Episode 60
Obesity is not about Forks and Willpower
Obesity: Not Just About Forks and Willpower
For years, obesity has been misunderstood, oversimplified, and even stigmatized. It's been framed as a personal failing, a lifestyle choice, or simply a matter of "eating less and moving more." But science tells a different, more nuanced story—one where our brains, biology, and ultra-processed food environment play starring roles. And thanks to groundbreaking medications like GLP-1 drugs, we’re gaining a clearer picture of how obesity works and how to treat it.
Let’s dive into why obesity is a disease, how ultra-processed foods exacerbate it, and why we need to ditch the harmful myth that obesity is a lifestyle choice.
The Myth of "Just Eat Less and Move More"
"Just eat less and move more." It’s the phrase everyone loves to repeat—and no one finds helpful. This simplistic advice ignores the reality that obesity is not merely about calories in and calories out. It’s about a complex interplay between your biology, brain chemistry, and environment.
Obesity isn’t a character flaw or a lack of willpower. If it were, we wouldn’t see an obesity epidemic in societies flooded with cheap, ultra-processed foods engineered to make us eat more. These foods hijack our biology, overpowering the mechanisms our bodies use to regulate hunger and fullness.
The Hungry Brain: Why You Can’t Stop Eating
Our brains evolved to keep us alive in times of scarcity. Back in the caveman days, this was helpful. Today, it’s less so because our brains are still wired to seek out high-calorie foods to avoid starvation—even when we’re surrounded by abundance.
When you eat ultra-processed foods, they light up the reward centers in your brain like a Christmas tree. These foods—laden with sugar, fat, and salt—trigger the release of dopamine, the same neurotransmitter involved in addiction. It’s no wonder we keep going back for more.
Adding to the complexity, hormones like ghrelin (the "hunger hormone") and leptin (the "fullness hormone") can go haywire in people with obesity. Ultra-processed foods amplify ghrelin’s effects, making you feel hungrier while reducing your sensitivity to leptin, so you never feel full. It’s a biological double whammy.
Citation: Studies show that diets high in ultra-processed foods increase calorie consumption by about 500 calories per day compared to diets of unprocessed foods (Hall et al., 2019).
GLP-1: The Game-Changing Hormone
Here’s where things get interesting: GLP-1, or glucagon-like peptide-1, is a hormone that helps regulate appetite. It tells your brain, “You’re full; you can stop eating now.” But for many people with obesity, this system doesn’t work properly. Their brains don’t get the message, leading to overeating.
Enter GLP-1 receptor agonists like semaglutide and liraglutide—medications that mimic the effects of GLP-1. These drugs help regulate appetite, making people feel full sooner and reducing cravings. The results have been extraordinary: clinical trials show average weight loss of 15% or more with these medications, far outpacing what’s possible with lifestyle changes alone.
These drugs have done more than help people lose weight—they’ve also shifted the way we think about obesity. They show that obesity is a medical condition influenced by hormones and brain chemistry, not just a matter of willpower.
Citation: Clinical trials on GLP-1 receptor agonists show significant and sustained weight loss, with participants losing 15% or more of their body weight (Wilding et al., 2021).
Why Obesity Is a Disease, Not a Lifestyle Choice
The idea that obesity is a "lifestyle choice" is not only incorrect—it’s harmful. Framing obesity this way ignores the biological, genetic, and environmental factors that contribute to it. Worse, it stigmatizes people with obesity, making them feel like they’re to blame for their condition.
Obesity meets all the criteria for a chronic disease: it has a defined pathology (dysregulation of appetite and metabolism), it leads to complications (diabetes, heart disease, etc.), and it requires long-term management. Lifestyle factors like diet and exercise can influence obesity, but they’re not the sole cause. Blaming someone for their obesity is like blaming someone with asthma for living in a polluted city.
Citation: The American Medical Association classified obesity as a chronic disease in 2013, recognizing it as a condition requiring medical treatment (AMA, 2013).
Ultra-Processed Foods: The Real Culprit
If obesity is a fire, ultra-processed foods are the gasoline. These foods are engineered for maximum palatability, combining sugar, fat, and salt in ways that overwhelm our natural appetite-regulation systems. They’re calorie-dense, nutrient-poor, and often stripped of fiber, which would otherwise help us feel full.
