If we want to better prevent and manage obesity, we need to recognise the determinants, biology and reality from a lived experience perspective, in the way we talk about obesity. The way we frame the challenge and solutions affects media portrayal, health service offerings, policies, funding, societal perceptions, future research and how people feel about themselves. People with obesity are not treated fairly in society, including by the health system, because of the way obesity is portrayed in society. Oversimplifying the topic perpetuates stigma and slows progress. We need to invest in systems thinking, prevention, treatment and tackling stigma, and failure to recognise this has been an important barrier to action in the past. Collectively we need to overcome a lack of political commitment, misinformation, influence from vested interests, stigma and bias, and the false dichotomy of prevention versus treatment.