Rethinking obesity management targets: Findings from an international MoSCoW prioritization workshop.

BACKGROUND

Obesity is a chronic disease that requires individualized, person-centred care beyond traditional weight-centric targets. Despite growing global recognition of obesity's multifactorial nature, research and treatment goals remain narrowly focused on percent weight loss, often misaligned with patient experiences and broader health outcomes. To address this gap, and building on a prior scoping review, we convened an international priority-setting workshop to identify and prioritize requirements to inform the subsequent development of a comprehensive obesity management framework.

METHODS

This was an international workshop study using the MoSCoW (Must have, Should have, Could have, Won't have) prioritization method to identify and prioritize requirements, outcome domains, and implementation considerations to inform the future development of an obesity management framework. The invitation-only workshop was held in Toronto, Canada, with participants including clinicians, researchers, organizational representatives, and individuals with lived experience. Data from breakout group discussions were synthesized into thematic categories and validated through member checking.

RESULTS

Eighteen participants contributed to the workshop, resulting in 15 prioritized themes across the four MoSCoW categories. "Must-have" themes included multi-faceted pillars of obesity care (e.g., pharmacotherapy, behavioral support, surgery), healthcare provider sensitivity training, and valid outcome measures that assess complications and patient-reported outcomes. "Should-have" themes emphasized mental health tracking, functional outcomes, and personalized metrics. "Could-have" themes included ongoing education, team-based care, and policy integration. "Won't-have" themes rejected stigmatizing language, aesthetic-based success markers, and short-term interventions. Across the prioritized themes, participants emphasized shared decision-making, compassionate care, and alignment with patient values, preferences, and lived experience.

CONCLUSIONS

The themes address obesity management targets alongside related care, measurement, education, and implementation considerations. This workshop represents a foundational step toward developing a comprehensive obesity management framework that integrates clinical evidence, patient priorities, and system-level considerations. Future work will focus on framework co-development, implementation, customization, and evaluation across healthcare settings.