obesity rates are increasing worldwide and although it is recognized by the world health organization as one of the  greatest public health challenges of the twenty first century , there is still no clear , well - defined solution . reducing obesity poses a significant challenge because it is a complex problem with numerous interconnected variables . experts suggest that influencing this complex web of interdependent parts will require a holistic , integrated response from various sectors [ 2 , 3 ] . unfortunately , current practices in health care do not usually treat obesity as a complex problem and practitioners are left with minimal resources to address an overwhelming issue . in this review we consider the challenges that the complexity of obesity presents to the healthcare sector , and the ways in which the field is evolving in response . using examples of how complexity and systems thinking can shift health care practices in addressing obesity , we demonstrate that accepting this complexity can help health care move past common responses to complex problems and work toward more effective solutions . there are several models of obesity s causality and they range in their depiction of complexity . obesity research predominantly focuses on biomedical models in an attempt to isolate specific physiological causal mechanisms at the level of the individual [ 4 , 5 , 6 ] . according to the biomedical perspective , obesity is essentially the result of an energy imbalance driven by individual behavior wherein energy intake exceeds energy expenditure over time [ 5 ] . this approach has had significant implications for obesity treatment and prevention , influencing clinical practice and government policy in spite of the evidence against its effectiveness at the population level [ 5 ] . the past few decades have seen a shift toward a socio - ecological view of obesity , in which individual behavior is situated within a broader social context . the socio - ecological model takes economic , cultural , and political determinants into consideration and presents individual obesity as at least partially influenced by forces external to the individual [ 7 , 8 ] . it presents obesity as being complicated , but falls short of accounting for the characteristics of complexity embodied by obesity [ 7 , 9 , 10 ] . understanding obesity as a consequence of complex interactions between many variables has been an important milestone for obesity research . hamid   suggests that system complexity is driven by the number of elements and the degree and nature of the interactions between them . the foresight group has developed a model that effectively displays these and other characteristics of complexity , framing obesity as a property emerging from over 100 variables and 300 interconnections . the diversity within the multiple elements , which can range from variability in an individual s genetic makeup , to the quality of food formulation to individual psychology , reflects the heterogeneity characteristic of complex systems . the model also depicts numerous feedback loops , the presence of which demonstrates interdependence and non - linear relationships between system components . like socio - ecological models , for example , an individuals food choices can be influenced by the price of food , the availability of food , the biological responses to the reward value of food and the cultural meaning of food . furthermore , systems typically have  fuzzy  boundaries , such that pushing on one part of the system can have unintended consequences in other areas or systems . the foresight map successfully communicates these interdependencies and the real difficulty of dealing with complex social problems . relationships are furthermore difficult to predict in complex systems due to time delays between actions and results . biomedical , socio - ecological and complex models all contribute to our understanding of obesity and are needed to inform our efforts to intervene . the variations between them , however , highlight the need for different approaches to problems based in part on their complexity . despite the evolution in our understanding of obesity as a complex problem , the most common approach to obesity treatment is to view it as a simple problem and attempt to change individual behavior by changing energy balance , primarily through health education [ 2 , 6 , 11 ] . bariatric surgery has shown significant success in treating obesity however access to patients is limited for a variety of reasons , including long wait lists and the invasive nature of surgery . pharmacotherapy has been associated with modest weight loss yet requires more research regarding long - term health benefits and safety . lifestyle interventions remain the foundation of obesity treatment as they are the least invasive option . however , adherence to programs is poor and patients experience a lack of long - term success . although lifestyle intervention is a cornerstone of clinical treatments for obesity , there are many barriers to its widespread application . physicians may be poorly equipped in that they lack training in weight loss strategies and obesity management , and do not have the appropriate strategies to support recommendations to eat less and move more . research has also suggested that the stigma associated with obesity complicates health care interactions , impacting patient experiences and the quality of care received . structural barriers to effective care include a lack of appropriately sized equipment , insurance schemes that do not cover obesity and lack of access to interdisciplinary care teams whose multifaceted expertise matches the complexity of the problem . the complexity of obesity challenges traditional primary care practices that have been structured to address typically acute and less complicated conditions . for practitioners , addressing obesity as a simple problem has produced discouraging results with clinicians often reporting obesity treatment as being  doomed to failure  , frustrating and ineffective [ 19 , 2123 ] in spite of the challenges posed by obesity , evidence suggests that primary care physicians have an important role to play in delivering preventive services , as their counseling can be effective when offered . unfortunately , physicians are often reluctant to advise their patients on weight