Reframing obesity: what it means for clinical practice

Despite decades of research pointing to its biological and social complexity, obesity is still often viewed as a matter of personal choice and willpower. Dr Angie Jackson-Morris, director of programme development and strategy at World Obesity Federation, explains why reframing obesity as a chronic, relapsing disease is essential to delivering effective, compassionate care.

For too long obesity has been framed as a matter of personal responsibility. A question of willpower, motivation, or lifestyle choices. This framing remains widespread, including within healthcare settings. However, this approach does not reflect the evidence and it risks undermining effective care.

Today, leading health bodies, including the World Health Organization, recognise obesity as a chronic, relapsing disease. This shift in language is not without reason. It reflects decades of research and scientific understanding, and it enables obesity to be properly addressed through clinical guidelines, structured care, and sustained investment.¹

From individual responsibility to complex systems

Obesity does not develop in isolation.

It emerges from the interaction of biological, environmental and social factors.^2,3 These include how the body regulates appetite and energy balance, the food environments people live in, and the broader socioeconomic conditions that shape daily life.

Research has shown that body fat is regulated by multiple interlocking systems, including hormonal signals, neurological pathways, metabolic adaptation and genetic predisposition. Obesity is increasingly understood as a ‘defended state’, where biological systems act to resist loss of body fat and favour regain.^4-6 This is one of the key elements that underpins designating obesity as a chronic, relapsing disease, that requires ongoing management and support.

At the same time, many people are living in environments where healthy foods are less accessible, less affordable or harder to sustain.⁷ Behaviour still matters, but it operates within these constraints.

Recognising this complexity shifts the focus away from blame and towards understanding, support and long-term care.

Why the ‘willpower’ narrative holds us back

Framing obesity as a personal failure is not only inaccurate, it has real consequences for care.

Stigma towards people living with obesity remains prevalent in healthcare settings and can influence communication, clinical decision-making, and patient engagement.⁸ People living with obesity frequently report feeling judged or dismissed, which can reduce trust in health services and delay or deter healthcare seeking.

The way obesity is described also influences how it is prioritised. When seen primarily as an issue related to personal responsibility or lifestyle choices it is less likely to be resourced with appropriate support or treatment using evidence-based approaches and can remain under-prioritised within health systems.⁹

As with other chronic conditions, improving health outcomes depends on moving beyond assumptions and towards consistent, structured and compassionate care.

What this means in everyday practice

For nurses, who often represent the most accessible points of care in a health system, this shift is highly practical.

Start with language
Using person-first, non-judgemental language, such as ‘people living with obesity’, helps to reduce stigma and signals respect. This can shape the tone of a consultation and influence how patients engage with care.
Recognise obesity as long-term
Like other chronic conditions, obesity requires ongoing management. This means moving beyond one-off advice towards accessible, ongoing support, follow-up and care that adapts over time.
Put people at the centre
Patients bring lived experience, and sometimes frustration with previous approaches. Listening, building trust and working in partnership are ingredients for success.
Use the full range of tools
Care should include advice and support on nutrition, physical activity, and mental wellbeing for overall health outcomes, alongside medical treatment and referral where appropriate.

The new generation of GLP-1 receptor agonist-based medications are expanding treatment options for some patients, but should only be prescribed under medical supervision and alongside wraparound advice and support on healthy nutrition and physical activity to minimise side effects and maximise positive outcomes.

Addressing inequality and access

Obesity affects people of all ages, ethnicities, and social backgrounds. Nonetheless it also reflects wider patterns of inequality. In high income countries, such as the UK and Saudi Arabia, prevalence rates are generally higher in communities facing socioeconomic disadvantage, where structural barriers limit access to nutritious food, safe environments for physical activity, and healthcare services.¹⁰

Conversely, in low-income and middle-income countries, the reverse is often the case, with the prevalence typically being higher among families with higher disposable income. Nevertheless, trends suggest that obesity is also starting to rapidly increase in rural and lower income communities and families.¹¹

Access to treatment, including obesity medications, remains unequal. Improving access to treatment for people based on clinical need is crucial, however, a clinical approach alone is not sufficient and must be accompanied by government action on wider determinants of health, including socioeconomic deprivation, commercial influences, and the built environment.

For healthcare professionals, this context matters. Supporting patients effectively includes recognising these constraints and working within them, signposting to resources of support available online or at local level and advocating for supportive policy changes with local authorities and service providers where possible.

A shift that improves care

Reframing obesity as a chronic, relapsing disease is not about removing personal responsibility. Instead it is about placing obesity within a more accurate and clinically useful context.

For nurses, this supports care that is better aligned with the evidence. Care that acknowledges complexity, reduces stigma, and focuses on long-term health.

The World Obesity Federation’s online SCOPE platform provides accessible, evidence-based education on obesity and its clinical management and treatment developed by international experts. Links can be found in the resources section below.