Do people choose to be obese?

I've been wanting to offer my take on the belief that people choose to be obese for a very long time. I will try to go in order and try to make you understand as best I can what my thinking is in the hope of offering you an interpretation that is certainly a little different from the stereotypes.

It occurred to me to write this article when, a short while ago, while watching a live stream on twitch, I read someone who wrote something like this:

Obese people should not play the victim when they are mocked or for the discomfort arising from this condition because they choose to be obese.

Needless to say, I felt very sorry when I read this sentence. It is true that it is unhealthy to convince oneself that one is a victim but not for these reasons. What may not be clear is why I had this kind of emotional reaction. Do not think that sentences like these are rare.

Those unfortunate enough to be fat hear them all the time and they are said with a levity directly proportional to the embarrassment they provoke. We can indeed admire these pearls of wisdom in comments on social media and in everyday discussions when it goes well.

I believe that most of you do not know what an obese person is. You undoubtedly know how to recognise him if you meet him on the street (maybe), but that does not mean you know what an obese person is.

I will now explain to you what an obese person is, or rather ‘who he is’. Let us start by saying, although there should be no need, that from a psychological point of view, an obese person is a creature like you who has feelings.

These feelings can be gratified or hurt just as they are with you when they pay you a compliment or tease you. From a physical point of view, an obese person is a person who struggles with life like you and does so with a lot more weight, experiencing more fatigue and overcoming more obstacles.

Please read this article as my personal thoughts, do not see it as a guide or similar. However, it is important to emphasise that what I am about to write in this article is my personal take on one of the many stereotypes that circulate about obese people.

By the word stereotype, I do not necessarily mean something negative. When I refer to the word stereotype, I mean a model that is learnt from several sources because it is shared and repeated by several people, including my interlocutor.

That said, my article will focus on myself because I have no title or mandate to speak for all categories of obese people. So, to lessen the natural inclination of some to feel targeted, albeit somewhat improperly, when I refer to the obese, please consider that I am talking about me and only me.

It should be specified that I am not a dietician, a doctor, a psychologist or any other type of professional in the field, but I will nevertheless try to set out the facts as I think they are based on my empirical experience in the matter.

That experience spans a period of about forty years.

I have been an obese person all my life, so I should know a little more than someone who has never had this ‘characteristic’. I know, you would almost have read the word ‘problem’ instead of ‘characteristic’ more willingly. You will hopefully understand later why I decided to use this term.

At this point, many of you are probably thinking that this is yet another article written by a person without any title and that given my obese condition, this writing can never be objective and honest.

We will see if you will be of the same opinion in the end. Assuming you will read this article to the end, I dare you.

In any case, if you think you can accept this premise then by all means continue reading, otherwise I advise you to leave immediately to better use your time.

How do you recognise an obese person?

My dear readers, the answer to this question may seem apparently obvious, but I am sure you would be surprised to know how few people really know what the benchmarks are to understand whether they are dealing with an obese person or not.

Let's start, as is almost always the case, with the definition. According to what I consider to be the best encyclopaedia for my language, which is Italian (the Treccani), obesity is that ‘multifactorial pathological condition characterised by an increase in fat mass to which is associated a significant increase in morbillity and mortality’.

As you will no doubt have noticed from this definition, there is no reference to physical appearance, which is almost the only reason why obesity is mentioned as much by the non-obese as by the obese.

Let us therefore try to explain the above description in an even more elementary way, should this be necessary. A pathological condition, in this case, is one in which the organism suffers. Multifactorial means that many different factors together or disparate factors may contribute to triggering this condition.

Morbillity should not be confused with morbidity. It is in fact a word that is used in statistics to define a number of cases of disease that are examined in a given period divided by the total number of people examined.

So when we talk about morbillity in the definition, we mean that obesity can increase the body's predisposition to develop other pathologies, diseases, ‘morbidities’.

We have seen the definition of obesity but the question that arises at this point is: how can one tell if a person is obese? The answer will not be news to those who, like me, have a few extra kilos, but we will explain it anyway.

Let us not forget that having a few extra kilos does not necessarily mean being obese. As a yardstick we use the body mass index, which can be calculated very easily by dividing kilograms by the square of height in metres.

So if I weighed 150 kilos and was 1.8 metres tall, I would have to do: 150 / (1.8*1.8) = 46.29.

At this point, you may be wondering what you can possibly do with this number since you have calculated it and what significance it could possibly have.

