It’s Not Your Fault: Understanding Obesity as a Disease

by Allen F. Browne, MD, FACS, FAAP, FOMA

Summer 2023

“It’s not your fault!” These four words are some of the first ones I use when discussing the disease of obesity with a child who has it, as well as their parents.

In many parts of the world, there has been a common misunderstanding that people with obesity are solely responsible for their condition because they eat too much and don’t exercise enough. This belief leads others to think that individuals with obesity are lazy and that all they need to do is eat less and exercise more. Unfortunately, growing up in a society that perpetuates these stereotypes can cause people with obesity to internalize these negative beliefs about themselves. However, this understanding of obesity is completely incorrect.

Obesity is a disease. Our bodies have automatic control systems that regulate our blood pressure and body temperature to keep them in a healthy range. We don’t have to consciously think about or try to maintain a healthy blood pressure or body temperature. When we feel cold, we shiver. When we feel hot, we sweat. If our blood pressure drops, our body shifts blood to vital organs. Just like hypertension (high blood pressure), hypotension (low blood pressure), hyperthermia (high body temperature), or hypothermia (low body temperature) can occur due to malfunctions in these control systems, obesity can also be caused by similar unknown factors. The good news is that we can treat these malfunctions.

Obesity and Set Point

The body has subconscious control mechanisms to regulate the amount of fat tissue in it. These mechanisms are known as the energy regulation system (ERS). Our body has a specific point, called a set point, which can either be healthy or unhealthy. The ERS protects this set point when the amount of fat in the body increases or decreases. Except in rare cases, obesity develops when the set point becomes unhealthy and the body defends that unhealthy set point. It’s usually difficult to determine what causes the set point to become unhealthy. The body’s defense mechanisms are triggered by any movement away from the set point, not by our health. If we try to intentionally gain or lose fat beyond the set point, it becomes challenging, and if we stop trying, the amount of fat automatically returns to the set point level.

Obesity is a health problem in which the body accumulates an unhealthy amount of fat tissue and stores it. This excess fat can cause more than 200 different issues, including:

• Type 2 diabetes
• Heart attack
• Stroke
• Cancers
• Liver disease
• Musculoskeletal problems
• Anxiety and depression
• Eating disorders
• Bullying and loneliness

We don’t know exactly what causes an individual’s set point to become unhealthy. However, we do know there are several factors in our environment and genes that can increase the likelihood of developing obesity. If you have many relatives in your family who have obesity, your chances of developing it are higher. Similarly, experiencing a lot of stressful events in your life or having irregular and insufficient sleep can also increase your chances of developing obesity. Additionally, exposure to certain chemicals called obesogens can increase the risk. It’s important to note that not everyone exposed to these factors will develop obesity, and we’re still uncertain about why that is.

Managing Obesity: Shifting the Set Point

Despite efforts to prevent obesity, the number of people who have it has steadily risen over the past several decades. Right now, we don’t know any fail-safe ways to prevent obesity. It’s important to remember that obesity is a disease, and we shouldn’t blame individuals for it because the causes are not always something they can control. In other words, it’s not your fault if you have obesity.

The good news is that we now have ways to manage the disease of obesity. Simply trying to eat less and exercise more doesn’t usually work for most people. The body has subconscious control mechanisms that fight against a person’s attempt to change their body fat, forcing it back to the set point mentioned earlier. Fortunately, we now have medications and surgical procedures that can help people with obesity. These treatments seem to shift the set point to a healthier level. This means that people can eat less without feeling excessively hungry or having strong cravings. They can also increase their activity levels without feeling stressed. They will find that they feel satisfied with smaller amounts of food. However, medications and surgery do create some issues that should be considered beforehand.

Lifestyle Considerations with Obesity Treatment

It’s important for individuals to make sure they are eating healthy foods since they won’t be eating as much. To find healthy foods that they enjoy and that align with their cultural background, it’s a good idea for patients to work with a dietitian. Physical activity will become easier, but it should be done with guidance from an activity specialist to ensure that the type and amount of activity they engage in is safe and suitable for them. As a person’s body fat decreases and they become healthier, their interactions with others may change. It can be challenging to experience a reduction in bullying and stigma simply because their appearance is different, and that’s why receiving mental health support and coaching is very important.

Working Closely with Medical Professionals

Medications and surgical procedures come with risks and dangers. Most of these are small and can be controlled, but it’s important to have a medical professional with training in obesity medicine working closely with the patient and their family. Often, a combination of medications and surgical procedures is needed to achieve the best and longest-lasting results. The specific medication or surgical procedure, as well as the combination of treatment tools, will vary for each person. Additionally, the obesity treatment plan may need to be adjusted over time. Decisions about which medication or procedure to use should involve the patient, their family and the medical providers.

Treatment as a Lifelong Commitment

Currently, obesity cannot be completely cured. However, treatment for obesity can greatly improve a person’s health, similar to how treatment helps manage other chronic diseases like high blood pressure and type 1 diabetes. The treatment for obesity is a lifelong commitment. When individuals reach a healthier body fat level, many of the complications associated with obesity may decrease, and they may require fewer medications. Having a healthier amount of body fat reduces the chances of developing obesity-related complications such as type 2 diabetes, heart attacks, strokes, cancers, liver disease, musculoskeletal problems, and mental health issues like anxiety, depression, eating disorders, bullying and loneliness.

The future is promising for individuals with obesity. It starts with understanding that “it’s not your fault” and knowing that we have ways to treat the disease.

About the Author:

Allen F. Browne, MD, FACS, FAAP, FOMA, is an expert in managing weight in children and teenagers. He specializes in pediatric surgery and is highly knowledgeable in the field of pediatric obesity. Dr. Browne has held multiple leadership positions, including serving as the Chairman of the Committee on Pediatric Obesity for the American Society for Metabolic and Bariatric Surgery. He is an active member of the Pediatric Committee of the Obesity Medicine Association and the Section on Obesity of The American Academy of Pediatrics. Dr. Browne is also recognized as a fellow of the Obesity Medicine Association.

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