Even worse, ultra-processed foods alter the way our brains respond to food. They increase cravings, reduce satiety, and encourage overeating. Over time, this can lead to weight gain and metabolic issues, creating a vicious cycle that’s hard to break.
Citation: Research shows that people who consume diets high in ultra-processed foods are more likely to develop obesity and metabolic diseases (Monteiro et al., 2018).
How GLP-1 Drugs Have Changed the Game
GLP-1 drugs have given us new tools to treat obesity—and new insights into its underlying causes. They’ve proven that obesity isn’t just about behavior; it’s about biology. When you treat obesity like a disease rather than a moral failing, people get better.
But these medications are just one piece of the puzzle. To tackle obesity on a larger scale, we need to address the broader food environment. That means making healthy, unprocessed foods more accessible, reducing the marketing of ultra-processed foods, and investing in public health initiatives that promote nutrition education.
Why Fat Shaming Is Harmful (and Wrong)
Let’s address the elephant in the room: fat shaming. The idea that you can "shame" someone into losing weight is not only cruel—it’s ineffective. Research shows that weight stigma leads to stress, low self-esteem, and even more weight gain. It’s a lose-lose situation.
Instead of shaming people for their weight, we need to focus on creating supportive environments that help everyone make healthier choices. That includes treating obesity as the complex, multifactorial disease that it is—not a personal failure.
Citation: Weight stigma is associated with increased psychological distress, unhealthy eating behaviors, and reduced motivation for physical activity (Puhl & Heuer, 2010).
Moving Forward: What We Can Do
Here’s how we can start to shift the conversation around obesity:
Acknowledge Obesity as a Disease: Let’s treat obesity like any other chronic condition with empathy and evidence-based care.
Focus on the Food Environment: We need to address the root causes of obesity, including the overabundance of ultra-processed foods.
Reduce Stigma: Stop blaming individuals for their weight. Instead, offer support and solutions.
Expand Access to GLP-1 Drugs: These medications are game-changers, but they’re expensive and not always covered by insurance. Making them accessible is crucial.
Conclusion: It’s Time to Change the Narrative
Obesity is not a lifestyle choice. It’s a complex, chronic disease driven by biology, brain chemistry, and the environment we live in. Thanks to advances in science, like GLP-1 drugs, we’re starting to understand and treat obesity in ways that are effective and compassionate.
The next time someone tells you to “just eat less and move more,” remind them that obesity is about much more than that. It’s time to move past the myths, embrace the science, and support people on their journey to better health.
And maybe, just maybe, it’s time to rethink that bag of chips.
References
AMA (2013). "American Medical Association House of Delegates Resolution 420 (A-13)."
Transcript
>> Dr. Terry Simpson: Here's a question for you. Is obesity a
Speaker:lifestyle choice? Short answer,
Speaker:Absolutely not. Long answer. That's
Speaker:what this podcast is about.
Speaker:Buckle up, because today we're going to unravel the
Speaker:complex, fascinating, and occasionally
Speaker:ridiculous way our brains, ultra
Speaker:processed food, and a little hormone called
Speaker:GLP1 are running the show when it comes to
Speaker:obesity. Oh, and spoiler alert.
Speaker:Calling obesity a, uh, lifestyle choice is not only
Speaker:incorrect, it is also fat shaming.
Speaker:So let's put that nonsense to
Speaker:rest.
Speaker:I am your Chief Medical Explanationist, Dr. Terry
Speaker:Simpson, and this is Forku
Speaker:Fork University, where we bust myths, make
Speaker:sense of the madness, and learn a little bit about food
Speaker:and medicine.
Speaker:Let's start with the oldest, most tired
Speaker:advice in the world. Just eat less
Speaker:and move more. It's the go to slogan of
Speaker:diet culture, printed on motivational posters
Speaker:and yelled by personal trainers everywhere.
Speaker:And guess what? It's as useful as
Speaker:telling a person with depression to just cheer
Speaker:up. If that advice worked, this
Speaker:podcast would be about something way more fun,
Speaker:like how to make a perfect sourdough bread.
