J Health Behav Med Hist 2026-9.
Debate 2: Does focusing on behaviour risk blaming individuals?
Robert C. van de Graaf, Performance Medicine Specialist, Director
MEDTCC Institute for Health, Behaviour, Medicine and its History, and Perform Health Clinic ,The Netherlands
Another concern raised in response to the theory presented in Reframing obesity: from adipose tissue disease to behavioural system outcome [1] is that emphasising behaviour might unintentionally reinforce narratives of individual responsibility.
Historically, lifestyle explanations of obesity have sometimes been associated with stigma and moral judgement. The modern framing of obesity as a chronic disease partly emerged to counter such narratives and to acknowledge the complex biological regulation of body weight.
However, within the behavioural organ system perspective behaviour is not interpreted as the product of isolated personal choices.
Behaviour emerges from the continuous interaction between biological processes within the organism and environmental structures that shape behavioural possibilities. Biological predispositions influence how individuals experience hunger, satiety, reward, fatigue, and stress, while environmental conditions influence which behavioural options are available, encouraged, or discouraged.
Modern environments exert particularly strong influences on behavioural dynamics. Highly palatable foods are widely available and heavily marketed, while digital technologies and modern transportation systems substantially reduce the need for physical activity. Social networks and cultural norms further shape patterns of eating, activity, and coping behaviour.
Within the behavioural organ system framework, these environmental structures are not merely external determinants but form part of the behavioural organ system itself. They shape the behavioural landscape within which individuals regulate their actions.
Understanding obesity through behavioural systems thinking therefore highlights the interaction between biological susceptibility and environmental structures, rather than attributing responsibility solely to individuals.
From this perspective, behaviour represents the output of a relational system shaped by biological predispositions, environmental contexts, and learned behavioural patterns.
- Van de Graaf RC, Van de Graaf PF. Reframing obesity: from adipose tissue disease to behavioural system outcome. J Health Behav Med Hist 2026-6.