Patients’ Perceptions of Combining Pharmacotherapy and Lifestyle Modifications for Weight Management: Barriers, Facilitators, and Impacts on Adherence

Date of Graduation

5-2026

Document Type

Project

Keywords

lifestyle modification or lifestyle change or lifestyle intervention, weight loss or weight reduction or lose weight, medication or medicine or drugs or pharmacological therapy, and survey or questionnaire

Degree Name

Doctor of Nursing Practice (DNP)

Degree Level

Graduate

Advisor/Mentor

Shreve, Marilou

Committee Member

Ballentine, Hope

Second Committee Member

Kruse, Carmel

Abstract

Patients’ Perceptions of Combining Pharmacotherapy and Lifestyle Modifications for Weight Management: Barriers, Facilitators, and Impacts on Adherence

Catherine Miget, Hope Ballentine, Carmel Kruse

The University of Arkansas

Eleanor Mann School of Nursing

1 University of Arkansas

Fayetteville, AR 72701

No conflicts of interest.

Abstract

This Doctor of Nursing Practice (DNP) project explored patients’ perceptions of combining pharmacotherapy with lifestyle modifications for weight management. As the prevalence of obesity rises, GLP-1 receptor agonists have become a common treatment option. Many patients view these medications as a standalone solution, often neglecting essential lifestyle changes such as diet and physical activity. This project aimed to identify barriers and facilitators influencing adherence and readiness to adopt lifestyle modifications alongside medication. Grounded in the Transtheoretical Model, the project utilized two validated tools—the S-Weight and P-Weight questionnaires—to assess participants’ stage of change and behavioral processes related to weight management. Data was collected from adult patients at a suburban, private clinic who were prescribed GLP-1 receptor agonists. Questionnaire results were analyzed using exploratory descriptive statistics to determine whether mean scores differed by stage of change. Findings will help identify motivational gaps, readiness levels, and opportunities for targeted support. The goal was to inform individualized, evidence-based interventions that can be sustainably integrated into clinical workflows. By enhancing patient-provider communication and aligning interventions with behavioral readiness, this project sought to improve adherence, promote lasting weight management, and support better health outcomes. Results were shared with clinic stakeholders in hopes to inform broader practice changes, such as routine behavioral readiness assessments in weight management programs.

Keywords: lifestyle modification or lifestyle change or lifestyle intervention, weight loss or weight reduction or lose weight, medication or medicine or drugs or pharmacological therapy, and survey or questionnaire

Introduction

Obesity is a complex, multifactorial disease influenced by genetic, environmental, and behavioral factors. Genetic variations occur that are linked to increased adiposity, but lifestyle and environmental factors play a substantial role in its development (Frayling et al., 2007; Perreault & Rosenbaum, 2025). Attributing factors such as energy intake and expenditure, marketing, irregular sleep patterns, increased screen usage, and lower socioeconomic status have contributed to the rising prevalence of obesity worldwide (Cappuccio et al., 2008; Nicolaidis, 2019., Salerno et al., 2024).

The global prevalence of obesity has increased from 3% and 6% to 11% and 15% in men and women respectively since 1975 (Jaacks et al., 2019). In the United States, obesity affects more than 40% of adults (CDC, 2024). Projections suggest that nearly half of Americans will have obesity by 2030 (Ward et al., 2019). In Missouri, obesity prevalence is the 20th highest, with rates exceeding 40% in Cape Girardeau County (Data Commons, 2022). This is problematic as obesity significantly increases the risk of numerous chronic diseases including type 2 diabetes, cardiovascular disease, cancer, musculoskeletal disorders, and depression, contributing to diminished quality of life and premature mortality (Blüher, 2019; Wilding et al., 2022). Beyond individual health effects, obesity imposes a major economic burden, accounting for over $170 billion in annual U.S. healthcare costs and contributing to decreased productivity and increased disability (Cawley et al., 2021; Goettler et al., 2017).

