THE REAL CAUSES OF OBESITY
One of Australia's Most Popular Podcasts with Hundreds of 5 Star Reviews
Grab your FREE Ebook copy now!
Have you struggled to lose weight and keep it off?
Start your journey to boost metabolism and transform your body into a fat-burning powerhouse.
Episode 262:
Show Notes
In this week’s episode of The Real Health and Weight Loss Podcast, Dr Mary and Dr Lucy dive into the very real experience of feeling overwhelmed by daily life—and how that can impact our health. This episode also marks Part One of a special three-part series on a powerful and often misunderstood topic: obesity.
Far from being simply a matter of willpower or personal choice, obesity is a complex, multifactorial condition, shaped by genetics, environment, socioeconomic factors, stress, sleep, and more. Addressing it takes compassion, nuance, and a clear rejection of stigma and oversimplified solutions. It’s been a while since we explored this topic—so we’re thrilled to unpack it with fresh insight and heart.
Key Points:
- Life Overwhelm and Mental Load:
Dr. Mary Barson opens up about feeling overwhelmed by daily tasks, particularly laundry, highlighting how busy and complex modern life can be, especially for solo parents juggling multiple responsibilities. This sets the stage for a discussion on how such overwhelm is common and not a personal failing. - Obesity Is Not Simple:
The hosts challenge the widespread myth that obesity is caused solely by poor personal choices or overeating. Instead, they emphasise that obesity is a complex condition influenced by a multifaceted interplay of genetics, environment, behavior, and social factors—many of which are not fully within individual control. - Role of Genetics:
Genetics play a significant role, but for most people, it’s not due to a single gene but rather the combined effect of many gene variants. Rare single-gene causes exist (e.g., LEP gene mutations, Prader-Willi syndrome), but these are exceptions. Most people have a genetic predisposition that interacts with other factors. - Impact of Dieting and Metabolism:
Lifelong restrictive dieting, especially among women, can lower basal metabolic rate, making it harder to maintain a healthy weight later in life. This adaptation can lead to a cycle where people feel they must eat extremely little to avoid weight gain, contributing to a poor quality of life. - Environmental and Socioeconomic Factors:
The environment, including the prevalence of ultra-processed foods and limited access to fresh, nutritious food—especially in lower socioeconomic or remote areas—significantly influences body weight. Food insecurity and the cost of healthy food are major barriers for many people. - Sleep and Stress:
Poor sleep and chronic stress are both causes and consequences of obesity. Sleep disorders like sleep apnea are more common in people with obesity, but poor sleep can also contribute to weight gain. Stress can disrupt sleep and eating patterns, creating a vicious cycle. - Satiety and Hunger Are Complex:
Hunger and fullness are regulated by a complex interplay of hormones (GLP, GIP, leptin, ghrelin, peptide YY, cholecystokinin, etc.), not just the volume of food consumed. The idea that simply eating more low-calorie, high-volume foods will solve the problem is an oversimplification. - Stigma and Mental Health:
Weight stigma and negative self-image can worsen health outcomes and paradoxically contribute to further weight gain. The hosts stress the importance of compassion and understanding, rather than blame. - No Simple Solutions:
Anyone offering a “simple solution” to obesity is ignoring its complexity. Effective management requires a holistic, multifactorial approach, and consistency is more important than perfection. The hosts plan to cover practical strategies in upcoming episodes
Episode 262:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Mary Barson (0:21) Hello, my lovely friend. Dr Mary here. Welcome to today's episode. And I'm joined by my fabulous colleague, my lovely Dr Lucy. How are you, gorgeous one?
Dr Lucy Burns (00:32): I am well, Dr Miss. How are you?
Dr Mary Barson (00:35) Look, I'm good. I feel like anyone—life is busy, and it piles up on top of me a little bit. Sometimes it can feel like a bit of a house of cards. At the moment, the thing that is taking up far too much space in my brain—too much rental space—is my washing. It's wintry. I've got a property that doesn't... it's off the grid. I can't dry things. And for some reason, I'm choosing to feel overwhelmed about this aspect of my life right now. I can recognise that it's just a thought. It's not necessarily real, but I'm also... that's what I'm currently grappling with at the moment. Laundry.
Dr Lucy Burns (01:13) Well, I think there's two things with that. One is that you do have a busy life. You've your a mum, two small kids, solo parenting, off the grid, juggling all of the things, plus working full-time, plus running a business—you know, plus, plus, plus, plus.
