Why weight management is not only down to willpower

I was reading a major newspaper this morning and came across what I already see daily in the clinic — NHS budget cuts have been particularly severe around obesity care, as the condition is perceived as a lack of willpower.

But if that were the truth, why so many people are still struggling despite their best efforts?  Despite obesity care and related treatments costing the NHS £6.5 bn per year, this condition is often misunderstood and little guidance is offered to patients who feel they are stigmatised and or been told to “eat less” or “eat more vegetables” instead of been offered a holistic and comprehensive approach.

Weight management is far more complex and nuanced than “kcal in and kcal out” and willpower. Multiple factors, such as genetics, medical conditions, psychological conditions and trauma, gut health, and food quality, can profoundly impact obesity.

Genetics

There is a genetic component to how our metabolism reacts to the food we eat and exercise, making it far harder for certain individuals to achieve and maintain weight loss. Genes can influence our hunger and satiety hormones, how fast and how our body burns calories when resting or exercising as well as levels of body fat we tend to accumulate (this gene is called FOT). For instance, two people can follow the same dietary and fitness plan and have different outcomes. This highlights that it is no matter of trying harder, it is a matter of personalising nutrition and exercise plans for the individual.

Medical conditions

Certain conditions such as PCOS (polycystic ovary syndrome), hypothyroidism, and Cushing’s syndrome are associated with weight increase and the difficulty of losing it. All these conditions are connected to hormonal imbalances, which favour an increase in weight and are associated with increased tiredness and difficulty in exercising. Reducing calorie intake will have a minimal impact on weight until the root cause of the hormonal unbalance is addressed, so is no matter of willpower for not hitting the gym harder or being stricter with the diet – it is a matter of understanding and addressing the cause of this imbalance.

Trauma and psychological conditions

Body and mind are deeply connected, and at times, overeating, disordered eating patterns, or binge eating disorders are coping mechanisms. Conditions such as depression, anxiety, trauma, and PTSD (post-traumatic stress disorder) can trigger emotional eating, where food becomes the crutch to self-medicate and deal with these emotions. Therapy and emotional support should be part of obesity therapy to address underlying psychological issues that impact eating habits. Working with a holistic team or nutritionist trained in eating disorders and obesity management can help address the emotional side of eating and offer targeted support. 

Gut health

Our gut microbiome can enormously impact our metabolism, how we absorb foods, neurotransmitter production (GABA, dopamine, serotonin and more!), as well as insulin, hunger and satiety hormones metabolism. Neurotransmitters can have an impact on our mood, and an imbalance can lead to seeking happiness in food. Metabolic hormones have a direct effect on our metabolism. Addressing gut health and any eventual dysbiosis can help regulate this delicate balance, and working one-on-one with a nutritionist is key to doing so.

Food quality

Unfortunately, certain healthy foods such as organic fruit and vegetables and lean fresh proteins can be more expensive than junk food or frozen and pre-packaged food, which then becomes the only available option when eating on a budget. Education about healthy eating strategies, when an individual is on a budget, is key, as well as learning techniques on batch cooking and making the most of cheap ingredients such as pulses, eggs and seasonal vegetables. A nutritionist can guide you in doing so, providing healthy, quick and budget-friendly recipes.

As you can see weight management is complex and many factors need to be considered, first of all, health. Seeking help to manage weight should come from addressing health imbalances that lead to weight gain, not just conforming to the pressure of achieving a certain body shape and lifestyle imposed by society. Referring to a specialist can navigate health issues and create a personalised plan that fits into the individual lifestyle and addresses health issues that stop you from thriving.