When "It's Just Biology" Misses the Whole Story

A Review of "Enough: Your Health, Your Weight, and What It's Like to Be Free" by Oprah Winfrey and Dr. Ania Jastreboff

I need to start by saying something important:

There is so much pain and truth in the pages of this book.

Reading "Enough," I saw myself on nearly every page. The shame. The blame. The decades of being treated as "less than." The public humiliation. The private desperation. The diets that worked until they didn't. The hope and the heartbreak.

How many books are even out there about what it's like to wear your issues on your sleeve? To have your struggles visible to everyone? To walk through the world in a body that invites judgment from strangers?

Not many. And Oprah's willingness to share her story—the liquid diet, the wagon of fat, the regain, the shame spiral, all of it—matters. It gives people permission to see themselves.

So I want to be clear: I'm not dismissing this book. I'm honoring it. AND I'm saying there's more.

I got fired up in our Magic call this week.

We were talking about Oprah's new book, co-written with Dr. Ania Jastreboff, an endocrinologist from Yale. I've now read significant portions of it, and I want to be fair: there's good science in this book.

The thermostat metaphor for the body's "Enough Point" (Adiposity Level Setpoint theory) is helpful. The explanation of how our brains defend fat stores through hormone signaling is accurate. The validation that this isn't about willpower—that our biology literally fights weight loss through metabolic adaptation—is important for people to hear.

And this line matters: "No one should ever be blamed or shamed or face stigma for having a disease."

Yes. Agreed. Absolutely.

But here's where I get fired up.

The book explicitly states that delving into the history and psychology of shame is "beyond the expertise of this book." The innate reasons we carry shame? Beyond its scope. The emotional, relational, and trauma-based reasons we go to food? Not addressed.

And that's honest. I appreciate the honesty. The book is focused on biology and medication.

But when the messaging around this book reaches millions of people, and what they hear is "it's a gene, it's a disease, the medication quiets the food noise, you're handled"—something crucial gets lost.

Because the biology is real. AND it's not the whole story. Not even close.

The Double-Edged Truth Nobody Wants to Accept

Here's the thing that makes this so complicated—and so hopeful, once you understand it:

There isn't ONE reason we struggle with food. There are TWO completely different categories of reasons, and they require completely different approaches.

The first edge: Biology.

Some bodies genuinely struggle to regulate weight and hunger signals. This is real. Just like some bodies struggle to maintain healthy blood pressure and require medication to adjust it, some bodies have biological systems that fight against weight regulation. The Adiposity Level Setpoint theory Oprah describes? Valid. The food noise that comes from living below your body's preferred set point? Real. The metabolic adaptation that makes your body defend fat stores? Scientifically documented.

This is the "disease" framing, and for some people, it's accurate. GLP-1 medications can help here the same way blood pressure medications help regulate blood pressure. No shame in that. None.

The second edge: Coping mechanisms.

AND there are also reasons we go to food that have absolutely nothing to do with biological set points. These are the learned patterns, the survival strategies, the ways we learned to soothe ourselves when no one else was available to soothe us. This is reaching for food when we're not hungry but we're lonely. Stressed. Overwhelmed. This is the late-night urge that has nothing to do with your Enough Point and everything to do with the day you just survived. This is veering into the drive-thru not because your body needs fuel but because something inside you needs comfort.

This is the addiction and coping piece—and medication doesn't touch it.

Here's why this matters so much:

If you ONLY address the biology, you'll still struggle. You'll take the medication, the food noise will quiet, and you'll STILL find yourself reaching for something at 10pm. You'll STILL make choices you wish you hadn't. You'll wonder what's wrong with you—why the medication "isn't working."

Nothing is wrong with you. You're just complex. And human.

If you ONLY address the coping mechanisms and ignore the biology, you'll exhaust yourself with willpower trying to override legitimate biological signals. You'll shame yourself for "failing" when your body is literally fighting you.

You need BOTH. That's the hard truth people don't want to accept.

Why I Use "Food Dysfunction" Instead of "Disease" or "Addiction"

This is why I prefer the term "food dysfunction."

"Disease" captures the biology but misses the coping. It can let people off the hook for the internal work by suggesting medication handles everything.

"Addiction" captures the coping patterns but can minimize legitimate biological factors. It can pile on shame by implying it's all about willpower and choice.

"Food dysfunction" holds BOTH truths. It acknowledges that something isn't functioning the way we want it to—without reducing the complexity to a single cause or a single solution.

