Leadership in Obesity Care: Strategies to Support Healthcare Professionals in Effective Decisions, Communication, and Solutions – A Scoping Review

Introduction

Obesity affects millions of people worldwide and, with one in eight people living with the condition, it remains a significant global health challenge.¹ People living with obesity often face increased risks of illness, reduced quality of life, and barriers to care, with many people continuing to encounter limited options for effective, long-term support for this condition.¹ Although decades of research and public health initiatives have sought to address rising obesity rates, more recent evidence has demonstrated that obesity is recognized as a chronic, recurring condition influenced by biological, psychological, and social factors.^2,3 Additionally, the World Health Organization⁴ described obesity as complex with multifactorial determinants and emphasized that no single intervention alone can stop the increase in obesity. This complexity necessitates system-level responses, reinforcing the need to understand from research how those within healthcare systems can respond to this health challenge with improved communication, decisions, and solutions to obesity care.

Previous understandings of obesity limited the development of effective policy and research programs for its prevention and treatment and were often shaped by obesity bias and weight stigma. Obesity bias refers to the negative assumptions and judgments held about people with obesity,⁵ and weight stigma refers to the resulting discriminatory experiences and outcomes.⁶ Together, bias and stigma have contributed to barriers across healthcare, education, and employment, and continue to reinforce inequities in obesity care. Within healthcare systems, these attitudes and actions influence treatment beliefs, funding priorities, service design, and delivery of healthcare,^6,7 undermining the implementation of evidence-based policies.⁷ As a result, obesity can be inaccurately framed as solely individual in etiology, leading to reductionist approaches that rely on single intervention strategies, such as a narrow focus on weight loss or general advice to “eat less, move more”, while neglecting the wider multifactorial determinants and the structural and commercial drivers of obesity.⁴ In many regions, health systems can struggle to provide equitable and person-centered evidence-based care, resulting in gaps and missed opportunities for prevention and treatment options in healthcare.⁸ Consequently, patient voice research reporting the need for holistic care that addresses their mental health, social circumstances, and provides longer-term support can be ignored.^9,10 In light of growing evidence of obesity as a condition with biological, psychological, and social determinants beyond individual behavior,^2,3 there is an urgent need for leadership within healthcare systems to inform new directions for appropriate prevention, management, and education.

Leadership within healthcare systems plays a central role in shaping how obesity is understood, communicated, and addressed in practice.¹¹ Within healthcare settings, leadership is enacted through clinical decision-making, service design, advocacy, and communication practices that shape patient experience and access to care. Leadership through policy is also critical in supporting healthcare professionals (HCPs) in the delivery of evidence-based healthcare⁴, and effective examples of such can be observed from preventative approaches to improve or stabilize children’s obesity rates. In Ireland, surveillance data suggest that the proportion of primary school children living with overweight or obesity has remained stable for more than a decade.¹⁰ Similar trends have been reported in Italy¹² and France.¹³ The examples demonstrate how coordinated systems-level leadership, supported by political commitment and appropriate resources, can create the conditions necessary for meaningful and sustained change.⁴ Such lessons are relevant not only for preventing and treating obesity in childhood but also for adults seeking effective obesity care within healthcare systems.

Establishing the leadership strategies from research that support effective interventions in obesity healthcare is an important starting point. HCPs role span advocacy for equitable access, creation of supportive team cultures, to the design of person-centered services.^8,14,15 Leadership strategies, such as weight-inclusive care, stigma reduction, practitioner training in new models of care and treatment (including obesity management medication), and structured communication frameworks are increasingly emphasized.^14–19 However, despite a substantial body of obesity research, no review has systematically mapped the leadership strategies used by healthcare practitioners with effective decision-making, communication, and solutions to care for people living with obesity. To address this gap, this scoping review maps and synthesizes, from the existing literature, what strategies are used in obesity healthcare by HCPs to support people living with obesity.

Aim and Scope

This study was guided by the research question:

What leadership strategies in obesity care can support healthcare practitioners with effective decisions, communication, and solutions for people living with obesity?

Thus, this study aimed to conduct a scoping review for leadership strategies on how healthcare professionals can provide effective decisions, communication, and solutions for people living with obesity. This was achieved with the three following objectives:

Objective 1: To scope the literature and identify studies that report strategies in relation to effective decisions, communication and solutions by healthcare professionals when providing obesity care and support.

