Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland.
Department of Psychology, City Colleges, Dublin, Ireland.
Obes Rev. 2021 Aug;22(8):e13270. doi: 10.1111/obr.13270. Epub 2021 May 12.
Despite obesity declared a disease, there still exists considerable weight stigma in both popular culture and health care, which negatively impacts policy making regarding prevention and treatment. While viewed as a choice or a failure of willpower by many, evidence exists to challenge the argument that both weight gain and failure to achieve weight loss maintenance are the individuals' fault due to personal failure or lack of responsibility. In this article, we draw upon literature from obesity treatment, neuroscience, philosophy of mind, and weight stigma to challenge the commonly held beliefs that individuals are free to choose how much they can weigh, and achievement of long-term weight loss maintenance is completely subject to conscious choice. In reality, the regulation of hunger, satiety, energy balance, and body weight takes place in subcortical regions of the brain. Thus, hunger and satiety signals are generated in regions of the brain, which are not associated with conscious experience. This points towards biological determinism of weight and challenges ideas of willpower and resultant moralization regarding body weight regulation. In this article, we will thus argue that in the context of dysregulation of hunger and satiety contributing to the obesity epidemic, a wider discourse related to personal responsibility and the stigma of obesity is needed to enhance understanding, prevention, and treatment of this complex disease. Obesity is a chronic disease requiring personalized treatment. Lifestyle interventions alone may not be enough to achieve medically significant and sustained weight loss for many individuals with obesity. By understanding that obesity is not due to a lack of motivation or willpower, the availability and utilization of additional treatments or combination of treatments such as lifestyle, pharmacotherapy, and surgery are likely to improve the quality of life for many suffering with this disease.
尽管肥胖已被宣布为一种疾病，但在流行文化和医疗保健中仍存在相当大的体重污名，这对预防和治疗政策的制定产生了负面影响。尽管许多人认为肥胖是个人选择或意志力失败的结果，但有证据表明，肥胖的发生和减肥后体重的维持失败并非个人的过错，不应归咎于个人的失败或缺乏责任感。在本文中，我们借鉴了肥胖治疗、神经科学、心智哲学和体重污名的文献，对以下普遍观点提出了挑战：即个人可以自由选择体重，而长期保持减肥效果完全取决于有意识的选择。实际上，饥饿、饱腹感、能量平衡和体重的调节发生在大脑的皮质下区域。因此，饥饿和饱腹感信号是在大脑的某些区域产生的，而这些区域与有意识的体验无关。这表明体重受到生物学决定因素的影响，挑战了关于体重调节的意志力和由此产生的道德观念。在本文中，我们将因此认为，在饥饿和饱腹感失调导致肥胖流行的背景下，需要更广泛地讨论个人责任和肥胖污名问题，以增进对这一复杂疾病的理解、预防和治疗。肥胖是一种慢性疾病，需要个性化治疗。对于许多肥胖患者，单独的生活方式干预可能不足以实现医学上显著且持续的体重减轻。通过认识到肥胖不是由于缺乏动力或意志力造成的，就有可能增加额外治疗或联合治疗（如生活方式、药物治疗和手术）的可及性和使用率，从而改善许多肥胖患者的生活质量。
