#11: Is obesity a choice?

Is Obesity a Choice? A Deep Dive into the Science, the Stigma, and the Reality

Obesity remains one of the most misunderstood health issues of our time. Despite affecting over 650 million adults globally according to the World Health Organization  , it is often blamed on personal failings—sloth, gluttony, or lack of self-control. But is obesity truly a choice? A chronic disease? Or somewhere in between?

1. Obesity: A Chronic Disease, Not Just a Lifestyle

• Global medical consensus: The American Medical Association recognized obesity as a chronic disease in 2013  . This aligns with WHO definitions emphasizing excessive fat accumulation that impairs health.
• Recognized by major bodies: Organizations like the CDC, European Medical Association, World Obesity Federation, and U.S. NIH affirm obesity’s multifactorial nature—encompassing physiological, genetic, environmental, and psychological factors .

2. What Science Actually Says: Beyond Calories In vs. Calories Out

While diet and exercise matter, they are only part of a much larger picture:

• Genetics & hormones: Twin studies suggest genetics account for up to 70% of obesity risk  . Hormones like ghrelin and GLP‑1 regulate hunger and satiety—factors that vary widely among individuals .
• Obesogenic environments: From food deserts and technological disruption to nightly screen exposure and limited green spaces, our environment heavily shapes choices .
• Biological mismatch: Modern life clashes with ancient biology. As quoted in the literature:
  “We have created a biology–environment mismatch… unable to evolve fast enough to keep pace with the environmental change.”  

3. The Stigma That Hurts

Despite scientific clarity, social perceptions lag drastically:

• Public bias: A Yazen Health survey found 37% of Brits view obesity as a personal choice, and 43% link it to laziness .
• Harmful stereotypes: Stigma can be more damaging than obesity itself—driving emotional distress, healthcare avoidance, and worsening mental health. One individual shared:
  “Obese people, it’s their own fault because they are lazy … All they have to do is eat less.”  
• Clinician bias: Many healthcare providers unintentionally promote stigma, viewing obesity through a lens of personal failure rather than disease management  .

4. Why “It’s a Choice” is Dangerous and Inaccurate

• Undermines treatment: Viewing obesity as solely self-inflicted rationalises stigma and discourages patients from seeking or sticking with effective therapy.
• Prevents public health progress: A blame-centric paradigm limits our ability to address food deserts, marketing excess, and urban design—all systemic contributors to weight gain .
• Misleads the public: While moderate weight loss (5–10%) can yield health benefits, most people regain weight due to biological adaptations—underscoring obesity’s complexity and the need for medical support .

5. A Holistic Call to Action

✦ Rethink the narrative

Shift from “If you’re fat, you’re lazy” to “Obesity is a chronic medical condition influenced by many factors.”

✦ Educate the public

Boost understanding through school programs, community outreach, and clear public-health messaging—especially in regions like the UK where millions live in obesity’s shadow .

✦ Reform environments

Support initiatives targeting food quality, urban planning, and equitable access to nutrition and healthcare—reducing systemic barriers that feed obesity  .

✦ Provide compassionate care

Healthcare providers must tackle implicit bias, and treat obesity with the same ongoing, multidisciplinary approach as other chronic diseases .

6. In Conclusion: It’s Not That Simple—or That Simple

Yes, individuals can make choices affecting their weight. But obesity is far more than a choice—it’s the outcome of intertwined genetics, biology, societal factors, and environments. Labelling it a simple matter of willpower not only ignores evidence—it perpetuates stigma and undermines progress.

 

The Epidemic of Obesity: Who Is Affected?

A Global Health Crisis

Obesity is no longer confined to specific countries or demographics—it is a worldwide epidemic. According to the World Health Organization (WHO), more than one billion people globally were living with obesity in 2022. This includes:

• 890 million adults (BMI ≥ 30)
• 160 million children and adolescents (ages 5–19)
• 37 million children under age 5

The number of overweight adults worldwide has risen to 2.5 billion, representing roughly 43% of all adults.

Trends Over Time

• Since 1990, adult obesity rates have more than doubled.
• Childhood obesity has quadrupled globally in the same timeframe.
• Between 1990 and 2021, the number of overweight or obese adults rose from 731 million to 2.11 billion.
• Among young people aged 5–24, the number increased from 198 million to 493 million.
• Projections suggest that by 2050, nearly 60% of adults (about 3.8 billion people) and 31% of young people (about 746 million) will be overweight or obese if current trends continue.

Age and Gender Differences

• In countries like the UK, approximately 80% of men aged 55–64 are overweight or obese, compared to only about a third of men aged 16–24.
• In the United States, severe obesity (BMI ≥ 40) affects 12.1% of women and 6.7% of men, a gap that has persisted for decades.
• Globally, male obesity rates have risen by approximately 155% since 1990, compared to a 105% increase among women. However, women still tend to have higher rates of severe obesity in most regions.

Obesity by Nationality

Some countries face disproportionately high obesity rates:

• United States: ~45% of adults are obese
• United Kingdom: ~31% of adults are obese; two-thirds are overweight or obese
• Samoa: ~81% of adults obese
• Nauru: ~75%
• Tonga: ~74%

These rates are influenced by factors such as diet shifts, urbanisation, socioeconomic status, and food marketing practices.

Regional Focus

• Europe: Roughly 60% of adults are overweight or obese. One in three children is now affected by overweight or obesity. Obesity contributes to an estimated 1.2 million deaths annually in the WHO European Region.
• Low- and Middle-Income Countries (LMICs): These countries now account for 79% of overweight/obese adults and 88% of affected children. Adult obesity is expected to rise from 810 million (2020) to 1.53 billion (2035) in LMICs.