Effective obesity management typically begins with lifestyle modification, including diet, exercise, and behavior therapy (Jensen, 2014). However, adherence to lifestyle change is often poor, limiting long-term success (Wu et al., 2009). Likewise, many patients perceive pharmacotherapy as a standalone solution, leading to inadequate lifestyle engagement and gaining weight back upon discontinuation (Qin et al., 2024; Wadden et al., 2022).

This trend emphasizes the importance of understanding patients’ perceptions of integrating pharmacotherapy with lifestyle interventions. Pharmacologic therapies have emerged as valuable adjuncts to behavioral interventions. Anti-obesity medications, including GLP-1 receptor agonists, have demonstrated clinically meaningful weight reduction, particularly when combined with diet and physical activity (Wilding et al., 2022; Chang et al., 2022). Research indicates that combining GLP-1 receptor agonists with behavioral modification results in greater weight loss and improved cardiometabolic outcomes compared to medication alone (Chu et al., 2025). There is a lack of literature about how patients view this integration, what barriers they encounter, and their readiness to adopt and sustain healthy behaviors during medical treatment.

At a suburban private clinic in Missouri, clinicians observed that many patients using weight loss medications struggled to maintain long-term results due to low adherence to diet and exercise recommendations. This observation prompted a clinical inquiry project to explore patients’ perceptions, barriers, and readiness for lifestyle change while taking GLP-1 receptor agonists.

The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate patients’ readiness for lifestyle modifications while using pharmacotherapy for weight management, using the P-Weight and S-Weight questionnaires based on the Transtheoretical Model (TTM). Using results, we aimed to improve the understanding of patients’ readiness to make lifestyle changes while taking prescription weight loss medication.

These questionnaires are validated tools that have already been studied using the TTM and have shown excellent reliability and retest properties (Gohari et al., 2019). They are helpful in assessing the process of weight management and relationship with external measures. Understanding patients’ stages of change and behavioral processes can guide providers in tailoring education and support strategies to improve adherence, enhance outcomes, and promote sustainable weight management. Most protocols for weight management focus only on the medical component (Seals, 2007).

Methodology

Design

This Doctor of Nursing Practice (DNP) project utilized a descriptive, cross-sectional design to examine patients’ perceptions and readiness to adopt lifestyle changes while using pharmacotherapy for weight management. Specifically, the study focused on adults prescribed glucagon-like peptide-1 (GLP-1) receptor agonists. Quantitative data were collected using two validated instruments—the S-Weight and P-Weight questionnaires—both grounded in the Transtheoretical Model (TTM). The S-Weight questionnaire was administered first to determine each participant’s stage of change related to weight management, followed by the P-Weight questionnaire to assess readiness to change across four behavioral domains: emotional re-evaluation, weight management actions, supporting relationships, and consequences of excess weight.

The design was appropriate for identifying trends in readiness and potential barriers to behavioral change within the existing clinical workflow. This approach aligned with the clinic’s mission to deliver individualized, evidence-based care and supported its quality improvement goal of integrating behavioral readiness assessments into obesity management practices.

Setting

The project was conducted in a suburban, private clinic specializing in wellness and weight management. The clinic provides pharmacologic and lifestyle-based interventions for obesity, including the prescription of GLP-1 receptor agonists.

Population and Sample

The study population included adults aged 18 years and older who were prescribed GLP-1 receptor agonists for weight management at the participating clinic. Inclusion criteria required participants to be English-speaking and actively engaged in the clinic’s weight-loss program. Exclusion criteria included cognitive impairment or lack of current pharmacotherapy use. All eligible patients were invited to participate using a convenience sampling approach. A sample size of 200 would have been needed to complete an analysis of variance, and this was not feasible at this site.

Intervention

The project intervention consisted solely of administering the S-Weight and P-Weight questionnaires. Both tools are validated and measure behavioral and cognitive readiness for weight management. No physical or behavioral interventions were implemented.

Measures

Conceptual Measures

The Transtheoretical Model (TTM) guided the conceptual framework, enabling assessment of participants’ stages and processes of change through the S-Weight and P-Weight questionnaires.

