaviors, such as increasing fruit and vegetable consumption and reducing intake of foods with added sugar. Rather than improving eating behaviors, it is more likely that these motivators place individuals at a higher likelihood of engaging in risky practices, such as intense fasting, to control weight (42). Only a few participants mentioned that they felt guilty when they did not exercise. Avoiding guilt is a component of introjected regulation and can be considered positive if it fuels an individual to engage in a healthy behavior such as exercising, however it can negatively affect perceived wellbeing from not following social expectations (42).

Wanting to improve physical attractiveness was another motivator for participants. Societal standards of attractiveness include thinness for women and increased muscularity for men (43). Attempts to conform to these standards through weight loss is seen more often in women with an increased motivation to exercise to manage weight, and enhance their attractiveness (44). Among the four men interviewed, there was no mention of wanting to lose weight or participate in “The Challenge” to increase their physical appearance. Female participants in this study who mentioned gaining confidence in their appearance also cited improved mental health benefits. The dual nature of the benefits reflected the introjected and intrinsic regulation constructs. The motivation to conform to standards of attractiveness is externally regulated and consequently has a lower degree of self-determination whereas improved confidence from weight loss is a potential value closer to intrinsic motivation.

Results from our study are consistent with previous findings about motivators for weight loss that include worries about health conditions (45). Participants mentioned that they wanted to improve their health, secondary to their worry about the adverse consequences of an unhealthy life. Participants reported worry about blindness, amputations, early death, and dialysis.

Individuals who feel susceptible to diseases commonly attributed to obesity may be more likely to exercise and maintain a healthy weight (46). This is in accordance with the magnitude of worry or concern about disease susceptibility and the link to perceived risk (47, 48). Worry and concern about susceptibility can have a positive effect through motivating individuals to engage in behaviors protective of their health (49). Although this is not an explicit construct of the SDT, perceived risk is a core component of other health behavior theories, including the Health Belief Model and Protection Motivation Theory. In our study, we found that health worry and concern were a major theme in the desire to lose weight and adopt healthy behaviors. The desire to maintain health and avoid health complications to spend more time with family and enjoy the milestones in their families' lives, such as graduations and weddings, was a repeated theme throughout. This is consistent with integrated regulation where the goal of maintaining health was in harmony with valuing time with family.

Participants reported valuing health and healthy behaviors which are more toward the continuum of self-determined behavior and intrinsic motivation. Previous research has shown that engagement in behaviors that are inherently satisfying and autonomously regulated are positively associated with more significant weight loss and improved weight loss maintenance (50, 51). In this study participants reported that they enjoyed engaging in physical activity which is in line with the development of intrinsic motivation.

A significant source of motivation, and link with SDT that has not been previously documented in the literature, is the multiple ways in which family affects motivational regulation in this predominantly Hispanic population. Participants mentioned not wanting to suffer from health conditions that had affected their family members. Motivators included wanting to improve health to be around for important family events as well as the value of providing a healthy environment and example for their children. Finally, family was also present in intrinsic regulation as participants mentioned that they ended up finding physical activity to be enjoyable because it was something that they could do together as a family. This emphasis on family is consistent with the strong orientation toward family, or familism (52). Although this value is found in other cultures it is very relevant among Hispanics cultures (53). Studies have shown that involving families and incorporating lifestyle changes that can be implemented at home are effective at helping Mexican Americans lose weight (54). Overall, in this study family is a consistent motivator present in different regulation types outlined by SDT.

This study explored the perceptions and motivation for weight loss of participants who completed a free community-based weight loss program in a predominantly Hispanic and low-income region along the US-Mexico border. Many participants mentioned external sources of motivation, such as preventing adverse health outcomes, wanting to improve their physical appearance, and being motivated by financial incentives. Fewer participants mentioned intrinsic motivators, which are more likely to create lasting change and improved health behaviors. Understanding the motivation for behavior change and completion of weight loss programs is essential to help participants reach their goals effectively. A greater understanding of the motivations for individuals to lose weight may help improve outcomes in weight-loss interventions. Additionally, increasing strategies targeted at improving intrinsic motivation for weight loss may be beneficial.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by UTHealth Committee for the Protection of Human Subjects. The patients/participants provided their written informed consent to participate in this study.

The writing and first draft of the manuscript was led by MM. MM and CS-C completed data analyses and JP helped with the topic guide, data collection and review of the manuscript. AW, EC, and BR provided critical revisions and EC and BR provided conceptual guidance throughout this project. All authors contributed to the article and approved the submitted version.

Funding for The Challenge comes in part from the City of Brownsville, local sponsors and UTHealth. This study was partially supported by the Center for Clinical and Translational Sciences, which is funded by National Institutes of Health Clinical and Translational Award no. UL1 TR003167 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. Funding for analysis software and transcription services were provided by the University of Texas Rio Grande Valley School of Medicine Office of the Associate Dean of Research.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.