We must consider this question: do people really have a choice what they weigh?
Can a 5' 8" 350 lbs. 45 year old man suddenly decide to lose half his bodyweight?
Yes, he may make a decision, and set this goal for himself. Whether the decision is based on a realistic expectation of achieving the goal, or not, is another question.
Basically, can this middle aged man, having achieved a severe degree of obesity, now achieve a normal body weight, with optimal health and functional ability?
Thus, the real question is, is achieving a healthy weight within one's "self-control", or are forces beyond one's control simply too powerful?
To answer this question I will make use of an analogy. The need to breathe is obvious to all, as within a few seconds of being deprived of air one begins to show ill effects. No one would suggest that not breathing is a choice.
But even a function as automatic as breathing can be controlled at times and perhaps permanently altered through persistent efforts. We can slow our breathing, practice deep breathing, and engage in increased (aerobic) breathing (e.g. while running, climbing, lifting, swimming). We can also choose what we breathe (e.g. cigarette smoke, polluted air, fresh air). All of these "intentional" manipulations of breathing may have significant long-term effects.
Similarly, eating is not a choice (we need to eat) even if the consequences of not eating come more slowly than those of not breathing. But clearly, if we have some control over breathing, then we certainly have some control over eating. It is within our power to choose when, where, what and how to eat.
"Weight regulation" refers to the various processes determining one's actual bodyweight. Genetic factors affect metabolism, energy levels, athletic ability and enjoyment, food preferences and eating styles. Environment too is a strong influence on eating and activity behaviours.
It is within those important contexts - one's genes and environment - that one engages in the "self-regulation" of weight. One chooses to be thinner, healthier, fitter, and then uses strategies to achieve the goal, but the outcome of such practices are influenced by genetics and environment.
Here is where the capacity for self-awareness is important. An individual like our middle-aged gentleman can become more conscious of his body, mind and environment, and start using this self-awareness to guide a process of change and self-improvement. Small choices made consistently can gradually modify his physiology, mental programming and social situations, creating new habits and a new lifestyle.
It truly does start with a choice, deciding to make the change. He may not become a model or an Olympian, but he will surely be healthier and feel better about himself.
Stephen Stotland, Ph.D.