For decades, the story most of us have been told is that weight is a matter of willpower. If we just tried harder – ate less, moved more, stayed disciplined – the problem would disappear. But people living with obesity know that this explanation doesn’t fit. The truth is more complicated, and far more hopeful. Obesity is a real, treatable disease shaped by both biology and environment – not a reflection of weakness or failure.
At the same time, the newer narrative says weight is genetic and can only be managed with lifelong medication. While medication can be a powerful tool, it isn’t the whole answer.
At Heartland Weight Loss, we work in that middle space – where science, environment, and personal agency meet. Read more to explore why both extremes of the weight conversation fall short, and how a more balanced, evidence-based approach can lead to lasting health.
We don’t like to admit it, but many of us carry the belief that weight is a reflection of willpower. That people living with obesity – including ourselves – just need to try harder. Push away the plate. Move more. Commit. For many, that belief is part of our identity – woven into how we see and judge ourselves. Changing a framework like that is hard. We’ve seen it in other areas – addiction, mental illness, even chronic pain. We’re slowly moving away from narratives that blame people for struggling, but the shift is slow. And usually, the people who change first aren’t the critics. They’re the ones suffering under the weight of the belief. Not always because they’ve done a deep dive into the science, but because they’re desperate for an explanation that lifts some of the burden of shame and guilt. Something that helps resolve the tension between “I have plenty of discipline in other areas of my life” and “I struggle with my weight.” That tension – that cognitive dissonance – is exhausting.
So when another explanation is offered, one that lifts the emotional burden, it makes sense that people cling to it.
It’s human nature.
The new narrative getting most of the attention these days says obesity is genetic – that it’s a lifelong disease requiring lifelong medication – that we’re powerless to change it without lifelong help from Big Pharma. For some, that framing feels like relief. It removes guilt. But it also removes our sense of agency, replacing it with helplessness. And while that might feel emotionally easier – especially at first – it’s not a great long-term trade-off. We’ve simply swapped one oversimplified narrative for another.
Neither one tells the full story.
At Heartland Weight Loss, we live in the space between “just try harder” and “you’re powerless.”. It’s not the most comfortable place to be. But it’s where the truth lives. Yes, excess weight is driven by physiology. But for most people, that physiology is shaped far more by environment than genetics. And that matters. It means the solution isn’t about “fixing” willpower. It’s about understanding – and adjusting – the world we live in. Food. Sleep. Stress. Movement. It’s hard work. It’s exhausting work. So we use medications to help quiet the noise. To create space for that work to actually happen.
Medications aren’t the change.
They make the change possible.
Think of weight loss like pulling on a rubber band. The more we pull, the harder it gets – and the more tension builds. If we only have one rubber band (whether that rubber band is medication or dietary changes) and we let go of it, it snaps back – quickly and powerfully – and the weight comes flying back on. However, if we think of all of our different strategies as individual rubber bands and weave them together, we have a different scenario. Use the powerful medication rubber band, but while it’s in place, layer on a whole host of lifestyle rubber bands so that the tension is distributed among the whole lot of them. This creates not only a lot more strength, but it also creates redundancy. If we stop the medication with all the other rubber bands in place, we have a much better chance of maintaining the tension – maintaining the weight loss. Now, if we stop the lifestyle changes too – let go of those rubber bands – if we think of them as temporary changes too – like traditional diet culture has taught us, the weight comes flying back on too.
Something has to be permanent.
If it’s not the medication, it has to be the lifestyle changes. Sometimes both. But getting smaller and then going back to the lifestyle that was part of the problem – and expecting to keep the results – isn’t science. It’s magical thinking. It’s diet culture all over again. If the plan is to stop and rely on willpower to maintain the tension, weight regain is almost guaranteed. It’s toxic diet culture simply moved into the halls of medicine.
The willpower narrative frames us as lacking.
The genetics/disease narrative frames us as broken and powerless.
We are neither.
The reality is a bit more complicated to understand – and manage – but with the right tools, it gives us a path forward – without getting stuck in shame, and without handing over all of our agency to a medication. That’s the middle space. That’s where we live. And that’s where we meet our patients.