Nurturing Nature

Nature, Nurture, and Willpower in Obesity

The eternal debate grinds on. What determines our destiny more? Nature or nurture? And where does that leave the important matter of free will? When the subject is obesity, this debate is especially contentious. The most common – but incorrect – understanding of obesity holds that it is a failure of willpower. Nature and nurture take a back seat. Shame and blame sit up front.

Thus, for three decades, that kind of flawed thinking took us nowhere. Obesity prevalence grew to staggering levels. Bias and stigma flourished and made the problem worse.

Coping Skills for a Toxic Environment

But in recent years, understanding has grown for the physiologic basis of obesity. With that understanding, the options for effective treatment have grown as well. Speaking at the Obesity Medicine Association summit last week, David Sarwer explained the importance of keeping a balance in our approach.

Despite the importance of the physiology in obesity, neglecting the psychological aspects of this disease would be a mistake, he said. As a matter of fact, the psychosocial burden is huge. Though physiology is important, for some patients, psychological issues can interfere with a successful outcome for even the most potent treatments.

This is precisely why a psychosocial evaluation is critical for developing an effective treatment plan, said Sarwer. He explained that patients are living in an environment that promotes obesity and undermines treatment. So we must equip them with coping skills.

Fascination with Our Genetic Blueprint

Meanwhile, the popular fascination with our genetic identity continues to grow. Behavioral geneticist Robert Plomin has a hot new book coming in November – Blueprint: How DNA Makes Us Who We Are. Reviews tell us that it will sell briskly and add to the common understanding that genes play a vital role in behavior as well as physical traits.

But it is also stirring controversy. Writing in Nature, Nathaniel Comfort dismisses the book as a work of genetic determinism. This age old debate will never end – because it presents a false choice. Nature and nurture are interdependent. Willpower plays a role, too.

Picking only one of the above will always bring problems and controversies. It leads us to overestimate the importance of one – only to get blindsided when we neglect the others.

Click here for Sarwer’s slides and here for more on Plomin’s forthcoming book.

Nurturing Nature, photograph © Ritesh Man Tamrakar / flickr

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3 Responses to “Nature, Nurture, and Willpower in Obesity”

  1. October 06, 2018 at 9:10 am, Allen Browne said:

    Yup. Nature and nurture are interdependent. The relationship is bidirectional. Thanks, Ted.

  2. October 07, 2018 at 10:23 am, Cathy Arsenault said:

    Will gut hormones be addressed? As someone who has lived with this disease my entire life , reading about willpower or lack of – to me is shameful. The year is 2018. Yes nature vs nurture. Yes, there are so many choices but let’s focus on how we help people make better choices. Willpower promotes stigma.

    • October 07, 2018 at 11:45 am, Ted said:

      You’re right, Cathy. Just like any disease, obesity starts with physiology. It interacts with behavior. And everyone has to choose what they’re going to do about it. All that stigma makes it harder.