Reframing The Debate on Current Obesity Crisis: Beyond Character Flaw or Disease Model- A Nuanced Perspective for Comprehensive Understanding and Support

Unless you have lived under a rock, you will be aware that levels of obesity continues to increase at an alarming rate across all sectors of society. According to the NHS, around two-thirds of adults in the UK are considered overweight or obese. And even more heart breaking, childhood obesity is reaching alarming levels. And this trend is not limited to the UK alone. WHO estimates that world-wide obesity has nearly tripled since 1975 and now considers it as a global epidemic.

Factors contributing to this rise include changes in dietary patterns, increased consumption of processed and high-calorie foods, sedentary lifestyles and urbanization.

From a scientific standpoint, obesity involves an imbalance between energy intake and expenditure. More recently, there is an acknowledgement that genetics have a strong influence on an individual’s susceptibility to obesity. However, scientific approaches tend to be quite reductionistic; and I feel that the current debate falls into two camps: viewing obesity either as a will-power deficiency state or describing obesity as a disease. But, like everything to do with human biology and psychology, it’s never that black and white.

The perspective that obesity is a disease state

Obesity simply isn’t a disease. According to the Oxford dictionary, the definition of disease starts with ‘a disorder of structure or function…’. By way of an analogy, fever is not a disease. It’s an adaptive response of the body to help defend pathogens. It’s a symptom of a disease but not the disease itself. Malaria, in contrast, is a disease as it causes ‘disorder of function’ when a parasite takes up residence in your red blood cells, replicates itself there, and then burst those cells upon exit.

As it is normal and adaptive for the body to mount a fever in self-defence, it is also normal for the body to store surplus of calories against the advent of a famine in the future. Therefore, converting excess energy to body fat and accumulating this body fat (often around your middle) is a normal function of the body. Therefore, it does not equate to a disease state. Of course, obesity is implicated in many chronic diseases and can have detrimental effects on someone’s mental health. But I am talking about obesity in its own right.

Describing obesity as a disease, in theory, should help to destigmatise, promote greater understanding and encourage a more compassionate approach towards addressing the complex nature of this condition. The problem is that it also invites a myriad of ‘medical’ solutions. Examples include drugs, the latest example being Ozempic. Or bariatric surgery. And there is the quest to find natural supplements and potions with alleged superpowers. Have you read about berberine being described as nature’s Ozempic? All these interventions are big business with massive profit margins for the organisations promoting them, with limited success rates for individuals struggling with their weight issues.

What about the narrative that views obesity as a character flaw and lack of will power?

Oversimplified concepts like ‘calories in, calories out’ reinforce the belief that if you reduce your calorie intake and increase exercise, you will lose weight. And if you don’t, you should try harder. It is clear from the research that calories do count, but where they come from, counts more! Creating a calorific deficit will help to lose weight in the short term. But why don’t we keep the weight off?

Everyone has a unique set point. This is the weight range your body naturally tends to gravitate to. This is influenced by factors such as genetics, metabolic rate, and hormonal regulation. The body’s set point works to defend against drastic changes in weight (up or down) that may threaten its survival.  

So, when you try to lose weight through calorie restriction and/or intense exercise, the body will respond to restore its set point. It does this by slowing down your metabolic rate and increase hunger hormones. This is totally outside your control and has nothing to do with lack of will power. It is about your body’s survival instincts and if you fight against these, you are fighting a losing battle.

The big problem, and many people that have engaged in yo-yo dieting will know this, every time you regain the weight, you will damage your metabolism. This is because the weight you have lost will be replaced by fat rather than muscle mass. This shift in body composition will slow down your metabolic basal rate, increase insulin resistance, and mess up your hormones. The result? You eat less and weigh more than before.

Is increasing exercise the answer?

The next strategy people adopt is upping their exercise regime in a desperate attempt to control their weight. They spend gruelling hours in the gym and go for mega runs to burn up calories. Don’t get me wrong – exercise and especially as we age, resistance and strength training as well as shortish cardio sessions, are vital for our metabolic and cardiovascular health, strength and flexibility. But YOU CANNOT OUTRUN A BAD DIET.

