Fighting obesity: From hormones to habits, doctor explains why obesity is more than just overeating

Once dismissed as a lifestyle issue or a matter of willpower, obesity is now recognised as a chronic medical condition with wide-reaching effects on health. And the numbers are rising fast. Experts warn that by 2050, more than half the world’s adults could be overweight or obese. In India, the bar is set even lower — with a BMI over 25 kg/m² considered obese, and a waistline over 90 cm for men or 80 cm for women raising red flags.

Obesity isn’t just about looks or fitness, says Dr Jasjeet Singh Wasir, Director of Diabetes and Endocrinology,  Medanta, Gurugram. “It’s a medical condition that impacts nearly every system in the body; from metabolism and hormones to joints and mental health.” According to Dr Wasir, obesity affects health across four major areas, often referred to as the “4 M’s.”

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The 4 ways obesity affects your health

• Metabolic: Increases the risk of type 2 diabetes, high blood pressure, high cholesterol, fatty liver, and PCOS

• Mechanical: Leads to joint pain, backache, sleep problems, and even acid reflux due to physical strain

• Mental: Impacts self-esteem, body image, and overall emotional wellbeing. “People often underestimate the psychological toll,” Dr Wasir notes

• .Monetary: The hidden cost is financial,” he adds. “Obesity-related illnesses drive up healthcare bills and medication costs over time.

For years, the prevailing belief was that obesity comes from overeating or not exercising enough. However studies suggest that the genes can account for up to 80% of a person’s weight. Dr. Wasir explains, “Along with your genes,  poor sleep, stress, urban pollution, and calorie-dense diets, can all be the reason.” Even those who lose weight often struggle to keep it off. “That’s because the body defends its “set point” weight — slowing down metabolism and curbing hunger when the number on the scale drops.

Dr Wasir outlines a multi-disciplinary medical approach that may help in managing obesity: 

• Balanced nutrition guided by a dietitian

• Physical activity tailored to individual needs

• Behaviour therapy to manage cravings and emotional eating

• Medications that regulate appetite and metabolism

• Surgery or devices where medically necessary

“The best outcomes come from team-based care,” he says. “When doctors, nutritionists, psychologists, and fitness professionals work together, patients get long-term results.”

Recent advances in weight-loss drugs, like Ozempic, Wegovy, and Mounjaro, have changed the game. “They work by suppressing hunger and helping the body process calories more efficiently,” says Dr Wasir. These medications, he says, may be recommended for those with:

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• BMI over 30 kg/m², or

• BMI over 27 kg/m² with complications like diabetes or high blood pressure

Dr Wasir reminds, “However, there’s no one-size-fits-all. Every treatment must be personalised.”