Shared Decision-Making and Obesity Management Across Healthcare Models in the United States: A Narrative Review

Abstract

Background: Obesity remains a significant and complex public health challenge in the United States, contributing to chronic diseases and rising healthcare costs. Shared decision-making (SDM), a collaborative approach that aligns clinical expertise with patient preferences and values, offers a promising yet underutilized framework in obesity care. This narrative review explores real-world applications of SDM within U.S.-based obesity management programs. It synthesizes evidence from diverse healthcare models to identify effective strategies, implementation barriers, and potential implications for clinical practice and health policy. Methodology: A narrative review that adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) principles was conducted; focusing on selected case studies, including Kaiser Permanente’s bariatric surgery pathway, the practice-based opportunities for weight reduction (POWER) Trials, program to reduce incontinence by diet and exercise (PRIDE) trials, the Look AHEAD (Action for health in diabetes) study, and Duke Health’s pediatric obesity interventions. Each case was assessed for its integration of SDM principles, clinical outcomes, and adaptability across care settings and specialties. Results: The review identifies common facilitators of SDM success, such as the use of decision aids, culturally tailored counseling, and multidisciplinary team involvement. Barriers include time constraints, limited provider training in SDM, and systemic fragmentation. Programs incorporating SDM reported improved patient engagement, satisfaction, and health outcomes across diverse demographic groups. Conclusion: Integrating SDM into obesity enhances patient-centered care and has the potential to improve long-term outcomes. Greater emphasis on providing education, supportive policies, and scalable decision support tools is necessary to embed SDM more widely into clinical practice.