Integrating Shared Decision-Making, Motivational Interviewing, and Health Coaching in Obesity Care: A Stage-Based Conceptual Framework for Sustainable Behavior Change.

backgroundObesity is a chronic, multifactorial disease that requires sustained modification of health behaviors. Although effective behavioral, pharmacological, and surgical treatments are available, long-term weight loss maintenance remains challenging. Shared decision-making (SDM), motivational interviewing (MI), and health coaching (HC) have been studied as patient-centered approaches that may support communication, decision-making, motivation, and engagement. However, their impact on behavioral and clinical outcomes, particularly sustained weight loss, varies considerably across studies. The aim of the review was to critically examine SDM, MI, and HC as complementary patient-centered approaches to facilitating behavior change in obesity care and to propose a stage-specific conceptual framework integrating these interventions across the clinical care pathway.

methodsA critical integrative narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science. English-language publications published between 2017 and 2026 addressing SDM, MI, or HC in adult obesity care were included. Evidence was synthesized using directed qualitative content analysis to compare theoretical foundations, mechanisms of action, clinical functions, and implementation considerations.

resultsThe reviewed approaches addressed distinct but interconnected phases of behavior change. SDM primarily supports informed treatment decisions aligned with patient values and preferences. MI facilitates the transition from ambivalence to action by strengthening autonomous motivation and readiness for change. HC focuses on the implementation and long-term maintenance of health behaviors through goal setting, self-monitoring, feedback, and self-regulation strategies. Based on this synthesis, we propose a conceptual framework that maps the complementary primary functions of SDM, MI, and HC onto different, potentially overlapping phases of the behavior change process.

conclusionsSDM, MI, and HC should be viewed as complementary rather than competing approaches in obesity management. The proposed framework may help clinicians conceptualize how SDM, MI, and HC could complement one another in obesity care. Whether their integration improves patient engagement, treatment adherence, or long-term weight management outcomes remains to be established empirically.