In the context of rising obesity rates, metabolically healthy obesity (MHO) can achieve favorable outcomes through early intervention. However, grazing behavior in this population poses a significant barrier to weight management. Understanding the factors influencing grazing behavior is essential to improve dietary compliance in obesity management. Currently, there is a lack of qualitative research on this topic.

To explore the influencing factors of grazing behavior in metabolically healthy obese individuals.

Based on the capacity opportunity motivation-behavior (COM-B) model and the theoretical domains framework (TDF), the interview guide was developed. 17 cases of metabolically healthy obese were selected from the Department of Endocrinology, Northern Jiangsu People's Hospital for semi-structured interviews via purpose sampling method. The interview data were coded using the COM-B and TDF frameworks and analyzed through both inductive thematic analysis and deductive framework methods.

Six core themes were identified, including lack of dietary management knowledge, insufficient cognitive resources, perceptual and practical influences, maladaptive coping strategies, absence of reflection/self-motivation, environmental and social influences.

Grazing behavior in individuals with MHO are shaped by a multifaceted interplay of personal, healthcare-related and societal factors. Appropriate intervention measures should be taken according to the multidimensional needs of patients and help them establish healthy eating habits and behaviors.