Well... I think it is really very complicated but there is a lot of physiological contributors to obesity. Yes, it is a mental health issue as well, but I don't think it is more of one or the other.

If you look into the secretion of a number of hormones that cause satiation and hunger, you can see that those with obesity have significant and long-lasting changes even years after losing weight. There have also been links to some genetic components that cause altered levels of these hormones. So, while I do not disagree that there are clear mental health issues involved, physiological issues reinforce obesity and cause it to be difficult to change. And many patients may not have done anything about it because it's not simple, but most of the patients I see (who have a lot of long term illness and are generally not proactive about their health) don't even take simple steps and actively do things to undermine their health such as getting family members to sneak in 2 liters of coke or McDonald's. It's very frustrating to have patients demand you "fix" them with a pill when they are less seemingly less invested in their health than you are. In a lot of ways obesity is an issue of culture (what the person eats, what they can afford, etc) and that is difficult to change without being able to sit down and talk with the patient for an extended period of time.

And yes, the issue of mental health in health care is appalling. You cannot really separate mental health from physical well being, as studies show again and again and yet we do.. and then we wonder why our patients suffering from chronic illness have so much mental illness as well. Hopefully there will be a shift from the strictly medical focus of providers, unfortunately this is really complicated as it's hard to bill for a lot of things that support mental health if it's not a pill.

Ok, my disconnected rant is about over too! Man, don't get me started on the state of health care and the role of the provider vs patient! I love to have the intelligent conversation though so thanks for that!