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Appeals to individual agency and responsibility are increasingly viewed as antithetical to the goals of reducing stigma towards overweight and obesity and are sometimes even framed as anathema to civil discussion in academia. The current paper argues that this is a naïve view of agency and responsibility and, contrary to helping prevent or reduce stigma, removing these concepts from our conversations around obesity may instead worsen outcomes for those most at risk. This paper provides background for what follows and an introduction to the topic, before detailing and responding to the most common arguments for the futility of agency: from subconscious processes; from biological determinism; from free will; from obesity as a disease; and from framing and stigma. It then considers the impact on research of this proposed framing / perspective. The final section considers three key shifts in conceptualisation which I believe are necessary to highlight the importance of agency in weight management, whilst also providing the best care possible to patients and society at large. The proposed conceptual shifts are: agency is necessary but often not sufficient as it is constrained; diseases are not created equal; and there are multiple pathways to obesity. Acknowledging these fundamental realities can help us avoid the schism currently developing in researchers’ and clinicians’ conceptions of overweight and obesity.

Keywords: obesity; stigma; agency; responsibility; addiction; biological determinism