“You Are Always at War With Yourself” The Perceptions and Beliefs of People With Obesity Regarding Obesity as a Disease

Abstract

Obesity as a disease remains poorly understood by key stakeholders. Here, in people living with severe obesity, perceptions and beliefs relating to obesity as a disease and obesity causality were examined. Semi-structured interviews were conducted in a tertiary care obesity clinic. 23 people with obesity (10 males, 13 females) volunteered. An overall agreement that obesity is a disease was present. Perceptions related to why obesity is and is not a disease were diverse: Lack of control and addiction, biological determinism, and personal responsibility. For weight loss maintenance, the perceptions and beliefs were heterogeneous with biological factors not considered a determinant of success. Instead, exercise, support, and willpower were described as associated with success. Barriers related to remaining in a weight-reduced state included the following: Emotional eating, sustainability of diet, occupational impact, and defeatism due to misaligned expectation and outcome. In conclusion, people living with obesity tend to agree obesity is a disease yet an incomplete understanding of the disease is present.

Reframing the need for exercise therapy in the clinical management of people living with obesity

“…This is not the case for most individuals and the lack of response may diminish the individuals sense of self‐efficacy as a result of a perceived personal failure. High volumes of unpalatable exercise undertaken with weight loss in mind and “no pain no gain” mentality is likely to lead to frustration and a sense of defeatism 10,11 . Repetitive weight loss attempts by eating less and moving more followed by regain may increase disease severity over time 12 .…”

“…High volumes of unpalatable exercise undertaken with weight loss in mind and "no pain no gain" mentality is likely to lead to frustration and a sense of defeatism. 10,11 Repetitive weight loss attempts by eating less and moving more followed by regain may increase disease severity over time. 12 Thus a negatively framed and often inappropriate focus on weight loss for exercise can often be damaging to patients' interests.…”