Rethinking obesity

Misconceptions about obesity are common. For instance, many people believe that if people with obesity would just exert extra willpower to eat less and exercise more, they could easily reach and stay at a healthy, normal weight.

Even people who struggle with obesity may believe this, despite the fact that repeated personal experience often tells them otherwise. The growing prevalence of obesity — which now affects just over 42% of people in this country — is further evidence that it's a complex, challenging disease (see "Defining obesity").

"Incorrect assumptions and biases about obesity can really derail progress against this problem, which has become the most common chronic disease of our time," says Dr. Fatima Cody Stanford, an obesity specialist and associate professor of medicine and pediatrics at Harvard Medical School. Addressing these issues and encouraging people to pursue effective treatments can also reduce the risk of the multiple, serious health conditions that often go hand in hand with obesity. Many of these afflictions, including type 2 diabetes, high blood pressure, and sleep apnea, are closely linked to cardiovascular disease.

Misplaced bias

To begin with, don't refer to other people or yourself as "obese" but rather as a person with obesity, Dr. Stanford recommends. Bias and stigma against people with obesity is widespread, often due to a belief that poor choices and lack of motivation are the only causes. But as is true for many diseases, a number of interconnected factors play a role, says Dr. Stanford.

A major issue is the "obesogenic" (obesity-promoting) environment we've all been living in for the past few decades. One aspect is the constant exposure and ready access to jumbo-sized portions of highly processed foods, which now make up more than half of the food Americans eat. Laden with fat, salt, and sugar, these tempting foods are easy to gobble down quickly — and all those extra calories are often stored as fat. Another is lack of physical activity, which makes it harder to maintain a healthy weight.

But other lifestyle and health issues can also contribute to weight gain and foil weight-loss efforts, says Dr. Stanford. These are some of the key culprits:

Lack of sufficient sleep. Too little sleep — especially six or fewer hours per night — is a well-known contributor to weight gain. While sleep disorders such as insomnia may be to blame, a fixation with screens — computers, smartphones, and television — often prevents us from getting enough shut-eye.

Depression, anxiety, and stress. These common mental health issues can sap your motivation to exercise and to prepare healthy meals. They may also trigger emotional eating, which often leads to overeating high-calorie foods.

Prescription medications. About one in five people takes prescription medications that can cause weight gain, according to a recent study by the CDC. These include certain drugs used to treat diabetes, high blood pressure, depression, and muscle pain or inflammation.

All of these factors — along with genetics — affect metabolism, which is governed by the hypothalamus. This brain region, which regulates many body functions such as temperature control and hunger, also works to keep body weight within a narrow range, or "set point." That means people with obesity often regain the weight they lose—their brains work against them to return to their previous, higher weight, Dr. Stanford explains.

What you can do

That's not to say people with obesity can't lose weight. But they often need a more nuanced, personalized approach that goes beyond diet and exercise, possibly including weight-loss medications or surgery. Dr. Stanford, who treats patients at the Massachusetts General Hospital Weight Center, never suggests specific diets. Instead, she counsels people to focus on eating lean protein, whole grains, fruits, and vegetables and to find their "soul mate" exercise — something they'll enjoy doing every day. She also helps them address the other lifestyle issues that can affect weight: getting enough sleep, treating mental health problems, and swapping out weight-promoting medications when possible. To find a physician near you who specializes in treating obesity, the Obesity Action Coalition maintains a searchable list at https://obesitycareproviders.com.

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