We Have Confused Empathy With Removing Responsibility

Somewhere along the way, we started confusing empathy with removing responsibility.

We became so afraid of blaming people for their health problems that we became uncomfortable acknowledging the role their own decisions can play in improving them.

Being obese or mentally ill does not decrease your intrinsic value as a human.

That doesn’t mean that we should normalize 300lb Walmart shoppers on mobility scooters. You can acknowledge someone's value and treat them with dignity while still being critical of destructive decisions. In fact, convincing someone that harmful behaviors are healthy, unavoidable, or something that should be celebrated isn't compassion. Sometimes the empathetic thing to do is tell someone something they don't want to hear.

This extends to more than just fitness too. You can acknowledge that depression is a real medical condition without pretending sleep, exercise, social interaction, diet, alcohol use, stress, and daily habits don't matter.

And you can recognize the enormous value of modern medicine without believing that a prescription should always be the first answer.

A quick note on modern medicine: It can save lives. There are chronic conditions that require lifelong treatment. There are people whose health is already at a point where telling them to simply "try harder" would be ignorant and potentially dangerous.

My problem isn't with medication.

My problem is when medication becomes a substitute for even attempting to address the behaviors and circumstances contributing to the problem.

The Role of Big Pharma

There is also an elephant in the room when we talk about long-term medication or treatment:

Money.

Pharmaceutical companies are not charities. They are businesses, and extraordinarily successful ones. Their responsibility to develop effective medicines exists alongside a very obvious financial incentive: selling more medicine generates more revenue.

A pharmaceutical company makes nothing from someone improving their diet, becoming more educated on nutrition, or exercising more.

The same basic incentive can exist elsewhere in healthcare and wellness.

A therapist gets paid when you continue attending therapy. A personal trainer gets paid when you continue buying training sessions.

The biggest mistake you can make is blindly trusting someone that is profiting from you.

Be wary of “yes-men” in your life. A good therapist or personal trainer should challenge you and hold you accountable when appropriate. If they always tell you what you want to hear, constantly validate every decision, and never challenge your behavior, ask yourself whether they are actually helping you improve or simply keeping you comfortable enough to remain a paying client.

None of that means the service is unnecessary or that the person providing it is intentionally taking advantage of you.

But incentives matter.

When someone's illness or dependence becomes someone else's recurring revenue, skepticism isn't automatically anti-medicine.

Plus, drugs have tradeoffs. Depending on the medication, those can include side effects, withdrawal or return of the condition they were treating. With GLP-1s specifically, substantial weight regain after discontinuation has been observed in clinical trials. This doesn’t mean you should be fearful of treatment. It means that you should focus on tackling the root cause before making a big decision.

When seeking treatment ask yourself: Is this intervention moving me toward greater health and independence, or am I just another customer who will be dependent on a service indefinitely?

Before You Change Your Brain Chemistry, Look at Your Life

Mental health is probably the most sensitive example of what I'm talking about.

Depression is real. Anxiety is real. Mental illness is real.

But so are our personal choices.

Imagine someone who sleeps five hours every night, barely exercises, rarely goes outside, spends six hours a day scrolling through social media, drinks heavily every weekend, eats poorly, hates their job, and has almost no meaningful social interaction.

Now imagine that person feels terrible.

Should we really be surprised?

That doesn't mean every depressed person created their depression. It doesn't mean going for a walk cures major depressive disorder.

But exercise isn't some meaningless wellness cliché.

A 2026 Cochrane review concluded that exercise may produce a moderate reduction in depressive symptoms compared with no therapy. Interestingly, the available trials comparing exercise directly with psychological therapy or antidepressants found little to no difference in symptom reduction, although Cochrane specifically cautioned that those direct comparisons were based on relatively few small studies and that long-term follow-up was limited.

Social connection matters too.

An umbrella review encompassing 53 systematic reviews found evidence linking loneliness, social isolation, social support, and characteristics of people's social networks with mental-health outcomes. Depression was among the conditions studied most frequently.

None of this means getting eight hours of sleep, making some friends, and going to the gym will cure clinical depression.

That's not my argument.

My argument is that these things matter, and we shouldn't be mindlessly throwing drugs at people with major lifestyle problems.

Think about how many variables could potentially be affecting someone's mental health.

How much do they sleep? Do they exercise? How often do they leave the house? Do they have meaningful relationships? How much time do they spend alone? How much time do they spend staring at a screen? What does their diet look like? How much alcohol do they consume? Do they have hobbies? Do they have a sense of purpose? Do they hate their job? Are they under constant financial stress?

