J Health Behav Med Hist 2026-11.
Debate 4: Should obesity be considered the disease, or the dysregulated behavioural system?
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 final question raised in debates about the theory from the article Reframing obesity: from adipose tissue disease to behavioural system outcome [1] concerns the level at which the concept of disease should be applied.
In contemporary medicine, obesity is widely described as a chronic disease. This framing has played an important role in reducing stigma and legitimising medical care. It has also facilitated the development of pharmacological treatments, bariatric surgery, and specialised obesity care.
However, the behavioural systems perspective raises an additional question: at which level in the causal chain should the concept of disease be applied?
If obesity represents the biological outcome of persistent behavioural dynamics generated within behavioural regulatory systems, it may be argued that the underlying dysregulation occurs primarily within the behavioural system rather than within adipose tissue itself.
From this perspective, obesity may represent one biological manifestation of prolonged behavioural dysregulation.
This observation reveals a potential paradox. Many individuals experience persistent health-compromising behavioural (PHCB) [1] patterns long before obesity develops, yet structured care often becomes widely available only after obesity is present.
A comparable situation exists in addiction medicine, where treatment targets dysregulated behavioural and neurobiological systems rather than waiting for severe somatic complications.
From this perspective, one might ask whether obesity care could also include earlier intervention aimed at behavioural dysregulation itself.
Applying the disease concept to dysregulated behavioural organ functioning could potentially allow earlier intervention, support stepped-care behavioural treatment models, such as in addiction care, and provide a broader framework for addressing health challenges that share similar behavioural dynamics, such as cancer or cardiovascular diseases.
At the same time, important ethical and conceptual questions remain regarding how behavioural dysregulation should be defined and addressed within healthcare systems.
For this reason, the question is not whether obesity should cease to be considered a disease. Rather, the debate concerns whether obesity represents the disease itself – or the biological manifestation of dysregulation within the behavioural system that produces behaviour is the disease.
- 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.