“What Patients Want”: a qualitative study of expectations and ideal clinical encounters in obesity consultations

Background: Although obesity is increasingly recognized as a chronic, relapsing disease, clinical consultations remain inconsistently delivered, often perceived by patients as generic, stigmatizing, and insufficiently person-centered. While dissatisfaction with weight-related care is well documented, limited research has systematically examined how patients themselves define the core features of an effective obesity consultation. Objective: This study aimed to develop a patient-informed framework for clinical obesity consultations by exploring the expectations and experiences of individuals with lived experience of obesity. Methods: A qualitative descriptive design was employed. Twenty adults (BMI ≥ 27 kg/m2 with at least one obesity-related complication) who had received treatment for obesity were recruited via purposive sampling. Semi-structured interviews were conducted via Zoom, transcribed, anonymized, and analyzed using reflexive thematic analysis. Coding was inductive and organized using MAXQDA. Results: Participants articulated a coherent and detailed model of the ideal clinical encounter, extending beyond previously reported dissatisfaction. Five key themes were identified: (1) the need for consent-based and context-sensitive initiation of weight discussions; (2) the rejection of moralizing or reductive language in favor of medically grounded and neutral communication; (3) recognition of obesity as heterogeneous, multifactorial disease requiring individualized assessment; (4) expectations for clear, evidence-based information on treatment options and likely outcomes; and (5) a strong preference for ongoing, relationship-based support rather than episodic advice. Patients revealed that unmet informational and relational needs, especially regarding clinical competence, emotional sensitivity, and collaborative treatment planning, were primary barriers to trust and engagement. Conclusion: This study advances current understanding by proposing a patient-defined model for obesity consultations, with implications for improving clinical communication, shared decision-making, and continuity of care.