Resources

Is Obesity a Choice?

Ever feel like you’ve tried everything to lose weight but you just don’t seem to get the same results as other people?  You’re not alone.

If you turn to the world of social media for support, you have likely been told, its because you didn’t work hard enough, you have a lack will power or just aren’t consistent enough, in an attempt from fitness influencers to ‘inspire’ their audience into action.

Obesity: A Health Issue, Not a Lifestyle Choice

Obesity is a serious public health issue, linked to diseases like heart disease, diabetes and certain cancers. The American Medical Association recognises obesity as a complex, chronic disease (1) and the truth is, whilst the crux of it does come down to ‘energy in vs energy out’, in that weight gain is caused by consuming more calories than you burn. The CHOICE to consume more calories than you burn is actually a complex one, that is influenced by both genetic and environmental factors. Understanding how these factors influence our choice (and importantly, why our choices are not built on an even playing field) can shed light on why some people struggle more with weight loss than others.

Genetics and Weight

Did you know that obesity is highly heritable, with estimates ranging from 40% to 85% (2, 3)? This means our genes play a huge role in our overall weight. This figure includes impact on physiological factors, such as satiety cues and hunger signalling (more below), as well as our behavioural tendencies such as willpower, motivation etc. So even if it did come down to ‘the willpower to move more and eat less’, we are all different in our baseline motivations, interests and willpower to do so!

Repeated twin studies have also provided fascinating insights into the genetic influence on weight gain during overfeeding. Identical twins often show significant similarities in weight gain, fat mass, and fat distribution when overfed, but when you compare their results to other pairs of twins (even on the same calorie surplus) you can see differences from 4-13kgs in weight gain, on the same diet (4)! Not only, this but we also see differences in how and where fat is stored and how much muscle is built. This explains why two people can follow the same diet and exercise plan yet experience different results.

Again, each person might be ‘choosing to exercise and eat less’ but the results of that ‘choice’ might look different, with some people losing more than others, even for the same amount of effort given!

An additional point I would like to add here is that healthy looks different on everyone, where we store fat, the shape of our muscle and many other factors that link to our genetics can determine our overall body shape and it is important to acknowledge that as with many other things shown, chasing a once size fits all ‘ideal’ as to what a healthy body looks like is something we should look to avoid, finding your version of what healthy looks like is key.

Why Some People Have to Work Harder

Obesity carries a stigma that those affected are merely ‘choosing’ to eat more food. This assumption ignores the reality that individuals with higher body fat percentages may have different levels of appetite compared to leaner individuals. They are not overeating simply because they ‘have no self-control’.

Studies show that satiety responsiveness and food cue responsiveness are highly heritable, with estimates of 63% and 75% respectively (5). This suggests a significant genetic component in how individuals experience hunger and satiety. Some people have higher baseline appetite levels, and when they lose weight, their hunger can actually increase. For naturally hungry individuals, reducing calorie intake is significantly more challenging and much more difficult of a ‘choice’ to eat less, than someone with a naturally lower appetite who may find the same process easier to stick to with actually less ‘willpower’ needed.

Genetics vs Lifestyle: Is Genetics an Excuse?

It is of course, important to acknowledge that even those with high heritability of increased weight, can still manage their weight and make significant change through lifestyle modifications such as diet and exercise, we are not victims to our genetics. This is why when genetics are discussed in the context of obesity, it is often met with criticism, as many believe it is used an excuse or a reason to avoid taking control of your health (interestingly when we recognise the ability for someone to ‘stay skinny’ with relatively little effort, the same criticism of genetics is rarely applied).

However, I believe the reality is quite the opposite.

Understanding genetics is crucial to obesity research, which aims to determine why weight loss is particularly challenging for some individuals. The general population frequently oversimplifies this complex issue as ‘just a choice’, which in turn downplays the struggles that some people go through on their weight loss journey, and how for the same input of effort, there will be a different result for different people.

By recognising the roles of genetics, physiology, and environment, we can better support individuals on their unique weight loss journey. This understanding empowers people to set realistic expectations and find the appropriate level of support, rather than setting unrealistic comparisons of their progress to others and believing that the only reason for their struggle is a lack of ‘willpower’. Acknowledging these factors provides a more empowering and supportive approach to obesity and weight management in general.

Conclusion

Obesity is not just about personal choice. It’s a complex health issue influenced by genetics, lifestyle, and environmental conditions. Understanding that each person’s weight loss journey is unique fosters empathy and support, validating the struggles of those who find weight loss particularly challenging and empowers people to focus on their own journey whilst removing unrealistic comparisons and expectations. 

So, if you are someone that feels like weight loss is difficult, even when doing ‘all of the right things’, know that you’re not alone, know that you can make positive change for your health, know that you are in control. But also recognise that your journey is unique, that your choices may be harder to make than others, but that support is available, that healthy looks different on everybody, that the ideal body shape is different for everybody and that speed of results may differ. 

And that is OK! 

Instead of focussing on the numbers on the scales, focus on developing healthy habits, in aligning your behaviours with the best version of yourself and most importantly, learning to love yourself on every step of your wellness journey.

References

1. Brown, W., Fujioka, K., Wilson, P., & Woodworth, K. (2009). Obesity: why be concerned?. The American journal of medicine, 122 4 Suppl 1, S4-11 . https://doi.org/10.1016/j.amjmed.2009.01.002.
2. 1. Khera, A., Chaffin, M., Wade, K., Zahid, S., Brancale, J., Xia, R., DiStefano, M., Senol-Cosar, O., Haas, M., Bick, A., Aragam, K., Lander, E., Smith, G., Mason-Suares, H., Fornage, M., Lebo, M., Timpson, N., Kaplan, L., & Kathiresan, S. (2019). Polygenic Prediction of Weight and Obesity Trajectories from Birth to Adulthood. Cell, 177, 587-596.e9. https://doi.org/10.1016/j.cell.2019.03.028.
   2. Nan, C., Guo, B., Warner, C., Fowler, T., Barrett, T., Boomsma, D., Nelson, T., Whitfield, K., Beunen, G., Thomis, M., Maes, H., Derom, C., Ordoñana, J., Deeks, J., & Zeegers, M. (2012). Heritability of body mass index in pre-adolescence, young adulthood and late adulthood. European Journal of Epidemiology, 27, 247-253. https://doi.org/10.1007/s10654-012-9678-6.
3. Yang, W., Kelly, T., & He, J. (2007). Genetic epidemiology of obesity.. Epidemiologic reviews, 29, 49-61 . https://doi.org/10.1093/EPIREV/MXM004.
4. Bouchard, C., Tremblay, A., Despres, J., Nadeau, A., Lupien, P., Thériault, G., Dussault, J., Moorjani, S., Pinault, S., & Fournier, G. (1990). The response to long-term overfeeding in identical twins.. The New England journal of medicine, 322 21, 1477-82 . https://doi.org/10.1056/NEJM199005243222101.
5. O’Rahilly, S., & Farooqi, I. (2008). Human obesity as a heritable disorder of the central control of energy balance. International Journal of Obesity, 32, S55-S61. https://doi.org/10.1038/ijo.2008.239. 

Further Support

If you would like support in working on your long term habits and becoming the best version of yourself, why not join us on our upcoming 21-day challenge, in which we hone in on 4  key pillars of health with a focus on long-term sustainable behaviour change.