There are tables that indicate the severity of a given obesity i.e. less than 16 you are very underweight, from 16 to 18.5 you are underweight, from 18.5 to 25 you are normal weight (normal), from 25 to 30 you are overweight, from 30 to 35 obesity grade 1, from 35 to 40 obesity grade 2, more than 40 obesity grade 3;

Some of you, noticing a certain symmetry in the succession of numbers, might think I made them up. But no! These numbers are really the result of scientific research. These numbers are obviously indicative and in no case replace a visit to a professional specialised in the field.

Furthermore, some of you may have noticed a problem with this calculation. Since muscles have a higher specific weight than fat, what happens with bodybuilders? Are they obese too? Let's say the answer is no, because in the definition we talk about fat mass.

So the most accurate system, which I recommend and which can be done by a professional, is to calculate the percentage of fat mass with a special gauge.

Basically, the professional pinches certain areas of the body with a gauge called a plicometer (don't worry, it's not painful).

Why is a person obese?

After realising that I am an obese person, I asked myself why.

The answer, quite simply, lies in the fact that I take in more than I consume.

I admit that the phrase is not mine but was told to me by a doctor but I completely agree.

I am of the school of thought according to which nothing is created and nothing is destroyed but everything is transformed. The problem, however, is how it is created and how it is transformed!

And above all, why do some people continue to eat as if they were under some kind of addiction?

I will try to explain my thinking with an example and I hope it will not be misunderstood and exploited.

It is scientifically proven by very accurate research that about 70 per cent of obese people synthesise fat more efficiently.

For those who want to delve deeper into the subject, there is a wealth of published scientific articles that you can search for on the ‘google scholar’ search engine that precisely link genetics to this kind of pathology.

Moreover, obese people tend to be much hungrier than people who are not. This hunger is not due to a physical emptiness or the so-called hole in the stomach. We perceive a hunger that is hardly comparable to that of ‘normal-weight’ people.

This happens for various reasons, which can be psychological with a dog biting its own tail mechanism, psychiatric neurological when there are certain dysfunctions such as a deficit in the satiety mechanism or malformations, physiological when, for example, hormonal dysfunctions are observed, or even anatomical when, for example, an increase in the stomach's restraining capacity is observed.

I am trying not to make it too technical by using constructs that are not necessarily formal and 100% correct, in order to make it better understood even by those who are secular in the matter at hand.

This article is only written in the hope, for better or worse, of being a cue to lead some people to ask the right questions to their doctor, dietician or psychologist.

I will base this example on dogs because they are creatures I feel particularly attached to. My life would not have been the same if I had not always had such a noble creature by my side.

When we look at an English bulldog and read its characteristics, we learn that it is a massive, lazy dog that tends to put on weight very easily. A greyhound, on the other hand, is a fairly active, slender and agile dog.

Both are dogs and both love food. At this point one wonders what on earth goes through the minds of those people who believe that there is no direct, unequivocal and absolute relationship between genetics and what we are.

Usually, when I point this out to some people, they reply that everyone likes to eat, that they do a lot of physical exercise and that their being slim is the result of hard work and discipline.

They do not realise that by saying these things lightly, they are doing me absurd psychological damage. To know everything there is to know about obesity, the efforts of thousands of scholars and scientists who have been studying just that for decades would not be enough, let alone that the subject can be dismissed so quickly and so superficially.

Now that I think about it, it is actually not far-fetched to think that already for decades, thousands of scientists have been engaged in studying this ‘pathology’.

However, you don't have to be a Nobel Prize winner to know that for centuries breeders have been selecting cattle from certain bloodlines because they produce more wool or have a greater tendency to put on weight than others.

If you live in the real world, you cannot ignore the facts. The picture becomes much more complicated when external factors such as other diseases, events and taking certain medications come into play.

To give you an example, if all of your relatives are obese, if you take drugs such as cortisone, if you also suffer from conditions such as arthrosis, and if you stay at home for two months because of a lockdown, you are not only particularly unlucky but there is a serious risk that you will enter a vicious circle from which you can only get out with constant effort.

When I point this out, I am usually answered that it is just a question of nutritional education.

It is clear that one would gain less or no weight if one had a controlled, adequate diet and followed a daily programme of physical activity.

At this point, as someone said, the question arises. Why does an obese person feel the need to eat? Is it an educational question? Is it a psychological question? Is it a psychiatric issue? Is it a neurological question? Is it a physiological question?

I am persuaded that it is to some extent a combination of things. Going a little further with the fantasy, I imagine a subject who by nature is fat, i.e. has a predisposition to be fat, has a greater production of adipocytes (fat cells), is lazier, feels more tired, is depressed, tends to eat, with time the stomach dilates and at this point, as you will have understood, one begins a journey in which one is rarely treated with the respect due to every human being.

