Why Some Patients Choose Nutritional Therapy over Medications and Surgery in Obesity Care

Introduction: Obesity is a well-established risk factor for numerous chronic diseases, including type 2 diabetes, cardiovascular disease, and certain cancers. Obesity-related complications can be managed through nutritional therapy, pharmacotherapy, and surgical interventions, each capable of achieving weight loss of over 10%. Understanding patient preferences and the factors that influence treatment choices is crucial to enhancing adherence and effectiveness. This sub-study aimed to identify the factors shaping patient preferences for nutritional therapies in the context of available pharmacological and surgical options. Methods: A participatory action study recruited 43 patients aged 18-75 years with a BMI greater than 35 kg/m2 and obesity-related complications, including metabolic dysfunction, diabetes, hypertension, and chronic kidney disease. Participants viewed a 60-min informational video outlining treatment options before taking part in one-to-one interviews. Data were analysed using reflective thematic analysis. Results: This sub-study focuses on patients who expressed distinct attitudes toward nutritional therapy. Of the participants, 47% preferred nutritional therapy, 41% chose pharmacotherapy alone, and 6% selected a combination of pharmacotherapy and nutritional therapy. Five themes emerged to explain the preference for nutritional therapy: patient satisfaction, the personalised approach, effectiveness, empowerment, and side effects. Discussion: Nutritional therapies were still the most popular choice of many patients, suggesting there remain unmet needs of patients and that it should not be assumed that large majorities of patients with obesity only want pharmacotherapies or surgical therapies. Conclusion: Ensuring patients receive comprehensive information and regular guidance from nutritional experts is likely to further strengthen engagement.