In this narrative, I describe a patient who has lost 25% of her starting body weight and the behaviors that she practices to maintain this weight loss. Patients who have lost weight have reductions in metabolism that are out of proportion to their amount of weight loss. They also have increases in appetite. I propose that physicians must improve in their treatment of obesity as a chronic disease. To achieve this, they must understand the physiologic and behavioral barriers to long-term weight loss, and they must be open to the use of medications for treating obesity.