loss . applying a complex systems lens to the prevention and treatment for many of the systems - based strategies for addressing obesity relate to the core principle of capacity building . health education strategies are rooted in the notion of building self - efficacy in order to promote behavior change , and evidence suggests that providing physicians with the right tools for the job can improve outcomes . increased knowledge of weight loss diets among health care professionals , for example , is associated with less dislike of discussing weight loss with patients , less frustration and less belief that treatment is ineffective . for the most part , however , health education proves unsuccessful in creating long - term behavior change . this suggests that education may only increase capacity marginally , or that other factors may be too influential on behavior to make education an efficient target for creating change [ 26 ] . systems theorists note that when the capacity of an individual is mismatched with the complexity of the task at hand , the individual is more likely to fail [ 26 , 27 ] . for example , clinicians in a typically busy health care practice may avoid discussing obesity with patients if they feel constrained by the need to keep clinical visits short , a large patient load , minimal resources and a poor understanding of effective treatments . on the other hand , a clinician with a smaller patient load , with access to information regarding best practices and with a supportive collaborative healthcare team may be better prepared to address the complexity of an individual s obesity . a patient that is overwhelmed by the complexity of behavior change may be resistant to treatment or advice from a health practitioner if they feel judged or stigmatized in the clinical setting and this may impact their own capacity to deal with the issue . ideally , other actions should be considered in tandem with health education that would address the relationship between individuals and their environment . in practice , there are limits to the extent of intervention a physician can provide to a patient navigating the complexities of their own individual environment . one strategy for primary care would be to reduce the complexity of the task at hand by focusing on the process , as opposed to the desired outcome . this approach aligns with basic principles of behavior change efforts to break goals down into smaller , regularly achievable actions [ 2931 ] , rather than reaching for overwhelming changes . a clinician could practice this by encouraging a patient to aim for a certain number of steps walked per day , as opposed to focusing solely on the desired amount of weight loss over a certain time frame . system. the 5as counselling framework is one such tool that has been proposed to help guide physicians through obesity counseling [ 33 , 34 ] . physicians are instructed to assess risk , current behavior , and readiness to change ; advise change of specific behaviors ; agree and collaboratively set goals ; assist in addressing barriers and securing support ; and arrange for follow - up [ 33 , 34 ] . another potential tool involves the use of patient - physician communication cards , which have been successfully employed in the treatment of diabetes   and are being tested for applicability to obesity in order to improve patient outcomes . in a recent pilot study , patients sorted cards based on summaries of the complex factors associated with obesity to highlight the determinants of obesity that were meaningful to them . the results found that prioritizing cards that were important to the individual had the potential to create a more efficient clinical visit by improving the conversation around obesity between patient and healthcare practitioners . moreover , the act of prioritizing values proved helpful in providing feedback to patients on their progress to date . many patients demonstrate insufficient knowledge of their medical conditions and uninformed patients are less likely to use preventive services [ 37 , 38 ] . addressing patient engagement and promoting shared decision - making in health care provides an example of using systems thinking to improve patient knowledge and ultimately improve their health outcomes . [ 39 ] proposed a health literate care model to address patient engagement by weaving health literacy strategies into the already existing and widely popular care model . increasing patient engagement likewise increases the capacity of individuals dealing with their health conditions , while also benefitting health care organizations by improving health practitioner and patient communication . the model improves upon current primary care , where programs to support patients in these areas are not yet well developed or widely implemented . the health literate care model demonstrates a holistic , systems - based approach by treating health literacy as an organizational value infused into all aspects of planning and operations , including self - management support [ 39 ] . a health literacy team is assigned the tasks of championing strategies , identifying targets and monitoring results . creating a health literacy team has the additional benefit of establishing a network of like - minded thinkers that have the potential to increase awareness among the rest of the organization . the model increases organizational capacity by addressing the complexity inherent to health care systems [ 15 , 41 , 42 ] . improving collaboration among health practitioners and throughout system sectors has been identified as a means of improving the standard of care ; the model succeeds by facilitating collaboration . finally , the model places an emphasis on feedback through patient surveys and constant assessment of methods [ 39 ] . this study proposes a practical systems framework for improving patients health literacy with the hope of improving the patient experience and ultimately improving health . by adopting a systems based approach , the study not only increases the capacity of individuals within the health care organization but opportunities to obtain feedback , initiate dialogue and leverage a diversity of perspectives has the potential to significantly change system behavior by improving information flows and shaping relationships between system members . leischow and milstein   