No matter how much you hit the gym or go for a run, if your diet consists of junk food and unhealthy choices, you will not have the right nutrients to aid recovery or function well. Plus, let’s not forget about the impact of stress and cortisol. Elevated cortisol levels can stimulate appetite, particularly calorie-dense and sugary foods, leading to overeating. I’ve been there – indulging in my well deserved chocolate chip muffin after a long run. Moreover, cortisol (together with its partner insulin) promotes the storage of visceral (around the tummy) fat. You need to choose the right type of exercise for you. And give your body what it needs – a balanced, nutrient-rich diet together with adequate sleep and lots of rest.

Who really benefits from diet culture?

The global weight loss and weight management diet market size has reached a value of more than USD 175.44 billion in 2022 and is expected to continue to grow. This includes everything from commercial weight loss programmes and clubs, meal replacement shakes, diet books on the on the latest fads promising quick results, to fitness gadgets and supplements. And why does it keep growing? This is largely due to the 80% failure rate of these diets and products and human’s desire for a quick fix.

Diet culture and its strict rules around food, weight and body image clearly doesn’t work. We need to move away from polarizing perspectives that label obesity to either a disease state or a character flaw. Instead, we need to adopt a more nuanced approach that acknowledges the interplay of various factors, including cultural foods and lifestyle choices. Rather than focusing solely on weight, I believe our emphasis should be on promoting health and well-being and eating whole minimally processed foods. Your body will then do the rest and give you the weight and body composition that is optimal for you.

Where should I start?

UNPROCESS YOUR DIET and minimise calorie rich, refined and highly processed foods. Move to a balanced whole food, mainly plant based diet with adequate amounts of quality protein and a small amount of healthy fats.

Why does this help with weight loss?

It doesn’t matter whether you are looking at carbohydrates, fats or alcohol. Calorie rich, refined and highly processed foods will not benefit from build-in mechanisms that help your body to maintain its optimal body composition. These are:

  1. The ‘ileal break’ based reduced appetite response. This occurs when food enters the final part of the small intestine, the ileum. Regularly eating intact fibre rich foods that make it to this part of the intestine are harder to absorb. They will result in an increased ratio of satiety-to-hunger hormones leading to reduced appetite. In contrast, refined foods that are quickly absorbed do not offer this benefit.
  2. Gut Microbiome diversity. This plays a role in appetite suppression through the fermentation of dietary fibre that produces short-chain fatty acids. These compounds will stimulate the release of hormones that suppress appetite and increase feelings of fullness.
  3. Highly intact plant-based foods. We do not absorb all the calories shown on the label of whole plant-based foods. For example, with a handful of nuts, you will absorb around 70% of the calories, with nut butters about 90% and highly processed foods around 100%. In addition, whole plant-based foods are harder to break down, digest and absorb and therefore use up more energy.

How? Try these initial steps:

  • Cut out Ultra-Processed Foods (for more info watch the recent Panorama programme ‘Ultra-Processed Food: A Recipe for Ill Health on BBC iPlayer )
    • Read labels on packaged foods – if they have an extra-long shelf-life, or list many unfamiliar and unpronounceable ingredients, or have high sugar, fat, and salt levels, don’t eat them.  
    • Prioritise whole, unprocessed foods like fruits, vegetables, whole grains, lean proteins, and healthy fats.
  • While it’s unrealistic to completely eliminate convenience foods, aim to reduce their frequency in your diet. Reserve them for occasional use rather than relying on them as a staple; and always add some vegetables (mega quick if steamed) or salads to provide extra antioxidants that will help to counteract the negative effects of not so healthy food choices.
  • If you can, cut out snacks. This allows your body to switch from digestion to other important maintenance tasks in your body. But if too much of a stretch, snack on wholefoods. These include dates, dried apricots, figs, nuts, nut butters, seeds, and dark chocolate. Or try apple and cheese or a pear with a handful of walnuts.
  • Swap sweetened breakfast cereals for homemade porridge or granola with yoghurt and fruit, or a savoury breakfast like eggs, savoury pancakes.
  • Stop drinking your calories – swap sugary or sweetened (including artificial sweeteners) drinks for water (with a slice of orange or lemon, mineral water, herbal teas etc.)

These relatively small steps will start you on a journey of optimising your health by improving your metabolism and insulin sensitivity, make you feel fuller and reduce cravings, nourish your body, and reset your satiety/hunger signals.

Remember, ageing is inevitable, but getting bigger, sicker, and more miserable isn’t.  

For more individualised support, go to Eat for Life or contact me at [email protected].