Many people who have struggled with their weight have been told to “eat less and move more.” Others have spent years juggling trendy diets, from keto to fasting, with minimal results. Despite their best efforts, what they often hear from physicians, friends, family and even strangers, is that they lack discipline. However, for many people with obesity, their bodies are fighting against them — a battle dictated by biological mechanisms beyond sheer willpower.
Millions struggle under the weight of societal blame for a condition rooted in complex metabolic science.
Obesity is a critical public health concern affecting millions worldwide. Yet, it is often oversimplified as an issue of personal choice. Canadian data highlights the staggering prevalence of obesity (26.6 per cent) and diabetes (8.1 per cent). For too long, societal attitudes have focused on blaming individuals for poor lifestyle choices, ignoring the deeper, multifaceted causes of the condition.
Read more: Stop asking me if I’ve tried keto: Why weight stigma is more than just being mean to fat people
The need to understand obesity beyond lifestyle changes is urgent — particularly through scientific inquiry into its genetic, environmental and physiological roots. It is beyond the simple equation of calories in versus calories out; this perspective only serves to create stigma by oversimplifying the science.
Malfunctioning fat tissue
The reality lies within the fat in our bodies. Body fat, particularly fat under the skin, known as subcutaneous adipose tissue (SAT), plays a crucial role in energy regulation and metabolic health. When fat accumulates, SAT malfunctions. This seemingly adds to excessive fat storage in organs like the liver and muscles, increasing the risk of diabetes and cardiovascular disease.
Through identifying these specific dysfunctions, researchers can work towards therapies that restore SAT function rather than simply reducing body weight.
Research from our metabolism, nutrition and obesity (MON) lab at Concordia University focuses on understanding the adipose tissue (fat tissue) environment to uncover how these complex mechanisms and their interactions can lead to the development of diabetes and cardiovascular diseases. The goal is to eventually use our discoveries to provide more effective treatment approaches based on individual differences.
One aspect that can contribute to individual differences is where fat is stored in the body. SAT from the lower body, around the hips and thighs, seems to function differently from SAT around the belly in the upper body. We are exploring the cellular and genetic aspects of these different fat depots, and their link with obesity and diabetes.
Obesity is not just about extra weight — it’s about how the body stores and processes fat. Our research also shows that external factors may come into play in how SAT behaves. For example, different SAT depots behave differently depending on sex. Whether a person is male, or female makes a difference to how their fat tissue handles fat.
A closer look at fat tissue under a microscope shows that the tissue is made up of different types of cells including fat cells or adipocytes, and immune cells. Fat cells, or adipocytes, are not passive storage units; they regulate energy, produce hormones, and interact with other systems in the body. However, when these cells become dysfunctional, they can trigger inflammation, insulin resistance and other metabolic disturbances.
We have found that not only is sex a factor in fat cell characteristics of different depots but fat cell characteristics are also affected by whether obesity develops during childhood compared to adulthood. Immune cells are also important components of fat tissue that also play a role in inflammation and metabolic disturbances.
Shifting the conversation
Instead of blaming individuals, we need to shift the conversation towards understanding these pathophysiological mechanisms. By doing so, we can develop targeted treatments that address the root causes of obesity rather than relying on generic, often ineffective solutions.
Obesity Canada reports that failing to treat obesity costs Canada $5.9 billion in health care and $21.7 billion in lost workplace productivity annually, with a $5.1 billion hit to government revenue from premature deaths and reduced workforce participation. Women with obesity face disproportionate impacts, earning four per cent less and being 5.3 per cent less likely to be employed than those with a healthy weight.
In 2023, obesity-related diseases placed over 10,000 seniors in long-term care, costing $639 million. Yet, fewer than 20 per cent of privately insured Canadians have access to approved treatments, and bariatric surgery wait times stretch up to eight years — reinforcing harmful stigma and delaying essential care.
The challenge is that our health-care system still leans toward tried and tested weight-loss approaches, such as medication, exercise and nutrition, often to the exclusion of how individual bodies respond biologically. Personalized medicine is a potential replacement. By matching treatment to each patient’s metabolic profile, we can move away from one-size-fits-all approaches and toward more effective interventions.
The need to shift our perspective on obesity is not solely a medical necessity but a societal one. The stigma attached to excess weight and obesity prevents people from receiving medical treatment, drives mental illness and perpetuates damaging myths. A more empathetic, science-based approach could help reshape public attitudes and clinical practices.
Millions of people have been misled by the myth that self-control can cure obesity. Seeing obesity as a chronic metabolic disease rather than a moral one is a way forward for effective remedies. The future of obesity treatment depends on research-driven, personalized interventions — ones that substitute blame with knowledge and stigma with support. Only then can we fully address this global public health crisis.
