# Logistics, effectiveness, safety, and accessibility: Factors determining obesity medication patient preferences from a photovoice analysis

## TL;DR

This study explores what factors influence patients' choices for obesity medications, focusing on lifestyle, effectiveness, safety, and accessibility.

## Contribution

The study introduces a photovoice methodology to uncover patient preferences for obesity pharmacotherapy.

## Key findings

- Patient preferences are shaped by the interaction of efficacy expectations and logistical challenges.
- Safety, risk, and tolerability are significant concerns in medication decision-making.
- Accessibility and structural barriers affect patients' ability to access and sustain treatment.

## Abstract

Obesity is a chronic, relapsing, and multifactorial disease that necessitates sustained, patient-centred management. Although pharmacotherapy is now an integral component of obesity care, there is limited evidence regarding the factors influencing patients’ choices among specific medications. As part of the Innovative Medicines Initiative 2 (IMI2) programme. Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy (SOPHIA) and the second phase of a three-part qualitative doctoral programme, the present study is built upon previous interview findings that examined how patients conceptualize and interpret the factors shaping their pharmacotherapy preferences.

A qualitative Photovoice methodology was employed with treatment naive adults attending a specialist weight management clinic. Participants captured photographs reflecting factors shaping their medication choices and they also engaged in facilitated reflective interviews. Data was analysed using the MAXQDA 2024 software and the Braun and Clarke's framework for reflexive thematic analysis.

The photovoice analysis revealed 4 themes around patient preferences for obesity medications including a) Logistics around Lifestyle, b) Effectiveness, c) Safety, risk and tolerability and d) Accessibility.

Patient preferences for obesity pharmacotherapy arise from the interaction of efficacy expectations with logistical challenged, while concerns regarding safety and accessibility also contribute to decision making. Clinicians should include explanations how the medications can fit into the lifestyle of patients, while also addressing structural barriers that may affect access to treatment, but ultimately allowing patients to understand the balance between efficacy and safety will allow optimal shared decision-making to support sustainable pharmacotherapy pathways.

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