The Psychology of Obesity: Scourge and Treatment

Obesity is a common problem in this country, with 42% of American adults and 20% of children under 18 considered obese. Negative attitudes toward those with the affliction are lessening as treatments become more available. Obesity is now becoming more accepted as a chronic medical condition rather than a personal failing consisting of lack of willpower, lack of motivation, or poor choices. This isn’t the first example of when public stigma was correctly replaced with understanding. In the last century, we have seen several examples.

“Shell shock” and “battle fatigue” were terms applied to war veterans who were traumatized by war. But years ago they might have been considered weak or even cowards. (Remember General Patton’s slap of the traumatized soldier?) Today we understand this condition as a treatable medical condition, post-traumatic stress disorder (PTSD). Until the middle of the last century, depression was often viewed as a self-pitying character flaw, a failure to “pull yourself up by the bootstraps.” Now we better understand the genetics and environmental contributions to major depressive disorder that is responsive to treatment. In the past, alcoholism and other substance abuse were considered weak-willed attempts to avoid reality and could readily be cured if subjects would follow Nancy Reagan’s solution and “just say no.” There is now better understanding of genetic risk factors and a number of treatment programs are available for those contending with addiction.

Obesity for many years has also suffered from stigma. Many sufferers recall expressions of disgust from others at a restaurant watching them eat. Many overweight individuals are embarrassed and avoid meals around others. Many have been frustrated in the past over failed diet plans. Until recently, the only other treatment approach to obesity besides various diet or forced-starvation plans was gastric bypass surgery. However, new medicines have been introduced that are significantly helpful with weight reduction.

Semaglutide, marketed as Wegovy® and Ozempic®, is currently FDA-approved for diabetes mellitus. It can be used for obesity when another health-related illness is present, such as hypertension. It is an injectable medicine usually administered once a week. Semaglutide is a peptide that works by balancing releases of insulin and glucose resulting in appetite suppression and earlier feelings of satiety. Placebo-controlled studies demonstrate significant weight loss. Side effects include nausea, vomiting, potential kidney damage, and others. Other treatments are emerging, including bimagrumab, which increases muscle mass while decreasing fat tissue.

Some overweight individuals have expressed guilt over weight loss that wasn’t “natural.” These patients are embarrassed to reveal that weight loss was achieved “the easy way” with medicine, although obviously, decreased food intake is what results in the decrease in weight. A remarkable change in appearance can also have a profound effect on others in a person's life. Friends and family who previously expressed compassionate support may now feel unnecessary or even rivalrous. Some may feel guilty or resentful that they haven’t been able to make similar changes. Overcoming these potential ripple effects is important. But hopefully, like what has been happening with other health issues, obesity will eventually conquer the stigma that has been attached to it.