Blame has no business in medicine, that is a moral hang up. Medicinal or other treatment deals in cause, which is why the appearance of blame in matters of weight gives a clue as to how much it has to do with science as opposed to a hangover from religious style moralizing. There blame is extremely important because you must answer to a higher supernatural power.
In medicine it only matters so far is it may impinge on the condition or state itself, which may influence the kind or form of treatment, personally accountability only goes as far as taking the treatment the doctor prescribes or following their directs. Hopefully, they have been proven to work and have positive effects, although not necessarily, as some of us have discovered at great cost.
If there are any problems with treatment, the answer is to deal with that not to have a moral reckoning, so blame is a pointless irrelevancy. It is the no answers bit that is where it can all go pear shaped, then "blame" may come up depending on things like the ethics of the professionals involved and how much they believe they are or can do something about finding a remedy. Fatness is immoral starts with the scientific/ medical establishment failure to defeat it in the way that fits their preferred models, magic bullet or treating symptoms.
This cannot possibly be, so a culprit must be found.
The idea of actually reversing or curing things is a little old fashioned nowadays, it seems to have an air of unprofitability about it. If you cure that's the end of that, if you palliate, it could be lifelong pay day. Yoni Freedhoff a Canadian doctor and with an interest in bariatrics, plays with the delicate notion of the genetics of fatness. Assuming as usual that we are all desperate to find fatness genetically determined rather than the only alternative on offer, our own culinary incontinence etc.,
I've never been on board with fat genetics myself, it seems too sure and direct a way to define fatness. I'm not dismissing it out of hand, but I'd have to make a distinction between fat genes-genes specifically and for genes that influence weight. For instance, let's say you are genetically predisposed to gain a load of weight, when you are depressed. If you are predisposed to depression, which is the gene most relevant to your fatness? The one(s) which make you susceptible to depression or those that respond to that with weight gain or fatness?
There are different ways bodies can respond in this kind of scenario, there's early warning fatness, where long before you experience any noticeable lowering of mood, weight gain kicks in to see it off, sort of early warning fatness. Then there's when mood imbalance has got a noticeable although not necessarily dominant grip on you to stop progression. Then there is the weigh gain/fatness of when you are pretty far gone in terms of mood imbalance, to try and stop you from getting to a point of no return.
There are other instances of this kind of link between certain mood disorders, things like PSTD etc., and gaining weight and becoming fat. I suspect that given those living in societies that can feed most people above the barest of subsistence level, that's probably all it takes for these effects to manifest clearly. And this the way most fatness is more than genes specifically for fatness.
I know there is the 'thrifty gene' hypothesis-that fatness is genetically useful adaptation for surviving times of famine. But I don't see any reason to just be fat, for it's own sake, it's either some kind of eccentricity in your genes, or a side effect of something else. Maybe some would see this as offensive, possibly it would be seen to go down the path of fatness as a pathology, but I just think it's a realistic idea of how our bodies tend to work.
We tend not to consider things the body must guard against, over and above say the immune system. We overlook that there are other things that can sink us and in fact end our lives that are not as tangible as germs or pathogens. And that we must have as many defences as is practicable when it comes to things that are vitally important to our survival. As the will to live can be destroyed by depression and as a species we are vulnerable to it, you can see that leaving it up to chance as to how depressed we might get at any given time, would be way too risky.
There's probably a similar thing going on with eating and anorexia. In a way the latter is like a kind of depression affecting the eating processes which can lead directly to compromising life itself, so all our 'difficulties' with calorie restriction are just ways of preventing us from moving from long periods of self induced hunger to anorexia where it is no longer directly under the control of the will. Without this, it's hard to see what would get in the way of this development.
Dr Freedhoff has helpfully reminded me that us fattiez are desperate to be exonerated and absolved from our crimes and to evade the wages of sin, which is starvation, comensurate with our purported gluttony. I suppose it's similar to the medical prinicple that if you have had a fever, you must be locked in the freezer for a similar period, to atone so that the earth will continue on it's correct course. As ever, he does what every other person on planet earth does with fatness, namely makes a general statement.
People like to blame genes.Then pretty quickly people becomes, fat people, only. Do you notice the way we are always isolated in this way, always, fatness is compared to itself. We cannot be compared to others, because our 'sins' would not show up. This trick is played with our reactions and thinking patterns that are just as much a product of the societies we live in as any other groups of people.
Fatness has been found by quite a few researchers to have a high degree of genetic bias, you'd guess that a hell of a lot of other things ascribed as the product of genes are probably somewhat exaggerated, in comparison to this. What are they? Alas, as usual they spoil the fun by not bothering to mention any, except everyone's incubator for unabashed judgment.
So what becomes everyone's issues, quickly narrows to becomes purely a problem for fat people. Such is the service we have been pressganged into.