What if we made the world unpleasant for obese people?

The number of people with obesity in the Netherlands is rising. The government and many health organisations view this as a major problem: it affects people’s quality of life and costs society a great deal of money. It’s high time we did something about it, because with weight-loss medications like Ozempic, we can all choose to be a healthy weight, can’t we? Arie Dijkstra, Professor of Applied Psychology at the University of Groningen, disagrees: obesity is not a choice.

Banning Obese People

‘Imagine this: we make the world uncomfortable and inaccessible for obese people. We refuse to adjust planes or hospitals to accommodate them and ban them from schoolyards and public spaces, so children do not grow up thinking obesity is normal. We make life so difficult for obese people that they have to lose weight, just as we did with smoking. Obesity costs society billions, just like smoking. So why not use the same approach to motivate people to lose weight? The answer is simple: it only works if you take it to extremes. But do you want that? Because it is, above all, cruel.’

Obesity Is Not a Choice

‘Every extra pound comes through the mouth’, right? In principle, that is true, but obesity is far more complex. Genetics account for 40 to 75% of obesity. It is not just about genes that affect your metabolism, but also genes that regulate hunger, satiety, impulse control, and even your preference for fat or sugar. Of course, lifestyle plays a huge role, but there are also genes that determine how easily you move and how enjoyable that is for you. And we have not even touched on environmental factors: cheap, unhealthy food and a lack of knowledge about healthy eating.’

Do You Know What Is Healthy?

‘In the Netherlands, we spend only 15% of our income on food, whereas in some parts of Africa, that figure is 65%. We have the luxury of overeating, and the industry makes it easy for us: fast food is cheap, widely available, and often the most appealing option. But why do we expect people to make the right choices? Because they know what is healthy? No. Many people have never learned how to take care of their bodies. They eat what is put in front of them, what tastes good, what is cheap. And if you do not know what a Nutri-Score D or G means, how can you make an informed choice?’

Stigma Does Not Help

‘People with obesity are not lazy or weak. Stigma only makes things worse, and shame does not lead to behavioural change. It leads to isolation, stress, and sometimes even more eating. Obesity is a complex interplay of biology, psychology, and societal influence. Only by acknowledging this can we truly bring about change.’

Ozempic Alone Is Not the Solution

‘Ozempic and GLP-1 agonists can genuinely help some people, especially those with severe obesity and medical risks. But it is not a quick fix, and injections alone are not enough. If you stop taking the medication, the weight often returns because the underlying hunger and metabolism have not been addressed structurally. Weight-loss medication must be combined with professional support in nutrition, behavioural change, and long-term strategies, but at the moment, this is not yet sufficiently professionalised.’

Tackle the Environment

Prevention is better than cure. With smoking, we did tackle the environment. Not just by excluding smokers, but also through age restrictions, advertising bans, and limiting where tobacco can be sold. We do not do this with food. A 1,500-calorie burger? You can still advertise it freely. We can change that, just as we can introduce a sugar tax and make healthy options more accessible. In addition: education. Teach people more about healthy nutrition so they can pass that knowledge on to their children. Otherwise, those children are already at a disadvantage.

More information

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• Arie Dijkstra