Dr Mary Barson (01:30) Plus, plus, plus.
Dr Lucy Burns (01:31) I think lots of people will gaslight themselves, thinking they're being pathetic because they're overwhelmed, when really we often know that, you know, time sadly is not flexible.
Dr Mary Barson (01:43) I know. It's depressingly finite at times, isn't it? Yeah, absolutely.
Dr Lucy Burns (01:47) And that sometimes there are just too many things to fit in this finite space. And so, you know, again, every now and then we have to do a little cull and see what's important. And is it important to, you know—well, it's probably important to have clean undies—but, you know.
Dr Mary Barson (02:04 ) For sure. I feel this way.
Dr Lucy Burns (01:09) Yeah, absolutely. I love that. So, coming up, we're doing a little series. We thought we'd do a three-part series because it's been a while since we've visited this topic. One of our core sort of topics that we talk a lot about, and our core level of expertise, is really looking at obesity. And I know obesity can be a triggering word. So, you know, it's the medical word. But if we think about it as just maybe storing excess body fat, we thought we'd talk actually about the causes of that—because there are a bazillion people out there who would have you believe that the cause is simple, and therefore the solution is simple.
Dr Mary Barson (02:50) They've got the simple solution.
Dr Lucy Burns (02:52) Yeah, let's talk a little bit more about this.
Dr Mary Barson (02:56) So I'm going to use the word obesity because I think that it's helpful in this context, even though I wouldn't tell someone, you are obese, but just obesity as in the concept of people who are carrying extra weight—extra weight that is affecting their health and their lives. So that's sort of what I mean by obesity. And often, people will want to tell you that it's simple, and you just, you know, it's due to personal choices or overeating. But this really isn't the case. Obesity is shaped by a complex interplay of our genes, our environment, our behaviour, and social factors. And some of these are modifiable—like you can change aspects of your environment, aspects of your behaviour. You can't change your genetics—some things can't change. But it's not just about genes. It's not just about overeating. It's about all of the things, and it's really important to have an understanding of the complexity.
Dr Lucy Burns (04:02) Yes, and I think one of the things we talk a lot about is the fact that it is not just simply, you know, eat less and move more, or that people who have a bigger body are, you know, lazy and gluttonous, or that they're just out there chowing down 10 donuts a day and that's, you know, why their body looks the way it does. Although there are plenty of people who would have you believe that that's why. And for many of us, we will sometimes internalise that as well and think that, yeah, this is my fault.
Dr Mary Barson (04:37) Yes, and the stigma and the negative self-image that we can develop about ourselves if we're in a bigger body—apart from the fact that it is really, really detrimental to our wellbeing and our quality of life—it actually can paradoxically contribute to those causes that can cause obesity. You know, we know that that is a really big problem. There are over 8 million people worldwide who live with obesity, that most of us are also very unhappy about and want help with. And it seems just ludicrous to assume that there is a simple cause and a simple solution to something that is so widespread. Like, it just can't be. It makes absolutely no sense. So I mentioned before genetics. Genetics do play a role, but for most people—nearly everybody—it’s going to be lots of different genes and, you know, it's going to be a combined effect of many different gene variants. And some of these we know, and I think some of them we don't know. But each of these genes only plays a small role. So it's not like we're able to pin down this one or two genes. There actually are very rare causes of single gene mutations that do cause obesity, but that's typically very early onset, severe—like, you know, children, toddlers—severe causes, like changes in the LEP gene, for example. But that's really rare. It's been helpful for science to understand this, but that's not the case for most people. And then there are also certain syndromes as well, like Prader-Willi syndrome, which is a developmental or congenital syndrome that is strongly associated with obesity, but that's rarer too. For most of us, it's just lots and lots of little genes that generally make us a little bit more predisposed in varying ways. And that's our genetics. We can't do anything about our genetics. Our genetics are our genetics.
