Understanding Obesity Without Shame
- rx4trauma
- 7 days ago
- 4 min read
In the 1980s, the explanation for obesity was simple: overconsumption and inactivity. And to be fair, that wasn’t wrong. But it also wasn’t the whole story. Obesity is far more complex than “eat less, move more.” Most of the time, it’s the result of multiple factors working together—many of them outside a person’s control. Let’s talk about a few.
Genetics
You can always blame your parents, right?
There are more than 50 genes associated with obesity. Sometimes there are mutations, but more often there are subtle, normal variations in DNA. There can also be changes in how genes are expressed. All of these can increase a person’s susceptibility to weight gain, long before lifestyle ever enters the picture.
Leptin (and the train whistle)
Before I explain leptin, let me tell you a quick story. During my second year of medical school, I lived in an apartment directly across from the train tracks. When I first moved in, I heard every train. The whistle woke me up night after night. But about a month in, the trains passed so often that I barely noticed them anymore.
A train chugs through a neighborhood, puffing steam and adding life and sound to the peaceful surroundings. That’s leptin.
Leptin is a hormone made by fat cells. The more fat cells you have, the more leptin your body produces. In theory, leptin travels to the brain and tells the hunger center to quiet down—you’ve had enough. But when leptin levels stay high for too long, the brain can stop responding. Like the constant train whistle, the signal fades into the background.
When this happens, the brain behaves as if the body is starving. Hunger increases. Metabolism slows. And despite having adequate—or even excess—energy stores, the body actively resists weight loss.
What happens in the uterus doesn’t stay in the uterus
A mother’s health during pregnancy matters more than we once realized. Obesity in pregnancy is one of the strongest risk factors for obesity in childhood. Smoking during pregnancy has also been linked to higher rates of childhood obesity. Excess weight gain can lead to gestational diabetes, increasing the likelihood of having a larger baby—and higher birth weight is directly associated with obesity later in life.
The “fourth trimester”
Early infancy plays a role too. Poor sleep in newborns is associated with weight gain both early and later in life. Longer durations of breastfeeding are linked to lower rates of infant obesity (which makes my two-hour attempt feel… less impactful). Rapid weight gain in infancy is also associated with obesity later on.
A new mom lovingly cradles her sleeping baby, feeling both the exhaustion and joy of early motherhood.
Counting sheep
Sleep matters at every age. Lack of sleep increases glucose levels, worsens insulin resistance (remember the train whistle), lowers leptin, and raises cortisol and ghrelin—hormones that stimulate appetite. In short, chronic sleep deprivation sets the stage for weight gain.
Medications that make a difference
Many commonly prescribed medications are associated with weight gain. This is a tough one, because when a medication is necessary, it becomes a matter of weighing risks and benefits. Certain antidepressants, antipsychotics, blood pressure medications, and diabetes drugs can all contribute to weight gain.
Inner chemistry
Hormones! That’s what perimenopause is all about, right? But estrogen and progesterone are just part of the story. Multiple hormonal imbalances can contribute to obesity. Conditions like metabolic syndrome and polycystic ovary syndrome are just two examples.
Money, money, money—it’s complicated
The relationship between socioeconomic status and obesity isn’t straightforward. Some studies link lower socioeconomic status with higher obesity rates. Others show obesity increasing as countries become more economically developed. Interestingly, in lower-income countries, higher socioeconomic status is associated with obesity, while in higher-income countries, the opposite is true. Context matters.
Brain hiccups
That’s what we’re calling stress. And honestly—do I even need to say more about the connection between chronic stress and weight gain?
Believe it or not, there are even more causes I haven’t included—mostly to avoid completely losing your attention (which may have already happened).
The bigger picture
The purpose of this post isn’t to shame anyone into tallying up which of these apply to them. And that matters, because shame itself is a powerful driver of obesity. Weight stigma doesn’t motivate health—it increases weight gain, worsens mental health, damages the doctor–patient relationship, and is even associated with a higher risk of death.
I keep thinking about the woman sitting in the hallway from the previous post. Did she feel safe enough to go back to a doctor? I don’t know. I made a mistake. But this story isn’t really about me—at least not yet. It’s about changing the narrative around obesity and recognizing that it is not a moral failure, a lack of intelligence, or a character flaw. It’s a complex, chronic disease. And people deserve care, compassion, and space; not judgment.
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