Obesity: Scaling the numbers

For decades, obesity has been reduced to a simple equation: calories in versus calories out. If it were truly that simple, wouldn’t weight management be easy? Yet, for millions of people, the struggle with weight is anything but straightforward.

Obesity is not just about willpower or discipline—it is a complex medical condition influenced by genetics, hormones, metabolism, psychology, and environment. Understanding obesity means stepping away from shame and blame and stepping into a science-based approach to health.

What Does It Mean to Be Overweight or Obese?

In medicine, weight status is typically classified using Body Mass Index (BMI):

• Normal weight: BMI 18.5–24.9

• Overweight: BMI 25.0–29.9

• Obesity (Class 1): BMI 30.0–34.9

• Obesity (Class 2): BMI 35.0–39.9

• Severe obesity (Class 3): BMI 40+

But BMI is an imperfect tool. It was designed in the 1800s as a statistical measure—not as a diagnostic tool for individual health.

Why BMI Falls Short

1. It Doesn’t Differentiate Between Fat and Muscle

• A bodybuilder with low body fat may have a BMI of 31 (classified as obese), while a sedentary person with high body fat and a BMI of 24.9 (classified as “normal”) may actually have greater health risks.

2. It Doesn’t Account for Fat Distribution

• Carrying weight around the abdomen (visceral fat) is more dangerous than carrying weight in the thighs or hips (subcutaneous fat).

• A person with a BMI of 26 but high visceral fat may be at greater risk for diabetes and heart disease than someone with a BMI of 31 but lower visceral fat.

3. It Ignores Metabolic Health

• Some people with higher BMIs have normal blood pressure, cholesterol, and insulin levels, while others in the “normal” BMI range have metabolic disorders. This is known as metabolically healthy obesity vs. metabolically unhealthy normal weight.

A More Accurate Picture of Health

Because BMI alone is unreliable, doctors look at multiple factors to assess health risks:

Waist circumference – More than 35 inches in women or 40 inches in men suggests higher risk.

Body fat distribution – Belly fat (visceral) is riskier than fat in thighs/hips.

Metabolic health markers – Cholesterol, blood sugar, and insulin resistance.

Family history – If obesity-related diseases run in your family, risk may be higher.

Why Obesity (or Being Overweight) Isn’t Always a Choice

The idea that weight is simply about personal choices—how much we eat and how much we move—is outdated and scientifically incorrect. Many factors beyond personal control contribute to obesity:

1. Genetics Plays a Major Role

• If both parents have obesity, a child has a 70–80% chance of developing it.

• Genes influence metabolism, appetite, and how the body stores fat.

• Some people naturally produce higher levels of hunger hormones or have a “thrifty” metabolism that holds onto calories more efficiently.

2. Hormones and Brain Chemistry Drive Hunger and Fat Storage

• Leptin & Ghrelin: Leptin signals fullness, ghrelin signals hunger. In obesity, leptin resistance can occur, making the brain think the body needs more food.

• The Set Point Theory: The body “defends” a certain weight, increasing hunger and slowing metabolism when weight is lost.

• Insulin Resistance: When cells become resistant to insulin, the body stores more fat, leading to a vicious cycle of weight gain.

3. Environment and Society Shape Our Eating and Activity

• Ultra-processed foods are cheap, addictive, and heavily marketed.

• Many people live in food deserts—areas with little access to fresh, healthy food.

• Sedentary jobs and urban lifestyles mean less daily movement compared to previous generations.

4. Medications and Medical Conditions Can Cause Weight Gain

• Antidepressants, antipsychotics, and steroids can lead to significant weight gain.

• Thyroid disorders (hypothyroidism) slow metabolism.

• Polycystic Ovary Syndrome (PCOS) and insulin resistance promote fat storage.

Obesity as a Chronic Disease

Major medical organizations (AMA, WHO, CDC) recognize obesity as a chronic disease, just like diabetes or hypertension. This shift is important because it reframes treatment:

Not: “Just eat less and move more.”

Instead: “Let’s address the biological, psychological, and environmental factors contributing to your weight.”

This means:

• Medical treatments like GLP-1 medications can help regulate hunger hormones.

• Psychological support for emotional eating is just as important as diet and exercise.

• Bariatric surgery isn’t an “easy way out” but a life-saving intervention for many.

Breaking the Myths

Let’s bust some common myths right away:

1. Obesity is a choice.

Reality: No one chooses to have a chronic disease. Many factors—genetics, hormones, social determinants—affect weight.

2. Weight loss is just about willpower.

Reality: Obesity alters brain chemistry, making weight regulation far more complex than “just trying harder.”

3. Medications and surgery are the ‘easy way out.’

Reality: Obesity treatments are medical interventions like any other disease management tool. Would you tell a person with diabetes to “just try harder” instead of using insulin?

Self-Assessment: What’s Driving My Weight?

Answer the following questions honestly to better understand your own weight-related challenges.

1. Do you often feel hungry even after eating?

A) Yes, almost always

B) Sometimes

C) Rarely or never

2. Do you gain weight easily even with a healthy diet?

A) Yes, it feels like my body holds onto weight no matter what

B) Somewhat, but I see changes when I adjust my habits

C) No, my weight responds predictably to diet and exercise

3. Have you experienced weight gain after starting a new medication?

A) Yes, I noticed significant weight gain

B) Maybe, I gained weight but I’m not sure if it’s related

C) No, medications haven’t affected my weight

4. Do you struggle with emotional or stress-related eating?

A) Yes, I eat in response to stress, sadness, or boredom

B) Occasionally, but I can usually control it

C) No, my eating habits are not affected by emotions

5. Has a doctor ever diagnosed you with a metabolic or hormonal condition (e.g., PCOS, thyroid disorder, insulin resistance)?

A) Yes

B) No, but I suspect I may have one

C) No

Interpreting Your Results:

• Mostly A’s – Your weight challenges may have strong biological, hormonal, or metabolic drivers. Consider discussing medical interventions with your doctor.

• Mostly B’s – A combination of lifestyle adjustments and targeted medical support could help.

• Mostly C’s – While lifestyle plays a role, weight regulation is still complex—keep learning and tailoring your approach.

A New Path Forward

Obesity is a complex, multifaceted condition that deserves a comprehensive, compassionate approach. In our next article, we’ll dive into the history of obesity—how different cultures have perceived weight, how medical understanding has evolved, and what the obesity epidemic really means for society today.