Speaker:The reality is, obesity isn't just about
Speaker:calories in and calories out. It's a
Speaker:complex interplay of your brain, your
Speaker:biology, and the world around you. A
Speaker:world stuffed to the gills with ultra
Speaker:processed foods engineered to make you eat
Speaker:more. I'm talking about foods so refined
Speaker:they could pass as a contestant on the
Speaker:Bachelor. But why do we keep eating them? This
Speaker:brings me to my next point. Your brain is not
Speaker:your BFF when it comes to food.
Speaker:And here's the thing. Your brain has one job when it
Speaker:comes to food. To keep you alive. And
Speaker:it's stuck in the caveman mode,
Speaker:constantly afraid you're going to starve.
Speaker:So when you eat that bag of chips or that tub of ice cream,
Speaker:your brain throws a party. Why? Because
Speaker:these foods are packed with calories. And your brain
Speaker:sees calories as survival. The
Speaker:problem. Ultra processed foods
Speaker:hack to the system. They're designed to hit
Speaker:reward centers of your brain harder than a toddler hits a
Speaker:pinata. They combine sugar, fat, and
Speaker:salt into an unholy trinity of
Speaker:deliciousness that keeps you coming back for more.
Speaker:Your brain doesn't stand a chance. It's like playing
Speaker:poker against a deck full of aces. And you're going to lose
Speaker:every time. Oh, and let's not
Speaker:forget the lovely hormone Ghrelin. The
Speaker:I'm hungry hormone. Think of Ghrelin as
Speaker:your annoying co worker who keeps reminding
Speaker:you it's lunchtime even though you just ate. And guess
Speaker:what? Ultra processed foods can
Speaker:Amplify ghrelin's effects, making you
Speaker:feel hungrier and eat more. It's a
Speaker:vicious cycle.
Speaker:Now let's talk about the hero of our story, modern
Speaker:medicine and the GLP1s.
Speaker:GLP1 is a hormone that helps you regulate your
Speaker:appetite. And it's key to understanding why
Speaker:obesity isn't just a willpower issue. You
Speaker:see, GLP1 tells your brain, hey, you're full. You can stop
Speaker:eating now. But for people with
Speaker:obesity, that system is out of whack.
Speaker:Enter GLP1. Like semaglutide
Speaker:or Mounjaro. These medications mimic
Speaker:the effect of GLP1, essentially whispering to the brain,
Speaker:hey, chill out. You don't need another slice of pizza. And the
Speaker:results? People lose a significant amount
Speaker:of weight not just because they suddenly develop
Speaker:superhuman willpower, but because their biology
Speaker:is finally working with them instead of
Speaker:against them. And here's the kicker.
Speaker:These drugs have shown us that obesity isn't about
Speaker:eating too much. It's a disease. A
Speaker:complex chronic condition influenced by your
Speaker:genes, your hormones, and, yes, that sneaky brain
Speaker:of yours. And when you treat it like a
Speaker:disease, guess what happens? People get
Speaker:better.
Speaker:Now, uh, let's tackle the elephant in the room. The idea that
Speaker:obesity is a lifestyle choice. I'm just going to say it.
Speaker:This is one of the most damaging myths out there. Calling
Speaker:obesity a lifestyle choice is like calling an
Speaker:asthmatic a bad breathing decision.
Speaker:It's not just wrong, it's harmful.
Speaker:When we frame obesity as a lifestyle choice, we're
Speaker:essentially saying, if you're overweight, it's your fault.
Speaker:That kind of thinking leads to the stigmata, shame, and
Speaker:discrimination. And guess what? Shame is not a good
Speaker:motivator for change. If it were, the
Speaker:gym would be packed with people who got roasted at
Speaker:Thanksgiving dinner. Let's be clear. When
Speaker:lifestyle factors like diet and exercise contribute to
Speaker:obesity, they're not the sole cause. Genetics plays a
Speaker:massive role, as does the food environment we live
Speaker:in. Blaming someone for their obesity is like blaming
Speaker:someone for living in a city with terrible air quality. Sure,
Speaker:they can try and breathe better, but the odds are stacked against
Speaker:them. And let's take a moment to appreciate how
Speaker:diabolical ultra processed foods really
Speaker:are. These aren't just foods.
