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Understanding The Complexity Of Obesity

Obese patient with doctor

Obesity is a complex disease with many underlying factors and causes. The oversimplification of weight loss that many coaches and trainers subscribe to (“move more and eat less”) tends to blame clients for lacking self-control, being lazy or having “no motivation.” This can lead to weight bias among health and fitness pros and alienate clients with obesity.

The path to improving strength, making dietary changes or losing weight may seem clear to those who have never personally struggled with weight challenges. The common approach to weight loss—“calories in, calories out”—fails to consider the complexity of metabolism, set-point weight and the hormonal impact of dieting over a long period of time.

Factors That Influence Obesity

The underlying causes of obesity include a combination of psychological, emotional and physical factors.

Socioeconomic Status

A 2018 study found that low socioeconomic status (SES) was a direct link to developing type 2 diabetes mellitus, due to “restricted autonomy and opportunities that could lead to more stress and consequently [an] increase in stress hormones . . . which might ultimately change fat deposition, increasing visceral fat and increasing the risk of T2DM development” (Volaco et al. 2018). Socioeconomic factors include access to food and opportunities or safe spaces for exercise.

Psychological Factors and Obesity

Underlying psychological factors can have a big impact on nutritional habits. Clients who grew up with food insecurity (or were raised by parents who experienced food insecurity) can develop eating habits based on a food scarcity mentality. Obeying a food rule like “clear your plate” or eating quickly to make sure you get your share are habits that can develop in childhood and be very challenging to break later in life. Even when there is no shortage of food, underlying psychological factors can be difficult to overcome.

Other psychological factors include emotional eating, binge eating and having been raised by a parent who suffered from emotional eating habits.

See also: It’s Time to End the Stigma of Obesity

Physical Factors

Underlying physical causes of weight gain include hormonal and metabolic function, genetics, habits, and ethnicity. Research has linked a history of dieting to weight gain, owing to both the impact of hormonal control of appetite and the role of weight loss in reducing metabolic rate (Dulloo, Miles-Chan & Schutz 2018). Simply put, after weight loss, appetite may increase, whereas metabolism has decreased; this can lead to renewed weight gain.

Sleep has also been linked with weight gain. Shift work can influence weight gain through the disruption of sleep cycles (Sun et al. 2018). Stress can also influence weight, since stress hormones disturb sleep, enhance appetite, trigger cravings and reduce motivation for physical activity (Geiker et al. 2018).

Of course, current nutritional and exercise habits are important, but having empathy for the life experiences of your clients, their deeply rooted habits and their past attempts at weight loss can build rapport and begin to remove weight stigma, improving the coach-client relationship.

See also: Undoing Weight Bias Within Yourself




Dulloo, A.G., Miles-Chan, J.L., & Schutz, Y. 2018. Collateral fattening in body composition autoregulation: Its determinants and significance for obesity predisposition. European Journal of Clinical Nutrition, 72 (5), 657–64.

Geiker, N.R.W., et al. 2018. Does stress influence sleep patterns, food intake, weight gain, abdominal obesity and weight loss interventions and vice versa? Obesity Reviews, 19 (1), 81–97.

Sun, M., et al. 2018. Meta-analysis on shift work and risks of specific obesity types.Obesity Reviews, 19 (1), 28–40.

Volaco, A., et al. 2018. Socioeconomic status: The missing link between obesity and diabetes mellitus? Current Diabetes Reviews, 14 (4), 321–26

Cassandra Padgett, MS

"Cassandra Padgett, MS, is a health educator, ACE-certified health coach, Precision Nutrition Level 1 coach, and contributing author for ACE and IDEA. She is committed to providing evidence-based nutrition coaching to women and children, and helps run a pediatric healthy weight clinic in San Diego. She is passionate about combining the science of nutrition with the practice of intuitive eating, and helpi"

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