Abstract

Objectives

Understanding features of weight loss treatments that matter most to patients can inform clinical, reimbursement, and policy decisions. This systematic review synthesizes qualitative and quantitative evidence to characterize treatment attributes patients consider most important in weight loss pharmacotherapy and bariatric surgery.

Methods

We conducted a systematic search of PubMed, Embase, and the Cochrane Library. Studies were included if they assessed patient perspectives or preferences for weight loss pharmacotherapy or bariatric surgery among adults with overweight or obesity. Data extraction covered study characteristics, methodological features, and key findings. A narrative synthesis was conducted because of methodological heterogeneity. Study quality was assessed using 3 validated tools.

Results

Of the 965 articles identified, 14 met inclusion criteria (5 discrete choice experiments [DCEs], 4 surveys, and 5 qualitative studies) from 9 countries. Most were published after 2017. Sample sizes ranged from 10 to 2500. Treatment effectiveness (eg, percentage weight loss, comorbidity resolution) consistently emerged as the most valued attribute, followed by cost and safety (notably gastrointestinal adverse effects). Willingness-to-pay estimates from DCEs showed patients were willing to pay more for greater weight loss, fewer adverse effects, and improved comorbidity outcomes. However, DCE methodologies varied considerably in design and analysis. Qualitative and survey studies further highlighted the influence of social support, stigma, and long-term risk perceptions.

Conclusions

Patients prioritize effectiveness, cost, and safety in weight management and are willing to make meaningful trade-offs among these attributes. As the obesity treatment landscape evolves, preference studies using more standardized methods are critical for advancing patient-centered weight management.