Rethinking Obesity: From Blame to Biology

Deepa Sarkar Health A-Z, Weight Loss

Obesity
Wait—Is Obesity Really a Disease?

Yes. It is.

And that’s not just a catchy headline — it’s a medical fact, backed by the World Health Organization (WHO). Obesity is officially classified as a chronic disease. [1]

And it’s more common than most people realize. According to India’s National Family Health Survey-5 (NFHS-5), 1 in every 4 Indians is now living with obesity. That’s millions of people navigating a serious health condition. [2]

But here’s the thing: most of us still view obesity through the lens of blame, shame, and quick fixes. We treat it like a personal failure instead of a complex condition. And that’s a huge problem — because if we don’t understand obesity as a disease, we don’t treat it like one.

Let’s put it another way:
Would you treat asthma or diabetes with willpower alone? Of course not.
Obesity is no different — it deserves the same medical attention, compassion, and care.

You’re not alone. Support is available.

So… What Actually Causes Obesity?

Spoiler: it’s not just about eating too much and moving too little.

Obesity is driven by a complex mix of biology, hormones, genetics, behavior, and environment [3]. There’s no one-size-fits-all cause — and no one-size-fits-all solution, either.

For example, two people can eat the same food, do the same workouts, and still gain or lose weight at totally different rates. That’s because our bodies process energy differently. Blame your metabolism? Sometimes, yes — but also your hormones, gut health, sleep patterns, stress levels, and even childhood experiences. [4,5]

So no — it’s not just “calories in, calories out” [6]. That’s old-school thinking.

Let’s Talk About Real Obesity Treatment Options

Here’s the good news: there are more tools than ever to help you manage weight in a way that’s science-backed, safe, and sustainable. Let’s break it down.

1. Lifestyle Changes — But Smarter 

Forget the crash diets. Real lifestyle changes are about how and why we eat, along with what.

Here are a few things that matter more than most people realize:

When You Eat

Late-night snacks or skipped meals? They mess with your metabolism. Eating earlier in the day can actually help your body process food better.

Where You Eat

On the couch, phone in hand? Your brain barely registers what you’re eating. Eating mindfully — at a table, without distractions — helps you notice fullness and avoid overeating.

Emotional Eating

Stress, boredom, sadness… they all show up as cravings. Learning to manage emotions without turning to food is a huge step toward long-term change.

Hunger-satiety cues

Many of us are out of sync with hunger and fullness. Slowing down, eating without distractions, and tuning in to your body can make a big difference.

Moving More

Start small: stand more, walk a little extra, stretch between office calls. Even 10 minutes at a time adds up. The goal? About 150 minutes a week, eventually. [7]

2. Behavioral Therapy  

Obesity isn’t just about food or fitness. It’s also about our thoughts, habits, and emotions.

That’s where behavioral therapy comes in [8]. It helps you understand your patterns — and then change them in a way that sticks.

Think of it as mental training for your health.

How Behavioral Therapy Supports Sustainable Weight Loss: 

  • Identifies triggers that lead to overeating or inactivity
  • Develops healthy coping strategies to replace emotional eating
  • Builds self-monitoring skills, such as keeping food logs or tracking activity
  • Helps set realistic and achievable goals for lasting behavior change
  • Enhances motivation and accountability through ongoing support

3. Medications 

Today’s anti-obesity medications are FDA-approved, clinically tested, and have become game-changers in the treatment of obesity for many individuals. These medications are designed to work with the body’s biological processes involved in the development and persistence of obesity. 

Obesity medications function in a variety of ways:

  • Suppressing appetite
  • Reducing food cravings
  • Altering the brain’s response to food and hunger
  • Managing hormonal signals that drive eating behavior

These medications not only support initial weight loss but can also help prevent weight regain. They do this by addressing the physiological responses to weight loss, such as the persistent feeling of hunger that often causes people to regain lost weight. [9,10]

For example, the recently launched Wegovy (Semaglutide) mimics a natural hormone known as GLP-1, which helps you feel full, reduces appetite, and regulates blood sugar levels.

4. Bariatric Surgery

For some people, especially those with severe obesity or related health problems, surgery is a powerful option.

Procedures like gastric bypass change how your digestive system works — which can lead to major weight loss and dramatic improvements in conditions like diabetes, blood pressure, and more. [11]

Have questions about managing weight with medical support? Our expert can help guide you.