Your food dysfunction might be 80% biological and 20% coping patterns. Or 30% biological and 70% coping patterns. Or some constantly shifting mixture that changes based on stress, sleep, life circumstances, and what phase of healing you're in.

The point isn't to figure out the exact percentage. The point is to stop pretending it's only one thing.

Why Food Is the Most Complicated Challenge

Here's something the simplified messaging completely misses:

Food dysfunction is categorically different from every other struggle.

Alcoholism? You can abstain completely. Drugs? You can abstain completely. Tobacco? You can abstain completely. The path is brutal, but it's clear: stop using the substance.

But food?

Imagine telling an alcoholic they need to have one drink a day. Or even one drink a week.

Imagine saying: "You're addicted to alcohol, and the solution is to have a moderate, healthy relationship with alcohol. Just have one glass of wine with dinner and stop there."

That's insane. We would never say that.

And yet that's exactly what we ask of people struggling with food.

You cannot abstain from eating. You have to engage with food multiple times a day, every day, for the rest of your life. You have to make decisions, over and over, about what to eat, how much, when to stop.

Yes, we can distinguish between real food and what I call "Not Food"—ultra-processed garbage substances engineered to hijack our biology. And abstaining from THOSE is possible and helpful.

But even then, you're still eating. You're still making choices. You're still navigating a world where food is everywhere, where eating is social, where celebrations center on meals, where comfort and connection and love have been tangled up with food since childhood.

This is INCREDIBLY complicated.

A medication that quiets the "food noise" doesn't teach you how to navigate a family dinner. It doesn't heal the wound that made food your safest companion. It doesn't help you figure out why you reach for something crunchy when you're anxious, or something sweet when you're lonely, or something—anything—when you feel that crushing sense of alarmed aloneness.

The Brilliance Underneath

Here's where this gets hopeful.

Once you understand the double-edged nature of food dysfunction, something remarkable happens: you can stop fighting yourself.

Those coping patterns you developed? They're not character flaws. They're not evidence that you're broken or weak or lacking willpower. They're intelligent adaptations. Every single one of them developed for a reason—usually in childhood, usually in response to something that overwhelmed your capacity to cope.

The child who learned that food was the only reliable source of comfort when caregivers were unavailable? Brilliant adaptation.

The nervous system that discovered certain foods could regulate overwhelming emotions? Intelligent solution.

The brain that wired "stress → food" because food actually works to calm the nervous system? That's not dysfunction—that's your brain doing exactly what it's designed to do.

The problem isn't that these patterns exist. The problem is that they're still running the show long after we have access to other options.

And THAT can change. Not through willpower. Not through shame. Through understanding, through compassion, through slowly building new neural pathways while honoring the brilliance of the old ones.

This is the territory Oprah's book explicitly says is "beyond its scope." And this is where lasting freedom actually lives.

The Both/And (Because It's Always Both/And)

Let me be crystal clear:

I am never going to tell anyone not to take a GLP-1 medication. Ever.

I get it. I LIVED with that noise. The constant food chatter. The obsessing. The planning every bite. The white-knuckling through every social event.

Who wouldn't want that to turn down? Of course you would. Of course.

Here's what I can tell you from my own journey: over the last 15 years, I have significantly turned down that noise. Not with medication—through the work. Through instinct at first, and then through becoming absolutely fixated on figuring out this puzzle.

And I want to be clear—I'm not "done." I'm not "fixed." I'm not "better" in some final way. We're never done. But the chaos I used to live with? The constant food chatter? It's quiet now. Most of the time, it's quiet.

I did that by understanding WHY I was going to food. By learning about my nervous system, my patterns, my wounds. By finding community. By doing the work that's "beyond the scope" of biology books.

This puzzle—our lives—it's so complicated and crazy and awesome. And it CAN get quieter. With or without medication.

One of our community members takes a GLP-1. She told everyone on the call—no shame, no embarrassment. And she shouldn't feel any. These medications can be incredibly helpful. They can turn down the noise. They can give people breathing room they've never had.

Someone else in the conversation compared them to antidepressants, and I thought it was brilliant:

"It's not a magic bullet. Maybe it takes this tiny foggy layer off that allows you to actually apply the techniques. You still have to climb out. You still have to find the footholds. But maybe you need that little boulder at the bottom of the hole to start."

Yes. AND.

I want to be clear about why I'm sharing all of this. It's not to dissuade you from taking GLP-1 medications. It's not to persuade you to take them either.