suggest that relationships are  the heart of a systems orientation ; building on those relationships to increase collaboration among system members is essential and can be further improved with successful knowledge exchange . health care organizations would be served by identifying influential leaders who value collaboration as they can have a key role in establishing effective networks , thereby enhancing knowledge exchange . influential leaders should model the openness , risk taking and reflection necessary for learning , and communicate a compelling vision of the required organizational change , providing the support and personal advocacy needed to lead others toward it . connecting individual practitioners with like - minded thinkers and creating the conditions for new approaches and knowledge exchange can promote emergence . emergence is the system property wherein novel structures and patterns develop during the process of self - organization in complex systems [ 26 ] . wheatley and frieze   suggest that emergence is a means of turning local changes into meaningful shifts for system - wide change . networks have fluid membership and can trigger  communities of practice where new knowledge and ideas are quickly shared with a wider audience . eventually ,  communities of practice can grow into a  system of influence where the novel and innovative ideas or efforts become the norm , are easily adopted by others , and spread throughout a system . complex health issues requiring multifactorial solutions can benefit from the establishment of new networks made up of diverse parties . while this facilitated collaboration in decision making , creating new linkages would benefit from diversity among individuals in order to foster novelty and innovation among health care organizations . spreading innovation , such as addressing obesity as a complex problem , the bridging together of clinical practitioners to address the multiple determinants of obesity may improve patient care and establish the conditions necessary for emergence to take place . feedback is also an integral part of a system s functioning , and is understood to be essential for successful behavior change . feedback drives the learning process ; by receiving feedback about the effects of action taken , individuals are provided with the information with which to maintain that action or change course . some of the weakness of traditional health education approaches can be attributed to the absence of built - in processes for generating feedback   and feedback loops and delays tend to be ignored or poorly understood when it comes to creating interventions , policies or clinical treatment . delays in particular can have powerful influence on learning from interventions and developing an evidence base . in the case of obesity , the length of time required to lose a certain amount of weight will vary greatly from individual to individual and successful weight loss may not be equal to reaching one s the importance of feedback in the clinical treatment of obesity has been demonstrated through the success of self - monitoring in modifying behavior [ 25 , 32 ] . the power of feedback can be further enhanced in clinical settings through improved patient engagement . health care is often provider - directed and shows little patient engagement , decreasing opportunities for learning for both parties . increased participation from all members provides the opportunity to break down barriers between patients and providers . preference for involvement in decision - making varies among patients ; however this may be because they are ill informed about the benefits they stand to gain . clinicians are also poor at assessing their patients preferences for involvement   and poor patient education and engagement is one of the primary causes of negative treatment outcomes , non - response to medications and poor adherence . efforts to promote patient activation and engagement are likely to produce better patient outcomes and better care experiences . a similar strategy was piloted in a nursing study where patient outcomes improved using an evidence - based , holistic , person - centered approach to obesity management by helping individuals identify barriers and , as a result , initiate self - care strategies for weight loss . activities taking place in a clinical setting flow in part from the system s guiding paradigms . a paradigm can be defined as a shared unstated assumption under which a system operates ; it is the source of system goals , information flows , feedback and everything else about the system . paradigm shifts may result over time due to the cumulative effect of changes enacted throughout a system . for example , the shift in perception of tobacco from a socially accepted norm to an undesirable trait in north america was the result of hundreds of smaller changes in policy , health education , treatment options and other areas , all of which pushed attitudes about tobacco toward a tipping point . these are weight modification , modification of other health - related variables beyond weight ( i.e. , diet and physical activity ) , and emphasis on changing attitudes among and toward obese individuals . each of these approaches can be identified with different paradigms , goals and treatment methods . the conversation of which approach is best is taking place in many sectors as policymakers , physicians , and the public grapple with the issue of weight bias and its possibly being perpetuated by the focus on obesity as a social issue [ 5 ] . many of the issues previously identified in this piece - weight bias , poor communication , effectiveness of treatment - can be better understood and addressed through multi - disciplinary teams working from different paradigms , and from improved patient - clinician engagement in order to establish the paradigms and values of the patients themselves . best practice suggests that a chronic disease model provides the most useful framework for developing the treatment approaches needed for obesity . the benefits of this model lie in its recognition that the pathogenesis of obesity involves both genetic and environmental influences , that obesity can not be cured but can be managed , and that relapses occur when treatment is stopped or not followed [ 19 , 25 ] . as a paradigm of health promotion , the chronic