Needless to deny it, some people enjoy making fun of fat people. They do not ask themselves how these people live. They do not ask what it feels like when you cannot find clothes in your size, when you cannot run, when you are unsuccessful in love, when you try to live with insecurity, when you believe that others, the thin ones, are somehow more deserving and valuable.

One immediately recognises people who have at least once made fun of someone because of their size or a defect. Some cultures, in some mythological texts, portray heroes as slim and symmetrical people.

Likewise, the villain is almost always presented as the unpleasant-looking monster. Even Dante Alighieri placed gluttony as a capital sin and therefore unforgivable.

In fact, I have had the impression that those who tend to have these kinds of preconceptions have a predisposition to justify them by labelling the subject as someone who is particularly accustomed to vices such as gluttony and who therefore deserves mockery and other problems.

It is not their fault, probably nature endows the most symmetrical and healthy specimens with the privilege of looking better.

Have you wondered why we consider something beautiful?

I am not an expert on these mechanisms but I think it is more the usual human predisposition to be both jury and executioner but without losing a certain spirit of self-indulgence.

Even I who am a fat person am not immune to self-indulgence. Who has never stopped a diet when they were sick for some reason? Please, my fellow readers, do not trivialise the plight of obese people.

It is not as simple as you think. It does not boil down to eating less and moving more. Do not confuse overweight people with people with severe obesity.

How does one become ‘normal’? When I talk about my status as an obese person, it sometimes happens that I relate to people who in turn expose another problem of theirs. Among them, there are those who complain that they are too thin and cannot gain weight even though they eat a lot.

I won't lie to you, for an obese person to lose weight permanently is extremely difficult. It is possible although not easy (under normal conditions) to lose weight, but keeping thin is no mean feat because you have to maintain a constant commitment throughout your life.

The fact that an obese person has to maintain a strictly controlled diet throughout his or her life is unfortunate, but it is the truth.

The discourse is completely different for people who have no particular tendency to gain weight and who are free to lead a normal life without any particular dietary constraints.

Let's face it, everyone benefits from a controlled diet and appropriate physical activity. However, there are those who are forced to do this every day of their lives and those who are not. Those who can let themselves go for a certain period of time and those who cannot lose their way even for a moment.

In the unlikely event that one succeeds in reaching one's fitness weight, an obese person will have to be much more careful than others about what he or she eats and will have to engage in constant and appropriate exercise.

People see excess fat as a kind of fuel for cars. They think that once this fuel is burnt, there is no fuel left unless it is reintroduced somehow. This is not a wrong idea but it oversimplifies things a bit because cars consume and process fuel very differently.

Obese people, in most cases (not all), gain weight much more easily than others. Indeed, there are some pathologies that push the body to conserve fat at the expense of the blood glucose level and therefore, there are also obese people who, if they were to eat like normal people, would feel as exhausted and lacking in strength as a normal person on an empty stomach.

Of course, these pathologies are not just talk; they have a name and a large number of scientists who study them with dedication and professionalism. I would not like to go into too much detail because otherwise I would risk being too long-winded and bore you. As I said before, there would be so many aspects and topics to analyse or propose that a thousand books would probably not be enough. But that is not the purpose of my article, my dear friends, ask yourself the right questions and think about your health.

If you are fat like me, I advise you to accept the fact that you have a problem and fight to mitigate it. Make sure you feel good about yourself because the longer you go with the years, the harder it will be to achieve results.

Ignore stupid people who talk out of turn and also ignore people who think they are doing you good by provoking negative emotional reactions about you. We have now reached a point where medicine can help us get better.

I understand that it is a kind of commitment to life and I understand that those who always have to stay on the straight and narrow will always feel a little different from others.

However, we realise that there are people who have different pathologies that prevent or restrict them in speaking, hearing, walking, moving or reasoning. They, like us, have to adapt their lives to what they are and not to what they would like to be.

They have to take care of themselves and their physical and mental health. So, let us take note of who we are, forget the malicious or benevolent judgements of others, and take charge of our lives with the indispensable help of professionals.

Yes, there are no miracle diets with bananas in this article, I am advising you to talk to more than one professional even if it will cost you in every sense.

If I may make a suggestion, first of all, I would declare my firm will to lose weight to my attending physician who will certainly be very pleased. The next step is to collect your medical history, trying not to omit and ‘supplement’ missing documentation. The second step is to do as many tests as possible on the causes that may lead you to gain weight.

