Weightless

Weightless

Chapter 1

Rethinking Obesity: What We Got Wrong

There is one patient consultation that has stayed with me over the years. The patient was fifty-one years old, successful in his career, polite, thoughtful—and clearly uneasy the moment he stepped into my office. When I asked what had brought him in, he explained that he had tried everything: dieting, fasting, overexercising. He had lost weight many times but always gained it back. He said, “I guess I’m just not trying hard enough, but I just don’t know what else to do.”

I shook my head and told him, “Obesity is not your fault.”

I explained what we now understand about obesity: that it’s not just about what you eat or how much you move; it’s about hormones, genetics, the brain, the gut, and many other factors outside of willpower. And then something unexpected happened. There was a visible shift; I watched the tension in his shoulders ease as his emotional burden was lifted. He started to cry. For the first time, he heard that he hadn’t failed. He felt the validation that what he was up against wasn’t a personal flaw but a medical condition.

And I hadn’t even told him the best part yet: There was something we could do about it.

When I see a reaction like that, it makes me want to share everything I’ve learned about obesity with everyone—and repeat it over and over. In this chapter, you’ll learn what’s going on “behind the scenes of the body” and the reasons behind weight gain in cases like my patient’s—and maybe yours, even if you don’t identify with the term obesity.

Whether or not you’ve been formally diagnosed with obesity, this is a crucial chapter to help you understand your body and its treatment in a whole new way. If you’re someone with excess weight who is considering taking GLP-1 medication—or even just trying to better understand why your body holds on to weight despite all your efforts—read on.

In the pages ahead, we’ll pull back the curtain on what obesity actually is: not a character flaw but a disease influenced by many aspects of our biology and environment. I share this information not to lecture you but to make your experience with GLP-1 therapy more effective, more comprehensive, and ultimately more empowering. I want you to understand that this treatment is informed by real people and real life. Along the way, you’ll also begin to see the full picture of obesity—one grounded in science, not bias.

There’s much to learn ahead, but just as important, there’s much to unlearn.

Understanding Obesity

In medicine, there is a commonly accepted idea that within the patient/doctor dynamic, it is only the patient who needs to learn. This couldn’t be further from the truth, and I am proof of this. In my opinion, a physician who is not learning is a physician who is not listening to their patients.

For decades, medical professionals have been taught to approach obesity as a simple math problem: Eat less, exercise more. This advice was repeated in exam rooms, public health campaigns, and weight loss programs. And because it was presented as a straightforward solution, it also carried an unspoken assumption: If a patient wasn’t losing weight, it must have been due to a lack of effort, discipline, or willpower.

But if this approach truly worked, why did obesity rates continue to rise? Why do millions of people—many of whom have followed every diet, exercise plan, and medical recommendation—still find themselves struggling with their weight? The answer: It’s not because patients aren’t trying but because this approach to treating obesity is fundamentally flawed.

To fully grasp the scope of this issue, let’s step back and examine the bigger picture. The statistics on obesity tell a story—one that makes it clear that obesity isn’t just a personal challenge but a global public health emergency.

The Landscape of Obesity: A Global and National Crisis

Obesity is defined as the abnormal or excessive expansion of adipose tissue. It is a complex disease that affects nearly half of all U.S. adults, and its prevalence is increasing worldwide.

According to the World Health Organization (WHO), worldwide obesity rates have nearly tripled since 1975. Nearly every developed nation has experienced an increase in obesity prevalence. The United States has been at the forefront of this crisis; I’m sure it’s no surprise to you that our obesity rate has been rising at an alarming pace. In 1962, only 13 percent of U.S. adults were classified as having obesity. By 1999, that number had skyrocketed to 30.5 percent. By 2020, obesity affected 41.9 percent of U.S. adults. And today, nearly one in five children in the United States lives with obesity.

At the current trajectory, nearly half of U.S. adults will be classified as having obesity in the next decade. But this is not just an American problem; it’s a global phenomenon. Countries around the world, from the United Kingdom to China, are experiencing rising obesity rates.

What changed? Just a few generations ago, obesity was far less common. People moved more, food was less processed, and portion sizes were smaller. But today’s world looks different. The rise of ultraprocessed foods has made calorie-dense, nutrient-poor options more accessible and affordable than ever before. Sedentary lifestyles have become the norm, with more jobs shifting to office work and many people working remotely. Cities are designed for cars instead of pedestrians, and there are fewer opportunities for physical activity built into daily life. Stress, poor sleep, and environmental factors have contributed to weight gain in ways that weren’t as prevalent in previous generations. The result? A public health crisis that affects every aspect of society.

Obesity is not just about physical appearance or weight; it is directly linked to serious chronic diseases. Individuals with obesity are at higher risk of developing type 2 diabetes, heart disease, stroke, and more than thirteen obesity-related cancers. Because it increases the risk of these diseases, it can shorten lifespan significantly, making it one of the most notable modifiable risk factors for early death. But the impact goes beyond physical health; obesity is also tied to higher rates of depression and anxiety and increases the likelihood of experiencing social stigma, creating a vicious cycle that makes weight management even more difficult.

Obesity is not a simple condition, and it is certainly not just a result of individual lifestyle choices. If personal effort alone were enough, we would have seen a decline in obesity rates, not a continued surge. This crisis is not the result of individual failures; it is the result of a systemic misunderstanding of obesity within the medical community and beyond.

But what if we could change this trajectory? Imagine a world where individuals could live longer, healthier lives, where the healthcare system wasn’t overwhelmed by preventable diseases, and where people had the energy, confidence, and physical well-being to fully engage in their lives. What if instead of reacting to obesity by shrugging our shoulders, we addressed it as a treatable medical condition?

Beyond Willpower: The Real Causes of Excess Fat Tissue

Throughout the many years of my career, I have seen thousands of patients. Each one of them has taught me something about this varied and persistent disease. What I believed at the start of my practice is not what I believe today. Over time, I have amassed an entirely new body of knowledge—not from textbooks but from the patients themselves. But before I could learn from them, I had to unlearn much of what I was taught.

For decades, we told patients that obesity and overweight were a personal problem—a matter of willpower, discipline, and self-control. Patients who struggled with their weight were told the same thing over and over: Eat less. Move more. Try harder. Repeat.

When a patient who had overweight or obesity would tell us that they followed the recommendations but did not lose weight, we did the worst thing possible: We didn’t believe them. If after several appointments the patient’s weight seemed static or even increased, then either the doctor or the patient, sometimes both of them, would come to see that lack of progress as an impossible hurdle to overcome—and simply stop talking about it. We would instead turn to treating the symptoms of obesity because, for them, we did have medications that provided results. In the medical community, conventional wisdom told us that that was the best we could do.

It wasn’t until I started seeing patients with obesity five days a week, eight hours a day, that I finally learned something new—something that defied what I’d been taught in medical school: Our patients were listening to us.