disease model emphasizes life - long intervention with an understanding that relapses will occur and provide learning opportunities . it shifts the focus of behavior change to process rather than outcomes , therefore aligning with methods of treatment that address health - related variables other than body weight . behavioral treatment , for example , has been shown to have benefits in enhancing patient self - esteem and increasing obese people s ability to cope with adverse consequences regardless of outcomes in regard to changing body weight . improving education about the complexity of obesity and of systems theory is another means of providing practitioners and patients with improved resources and capacity while shifting treatment paradigms . nonlinearity , for example , is a characteristic of complex systems , in which changing one variable in a relationship may have inconsistent effects on another . the human body has been shown to adapt to changes in caloric intake and become unpredictable , thereby behaving in a nonlinear fashion when it comes to weight loss . this knowledge informs patients and practitioners that it may not be enough to simply eat less and achieve predictable weight loss , reinforcing the fact that some aspects of weight management are beyond the control of the individual . research suggests that even though health professionals and policymakers understand obesity to be a socio - ecological problem , they are still more inclined toward individually focused weight management interventions as effective responses [ 5 ] . a stronger understanding among health professionals of the complexities of obesity will be beneficial in health care adopting a more holistic , patient centered model of obesity treatment and management . negative depictions of obese and overweight people in the media and political discourse have the power to perpetuate weight bias and shape public policy , thereby having downstream impacts on health care access and quality . physicians advocating for the rights of obese patients are helping to shift paradigms away from blaming the individual and toward more patient - friendly , solution - focused perspectives . many of the systems - based strategies for addressing obesity relate to the core principle of capacity building . health education strategies are rooted in the notion of building self - efficacy in order to promote behavior change , and evidence suggests that providing physicians with the right tools for the job can improve outcomes . increased knowledge of weight loss diets among health care professionals , for example , is associated with less dislike of discussing weight loss with patients , less frustration and less belief that treatment is ineffective . for the most part , however , health education proves unsuccessful in creating long - term behavior change . this suggests that education may only increase capacity marginally , or that other factors may be too influential on behavior to make education an efficient target for creating change [ 26 ] . systems theorists note that when the capacity of an individual is mismatched with the complexity of the task at hand , the individual is more likely to fail [ 26 , 27 ] . for example , clinicians in a typically busy health care practice may avoid discussing obesity with patients if they feel constrained by the need to keep clinical visits short , a large patient load , minimal resources and a poor understanding of effective treatments . on the other hand , a clinician with a smaller patient load , with access to information regarding best practices and with a supportive collaborative healthcare team may be better prepared to address the complexity of an individual s obesity . a patient that is overwhelmed by the complexity of behavior change may be resistant to treatment or advice from a health practitioner if they feel judged or stigmatized in the clinical setting and this may impact their own capacity to deal with the issue . ideally , other actions should be considered in tandem with health education that would address the relationship between individuals and their environment . in practice , there are limits to the extent of intervention a physician can provide to a patient navigating the complexities of their own individual environment . one strategy for primary care would be to reduce the complexity of the task at hand by focusing on the process , as opposed to the desired outcome . this approach aligns with basic principles of behavior change efforts to break goals down into smaller , regularly achievable actions [ 2931 ] , rather than reaching for overwhelming changes . a clinician could practice this by encouraging a patient to aim for a certain number of steps walked per day , as opposed to focusing solely on the desired amount of weight loss over a certain time frame . system. the 5as counselling framework is one such tool that has been proposed to help guide physicians through obesity counseling [ 33 , 34 ] . physicians are instructed to assess risk , current behavior , and readiness to change ; advise change of specific behaviors ; agree and collaboratively set goals ; assist in addressing barriers and securing support ; and arrange for follow - up [ 33 , 34 ] . another potential tool involves the use of patient - physician communication cards , which have been successfully employed in the treatment of diabetes   and are being tested for applicability to obesity in order to improve patient outcomes . in a recent pilot study , patients sorted cards based on summaries of the complex factors associated with obesity to highlight the determinants of obesity that were meaningful to them . the results found that prioritizing cards that were important to the individual had the potential to create a more efficient clinical visit by improving the conversation around obesity between patient and healthcare practitioners . moreover , the act of prioritizing values proved helpful in providing feedback to patients on their progress to date . many patients demonstrate insufficient knowledge of their medical conditions and uninformed patients are less likely to use preventive services [ 37 , 38 ] . addressing patient engagement and promoting shared decision - making in health care provides an example of using systems thinking to improve patient knowledge and ultimately improve their health