inspiring canadians to live better.

healthing leaf

inspiring canadians to live better.

healthing leaf
get healthing in your inbox with the morning checkup and weekender newsletter!

'obesity is triggered by brain chemistry, not willpower'

dr. sean wharton says the belief that those with obesity lack discipline and self-control creates stigma so 'thick and intense' that it prevents people from seeking help.

by maja begovic
published oct 18, 2021
last updated feb 01, 2024
read time 5 minute read
join the conversation
read time 5 minute read
join the conversation
'obesity is triggered by brain chemistry, not willpower'
dr. sean wharton is the co-author of the new canadian obesity guidelines and medical director of the wharton medical clinic. supplied
living with elevated weight caused by obesity can be life-changing— and not in a good way. more than seven million canadians are more likely to be overlooked for jobs, be poorly treated by their physician, and suffer criticism from those who believe that greater self-control can prevent obesity.
according to dr. sean wharton, co-author of the new canadian obesity guidelines and medical director of the wharton medical clinic, a community based internal medicine, weight management and diabetes clinic, obesity is actually a progressive, complex and chronic disease that’s triggered by brain chemistry and not by lack of willpower.
he says that the pervasive belief that those with obesity lack discipline and self-control creates bias and stigma so thick and so intense that it sometimes prevents people from seeking help for the disease. avoiding medical care may lead some down the path of health risks caused by the disease, such as type 2 diabetes, high blood pressure, heart disease, stroke, arthritis and cancer. it’s not uncommon for people with obesity to also experience debilitating anxiety and depression.
wharton talked to healthing about how physicians who blame obesity on overconsumption can contribute to the false narrative, the connection between the brain and disease, and how new treatment can help manage obesity and improve the lives of those affected by it.

related stories

i wasn't born big
intense diets don’t work, weight management isn’t about ‘willpower,’ and your self-worth isn’t determined by the scale, writes obesity matters' priti chawla.
priti chawla is the head of obesity matters, a toronto-based group dedicated to changing the conversation around obesity. supplied

study identifies 14 genes that cause obesity
new research from the university of virginia suggests obesity has more to do with genetics than behaviour or lifestyle choices.
many experts believe obesity is more related to genetics than to behaviour or lifestyle.
story continues below
this interview has been edited for length and clarity.
 
let’s start with the question at the root of misperceptions of obesity: does overeating cause obesity?
overeating does not cause obesity, but obesity causes overeating. obesity is biology and genetics. if the genetics of your hedonic system — in your brain — say that you need to eat food in the evening to feel better, it’s going to be really hard to deal with that every single day, for the rest of your life. if you fix the neurochemical in the brain, you fix the behaviour of overeating.
walk us through that process.
our genetics are the primary drivers of weight regulation. genes code for specific regions in the brain primarily the mesolimbic lobe (hedonic area), the hypothalamus (the hunger centre) and the frontal lobe (the executive area). these areas of the brain are designed to prevent weight loss and encourage the regain of weight. the degree of the intensity of weight preservation is dictated by genetic coding. neurochemicals and specific hormones dictate the degree of hunger and cravings. the ability to modulate or dampen these neurochemicals will determine how effective an intervention is at preventing weight gain or weight regain after weight loss.
powered by
obesity canada
story continues below
so, obesity is not our fault.
correct, it is not necessarily all the patient’s fault. blame and shame is the most common approach to elevated weight, and the biggest barriers to care are bias and stigma, which leads to discrimination. the finger wagging, paternalistic approach that some physicians use contributes to the false narrative that we can shame a person enough for them to change their behaviours over an extended period. this approach does not work for those who have a family history of the disease and genetic factors working against them. as doctors, we’re supposed to provide unbiased, compassionate care, not assign blame.
the blame and shame culture is prevalent online as well.
you may see a picture of somebody with elevated weight, and the impression that most of the images display leads you to think that they are not very bright, they don’t dress well, and that they are always sweating. those stigmatizing images start to form a viewpoint. if you show a child in kindergarten an image of a child living with obesity and an image of a child with a disability, they will never choose a child with obesity as their playmate. at such a young age, they’ve already assigned negative attributes to the child living with obesity as “not bright, “lazy” and “not fun.” when someone implies or explicitly states that a person with obesity doesn’t deserve care because they’re not bright enough or disciplined enough to manage their weight and health, it forms an impact on the person with the disease. even people who live with obesity have internalized bias. they think of themselves as not bright, not capable and not worthy of care. this has to change.
powered by
obesity matters
story continues below
when people come forward to ask for help, what treatment options are available?
psychological intervention, pharmacological therapy and bariatric surgery are the main pillars of therapy. pharmacological therapy will be a game-changer and will help revolutionize obesity management in the same way it completely changed and revolutionized hypertension, depression and diabetes. pharmacological therapy works by addressing the neurochemical imbalances in the brain that are driving eating behaviours.
what about other interventions?
we have seen positive results with cognitive behavioural therapy (cbt). the first thing is to be cognizant when you’re using food as a soothing mechanism and then working on changing that behaviour by addressing the root causes. cbt addresses and identifies antecedent that leads to overeating behaviours. you have to get yourself out of the environment that promotes hedonistic eating. cbt is very different than accountability — when you’re on the jenny craig or weight watchers program, accountability is about weighing in, it’s someone telling you to eat better, and educating you on carbs, fats and fibre. cbt is about understanding your own vulnerabilities and how to make changes within your environment or how to interact with the environments that we find ourselves in.
story continues below
tell us more about bariatric surgery.
i’d like to see greater availability of bariatric surgery across canada so that people who have severe obesity can get the help they need. unfortunately, bariatric surgery is most accessible in ontario and quebec, but not in other provinces. the cost of the surgery is covered by the government, and it can cost up to $20,000 — this may be a barrier for some provinces. i would also like to see greater coverage of pharmacological therapy. in the most recent new england journal of medicine trial, with a once weekly injection, one third of patients achieved over 20 per cent of sustained weight loss, which is nearing surgical levels.
in the next 25 years, what do you think the treatment options for obesity will look like?
pharmacological therapy is going to make a significant difference because it will allow people to do the psychological treatment such as cognitive behavioural therapy in a much more effective manner. medications will also assist patients in both pre- and post- bariatric surgery.
will new drugs that help people with obesity look and feel better end the stigma?
the stigma will only come to an end when people living with obesity are respected for who they are. effective treatments should not be the answer to end the stigma. we should treat the people we love and care about with a much greater level of respect and dignity.
story continues below
this interview is a part of healthing’s the shape of us. read about how tony vassallo’s experience with weight is now helping other men to be comfortable in their bodies. 

