I think environment is a big factor. The American diet is simply awful, and if people were fully immersed in Japanese, or French style diets their calorie intake would be greatly decreased because the portion sizes are more reasonable. I think many people genetically are not suited to eat the western diet and stay in a respectable weight - example certain Native American's gain enormous weight on the American diet simply because their genetics were designed to keep them alive in scarcity of calories.
So, I do think it is fair to point out that it is not equally easy for everyone to get to certain weights. I have always been scrawny - I can eat as much as I want and not get real weight, probably because I burn calories very quickly. On the flip side - I have great difficulty gaining muscle.
Exercise is good though, and doctors should recommend that everyone who is overweight get on a real exercise plan that is ambitious - that is one of the best ways to lose weight, because it will over time increase their metabolism and help them keep the weight off.
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