The New Obesity Treatment Landscape: Challenges and Opportunities to Promote Shared Decision-Making in People With Obesity and Type 2 Diabetes.

New obesity management guidelines, including those from the American Diabetes Association, advocate the use of shared decision-making (SDM) for obesity treatment. SDM is an evidence-based approach for promoting person-centered care and is widely recommended across medical specialties. However, a variety of issues challenge the use of SDM in daily practice. In this narrative review we discuss factors that may impede the use of SDM in adults with obesity and type 2 diabetes, as well as past efforts to address these barriers. Patient-level factors such as internalized weight bias and lack of knowledge about obesity and its treatment, provider-level factors such as limited training in obesity management and lack of confidence in sensitively discussing weight, and system-level factors like poor treatment access and limited care coordination stymie effective SDM around obesity management. A perceived power imbalance between patients and providers and medical mistrust are additional barriers for some. In the past, researchers have attempted to overcome these barriers to advancing SDM through approaches including patient decision aids, provider training, and clinical decision support systems, with moderate success. This article concludes with recommended strategies for clinical adoption of SDM for patients with obesity and type 2 diabetes, a call for system-level changes to create an environment more conducive to effective SDM, and directions for future research.