Obesity

A complex condition driven by biology, environment and circumstance. Shame has been the main treatment offered, and it does not work.

What it is

Obesity is treated in public discourse as a character problem and in medicine as a risk factor, and neither framing has helped anybody.

It is a complex condition with genetic, hormonal, environmental and social drivers. Around two thirds of adults in England are overweight or obese. Deprivation is one of the strongest predictors, which tells you it is not primarily about individual choice.

Weight stigma is itself a health hazard. People who experience it avoid healthcare, delay presenting with symptoms, and receive worse care when they do. That avoidance kills people, and it is caused by how they are spoken to.

The treatment landscape has changed substantially with GLP-1 medications, which work on appetite regulation rather than willpower, and that shift has quietly confirmed what the biology always suggested.

Signs you might notice

This is not a condition anybody needs help recognising, so what follows is the complications worth watching for.

Type 2 diabetes, high blood pressure, sleep apnoea, osteoarthritis and fatty liver disease.

Reduced mobility, breathlessness on exertion, joint pain.

Depression and anxiety, which travel in both directions.

In care settings: skin problems in folds, moving and handling risks, and equipment that does not fit.

How it can affect day-to-day life

Diagnostic overshadowing is real here too. Symptoms get attributed to weight and not investigated, and people are told to lose weight for problems that turn out to have another cause entirely.

Equipment is a practical dignity issue. Chairs, beds, hoists, scanners and blood pressure cuffs that do not fit are common, and being unable to be weighed or scanned delays diagnosis.

Weight cycling, repeated loss and regain, is common with restrictive dieting and is associated with its own harms.

Supporting someone well

Do not moralise. Weight is not a measure of effort or worth, and every conversation that implies otherwise makes healthcare avoidance likelier.

Investigate symptoms properly rather than attributing them to weight.

Have the right equipment: correctly sized cuffs, scales, chairs and hoists, and know where a bariatric scanner is before it is needed.

Focus on function and health markers rather than only on the number. Blood pressure, glucose, fitness and mobility all improve with modest changes.

Ask about specialist weight management services and about medication or surgery where appropriate. Both are effective and both are rationed and stigmatised.

Address binge eating disorder if it is present, because prescribing restriction to somebody who binges makes things worse.

Where to get help

A GP can refer to NHS weight management services and assess for specialist tiers.

Obesity UK provide peer support written by people with lived experience.

Ask for referral to an eating disorder service if there is bingeing, rather than a weight service.