Bariatric physician Karen Hitchcock admits that she no longer knows what to do about obesity. Excerpt from an intense essay:

Eating is not a purely rational, biological act. I can give you a diet that will keep you full all day and make you lose weight, but it won’t be very entertaining: it will be mainly made up of watery vegetables like cabbage and celery, egg whites and very lean meat. The pain of abstinence, of unmet desire, is something quite separate from the pain of an empty stomach. The pleasures of eating are complex and multifaceted. In our society, consumption is a form of entertainment and pleasure. Eating is part of this: from the theatre of a meal at a fine-dining establishment to a bag of chips augmenting the television-viewing experience. Most people do not overeat because of a feeling of hunger emanating from the stomach; they are giving in to a desire to consume – they are seeking pleasure or relief, or hoping to fill a void.

I had a friend who had been anorexic and spent her teenage years in and out of hospital, being fed through a nasogastric tube. She recovered in her 20s and managed to channel all of her intrusive obsessional thinking about food into athletics. One day she said to me that she didn’t understand why she could be hospitalised against her will for not eating enough, and yet there was no limitation on how fat you could get. It was completely unfair, she said, that you could be refused alcohol if intoxicated but roll into your local fish-and-chip shop 100 kg overweight and be served the equivalent of a week’s worth of calories for lunch.

In thousands of labs across the planet, medical researchers are trying to find the cause of, and cure for, obesity. They examine genes, chemical exposures and metabolic pathways. They experiment with amphetamines, anticonvulsants, probiotics. Some of this research is funded by the companies that make and sell the food that makes us fat. In thousands of other labs across the planet, food scientists and marketers are working on ways to make you eat more. They employ highly sophisticated psychological and physiological research to this end; they examine the effects of colour, unit size, price, texture, packaging and advertising on human desire. Look around you: who is winning?

In some ways, scientific research has taken obesity outside the realm where it is a consequence of choices made by a more or less free-willed individual in a more or less free society, which nonetheless disapproves of excess. In current medical research obesity is often conceptualised as an unavoidable disease. It’s your genes, your metabolism, the chemicals in your environment, what your mother ate when she was pregnant, whether she fed you at her breast. It is everything but what you choose to put in your mouth.

More:

For whatever reason, the majority of the population can no longer sayI have had enough. For whatever reason, the majority of human beings respond to advertisements inviting them to enter a pleasure state by eating a day’s worth of calories in one sitting, again and again. In the face of this, we are stuffed. We could say, “You are free agents, totally free, so pay for your own consequences.” We could make people pay at the point of choice, via a food tax, or we could limit choice. The other option, always unspoken, is: let us have our cake. Let’s just eat and eat, get fatter and fatter, and work out how best to live with it. This is where we are heading now: fatness, outside of morality, as an accepted consequence of the world as we have made it.