What treatments options do patients with obesity complications prefer?

Objectives: Nutritional therapy, lifestyle modification, pharmacotherapy, and surgical intervention are all potential management strategies for obesity and its comorbidities. However, relatively little is known about patients' preferences regarding treatment options or what factors influence those preferences, even though it is possible that taking into account a patient’s preferences may well impact treatment adherence, improving efficacy. The objective of this study was to identify what treatment patients preferred and what factors influence that preference, among those seeking treatment for obesity-related complications.

Methods: Participatory action research, using purposeful sampling, was used to recruit 55 patients with obesity complications, in specialist clinics for Non-alcoholic Fatty Liver disease, Diabetes, Hypertension, and Chronic Kidney disease. I recruited twenty-five males and thirty females aged 18-70 years, with a BMI>35kg/m2 to interview and participate in focus groups. Data was collected in one-to-one semi-structured interviews using Zoom or the telephone; photovoice using pictures submitted by the participants, and World Café using focus groups, reflective thematic analysis was used. Before each methodology, participants watched a 60-minute video explaining nutritional therapies, pharmacotherapies, and surgical therapies in equipoise. Intha addition, we assembled a Patient Advisory Panel, which was a subset of the study participants. to present the overall findings of the study. When the results of the study were reported to the Patient Advisory Panel, their feedback confirmed our findings.

Results: Data triangulation yielded four themes 1) structural factors for example access to treatments and the cost of treatments 2) impact on the patient both physical and emotional – for example, deterioration of other health diseases, lack of mobility and the impact that both have on their quality of life 3) knowledge – the HCP's knowledge of treatment options for intentional weight loss and the participant's knowledge – of their need to improve their health literacy, and 4) support, the importance of support from HCPs, family, and community. Overall, 41% of participants preferred nutritional therapy with support from medical professionals. 25% chose pharmacotherapy alone, 25% chose bariatric surgery, 6% chose pharmacotherapy combined with nutritional therapy, and 3% of participants wanted no intervention.

Conclusion: Patients identified specific preferences for treatment options, expressing the need for more effective patient-centred, equitable health care for obesity-driven diseases. More research should be done to investigate the impact of a patient-centred approach on treatment outcomes.