Acceptance of weight loss medication in patients with atypical hyperplasia or carcinoma of the endometrium as part of the fertility preservation treatment: A qualitative study

• Patients’ understanding of impact of obesity on endometrial cancer is limited. • Weight loss medications are acceptable to young patients with endometrial cancer. • Comprehensive counselling with clear risk–benefit discussion is needed. Sustained weight loss in combination with progestin may improve oncologic and fertility outcomes for young patients with endometrial cancer/atypical hyperplasia (EC/AH) desiring fertility-preserving treatment. Weight-loss medications are non-invasive and effective weight management tools; however, their acceptability is unknown in this population. Thus, we conducted a qualitative study to understand the acceptability of weight loss medication in young patients with obesity and EC/AH. Purposive sampling was used to recruit patients between 18 and 41 years of age with body mass index (BMI) ≥ 27, and a diagnosis of grade 1 endometrioid EC or AH. Semi-structured interviews were conducted to explore participants’ perception of their weight, its relationship to their EC/AH diagnosis, and their acceptability of weight-loss medication as part of fertility-sparing treatment. Thirteen interviews were conducted. The median participant age was 37 years (26–40), and the median BMI was 34.8 (28–48). Participants lacked understanding of the relationship between obesity, EC/AH, and infertility. Participants identified the need for honest, early, actionable, and sensitive obesity counselling in the context of EC/AH management. Participants were receptive to the use of weight-loss medication and expressed little worry about associated stigma; however, they were highly concerned about cost, side effects, and sustainable weight loss, and emphasized that addressing these concerns would be essential to increase their comfort. Weight-loss medication may be an acceptable adjunct to progestin treatment in this population, if preceded by a thorough risk–benefit discussion and early counselling on the role and management of obesity in EC/AH.