outcomes . [ 39 ] proposed a health literate care model to address patient engagement by weaving health literacy strategies into the already existing and widely popular care model . increasing patient engagement likewise increases the capacity of individuals dealing with their health conditions , while also benefitting health care organizations by improving health practitioner and patient communication . the model improves upon current primary care , where programs to support patients in these areas are not yet well developed or widely implemented . the health literate care model demonstrates a holistic , systems - based approach by treating health literacy as an organizational value infused into all aspects of planning and operations , including self - management support [ 39 ] . a health literacy team is assigned the tasks of championing strategies , identifying targets and monitoring results . creating a health literacy team has the additional benefit of establishing a network of like - minded thinkers that have the potential to increase awareness among the rest of the organization . the model increases organizational capacity by addressing the complexity inherent to health care systems [ 15 , 41 , 42 ] . improving collaboration among health practitioners and throughout system sectors has been identified as a means of improving the standard of care ; the model succeeds by facilitating collaboration . finally , the model places an emphasis on feedback through patient surveys and constant assessment of methods [ 39 ] . this study proposes a practical systems framework for improving patients health literacy with the hope of improving the patient experience and ultimately improving health . by adopting a systems based approach , the study not only increases the capacity of individuals within the health care organization but also creates an environment that encourages communication , feedback and continuous assessment and improvement . the flow of information holds powerful influence over system functioning . opportunities to obtain feedback , initiate dialogue and leverage a diversity of perspectives has the potential to significantly change system behavior by improving information flows and shaping relationships between system members . leischow and milstein   suggest that relationships are  the heart of a systems orientation ; building on those relationships to increase collaboration among system members is essential and can be further improved with successful knowledge exchange . health care organizations would be served by identifying influential leaders who value collaboration as they can have a key role in establishing effective networks , thereby enhancing knowledge exchange . influential leaders should model the openness , risk taking and reflection necessary for learning , and communicate a compelling vision of the required organizational change , providing the support and personal advocacy needed to lead others toward it . connecting individual practitioners with like - minded thinkers and creating the conditions for new approaches and knowledge exchange can promote emergence . emergence is the system property wherein novel structures and patterns develop during the process of self - organization in complex systems [ 26 ] . wheatley and frieze   suggest that emergence is a means of turning local changes into meaningful shifts for system - wide change . when local actions occur in isolation , their impact is limited to that area . networks have fluid membership and can trigger  communities of practice where new knowledge and ideas are quickly shared with a wider audience . eventually ,  communities of practice can grow into a  system of influence where the novel and innovative ideas or efforts become the norm , are easily adopted by others , and spread throughout a system . complex health issues requiring multifactorial solutions can benefit from the establishment of new networks made up of diverse parties . while this facilitated collaboration in decision making , creating new linkages would benefit from diversity among individuals in order to foster novelty and innovation among health care organizations . spreading innovation , such as addressing obesity as a complex problem , the bridging together of clinical practitioners to address the multiple determinants of obesity may improve patient care and establish the conditions necessary for emergence to take place . feedback is also an integral part of a system s functioning , and is understood to be essential for successful behavior change . feedback drives the learning process ; by receiving feedback about the effects of action taken , individuals are provided with the information with which to maintain that action or change course . some of the weakness of traditional health education approaches can be attributed to the absence of built - in processes for generating feedback   and feedback loops and delays tend to be ignored or poorly understood when it comes to creating interventions , policies or clinical treatment . delays in particular can have powerful influence on learning from interventions and developing an evidence base . in the case of obesity , the length of time required to lose a certain amount of weight will vary greatly from individual to individual and successful weight loss may not be equal to reaching one s the importance of feedback in the clinical treatment of obesity has been demonstrated through the success of self - monitoring in modifying behavior [ 25 , 32 ] . the power of feedback can be further enhanced in clinical settings through improved patient engagement . health care is often provider - directed and shows little patient engagement , decreasing opportunities for learning for both parties . increased participation from all members provides the opportunity to break down barriers between patients and providers . preference for involvement in decision - making varies among patients ; however this may be because they are ill informed about the benefits they stand to gain . clinicians are also poor at assessing their patients preferences for involvement   and poor patient education and engagement is one of the primary causes of negative treatment outcomes , non - response to medications and poor adherence . efforts to promote patient activation and engagement are likely to produce better patient outcomes