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. 2025 Sep:138:109193.
doi: 10.1016/j.pec.2025.109193. Epub 2025 May 27.

Attitudes towards different weight loss approaches among adults with type 2 diabetes and obesity

Stephanie A Hooker  1 , Lilian Chumba  2 , Heidi Ekstrom  2 , Mary Sue Beran  2 , Nicolaas P Pronk  2 , Jennifer Vesely  3 , Patrick J O'Connor  2
Affiliations

Attitudes towards different weight loss approaches among adults with type 2 diabetes and obesity

Stephanie A Hooker et al. Patient Educ Couns. 2025 Sep.

Abstract

Objectives: This study aimed to understand how patients with type 2 diabetes (T2D) and obesity view weight loss treatments (lifestyle changes, metabolic bariatric surgery [MBS], and anti-obesity medications [AOM]) in the context of shared decision-making conversations.

Methods: Patients (N = 30) with T2D and obesity participated in semi-structured qualitative interviews focused on attitudes and informational needs related to MBS, AOM, and lifestyle approaches, as well as comfort in discussing weight loss with primary care clinicians (PCCs). Themes were generated using inductive content analysis.

Results: Two main themes emerged: (1) The way PCCs and patients discuss weight loss in the context of diabetes influence patients' willingness to try weight loss treatments, and (2) although patients' attitudes towards treatments vary, most patients prefer using lifestyle changes first, then AOM, and finally MBS. Within the first theme, subthemes included PCCs need to approach weight loss conversations with sensitivity and tangible solutions; personal stories influence attitudes towards MBS and AOM; patients may be more open to trying MBS and AOM if they are reframed as treatments for diabetes; and patients want to compare risks and benefits of each option.

Conclusions: Patients with T2D and obesity are open to discussing weight loss with their PCCs and prefer lifestyle approaches, followed by AOM and then MBS. PCCs may use these findings to improve the quality of shared decision-making conversations about weight loss in T2D.

Practice implications: Providing information to support shared decision-making about weight loss treatments is warranted.

Keywords: Attitudes; Diabetes; Obesity treatment; Primary care; Qualitative methods.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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