Obesity is not about Forks and Willpower

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Obesity: Not Just About Forks and Willpower

For years, obesity has been misunderstood, oversimplified, and even stigmatized. It's been framed as a personal failing, a lifestyle choice, or simply a matter of "eating less and moving more." But science tells a different, more nuanced story—one where our brains, biology, and ultra-processed food environment play starring roles. And thanks to groundbreaking medications like GLP-1 drugs, we’re gaining a clearer picture of how obesity works and how to treat it.

Let’s dive into why obesity is a disease, how ultra-processed foods exacerbate it, and why we need to ditch the harmful myth that obesity is a lifestyle choice.

The Myth of "Just Eat Less and Move More"

"Just eat less and move more." It’s the phrase everyone loves to repeat—and no one finds helpful. This simplistic advice ignores the reality that obesity is not merely about calories in and calories out. It’s about a complex interplay between your biology, brain chemistry, and environment.

Obesity isn’t a character flaw or a lack of willpower. If it were, we wouldn’t see an obesity epidemic in societies flooded with cheap, ultra-processed foods engineered to make us eat more. These foods hijack our biology, overpowering the mechanisms our bodies use to regulate hunger and fullness.

The Hungry Brain: Why You Can’t Stop Eating

Our brains evolved to keep us alive in times of scarcity. Back in the caveman days, this was helpful. Today, it’s less so because our brains are still wired to seek out high-calorie foods to avoid starvation—even when we’re surrounded by abundance.

When you eat ultra-processed foods, they light up the reward centers in your brain like a Christmas tree. These foods—laden with sugar, fat, and salt—trigger the release of dopamine, the same neurotransmitter involved in addiction. It’s no wonder we keep going back for more.

Adding to the complexity, hormones like ghrelin (the "hunger hormone") and leptin (the "fullness hormone") can go haywire in people with obesity. Ultra-processed foods amplify ghrelin’s effects, making you feel hungrier while reducing your sensitivity to leptin, so you never feel full. It’s a biological double whammy.

Citation: Studies show that diets high in ultra-processed foods increase calorie consumption by about 500 calories per day compared to diets of unprocessed foods (Hall et al., 2019).

GLP-1: The Game-Changing Hormone

Here’s where things get interesting: GLP-1, or glucagon-like peptide-1, is a hormone that helps regulate appetite. It tells your brain, “You’re full; you can stop eating now.” But for many people with obesity, this system doesn’t work properly. Their brains don’t get the message, leading to overeating.

Enter GLP-1 receptor agonists like semaglutide and liraglutide—medications that mimic the effects of GLP-1. These drugs help regulate appetite, making people feel full sooner and reducing cravings. The results have been extraordinary: clinical trials show average weight loss of 15% or more with these medications, far outpacing what’s possible with lifestyle changes alone.

These drugs have done more than help people lose weight—they’ve also shifted the way we think about obesity. They show that obesity is a medical condition influenced by hormones and brain chemistry, not just a matter of willpower.

Citation: Clinical trials on GLP-1 receptor agonists show significant and sustained weight loss, with participants losing 15% or more of their body weight (Wilding et al., 2021).

Why Obesity Is a Disease, Not a Lifestyle Choice

The idea that obesity is a "lifestyle choice" is not only incorrect—it’s harmful. Framing obesity this way ignores the biological, genetic, and environmental factors that contribute to it. Worse, it stigmatizes people with obesity, making them feel like they’re to blame for their condition.

Obesity meets all the criteria for a chronic disease: it has a defined pathology (dysregulation of appetite and metabolism), it leads to complications (diabetes, heart disease, etc.), and it requires long-term management. Lifestyle factors like diet and exercise can influence obesity, but they’re not the sole cause. Blaming someone for their obesity is like blaming someone with asthma for living in a polluted city.

Citation: The American Medical Association classified obesity as a chronic disease in 2013, recognizing it as a condition requiring medical treatment (AMA, 2013).

Ultra-Processed Foods: The Real Culprit

If obesity is a fire, ultra-processed foods are the gasoline. These foods are engineered for maximum palatability, combining sugar, fat, and salt in ways that overwhelm our natural appetite-regulation systems. They’re calorie-dense, nutrient-poor, and often stripped of fiber, which would otherwise help us feel full.

Even worse, ultra-processed foods alter the way our brains respond to food. They increase cravings, reduce satiety, and encourage overeating. Over time, this can lead to weight gain and metabolic issues, creating a vicious cycle that’s hard to break.

Citation: Research shows that people who consume diets high in ultra-processed foods are more likely to develop obesity and metabolic diseases (Monteiro et al., 2018).

How GLP-1 Drugs Have Changed the Game

GLP-1 drugs have given us new tools to treat obesity—and new insights into its underlying causes. They’ve proven that obesity isn’t just about behavior; it’s about biology. When you treat obesity like a disease rather than a moral failing, people get better.

But these medications are just one piece of the puzzle. To tackle obesity on a larger scale, we need to address the broader food environment. That means making healthy, unprocessed foods more accessible, reducing the marketing of ultra-processed foods, and investing in public health initiatives that promote nutrition education.

Why Fat Shaming Is Harmful (and Wrong)

Let’s address the elephant in the room: fat shaming. The idea that you can "shame" someone into losing weight is not only cruel—it’s ineffective. Research shows that weight stigma leads to stress, low self-esteem, and even more weight gain. It’s a lose-lose situation.

Instead of shaming people for their weight, we need to focus on creating supportive environments that help everyone make healthier choices. That includes treating obesity as the complex, multifactorial disease that it is—not a personal failure.

Citation: Weight stigma is associated with increased psychological distress, unhealthy eating behaviors, and reduced motivation for physical activity (Puhl & Heuer, 2010).

Moving Forward: What We Can Do

Here’s how we can start to shift the conversation around obesity:

Acknowledge Obesity as a Disease: Let’s treat obesity like any other chronic condition with empathy and evidence-based care.

Focus on the Food Environment: We need to address the root causes of obesity, including the overabundance of ultra-processed foods.

Reduce Stigma: Stop blaming individuals for their weight. Instead, offer support and solutions.

Expand Access to GLP-1 Drugs: These medications are game-changers, but they’re expensive and not always covered by insurance. Making them accessible is crucial.

Conclusion: It’s Time to Change the Narrative

Obesity is not a lifestyle choice. It’s a complex, chronic disease driven by biology, brain chemistry, and the environment we live in. Thanks to advances in science, like GLP-1 drugs, we’re starting to understand and treat obesity in ways that are effective and compassionate.

The next time someone tells you to “just eat less and move more,” remind them that obesity is about much more than that. It’s time to move past the myths, embrace the science, and support people on their journey to better health.

And maybe, just maybe, it’s time to rethink that bag of chips.

References

Hall, K. D., et al. (2019). "Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain." Cell Metabolism.

Wilding, J. P. H., et al. (2021). "Once-Weekly Semaglutide in Adults with Overweight or Obesity." The New England Journal of Medicine.

Monteiro, C. A., et al. (2018). "Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System." Public Health Nutrition.

Puhl, R., & Heuer, C. (2010). "Obesity Stigma: Important Considerations for Public Health." American Journal of Public Health.

AMA (2013). "American Medical Association House of Delegates Resolution 420 (A-13)."