Factors influencing patient preferences for obesity pharmacotherapy: The triangulation of semi-structured interviews, photovoice study and focus group discussions.
This qualitative, multi-method study explored how adults living with obesity make decisions about initiating pharmacotherapy. Researchers used three complementary methods — semi-structured interviews (n=15), a Photovoice study (n=12), and focus group discussions (n=12) — to purposively recruit adults aged 18–70 with a BMI ≥27 kg/m² and at least one obesity-related complication, all of whom were naïve to obesity medications. Through triangulation of findings across all three methods, the study identified five key factors shaping patient preferences: (1) anticipated treatment efficacy, (2) adequacy of information and community support, (3) safety and tolerability profile, (4) treatment burden and lifestyle integration, and (5) logistical and structural barriers. Tirzepatide was the most preferred agent across all methods, largely due to its perceived weight-reduction potential, while semaglutide ranked second, aided by its broader societal familiarity. Perceived efficacy and information trustworthiness emerged as the dominant drivers of preference, with safety concerns consistently moderating enthusiasm. The study is limited by its qualitative design, modest sample sizes, and the fact that all participants were medication-naïve, which may limit transferability to experienced patients. The authors recommend clinicians engage in shared decision-making tailored to individual information needs and social contexts.
Why this grade: This qualitative observational study involves human participants but uses small, purposively sampled groups without controls, randomization, or quantitative outcome measurement, limiting generalizability.
Introduction Obesity is a complex and chronic disease associated with complications including type 2 diabetes, cardiovascular disease, and malignancy. Although pharmacotherapy has emerged as an effective treatment option, the determinants of patient preferences for specific pharmacological agents remain insufficiently characterized. Methods This was a qualitative, multi-method, triangulated study designed to understand how adults living with obesity make decisions about initiating pharmacotherapy. Adults aged 18-70 years with a body mass index of ≥27 kg/m 2 and at least one obesity complication were purposively recruited. All participants from semi-structured interviews (n = 15), Photovoice Study (n = 12) and focus group discussions (n = 12) were naive to obesity medications. Results Tirzepatide was the most popular agent across all qualitative methods, primarily due to its clinically significant weight reduction. Semaglutide was the second most frequently selected option, attributed to its efficacy and widespread societal familiarity. Triangulation of data identified five principal factors shaping patient preferences for pharmacotherapy: a) Anticipated treatment efficacy, b) Adequacy of information and community supports, c) safety and tolerability profile, d) Treatment burden and lifestyle integration, e) Logistics and structural barriers. While perceived efficacy and information transparency were the most influential determinants, safety perceptions consistently moderated patient enthusiasm for treatment options. Conclusion Patients demonstrated clear hierarchies in their preferences for pharmacotherapy, with tirzepatide and semaglutide receiving the strongest endorsement. These preferences were primarily influenced by perceived efficacy and the trustworthiness of medication information, while safety, practicality, and social context serve as supporting factors. Clinicians should engage in shared decision-making, collaborating with patients to develop treatment plans that align with individual information needs and social support systems.
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