Obesity Is Not Solved by Simple Advice Such as “Eat Less, Move More”

Obesity, now a global epidemic and one of the greatest health challenges, is often misunderstood by the public and healthcare professionals. Simple advice such as “Eat less, move more” ignores its complex biological, genetic, and environmental factors, reducing the problem to a lack of individual willpower. Such approaches reinforce prejudice against obesity and adversely affect public health policy and clinical practice.

Scientific Realities and Public Misconceptions

In 2020, a group of 36 international experts published in Nature Medicine a joint statement calling for an end to obesity stigma. They emphasized that common beliefs such as “Obesity is a choice and can be reversed by eating less and exercising more” are misleading . These assumptions misdirect public health policy, confuse messages in popular media, and impede access to evidence-based treatments.

Genetic and Biological Factors

Obesity results from a combination of complex factors, including genetic predisposition, hormonal imbalances, metabolism, and environmental influences. For example, the FTO gene (Fat Mass and Obesity-Associated gene) has been linked to obesity risk. Studies show that people with the FTO gene have a higher body mass index (BMI).

In particular, rs9939609 (T/A) and similar FTO SNPs (single nucleotide polymorphisms) significantly increase weight gain and obesity risk in people carrying the gene. Those with this variant have been found to weigh approximately 3 kg more and have 1.67 times the obesity risk of those without it.

The FTO gene's effect on obesity relates to its role in energy intake and satiety. People with certain variants (changes) in the FTO gene tend to prefer more energy-dense foods, potentially leading to overeating. Some studies also suggest that physical activity reduces the effects of this genetic variant on obesity.

Leptin is an important hormone regulating appetite and energy balance. Leptin resistance is common in obesity and impairs the body's ability to respond to hunger signals, potentially causing increased food intake and weight gain.

Weight Bias Among Healthcare Professionals

An Australian systematic review and meta-analysis found that healthcare professionals, including doctors, nurses, dietitians, psychologists, physiotherapists, occupational therapists, speech pathologists, podiatrists, and exercise physiologists, showed explicit and implicit biased attitudes toward obesity. The review assessed weight bias using 27 different outcomes .

Another systematic review from Brazil found that weight bias affects clinical decisions and care quality. Patients with obesity benefit less from cancer screening , receive less frequent treatment intensification for obesity, and undergo fewer gynecological examinations. These findings highlight an urgent need for strategies to reduce the adverse effects of weight bias.

Manifestations of Weight Bias

The Obesity Action Coalition (OAC = Obesity Action Coalition) defines weight bias as “negative attitudes, beliefs, judgments, stereotypes, and discriminatory actions directed at people solely because of their weight”. Bias may be explicit or implicit and can occur anywhere, including workplaces, healthcare, education, media, and relationships with family and friends.

Explicit bias can take verbal, written, media, and online forms. Obesity stigma involves social devaluation and belittling people who are overweight, leading to negative attitudes, stereotypes, prejudice, and discrimination.

Bias in Clinical Practice

Research shows how weight bias appears in healthcare. For example, patients with obesity undergo cancer screening tests such as mammography and colonoscopy less often. Treatment intensification and follow-up visits for obesity are also less frequent, resulting in lower-quality care and poorer health outcomes.

Lack of Education

Insufficient obesity education in medical schools is a major reason for widespread bias. One study found that only 10% of 40 medical schools considered their students “very prepared” to manage obesity , and one-third had no obesity education program or plans to develop one. This gap highlights the need to update medical training curricula.

Obesity and Genetic Diversity: Personalized Treatment with MyPhenome™ Hungry Gut

In obesity treatment, individualized approaches have the potential to improve outcomes. Developed by Mayo Clinic researchers and commercialized by Phenomix Sciences, an obesity test was launched in 2024 under the name “MyPhenome™.” It uses genetic information from a saliva sample to identify an individual's obesity phenotype and aims to predict which treatments will be more effective.

Obesity Phenotypes Identified by MyPhenome

The test identifies four main obesity phenotypes:

1. Hungry Brain
2. Hungry Gut
3. Emotional Hunger
4. Slow Burning (Metabolism)

How the Test Works

By measuring genetic SNPs (single nucleotide polymorphisms), metabolites, and hormones, the test helps create a personalized treatment plan. It analyzes approximately 6,000 genetic SNPs, providing an extensive genetic assessment.

Research and Pilot Studies

In research begun in 2015, Mayo Clinic investigators used AI and machine learning to classify obesity into 11 types, later reducing these to four phenotypes for practical ease of use.

The most advanced test, “MyPhenome Hungry Gut,” was developed to predict response to GLP-1 medicines (weight-loss injections) . People with this phenotype feel hungry sooner after eating and may therefore respond better to GLP-1 medicines.

Weight-Loss Injections and MyPhenome™ Hungry Gut

Ozempic and Wegovy injections, which contain semaglutide, are effective medicines used in obesity treatment. Clinical studies, however, show considerable variation in semaglutide response.

An independent study conducted by Mayo Clinic and presented at Digestive Disease Week 2024 demonstrated MyPhenome™ Hungry Gut's ability to reduce this response variability and identify patients responding better to semaglutide. At 12 months, Hungry Gut-positive individuals lost 19.5% of total body weight, compared with only 10% in those testing negative.

The study emphasizes obesity's strong genetic and biological basis and the potential for personalized treatment to improve outcomes.

What Needs to Be Done

Overcoming weight bias requires treating patients respectfully and being sensitive to their bodies and health goals. Clinical environments should accommodate people with obesity, and healthcare providers should examine their own attitudes and prejudices. The OAC offers resources and strategies to reduce weight bias.

Steps that may help reduce bias include:

• Identifying Obesity Type and Personalizing Treatment: Use genetic testing and biometric analyses to identify obesity types. Personalized approaches, such as MyPhenome™ Hungry Gut, may improve outcomes and reduce bias.
• Encourage patients to share experiences of stigma.
• Help patients identify effective ways to cope with stigma.
• Encourage social support and positive self-talk techniques.
• Make consulting rooms more accessible for people with obesity, for example with wider examination tables, appropriately sized gowns, and blood pressure cuffs.

Conclusion

Simple advice such as “Eat less, move more” reinforces existing prejudice, making effective, inclusive approaches to obesity harder to develop. Better obesity education for healthcare professionals and unbiased care are critical to improving patient outcomes.

More informed and compassionate approaches should consider obesity's biological, genetic, and environmental factors. This can help combat prejudice and create a fairer, more effective healthcare system.