Patient-Centric Metrics in Obesity Treatment Planning

In South Asian populations, particularly Asian Indians, the risk of metabolic complications begins at lower BMI levels than in Western populations. As such, classification and treatment thresholds are adjusted accordingly. [11]

BMI Classification for South Asians (Asian Indians)

  • Overweight: BMI 23–24.9 kg/m²
  • Obesity Grade I: BMI 25–29.9 kg/m²
  • Obesity Grade II: BMI 30–34.9 kg/m²
  • Obesity Grade III: BMI ≥37.5 kg/m²

1. Lifestyle Interventions

  • Recommended starting at BMI ≥23 kg/m²
  • Includes:
    • Dietary modifications
    • Regular physical activity
    • Behavioral therapy
  • Applicable across all higher BMI categories

2. Pharmacotherapy

Pharmacotherapy should be initiated along with lifestyle modifications in the following scenarios:

  • BMI >27 kg/m², regardless of comorbidities
  • BMI >25 kg/m², if at least one obesity-related comorbidity is present, such as:
    • Hypertension
    • Dyslipidemia
    • Type 2 diabetes (T2DM)
    • Obstructive sleep apnea

Note: These thresholds are lower than Western guidelines, which recommend pharmacotherapy starting at a BMI >30 kg/m², or >27 kg/m² with comorbidities, due to higher metabolic risk in Asian Indians.

3. Bariatric Surgery

Bariatric surgery may be considered based on the following BMI criteria:

  • BMI >32.5 kg/m² with at least one obesity-related comorbidity
  • BMI >37.5 kg/m² without comorbidities

Note: These lower cutoffs reflect the increased cardiometabolic risk at lower BMI levels in the South Asian population.

Takeaway

Obesity isn’t a failure of character.
It’s not a lack of discipline.
It’s not your fault.

It is a chronic disease — and it’s one you can manage with the right tools, support, and care.

Disclaimer: This article is an editorial initiative by Tata 1mg for Novo Nordisk. The information is for educational purposes only and is not a substitute for medical advice. Weight loss medications should be individualized and should be taken under the guidance of a doctor. Please note that Tata 1mg does not endorse any brands and is not responsible for their efficacy.

(The article is written by Dr. Nitika Makhija, Manager, Clinical Health and Content  and is reviewed by Dr. Swati Mishra,Director (Clinical Health & Content)

References

[1] World Health Organization. One in eight people are now live with obesity [Internet]. Geneva: WHO; 2024 Mar 1 [cited 2025 Jul 2]. Available from: https://www.who.int/news/item/01-03-2024-one-in-eight-people-are-now-living-with-obesity

[2] Kalra S, Kapoor N, Verma M, et al. Defining and diagnosing obesity in India: A call for advocacy and action. J Obes. 2023;2023:4178121. Published 2023 Nov 7. doi:10.1155/2023/4178121. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645500/

[3] Albuquerque D, Nóbrega C, Manco L, Padez C. The contribution of genetics and environment to obesity. Br Med Bull. 2017 Sep 1;123(1):159–73. Available from: https://pubmed.ncbi.nlm.nih.gov/28910990/

[4] Sominsky L, Spencer SJ. Eating behavior and stress: a pathway to obesity. Front Psychol. 2014 May 13;5:434. Available from: https://pubmed.ncbi.nlm.nih.gov/24860541/

[5] Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011 Oct 27;365(17):1597–604. Available from: https://pubmed.ncbi.nlm.nih.gov/22029981/

[6] Hall KD, Farooqi IS, Friedman JM, Klein S, Loos RJF, Mangelsdorf DJ, et al. The energy balance model of obesity: beyond calories in, calories out. Am J Clin Nutr. 2022 May 1;115(5):1243–54. Available from: https://pubmed.ncbi.nlm.nih.gov/35134825/

[7] American Association of Clinical Endocrinologists. Empower your health: Guide to physical activity. Available from: https://www.cdc.gov/physical-activity-basics/guidelines/adults.html

[8] Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34(4):841-859. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3233993/ 

[9] Horn DB, Almandoz JP, Look M. What is clinically relevant weight loss for your patients and how can it be achieved? A narrative review. Postgrad Med. 2022 May;134(4):359–75. Available from: https://pubmed.ncbi.nlm.nih.gov/35315311/

[10] Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D. Obesity in adults: a clinical practice guideline. CMAJ. 2020 Aug 4;192(31):E875–91. Available from: https://pubmed.ncbi.nlm.nih.gov/32753461/

[11] Madhu SV et al; on behalf of Endocrine Society of India. ESI clinical practice guidelines for the evaluation and management of obesity in India. Indian J Endocrinol Metab. 2022;26(4):295–318. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9519829/

Facebook Comments
, ,