Enough, Oprah! We Can Control Our Choices
Reframing obesity as a “disease” has dangerous consequences for health and longevity
Oprah Winfrey is on a media tour to promote her new book, Enough: Your Health, Your Weight, and What It’s Like to Be Free, which attempts to redefine obesity through two narratives: first, Oprah’s own long-running emotional struggles around being overweight; and second, current research suggesting obesity is a biological disease. She endeavors to reframe obesity as a condition people passively “have,” powerless victims of our modern environment.
Emboldened by her co-author, endocrinologist and head of the Yale Obesity Research Center (Y-Weight), Dr. Ania Jastreboff, who has been instrumental in the current wave of weight-loss pharmaceutical promises, Oprah is advocating that society and insurance companies recognize obesity as an “illness,” opening the floodgates of insurance-supported pharmaceuticals and treatments.
Here’s the problem: health is incalculably complex and inextricably nuanced. Even more so in an increasingly toxin-filled world that impacts foundational cellular function beyond comprehension. But we humans want simplistic, easy solutions—now. Like microwave popcorn. Or popping a pill. Or taking a shot. Our discipline muscles are deconditioned by industries and voices more than happy to spoon-feed quick fixes to a hungry public.
Enter a new, megaphoned permission slip to excuse what’s left of personal responsibility.
A brief backstory
When I heard Oprah’s perhaps well-intentioned yet perilous message that releases and absolves people of accountability, I had an immediate visceral reaction.
Memories of caring for my mom, who was morbidly obese, flooded my mind. I can’t begin to tell you how physically hard and compromised her life was in her last 30 years. How her hopes and dreams evaporated because of the limitations imposed by the very real burden of weight. My heart broke for her.
Then it broke for my family. We cared for her in our home for the last thirteen years of her life. It was an extreme challenge to move and care for a very heavy individual who used first a walker, then a wheelchair. Absolutely every activity presented obstacles and became a chore. Nearly every day, I dreaded something. The prospect of getting her out of the house for appointments was daunting. The fear of her sliding onto the floor trying to get her into her wheelchair…which happened a handful of times…was constant. And when it did happen, I was faced with the seemingly impossible job of lifting her without calling the paramedics.
Those were but a few examples of daily worries and physical hardships. I’m going to completely skip over the middle years of three surgeries, five hospital and transitional care facility stays, and the ensuing jigsaw puzzle of home care.
The last two years of my mom’s life were spent in bed. She had spinal compression fractures from sitting in her wheelchair, and it became too much of a struggle to move, so she stopped. This presented a whole new set of challenges in caring for her, which were compounded by her size. My mom deserves the dignity of discretion; suffice to say, I wouldn’t wish her slow downward spiral on anyone or their family.
Although she passed shortly after noon, I believe her soul was freed during the wee morning hours. She came to me in a vivid dream that I will always cherish. I saw her around the doorway of our kitchen, effortlessly gliding above the floor, enveloped in a glowing light. Her face was joyous. She was beaming. She had shed the earthly shackles of her broken body and felt pure bliss on her way to heaven.
Similar paths
On the surface, the struggles my mom and Oprah faced were not dissimilar. My mom was born chubby and was a very plump child. She endured a very tumultuous early life with a distant, abusive father, and suffered the death of her mother when she was only 16. As a grown woman, she was on a perpetual weight rollercoaster. I would venture to guess she was one of those people who would now be considered genetically predisposed to obesity.
So wouldn’t she have welcomed a shot to make the pounds melt away? Indeed, she did. She went through countless weight-loss clinics and doctors in the 1960s and 1970s. The promises of today mirror the assurances of yesteryear, and I see history repeating itself: great successes accompanied by unintended consequences, followed by boomerang failure.
My mom’s numerous weight loss victories were short-lived because her core lifestyle habits and emotional issues remained unchanged. While she was never going to be model-thin (she was what we termed “big-boned”), she didn’t always reach the obese threshold and had many stretches of good health.
But then, in her early seventies, the medical establishment gave her license to be overweight: she received a handicapped placard so she could walk as little distance as possible. I remember being incensed. Sadly, in her mind, being “handicapped” meant she didn’t have to work anymore on her health, let alone her weight. She was absolved of having any active role in her wellness.
Imagine if her doctor had given her a health coach instead of a handicap pass.
Bolstered by doctors who enabled her with band-aid medications, tempted by grocery stores brimming with engineered frankenfood and an incresingly toxic envionment, her weight ballooned and a vicious cycle began. These are the “golden years” in the life of an obese person that no one talks about, when a frail, elderly body starts to buckle under the burden of weight and obesity-related diseases take hold. These poor souls are often relegated to nursing facilities simply because their care is too onerous otherwise. While they may live longer, they essentially stop living.
Don’t outsource your control
Here is the truth about my mom’s obesity: genetics may have loaded the gun, but lifestyle pulled the trigger. Once she moved in with us and was placed on a whole foods diet in a low-toxin environment, even at the sedentary age of 86, she lost 80 pounds and was able to wean herself off all high blood pressure and high cholesterol medications. No shots. No pills.
Is there a genetic element that causes people to overeat, process nutrients differently, or store fat? Quite possibly, yes. And as Oprah outlined, our modern world exacerbates these genetic inclinations.
