Obesity Isn’t About Willpower, But It’s Still a Problem

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 By Stewart Lonky, M.D.

Let's put our cards on the table: obesity isn't about willpower. 

It's not a moral failing or a sign of weakness. And for the most part, it's not a matter of choice, and we're not helping matters if we make people feel worse about themselves.

Sure, we can change the language around obesity to reduce stigma, and help people generally feel better about themselves. 

However, this is where the rubber meets the road. Whether we refer to someone as a "person with obesity," or an "obese person," that's not going to change the reality that obesity is a global public health epidemic. Today, obesity is on par with air pollution, noncommunicable diseases, and vaccine hesitancy as the greatest threats to human health. 

Since 1980, the worldwide overweight and obesity rate have more than doubled, spiking from 850 million to over two billion people today. Obesity cuts across all demographic categories and geographical regions.  

Obesity and its associated diseases, including diabetes, high blood pressure, heart disease and cancer, and dementia, are major drivers of spiraling healthcare costs, particularly in the U.S., where adult obesity hovers around 40 percent. Imagine if 40 percent of the population had cancer.

So, while we're perseverating over language to reduce stigma, and searching for ways to help the millions who struggle with weight issues, let's remember the magnitude of the problem at hand.

Obesity is a complicated, multifactorial disease. Genetics, epigenetics, environment, activity level, food choice, toxic exposures, stress, trauma, and psychological makeup are all factors in the obesity equation. One study found that up to 50 percent of obese adults experienced difficult childhoods or suffered early life trauma.

And yes, fat shaming - being made to feel ashamed or embarrassed about one's weight - can trigger overeating and lead to weight gain. Fat shaming is deplorable, and we should condemn it. 

However, please don't buy into the idea pushed in the popular media and some academic circles that you can be healthy at every size. Of course, it's good to encourage people and be accepting and open towards overweight and obese people. However, we must acknowledge that Healthy At Every Size is propaganda, with no grounding in scientific fact. 

Do the HAES folks want to lump anorexia and bulimia into the mix? Like obesity, both are complex neurobiological disorders with an array of metabolic effects. Anorexia and bulimia are epigenetically and genetically rooted as well, which is why both conditions earn the "weight-related problem" label. 

Obesity isn't, and never will be a "moral failing," or sign of weakness or mental illness. However, the idea of healthy at every size contradicts all existing evidence of what it means to be healthy. 

Healthcare practitioners shouldn't be in the business of spreading misinformation. I don't want to normalize a body size that increases disease. The research is unambiguous: you're at increased risk of a myriad of acute and chronic health problems if you carry excess body fat. 

Sure, you can be healthy at every size if that size doesn't increase disease and mortality risk, and that size doesn't reduce the length and quality of your life.

However, you can't be healthy at every size just because you think it’s OK, or some self-anointed expert told you to love yourself, no matter how much excess weight you’re carrying around your waist, hips and thighs.    

That's not how health works.