Changes in human lifestyle over the last century have produced a dramatic increase of diabetes and obesity worldwide. These two chronic diseases are components of the metabolic syndrome, which is associated with high incidence of cardiovascular disease. Genetic and environmental factors such as high calories diet and inactivity are clearly associated with the metabolic syndrome. The science of complex adaptative systems provides important concepts and perspectives to better understand the pathophysiology and the multi-dimensional approach of the treatment of "diabesity". New treatment frameworks are needed to improve the effectiveness of clinicians in promoting behavioural changes and therapeutic adherence. Goal setting should focus on the individual with a metabolic syndrome and not only to the biological and hemodynamic components of the disease. We should take into account the life circumstances of the patient, his motivations and his therapeutic priorities.