Modern Metabolic Health with Dr. Lindsay Ogle, MD

Obesity Is A Chronic Disease

• Lindsay Ogle, MD

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0:00 | 12:33

The story you’ve heard about weight—try harder, eat less, move more—misses the underlying biology. We expose the pathophysiology of obesity as a chronic, relapsing disease, showing how hormones, brain circuits, and adipose tissue actively defend a higher set point. That’s not a character flaw; it’s biology shaped by human history and amplified by modern food, stress, and sleep patterns. Once you understand weight defense and homeostasis, the path to better metabolic health looks very different: treatment becomes proactive, sustained, and tailored.

We unpack clear medical definitions from the AMA, WHO, and OMA, then translate them into plain language that respects people and rejects stigma. Using everyday analogies—especially the comparison to high blood pressure—we explain why effective care continues long term. If a therapy lowers blood pressure, we don’t stop it; if a therapy improves weight regulation, glucose, and blood pressure, we keep it going. That shift reframes success from short bursts of loss to stable, realistic outcomes: improved energy, better labs, lower sleep apnea risk, less joint pain, and reduced cardiometabolic risk.

You’ll hear a practical breakdown of prevention versus treatment. Nutrition, movement, sleep, and stress skills are essential at every stage, but established obesity usually needs more. We cover how anti-obesity medications target appetite and satiety pathways and why bariatric and metabolic surgeries change gut signaling and insulin sensitivity. Most importantly, we focus on individualized plans that put health outcomes first and dignity at the center. If you’re ready to move past myths and embrace evidence-based care, this conversation offers clarity, compassion, and a roadmap you can use with your clinician.

If this resonates, follow along for more metabolic health insights, share the episode with someone who needs it, and leave a quick review so others can find evidence-based, stigma-free help. Your story and questions guide future topics—join the conversation and tell us what you want to explore next.

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Dr. Lindsay Ogle, MD:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, board certified family medicine and obesity medicine physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. What I said was that obesity is a chronic medical condition that requires chronic treatment. Now, depending on your exposure to the field of obesity medicine, this may seem like dramatic out there crazy, or it may seem obvious. As a physician who sees patients with the do with the disease of obesity every day, this to me was an obvious statement. But to many people it was not, and it was offensive or seen as untrue. The American Medical Association first recognized obesity as a chronic medical disease in 2013. And so it has not been that long that even our main medical association has identified obesity as a disease. So I understand why the general public may have some misunderstanding of this condition. The World Health Organization defines obesity as abnormal or excessive fat accumulation that presents a risk to health. And I'm going to also share the Obesity Medicine Association definition of obesity. This one is a little bit more complex, so I'm going to read it directly. It is that obesity is a chronic relapsing multifactorial neurobehavioral disease wherein increase in body fat promotes promotes adipose tissue dysfunction and abnormal fat mass physical forces resulting in adverse metabolic, biomechanical, and psychosocial health consequences. I like both of these definitions. I tend to favor simplicity, and so I do like the World Health Organization definition for that reason. But I also really like the Obesity Medical Association definition because it touches on the complexity of obesity and weight management. I want to stop and really emphasize one important fact, and that is even though I say and these medical associations say that obesity is a disease, in no way are we saying that somebody who has obesity or has an elevated body mass index or higher body weight or is carrying excess weight, in no way are they a diseased person, are lesser, are seen as lesser. We are trying to emphasize the opposite. We are trying to highlight what is happening inside their body. This has nothing to do with somebody's self-worth. We all, no matter what our body size, shape, age, gender, color of our skin, how we look in any way or fashion, we are all a hundred percent worthy. And I want to really emphasize this. By identifying obesity as a disease, we are able to study it, address those changes that we know are occurring, and then learn how to appropriately, effectively, safely correct that to improve health outcomes. The reason that obesity is a disease from a medical standpoint is that once somebody has excess weight, there are real proven biologic changes that happen in their body that affect their health and affect their metabolism and the way that they are able to maintain their weight or if they're able to lose weight or not. Like anything in our body system, we want to maintain what we call homeostasis, which is a consistent state to keep ourselves healthy and functioning optimally, and our weight is the exact same. And so once we have gained weight over time, our body wants to protect us, and this is where we see those physiologic biologic changes occur to protect us from weight loss. And this occurred over thousands of years of us being humans, and previously food, calories, energy, it was hard to come by. And so the people who were able to store the extra calories, the extra energy as fat were the ones who survived and thrived, and those are our ancestors. We now live in a modern society where food for most of us is easier to come by, but our biology, our genetics have not caught up with that. And so, in an attempt again to protect us, when we are trying to diet and lose weight, our metabolism decreases, our hunger hormones go up. This is why obesity is considered a disease state, because it is a deviation from what is considered normal biology, physiology, human function, and it leads to poor health outcomes. Not 100%, not all the time, and not in everybody, but it increases your risk. And so to protect the majority of our population, because we know that 40% of Americans, at least American adults, are in the obese category. So 40% of our population is at higher risk for diabetes, heart disease, high blood pressure, stroke, blood clots, osteoarthritis, sleep apnea, certain types of cancers, and many more conditions. I think what has a lot of people confused is that there is a difference between the prevention and the treatment of a condition. The same thing with obesity. There are things that people in the health and wellness community are doing that are preventing the development of obesity, and they believe that if people who had excess weight, who had obesity did those things, then they would not have obesity. And that's not the case because we know those biologic pathologic changes have occurred. We see this with all other diseases and conditions. A great example is lung cancer. We know that smoking is a risk factor for lung cancer. Does everybody who have who smokes develop lung cancer? No. Are there people who did not smoke that developed lung cancer? Yes. And the treatment of lung cancer is not to stop smoking. While that is extremely helpful, that won't cure the cancer. We need to either have surgery, radiation, chemotherapy, immunologic therapy, or other treatments. Same is true with the disease of obesity. Healthy nutrition, exercise, sleep, stress management, all of those things are going to help once somebody has obesity. It's going to help prevent the development of obesity, but for most people, it is not going to treat and manage their obesity. We need other options. And that is where medications and surgery come in. What's wonderful in the time that we live right now, and what is going to continue to be available, are several options for treatment. And working with your doctor, especially somebody board certified in obesity medicine, is going to make sure that you have the best, most optimal, individualized treatment plan for you that really focuses on health-related outcomes. In that post that went viral, I compared obesity to blood pressure, high blood pressure. And if we give somebody who has high blood pressure a medication and we get their blood pressure under control, that's great. The blood pressure medication is working. We continue it. If we stop the blood pressure medication, then their blood pressure goes back up. Anybody who has worked in medicine or has had high blood pressure knows this to be true. It's the exact same for obesity treatments. If we decide to start a medication to manage obesity, we are going or very likely we are going to need to continue that long term. And just like everything that's individualized, and maybe somebody who did not carry excess weight for a long time, maybe they don't need long-term treatment. But for those people who have struggled with obesity for the majority of their life, it is highly, highly likely that they will need treatment indefinitely. At least from what we know now. Of course, there are things that change all the time. So I will continue to spread this message along with my colleagues in obesity medicine that obesity is a disease. That does not mean that people who have obesity are a diseased person or should be treated as less than. They are 100% worthy. We are all 100% worthy, and we are all worthy of effective and safe treatments for whatever condition we have. And that treatment should be continued long term to maintain that effectiveness. We see parallels in other chronic conditions, and obesity really should be treated the same. Please let me know if you agree, if you have questions. I also encourage a continued conversation on Instagram or TikTok. You can find me at Dr. Lindsay Ogle. All the links are below. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.