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. This was a qualitative, multi-method, triangulated study designed to understand how adults living with obesity make decisions about initiating pharmacotherapy. Adults aged 18 to 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. 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. 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.
Mondoh et al. (Sun,) studied this question.