Enough: Your Health, Your Weight, and What It's Like to Be Free
52 pages • 1-hour read
Oprah Winfrey, Ania M. JastreboffEnough: Your Health, Your Weight, and What It's Like to Be Free
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Themes
Content Warning: This section of the guide includes discussion of illness.
Obesity as a Disease Versus Personal Failure
Dr. Ania Jastreboff and Oprah Winfrey explain their position that obesity is a disease and not a failure of people’s common sense or self-discipline. They both feel discouraged that so many people with obesity suffer from negative self-image when, they argue, their body weight is outside of their control. They thus examine obesity as a disease versus personal failure throughout Enough.
Jastreboff reports that many of her patients’ mental health and self-image suffer because they do not perceive obesity to be a disease but a personal failure that only they can fix. She explains, “The guilt piles on. The cycle becomes self-reinforcing: Blame leads to shame, and shame leads to self-blame, which then fuels self-shame. And because the voice is internal, it often feels inescapable. Not all, but many of my patients with obesity share with me that they have this inner voice” (26). Winfrey recalls how this exact mindset plagued her for years as she tried to lose weight and keep it off. She shares, “I was so disappointed in myself for gaining weight back. For letting it happen again…I swallowed my shame. I accepted that I’d brought this on myself. The cycle continued” (4).
Moreover, Winfrey and Jastreboff argue that the popular perception of obesity as being a result of personal choices is based more on cultural beliefs than hard facts. Jastreboff emphasizes the powerful processes behind the “Enough Point” in an effort to persuade the readers that people with obesity are not at fault for their condition. She explains, “Our brain’s weight control system thinks that too much is not enough. It’s calling the shots, and yet we feel as if it’s all our fault for not controlling our weight” (62). Her explanations position biology as a powerful system that willpower alone cannot change. She argues that obesity is “not a matter of choice or a failure of willpower but a chronic medical condition rooted in the body’s own regulatory systems” (23).
Winfrey acknowledges that her new perception of obesity has helped her mental health, relieving her from decades of shame. She explains, “Understanding this has been profoundly liberating for me—and it offers all of us such an opportunity to release the shaming and blaming” (20). In continuing to treat larger bodies as a problem to be solved, however, Enough arguably contributes to the discourse of shame and stigmatization that it purports to reject and raises questions as to how societies define what “health” looks like and why. The authors do not engage with counterviewpoints that promote a “health at every size” approach, even though some experts regard equating thinness with health as a misleading metric (See: Background). Winfrey and Jastreboff’s rhetoric thus continues to frame obesity as something that must be treated, but there is still no medical consensus on the issue and no consistent categorization of obesity as a “disease” in the medical community.
The Biology of Obesity
In her work, Jastreboff draws on her experience as a doctor and researcher to explain how and why the body stores fat and how this process can eventually foster obesity in some people. In doing so, she repeatedly draws attention to the biology of obesity and its wider implications.
Jastreboff offers two main reasons for why some people are obese. First, there is the person’s environment. According to Jastreboff, everyone in modern, developed societies live in an obesogenic, or obesity-causing, environment due to the huge changes in lifestyle and food that have occurred over the last several centuries. The author portrays the human body as a set of systems designed for survival in an environment that, for most of us, no longer exists. She writes, “Obesity is not a choice; it’s confused biology. So what happened? Why do so many of us store extra energy, extra fat? It turns out that our environment changed much more quickly than our biology evolved” (16).
Jastreboff explains that today’s environment is obesogenic in many ways, writing, “Our bodies were never meant to exist in a world of ultra-processed foods, desk jobs, no respect for rest or sleep, endless screens and pings, and stressful commutes” (47). Her presentation of modern life emphasizes how the human body, which evolved in completely different conditions, is bewildered by the confusing cues that modern life produces. Modern food is also a major culprit, as obesogens are now common in foods. They range from preservatives and colorings to sweeteners and processed foods, as well as high caloric intake in general. Despite this, Jastreboff does not advocate for any systemic changes that could address these factors, such as better government regulation of food additives.
Jastreboff argues that human biology is simply not wired for these conditions and copes by storing excess fat—and then working to “defend” it. Her explanations of metabolic adaptation and the Enough Point prove that the human brain will go to great lengths to store as much fat as it believes is normal and necessary for survival. She writes, “Taken together, this suggests that our brains have a memory of how much fat our body wants to store at any one time. Our bodies go back to whatever the brain perceives to be the appropriate or optimal fat stores” (61).
Jastreboff’s discussion of the biological foundation of obesity connects with her opinion that it is a disease and not a choice, as she points out that no one can consciously understand or manage their body’s metabolism. She argues that the body’s fat-storage system is “incredibly powerful, wired for survival, and not in our conscious control” (90). Her detailed breakdown of the biology of obesity seeks to frame it as an unavoidable issue that is only fixable with her preferred form of treatment, but she neglects to pay sufficient attention to possible solutions for the other environmental and socioeconomic factors at play.
The Medical Necessity of Treating Obesity
While Jastreboff does not blame people with obesity for their condition, she does emphasize its inherent risks and dangers. In describing how obesity compromises people’s physical and mental health, the author argues for the medical necessity of treating obesity. While some people perceive obesity medications as a form of “cheating” or a “lazy” way of losing weight, the author advances this option as a viable, and sometimes sole, solution to the problem.
While she acknowledges the risks of the medications, which have side effects ranging from hair loss and nausea to gallstones, she encourages readers to weigh these risks against the dangers of untreated obesity. She claims that, left untreated, obesity not only shortens lives but also has a damaging effect on people’s quality of life. She writes, “When considering the risks of treating obesity, remember there are also dangers in not addressing it. In addition to a shortened life expectancy for those with severe obesity, if obesity is left untreated, its consequences and impact on daily life can increase” (226). This position helps Jastreboff portray obesity medications as a viable and sometimes necessary way of reducing people’s obesity.
She points to the cognitive burden of obesity as an example of how living with this condition can compromise one’s quality of life. She explains that food noise, cognitive load, and shame have a destructive effect on many people’s states of mind. Furthermore, Jastreboff emphasizes that obesity is not merely an aesthetic issue or social taboo but a serious health problem. She reports that there are “over two hundred obesity-related diseases or obesity complications” (144). She points to numerous studies that prove that obesity is a contributing factor to these other serious conditions, writing, “[I]n addition to being a disease in and of itself, obesity leads to obesity-related diseases and complications from obesity, including type 2 diabetes, high blood pressure, high cholesterol, and certain types of cancers, including colon cancer, thyroid cancer, and breast cancer in postmenopausal women” (144).
This framing does not address the critics of the approaches that Jastreboff advocates or the possible serious side effects of the medications she has helped to develop, leaving her portrait of obesity somewhat incomplete. Not all medical experts regard obesity as something that automatically requires treatment (See: Background), and in placing a heavy emphasis on weight, Jastreboff risks creating a reductive framework for what it means to be “healthy.” Nevertheless, Jastreboff offers this list of serious illnesses to suggest that it is in the best interests of patients to treat obesity before it snowballs into other associated conditions.
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