Objective 2: To map the identified strategies recommended by research that support people living with obesity across all levels of healthcare.

Objective 3: To synthesize the data to identify key findings on effective decisions, communication, and solutions for people living with obesity.

Methods

Research Design

This scoping review systematically identified and mapped the breadth of evidence available on strategies used by HCPs in practice to provide a broad understanding of what is working for HCPs based on the guidelines provided by Pollock et al¹⁹ and Munn et al.²⁰

Selection of Sources of Evidence

A systematic search and retrieval of studies from nine databases was conducted, which included PubMed, Web of Science, and databases searched through EBSCOHost: Academic Search Ultimate, APA PsycArticles, APA PsycInfo, CINAHL with Full Text, and MEDLINE. In addition, we conducted additional searches using Google Scholar to identify eligible studies.

Search Strategy and Selection Criteria

After a pilot search, the search string used was: (“strategies” AND “obesity” AND (“health professionals” OR “healthcare professionals”) AND (“decision” OR “decision-making” OR “communication” OR “solutions”)). Selection criteria were established (Table 1) prior to searching, and authors (AM, LL) screened abstracts and full texts as described in PRISMA using Covidence.

Table 1 Scoping Review Inclusion and Exclusion Criteria

Data Extraction

After screening and selection, 28 studies were included. Information that provided insight into strategies that HCPs report as effective or ineffective in their daily practice was extracted from the abstract, results/findings, discussion, and conclusion sections of articles. During screening, it became apparent that many studies were exploratory and evaluative with HCPs, directly regarding the strategies they use and their effectiveness, which resulted in the presentation of many gaps, barriers, and challenges. Authors mapped these findings from the literature in two ways: 1. presenting HCPs/article recommendations for strategies to counter these barriers (n=21) and 2. presenting findings from interventions that were tested with HCPs and provided outcomes (n=4). This procedure is provided in a PRISMA diagram (Figure 1).

Figure 1 PRISMA flowchart – obesity leadership scoping review.

Data Analysis

Due to the heterogeneity across study designs, two approaches were taken to data analysis. First, an inductive qualitative data extraction and analysis process^19,20 for identifying, organizing, and mapping strategies identified by HCPs within primary research studies was used. This involved content analysis methodology,²¹ which supported the reliable and systematic organization of data to generate findings in context.²² Specifically, two approaches were used: 1. Manifest content analysis²³ was utilized to produce summary tables to understand strategy prevalence across studies and 2. Qualitative content analysis²³ was utilized to complete the grouping of codes into categories and sub-categories that were then described under the related theme. A descriptive narrative summary was produced,²³ which supported the identification of the constructs or concepts discussed and a method to support an organized structure to the findings being described in studies. Second, using a deductive approach,^23,24 a narrative synthesis was produced employing content analysis to synthesize findings on effective communication, decision-making, and solutions.

Quality of Evidence

As this review included research with quantitative, qualitative, and mixed methods designs, two authors (L.L. and A.M.) independently appraised all included articles using the Mixed-Methods Assessment Tool (MMAT).²⁵ Using this tool, studies were rated employing a star system based on the five core quality criteria (20% (*), 40% (**), 60% (***), 80% (****), or 100% (*****)).²⁵ In addition, this review also used the Scoping Review Checklist (SRC) by Cooper²⁶ to guide the reporting of the methodology and the authors self-appraised the article as meeting 20 out of 22 items on the SRC checklist, excluding stage 6.

Results

In total, 28 studies met inclusion criteria for this review, and a summary table (Supplementary file 1, summary of selected studies) was informed by the presentation of scoping methodology of Pollock et al.¹⁹

Characteristics of the Studies

The selected 28 studies had a range of characteristics. The studies were published between 2014–May 2025 and were from 13 different countries, namely Australia (n=3), Brazil (n=3), Canada (n=3), Netherlands (n=3), United Kingdom (n=3), USA (n=3), Sweden (n=2), multinational (n=2), Denmark (n=1), Ireland (n=1), Malaysia (n=1), New Zealand (n=1), Portugal (n=1), Taiwan (n=1). There were a mix of methodologies with more than half of the studies (n=16) having used qualitative methods, eight studies used quantitative methods, three used mixed methods and one used a secondary data analysis approach of video recordings. The participants were HCPs working in a range of settings including primary care, public and private systems, consultants, clinics, and hospital settings. Generally, there were more female than male participants. Some studies included patients as well as HCPs, and only findings clearly indicated as relating to HCPs were included. Participants’ sample sizes ranged between 11 and 1,567 HCPs.

