Abstract:
Background: Real world persistence with anti obesity medications is historically a challenge; approximately 20–50% discontinue within one year and weight regain after cessation is common. Beyond medication tolerability, psychosocial barriers (emotional distress, disrupted routines/social eating norms, household dynamics, stigma) impede initiation and continuation, whilst routine healthcare visits focus heavily on physical aspects of disease management and education, limiting identification of psychosocial and behavioural barriers.
Objectives: To characterize patient reported psychosocial barrier profiles across core domains of disease management using an AI enabled patient priority tool, and to assess patterns by GLP 1 use status.
Methods: In Q1 2026, adults with obesity completed a validated psychosocial assessment selecting and ranking their top two barriers and rating importance (low/moderate/high). Weighted unmet need intensity scores were calculated by multiplying the number of times each barrier was selected by respondent assigned importance ratings and aggregated by domain and priority level. Results were summarized overall and by GLP 1 use status, with depressive symptoms assessed using PHQ 2.
Results: Cohorts included patients with current GLP 1 use (n=97; 34%), prior GLP 1 use with discontinuation (n=111; 39%), and GLP 1–interested patients with no prior use (n=75; 27%) (N=283; 191 female/92 male). Psychological and therapy/support domains accounted for 75% of total weighted intensity. Psychological barriers dominated primary priorities (74%) and were highly concentrated in a small set of emotional statements (fear, overwhelm, sadness) representing 98% of psychological intensity. Therapy/support domains dominated secondary priorities (71%) and showed concentrated unmet-need intensity. Beyond the primary and secondary priority domains, social barriers were concentrated, with 83% of intensity captured within support gaps and stigma. Knowledge/execution contributed <10% of total unmet-need intensity and was primarily focused on routine and skill-based execution challenges. GLP 1 interested respondents showed the highest overall unmet need concentration, while discontinued respondents shifted toward therapy/support as a primary priority. Mean PHQ2 scores were highest in the cohort of interested in GLP-1 patients but with no prior use.
Conclusions: Barriers were highly concentrated around psychological and therapy/support needs across GLP 1 cohorts, rather than gaps in lack of knowledge. These findings highlight opportunities to personalize care plans, treatment, and communication by aligning support to patient reported priorities and stage of treatment. A patient priority tool may help care teams better target support and improve adherence.