A doctor can ask about these things.

What they cannot do is follow you home and change them for you.

When Struggle Becomes an Identity

There is another uncomfortable part of the mental-health conversation that I think we need to talk about.

We have created a culture that sometimes seems to reward struggle.

There was a time when growing up wealthy, having supportive parents, living in a safe neighborhood, and having access to opportunities would have been considered an incredibly fortunate upbringing. Today, people can almost seem embarrassed to admit they had a nice upbringing.

Everyone has a struggle.

Everyone came from a "rough" area.

Everyone has trauma.

Everyone has anxiety.

Everyone is depressed.

And increasingly, people don't even wait for a medical professional to tell them that something is wrong. They self-diagnose.

A bad attention span becomes ADHD. Being particular about something becomes OCD. Feeling nervous becomes an anxietydisorder. Going through a difficult period becomes depression. A painful experience becomes trauma.

There is an important difference between experiencing a normal human emotion or personality trait and having a psychiatric disorder.

So why are people sometimes so eager to adopt these labels?

Attention may be part of it. Social media probably doesn't help. Finding a community of people who understand what you're experiencing can also be genuinely comforting.

But I think there's another reason that is much harder to talk about:

A diagnosis can become an explanation for failure.

Failure hurts.

It's uncomfortable to admit that maybe you didn't work hard enough. Maybe you weren't disciplined enough. Maybe someone else was better prepared. Maybe you wasted an opportunity. Maybe you made the wrong decisions. Maybe you simply weren't good enough at that particular thing.

It's much easier psychologically when there is something outside of your control that can explain the outcome.

"I failed to lose weight” becomes "I’m depressed, so I don’t have the motivation."

Sometimes those explanations are completely legitimate. Mental illness can seriously impair someone's ability to function andacknowledging that isn't always making an excuse.

The danger begins when an explanation becomes an identity, and the identity becomes permission to stop trying.

There is a huge difference between:

"This makes things harder for me."

and

"Therefore, I can't be expected to do it."

The first acknowledges reality.

The second surrenders responsibility.

Your Struggle Doesn't Change the Result

This might sound harsh, but reality doesn't always care about our explanations.

If I want to lose weight but consistently eat more calories than I expend, my body doesn't reduce the calories because I had a difficult childhood.

If I want to become stronger but rarely train, the barbell doesn't become lighter because I've been struggling mentally.

That's why I think obsessively searching for an explanation for every shortcoming can become counterproductive. Even when the explanation is legitimate, the more useful question is usually:

What can I do about it?

Maybe depression makes getting out of bed substantially harder.

Okay. What can we do about it?

Maybe your childhood put you ten steps behind someone else.

Okay. What can we do about it?

You Are More Than Your Diagnosis

A diagnosis should give you information.

It can explain patterns you didn't previously understand. It can help a professional determine appropriate treatment. It can connect you with resources.

But the diagnosis should be the beginning of figuring out what to do next, not the conclusion that nothing can be done.

You can acknowledge that someone started ten steps behind without telling them there is no point in walking forward.

Sometimes compassion means acknowledging that something is genuinely harder for someone, helping them get the treatment and support they need, and then still believing they're capable of moving forward.

GLP-1s Present the Same Question

GLP-1 medications such as semaglutide and tirzepatide are incredibly effective medications. In certain cases, they can be completely reasonable for someone to suggest.

But what about someone who has never seriously tried?

Someone who doesn't know how many calories they eat.

Someone who doesn't understand calorie density.

Someone who has never consistently tracked their food.

Someone who barely exercises.

Someone drinking hundreds of calories every day.

Someone who has never learned how protein, fiber, resistance training, sleep, and activity affect weight management.

Should our first instinct really be medication?

Even the World Health Organization's current guidance doesn't treat GLP-1s as a replacement for lifestyle. WHO recommends counseling on behavioral and lifestyle changes, including diet and physical activity, and describes GLP-1 treatment as one component of a comprehensive approach to obesity.

This is how it should be used, as a supplement to lifestyle changes and education. But often times it’s not.

Remember how many GLP-1 users regain significant weight after stopping treatment. In many cases, the underlying behaviors never changed. When the medication's appetite suppression disappears, old habits can return with it. If you haven't learned how to manage your diet and aren't willing to put in the work, all you did was become more dependent on drugs.

