Obesity is a Rigged System
Obesity isn’t a willpower problem. It’s a systems issue, and it’s time we act like it. We have to stop pretending obesity is a simple math problem. It isn’t just calories in and calories out. And it’s not a personal failing. Obesity is a complex, multifactorial disease driven by biology, environment, and systemic structures that are, quite frankly, stacked against people.
As an obesity medicine and internal medicine physician, I see the same pattern again and again: patients who feel defeated. They come to me saying, "I just need more discipline," or, "I’m doing everything right, but nothing is working." What they don’t know (and what many doctors still don’t acknowledges) is that their struggle isn’t just about behavior. It’s about a deeply entrenched system that fosters weight gain and makes weight loss incredibly difficult.
The Obesogenic Environment
Let’s start with the world we live in.
Our food environment is saturated with ultra-processed foods that are cheap, heavily marketed, and engineered to be hyper-palatable. Access to unprocessed, nutrient-dense foods is limited for many Americans, especially in marginalized communities. Meanwhile, our cities are built for cars, not for walking. Sedentary jobs dominate the workforce. Chronic stress is at an all-time high. And quality sleep? That’s become a luxury few can afford.
All of this contributes to what we call an "obesogenic environment:" a setting that promotes weight gain by default. The deck is stacked long before anyone has a chance to "make better choices."
Obesity Is a Disease. And It Changes Your Biology
Once weight gain occurs, obesity sets off a cascade of changes in the body. This is not just a cosmetic concern. It is a disease, what we call adiposopathy, or "sick fat disease."
Fat tissue becomes inflamed. Hormones involved in hunger, fullness, and metabolism become dysregulated. The brain receives altered signals that increase cravings, decrease satiety, and promote energy storage. In other words: your biology is now fighting your efforts to lose weight.
This is why so many people regain weight after dieting. It’s not about weakness. It’s about physiology.
The Limits of Personal Responsibility
Yes, personal responsibility plays a role. But so does the broader environment. So does access to care. So does mental health. So does generational trauma, poverty, education, and systemic inequality.
To pin it all on willpower is not only wrong. It’s cruel.
Imagine telling someone with asthma that they’re just not trying hard enough to breathe. That’s how it feels when we reduce obesity to "eat less, move more."
What Needs to Change
We need a paradigm shift in how we think about and treat obesity.
Reduce ultra-processed foods in our food system. These are designed to override satiety cues and promote overeating.
Prioritize mental and emotional health. Chronic stress, trauma, and depression are tightly linked to metabolic dysfunction.
Improve access to healthy food and safe environments for movement. That means better urban planning, grocery subsidies, and public health campaigns that go beyond shaming.
Offer insurance coverage for lifestyle counseling and prevention. Obesity prevention should be as covered and normalized as hypertension or diabetes management.
Cover anti-obesity medications. These are evidence-based, FDA-approved tools. Patients deserve access to the full toolkit, not just diet and exercise.
Educate kids (and adults) on nutrition and cooking. Real health starts at home and in schools.
We cannot solve a systemic issue with individual guilt. We need to create systems that empower people to thrive, not shame them for struggling.
Obesity is complex. The solutions must be too.
It’s time we stopped blaming people and started supporting them. Only then can we change the course of the obesity epidemic for good.