Obesity: it’s not just about willpower
Overweight people are often unfairly stigmatised over a condition that is not as simple as it seems.
Obesity is often viewed as the result of poor personal choices, such as overeating and inactivity.
But many people, including doctors, are challenging this view.
Physician Prescott Lee wrote in The Washington Post recently that his personal experience of losing weight through dietary changes gave him an overly simplistic attitude towards obesity.
“My own experience initially led me to believe that weight loss was just a matter of commitment and a modicum of self-control,” he wrote.
“It has taken me a decade or so to appreciate that obesity is a complex and mostly neurological and inheritable disease.”
Obesity has been recognised as a disease for decades, but perceptions of it –including among the medical profession – have not shifted to a great degree.
Too many people believe that people who are above average weight simply lack the willpower to eat less and exercise more.
Obesity is a complex medical condition influenced by biological, genetic, and environmental factors. It is a chronic disease that many people cannot fully control.
We know that it is associated with other health conditions, including:
Cardiovascular (heart) disease
High blood pressure (hypertension)
Type 2 diabetes
Sleep apnoea
Osteoarthritis, especially in the hip and knee joints
Gastro-oesophageal reflux disease (GORD)
Mental health problems such as depression and anxiety.
In Australian two out of three adults are either overweight or obese. In many cases, it can be controlled by diet and exercise – but it’s not easy.
Biology plays a significant role in obesity. The brain’s regulation of hunger and fullness can become disrupted, leading to overeating.
Some people experience leptin resistance, where the hormone that signals fullness doesn’t work properly, causing constant hunger.
Genetics influence how the body stores fat and how efficiently it burns calories, and even can govern food cravings. People with certain gene variants are more prone to gaining weight, regardless of their lifestyle choices.
Environmental factors also contribute. In many places, processed, calorie-dense foods are cheaper and more accessible than healthier options, especially in low-income areas.
This “obesogenic environment” makes it harder for people to make healthier choices, even if they want to.
At the same time, modern life has become more sedentary, with less physical activity due to long work hours, technology, and urban living, further compounding the issue.
Metabolism and set-point theory also make weight loss difficult. People with slower metabolisms burn fewer calories, even when active. Set-point theory suggests the body tries to maintain a specific weight range, slowing metabolism and increasing hunger when weight is lost, making it hard to keep the weight off.
Obesity stigma only worsens the condition. People with obesity often face discrimination and emotional distress, which can lead to anxiety, depression, and unhealthy coping mechanisms like emotional eating.
Recognising obesity as a medical condition rather than a personal failure is crucial for effective treatment.
It requires long-term management, much like diabetes or hypertension, through medical treatments such as behavioral interventions, medications, and sometimes surgery.
Dr Lee sees some hope in drugs such as Ozempic and Wegovy, which are only approved in Australia for people with diabetes. (It is, however, being prescribed by some doctors “off label” for obese patients who are not diabetic.)
He wrote, “Awaiting a broader and longer clinical experience with these seemingly revolutionary drugs, I am cautiously optimistic about physicians helping patients effectively treat this scourge of obesity.”
Note: Always consult a qualified medical professional before making changes to your diet and fitness regime.
Related reading: Washington Post, Health Direct, Sydney University