Quality of Evidence

In total, the MMAT²⁵ quality appraisal tool evaluated the quality of the selected articles, resulting in the majority being identified as high quality (4*/5*) (n=27), with only one article receiving 2*. The large number of higher-quality results is linked to the rigorous selection process.

Content Analysis Findings

The first stage of the content analysis included analyzing review data (n=28) for specific strategies. These are available in Supplementary file 2, which analysed for Strategies from primary research studies with HCPs by author, and Supplementary file 3, which coded for Strategy themes in obesity care and support by frequency. Specific strategies in Supplementary file 2 included information on strategy reporting, as either being an outcome of intervention or from recommendations based on the research from inquiry of HCPs practice, whether strategies were tested and their efficacy, and conclusion statements. The strategies were then organized into a summary of nine overarching strategies, and their frequency (%) of mention across studies to provide a visual overview of the most to least reported strategies in the literature (Figure 2).

Figure 2 Overarching strategies: frequency of strategy mention across studies (n=28).

The second stage of the content analysis was to map the strategies inductively from the review data (n=28) in Figure 2, to further understanding of how these strategies could be analyzed within systems and domains. Three distinct categories and two sub-categories were identified and the associated 13 codes are described in Figure 3.

Figure 3 Mapping of strategies in obesity care and support.

Key findings from the first category, Structural Obesity Care and Support, report that leadership strategies at structural, political, or societal level which emphasize systemic responsibility over individual blame are essential. Addressing weight stigma at a structural and service level, through education and HCPs training, improves patient experiences and outcomes.

The second category, Healthcare Strategies, reported that effective obesity care relies on multidisciplinary collaboration, including strong communication, improved GP training and referrals. Holistic, patient-centered approaches go beyond diet and exercise to include psychosocial and cultural factors. Building HCPs self-efficacy in weight-related conversations through structured protocols, motivational interviewing, and long-term patient relationships improves engagement and sustainable outcomes. Shifting focus from weight loss goals to medical endpoints (including maintenance of current weight, fasting glucose, or blood pressure) and developing standardized bariatric surgery guidelines further enhance care quality.

The third category, Population-specific Strategies, collated with the specific strategies reported under two sub-categories 1. Pediatric, which promoted coordinated multidisciplinary teams, evidence-based assessment tools and protocols, parental engagement and school nurse training; and 2. Obesity care and support during pregnancy and reproductive health in women, which recommends tailored dietary interventions, motivational support, and stigma-free HCP communication, strengthened referral pathways and inclusion of patient perspectives to improve adherence and outcomes.

Overall, effective obesity care combines systemic leadership, multidisciplinary collaboration, patient-centered approaches, and targeted population strategies, emphasizing training, stigma reduction, and holistic support to improve health outcomes across all age groups.

Narrative Synthesis

This section concludes with a narrative synthesis based on the key findings from the content analysis. The findings were explored deductively using predefined themes from the research question, on what is known from the identified strategies in relation to 1. Communication; 2. Decision-making; and 3. Solutions.

Identified Communication Strategies

Conversations About Weight

Constructive conversations in healthcare are central for obesity care and support.²⁷ Counselling and communication of prevention strategies with those whose BMI is classified in the overweight category (BMI 25–29.9) but are otherwise healthy^28,29 were found to be important to prevent comorbidities, as was the need for follow-ups, tailored guidance, and consistency in advice.²⁸ Motivational interviewing has been described as a cost-effective communication tool that supports HCPs and patients to improve self-awareness and communication styles in HCPs, contributing to more effective and person-centered plans, but requires support from management and follow-up supervision to ensure effectiveness.³⁰ Motivational interviewing has been found to be effective with pregnant women with obesity, who are reported as highly motivated towards weight management, with pregnancy lifestyle or dietetic clinics being reported as having high levels of attendance.³¹

When communicating about weight with young people and children, research has found that HCPs can be reluctant to raise the subject for various reasons.^32–34 Bradbury et al³⁵ reinforce the importance of communicating with parents about their child’s weight status as an important obesity support and care strategy. Weight-management-related counselling including goal setting, motivational interviewing, using a patient-centered collaborative approach underpinned by patient motivation were found by Nelson et al³⁶ to be important tools for obesity pediatric care and support. Skantze et al³⁴ also noted the need for the development of consistent and evidence-based procedures for HCPs on how to communicate both positive and concerning growth data and weight development to parents, with trust being an important tool for weight-related conversations.³³ All communication with families should be respectful and careful, especially with families who can carry negative previous or stigmatizing experiences with healthcare professionals.³