Outcome Measures

Primary outcome measures included (a) domain-specific scores from the P-Weight questionnaire evaluating emotional readiness, weight management actions, social support, and perceived consequences of excess weight. P-Weight items were rated on a 5-point Likert scale (1 = never, 5 = always); higher scores indicate greater use of processes of change, including cognitive, emotional, behavioral, and social strategies. Stage-of-change classifications from the S-Weight questionnaire identified each participant’s phase (1 = precontemplation, 2 = contemplation, 3 = preparation, 4 = action, or 5 = maintenance).

Process and Balancing Measures

Process measures included questionnaire completion rates and response accuracy to evaluate feasibility and patient engagement. Balancing measures included provider feedback on the utility and time burden of incorporating behavioral readiness tools into clinical practice.

Ethical Considerations

The project posed minimal risk to participants and involved no invasive procedures. Potential psychological discomfort related to self-assessment of weight behaviors was mitigated by allowing participants to skip any question or withdraw at any time. Data confidentiality was maintained by removing all identifiers and assigning numeric codes to responses. Informed consent was obtained prior to participation.

Recruitment and Consent Procedures

Patients were recruited in person by the DNP student or wellness practitioner during clinic visits. When unavailable, the DNP student joined telehealth visits to discuss participation. Each participant received an information sheet outlining the study’s purpose, procedures, risks, and voluntary nature. Informed consent was obtained prior to completing the questionnaires. The DNP student was in charge of all data analyses.

Data Collection

Participants completed both the S-Weight and P-Weight questionnaires during their scheduled clinic appointments. Data were collected either via printed surveys or secure electronic format. Each survey was coded and stored in a secure database accessible only to project personnel.

Data Analysis

All completed surveys were input by the DNP student into Qualtrics. Data was analyzed quantitatively using descriptive exploratory statistics to identify trends in readiness, stage of change, and potential barriers to lifestyle modification. Frequencies, means, and standard deviations were calculated for all major variables. The relationship between readiness levels and behavioral domains was examined to guide future interventions.

Timeline

The project took place from June 2025 through May 2026. The preparation phase (June–August 2025) included supply acquisition and stakeholder planning. Data collection occurred from November 2025 through February 2026. Data analysis and results dissemination occurred from March to May 2026.

Resources and Economic Considerations

Existing clinic infrastructure and staff support were utilized. Resources included printed or digital versions of the S-Weight and P-Weight questionnaires, secure data storage, and access to statistical software for data analysis. No external funding was required. The estimated time burden for staff participation was minimal.

Results

This quality improvement project evaluated the integration of the S and P-Weight Questionnaires into routine care for adults prescribed GLP-1 receptor agonists in a suburban private clinic. The findings suggest that structured readiness assessment may meaningfully enhance engagement in identifying weight-control behaviors and stages of change among patients receiving pharmacotherapy.

Participants were initially grouped into the appropriate stage of the Transtheoretical Model (TTM) and results of the S-Weight questionnaire (Table 1). There were 12 individuals that identified they had been making an effort to lose weight for less than six months; placing them into the action stage of the TTM. There were 16 individuals that identified they had been making an effort to maintain their weight for more than six months, placing them into the maintenance phase. A one-way ANOVA was then performed to compare scores on the two groups. Prior to this, a Levene’s test confirmed homogeneity of means. The subscales from the P-Weight Questionnaire included emotional re-evaluation (EmR), weight consequences evaluation (WCE), supporting relationships (SR), and weight management actions (WMA). Emotional re-evaluation reflects the individual’s affective response to their current weight and the emotional impact of potential weight-related changes. Weight consequences evaluation assesses the individual’s personal appraisal of the risks and outcomes associated with excess weight. Supporting relationships evaluates the presence and perceived quality of interpersonal support for weight management efforts. Weight management actions represent the individual’s engagement in concrete behaviors aimed at achieving or maintaining weight loss.