comments

postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. comments may take up to an hour for moderation before appearing on the site. we ask you to keep your comments relevant and respectful. we have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. visit our community guidelines for more information and details on how to adjust your email settings.

you may also like
ozempic insulin injection pen for diabetics and weight loss.
wegovy approved for lowered risk of heart attack: what it means for people living with obesity and heart disease
obesity matters has developed a series of 12 wellness workshops starting this fall to bring wellness resources and experts free of charge to all people through informative and actionable virtual gatherings.
obesity matters wellness workshop: embracing wellness beyond the scale
the obesity matters leadership team, pictured, has worked tirelessly to develop resources to bring unprecedented support to people living with obesity in quebec through the organization's new french division, parlons obésité.
obesity matters launches french division to support and advocate for people in quebec  
a group of cheerful small school kids in canteen, eating lunch and talking.
understanding the childhood obesity epidemic: environment, genetics and education
neda nasseri, product director of benefits at desjardins insurance and advisory board member with obesity matters; rachel atkins, board vice-chair, director of strategy, and patient advocate with obesity matters; and dr. david attalla, internal medicine and obesity medicine physician. (left to right)
the toll of obesity: long-term impact, access to care and insurance support
you may also like
ozempic insulin injection pen for diabetics and weight loss.
wegovy approved for lowered risk of heart attack: what it means for people living with obesity and heart disease
obesity matters has developed a series of 12 wellness workshops starting this fall to bring wellness resources and experts free of charge to all people through informative and actionable virtual gatherings.
obesity matters wellness workshop: embracing wellness beyond the scale
the obesity matters leadership team, pictured, has worked tirelessly to develop resources to bring unprecedented support to people living with obesity in quebec through the organization's new french division, parlons obésité.
obesity matters launches french division to support and advocate for people in quebec  
a group of cheerful small school kids in canteen, eating lunch and talking.
understanding the childhood obesity epidemic: environment, genetics and education
you may also like
ozempic insulin injection pen for diabetics and weight loss.
wegovy approved for lowered risk of heart attack: what it means for people living with obesity and heart disease
obesity matters has developed a series of 12 wellness workshops starting this fall to bring wellness resources and experts free of charge to all people through informative and actionable virtual gatherings.
obesity matters wellness workshop: embracing wellness beyond the scale