HCPs Communication Training

Central to effective obesity care and support is improved communication in interdisciplinary teams and relationships.^37,38 How a GP communicates with a patient can also be dependent on wider relationships with management and availability of services, thus training to improve multi-disciplinary approaches should extend to management and providers who have a pivotal role in care navigation and onward referral.^29,39 Training for management and providers,^29,39 especially in the interest of identifying and providing intervention for at-risk children and adolescents.^34,35

Training for HCPs directly has emerged as an important strategy, and barriers to communicating effectively have been identified as stemming from knowledge gaps on the etiology of obesity or on how to provide obesity care and support.^30,40–44 Research with HCPs also reports observations of pregnant patients’ experiences of weight stigma in healthcare settings from fellow HCP⁴⁵ and in antenatal and obesity care, emphasizing the need for obesity-specific training for recognizing potential weight-stigmatizing behaviors, appropriate discussions about gestational weight gain, and reflective practices to identify biases when providing obesity care and support during pregnancy.⁴⁵

HCPs can struggle to talk about obesity when they themselves live with it,⁴⁴ or can often fear offending patients.⁴¹ To address HCPs’ barriers and fears of negative responses, solutions include providing more structured approaches to GPs (protocols, tools, or support),^41,43 appropriate communication techniques,⁴⁶ addressing knowledge gaps,^30,40–44 and training on the timing and contextual factors that facilitate constructive conversations that are both culturally competent and clinically relevant.^40–47 Teixeira et al³⁸ found that HCPs had higher self-efficacy when interventions demonstrated effectiveness and cited toolsets to include CBT strategies, motivational interviewing techniques, and relapse prevention as important strategies.

Supporting Effective Decision-Making with Patients

Collaborative Approaches

Decision-making in obesity care and support can be facilitated by a long-term and trusting relationship between doctor and patient.^33,38,46,48 Multidisciplinary collaboration is an essential strategy in effective healthcare decisions as challenges within teams and clinic environments demonstrably impact the implementation of high-quality obesity care and support interventions.^{29,37,38,40,49} Deciding who to refer to and what professionals can make up a care team is important, as holistic interventions can include strategies to support change at different levels including the individual, the care provider, the system, and social settings,^28,32,48,49 and collaboration with private settings.³⁸ Decisions to support all aspects of the individual, such as addressing other physical issues (for example, sleep), is an important weight management strategy.⁵⁰ With children, effective strategies include identifying the different support needs they can have, and the appointment of care coordinators who can support comprehensive care strategies.^32,35,49,51

Including patients in decision-making at higher levels is essential and research in ante-natal and obesity care provision recommends the inclusion of women’s perspectives in the development of obesity-targeted services³¹ as well as HCPs who work with them.⁴⁴ Additionally, triangulating patient and professionals’ perspectives is an important strategy in the development of recommendations for improving weight management practice,^33,41 and this can lead to improved decision-making in obesity care and support.

Evidence-Based Training and Tools

Primary care is the gateway to holistic obesity care and support, and recommendations to support decision-making strategies with GPs suggests training to improve knowledge of tools, strategies, and referral options^29,38,46 which can improve effective multi-disciplinary work and patient outcomes. Connected with this, it is recommended that effective decision-making requires the development of tools and approaches that address the cultural, psychosocial, and psychological aspects that impact weight management instead of the conventional focus on diet and physical activity.^40,48–50 Additionally, the inclusion of mental health professionals is recommended,⁵⁰ especially for children⁴⁹ and adolescents with obesity.⁵² Key professionals for children can include oral HCPs (dentists), nutritionists, dietitians,²⁷ mental health HCPs, and school nurses^34,52 and so effective decision-making needs to include the building of motivation and capacity for all HCPs to provide specialized training, guidance, skills, tools, or knowledge in pediatric obesity care and support.^{32–35,49,51}

