by 
Control the Hunger, Not the Calories
In the mid-2010s, there was an overwhelming sense of optimism in the medical and public health communities—a belief that we were on the brink of solving the global obesity crisis. The answer, it seemed, wasn’t a pharmaceutical breakthrough or a revolutionary diet plan, but rather bariatric surgery. Popularized through shows like My 600-lb Life, which chronicled extreme weight loss journeys, these procedures seemed like a miracle. Patients lost hundreds of pounds, reversed diabetes, improved mobility, and often gained back years of life. For a while, it looked like obesity had met its match.
But reality told a different story.
The Hope That Faded
Initially, the results were dramatic. Patients who had struggled with obesity for decades were shedding weight rapidly. Yet as the years passed, a sobering truth emerged: many regained the weight they had lost, sometimes even surpassing their original weight.
The medical data reinforced this trend. Despite rising obesity rates, the number of bariatric surgeries dropped. Sleeve gastrectomy procedures peaked in 2014, but by 2020—before the COVID pandemic—they had fallen by nearly 50%. Roux-en-Y gastric bypass surgeries, once the gold standard, peaked in 2010 and declined by more than 60% in the same period. In surveys, almost half of patients expressed regret over their decision to undergo surgery.
Clearly, something wasn’t working. But what went wrong?
The Misunderstood Problem: It Was Never Just About Calories
Bariatric surgery effectively restricts how much food the stomach can hold. It’s a mechanical solution—shrink the stomach, reduce food intake, lose weight. This makes logical sense if you believe the problem is simply consuming too many calories.
But this view overlooks the deeper driver of eating: hunger.
In many patients, surgery didn’t meaningfully reduce their hunger signals. It may have restricted how much they could eat in one sitting, but it did little to address why they were eating in the first place—or why they were driven to eat again soon after. Hunger, especially homeostatic hunger (the biological drive to eat to maintain energy balance), remained strong.
Over time, people found ways to eat around the surgery. High-calorie soft foods, grazing, and snacking allowed them to bypass physical restrictions. Without addressing the root cause—hunger itself—sustainable weight loss was nearly impossible.
The Power of the 3 Whys: Getting to the Root
In logic and problem-solving, there’s a technique called “The Three Whys”. It suggests that to understand a problem deeply, you must ask “Why?” at least three times.
Let’s apply this to weight gain:
- Why do people gain weight?
→ Because they consume more calories than they burn. - Why do they consume too many calories?
→ Because they feel hungry—even when their body has enough energy stored. - Why do they feel hungry despite having enough stored energy (fat)?
→ Because their homeostatic hunger signals are dysregulated—their brain and body no longer communicate hunger and satiety correctly.
This third “why” is the key to understanding obesity as a disease of disordered energy regulation, not just poor willpower or overeating. It explains why calorie-restriction diets so often fail—because the biological drive to eat (hunger) remains high, even as calorie intake is reduced.
And bariatric surgery, as promising as it seemed, never truly addressed this dysregulation. It tried to control behavior (eating) without fully resolving the biological signals driving that behavior.
Understanding Homeostatic Hunger
Homeostatic hunger is the body’s natural system for maintaining energy balance. It’s regulated by a complex network of hormones (like ghrelin, leptin, insulin, and GLP-1) and neural pathways that signal when to eat and when to stop.
In a healthy system, this works beautifully. But in obesity, this system is disrupted. People with excess body fat should theoretically feel full for longer, since they have more stored energy. But many instead feel hungry—sometimes ravenously so. This happens because:
- Leptin resistance blunts the “I’m full” signal from fat stores.
- Ghrelin levels may remain abnormally high, driving hunger.
- Insulin resistance distorts blood sugar regulation and energy use.
- Highly processed foods hijack reward systems and create abnormal satiety responses.
In this context, asking someone to “just eat less” or to “have more discipline” ignores the powerful biological signals at play. That’s like telling someone to breathe less to lose weight. Hunger isn’t just a habit—it’s a survival signal deeply rooted in evolution.
Conclusion: Controlling Hunger, Not Just Calories
Obesity is not simply a condition of excess eating—it’s a disease of energy regulation, and at its core lies dysfunctional hunger. The mid-2010s optimism around bariatric surgery faded not because the surgeries were ineffective in the short term, but because they failed to fix the broken hunger mechanisms.
True, sustainable weight loss will come not from obsessively counting calories, but from regulating the drivers of hunger, especially homeostatic hunger. This means addressing hormonal imbalances, improving diet quality, reducing insulin resistance, and restoring normal satiety signaling.
As we’ll explore in Part 2, understanding the second type of hunger—hedonic hunger (the drive to eat for pleasure)—adds another layer to the story. But for now, remember:
Don’t just control how much you eat—understand why you’re eating in the first place.