But we have the power, through our choices, to control our environment and influence our genes and metabolic health. For instance, epigenetics, which are behavioral, environmental, and lifestyle choices, can cause changes that affect how your genes work; and obesogens, which are environmental chemicals, can interfere with normal metabolism and hormone function, promoting fat storage, increasing fat cell numbers, altering appetite, and potentially leading to obesity and metabolic issues.
Unfortunately, the pragmatic side of health is often overridden by the emotional pain. Obesity has a mental component that is an ever-present albatross, which cannot easily be shaken or ignored. It takes a toll. It is an inner, painful battle many people lose. I understand it. I lived it. Over and over.
Alternatively, I know that it was entirely possible to manage my mom’s lifelong affliction through lifestyle. I proved it as her caregiver. Granted, she was under my domain and not making these choices for herself, but nevertheless, the results were incontrovertible.
My mom didn’t “have” obesity; she made choices in the products she bought, the food she ate, and the lifestyle she created that made her obese. Period.
Two words about GLP-1s
Be careful. I haven’t ventured into the topic because it is very complicated, and I don’t want to be irresponsibly simplistic. Can these GLP-1 agonists be a useful tool for morbidly obese people to lose weight? Yes, for those with a significant amount of weight to lose, such as over 50 or 70 pounds. BUT, as time and research are confirming, they should only be used as part of an overall strategy to change lifestyle habits under the guidance of a seasoned practitioner.
In Oprah’s case, the irony is that her thesis is predicated on genetics being responsible for obesity, yet the drugs she touts don’t change anything about genetic expression. They have no epigenetic qualities whatsoever. In the simplest terms, they slow gastric emptying so people feel fuller longer, leading to less eating, which has cascading health effects—some positive, some negative. It’s not rocket science. It’s the same outcome weight loss drugs have promised for a century. But this time with much more powerful control, which is what she appears to be championing.
Unfortunately, an avalanche of unintended consequences is emerging from these drugs’ use, ranging from extreme muscle loss to liver and gut dysregulation to possible thyroid cancer concerns, as well as a long list of other side effects, including nausea, vomiting, diarrhea, constipation, bloating, headaches, fatigue, and hair thinning.
To top it off, University of Oxford researchers analyzed 37 studies published up to February 2025, involving more than 9,000 participants who had undergone an average of 39 weeks of weight-loss treatment. They found that once people discontinued the drugs, the weight came back on nearly four times faster than if they had simply quit a diet or exercise regimen.
We have no idea of the pharmaceutical Pandora’s box that has been opened.
Complex life issues
The road to hell is paved with good intentions. I have no doubt Oprah means well and wants to help people by sharing her emotional torment and encouraging others to shake off the shame and blame of obesity. (Although I’ll go out on a limb and speculate that her decades in a glaring and prying spotlight intensified her deep-seated personal issues to a much greater degree than the average person.) And clearly, the good doctor is extremely knowledgeable in the physical mechanics of losing weight and is equally sincere in her desire to help people.
But everyone has blind spots. Everyone has boxes they don’t or can’t think outside of.
Human nature wants the easy button, and I fear this book will be like a game of telephone—each person will glean something different and hear what suits them best, for better or for worse.
It will be my mom’s handicapped placard, her permit to be heavy and unhealthy.
I know people have demons to slay. I empathize with how treacherous the tightrope of victory and failure can be. But drugs and insurance companies are not the answer. That I know for certain.
A century of pharmaceutical crutches turned permanent ways of life has ultimately made people even more unhealthy mentally, physically, and spiritually than ever in human history.
I don’t fault Oprah’s purported message of compassion, education, and systemic change. Based on a lifetime with my mom (and 30 years of my own health journey), I share her certitude that obesity robs people of a fruitful, enjoyable life. She believes society needs to change the way it views and treats obesity. I agree, but we differ on both the view and the change.
I’ve had enough of first, the celebration, and now, the victimhood of obesity. We are not solely products of our genes and we have the power to mitigate our tendancies. Our goal should be to give people natural, holistic tools to create strong, resilient minds that fortify strong, resilient bodies, underpinned by a lifestyle that provides the foundation for true, enduring health and wellness.
We must stop looking outside ourselves for the answers. We have all the tools we need within ourselves to live well, age great.
Struggling to lose weight?
I understand weight struggles. I’ve had my share of fluctuations. A powerful tool I've discovered in the last couple of years is: you crave what you eat. That may seem too simple, but it's true. If you slowly eliminate your problem foods, over time, you will crave them less and then not at all. It takes a while, but you can rewire your brain to enjoy and crave clean food.
The biggest tool: before undertaking any diet, spend some time to shore up your foundation:
• Clear as many toxins as you possibly can from your kitchen, cleaning products, personal care products, clothing, etc.
• Eat whole and minimally processed foods. (If you don’t recognize a word in the ingredients, don’t eat it.)
• Give your body a 12-hour break from food every day. (For example, 7:00 to 7:00)
• Drink plenty of filtered water.
• Get morning sunlight.
• Prioritize your sleep. (7-9 hours)
• Move daily.
Once you’ve got these habits in place, you’ve got the underpinning for diet success.