Decisions around treatments should also be informed by the evidence base and HCPs experience as survey data shows that OB/GYNs report different opinions on effective strategies for obesity care and support in patients with PCOS, with stronger results for lifestyle improvements and oral contraceptives, followed by medication for type 2 diabetes, diuretic medications, specific diets, progestin medication, with anti-obesity medication being reported as the least effective.⁴² Education and improvement is needed with prescribing, referring to specialized care (including bariatric surgery) or counselling with patients with obesity attending OB/GYN HCPs.^39,42

Resourcing and Provision

Decision-making is considerably affected in obesity care by the available services, referral pathways, and resources. Key components underpinning decisions in healthcare include adequate time for planning group care activities^29,38 and improved referral processes,^27,38,39,42 such that primary care environments are adequate and supportive with sufficient time and resources.^38,46 In pediatric healthcare, support systems in primary care are necessary for HCPs implementing pediatric obesity care and support,⁵¹ and research found that devising care plans and the reality of implementing them with children and adolescents can be hindered by organizational barriers including a lack of access to adequate care and multidisciplinary teams, time, or financial constraints^32,33,51 and continuity of care or longer-term interventions.^32,51

Effective Solutions as Identified by HCPs

Policy and Research

Based on study recommendations, there is a responsibility and need for leadership strategies at a structural level to address obesity support and care at political and societal levels.^{32,38,40,46,48} There is also a need for the provision of adequate training for policymakers and adequate resourcing in public health systems,³⁸ which directly impact how HCPs provide obesity care and support strategies. There is a persistent call for a move away from discourse of individual blame, and towards strategies that can address practices and policies for the prevention of obesity, and facilitate healthier living by improving public amenities, the food environment, and access to affordable healthier foods.^{38,41,48,50,52} Regarding research, strategy recommendations include that multidisciplinary collaboration bridge the gaps between public health priorities and academic research, to ensure specifically, that child weight-related research is timely and relevant to practitioners.³⁵ This leadership can directly support changes to care and support strategies at the HCPs level.³²

Weight Stigma Reduction

An important leadership strategy is in improving inadequate models of care to embed patient-centered, supportive and nonjudgmental care, and acknowledging that individuals living with obesity often experience marginalization and stigma in healthcare.^48,49,52 Many studies recommend providing HCPs with training on weight bias, stigma, and the discriminatory behaviors that people with obesity face can positively reduce stigmatizing, blaming, and judgmental attitudes of HCPs, managers, and coordinators of care teams,^{32,40,41,48,50,52,53} which one study found to be an efficacious strategy.⁴⁵ Weight stigma reduction can contribute to the increased development of tools and strategies needed in obesity care and support. O’Keefe et al⁵³ reports that there is an association between higher weight stigma and beliefs about obesity, and theorizes that the lower prioritization of spending on obesity research is due to stigma, which affects decision-making at structural levels. Specifically, socially stigmatizing attitudes and beliefs surrounding overweight in children can responsibilize illness⁵² and hinder early intervention.³³ Education strategies⁵³ and public initiatives^33,48 are recommended as⁴⁸ improving societal understanding and knowledge on current scientific understandings of obesity could be an effective way to reduce weight stigma.

Evidence-Based Care

Bradbury et al³⁵ calls for an overarching strategy on the specific development of pediatric weight-related protocols and pathways to avoid inconsistent practice, especially in primary care, which is the recommended gateway.⁵² When working with children and adolescents, HCPs should work from evidence-based models of obesity care.^27,36 These are recommended from HCPs practice and include strategies such as anthropometric assessment methods, risk assessment tools, anticipatory guidance techniques, specialist referral pathway identification, and lifestyle-related modification counselling.²⁷ Similarly, Knight-Agarwal et al⁴⁴ report that HCPs believe that specialist dietary interventions and evidence-based guidelines for working with pregnant women is a public health priority. For bariatric surgery, Yang et al⁵⁴ described the next strategy is the development of best practice guidelines, as there are variations in practice when preparing patients for preoperative surgery including: nutritional screening, weight loss, glycemic control, helicobacter pylori eradication, obstructive sleep apnea screening, smoking cessation, psychological intervention, referral to obstetrician, decision-making, education, and consent, and low-molecular-weight heparin prophylaxis. Finally, Ashman et al⁴³ suggested a change in strategy from weight loss goals to emphasizing medical endpoints, including maintenance of current weight, fasting glucose, or blood pressure. These approaches could contribute to an improved doctor–patient relationship and contribute to self-efficacy and confidence of both GP and patient for healthier changes.⁴³

