{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:06:36Z","timestamp":1787241996962,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Irish Research Council"},{"name":"Science Foundation Ireland"},{"name":"Health Research Board"},{"name":"Anabio"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/nu15010012","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T01:32:53Z","timestamp":1671586373000},"page":"12","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Concept of Healthy Behaviours in Obesity May Have Unintended Consequences"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7288-5245","authenticated-orcid":false,"given":"Hilary C.","family":"Craig","sequence":"first","affiliation":[{"name":"Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Belfield, Dublin D04 VIW8, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb M.","family":"Doran","sequence":"additional","affiliation":[{"name":"Independent Researcher, Dublin D04 VIW8, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5521-5445","authenticated-orcid":false,"given":"Carel W.","family":"le Roux","sequence":"additional","affiliation":[{"name":"Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Belfield, Dublin D04 VIW8, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"key":"ref_1","unstructured":"Office CSO (2022, November 10). The Wellbeing of the Nation 2017\u20132021. Available online: https:\/\/www.cso.ie\/en\/releasesandpublications\/ep\/p-wbn\/thewellbeingofthenation2017\/hlt\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"161","DOI":"10.21037\/atm.2017.03.107","article-title":"Morbidity and mortality associated with obesity","volume":"5","author":"Abdelaal","year":"2017","journal-title":"Ann. Transl. Med."},{"key":"ref_3","unstructured":"OECDI Library (2022, November 10). The Economic burden of obesity Europe: OECD. Available online: https:\/\/www.oecd-ilibrary.org\/sites\/6cc2aacc-en\/index.html?itemId=\/content\/component\/6cc2aacc-en."},{"key":"ref_4","unstructured":"Organisation WHO (2022). WHO European Regional Obesity Report 2022, WHO."},{"key":"ref_5","unstructured":"Public Health HD, OECD (2019). The Heavy Burden of Obesity, OECD Europe."},{"key":"ref_6","first-page":"418","article-title":"European Commission classifies Obesity as a chronic disease","volume":"9","author":"Burki","year":"2021","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1210\/er.2006-0040","article-title":"Genetics of Obesity in Humans","volume":"27","author":"Farooqi","year":"2006","journal-title":"Endocr. Rev."},{"key":"ref_8","unstructured":"Foresight (2022, November 10). Foresight Tackling Obesities: Future Choices. UK: Project Report. In Foresight Programme GOfS; 2007, Available online: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/287937\/07-1184x-tackling-obesities-future-choices-report.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1038\/ijo.2008.247","article-title":"WHO recognition of the global obesity epidemic","volume":"7","author":"James","year":"2008","journal-title":"Int. J. Obes."},{"key":"ref_10","first-page":"6613385","article-title":"Structural Brain Changes Associated with Overweight and Obesity","volume":"2021","year":"2021","journal-title":"J. Obes."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.2105\/AJPH.2009.159491","article-title":"Obesity Stigma: Important Considerations for Public Health","volume":"100","author":"Puhl","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_12","first-page":"1","article-title":"Impact of obesity and diet on brain structure and function: A gut-brain-body crosstalk","volume":"8","author":"Medawar","year":"2022","journal-title":"Proc. Nutr. Soc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1186\/s12974-022-02519-6","article-title":"Perivascular macrophages in high-fat diet-induced hypothalamic inflammation","volume":"19","author":"Mendes","year":"2022","journal-title":"J. Neuroinflamm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"134231","DOI":"10.1016\/j.foodchem.2022.134231","article-title":"The positive correlation of antioxidant activity and prebiotic effect about oat phenolic compounds","volume":"402","author":"Zhang","year":"2023","journal-title":"Food Chem."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.2337\/db08-0210","article-title":"Human obesity: A heritable neurobehavioral disorder that is highly sensitive to environmental conditions","volume":"57","author":"Farooqi","year":"2008","journal-title":"Diabetes"},{"key":"ref_16","unstructured":"Organisation WHO (2022, November 10). Obesity and Overweight Key Fact Sheet Europe: WHO. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"205","DOI":"10.7861\/clinmedicine.19-3-205","article-title":"Current treatments for obesity","volume":"19","author":"Ruban","year":"2019","journal-title":"Clin. Med."},{"key":"ref_18","unstructured":"Erixon, F., Brandt, L., and Krol, M. (2022, November 10). Investing in Obesity Treatment to Deliver Significant Healthcare Savings: Estimating the Healthcare Costs of Obesity and the Benefits of Treatment. ECIPE 2014; No.1(2014:32). Available online: https:\/\/ecipe.org\/publications\/investing-obesity-treatment-deliver-significant-healthcare-savings-estimating-healthcare-costs-obesity-and-benefits-treatment\/."