For me it has also been a combination of things, the shortness of breath, inability to do the walking i used to, hating shopping for clothing because it would mean traipsing around crowded shops getting even hotter and sweatier then normal.
The final straw was the increase in my thyroxine levels for an underactive thyroid to a level that is over over 200mcgs per day..
at this point i knew i had to do something about my weight, improving my thyroid levels, and other medical problems