Obesity a chronic disease, not personal failure, say experts

2026-03-07 - 00:23

Obesity is a complex, chronic disease that requires structured, long-term and compassionate care. (Envato Elements pic) KUALA LUMPUR: For decades, obesity has carried a heavy burden – not only on the body but also in the form of stigma. Too often, it has been reduced to questions of appearance, willpower or personal discipline, viewed through a lens of blame rather than biology. But that narrative is steadily changing: medical experts are urging the public to rethink long-held assumptions, stressing that obesity is not a personal failure but a complex, chronic disease that requires structured, long-term and compassionate care. Consultant endocrinologist and internal medicine physician Dr Kiran Nair said one of the most persistent misconceptions is the belief that obesity stems purely from laziness or a lack of self-control. “This is medically inaccurate. Obesity is a chronic disease officially recognised by the World Health Organization in 1997, much like diabetes or heart disease,” she told Bernama in conjunction with World Obesity Day on Wednesday. “It is influenced by genetics, hormones and brain signals that regulate hunger, as well as sleep patterns, stress, medications and the environment we live in.” She said modern treatment approaches are increasingly adopting multidisciplinary strategies that address biological, psychological and lifestyle factors. More than willpower As Kiran explains, obesity is far more than a matter of body weight. It can affect nearly every organ system and significantly increases the risk of type-2 diabetes, heart disease, hypertension, certain cancers and infertility. For years, weight-loss advice revolved around a simple formula: eat less and exercise more. While balanced nutrition and physical activity remain essential, she said this approach alone does not work for everyone. “As with other chronic conditions, some individuals require structured medical care, medication or even surgery. Above all, people living with obesity deserve care and compassion, not condemnation or shame,” she said. Many patients, she added, describe years of trying diets and exercise programmes only to struggle repeatedly. The reason lies in biology: the body is programmed to defend its highest sustained weight. When weight loss occurs, hormonal pathways respond by increasing hunger and slowing metabolism, making it difficult to maintain results. “Our bodies are designed to protect us from starvation, not to help us lose weight,” Kiran said. The ‘Oatzempic’ trend involving oats, lime and water may reduce calorie intake temporarily but lacks strong scientific evidence for long-term benefits. (Envato Elements pic) Factors such as hormonal imbalances, medications, chronic stress, menopause and underlying medical conditions can further complicate weight management. In such cases, repeated setbacks are not signs of personal weakness but indicators that structured medical support is needed. One major shift in recent years is the growing recognition of obesity as a complex biological disease. “For individuals with significant biological resistance to weight loss, modern care now includes medically supervised weight management programmes, prescription therapies and, in selected cases, bariatric or minimally invasive endoscopic procedures,” Kiran outlined. Notable advances include medications known as glucagon-like peptide-1 (GLP-1) therapies, which work with the body’s natural systems to help people feel full sooner and improve how the body regulates blood sugar and metabolism. Kiran emphasised that drugs such as Ozempic, Mounjaro and Wegovy are not quick fixes. “They are tools – part of a comprehensive, long-term treatment plan that includes lifestyle modification, behavioural support and ongoing medical care.” Beyond fad diets While medication and medical procedures can support weight loss, nutrition remains the cornerstone of sustainable obesity management. Dietitian Ng Kar Foo said many people struggle because they turn to trendy or overly restrictive diets promoted online or by influencers. “One of the most common mistakes is excessive dietary restriction,” he said. “This includes skipping meals, eliminating entire food groups or following extreme plans such as juice cleanses or rigid fasting routines.” Ng pointed to the viral “Oatzempic” drink on TikTok – made from oats, lime and water – as an example of a trend that may reduce calorie intake temporarily but lacks strong scientific evidence for long-term benefits. Such approaches often lead to fatigue, emotional eating and rebound overeating. “When this cycle repeats, people often blame themselves. In reality, the issue is not a lack of willpower, but an approach that fails to recognise the complexity of obesity,” he said. More than a standard meal plan, effective weight management requires attention to food quality, meal timing, sleep, stress management, and a healthier relationship with food, Ng added. Nutrition and a balanced diet remain the cornerstone of sustainable obesity management. (Envato Elements pic) For some patients, lifestyle changes, nutrition support and medication may still be insufficient. According to consultant gastroenterologist and hepatologist Dr James Emmanuel, minimally invasive endoscopic procedures can play a role in such cases. These incisionless procedures – which include endoscopic sleeve gastroplasty (ESG) and intragastric balloons – are performed through the mouth without abdominal incisions. ESG reduces the size of the stomach using internal sutures, helping patients feel full sooner and eat less. Recovery typically takes only a few days. “These therapies preserve the natural anatomy of the gastrointestinal tract, involve shorter recovery periods and carry lower procedural risks than traditional bariatric surgery,” he said. They are generally recommended for individuals with a body mass index (BMI) of 30 or higher, or above 27 with metabolic risk factors, particularly when lifestyle interventions alone have not been sufficient. Emmanuel said large international studies show serious adverse events occur in fewer than 2-3% of cases, with most patients returning to normal activities within a few days. However, he stressed that procedures alone are not a long-term solution: as obesity is a chronic condition, sustained lifestyle changes and ongoing support remain essential. Looking ahead, Emmanuel expects obesity treatment to become increasingly personalised. “In the coming years, minimally invasive endoscopic procedures are likely to bridge the gap between medical therapy and surgery to form a crucial part of comprehensive obesity care,” he concluded.