The Concept of Healthy Behaviours in Obesity May Have Unintended Consequences.

Obesity has become a global epidemic, representing a major health crisis, with a significant impact both in human and financial terms. Obesity was originally seen as a condition, not a disease, which was considered self-inflicted. Thus, it was understandable that a simplistic approach, such as eat less and move more was proposed to manage obesity. Over the last 25 years, the perception of obesity has been gradually changing and the awareness has risen that it is a disease in its own right and not just a precipitating factor for type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), etc. Creation of a comprehensive algorithm for the management of obesity needs to be informed by an in-depth understanding of the issues impacting the provision of treatment. Promotion of healthy behaviours is essential to help the population become healthier, but these are not obesity treatment strategies. Twenty percent of patients with obesity may respond to approaches based on healthy behaviour, but the 80% who do not respond should not be stigmatised but rather their treatment should be escalated. The unintended consequences of promoting healthy behaviours to patients with obesity can be mitigated by understanding that obesity is likely to be a subset of complex diseases, that require chronic disease management. Once the biology of the disease has been addressed, then healthy behaviours may play an invaluable role in optimising self-care within a chronic disease management strategy.