Shared Decision-Making in Obesity Care Faces Patient, Provider, and System-Level Barriers

Dr. Samith A Shetty, MBBS, MDRC, Consultant Diabetologist, Sparsh Hospital Infantry Road and United Hospital. Bengaluru

A review found that successful shared decision-making in obesity and type 2 diabetes care requires better patient support, provider training, and healthcare system changes.

A narrative review explored the challenges of using shared decision-making (SDM) in the care of people with obesity and type 2 diabetes. Although recent obesity management guidelines, including those from the American Diabetes Association, recommend SDM as part of person-centered care, its use in routine practice remains limited.

The review examined barriers to SDM and looked at strategies that have been used to overcome them. The authors reviewed evidence on factors affecting SDM at the patient, healthcare provider, and healthcare system levels, along with approaches such as patient decision aids, provider training, and clinical decision support tools.

The review found that patients may face challenges such as weight-related stigma and limited knowledge about obesity and available treatments. Healthcare providers may have limited training in obesity care or feel uncomfortable discussing weight. System-level barriers included restricted access to treatment, poor care coordination, limited appointment time, and reimbursement challenges. Some patients may also experience medical mistrust or feel less involved in decision-making because of perceived differences in authority between themselves and their healthcare providers.

The authors noted that tools and training programs can help support SDM, but putting these approaches into routine practice remains difficult. They concluded that better obesity education, stronger support for healthcare professionals, and healthcare system improvements are needed to make shared decision-making a regular part of obesity and type 2 diabetes care.

(Reference: Leah M. Schumacher, Sarah Bauerle Bass, Jamy Ard, Daniel J. Rubin, Sharon J. Herring, Ajay D. Rao, Resa M. Jones, David B. Sarwer; The New Obesity Treatment Landscape: Challenges and Opportunities to Promote Shared Decision-Making in People With Obesity and Type 2 Diabetes. Diabetes Care 20 May 2026; 49 (6): 906–915. https://doi.org/10.2337/dci25-0094 )