Did you know that obesity is a chronic disease? Really. Turns out we had it quite wrong for quite a long time.

The cultural narrative has long maintained that weight can be controlled by simply tipping the balance between “calories in” and “calories out”. So, if you gain weight by taking in too many calories, simply cut back and you will lose weight.

Let’s not pretend weight control is simple

It turns out things aren’t so simple. Why? Because weight is not a behaviour. As a result, you cannot directly control your weight!

What an outrageous thing to say, eh? Here’s an example. If I asked you to eat 3 servings of fruits today, you could do that (provided you have access).

If I asked you to walk 30 minutes sometime between 8 am and 9 pm, you could likely do that, too. But if I asked you to gain 0.3 kg in the next 6 hours – wait, make that 5.5 kg – you couldn’t.

You have a lot of control (again within limits) over what you eat and how you exercise. But because weight is not a behaviour, our ability to alter weight as if it were a dial on a thermostat is very low.

Not only that, it turns out your genes count for a lot. It has been estimated that about 40% to 70% of a person’s likelihood of developing obesity is due to genes. Further, there is an association between your social environment and your weight.

Not to mention that our society has developed such that access to high-calorie, low-nutrition food is easy and the opportunities for activity are hard.

In other words, no matter how you slice it, scientific evidence clearly supports the case that weight is not a matter of choice and willpower, but the result of complex genetic, biological, sociocultural and psychological factors.

Well, not the number of kilos on the scale but the impact of excess fat cells on health, ability to function and quality of life. Fat cells are not passive. They don’t just sit there doing nothing.

Fat cells secrete hormones and peptides that, when close to the heart, liver, pancreas, etc. (intraabdominal adipose tissue) can cause diseases.

Let’s go one step further. It’s crucial to understand that the body defends – yes defends – its highest weight! Our bodies have basic instinctual coping responses. Let’s look at a few examples.

Because overheating puts us at risk of having brain damage, we automatically begin sweating to bring our body temperature down. Another example: Freezing is not good for us; it can damage us which is why we automatically begin to shiver when cold to bring our temperature back up. So far, all well and good.

Well, in a similar way the body has been built to resist weight loss. In the distant past, when food was not easily found, we were often at risk of starving. So, when we lose weight, our built-in mechanisms would kick back in. Rather than shiver or sweat, our brain would increase hunger, shut down fullness and slow down metabolism. So those life-preserving mechanisms are still at work behind the scenes today...

There is a predictable weight-loss curve that almost everyone knows. Early in the weight-loss journey, the weight drops nicely. Then, somewhere between 3 and 6 months in, the weight loss stops and plateaus. This is biology taking over. Calling it a failure is too simplistic.

So why I am telling you this? Well, when people operate under the energy-in/energy-out model, their goals and expectations are based on this.

Someone persuaded to think this way might set a goal of 0.5 kg loss each week. 5 weeks: 2.5 kg. 10 weeks: 5 kg. 30 weeks: 15 kg. Awesome! Hook me up! Well, unfortunately, the chances of this actually happening are very, very slim. Because your body has a different idea for you and, well, you can’t fool mother nature.

There is a huge problem with the widespread “eat less, move more” mindset. When people go through the predictable weight-loss stages – initial success followed by inevitable stopping of weight loss they invariably blame themselves.

That sets people up for an unproductive sequence of events. If there is anything we know about people living with obesity, it is that they repeatedly make significant efforts to lose weight. But over time, their experiences tend to look like this: I try and I fail; I try and I fail; I try and I fail. Sound familiar?

As a psychologist when I see this pattern it really upsets me. Why? Because this pattern of try and fail results in giving up! This is called “learned helplessness”, and it is a very dangerous psychological state. It feels like depression. It interferes with most aspects of a person’s life. And it erodes a person’s self-esteem.

Recently a number of studies aimed to understand how to improve care for people living with obesity have been done. What we are learning is that people living with obesity do not actually view healthcare providers as sources of support but think that weight management is up to them and that they just need to focus harder on diet and exercise. Providers think they can help but also think that diet and exercise is the only way to go.

I have been working with people living with obesity since the late 1970s. I have seen time and again how incredibly infuriating it is for people with obesity when someone comes along and says, “Well, you just need to eat less and get more exercise.”

It is as if they expect the person with obesity to respond by saying, “Really? Wow, no one has ever said that to me. I had no idea eating less and exercising more would help”.

Having heard this story too many times to recall tells me we have the wrong script. It is time to change the narrative of what obesity means, how it develops and how it is treated.

When someone asks me to explain why obesity rates are rising, my response is, “Because the human brain is no longer adapted to the environment in which it lives.” There’s nothing wrong with the person and the brain. But in combination with the environment, problems can arise.

What would happen if you changed your narrative from obesity is a matter of eating less and moving more, which makes you a failure?

By the way, when one feels like a failure and gives up they stop taking care of themselves.

So, what is the alternative? Well, let me run something by you

What if obesity was a chronic medical condition that results from genetic, environment, biological (especially brain-based biology), social and psychological issues which are amplified in the context of the modern environment of over processed food, overburdened lives, with little time for self-care.

What if despite all of your past efforts, you’ve never actually been treated for this condition. As of yet, no one has approached your care from our current knowledge. Past attempts have centered around the eat less move more perspective.

If you could make this shift, I wonder what would happen? 

Here’s my vision: I think this shift has the potential to reintroduce realistic hope into obesity management and to be a pathway to increasing self-esteem.

My worry is that people living with obesity blame themselves – in fact, we know they do; it is called “internalized weight bias” – and don’t see healthcare providers as being there to help.

However, If we approach obesity similar to any other chronic disease, we can make a difference. Healthcare providers can use the skills they have learned supporting people living with other chronic conditions to help those living with obesity. After all, obesity management is about treatment approaches that improve health, function and quality of life more so than how much weight a person can lose.

I wonder if you’d be willing to reach out and seek help for your condition?