As someone about this size, but has also been relatively "fit" at this size (I used to be able to go on casual 10+ mile hikes on weekends, pre-pandemic), it's also our health system failing us. I've never had a doctor give me a better answer than "diet and exercise" to change things. I got to a level of fitness where I could go on 10 mile hikes, which is a hell of a lot more fit than a lot than many Americans, yet they'd still give me doom and gloom and uninterested answers. It's exhausting.
America does not treat obesity well, and I feel like there's not good enough research going into it. I love to see reporting like—and hope there's more to come, in hopes that it changes both clinical mindsets and also how we think about obesity. It's more than what you eat.