{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T22:11:45Z","timestamp":1766182305880,"version":"3.48.0"},"reference-count":27,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["Clinical Lectureship"],"award-info":[{"award-number":["Clinical Lectureship"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000691","name":"Academy of Medical Sciences","doi-asserted-by":"publisher","award":["Starter Grant for Clinical Lecturers [SGL025\\1005]"],"award-info":[{"award-number":["Starter Grant for Clinical Lecturers [SGL025\\1005]"]}],"id":[{"id":"10.13039\/501100000691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,3,12]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Excess weight is highly prevalent in secure (forensic) mental health services and impacts negatively on patients\u2019 physical and mental health. This study sought to identify the key influences and challenges around weight management in UK adult secure mental health settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Qualitative focused ethnography. Analysis of written fieldnotes was undertaken through a combined inductive and deductive approach, informed by thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Low secure male mental health ward and associated patient activities and events, in a National Health Service Trust delivering mental health, intellectual disability and neurorehabilitation services in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>12 males (primarily white British) on the low secure ward; additional male participants from low and medium secure services, who took part in group events and activities; and multidisciplinary low and medium secure services staff. Approximately 23 hours of observation were undertaken over a 6-month period from April 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Secure mental healthcare delivered an environment predisposing patients to excessive weight gain and sedentary behaviour, which was often perceived as inevitable. Key themes highlighted the heightened salience of food in secure settings; inadequacy of catered hospital food and shortcomings of alternative food options; limited physical activity opportunities; and a ward culture that was not conducive to healthy behaviours. Perceptions and behaviour towards the ethnographer were primarily positive and accepting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Weight management in secure services is a complex challenge. In future, whole setting-based interventions to promote healthy weight are likely to be required. These should integrate physical and mental health, incorporate underpinning determinants such as adequate staffing and a culture promoting weight management, and involve both patients and staff.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-079406","type":"journal-article","created":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T22:12:47Z","timestamp":1711750367000},"page":"e079406","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["What are the key influences and challenges around weight management faced by patients in UK adult secure mental health settings? 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Working together to address obesity in adult mental health secure units: A systematic review of the evidence and a summary of the implications for practice. England, 2017."},{"key":"2025121514291598000_14.3.e079406.7","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.462","article-title":"Using mixed methods to explore diabetes care in a medium-secure setting in England: A case study","volume":"4","author":"Walker","year":"2021","journal-title":"Health Sci Rep"},{"key":"2025121514291598000_14.3.e079406.8","unstructured":"Government of the United Kingdom . Mental health act; 1983."},{"key":"2025121514291598000_14.3.e079406.9","unstructured":"National Health Service . The NHS long term plan. 2019."},{"key":"2025121514291598000_14.3.e079406.10","unstructured":"NHS England . PSS4 Achieving Healthy Weight in Adult Secure Mental Health Services PSS CQUIN Indicator. NHS England, 2019."},{"key":"2025121514291598000_14.3.e079406.11","unstructured":"NHS England . 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