Speaker:They're science experiments designed to keep you
Speaker:eating. They're hyper palatable, calorie
Speaker:dense, often stripped of fiber and nutrients.
Speaker:It's like the evil twin of a home cooked
Speaker:meal. Here's a fun fact. Studies have shown
Speaker:that people eat more when they consume ultra
Speaker:processed foods. About 500
Speaker:calories a day more. And guess what?
Speaker:Those calories add up over time. That's
Speaker:how you end up with weight gain, metabolic issues, and
Speaker:a lifelong addiction to Doritos.
Speaker:In my case, maybe it's Reese's. Ultra
Speaker:processed foods aren't just bad for your waistline,
Speaker:they're bad for your brain. They can hijack your
Speaker:dopamine system, making you crave more and more.
Speaker:It's like that one X. You can't quit texting at
Speaker:2am you know it's bad for you, but you do it
Speaker:anyway. So what have we learned today? To
Speaker:recap, obesity is a disease. It has
Speaker:been diagnosed as a disease since 2013.
Speaker:It is not a lifestyle choice. Blaming people
Speaker:for their obesity is not only wrong, it's unhelpful
Speaker:and cruel. Two, your brain and hormones
Speaker:are driving the bus and ultra processed foods are out there slashing
Speaker:the tires. Three GLP1 drugs,
Speaker:uh, are game changers. They've shown us that treating obesity
Speaker:as a medical condition can lead to real society, sustainable
Speaker:results. The bottom line, we
Speaker:need to stop shaming people for their weight and start
Speaker:addressing the root causes of obesity, starting with the food environment
Speaker:and the biologic factors that drive
Speaker:overconsumption. And here's one final
Speaker:kicker. You know your body makes its own
Speaker:GLP1. Did you know that ultra
Speaker:processed food starts
Speaker:feeding bacteria in your
Speaker:microbiome that actually destroy the
Speaker:cells that make GLP1? So imagine
Speaker:this. Ultra processed foods not
Speaker:only hack your brain into wanting to eat more, I
Speaker:mean, you can't just eat one, but
Speaker:they also promote a microbiome or the bacteria in your
Speaker:gut that destroy the cells that make your own
Speaker:endogenous GLP1. Oh, by the
Speaker:way, is there something you can do to help
Speaker:your cells make more GLP1 and
Speaker:support a healthy microbiome? Yeah, turns out
Speaker:eating more fiber, specifically a kind of fiber called
Speaker:inulin, can do that. Well, that's
Speaker:all for today's episode of Fork youk. If you've learned one thing, let it
Speaker:be obesity isn't about bad choices. It's about bad
Speaker:systems. And now we understand it better,
Speaker:we can start treating it better.
Speaker:Until next time, I'm Dr. Terry Simpson, your chief medical
Speaker:explanationist, reminding you to love your food, love your body,
Speaker:and remember, it's not about the fork in your
Speaker:hand. It's about what's at the end of it. This
Speaker:episode was written and researched by me, Dr. Terry Simpson.
Speaker:You can find references in my blog
Speaker:post@yourdoctorsorders.com and
Speaker:forku.com and please. If you're going to
Speaker:start a diet, start a diet for your nutrition.
Speaker:Think about the Mediterranean or the- diet. And on my website,
Speaker:Dr.terrysimpson.com, i actually have a course about the Mediterranean
Speaker:diet. Before you start any diet,
Speaker:please see your doctor. I am not your
Speaker:doctor, but someone is. And please make sure
Speaker:they're a western trained board certified physician,
Speaker:not a chiropractor. Or please see a registered
Speaker:dietitian. Your doctor and the dietitian will know
Speaker:your particular health issues and can help with
Speaker:diet that is good and nutritious and delicious for
Speaker:you. Until next time. We'll
Speaker:see you later. Have a great week and thanks to our friends at Simpler
Speaker:Media and The pod God, Mr. Mr. Evo
Speaker:Terra, for helping to distribute this
Speaker:episode.
Speaker:Remember when you were on the beer and sausage diet?
Speaker:Could you just drink one beer?
Speaker:You mean one right after another? Uh,
Speaker:yeah, sure.