and better care experiences . a similar strategy was piloted in a nursing study where patient outcomes improved using an evidence - based , holistic , person - centered approach to obesity management by helping individuals identify barriers and , as a result , initiate self - care strategies for weight loss . activities taking place in a clinical setting flow in part from the system s guiding paradigms . a paradigm can be defined as a shared unstated assumption under which a system operates ; it is the source of system goals , information flows , feedback and everything else about the system . paradigm shifts may result over time due to the cumulative effect of changes enacted throughout a system . for example , the shift in perception of tobacco from a socially accepted norm to an undesirable trait in north america was the result of hundreds of smaller changes in policy , health education , treatment options and other areas , all of which pushed attitudes about tobacco toward a tipping point . these are weight modification , modification of other health - related variables beyond weight ( i.e. , diet and physical activity ) , and emphasis on changing attitudes among and toward obese individuals . each of these approaches can be identified with different paradigms , goals and treatment methods . the conversation of which approach is best is taking place in many sectors as policymakers , physicians , and the public grapple with the issue of weight bias and its possibly being perpetuated by the focus on obesity as a social issue [ 5 ] . many of the issues previously identified in this piece - weight bias , poor communication , effectiveness of treatment - can be better understood and addressed through multi - disciplinary teams working from different paradigms , and from improved patient - clinician engagement in order to establish the paradigms and values of the patients themselves . best practice suggests that a chronic disease model provides the most useful framework for developing the treatment approaches needed for obesity . the benefits of this model lie in its recognition that the pathogenesis of obesity involves both genetic and environmental influences , that obesity can not be cured but can be managed , and that relapses occur when treatment is stopped or not followed [ 19 , 25 ] . as a paradigm of health promotion , the chronic disease model emphasizes life - long intervention with an understanding that relapses will occur and provide learning opportunities . it shifts the focus of behavior change to process rather than outcomes , therefore aligning with methods of treatment that address health - related variables other than body weight . behavioral treatment , for example , has been shown to have benefits in enhancing patient self - esteem and increasing obese people s ability to cope with adverse consequences regardless of outcomes in regard to changing body weight . improving education about the complexity of obesity and of systems theory is another means of providing practitioners and patients with improved resources and capacity while shifting treatment paradigms . nonlinearity , for example , is a characteristic of complex systems , in which changing one variable in a relationship may have inconsistent effects on another . the human body has been shown to adapt to changes in caloric intake and become unpredictable , thereby behaving in a nonlinear fashion when it comes to weight loss . this knowledge informs patients and practitioners that it may not be enough to simply eat less and achieve predictable weight loss , reinforcing the fact that some aspects of weight management are beyond the control of the individual . research suggests that even though health professionals and policymakers understand obesity to be a socio - ecological problem , they are still more inclined toward individually focused weight management interventions as effective responses [ 5 ] . a stronger understanding among health professionals of the complexities of obesity will be beneficial in health care adopting a more holistic , patient centered model of obesity treatment and management . negative depictions of obese and overweight people in the media and political discourse have the power to perpetuate weight bias and shape public policy , thereby having downstream impacts on health care access and quality . physicians advocating for the rights of obese patients are helping to shift paradigms away from blaming the individual and toward more patient - friendly , solution - focused perspectives . the literature considered in this review suggests that a reductionist approach toward treating obesity as a simple problem has had little effect in reducing obesity trends . accepting obesity as a complex problem is an important step in working toward solutions that will address the multiple interconnections and elements that contribute to obesity . systems thinking provides a way forward for resolving health challenges in complex , real world settings . shifting our paradigms around the causes of obesity is essential for creating a health care system that promotes innovative and collaborative practice for healthcare practitioners and individuals dealing with obesity . the literature suggests that while individual behavior change is at the center of obesity management , an effective health care team is essential to ensuring individuals receive the support , advice and guidance they need to improve their health status .
as obesity continues to increase throughout the world , there is still no well - defined solution to the issue . 
 reducing obesity poses a significant challenge for the health care system because it is a complex problem with numerous interconnections and elements . the complexity of obesity challenges traditional primary care practices that have been structured to address simple or less complicated conditions . 
 systems thinking provides a way forward for clinicians that are discouraged or overwhelmed by the complexity of obesity . at any given level , 
 individuals matter and system functioning is optimized when our capacity is well matched to the complexity of our tasks . 
 shifting paradigms around the causes of obesity is essential for creating a health care system that promotes innovative and collaborative practice for healthcare practitioners and individuals dealing with obesity .