Indeed speravi, people with whom I disagree are often as well informed as me and in many cases more so. I agree when you say "My earlier concern, which I should perhaps have elaborated, is that it disempowers patients presenting with these problems to tell them that they have an illness, when the remedy rests in themselves. Many of my colleagues argue that this is another manifestation of the contemporary "victim culture". Personal responsibility is a hugely important part of any successful treatment and we have seen a decline in this in all areas. However, I feel you are now taking a slightly different stance from that which you took originally which seemed (to me) to be much more judgemental when there are sometimes sound physiological reasons why the of weight gain or loss differs from one person to another irrespective of personal responsibility. I am quite willing to concede, however, that I come to this from a mental health service perspective which is the one exception you made. I see many folks who have had opportunities for the taking of personal responsibility severely restricted for years and so tackling obesity against this backdrop and whilst receiving strong medication(s) can make weight control (up and down) very much more difficult.