Understanding obesity treatment choices: a mixed-methods study of patient preferences and shared decision-making

Shared decision-making (SDM) is recommended in obesity treatment. Yet, little is known about how it occurs in real-world practice, particularly given recent advances in treatment options.

This prospective mixed-methods study aimed to understand patient preferences and decision-making processes for obesity treatment.

Adults with obesity (N = 103) seeking specialty weight management treatment completed a survey, and a subset (n = 17) participated in qualitative interviews. Both assessed weight loss history, knowledge and expectations of obesity treatment options, decision-making factors, and perceptions of SDM.

Participants reported an average of 10.1 (SD = 13.5) prior weight loss attempts and were primarily motivated by physical well-being (86.4%). Key factors influencing decision-making included desired weight loss (84.5%), provider recommendations (76.7%), and cost (62.1%). Anti-obesity medications were viewed most favorably, followed by behavioral and surgical approaches. Qualitative analysis generated four themes: (i) a chronic cycle of weight loss and regain; (ii) guided by stories, not science alone; (iii) navigating trade-offs in choosing weight-loss strategies; and (iv) feeling heard, but still seeking direction.

Patients demonstrate strong awareness of obesity treatments and value SDM and personalized recommendations when making decisions. Findings highlight the need for interventions that strengthen SDM and deliver tailored, high-quality health communication.