Discussion

Leadership within healthcare systems shapes obesity care through clinical decision-making, service design, advocacy, and communication, directly influencing patient experience and access to care.¹¹ This scoping review identified 28 studies and mapped leadership strategies reported by HCPs for supporting effective decision-making, communication, and solutions in obesity care. The most commonly reported leadership strategies for obesity healthcare included training for HCPs, managers, and providers; multidisciplinary approaches and teams; evidence-based models of care; and structural interventions to address policy, research, and stigma (Figure 2). Leadership is enacted not only through organizational and policy-level strategies but also through patient-centered and inclusive approaches, with attention to trust, longer-term care, and holistic approaches identified as the next most frequently reported strategies.

Mapping of strategies inductively showed that HCPs linked leadership to structural, healthcare, and population-specific strategies in the provision of obesity care and support (Figure 3). The final synthesis organized these strategies into three categories: communication, decision-making, and overarching solutions that answer the research question. In communication, leadership was evident through weight-related conversations and HCPs’ training emerged as central. In decision-making, leadership manifested in collaborative approaches, access to evidence-based training and tools, and ensuring adequate resourcing. At the systems level, solutions focused on policy reform, stigma reduction, and ensuring access to evidence-based care.

Leadership Strategies in Obesity Care: Integrating Systems, Practitioners, and Patients in Obesity Healthcare

Analysis of the literature from 2014 to 2025 identified a change in research focus in obesity healthcare from individual-level solutions (i.e. weight loss focused – “eat less, move more”) to include multi-level strategies that emphasize the role of leadership across structural and societal levels for both prevention and treatment. This shift reflects the broader scientific understanding of obesity as a complex healthcare issue and a chronic, and reoccurring condition that requires coordinated, multi-level leadership to deliver high-quality, evidence-based healthcare.^2–4 Figure 4 illustrates the relationships between levels.

Figure 4 Leadership strategies across domains in obesity care and support.

Topics such as access to specialist obesity services, the pervasive impact of weight stigma, evidence-based policy, adequate resourcing and provision were increasingly being reported in the literature, alongside calls for leadership at political levels. These issues are linked to inadequate policy, as many government obesity policies continue to focus on individual behavior change,^5,53 despite extensive evidence of their lack of effectiveness. For example, only 8% of England’s obesity policies over three decades met criteria for effectiveness, largely due to poor implementation and the aforementioned emphasis on personal responsibility.^55,56 Additionally, the UK sugar tax reduced sugar consumption but failed to address broader dietary patterns.⁵⁷ This shift in the literature reflects the urgent need for leadership to improve overarching and structural strategies towards policy, addressing weight stigma and obesity bias at both societal and provider levels. The leadership gaps are closely linked to insufficient research, resourcing and financing, and unaddressed policy gaps.^6,53,58

The most frequently reported strategy in this review regarded training. HCPs articulated the real-world challenges they face and the support they require to implement effective strategies when providing obesity care and support to patients.⁴⁹ These findings support a recent study in which HCPs call for evidence-based obesity education to be integrated into healthcare training programs to tackle stigma and build HCPs competence to provide improved obesity healthcare to patients.⁵⁹ Our review also highlighted that HCPs are calling for specialized approaches to meet the diverse needs of different populations across the lifespan (eg pediatrics, ante-natal), emphasizing that people living with obesity are not a homogenous demographic. Holistic and individualized approaches are essential, and leadership at research and policy levels can support the integration of patient voice and lived experiences to ensure interventions are relevant, responsive,⁶⁰ and guide system-level change toward equitable and evidence-based obesity care.

Constructive Communication

Central to high-quality, evidence-based obesity care and support is the need for constructive conversations in healthcare.^37,38 This extends beyond the patient–provider relationship to include HCPs working within teams, and between management and staff. Leadership in resourcing and organizational support requires listening to HCPs’ needs and supporting effective communication in multi-disciplinary teams. Communication is essential for both prevention and treatment strategies, and for HCPs working with patients directly, conversations need to foster understanding, trust, empathy, cultural sensitivity, and respect for each person’s health priorities and knowledge. This topic is pertinent as recent lived experience studies have shown that obesity bias continues to be a feature in HCPs’ communication.^6,61

