I remember asking a bariatric surgeon one time “how often do you see metabolic problems being the sole reason for someone to be morbidly obese?” He paused a moment then said “I have never met a patient that eats less than me [in 30 years of experience].”

Diabetes in 90% of type 2s is completely manageable with diet. Access and education to appropriate foods and poor impulse control is what drives the majority of uncontrolled diabetes. I do not fault majority of patients for this either: they didn’t create the crappy education system, lobby to the government to create a “food pyramid” that promotes carbohydrates, or elevate the costs of transport of fresh fruit and vegetables. That was all failure of our system. The fix is too complicated for a public entity with no incentive to address so it’s up to individuals to take care of themselves unfortunately.

It is a systemic problem but I just don’t see help coming from the government

Diet is definitely worse. Every corner is laden with carbohydrate fueled artificial garbage we call food. If we want to see health improve we need to shift our incentive structure to favor vegetables and lean meats or other natural protein sources institutionally.