Two colleagues are enjoying lunch in a business meeting. They both mention they’ve gained weight recently and how they’re trying to make lifestyle choices that will support a healthy weight.
If you look at them, they look similar on the outside. They have bodies of similar size. They both joke about trying to get their steps in and avoiding office snacks. And as months pass by, they both start seeing results.
These two women appear to be following similar paths, but if we zoom out, their stories are completely different.
One friend grew up with a healthy weight. She has occasionally gained a few pounds here and there over the years, but she’s usually lost them again by tweaking her lifestyle. Nobody in her family has ever reached clinical obesity.
The other friend was first put on a diet by a doctor when she was in primary school. By the time she reached her teenage years, she was already living with obesity. She is one of four siblings, all of them with similar trajectories. As an adult, her weight has been continuously fluctuating, and she has had several periods where she reached clinical obesity. Each of those times, she lost weight with great effort – and every single time, it crept back. But she cares deeply about her health, so what does she do? She just keeps trying. She calls herself an optimist… society calls her a yo-yo dieter.
If you met these two women either now or five years earlier when they both weighed the same, you’d have no way of knowing they have differences in their biology that influence their weight. And you wouldn’t know that one of them was working much harder than the other just to maintain that number on the scale.
When the World Health Organisation describes obesity as a chronic, complex disease – not just a matter of “too much food, not enough exercise” – they are recognising the second woman’s story. They are saying there is a common thread that runs through all those weight-gain episodes she has experienced. There are underlying biological mechanisms that keep nudging her weight upwards, whatever is happening in her life.
Redefining obesity as a chronic disease changes how we think about weight and helps explain why so many people feel stuck in an eternal cycle of losing and gaining weight.
Yo-yo dieting is more than “just frustrating” – it’s a health problem
If your body tends to regain weight, you know how this story goes.
A new plan. A burst of hope. The “good” days. The weight is coming down. The hunger. The tiredness.
Then, one day, the scales stop moving. Before you realise it, the weight creeps up. And tragically, you eventually end up at a higher weight than where you started.
So, you start thinking about your next plan. The one that won’t fail you.
That is what people mean by yo-yo dieting – repeated cycles of weight loss and regain, sometimes over decades.
Emotionally, it’s exhausting. You worked with everything you had, so every weight regain feels like wasted effort. Energy and headspace you could have used in other areas of your life.
Not only is this process emotionally draining, but what’s happening to your body during that process matters too. People going through what scientists call ‘weight cycling’– aka, yo-yo dieting – seem to have higher risks of cardiovascular disease, high blood pressure and earlier death.
Still, isn’t weight cycling “better than doing nothing”? Giving up entirely doesn’t seem like a wise decision when we’re constantly reminded of the detrimental effects of obesity and overweight on our health. We don’t have all the answers yet, but research suggests that weight cycling affects how organs like the pancreas, kidneys and fat tissue work. It is also linked with more fat around the waist, less muscle, higher inflammation, and poorer blood-sugar control.
There’s an alternative we should at least aim to achieve. We can change the way we treat obesity and overweight to offer better solutions, making sure that the management of the disease is not throwing people into that endless loop of weight loss and regain.
What is a chronic disease, and why should obesity be seen as one?
If you ask most people to list chronic diseases, they might mention conditions such as high blood pressure, asthma or type 2 diabetes. But few would mention obesity. And that strongly influences how we think about them.
Because we think about high blood pressure as a chronic condition, nobody expects it to be “fixed” after a 12-week programme. We accept that there is a predisposition that keeps pulling the person’s blood pressure upwards, and the tendency will not switch off when the treatment stops. We know that we need to keep an eye on it, and doctors might need to adjust the interventions used to manage the condition at different points.
Similarly, you wouldn’t tell someone with asthma that their inhaler “didn’t work” because their symptoms returned once they stopped using it. Because you know that asthma is a chronic condition, you understand it will still be there when the medication stops, and that it needs long-term management.
That’s what a chronic disease is. A condition that tends to last for a long time, can flare up or settle at different times, and often comes back if treatment stops.
In recent years, global health bodies and scientific societies have begun to use this language for obesity, a multifactorial, chronic condition in which excess body fat can harm health. Not simply a risk factor, nor a lifestyle issue, but a disease in its own right, influenced by genes, hormones, environment and life events.
