We see many examples of people who have never really engaged with behaviour change and many who have tried hard but failed to achieve any meaningful outcome. So, how do we encourage real, life-changing and long-lasting behaviour change in our patients? When faced with many disappointments, can it even work?
Lustig spends most of the first half of the book explaining why behaviour change alone is so difficult. Our bodies have multiple adaptations to protect our body weight and we do not relinquish it without a fight. This battle is waged day by day in our guts (gut hormones) and our brains (leptin) making sustained weight loss incredibly difficult. Lustig clearly believes that individual behaviour change, while important, is inadequate to fully tackle the global obesity epidemic. Orchestrating this disaster, according to Lustig, is a food environment which has changed dramatically over the last 50 years in the Western World, in parallel to the rise in obesity, and Lustig argues that tackling this aspect of our culture should be a greater concern.