Calling BS on Weight Bias: Your Weight is Not Your Fault
Have you ever been told your weight is just about willpower?
Or that if you simply “tried harder” you’d see the results you want? Maybe you’ve even heard that using medication or surgery is “cheating.” If so, you’re not alone—and it’s time to call BS on that thinking.
If you’ve ever felt shame or blame about your weight, I want you to know: it’s not your fault. Obesity is a complex, chronic disease influenced by biology, hormones, environment, and genetics—not a personal failing. And while healthy eating and exercise will always be important, for many people they’re not enough on their own. That’s where medical tools like medications and surgery come in—not as shortcuts, but as evidence-based treatments.
In the past couple of weeks, I’ve had moments that reminded me exactly why this conversation still matters so much. Some were hopeful—like connecting with state leaders who want to expand access to obesity care. Others were frustrating—clear signs that weight bias is alive and well in both the medical community and the media.
In this episode, I’m sharing three stories that reveal how weight bias shows up in everyday life and why it’s so important we challenge it. These examples might make you shake your head, but I hope they also give you language to push back and remind you that your health is worth celebrating at every step forward.
Let’s get into it.
Why Weight Loss Isn’t Just About Willpower
First story – Early in my career, and still today, I’ve had countless conversations with physicians who don’t fully understand the complex reality of obesity.
One conversation stands out. I was talking with a respected physician leader I’ve known for years. He is highly intelligent, deeply empathetic, and a well-known voice in medicine. We were discussing the challenges I face in getting medication coverage for patients with obesity when he paused and asked:
“But isn’t it just about the choices we make?”
When I explained it wasn’t, he shared his personal story. Years ago, he stepped on the scale, saw 195 pounds, decided it wasn’t healthy, and made changes. He cleaned up his diet, exercised more, and over time dropped to 145 pounds.
“If I can do it,” he asked, “why can’t others?”
It’s a question I’ve heard many times, and it comes from a place of personal experience. But it’s also based on an assumption that oversimplifies the problem. Yes, some people can lose a significant amount of weight and keep it off. But these cases are rare.
Research shows only about 5–10% of people can maintain a 10% weight loss over the long term. Many are successful for six to twelve months, but most regain the weight they lost. It’s not because they didn’t try hard enough. The reality is that lasting weight loss is influenced by far more than willpower.
Biology, hormones, environment, and access to resources all play a role. People who succeed long term often have fewer biological disruptions, less metabolic disease, and more stability in their daily lives. For many, even with the best intentions and consistent effort, lifestyle changes alone are not enough.
When “Not Enough” Is More Than Enough: Rethinking Weight Loss Goals
Recently, Eli Lilly, the maker of Zepbound, one of the newer anti-obesity medications, announced early trial results for an oral drug in development called orforglipron. It is a bit of a mouthful to pronounce, and importantly, it is not yet approved. No one should be taking it in 2025 outside of a clinical trial.
In the study, participants achieved an average weight loss of 12.4%. For perspective, I have long considered 10% weight loss to be a major win for my patients because of the clear and measurable improvements it brings to long-term health. A reliable 12.4% reduction would be, in my mind, an even greater victory, especially when we know that even 5% weight loss can have a real impact on metabolic health and disease risk.
And yet, the media reaction was almost entirely negative. Headlines called it underwhelming. Eli Lilly’s stock dropped. Investors framed the results as a disappointment. The underlying message was clear: “Only 12.4%? Not good enough.”
This mindset is a problem. When the conversation around weight loss focuses on the idea that more is always better, we shift the goal away from health and toward an arbitrary number on the scale. We reinforce the false belief that the only meaningful success is reaching a so-called “normal” weight. That simply is not true.
Treating obesity is not about fitting a certain clothing size or chasing an idealized body shape. It is about improving health, reducing the risk of disease, and helping people live longer, better lives. If a treatment can consistently produce a 12.4% reduction in body weight, that is a meaningful, clinically significant result that should be celebrated.
When headlines and market reactions frame that as failure, the message to people living with obesity is deeply damaging: no matter how much progress you make, it is never enough. This fuels unrealistic expectations and adds to the stigma and shame that far too many patients already carry with them.
Weight Bias Runs Deep
If you live with obesity, you have probably heard the stereotypes. People may assume you are not trying hard enough. They may suggest you are lying about what you eat. They may label you as lazy or undisciplined, or insist you must be doing something “wrong.” These messages, whether delivered outright or in subtle ways, can take a real emotional toll. They can make everyday life more stressful, create feelings of shame, and even discourage people from seeking the care they need.
Here is the truth: your weight is not your fault. You can be an athlete, a marathon runner, a dedicated CrossFitter, or even a physician who specializes in obesity medicine and still live with the disease. I treat multiple colleagues—doctors who are board-certified in obesity medicine—who struggle with it themselves. This is not about a lack of knowledge, discipline, or effort. Obesity is a chronic disease influenced by a complex mix of biological, environmental, and genetic factors. Hormones, metabolism, stress, sleep, and access to healthy food all play a role.
When someone has a chronic disease, we treat it with the tools available—whether that means lifestyle interventions, medications, surgery, or a combination. Eating a balanced diet and staying active will always be the foundation, but for many people, adding medication or surgery makes those lifestyle changes more effective and sustainable. These are not shortcuts. They are evidence-based treatments that help the body respond better, improve health, and make long-term changes more achievable.
If you’ve worked hard on nutrition and exercise yet still aren’t seeing the progress you need, it is not a personal failure. It’s a sign that your body may need additional support, and that is exactly what modern medicine is designed to provide. Seeking help isn’t giving up—it’s a smart, proactive step toward protecting your health, reducing the risk of chronic disease, and improving your quality of life. The most important takeaway is that progress is not measured by perfection, and every step toward better health—no matter the size—is meaningful and worth celebrating.
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