Obesity is usually considered a result of unhealthy eating or lack of self-control. However, research shows that obesity is a complex, chronic disease heavily influenced by underlying biological mechanisms.
The way the body stores and uses energy is shaped by multiple factors, including hormonal balance, genetic inheritance, and a person’s metabolic functioning.
In fact, these factors can even override an individual’s willpower. We speak to Dr Ranjeet Kumar Singh, Consultant (Bariatric Surgery), Regency Health, Kanpur, to understand these aspects so that it becomes easier to comprehend why typical methods based on dieting don’t work and why it is necessary to resort to holistic, medically guided interventions.
Hormonal Imbalance
Our bodies consist of hormones such as leptin, ghrelin, and insulin, which control hunger signals, satiety, and fat storage, yet they are frequently disrupted by obesity. Leptin is secreted by fat cells and is used by the brain to recognize that it has sufficient energy. However, in most cases of obesity, resistance to leptin is seen, and hunger continues.
Whereas ghrelin levels, which promote hunger, are elevated in such patients and may increase hunger by 30%. Statistics from the World Health Organisation indicate that over 1 billion people worldwide suffer from obesity, and hormonal disorders play a major role in addition to overeating. In India, urban populations have over 64% of people suffering from obesity due to disorders caused by a sedentary lifestyle, processed foods, and stress. Sleeve Gastrectomy can reduce ghrelin levels by 70%, resulting in reduced hunger.
Metabolic Dysfunction
Obesity is not only determined by calorie intake but also by how efficiently the body manages energy and fat metabolism. The “set point” theory, which involves the hypothalamus, genetics, and the brain, has been shown to maintain the body at a certain weight and will defend that weight, causing the individual to gain weight if they try to diet.
Adaptive thermogenesis, or the slowdown of the metabolism, occurs when dieting, causing the individual to regain their body weight. Twin studies have shown genetics may contribute to 40–70% of the differences in BMI among individuals, shaping how the body stores and holds onto fat. Metabolic syndrome also increases the risk of heart disease and accompanies obesity in a large percentage of cases.
Conventional dieting often fails to produce lasting results. Studies suggest that more than 80% of individuals regain the weight they lost within five years, partly because the body responds by slowing down metabolism. In contrast, procedures such as gastric bypass surgery have been shown to improve metabolic activity.
Genetics and Environment
Genetic predispositions combined with modern living, abundant food, and inactivity can heighten obesity risk. The FTO gene, which is present in 40% of people, increases obesity risk by 70%. This is because of altered brain function in relation to palatable food. What many people describe as “food noise” is often linked to dopamine-driven reward pathways in the brain.
Moreover, obesity rates have tripled over the past three decades worldwide, from 1975 to date, primarily due to dietary and lifestyle habits and not genetic factors. Physical inactivity has been shown to decrease the metabolic rate, which may contribute to genetic factors that cause weight gain. Newer drugs, such as those containing GLP-1 agonists, are similar to naturally occurring hormones in the intestines that control appetite. These drugs result in 15 to 20 percent weight reduction.
Treatment Beyond Diet
Despite widespread use, traditional dietary plans show only about a 5% long-term success rate, as they rarely address the biological mechanisms that influence weight regulation. Bariatric surgery attacks the root of the problem, maintaining a success rate of 90% for excess weight loss after a decade, according to Cleveland Clinic data, normalising hormone levels and metabolic rates, and curing high blood pressure.
Dietary plans are a good addition, but must be accompanied by medical interventions for genetically linked obesity. Measuring BMI above 30 kg/m² and waist circumference helps identify and act against the problem. A combination of medical, lifestyle, and behavioural interventions offers the best chance of tackling this growing health crisis.
