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Background Despite prison settings presenting opportunities for healthy eating and regular exercise, many incarcerated men supplement prison food with unhealthy snacks and drinks, and are less likely to achieve recommended physical activity guidelines than non-incarcerated men. This paper describes the co-development with prison staff of a healthy lifestyle intervention for delivery to incarcerated men, and feasibility testing of its delivery through prison physical education departments. Methods The starting point for intervention development was Football Fans in Training (FFIT), an evidence-based intervention successful in engaging men and supporting them to lose weight, make positive lifestyle changes and maintain these long term. We iteratively tested and adapted FFIT for delivery in prison gym facilities through a four Phase pilot and optimisation study. Methods used to evaluate each phase included: observations of session deliveries; semi-structured interviews with participants; and a focus group/semi-structured interviews with prison Physical Education Instructors (PEIs) who delivered the programme. Data were analysed thematically using the Framework approach. Findings from each phase informed development of the optimised programme. Results We iteratively co-developed a healthy lifestyle intervention (known as Fit for LIFE) tailored to the needs of incarcerated men and prison operational constraints. Fit for LIFE comprises elements specifically designed to address common barriers to a healthy lifestyle within prison, including: discussion of healthiest available food choices; trying out different physical activity options in the prison gym; and strategies (such as in-cell workouts) for dealing with prolonged time in cells at evenings/weekends. Weight loss was not always the most valued outcome. Instead, participants cited a wide range of behavioural, physical and mental health improvements as important to them, and were more motivated if they could focus on identifying and achieving personally relevant objectives. Conclusions Fit for LIFE is a 10-week, group-based healthy lifestyle programme tailored for delivery to incarcerated men in prison gymnasia. Weekly 90-min sessions include informative and interactive ‘classroom’ activities followed by a practical physical activity training session, often with group activities. Fit for LIFE aims to help incarcerated men to: increase physical activity; reduce sedentary time; eat more healthily; and start and maintain using prison gym facilities with confidence.

Additional file 1. Supplementary Materials.

Additional file 1. Typology development. This table summarizes the comparison of participants to determine participants’ involvement/reliance categories for diet or physical activity.

In this paper we use a social practice approach to explore men's experience of Football Fans in Training (FFIT), a group‐based weight management programme for men that harnesses men's symbolic attachment to professional football clubs to engage them in lifestyle change. FFIT is delivered by community coaches in clubs’ stadia and is gender‐sensitised in relation to context, content and style of delivery. Using a ‘toolkit’ of concepts from the work of Bourdieu, Goffman and Durkheim we analysed data from 13 focus group discussions with participants, and fieldwork notes from programme observations to investigate the appeal and success of FFIT, and how it worked to support change. Our analysis builds on our work on the importance of shared symbolic commitment to the football club and being with ‘men like me’ to understand how the interaction context facilitated ‘effervescent’ experiences. These experiences encouraged men to make changes to their diet and physical activity, talk about them, practice performing them and implement them in their lives. Thus a social practice approach illuminated the social processes through which lifestyle change was achieved, and we argue that it can deepen and enrich both intervention design and evaluation.

Additional follow up study results tables (baseline characteristics, clinical and psychological outcomes, and lifetime economic evaluation). (DOCX 103 kb)

Economic evaluation supplementary tables. (DOCX 57 kb)

Baseline differences between participants followed up at 12-weeks and participants lost to follow up. (DOCX 21 kb)

Study questionnaire. (PDF 1280 kb)

Objectives Recent qualitative research found young men reporting that an expectation that eating disorders (EDs) mainly affect young women led them, and others, to only recognise their symptoms when their ED had become entrenched. This raises questions about how these stereotypes persist. We therefore explored how EDs in males were represented in articles published in UK newspapers over a 10-year period (7.12.2002–7.12.2012), specifically attending to whether newsprint media represent EDs in males as ‘gender appropriate’, ‘gender anomalous’ or ‘gender neutral’.\ud \ud Design A qualitative thematic analysis of UK newspaper articles.\ud \ud Methods We searched two databases, Newsbank and LexisNexis, for newspaper articles including ED and male terms in the lead/first paragraph. Following de-duplication, 420 articles were scrutinised; 138 met inclusion criteria for detailed textual analysis and were imported into NVivo10.\ud \ud Findings The number of articles peaked in 2008 when a UK politician announced that he had experienced bulimia nervosa. Analysis of how the articles portrayed male ED-related characterisations and experiences revealed that they conveyed ambiguous messages about EDs in males. Despite apparently aiming to dispel stereotypes that only young women experience EDs and to address stigma surrounding EDs in males, many aspects of the articles, including repetition of phrases such as ‘a young woman's illness’, serve to reinforce messages that EDs are inherently ‘female’ and so ‘anomalous’ for men.\ud \ud Conclusions Newspaper articles represent men with EDs as atypical of men, as a result of having an ED (and any feminising or demasculinising characteristics associated with this), and as atypical of people with EDs, who are still usually portrayed as teenage girls. Such media representations frame a cultural paradigm in which there is an expectation that men may feel shame about or strive to conceal EDs, potentially contributing to men with EDs delaying help-seeking, gaining late access to treatments and reducing chances of successful outcomes.

Media presentations of health issues affect evaluations of personal susceptibility to\ud particular illnesses and hence help-seeking behaviours. We examined data on prevalence\ud of eating disorders (EDs—which are often characterised as “female”) among\ud males in: scientific literature; readily-accessible web-based information; and UK\ud newspaper articles (published 7/12/2002-7/12/2012). This revealed conflicting statistics.\ud Academic papers suggest men comprise around 25% of community-based\ud samples, but much lower proportions (10% or less) of clinic samples. Websites and\ud newspapers presented widely differing statistics both on prevalence overall (numbers\ud with EDs in the UK ranged from 60,000 to 2.7 million), and in men (generally\ud suggesting they constituted 10-25% of those with EDs), rarely distinguishing between\ud diagnosed and non-diagnosed samples. By 2011, newspapers were more consistent\ud on overall numbers with EDs in the UK (1.6 million) and the proportion who\ud were men (20%), drawing on one website as the authoritative source. Conflicting\ud statistics may confuse men searching for ED (or other) health-related information,\ud lead to underestimations of male susceptibility to EDs and/or reinforce inappropriate\ud stereotypes of EDs as confined to adolescent girls.