Dr Lucy Burns (06:33) Oh, absolutely. And I think one of the things that is tricky is that, particularly for women, you know, who have done lifelong histories of dieting. You know, if you were born—even if you're born now—there's still pressure to be thin. So, you know, thin is in, blah, blah, blah. So we've spent a whole lot of time trying to fit this mould of being thin, and at times that's meant we've severely calorie-restricted—not just for a day here and there, but for months, years, and decades. And that's resulted, then, in people having what we call a low basal metabolic rate. And so they find themselves in their 50s and literally are unable to eat more—unable to eat like a normal, you know, calorie diet, for example. And as you know, we don't talk a lot about calories, but there is a baseline. Calories are just your units of energy. So there is a baseline amount of energy that we need to run our body. But our bodies are so clever—they've adapted over these decades to run on less. So then, when people, you know, want to eat a bit more, they find their body just, again, starts becoming a fat-storing machine, and they feel like they can't actually do anything unless they maintain this extremely low-calorie diet. And that leads to a fairly miserable life.
Dr Mary Barson (08:59) Mm, mm, and can lead to all kinds of problems. Like, basal metabolic slowdown in itself can cause really unpleasant symptoms to live with—feeling slow, feeling depressed—but it also can affect our bone density, our muscle density, and quite literally our, like, length of life, our lifespan, as well as our healthspan. So yes, the thin sanity that we have all lived with for a long time has been really detrimental to our health and also not solving the problem. And it's created a whole lot of other issues. So the other contributing factors—we've talked about genetics, we've talked about dieting and the way that that can affect your metabolism. Other aspects that can affect our weight and the way that our bodies store weight are sleep, disruption to our circadian rhythms. Certainly, there's a big one—and it's a complex one—but our socioeconomic status. Like, there is a strong link between, you know, poverty, especially poverty and deprivation in childhood, and obesity, and in general trends that lower socioeconomic areas and lower socioeconomic countries… Also, I mentioned before a bit about childhood trauma and how wellbeing plays a significant role.
Dr Lucy Burns (09:21) Yeah, absolutely. And look, just going back to the socioeconomic status thing—or the level, I guess, in which you have access to money, to put it bluntly—it used to be, back in the olden days, that people without access to money didn't have access to food, and they were thin and, you know, bedraggled, so to speak. And that people who were plump—like, think about Victorian times, Henry VIII—they were the wealthy people because they had access to plenty of food. So it was really that people without money were malnourished, and it was visible. Now we've got the ultra-processed food industry that has come in and made fairly cheap food—or food-like products—that is not always providing nutrition. Although, you know, there are standards, so they do have to provide often a baseline level of vitamins and whatnot. But they provide poor quality food that is accessible for people without buckets of money. And, you know, that is often what is then driving, you know, their obesity—the overconsumption of... and when I say overconsumption, I'm not saying that that's their choice. That's often all they've got.
Dr. Mary Barson (10:42): So food aid often has a fairly high portion of, you know, processed foods that have got a long shelf life. It is definitely a significant factor.
Dr. Lucy Burns (10:51): Yeah, absolutely. And I think food security is something that people don't talk a lot about. But, you know, if you live in a remote—particularly, say, a remote town in Australia, in the middle of the Northern Territory, for example—you know, there's not access to the same fresh food that people who live in the city have. And if food does come into those towns that requires refrigeration, it's expensive—it's expensive to transport—and so then to purchase them is often out of the budget of many people. So, you know, whilst they technically might have access to grass-fed steak or fresh broccoli, they don't, because it's out of their financial reach. And I think it's really important, when we use the word "lifestyle choices," to recognise that actually not everybody has the same choice. No, by any stretch—it definitely isn't.
Dr. Mary Barson (11:50): Stress, along with sleep, is another really important factor that I think is often overlooked.
Dr Lucy Burns (12:00) Yes, absolutely. We have a worldwide sleep problem, and again, it can be a little bidirectional. We know that people who have obesity often have poorer sleep. You know, they develop sleep apnea. We also know that people who don't sleep well often develop obesity. So there's both ways, and we certainly need to treat any sleep disorders as part of a holistic, you know, obesity management plan. And that's not to say that all people who have sleep apnea also have obesity. We know that sleep apnea is a condition that can affect people who have, you know, a standard body size as well, just based on their anatomy and whatnot. And sleep apnea is not the only sleep issue, because we also know—again, this is the complexity of it all—that stress, people who are stressed or chronically stressed or haven’t been able to process their stress, necessarily sleep poorly. You know, they wake up at 3 a.m., suddenly their brains are awake, worrying. That then also contributes to their poor sleep. Then they're tired, they're reactive, they're not as resilient the next day, and so, you know, there's a little cycle that can go on there. Yes, indeed.