Adequate training for HCPs in health-related conversations is essential to ensure adequate care planning, support learning and growth for both patients and staff, and enable effective responses to challenges and opportunities in obesity healthcare.^61,62 Training, as the most frequently reported topic in our review, is therefore a central leadership strategy to support HCPs to address knowledge gaps, build confidence, and effectively provide obesity care and support.^30,40–44 Improved communication training can contribute to patient-centered, collaborative, and non-judgmental health advice, and improved health outcomes for patients. More recently, the role of artificial intelligence has offered important opportunities for developing HCPs’ communication skills.^41,63

Decision-Making in Obesity Care

When considering leadership in decision-making strategies, this review found that collaborative approaches that integrate leadership strategies across HCPs, patients, and multi-disciplinary teams were central. Decision-making can be greatly hindered when specialized services and primary care are not funded adequately, or HCPs’ lack knowledge about available healthcare options to meet their patient needs.⁶⁴ Additionally, poor referral pathways, service fragmentation, and access issues negatively impact patient decision-making with their healthcare and points to the need for improved training, resourcing, and system design.⁶⁴ HCPs want to improve knowledge and referral pathways, and findings in this review repeatedly highlight the futility in making decisions about healthcare without leadership-driven support to ensure services and referral pathways are available to meet patient need.

Considering the biological, psychological, and social determinants involved in obesity, leadership in multi-disciplinary teams is a key strategy for comprehensive care planning. This type of planning, when free from obesity bias, can improve health outcomes⁶ and reduce stigmatizing experiences, aligning with WHO¹ ‘Health in ll Policies’ (HiAP) approach to improving health and reducing inequalities. Moreover, treatment decisions should be evidence-based, with regard to age, gender, and life stage. Leadership in integrated care models can move healthcare away from fragmented or siloed approaches, creating a cohesive, supportive environment where patients are active participants in their treatment. Shared decision-making supports patients to make informed choices about treatment options and actively involves them in decisions that affect them, especially when dealing with variations in population needs and potential health disparities. A report on 50 countries found a lack of adequate services in many, especially in lower-income countries and in rural areas,⁶⁵ highlighting the critical role of leadership to address socio-economic determinants of obesity and enable individual providers to make effective decisions on health care with supportive policy and provision.

Whole System Interventions in Obesity Care

Effective obesity prevention and treatment require high-level government commitment,⁴ alongside coordinated multi-level action that addresses the many determinants of obesity. Leadership is critical for developing integrated food policies, fostering sustainable food systems, ensuring equitable access to nutritious options, and implementing interventions that tackle the root causes of obesity, which are frequently linked to socio-economic disadvantage and environmental factors. At the same time, investment in pharmacological treatments for obesity has grown rapidly, offering new options but also raising concerns, including equitable access and lack of longer-term support for patients.^6,66 Leadership can ensure that prevention and treatment strategies and policies are aligned with the evidence on disease etiology, and avoid placing blame and responsibility solely on individuals or individual interventions. Suggested strategies in our review included leveraging regulatory measures, reviewing the food environment and the impact of the built environment for opportunities that can best promote health and well-being. These approaches can support delivery of treatments, as a recent review concluded that primary care could play a pivotal role in addressing obesity.⁶⁶ This connects with recent findings on HCPs calls for leadership at higher levels to implement improved models of care and protocols. This can ensure best practice for HCPs and standardized, effective, and equitable approaches for individuals living with obesity.⁶⁴

Central topics that impact all system levels are obesity bias and weight stigma.^6,53 Addressing obesity bias reduction is a critical overarching leadership strategy, as it has globalizing and trickle-down effects impacting research, policy, and healthcare provision that results in stigmatizing experiences. On a political level, bias and stigma impact how policies are written and what resources are allocated, and similar impacts are seen in research.⁵³ At the healthcare level, a recent systematic review by Telo et al⁶ reports how obesity bias has negative effects on medical decision-making and the quality of care, noting that obesity bias is present from the beginning of medical education. Leadership is needed at all levels to reduce weight stigma and its adverse impacts on patient health outcomes, patient mental health and engagement, and the quality of care provided by HCPs.⁶ For people living with obesity, frequent reports describe stigmatizing experiences in healthcare, such as being dismissed or blamed for unrelated health issues during medical consultations.^15,67 These experiences can contribute not only to delays in diagnoses and avoidance of healthcare but can also negatively impact on the mental health of individuals living with obesity.⁶⁸ The internalization of societal biases that lead to self-directed shame has been strongly associated with reduced quality of life and heightened psychological distress amongst other mental health outcomes in adults.⁶⁹ Obesity bias can also be implicit in systems that are not structurally designed to support people with larger bodies.⁷⁰ Individuals who experience stigma are more likely to engage in disordered eating, such as binge eating or restrictive dieting, which exacerbates both physical and psychological health challenges.^68,71 This is problematic given the high comorbidity of eating disorders and obesity⁶² and further emphasizes how leadership in providing person-centered approaches can mitigate these harms and ensure that both HCPs and patients are supported. A recent trial demonstrated effectiveness in modifying prejudices and conceptions in HCP undergraduates,⁷² demonstrating effective strategies in tackling obesity bias and weight stigma.