Global experts now describe obesity as a biologically driven and progressive condition, linked with more than 200 health conditions, from diabetes to heart disease. When you put obesity in that category, alongside conditions like high blood pressure, obesity becomes more than just “a number on the scales”. It becomes a condition that requires and deserves long-term care and long-term tools.
Doctor reviewing a digital care plan on a laptop
Treatment for chronic conditions
Let’s step away from weight for a moment and think about health conditions in general and how we treat them.
When someone first arrives in the clinic with a slightly hig
h blood pressure reading, the doctor rarely jumps straight to the most aggressive treatment. They may begin with small steps – checking blood pressure more often or talking about diet and lifestyle interventions.
A pharmaceutical treatment might be recommended if the blood pressure readings stay high. Usually, one medication to begin with. At some point, a second one might be needed. If the blood pressure is still not under control, the person might be referred to a specialist who can look into other options.
For some conditions, doctors often describe this journey as using different lines of therapy – first line, second line, third line. The concept is simple: start with what is likely to help most people with the fewest side effects, then add or change treatments as you learn more about how that person’s body responds.
A doctor’s response to someone whose blood pressure rises again is unlikely to be “you failed on the medication”. Instead, the response is more along the lines of “this medication is not enough on its own – what else can we do to help manage your condition?”
What would treating obesity as a chronic disease look like?
When we apply that perspective to obesity and overweight, things start to look very different.
For many, the first wave of support will address patterns around food and daily life – understanding hunger and fullness, creating new eating patterns that fit with work, family and culture, and changing what’s within arm’s reach for a quick food fix at the end of a long day. Encouraging more movement comes in here too – to protect the heart, muscles and bones, and to help keep weight stable once it has been lost.
For some, that may be all that’s needed for a particular period in their life – the baby years, the menopause transition, a tough time at work. Weight rises, then comes down again as life shifts.
For others, especially those who relate to the second woman, that first wave might not be enough. Or might not always be enough, because their biology pushes back. It’s not just that they’re more likely to have a tendency towards obesity, but they are worse off after each weight loss cycle. Early research also suggests that fat cells can remember periods of higher weight, which may nudge the body to accumulate fat.
Doctors can consider additional lines of therapy when the first wave of support is not enough. For some people, psychological therapy can help untangle emotional eating. For others, we might consider pharmacological treatment that can tackle the biological influences themselves. GLP-1 medications such as Wegovy (semaglutide) and Mounjaro (tirzepatide) act on hormones and brain pathways that drive hunger, fullness and cravings. They lead to weight loss that, for many people with overweight and obesity, would be very difficult to reach and maintain with lifestyle changes alone.
For some people with higher weights and significant health complications, bariatric surgery offers another powerful option, changing both anatomy and hormones in ways that can support long-term weight loss.
None of these treatments replaces the others. They are all options to consider and can work together in the long-term management of weight. Simply said, we are just no longer pretending that everyone can manage a chronic, biologically complex condition with willpower and recipes alone.
How the chronic mindset can fight the weight cycling effect
So how does all of this help our two colleagues – and anyone who feels trapped in years of diets?
First, it softens the promise. Instead of hunting for the perfect plan that will “sort this out once and for all”, the goal becomes finding support you can live with over time. No 12-week makeover. No chasing the “after” picture.
Second, it changes the meaning of ‘weight regain’. We can now see it as a relapse, because even when the weight was gone, the condition had not. When weight goes up again after a tough year, the story shifts from “I failed again” to “my condition is flaring up – what needs adjusting?” That tiny change in wording can make the difference between giving up and reaching out for help.
Third, it encourages continuity in care, something we are passionate about at Genwell. Chronic diseases come with follow-up – regular appointments, check-ins, tweaks. Weight can be treated the same way. Instead of a series of programmes that end with “good luck”, you get an ongoing relationship with a team that knows your history and your biology and can help you ride the ups and downs.
And last but not least, it acknowledges and honours effort. For someone like our second friend, the chronic disease frame says something very simple and very powerful: you have not failed ten diets – you have been living with a strong biological pull towards higher weight in a world that makes it incredibly easy to eat more than your body needs. You deserve proper tools and care to manage your condition.
Key takeaways
- Obesity is recognised as a chronic, complex disease in which excess body fat can harm health, not just a simple result of poor choices
- Weight cycling, or repeated cycles of weight loss and regain, is emotionally draining and may be linked with higher health risks
- Redefining obesity as a chronic disease helps move away from short-term management to long-term care
Disclaimer: This article is for general information only and does not replace personalised medical advice. If you’re considering treatment, please contact our care team.