J Health Behav Med Hist 2026-10.
Debate 3: Do behavioural models compete with medical treatment?
Robert C. van de Graaf, Performance Medicine Specialist, Director
MEDTCC Institute for Health, Behaviour, Medicine and its History, and Perform Health Clinic ,The Netherlands
A third question arising from the theory presented in the article Reframing obesity: from adipose tissue disease to behavioural system outcome [1] concerns the relationship between behavioural explanations and biomedical treatments such as pharmacotherapy or bariatric surgery.
Some wondered whether emphasising behavioural regulation might imply that medical treatment is less relevant.
The behavioural organ systems perspective does not oppose medical treatment. On the contrary, it may help explain why certain medical interventions are effective for some patients but not for others.
Pharmacological treatments and surgical interventions modify biological processes that influence behavioural regulation – for example appetite signalling, reward sensitivity, or metabolic functioning. By altering these internal regulatory states, such interventions may help disrupt behavioural feedback loops that sustain persistent health-compromising behaviours (PHCB) [1].
From this viewpoint, biological and behavioural interventions operate at different levels within the same system.
Medical treatments primarily influence biological regulation within the organism. However, biological regulation is only one component of the relational behavioural organ system that generates behaviour through the interaction between organism and environment.
Behavioural therapy therefore represents the broader regulatory approach, within which medical treatments may function as supportive interventions that modify biological conditions influencing behaviour.
These approaches should therefore be understood as complementary rather than competing strategies.
- 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.