Obesity is not fair
Let’s get a few things straight about obesity first. Twin and adoption studies indicate that 40 – 70 % of obesity is heritable. Genes that predispose people for obesity influence many things, for example, they increase appetite, enhance fat storage ability, reduce spontaneous exercise activity, increase the frequency of thinking about food, and affect metabolism. More than 60 % of obese people have polygenetic obesity which means they have many different genes conspiring to make it hard to maintain a healthy weight.
Obesogenic environment
This genetic combination doesn’t necessarily mean that a person has to become obese. But the odds of it happening are certainly increased by living in an obesogenic environment filled with cheap, highly-palatable, energy-dense foods that are always readily available. Obesogenic environment is not just about food, it’s also all of those conveniences that allow people to reduce physical activity like cars, meal delivery services, elevators and escalators, remote controls, dishwashers and washing machines, and sedentary jobs.
Adaptations to weight gain
The weight gain itself makes matters even worse. That’s because the hormones in your gut, fat cells, and brain adapt to your increased weight and change how you experience hunger and fullness to “defend” this new weight and make it much harder to lose it. Unfortunately, many of these adaptations take many years to go away even if you do lose weight.
And your basal metabolic rate (BMR) adapts when you lose weight as well. This results in you actually needing less food to maintain your weight than someone who has always been at that given weight. So, if you eat the same amount of food as people who have always been lean, you are likely to start gaining weight again due to the metabolic efficiencies created by your weight loss process. The cards are certainly stacked against obese people and those trying to lose weight.
Increased stress levels
If all of this wasn’t enough, there are also the societal implications of being overweight or obese. As sad as it is, carrying extra fat often makes you a target for discrimination and mockery. You are more likely to be bullied at the gym, openly judged or lectured at the grocery store, and in many other common scenarios.
Even more insidiously, healthcare providers may overlook or downplay your symptoms, attributing health concerns solely to weight. This can lead to delayed or wrong diagnoses and inadequate care.
All of this are significant and ongoing sources of stress. And guess what? Stress contributes to increased appetite and pleasure from high-calorie foods, decreased activity, and poorer sleep quality. And poor sleep quality leads to even more increased appetite and less reward from food. It’s the definition of a vicious circle.
Obesity is a disease
A lot of these societal issues stem from the fact that people perceive obesity as something that has to do with a lack of willpower. To those who’ve never been overweight or obese, it seems easy to use willpower to simply eat less and exercise more. But there’s no evidence that obese people have less willpower than others. It’s harder for them to eat less for all of the reasons mentioned above.
With more research it’s become clear that obesity is much more complicated. Obesity has been first officially recognized as a disease in 1997 by the World Health Organization. Since then, it has also been recognized as such by the American Medical Association, the Royal College of Physicians in the U.K. or the European Commission.
So, just like insulin isn’t “cheating” type 1 diabetes, weight loss drugs aren’t “cheating” obesity. GLP-1 agonist medications like Ozempic or Wegovy are tools that should be used alongside healthy lifestyle behaviours to help offset some of the genetic and physiological disadvantages that people with obesity have, and have little individual control over otherwise.
This also means that weight loss drugs aren’t for everyone. We will explore who should consider taking them in the next article of the series.
