For one, people living with obesity report a heavy emotional burden, with feelings of shame, loneliness, and anxiety about seeing a healthcare professional, and even discrimination in their workplace. Adding to these emotional influencers, there are also practical roadblocks to trial engagement, like transportation to and from sites, time off from work, and potential for trial burden. When these realities are acknowledged and addressed during protocol design and related patient outreach activities and communication, engagement can improve.

How can this patient-centric protocol be put into practice?

• Co-create trial protocols with patients for downstream value. This includes integrating patient advisory boards and qualitative patient insights to help reduce amendments and accelerate start up.
• Prioritise flexibility. For some participants who have felt judged in the healthcare system, it is essential to reduce even small logistical frictions that can affect adherence more than motivation. Offering remote or hybrid site visits, flexible scheduling, travel support, and compassionate, non-stigmatising communication are all core ways to reduce trial burden.
• Embed respect and bias awareness into site training. Because participants with obesity may experience anxiety when interacting with healthcare teams, site training must go beyond technical requirements to include stigma-free language and bias mitigation.

In a survey of 179 sites across the US and Europe, the most highly rated retention tools included access to RDs, appreciation items, lifestyle resources, local peer support groups, and information on affordable, healthy food sources.

Other notable components of a strong engagement ecosystem include: 

• Insight driven segmentation: Use primary research and behavioural science to develop nuanced patient personas that reveal what motivates individuals to join a study (e.g., improved health, weight loss, access to care) and what may lead them to disengage (e.g., side effects, slow progress, logistical hurdles). These insights should inform tailored messaging, cadence, and support to meet the needs of each person, not only the protocol.
• Data informed, omnichannel strategies: Combining targeted digital outreach with healthcare provider referrals and community partnerships helps surface eligible participants, including those managing related conditions, such as type 2 diabetes or cardiovascular disease.
• Digital tools that meet patients where they are: Tools such as secure in-app messaging, concierge style scheduling, milestone alerts, micro learning modules, and culturally relevant content can meaningfully reduce friction and help sustain momentum throughout the study. Every digital interaction should feel helpful and genuinely worth the participant’s time, especially during periods when motivation naturally dips.

For underserved patient populations with a higher prevalence for obesity, these tailored materials reflect their lived realities, including cultural contexts, work patterns, caregiving responsibilities, and transportation needs. These details may seem small, but for individuals who have long felt judged, unseen, or dismissed, they signal that the trial is offering something unique and meaningful for them.

As progress rarely moves in a straight line, particularly in weight management efforts, clear expectation setting also plays a critical role. Participants may come into trials with anxiety about the placebo effect, concerns about slow progress or plateaus, or assumptions about therapies. Offering plain language explanations of treatment randomisation, the range of response patterns, possible side effects, and what progress can look like beyond the scale (e.g., improved sleep, mood, mobility, etc.) can help reduce discouragement and potential dropout.

Integrating supportive communication to keep patients engaged through the trial includes:

• Milestone based coaching by registered dietitians or trained health coaches to offer structured encouragement at key points in the trial journey, such as dose titration periods, early lab visits, or lifestyle goal setting moments.
• Small recognitions, including appreciation items or digital badges, to reinforce persistence and foster a sense of belonging.
• Anticipatory guidance and practical tools for managing side effects, helping participants to navigate common issues without feeling dismissed or alarmed.
• Continuous feedback loops through short surveys or quick check-ins for study teams to better spot emerging challenges (e.g., transportation, scheduling, or unclear instructions) and resolve them in real time.

As touched on previously, effective site engagement starts with training that prioritises tone and technique. Staff can focus on language that avoids moralising and reinforces trial participation as a “journey”, not a “struggle”. Training should also cover practical sensitivities, such as ensuring appropriately sized gowns, furniture, and equipment, which contribute to a more comforting participant experience from the moment someone enters the clinic.

Equally important is reducing operational barriers. When sponsors support sites with centralised scheduling tools, templated reminders, reimbursement automation, and other administrative infrastructure, site staff regain time to build the human connection with participants. Streamlining these processes allows coordinators and investigators to focus on the personal interactions that keep people feeling valued and motivated.

Site selection is another critical consideration. Choosing locations with prior obesity trial experience, welcoming clinical environments, and easy access to public transportation or community hubs can significantly influence whether participants may enrol and remain in a trial. The overall “feel” of a site can help mitigate stigma early and set the tone for a supportive trial experience.

It is important for sponsors to note that these needs vary globally. Dietary patterns, access to healthy foods, standard of care, and perceptions of research differ widely by region. For example, participants in the US may arrive with higher awareness of clinical trials and expectations for advanced therapies and digital support, while participants in European countries may require localised messaging, multiple translations, and closer coordination with general practitioners and regional authorities.

A motivating engagement ecosystem is essential to sustain patient interest, but also in delivering operational advantages, such as faster recruitment, stronger data quality, and greater external validity. When patients help shape obesity-focused trials from the start, every interaction becomes more respectful, more motivating, and ultimately more capable of generating meaningful results for the people these therapies aim to serve.