Make sure you don't just do the classic blood tests, you have to go very deep. You have to make sure that any aspect that may lead you to gain weight has been well analysed and diagnosed. So you have to spend, sorry. Once you have collected your medical history and the relevant tests, I should inform you that there are specialised hospital centres, including public ones, with teams of doctors who will analyse your condition and give you the most appropriate and adequate advice.

Don't forget to also see a psychologist because it is important. I know, many of you are ashamed to go to a psychologist, but I can assure you that if you want to take a serious path, it is of fundamental importance. Then it is clear that the results will depend on your commitment and the quality of the professionals because not everyone is the same and not everyone is capable.

However, I must warn you. If you are particularly fat, there is a possibility that you will be offered the surgical alternative. You be the judge of that, but from my experience, it only made my situation worse, at the beginning it was going great but after some time, I came back worse than before and the serious problems started from there.

It could be a case of course maybe with others it works but I always advise to rely on yourself first and then on others for anything.

Clearly you do what you think is best by following the advice of professionals. This article is not a bible, it seems normal to me that the advice of a professional is more reliable. Inform yourself also about the various pros and cons and the experiences of those who have done it before you.

Be sure to ask people who have done it a long time ago, because what counts are the long-term effects.

At the end of this article, I also wanted to dedicate a thought to those who, not having problems with obesity, have a tendency to talk about the subject with a certain superficiality and arbitrarily allow themselves the luxury of ridiculing people ‘of our calibre’.

I am referring to those micro-cephals from whose unworthy jaws words like fat, ball of lard, pig, whale, walrus, hippo and the like occasionally come out.

Those who laugh when, in a restaurant, someone doesn't fit in the chair because the armrests are too tight. Those who exchange nods with friends when they see someone in the mall who, with the attitude of someone asking for forgiveness, asks if their bounty is there.

Those who snigger among themselves or improvise as comedians when we exercise our right to be at the beach, perhaps in a T-shirt because shirtless like the others would be too much. Those who curl their lips as if they were watching a horror film. Those who underestimate our intellectual capacity.

At the time I am updating this article that I wrote a long time ago, I have lost several dozen kilos and am now much better with breathing and everything.

I had to make a lot of sacrifices also because I couldn't move much, I kept a diary of everything I introduced, even water.

I hope to continue like this and not gain weight again. I did it together with intelligent professionals who helped me a lot and moved heaven and earth for me.

I had setbacks, many really big failures, but I never gave up. I also had to do it because, in addition to my asthma, I unfortunately had a back problem and I came up against the fact that I only received the classic answer that all of us obese people receive:

You have to lose weight.

I realise that many professionals who perhaps specialise in other areas are right when they say this, but I have rarely been confronted with someone who wanted to treat any of my pathologies without first telling me the ritual phrase.

I understand that for better or worse everything can be traced back to overweight but that is precisely why I expected to be treated more carefully than others rather than simply being dismissed with this excuse.

To give you an example, for a back problem, I went to a professional, I won't even give you more details about the specific profession and its specialisation to avoid (pure) problems.

Basically, my problem was related to the fact that I have rings that have dehydrated and I may also have a vertebra that is not quite right.

To explain disc dehydration to me, the practitioner gives me an example. He starts talking to me in a low voice, as if he were talking to a child, and draws chocolate doughnuts on a sheet of paper.

He basically explains to me with chocolate doughnuts what my problem was.

Personally I couldn't believe it because this is a really good professional but apart from giving me this pastry lesson he didn't really solve anything for me because when I asked him if the problem would come back on its own once I lost weight he said no.

I guess if he hadn't explained the chocolate doughnut thing to me I would never have been able to understand.

Maybe I am wrong but I have my doubts that he would have chosen this unfortunate metaphor for someone who was not obese.

This is the wrong approach that we are subjected to every day. We know that being obese complicates everything and hurts, but do you at least want to solve the other problem for me or not?

Will you give me a plan of action? What can be done? Advice on the problem? Can this damage be repaired or not? It remained forever a mystery.

Needless to say, I went to Mc Donnald afterwards to vent my humiliation and frustration at having received no inherent advice on the problem I wanted to solve in my back.

Having said that, let's get to the salient part of the article - the facts.

Obesity is a complex condition influenced by a combination of genetic, environmental, psychological, social and behavioural factors. Listed below are the main factors that can promote the development of obesity:

1. Genetic factors

• Genetic predisposition: Some people may have a genetic predisposition to develop obesity. Genes can influence metabolism, appetite and body fat distribution.
• Obese relatives: If parents are obese, their children are more likely to develop the same condition, either due to genetics or family behaviour patterns.

