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Obesity Isn’t a Personal Failing – It’s a Classic Environmental Disease

By Kent Sasse August 20, 2023 Health and Fitness

I’ve had so many patients, friends and colleagues ask me this simple question: “Why, with the obesity epidemic running wild, are we so unsuccessful at finding solutions for it, and preventing it or solving it? Can it really be that it’s just our fault as humans, and this is all just about fallibility and lack of personal responsibility?”

I always have to take a big deep breath before I say, “No, it is not about personal responsibility and lack of discipline,” although clearly that plays a small role, as it has done throughout time.

But if one backs up and has a wider lens to look at the epidemic of obesity and diabetes, we realize that it’s negatively impacting life expectancy and quality of life across the globe, and that the underlying propensity of humans to lack willpower or discipline has not changed over the decades or centuries.

So, What Has Changed?

What has changed dramatically in these recent decades that correlates closely with the obesity and diabetes epidemics is the environment, and the inputs that are directly intersecting with our genetic makeup. Those would include several things, but of course the number one factor would be the changes in the food supply.

There is a great deal of research describing the change in the genomes of many food staples, including wheat, soy, rice, and corn, in ways that we don’t truly understand and have not fully examined. There may be beneficial effects of some of these changes, some of which came about from hybridization techniques and some from GMO techniques.

I’m not offering blanket opposition to GMO techniques or improvements in agriculture, but it’s clear that key properties of food have changed that are intersecting with our biology, causing unintended consequences of runaway obesity and type two diabetes. And we’ve yet to have a well-organized, galvanized research effort to understand exactly what the mechanisms are that have led to those changes.

My hunch is that the genomic properties of the key food supply ingredients are driving the epidemic, but food science-driven manipulations of our brain chemistry with fantastic flavors, food engineering, advertising, calorie density, and portions likely also contribute to the problem.

There may be many other culprits too. The antibiotics that are used in agriculture and in human and animal treatment are also associated with obesity. There are other factors involved in the food supply, such as the chemicals in pesticides, and our cultural changes, such as more screen time and less outdoor exercise.

My reading of the best research is that screen time is contributing a minority amount compared to the more profound changes of food supply, plant genetics and biochemistry.

Identifying the Real Problem

What’s sorely lacking is a Manhattan project effort at trying to understand why millions of people are suffering and dying unnecessarily from an epidemic that ought to be understandable, solvable, and preventable.

With effort, real science, scholarship, laboratory investigation, and dedicated scientists together with people who can help frame the questions, we ought to be able to get to the bottom of this problem. We need to understand what the precise environmental changes are that are causing runaway obesity, among not just adults and people who are thought to be lacking the necessary willpower, but kids and young adults too.

Certainly, this problem is not a result of humans lacking personal responsibility. This is a problem of environmental biology interacting with our genetic biology through a rapidly changing environment, producing very negative effects in terms of obesity and diabetes.

We don’t hear about it. It’s not a big priority among the major governmental institutions and research arms to understand the number one problem causing death and disease in the US. We have much, much larger research efforts organized at diseases that are affecting a tiny fraction of the humans afflicted with morbid obesity.

That is in part due to the poor understanding and the tremendous bias against people with obesity. The view of those people that it is their fault, and they are the ones who brought this on themselves. It’s a total lack of awareness by most scientists and policy makers.

But when it happens to an entire population, you can’t blame the individuals anymore. You have to begin to look at the factors that are causing it to the whole population.

Taking Responsibility

So, yes, we all need to take greater responsibility. Yes, we all need to eat better. Yes, we all need to exercise more. And we need to do so much more now that there’s a dreadful threat and a new environmental assault on human biology that’s causing obesity and diabetes.

But we also must have a much more organized, much more effective research endeavor to understand the factors causing this terrible epidemic amongst the people in this country and abroad. Everyone deserves better.

That’s my answer when someone asks me that question. It’s a mouthful; I usually lose them somewhere in there when I assert it is a classic environmental disease.

What I hope is that with greater outreach and understanding we will create the public space and resources for a more organized research effort to tackle the number one health problem in this country and around the world. I hope that adding my voice will make some small difference.

