A myth exists that behavior therapy solutions are not as effective as drugs or surgery for the treatment of metabolic disorders because they require both significant effort and adherence on the part of the patient and significant changes in how healthcare thinks about caring and paying for these people.  Both of these departures from business-as-usual in the treatment of metabolic disorders (clearly the largest drivers of healthcare costs today) are the very essence of consumer-directed healthcare.  Successful behavior therapy solutions do exist and need to be taken seriously and supported by patients, providers and payors alike - the stakes are just too high not to.  The key is understanding that successful solutions to the treatment of metabolic disorders require patient awareness of their own bodies and behaviors, not just generalities like “get more exercise”, combined with decision support tools for healthcare professionals,  that drive adherence to evidence-based programs.