2. Environmental factors

• Access to calorie-dense foods: The availability and consumption of foods high in calories, saturated fat, sugar and salt can contribute to obesity.
• Unhealthy eating habits: An unbalanced diet, characterised by an excess of processed foods, fast food, large portions and frequent snacking, can promote weight gain.
• Lack of nutrition education: A lack of knowledge about how to make healthy food choices can lead to overconsumption of unhealthy foods.
• Physical inactivity: A sedentary lifestyle, with little or no physical activity, is a major risk factor for obesity.

3. Psychological factors

• Emotional stress and anxiety: Eating as a coping mechanism during periods of emotional stress, anxiety or depression can lead to excessive calorie intake.
• Emotional eating: Eating for emotional reasons, rather than physical hunger, is a common cause of overweight and obesity.
• Low self-esteem: People with low self-esteem or body image disorders may be more prone to eating disorders that promote obesity.

4. Behavioural factors

• Eating habits: Eating irregularly, skipping meals or eating overly processed foods can alter the metabolism and increase the risk of obesity.
• Excessive calorie intake: Calorie intake in excess of daily energy requirements is a major contributor to weight gain.
• Sleep habits: Lack of sleep or poor sleep quality can alter the hormones that regulate appetite, leading to increased food intake.

5. Social and cultural factors

• Availability of junk food: The easy availability and consumption of junk or convenience food in modern societies is associated with higher rates of obesity.
• Influence of media and advertising: Aggressive advertising of unhealthy foods, especially for children, may negatively influence food choices.
• Body culture and beauty: Some cultures promote a thin body image, while others accept or emphasise obesity, influencing eating habits and weight-related behaviour.
• Limited access to healthy food: In some areas, access to fresh, healthy food is limited, while processed and high-calorie foods are readily available.

6. Biological and hormonal factors

• Hormonal dysfunction: Certain hormonal imbalances, such as those related to the thyroid gland, can contribute to obesity. Cushing's syndrome, for example, can increase cortisol production, encouraging fat accumulation.
• Insulin resistance: Insulin resistance can lead to increased blood sugar levels and a build-up of body fat, increasing the risk of obesity and type 2 diabetes.
• Alteration of the gut microbiota: Recent research suggests that the composition of the intestinal flora may affect metabolism and body weight management.

7. Medical and pharmaceutical factors

• Medications: Some medications, such as antidepressants, antipsychotics, corticosteroids and some diabetes medications, are known to increase the risk of obesity as a side effect.
• Chronic diseases: Diseases such as hypothyroidism, polycystic ovary syndrome (PCOS) and Prader-Willi syndrome may predispose to obesity.

8. Pregnancy-related factors

• Weight gain during pregnancy: Excessive weight gain during pregnancy may predispose the mother to developing postnatal obesity.
• Genetic and environmental factors: Children born to obese parents or living in environments with poor eating habits are more at risk of developing obesity during childhood and adolescence.

9. Age-related factors

• Ageing: With age, the metabolism slows down and muscle mass decreases, favouring the accumulation of fat. Older people also tend to be less active, increasing the risk of obesity.
• Hormonal changes: In women in particular, hormonal changes linked to the menopause can promote weight gain, particularly in the abdomen.

Hence

Obesity is a condition that results from a complex interaction of various factors, ranging from genetic and biological to environmental and behavioural. Awareness of these factors is essential for understanding the causes of obesity and for taking effective preventive and therapeutic measures. A combination of a healthy diet, regular physical activity, good psychological support and appropriate management of medical conditions can help counteract obesity and improve quality of life.

To conclude the article

If you have reached the end of this article, you are a hero. Believe me, this article is just the tip of the iceberg. There is an extremely complex world behind it and many studies.

That is why trivialising is never a smart thing to do.

I don't expect that there can be a human being with the will and fortitude to read my entire article. I would simply like to conclude by saying that at this point I think that, as it has also happened to me, some of you may wonder:

Do people choose to be obese?

Are we sure that this is not everyone's shared responsibility?

Are we sure that all it takes is a little exercise and smaller portions?

Is that all there is to it?

If we weigh so heavily even in the health system, why isn't proper information given in schools?

If it is a disease, why are drugs against obesity, if you are not diabetic, only available for a fee?

Yes, there are drugs that together with a correct lifestyle and an adequate diet can give results, I never wanted to use them because they are very expensive and because I wanted to do it on my own, I had no choice and I had something to prove.

I deliberately did not put these drugs here because I know that there might be obese ‘brothers’ who would do anything without thinking of the consequences and I don't want that for you. You all need to be well because everyone deserves to be healthy and happy.

Be patient and never give up, there are professionals who can help you, you just have to find the right one for you and always remember that you are not alone.