Let’s Have a Conversation:

Do you think obesity comes from a person’s own behavior? Is each of us responsible for our own weight? Do you think factors such as changes in the environment and food technology may be causing obesity? What’s your take on this global issue?

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Yes, what the author calls “environmental” factors do play a role in the obesity epidemic, but clearly those factors are not determinant factors, or else EVERYONE would be obese. What this means is that it has become much, much harder to reduce and maintain a healthy weight, but not impossible. Until those exogenous factors change, over which we as individuals have little power, the only tool we have *is* personal responsibility — to make wise food choices, refrain from fast food and sugar, and exercise.


Obesity and type 2 diabetes are preventable and reversible. Highly processed foods and large portion sizes are mostly to blame. If you eat lean, healthy proteins, vegetables and some fruits in reasonable portions, you will lose weight. Walk just 30 minutes per day even if broken up into two 15 minute segments. Type 2 diabetes and high blood pressure are effects of obesity. Yes it takes discipline. I personally eat lots of fish and chicken occasionally; I eat pork or beef very rarely. I also eat lots of leafy greens, berries, nuts and seeds, apples, avocados, yogurt, use only good quality olive oil and avocado oil, etc. I try to get as much organic produce as possible. Also, supplements and vitamins are important. I am 67, 5’5 and weigh 118 lbs. I also walk a minimum of 30 minutes per day. I feel healthy and am on no medications. It can be done, just start eliminating bad foods a bit at a time. Yes I do cheat and get a pizza, croissant and treats now and then. Make those cheats an occasional treat, not a daily thing.

Wendy Kurchak

Hi Kim, I’m wondering if you have a professional designation/ relevant knowledge base from which you are making these recommendations, or if these are based solely on your personal practices? Thanks.


Fish, fresh fruits and vegetables and “quality” olive oil are expensive commodities for a good portion of the American population, including our senior citizens trying to keep head above water on a fixed income. You are very lucky you can afford those types of food.


Hi Kim,
I agree with you 100%. I have a similar lifestyle; am 66, 5’3” and weigh 113 lbs. I exercise a lot, eat very healthy (but eat chocolate every day) and haven’t gained a pound in twenty years. I feel fabulous!

Susan Goodman

I am now obese. I have had several health problems where I was given prednisone. (a steroid). The last disease, shingles, included a prescription for a heavy dose of prednisone. Just so you know, I also have rheumatoid arthritis and emphysema— the latter means daily steroids.
I’m bringing this up because I am nonstop hungry when I take those medicines. I eat a regular meal. And then I want more and more and more. I’m not alone with this response to that medicine. Right now I’m dieting, but it very difficult. I was always thin and then I got sick.


I totally understand this as I gained 3st on high doses of Dexamethasone when I had breast cancer years ago. I had to be weaned off it by cutting the doseage down and have never been able to lose the weight I gained. I was a UK dress size 10/12 back then, now I’m stuck at a UK 16.


I think the access of fast food, the portion sizes have increased, the expense of healthy food, the need for two parents to work have all contributed to obesity. Also the “big is beautiful” campaign in recent years. You don’t have to hate yourself if you are large BUT it is not healthy for your heart, joints, diabetes, etc. Role models like Lizzo and others that say overweight is beautiful don’t help. Being healthy should be accessible to all. There are a lot of factors contributing to America’s obesity epidemic.

KD O’Neil

Your comment says larger people “don’t have to hate” themselves, but then put down people who espouse body positivity for all.
Plus-sized people are bombarded with negative assumptions and comments, from everyone from strangers to their healthcare providers.
Yes, we know we’re heavy. Yes, we know the health implications. Many of us have been fighting this battle since childhood, with varying degrees of success. Don’t begrudge us the few-and-far-between crumbs of positive regard thrown our way.


If we are all subject to the same environmental variables then why is that there are many people that never become obese? I think responsibility is a major factor not a minor one.

The Author

Dr. Kent Sasse, an Alpha Omega Alpha top medical school graduate of UCSF, earned fellowship at the prestigious Lahey Clinic in Boston and published research on pelvic floor therapy and metabolic surgery. He founded and directs The Continence Center and the nationally accredited Metabolic and Bariatric Surgery program in Reno, Nevada. His most recent book is Outpatient Weight-Loss Surgery.

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