Obesity: A Chronic Disease, Not Just a Matter of Willpower

For many years, obesity was misunderstood as simply the result of eating too much or not exercising enough. However, medical research has completely changed how we see this condition. Today, obesity is recognized as a chronic, long-term, and treatable disease, rather than merely a reflection of personal choices or discipline. Both the American Medical Association and The Obesity Society define obesity as a disease because it involves many complex processes in the body and brain that people often can’t control on their own.

Understanding Why Obesity Isn’t Just About Willpower

Obesity happens because of a mix of genetics, body chemistry, brain signals, environment, habits, and emotional health. For example:

• Brain signals play a big role in controlling hunger, fullness, and how rewarding certain foods feel. Changes in these signals can make it very hard for some people to feel satisfied after eating or to resist cravings.

• Hormones help decide how our bodies store fat, manage blood sugar, and handle metabolism. When these hormones are out of balance, it becomes easier to gain weight and harder to lose it.

• Genetics influence how our bodies burn calories, feel hunger, and store fat. Some people inherit traits that make weight gain more likely under certain conditions.

• Environmental factors—like having lots of cheap, high-calorie food around, busy lifestyles, and financial stress—make it even more challenging for people, especially those with a genetic tendency to gain weight.

Because of these factors, losing weight and keeping it off is rarely just about trying harder. It’s neither fair nor accurate to say people with obesity simply need more discipline.

Obesity’s Impact on Heart and Kidney Health

Obesity is not just about weight—it affects nearly every organ in the body. Two important areas are the heart and the kidneys.

How Obesity Affects the Heart

• People with obesity have a higher risk of heart failure, heart disease, irregular heartbeats, and strokes.

• Obesity increases the chances of having clogged arteries, high blood sugar, high cholesterol, and high blood pressure, all of which damage the heart over time.

• Carrying extra fat, especially around the belly, makes the heart work harder, which can weaken it and affect how well it pumps blood.

Even though some heart-related problems have become less common over time, heart failure hasn’t decreased as much, largely because obesity remains so common.

How Obesity Affects the Kidneys

Obesity is also a major risk factor for kidney disease, even for people who don’t have diabetes or high blood pressure. Some reasons include:

• The kidneys have to work harder to filter waste from the blood when someone has obesity, which can damage them over time.

• Extra fat can build up around the kidneys and press on them, hurting their function.

• Ongoing low-level inflammation and hormonal changes linked to obesity can damage kidney tissues.

• Certain fats can directly harm kidney cells.

People with obesity may notice protein in their urine or a slow decline in kidney function. The good news is that losing weight—whether through healthy eating, medications, or surgery—can help protect the kidneys, reduce stress on them, and slow further damage.

How Heart and Kidney Problems Are Linked

There’s a strong link between obesity, heart disease, and kidney disease. Doctors now talk about something called Cardiovascular-Kidney-Metabolic (CKM) Syndrome, which describes how all these conditions are connected. High blood pressure, high blood sugar, and inflammation affect both the heart and kidneys. For people with obesity, having kidney problems increases the risk of heart problems even more. This is why doctors often recommend treating these conditions together instead of separately.

Why It’s Important to Recognize Obesity as a Disease

Seeing obesity as a chronic disease changes everything:

• It reduces blame and stigma. People with obesity often face unfair judgment and criticism, which can stop them from seeking help. Recognizing obesity as a disease helps shift the focus to compassionate, evidence-based care.

• It improves access to treatment. When obesity is treated as a disease, insurance is more likely to cover treatments like medical care, nutrition counseling, medications, and surgery.

• It leads to better treatment plans. Instead of simply telling people to “eat less and exercise more,” doctors can create individualized plans based on science and each person’s unique situation.

Obesity is linked to more than 200 other health problems, including type 2 diabetes, some cancers, and mental health issues like anxiety and depression. Treating obesity properly can make a significant difference in a person’s health and overall well-being.

Moving Forward

Managing obesity successfully requires a long-term approach, similar to how we treat other chronic conditions like diabetes or high blood pressure. While healthy lifestyle changes remain essential, many people need additional medical help, such as:

• Nutrition counseling and support for building new habits

• Medications that help manage hunger or how the body uses energy

• Surgery, which can lead to significant, lasting weight loss for some people

Blaming obesity on willpower alone is both incorrect and unhelpful. Recognizing it as a real disease opens the door to effective treatments, better health outcomes, and a more compassionate approach to care.