These process of change items have their own scoring key with questions specific to each subscale (Table 1). Scores for each of the four processes of change are calculated by summing the scores obtained on items belonging to the same subscale. None of the items are reverse scored. In order to make scores from the different subscales comparable, these scores are transformed onto a scale from 0 to 100 (0 reflecting no use of a given process of change and 100 being full use of that process) (Andrés et al., 2015).

Table 1

Stages of change questionnaire in weight management (S-Weight English version)

Answer choices

TTM Stage of Change

At the moment I’m not doing anything to lose weight and I have no intention of doing anything over the next 6 months.

Precontemplation

At the moment I’m not doing anything to lose weight but I’m thinking about doing something over the next 6 months.

Contemplation

During the last year I haven’t done anything to lose weight but I’m planning to do something over the next 30 days.

Preparation

I’ve been making an effort to lose weight (by dieting and/or exercising) for less than 6 months.

Action

I’ve been making an effort to maintain my weight (by dieting and/or exercising) for more than 6 months.

Maintenance

Table 2

Processes of change in weight management and their Corresponding items according to the UK validation (Andres et al., 2015)

Process of change items

Questions from P-Weight Questionnaire

Emotional re-evaluation (EmR)

1, 9, 13, 17, 21, 23, 25, 27, 29, 31, and 34

Weight consequences evaluation (WCE)

4, 5, 8, 12, 16, and 20

Supporting relationships (SR)

24, 28, 30, 32, and 33

Weight management actions (WMA)

2, 3, 6, 7, 10, 15, 18, 19, 22, and 26

Quantitative analysis demonstrated a statistically significant difference in the weight consequences evaluation (WCE) subscale (F(1, 26) = 8.196, p = .008), with a moderate-to-large effect size (η² = .240). The magnitude of effect suggests clinical relevance beyond statistical significance, with approximately 24% of the variance in WCE scores attributable to group differences. Homogeneity of variance was confirmed (Levene’s F = 1.134, p = .297), strengthening the validity of the ANOVA findings (Table 5). 

 

 

 

Table 3

Demographics

Sex

100% Female

Origin

6.9% identified as Hispanic, 93.1% identified as White

Race

3.4% identified as Asian, 96.6% identified as White

Age

22-71, M=48

Table 4

Weight Consequences Descriptives

N

Mean

Std. Deviation

I’ve been making an effort to lose weight by dieting and/or exercising for less than 6 months

12 participants in action stage of TTM

3.1944

.51165

I’ve been making an effort to lose weight by dieting and/or exercising for more than 6 months

16 participants in maintenance stage of TTM

2.5000

.71233

Other readiness subscales including emotional re-evaluation, supporting relationships, and weight management actions did not demonstrate statistically significant differences (Table 5). This pattern suggests that while many people understand the implications of being overweight, a need remains for implementing counseling and behavior change.  

 

Table 5

ANOVA Results for EmR, SR, WMA, and WCE

Subscale

F

Sig

EmR

1.924

.177

SR

3.132

.089

WMA

.021

.886

WCE

1.134

.297

Table 6

Descriptive Results for SR

N

Mean

Std. Deviation

I’ve been making an effort to lose weight by dieting and/or exercising for less than 6 months

12

3.3667

.49604

I’ve been making an effort to lose weight by dieting and/or exercising for more than 6 months

16

2.9875

.60429

Table 7

Descriptive Results for WMA

N

Mean

Std. Deviation

I’ve been making an effort to lose weight by dieting and/or exercising for less than 6 months

12

3.2611

.40523

I’ve been making an effort to lose weight by dieting and/or exercising for more than 6 months

16

3.2375

.44102

Table 8

Descriptives Results for EMR

N

Mean

Std. Deviation

I’ve been making an effort to lose weight by dieting and/or exercising for less than 6 months

12

4.0530

.50163

I’ve been making an effort to lose weight by dieting and/or exercising for more than 6 months

16

3.7955

.47470

There was no formal process for collecting qualitative data, but the primary researcher sat in on many of the weight loss appointments and spoke often with the providers for feedback. Patients frequently described pharmacotherapy as reducing physiologic barriers to behavioral change, allowing them to more effectively implement lifestyle strategies. Providers reported that structured readiness data enhanced the specificity and depth of counseling conversations. Together, these findings suggest that readiness assessment helps to identify needed behavioral support when paired with pharmacological treatment. These findings support the benefit of pharmacotherapy as a facilitator of behavioral adherence when appropriately supported.

