Early in my career, I believed what most people believe about weight: that it comes down to willpower. Eat less, move more, want it badly enough. I don't think I ever said that out loud to a patient, but I know I believed some version of it.
Twenty-five years and thousands of operations later, I don't believe it anymore. Not even a little.
The patients who broke that belief
I've operated on patients who had more discipline than anyone I've ever met — people who tracked every calorie, who white-knuckled their way through diets for years, who had more willpower in a single week than I've had in most of my life. And their weight didn't move, or it moved and came back, or it came back worse.
I've also seen patients who, by their own account, had never successfully stuck to a diet in their life, do remarkably well once we addressed what was actually driving their metabolic disease. Not because they suddenly found willpower. Because willpower was never the actual variable.
If discipline were the answer, the most disciplined people I've treated would have solved this on their own. They didn't, because there was nothing to solve at that level. Their biology was working against them in ways that no amount of wanting it could override.
What's actually driving the outcome
Obesity and metabolic disease are physiological conditions — hormonal, metabolic, sometimes genetic. The body regulates weight through systems that operate well below the level of conscious choice: hunger signaling, energy expenditure, how efficiently the body stores versus burns fuel. Willpower operates in the space of conscious choice. It was never going to be strong enough to consistently override systems that don't ask for permission.
This is, honestly, one of the most useful things surgery taught me — not because surgery is the answer for everyone, but because it made the mechanism undeniable. When I change the physiology, the behavior that felt impossible before often becomes almost automatic. That's not a willpower story. That's a biology story.
GLP-1 medications have made this even more visible, on an even larger scale. Patients describe the same thing again and again: the food noise just stopped. Not "I found the discipline to ignore it." It stopped being there to ignore. That's not a character change. That's a physiological one.
Why this reframe matters for how you think about your own weight
If you've spent years blaming yourself for not having enough willpower, I want to be direct about this: that's very likely not what happened. You were probably fighting a physiological system with a psychological tool, and losing that fight was never a referendum on your character.
This isn't a reason to abandon effort or structure — habits, nutrition, movement all still matter enormously, and the patients who do best long-term are the ones who build strong ones. But building those habits on top of physiology that's working with you, rather than against you, is a completely different experience than trying to white-knuckle your way through physiology that's working against you.
What I'd want you to take from this
The failure, when it happened, usually wasn't a willpower failure. It was a mismatch between the tool and the problem. Twenty-five years of watching that mismatch play out, again and again, is what convinced me that the conversation needs to start with biology, not blame.
Want to understand what's actually driving your metabolic health, beyond willpower? [Reach out / subscribe / etc. — placeholder for your CTA.]