In the SURMOUNT-4 randomized clinical trial, participants initially lost an average of 20.9% of their body weight after 36 weeks of tirzepatide treatment. Participants who were then switched to placebo regained about 14% of their body weight over the following year, while those who continued tirzepatide lost an additional 5.5%.

A medication can reduce your appetite.

It cannot teach you nutrition.

It cannot teach you how to train.

It cannot teach you how to maintain muscle.

And it cannot make lifestyle education irrelevant.

If you've made serious attempts to lose weight, understand what you're doing, and still need additional help, modern medicine has given us an incredibly powerful tool.

Use it.

Counting Calories Is Not an Eating Disorder

Counting calories has somehow become controversial.

You'll hear claims that tracking calories is "toxic," that it creates an unhealthy relationship with food, or even that calorie counting causes eating disorders.

Can calorie tracking become obsessive for certain people?

Absolutely.

Someone with an eating disorder or a history of disordered eating may need completely different nutritional guidance. There are people for whom detailed tracking genuinely may not be appropriate.

But that doesn't make calorie counting inherently unhealthy.

A 2024 systematic review included 28 studies with 17,370 adults examining weight-related self-monitoring and eating-disorder symptoms. Nine studies involving 13,507 people were included in the meta-analysis. Researchers did not find a statistically significant association between self-monitoring and overall eating-disorder symptoms, and the same general pattern appeared in the subgroup examining diet monitoring.

Calories are information.

Temporarily tracking calories can be incredibly educational.

You might discover that the salad you assumed was a light meal becomes extremely calorie-dense once you add dressing, cheese, croutons, bacon, and sauce.

You might discover that the portion of peanut butter you've been calling one tablespoon is actually three.

Eventually, you may understand portions and calorie density well enough that detailed tracking becomes unnecessary.

Once again:

Over time, you should need the tool less.

Body Positivity Shouldn't Require Health Denial

The body positivity movement has lost the plot.

The original message is incredibly important:

Your body weight does not determine your value as a human being.

I completely agree.

But somewhere along the way, a reasonable message sometimes became something very different:

If you acknowledge that obesity carries health risks, you're judging someone's body.

No.

Respecting someone does not require lying to them.

You can accept where you currently are without accepting that you have to remain there forever.

In fact, improving your health can be an expression of self-love.

Responsibility Is Not the Same Thing as Blame

This distinction might be the most important point in this entire article.

Responsibility and blame are different things.

You may have been raised in a household that taught you terrible eating habits.

That's not your fault.

But at some point, learning better habits becomes your responsibility.

Over Time, You Should Need Me Less

I'll apply the same standard to my own industry.

I'm a personal trainer.

If someone comes to me knowing absolutely nothing about lifting, my job should not be to make sure that person needs me for the next ten years.

My job should be to educate them.

I should teach them how to perform exercises correctly. I should explain why they're doing those exercises. They should learn about progressive overload, recovery, exercise selection, intensity, volume, and how to recognize when their program needs to change.

Over time, they should need me less.

For an average person training for general health, strength, or appearance, I don't believe years of personal training should normally be necessary. In most cases, less than a year should provide enough time for a good trainer to give someone the knowledge and confidence necessary to train independently.

There are obvious exceptions. Professional athletes and competitive bodybuilders may benefit from long-term specialized coaching. Some people have disabilities or other circumstances requiring continued assistance. And there's nothing wrong with someone voluntarily continuing personal training simply because they enjoy having a trainer.

But dependency should never be the goal.

If I deliberately withhold information from you, convince you that fitness is too complicated to understand without me, or simply tell you what you want to hear because keeping you happy keeps your monthly payment coming, I'm not putting your interests first.

A successful trainer shouldn't be afraid of losing a client because that client learned enough to leave.

Graduation should be considered a success.

We have increasingly confused empathy with removing responsibility.

I think we can do better.

Sometimes the most compassionate thing you can do is give someone the knowledge, tools, treatment, support, and confidence necessary to take more control over their own health.

The ultimate goal shouldn't be to simply say whatever makes someone feel better. Telling someone they're perfect and validating every decision is easy. It gets a positive response and avoids an uncomfortable conversation.

Having an honest talk with someone about their habits, their health, or their weight because you genuinely want to see them improve is much harder.

Understanding where someone is, supporting them through their struggles, and still being willing to respectfully tell them what they may not want to hear isn't inherently “fatphobic” or “bigoted.”

That's real empathy.