Dr. Mary Barson (13:11): It is a complex problem. This idea that I've got a simple solution—it's probably too good to be true. I think another important factor is hunger and satiety. I mean, what makes us feel full and what makes us feel hungry is quite a complex interplay between hormones, as well as the volume in our stomach, as well as our genetics. Lots of things contribute to that. And I've heard some people say that obesity could be considered a disease of hunger. But even that is really complex. And that's important to understand. You can't just fill up on cabbage and hope that that will control your hunger.
Dr Lucy Burns (13:55) No, and I think, again, it's, you know, one of my big pet peeves is, you know, there's plenty of very engaging people on Instagram and TikTok who spend their time talking to people about volume of food, and they'll show them a giant plate and go, you can have this much food for the same calories as something that is smaller. What I think is really important is that we look at nutrient density and work out that actually protein and fat as a combination—protein sort of first, with some fat—that is a nutrient-dense way to eat that keeps you full. So it enhances or works with your satiety. And satiety is really hormonal. Yes, there are stretch receptors in our stomach, but if it was really volume that kept us full, then all of us would just—you know, you could just drink water all day. Look, that was a very old dieting trick—that, you know, oh, well, if you drink water with your meal, you won't eat so much food. Now, I'm not saying there's anything wrong with drinking water, and I think water and hydration are super important—and they absolutely are. And quite often we can confuse hunger and thirst. But it is not as simple as just telling people the volume of their food will help them lose weight and providing solutions that are volume in size—volumatic, whatever the word might be—large volume, because satiety is not based purely on volume. In fact, I would say that's a very small factor, and that satiety is based on hormones—in particular, our GLP hormone, our incretins, so GLP and GIP, and leptin. And I'm sure there's extras in there. There probably is. There's peptide YY, in fact.
Dr. Mary Barson (15:52): Ghrelin and cholecystokinin.
Dr. Lucy Burns (15:55): And there's a whole heap that we probably don't even know about yet.
Dr. Mary Barson (15:59): That's right. Yes.
Dr. Lucy Burns (16:00): Yes, so to simply say that the reason that you're hungry is because you haven't eaten my recipe that will allow you to eat three litres of jelly for, you know, two calories is rubbish.
Dr. Mary Barson (16:16): It is. Trying to sell a simple solution to a complex, complex condition.
Dr. Lucy Burns (16:22): Yes, absolutely. So in summary, my lovelies, the causes of obesity are wide and varied. They include genetic—and it's not just one gene. It's multiple genes. And the genes are, you know, not just the gene per se, but there's epigenetics, which means genes are turned off and turned on. And there are many reasons why that occurs, and we don't even know them all yet. So there's genetic. We know that there is environmental, and there's no doubt that ultra-processed food is a large contributor. But there are many, many reasons why people eat ultra-processed food, and we are going to be talking about those in next week's episode. There are environmental factors where we are now. It is actually now harder—it's quite hard to move your body without, you know, the whole concept of incidental exercise, where you moved more just without even trying. We do less of that. So there is no doubt that sedentary lifestyle contributes to obesity. It's not the only cause, as we know. And it's not the only solution. There are plenty of people out there who exercise like mofos and still their body stores fat. So it is not enough to say, well, the reason they're fat is because they're lazy and just lie around on the couch all day. That is not true. We also know—and we haven't even spoken about this—but we know that gut health is going to play a role, and there is gut bacteria and gut microbiomes that we don't even... we haven't even touched the surface of yet, but they do have a role. We've talked about the role of sleep and the bidirectional approach that sleep takes. We've talked about stress. And again, I would say there's also some bidirectional role there. We know that people who are stressed are more likely to eat. We know that when people eat more, they may well then, you know, develop internal stress around the stigma of living in a bigger body, and so that then sets up that pathway. So anyone who's offering you a simple solution to this complex problem is really just at surface level—and that's okay. What we do know, though, is there are many, many things that you can do. We're going to be talking about those over the next couple of weeks as well. Like everything, there's not one thing that you'll need to do. It's going to be a whole host of things, none of which you need to do perfectly.
Dr. Mary Barson (18:47): I love that. Yep. Consistency trumps perfection every time.
Dr. Lucy Burns (18:53): Absolutely. All right, lovelies, that's us for this week. We will talk with you all next week. As we finish, we're doing a three-part series on this, so tune in for next week's episode. Have a fabulous, fabulous week.
Dr. Mary Barson (19:05): Bye now.
Dr Lucy Burns (19:09) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
