Obesity is not due to Poor Self-Discipline.

I do not know how many times during my years in the military have I heard an officer and enlisted Soldier refer to someone overweight as weak.  It is more than just willpower and a decision to be thin.  It is 100% false that weight gain/loss is all about a lack of self-discipline.  A fat person cannot just make the decision to will themselves thin.  Obese people are not just weak and lazy.  In fact, it probably takes more effort for them to maintain their diet than someone that is of normal weight.  

Obesity is a disorder much more complex than a single decision eats or not eat or exercise and not exercise.   It involves many contributing causes in an environment that we do not fully understand.  Just like with nature versus nurture, some of the influences that cause obesity are genetic and others are learned.  Our understanding of human metabolism, genetics, and physiology is evolving on nearly a daily basis.  We have a good understanding of our bodies and how we become fat but to state that obesity is due to a single controllable decision is a vast understatement.

Although not a good medical textbook, Wikipedia list over 20 genes ties to obesity and I will tell you are re are many more.  I will name two diseases that run in families that contribute to nearly every case that I see as a physician that is not listed in the 20+ and those are Diabetes Type 2 and Depression.  There are other causes, but most of the patients I see have one of these two illnesses or an earlier stage of either or both.  I preparation for this post, I reviewed several articles and found that it is clear that the genetic interaction that causes obesity are much more complicated and involve hundreds and likely thousands of complex gene-gene interactions​[1]​,​[2]​.  

The body also has hormones and biochemical and physiologic pathways that regulate body weight.  For example, I recently wrote articles on Cortisol, Ghrelin, and Leptin and their complex interaction.  There are many other storied and poly-peptide hormones that regulate the process that result in obesity or lack thereof.  There are genres that code for polypeptides (short proteins) and their receptors.  There are genes that control the response to how your body responds to them.  The receptors and signal hormones do not respond the way they should in folks that are obese do it takes extra effort to overcome these poorly functioning genes in those that are predisposed to obesity or being overweight​[3]​.

To illustrate the complexity, let discuss leptin and ghrelin.  Leptin is released for fat cells surpasses hunger in the hypothalamus.   Ghrelin, on the other hand, is released from the stomach and stimulates the hypothalamus to cause hunger sensations.  In simple terms, ghrelin signals starvation, and leptin signals that you are full.  Obese or overweight tend to have less sensitivity to leptin so it takes more to induce satiety and the person feels hungry when they are full.  This poor sensitivity is likely genetic but may also be caused by other problems such as prior infections.  You can see this is not a simple process and we have only discussed a few possible genes in this paragraph and there are atlas hundreds of others that interact further.  

It is not easy to overcome the urge to eat.  Our bodies have set up these urges and cravings to ensure that humankind continues.  The urge to eat when one is starving is one that is nearly irresistible.  Trying to eat less and exert control by consciously eating less in the face of a starvation signal is difficult.  It is a survival-based signal and these are nearly impossible to ignore.  

Ok, now that I got the bleak and dark discussion out of the way, we can discuss the bottom line.  It is true that eating and exercise are behavior.  We chose to eater do them to not to do them.  We just need to choose to do them less and more often, respectively, to control our weight.  It is not as simple as making a choice, but you can choose today to do better.   Instead of using your genetics as a crutch, learn to fight the urge to eat and gain weight.  Instead of vilifying the individual for making poor choices, empower and help them to make good ones.  

Willpower and self-disciple are like muscles.  If you do not exercise them, they will atrophy.  With your willpower depleted, you will be more likely to give in to cravings and avoid exercise.  I recommend the following tips to avoid falling into those discipline road bumps.

Recommended Tips to Avoid Discipline Road Bumps:

1. Make your meals for the week on weekends.  Once a week, schedule time to make pre-portioned meals for the whole week.  I plan out 4-5 days’ worth of meals on Sunday and make them for the week.  I store them in the freezer or refrigerator.  Occasionally, I have to cook mid-week but it is rare.  This avoids the temptation of convenience meals after work and some cravings.  If you wait till you are hungry at the end of the day to cook, you might as well strap on the feed bag.
2. Write it down.  I keep a journal and put a lot of my thoughts online.  This allows me to review my successes and less successful choices.  The key to success in dieting, exercise, and weight maintenance is self-awareness.  With self-awareness, you can then avoid things I did identify as road bumps and without it, you are driving blind.
3. Healthy Snacks Only.  I keep healthy snacks with me at all times.  I usually have one serving of celery and apple slices with me where ever I go.  If I get hungry, I eat them.  This avoids that trip to the candy machine or bowl at work.  Grazing is an enemy in the war against the waistline.  
4. Portion Control.  Do not eat in front of the feed bag.  Measure out a serving and limit yourself to that size of the portion.  This does require you to know a portion size, but once you look them up a couple of times, you will remember them even when you are out to eat.
5. Eat on a regular schedule.  Do nto wait until you are starving hungry to eat.  Plan meals and regular snacks around set times and do not violate the schedule.  It only takes 4-6 weeks for a new change to become a routine.  When you skip or delay the snack, cravings will kick in and you will wander for the next candy bowl to grab another less healthy choice.  
6. Eat Slowly.  Chew your food and drink water in between bites to slow yourself down.  This will allow you to register when your stomach is full and you will be less likely to overeat stomach stretch takes time to register as fullness in the brain.  Eat slowly and allow the signal to catch up.  
7. Do not shop when you are hungry.  This is an absolute no-go.  If you shop hungry, you will evert to the hunter on the plain and the junk food will be your game.  It is very primitive and you will not be able to control yourself.  The next thing you know you have $40 worth of Twinkies in your cart.  Make a shopping list and do not stray and never shop hungry.
8. Cheat days.  Now, read this carefully.  I did not say all-you-can-eat day.  You must have some self-discipline. Take one meal a week and give yourself a treat.  I make a high-fiber vegetable pizza once a week as my treat.  It is not take-out, but it is better than nothing and fulfills my need for Italian without all the carbohydrates and fats in the take-out version.  
9. Develop Realistic Goals.  Small goals that are realistic are better.  Part of the problem with a lapse in a diet is if you have unrealistic goals.  Unrealistic goals lead to less confidence in your ability to be successful and people just plain quit.  As I have said before, the only way to truly lose 20 pounds of fat in a month is amputation and that is not a good weight loss technique.  
10. Control you stress and relax.  You must have downtime.  If you do not have some white space in your day, cortisol will take over and you will balloon up.  Take 5-10 minutes every day and do nothing.  Breath!  Relax.