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Obesity: Whose Fault Is It?

Obesity was recognized as a disease in 2015 by the Canadian Medical Association, and yet considerable weight stigma continues to persist in both our society and healthcare system. The main reason for this stigma is the belief that if individuals would just choose to eat less and move more, that would solve their challenges with weight… therefore, if someone is struggling with their weight, it is because they are lazy, unmotivated or lack willpower. 

A recent paper from Obesity Reviews (published by the World Obesity Federation) rigorously challenges the concept of agency when it comes to obesity, explaining the ways that hunger and satiety are regulated by complex physiological systems in the brain, many of which are not under our conscious control. 

This point of view is supported by endocrinologist Dr. Domenica Rubino who says the idea that people who are struggling with weight just need to have more willpower is actually, “kind of silly.” Why? Because, as she puts it, “people have been trying with willpower forever. And actually, no matter what your good intentions are, you really can’t control physiology.” 

Indeed, the Obesity Reviews paper addresses this physiology in great detail, describing animal studies examining the brain regions involved in appetite regulation that demonstrate how “the feeding drive can significantly transcend behavioral intent.” It further describes the physiological response to weight loss, citing randomized controlled trials showing that “significant weight regain is likely for even successful responders to diet and exercise.” 

It also details the effect of abundant food marketing efforts targeting consumer behavior / choices, prompting the authors to conclude “in an obesogenic environment, for many, the ability to make healthful decisions may be largely determined by processes outside conscious experience and control.” [It is well worth the time to read the paper in full HERE.]

However, one of the most important points made in the article is that: “Obesity is a chronic disease requiring personalized treatment. Lifestyle interventions alone may not be enough to achieve significant and sustained weight loss for many individuals with obesity.” 

Accepting this requires a significant shift of mindset for many people, but if we recognize that obesity is far more complex than “eat less and move more,” we can move beyond the misapprehension of obesity being caused by “limited self-control” which is the key factor driving weight stigma. We can then accept that lifestyle interventions alone will not be enough for many patients, despite their hard work and commitment. In order to treat obesity as the chronic condition it is, it’s necessary to ensure that proven medical treatments, such as behavioral interventions, pharmacotherapy and surgery, are readily available to patients and covered by insurance. 

As the authors of the article put it, “From a treatment standpoint, obesity as a disease is similar to hypertension as a disease and will benefit from further medicalization enabling its removal from the moral domain.” When we see obesity free of the lens of “personal responsibility and lack of willpower,” obesity treatments will be recognized as essential and people living with obesity will receive the care they deserve. To that end, we have a physician locator tool on this website that lists the physicians who specialize in obesity management– you can find it here. Referring your patients to find the right specialist who can treat their obesity will make all the difference in helping them be successful over the long-term.

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