I'm sharing this to explain why you still make less-than-healthy choices even when the "food noise" quiets. Why your late-night urges still happen. Why you might still veer into that drive-thru even though you're not actually hungry. Why the medication helps AND you still find yourself reaching for something when you're stressed or lonely or overwhelmed.

You're not broken. You're complex. And human.

Because here's what I know from every single person I've worked with who's on these medications:

They still go to food to soothe.

They still make choices they wish they hadn't. They still have moments when the noise gets loud. They still need to work on turning down the internal chaos.

The medication can turn down the volume. But it doesn't change the song.

Why Community Changes Everything

This is why community matters so much.

Not accountability—"Did you stick to your plan?" Not monitoring—"What did you eat today?"

Accompaniment. Walking alongside. Witnessing without fixing.

In our Magic call this week, here's what actually happened:

Someone shared that she'd been caring for her aging mother, all her buttons getting pressed, and she found a massive stash of candy in the kitchen. At her wit's end, she went looking for it.

And she didn't take any.

In most spaces, we'd rush past that. "Good job, moving on." Or worse—"But are you back on track?"

Instead, we stopped. We celebrated. We let her marinate in the win.

Because THAT moment—celebrated out loud, witnessed by people who understand—is what actually rewires neural pathways. That's the glimmer that replaces the trigger. That's the internal shift that no medication can create.

Later, someone else posted that she was struggling. She didn't say why. She didn't need to.

The response? "We're walking with you."

That's it. No advice. No fixing. Just presence.

And later she said: "I didn't eat over it."

This is what makes the difference. Not because community replaces biology—it doesn't. But because the work that's "beyond the scope" of a biology book? That work happens in relationship. In resonance. In being witnessed through the impossibly complicated daily reality of living with food.

The Hopeful Truth

Here's what I want you to take away from this:

Your struggles with food make sense. ALL of them.

The biological piece? Makes sense. Some bodies genuinely have different set points, different hunger signals, different metabolic responses. That's not a moral failing.

The coping piece? Makes sense too. You developed those patterns for good reasons. They helped you survive. They soothed you when nothing else could. They were intelligent adaptations to impossible situations.

Understanding this doesn't mean you're stuck with it. It means you can finally work WITH yourself instead of against yourself.

You can address the biology if that's part of your picture—without shame.

AND you can do the deeper work of understanding your patterns, rewiring your nervous system responses, and building new pathways—without pretending that work isn't necessary.

This is the both/and that sets people free.

Not "it's a disease, take this medication, you're handled."

Not "it's willpower, try harder, shame on you."

But: "You're complex. You're brilliant. Your patterns make sense. AND you can change them. Here's how. And you don't have to do it alone."

What Freedom Actually Looks Like

Freedom isn't white-knuckling through every meal.

Freedom isn't being terrified of regaining weight.

Freedom isn't obsessing over macros or points or bright lines or anything else.

Freedom is trusting yourself around food. Eating without the constant mental chatter. Having your brain quiet enough to actually live your life. Maintaining abstinence from harmful substances because you want to, not because you're terrified of what happens if you don't.

That's what I have now. That's what I've helped hundreds of people move toward.

And I didn't get there with a medication. I got there by doing the internal work—the work that can't be measured, can't be photographed, can't be reduced to before-and-after.

This Is What My Book Is About

Everything Oprah's book explicitly says is "beyond its scope"? That's my book.

"Thinking Outside the Box: A Revolutionary Approach to Food Dysfunction" covers the complete picture—both edges of this double-edged sword.

It explains why your patterns aren't character flaws but intelligent adaptations. It dives into the nervous system work, the identity work, the generational patterns, the coping mechanisms that made sense when they developed. It shows you how to rewire the neural pathways that got wired in the first place. And it does all of this from a place of profound hope—because once you understand why you do what you do, you can finally change it.

If you've read Oprah's book and thought, "Okay, but what about all the stuff underneath?"—that's the book I wrote.

📖 [GET THE BOOK: Thinking Outside the Box] [Insert book link here]

Take the Quiz

Want to discover YOUR real reasons for going to food? It's not just one thing—it's a constellation of patterns that make sense when you understand them.

[TAKE THE QUIZ: The REAL Reasons You Go to Food] [Insert quiz link here]

Your Turn

If you've been managing symptoms without exploring the puzzle underneath...

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See you in the space between. 💜

Sonja