Key result
Adults with obesity and diabetic cardiomyopathy manage lifestyle changes through an Energy-Fear-Control cycle.
Why the study?
Middle-aged adults with obesity and diabetes-related cardiomyopathy face competing demands regarding diet and physical activity, but how daily decisions are negotiated under fluctuating energy, fear, and responsibilities is little known.
The Energy-Fear-Control cycle highlights that lifestyle management in diabetes-related cardiomyopathy is an ongoing negotiation shaped by perceived energy, fear of symptoms, and family co-regulation, suggesting the need for flexible, context-sensitive counseling.
BACKGROUND: Middle-aged adults with obesity and diabetes-related cardiomyopathy (DRCM) face competing demands when attempting to implement dietary and physical-activity recommendations. However, little is known about how day-to-day decisions are negotiated under fluctuating energy, symptom-related fear, and competing role responsibilities. OBJECTIVE: To explore experiences of nutrition and physical-activity management among middle-aged adults with obesity and DRCM, and to develop an explanatory framework to inform individualised lifestyle counselling in general practice. METHODS: We conducted a qualitative study in the Department of General Practice, Zhongda Hospital, Southeast University (Nanjing, China), between August 2024 and August 2025. Seventeen adults aged 40–60 years with obesity (body mass index ≥ 28 kg/m²) and clinician-diagnosed DRCM participated in semi-structured, in-depth interviews. Data were analysed using reflexive thematic analysis, theoretically informed by self-regulation theory and the Capability–Opportunity–Motivation–Behaviour (COM-B) framework. RESULTS: Four interrelated themes described how participants managed nutrition and physical activity in everyday life: (1) negotiating between energy and fear; (2) confronting the limits of rigid self-control; (3) integrating family involvement into routines; and (4) reconstructing control through flexible pacing. Synthesising these themes, we propose the Energy–Fear–Control (EFC) cycle—a novel explanatory model in which perceived energy availability shapes feasibility, symptom-related fear constrains action, rigid control strategies contribute to fatigue and rebound, and family-enabled co-regulation supports flexible adaptation and sustained engagement. CONCLUSIONS: The EFC cycle extends existing accounts of lifestyle management by specifying a cyclical mechanism rather than a linear “adherence” pathway, and by highlighting actionable leverage points for general practice—assessing “energy reality,” eliciting fear triggers, involving family early, and negotiating small, repeatable adjustments that remain feasible under midlife constraints.
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Wang et al. (2026) studied Obesity and diabetes-related cardiomyopathy (n=17). Nutrition and physical activity management was evaluated on Experiences of nutrition and physical-activity management. Middle-aged adults with obesity and diabetes-related cardiomyopathy manage lifestyle changes through an Energy-Fear-Control cycle, shifting from rigid self-control to flexible, family-supported adaptation.
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