},{"key":"ref_19","unstructured":"Health Do. DOH, Obesity, Policy (2016). A Healthy Weight for Ireland Obesity Policy and Action Plan, Department of Health 2016\u20132025."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/j.1467-789X.2008.00524.x","article-title":"Obesity Policy Action framework and analysis grids for a comprehensive policy approach to reducing obesity","volume":"10","author":"Sacks","year":"2008","journal-title":"Obes. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wiley, L. (2013). Shame, Blame, and the Emerging Law of Obesity Control, UC Davis. UC Davis Law Review.","DOI":"10.2139\/ssrn.2286481"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S109","DOI":"10.21037\/atm.2018.11.60","article-title":"Pharmacotherapy in conjunction with lifestyle for the treatment of obesity complications, is it enough?","volume":"6","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2105\/AJPH.2007.110361","article-title":"Autonomy, Paternalism, and Justice: Ethical Priorities in Public Health","volume":"98","author":"Buchanan","year":"2008","journal-title":"Am. J. Public Health"},{"key":"ref_24","unstructured":"Barrett, D.H., Ortmann, L.W., Dawson, A., Saenz, C., Reis, A., and Bolan, G. (2016). Chronic Disease Prevention and Health Promotion, Springer. Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK435779\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.pec.2010.03.015","article-title":"Efficacy of therapeutic patient education in chronic diseases and obesity","volume":"79","author":"Lagger","year":"2010","journal-title":"Patient Educ. Couns."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.mcna.2017.08.012","article-title":"Maintenance of Lost Weight and Long-Term Management of Obesity","volume":"102","author":"Hall","year":"2018","journal-title":"Med. Clin. North Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1056\/NEJMoa2032183","article-title":"Once-Weekly Semaglutide in Adults with Overweight or Obesity","volume":"384","author":"Wilding","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1001\/jama.2021.1831","article-title":"Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults with Overweight or Obesity: The STEP 3 Randomized Clinical Trial","volume":"325","author":"Wadden","year":"2021","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1056\/NEJMoa2208601","article-title":"Once-Weekly Semaglutide in Adolescents with Obesity","volume":"387","author":"Weghuber","year":"2022","journal-title":"New Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"12686","DOI":"10.1039\/D2FO01746F","article-title":"Whole grain benefit: Synergistic effect of oat phenolic compounds and \u03b2-glucan on hyperlipidemia via gut microbiota in high-fat-diet mice","volume":"13","author":"Li","year":"2022","journal-title":"Food Funct."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2952","DOI":"10.1161\/01.CIR.0000145546.97738.1E","article-title":"Clinical Implications of Obesity With Specific Focus on Cardiovascular Disease","volume":"110","author":"Klein","year":"2004","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Reynolds, R., Dennis, S., Hasan, I., Slewa, J., Chen, W., Tian, D., Bobba, S., and Zwar, N. (2018). A systematic review of chronic disease management interventions in primary care. BMC Fam. Pract., 19.","DOI":"10.1186\/s12875-017-0692-3"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2165\/00115677-200311080-00001","article-title":"Chronic Disease Management","volume":"11","author":"Norris","year":"2003","journal-title":"Dis. Manag. Health Outcomes"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1136\/bmj.39372.540903.94","article-title":"Support for self care for patients with chronic disease","volume":"335","author":"Kennedy","year":"2007","journal-title":"BMJ"},{"key":"ref_35","first-page":"1379547","article-title":"Self-Care Experiences of Adults with Chronic Disease in Indonesia: An Integrative Review","volume":"2020","author":"Lukman","year":"2020","journal-title":"Int. J. Chronic Dis."},{"key":"ref_36","first-page":"1123","article-title":"Challenges of self-management when living with multiple chronic conditions: Systematic review of the qualitative literature","volume":"60","author":"Liddy","year":"2014","journal-title":"Can. Fam. Physician"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"103713","DOI":"10.1016\/j.ijnurstu.2020.103713","article-title":"Characteristics of self-care interventions for patients with a chronic condition: A scoping review","volume":"116","author":"Riegel","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_38","first-page":"1503","article-title":"Supporting self-management in patients with chronic illness","volume":"72","author":"Coleman","year":"2005","journal-title":"Am. Fam. Physician"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/S2213-8587(19)30068-3","article-title":"Faculty Opinions recommendation of Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial","volume":"7","author":"Lean","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"130","DOI":"10.12968\/pnur.2012.23.3.130","article-title":"Obesity: Self-care and illness prevention","volume":"23","author":"Hindle","year":"2012","journal-title":"Pr. 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