By Dr Mohgah Elsheikh: Obesity isn’t just a number on a scale—it’s a complex condition shaped by biology, environment, psychology, and behaviour. Let’s explore why it’s time to move beyond myths and embrace understanding and compassion.
Why We Need to Change the Conversation
Too often, obesity is oversimplified as “laziness” or “poor self-control,” but the overwhelming majority of people with obesity have tried countless diets, exercise routines and calorie-counting efforts with relentless dedication.
These efforts reflect determination, not a lack of willpower. So why does weight loss prove so elusive? The real story lies in the brain’s appetite systems.
The Biology of Appetite: Not a Choice
Hormones and Hunger
Two key hormones—leptin and ghrelin—play starring roles. Leptin signals fullness, while ghrelin triggers hunger. These signals begin deep in the brain, long before we even realise we’re hungry. For many people with obesity, these signals become amplified. They feel hungry more often, feel full less and experience intense cravings beyond conscious control.
Genes, Stress & Sleep
Genetics, early-life experiences, chronic stress and disrupted sleep influence appetite regulation. The modern environment—filled with calorie-dense, convenient foods and targeted marketing—only magnifies the challenge.
Energy Balance vs. Appetite Dysregulation
The classic “calories in, calories out” model assumes everyone can simply eat less and move more. But if hunger-system “defences” kick in—making you feel ravenous, less satiated, or prone to cravings—that approach usually fails.
People with obesity often exhaust themselves trying to outsmart biology. The result? Repeated cycles of dieting and regain. It’s not about a weak will; it’s about a brain wired to protect your weight.
Myths, Met & Debunked
1. “BMI is useless.”
2. “It’s the hormones.”
3. “Obesity is a choice.”
A More Effective, Compassionate Approach
What if instead of blaming willpower, we acknowledged biological reality? Here’s a more caring, evidence-based framework:
1. Eliminate Stigma
Frame obesity not as moral failure, but as a health condition influenced by many uncontrollable factors.
2. Target Biology
Investigate treatments—such as medications—that help reset appetite signals, reduce hunger and increase feelings of fullness.
3. Educate Everyone
Equip both patients and healthcare providers with a deeper understanding of obesity’s drivers—genes, hormones, environment, psychology—not just calories.
4. Reframe Responsibility
Rather than urging patients to “just try harder,” support them in accessing evidence-based interventions and building sustainable habits.
5. Embrace Whole-Person Care
Consider the broader context: mental health, stress, social factors, sleep, physical activity—not just weight metrics.
Why This Matters
Key Takeaways
Myth: Laziness equals Obesity. Truth: Most people with obesity have tried hard to lose weight.
Myth: Weight loss is just diet. Truth: Appetite biology often fights back, resetting hunger and fullness levels.
Myth: Obesity is a personal choice. Truth: Biological and environmental forces largely shape our weight set‑point.
Your Role in Compassionate Care
If you are living with obesity:
If you are caring for others living with obesity share this understanding. Offer support, not judgement. Help them access treatments that work with biology, not against it.
Final Thoughts
Obesity is a complex, common, chronic condition, not a moral failing or lack of willpower. By recognising the intricate interplay of hormones, brain circuits, stress, sleep, and genetics, we can shift from blame to empathy. The result?
Together, let’s reshape the obesity narrative—toward evidence, compassion, and real solutions.
Dr. Mohgah Elsheikh is a specialist in Endocrinology, Obesity and Bariatric Medicine, committed to empowering patients through understanding, support and scientific insight.