Discussion

Pharmacotherapy for weight management is increasingly prescribed; however, medication alone does not address behavioral determinants of long-term weight outcomes (Perreault & Reid, 2025). The Transtheoretical Model emphasizes stage-congruent intervention. Integrating a validated readiness assessment tool operationalized this framework within routine care, shifting counseling from generalized advice to stage-informed behavioral guidance. All 28 participants fell into either the action (n=12) or maintenance (n=16) stage of the Transtheoretical Model. This makes sense because they are all at the clinic seeking help to change their weight. By identifying behaviors that need to be addressed, the goal is that more patients can be successful as well in the maintenance stage.

Variation within the data was examined through subgroup comparison and effect size estimation. Although the sample size limited formal longitudinal modeling, descriptive analysis across early and later implementation phases revealed improvement in questionnaire completion rates.

Time functioned as an implementation variable. Data collection could not begin until IRB approval was obtained and had to be completed with plenty of time for analysis prior to graduation. Early workflow challenges affected process reliability. Changes supported through PDSA cycles helped improve provider support, which increased questionnaire completion rates. Future studies employing larger samples could implement the questionnaires at the check-in process instead of with the provider to maybe improve completion rates.

Ethical Considerations

The project was reviewed by the University of Arkansas’s IRB Board and determined to meet criteria for quality improvement. Ethical safeguards included voluntary participation, protection of confidentiality through de-identification, and secure data storage.

Because the intervention involved implementation of an evidence-based behavioral assessment tool within routine care, risk to participants was minimal. No financial relationships existed between the project team and pharmaceutical manufacturers of GLP-1 receptor agonists, mitigating potential conflict of interest in evaluating behavioral outcomes within a pharmacotherapy population.

Limitations

The project was conducted within a single suburban private clinic, which may limit generalizability to other settings such as academic medical centers, community health clinics, or rural practices. Organizational culture and workflow flexibility may have influenced implementation success. With an effect size of .24 and a sample size of 28, the power of the study was .25. Ideally, power should be around .8 according to G-power (Faul et al., 2007). The study was underpowered. A larger sample size (50) is recommended. Qualitative data were derived from provider observations and informal patient feedback rather than structured interviews. Although these findings supported interpretation, formal qualitative methods would strengthen this study. Additionally, the implementation period was relatively short. Finally, the absence of long-term behavioral or weight outcomes limits conclusions regarding sustained clinical impact.

Sustainability and Scalability

Sustainability was supported through workflow integration and standardization. Moving questionnaire administration to the beginning of visits, delegating distribution to clinical staff, and embedding documentation templates would reduce reliance on individual provider memory and minimize disruption to clinic flow. Because the S and P-Weight Questionnaires are brief, low-cost, and require minimal training, ongoing use is feasible without additional financial investment. When the questionnaires were administered, there was a 100% completion rate which further supports the feasibility of the intervention. The intervention also demonstrates strong potential for scalability. The questionnaires are standardized, low-cost, and easily adaptable to electronic health record (EHR) systems. Because the intervention does not require specialized equipment or extensive financial resources, dissemination across diverse practice settings is feasible.

Conclusion

Results help identify gaps in behavioral readiness and aligning interventions with patients’ current stage of change. Other practices or studies can also do this, which reduces the likelihood of premature escalation of pharmacotherapy, nonadherence, or ineffective counseling. Additionally, integrating validated tools like the S-Weight and P-Weight Questionnaires into practice supports evidence-based decision-making, patient-centered care, and stronger provider-patient communication. This ultimately leads to safer, more effective, and individualized treatment plans. 

 

 

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