Obesity is often misunderstood in both the public and medical spheres. For decades, it has been framed primarily as a consequence of personal choices—lack of discipline, willpower, or poor lifestyle habits. This oversimplification has led to stigma, shame, and, more importantly, a failure to address obesity as the medical condition it truly is.
Current science recognizes obesity as a complex, chronic disease influenced by a wide array of factors including genetics, biology, hormones, environment, and behavior. Leading health organizations such as the American Medical Association (AMA), the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) have all endorsed this view.
The Disease Process
Obesity involves the dysregulation of several physiological systems:
- Hormonal signals such as leptin, ghrelin, and insulin affect appetite and satiety.
- Genetic factors influence body weight set points, fat storage, and energy expenditure.
- Neurological pathways in the brain’s reward system can reinforce eating behavior.
- Environmental and psychosocial elements like food accessibility, sleep quality, stress, and mental health play a substantial role.
In response to caloric restriction or weight loss, the body often compensates by slowing metabolism and increasing hunger signals, making weight loss maintenance particularly difficult. These biological responses are not under conscious control and are part of why obesity is so challenging to manage without medical support.
The Role of Hormones in Midlife
During perimenopause and menopause, women experience significant hormonal changes that can contribute to weight gain and a shift in fat distribution—particularly toward the abdominal area. Declining estrogen levels, altered cortisol patterns, changes in insulin sensitivity, and sleep disturbances can all influence body composition and metabolic health.
For many women, this life stage marks a turning point where previously effective weight management strategies no longer work. These changes are physiological and not indicative of personal failure.
Evidence-Based Treatment Options
Because obesity is a medical condition, it requires a clinical approach. Treatment may include:
- Medical nutrition therapy tailored to metabolic needs
- Physical activity planning based on ability, health status, and lifestyle
- FDA-approved medications that target appetite regulation and metabolism
- Behavioral interventions for long-term support and change
- Hormonal evaluation and treatment when indicated
- Surgical options in appropriate cases
The goal of treatment is not simply weight loss, but improved overall health, function, and quality of life.
The Importance of Specialist Care
Obesity is best managed by clinicians trained in the complexity of the disease. Physicians certified by the American Board of Obesity Medicine (ABOM) have undergone specific education and training in the biological, behavioral, and clinical aspects of obesity.
This level of expertise allows for a nuanced and individualized approach, which is especially important in cases where other conditions—like insulin resistance, PCOS, or menopausal transition—are involved.
Moving Toward a Compassionate Understanding
Recognizing obesity as a chronic disease shifts the focus from blame to biology. It allows for more effective care, reduces stigma, and acknowledges the very real struggles faced by those living with this condition.
Treating obesity requires the same medical rigor and empathy as any other chronic illness. With appropriate care and a better understanding of the underlying processes, individuals can achieve meaningful improvements in health and well-being.