Recognizing obesity as a chronic condition is itself a leadership strategy. The development of relevant clinical definitions, evidence-based guidelines, and alignment with healthcare standards akin to other chronic conditions is needed.⁷ Once obesity is recognized in this way, a whole systems approach can then be implemented with leadership strategies involving collaboration across healthcare, education, urban planning, and policy-making. This approach can create supportive environments that can reduce obesity risk as well as ensuring that those who need services have access to person-centered and holistic healthcare with HCPs.⁶⁶ This integrated leadership approach addresses individual needs while tackling the broader societal determinants, enabling sustainable and improved public health outcomes. This is aligned with NICE⁷³ guidelines which reinforce that obesity management needs to be holistic in approach and align with Whole Systems Approaches (WSA), which aim to address obesity’s root causes through coordinated efforts across sectors in tackling societal, environmental, and economic contributors. France’s EPODE and Australia’s Healthy Together Victoria have shown promise in reducing obesity by engaging communities and integrating policies.^74,75 However, effectiveness depends on local contexts, resources, and sustained collaboration.⁷⁶ Finally, leadership must differentiate between “obesity prevention” and “obesity treatment” and evaluate how both approaches are best provided to people, families, and communities across the life course to achieve meaningful, equitable and sustainable health outcomes.^77–79

Limitations

This review focused on what strategies are enabling HCPs to provide effective decisions, communications, and solutions that improve the lives of people living with obesity. Studies that did not include HCPs were omitted. Research with patients who are in receipt of healthcare and can provide important perspectives, were not included and thus this review only represents the perspectives of one side of the HCP–patient relationship. The heterogeneity of study designs, populations, and outcomes limited direct comparison and synthesis of findings. Although included studies were rated as high-quality (n=27) using the MMAT, the presence of a lower-quality study (n=1) may have influenced the interpretation of some results.

Further Research

This review indicates that more research is needed to improve and evaluate currently used strategies and tools, and to develop evidence-based protocols for multi-disciplinary approaches. While this research systematically scoped findings from research studies with HCPs, they represent one half of the healthcare relationship; a similar scoping review is necessary to identify supportive strategies from research with patients. This would provide a more comprehensive understanding of the current barriers and facilitators to effective strategies in obesity care. Additionally, emerging interventions such as obesity management medications (eg GLP-1 therapies) were not a focus within this scoping review and may benefit from a targeted review in this area. Further research and evaluation is also needed in areas such as communication skills for HCPs when discussing weight, approaches to strengthening professional leadership in reducing weight stigma, and ways to better distinguish and coordinate obesity prevention and treatment strategies.

Conclusion

This scoping review demonstrates that the current evidence of effective strategies in obesity care is nascent and reflects a limited and inadequately developed set of strategies across communication, decision-making, and solutions. This review also highlights significant gaps in policy and research, particularly in relation to weight stigma, which remains a central challenge across all domains and continues to shape how obesity care is delivered and experienced. From the literature, this review identifies emerging evidence-based and conceptual leadership strategies for decisions, communications, and solutions. There is emerging evidence in areas such as HCPs’ training for constructive communication when discussing weight and care planning, collaborative use of evidence-based tools, and leadership in appropriate resourcing, policy, and research. Further evaluation is needed across all strategies to measure their effectiveness and impact.

The findings of this review map new directions from the literature to advancing obesity care. Coordinated, multi-level, and interdisciplinary approaches are needed to address the structural and societal factors driving obesity, while ensuring that at the service level, HCPs are empowered to provide evidence-based, de-stigmatized, well-resourced, and equitable care. By integrating leadership across policy, research, and practice, healthcare systems can move toward holistic, patient-centered approaches that improve outcomes for people living with obesity and guide future strategies in both prevention and treatment.