Handbook of obesity treatment. Second edition.

Handbook of obesity treatment. Second edition

Edited by Wadden TA, Stunkard AJ. The Guildford Press, New York, 2002, 617 pages, $128.00, ISBN 1-57230-722-6

The obesity epidemic presents a major therapeutic challenge--with so many affected people, what are the best treatment options? How can a single clinician attempt to understand the theory and practice behind such diverse interventions as behavioural weight control, different dietary approaches, drug therapies, obesity surgery, commercial weight loss programs, exercise prescriptions and so on? This book provides a generally very detailed, and often extremely practical, overview of the range of obesity treatments on offer.

The book's editors. Thomas Wadden and Albert Stunkard are well-recognised experts in the field of obesity. Their background in psychology and psychiatry to some extent has influenced the focus of the book. Thus, the psychosocial aspects of obesity and the range of behavioural therapies in the treatment of obesity are particularly well covered in several chapters. However, the editors have also brought together a range of other experts from quite diverse fields that make relevant contributions to the overall aims of the book. Inevitably, the book focusses on studies and interventions from the United States, a situation which has some limitations. For example, most of the treatment options presented are highly resource intensive and individualistic, with little attempt to look at what a coordinated regional, statewide or national strategy for treatment services might be. Nevertheless, much of what is presented is readily transferable to other countries and health care settings.

The book is divided into six parts. There are several excellent initial overviews on such diverse topics as the prevalence and consequences of obesity, the physiology of body weight regulation, energy metabolism, genetics of obesity, the toxic environment and eating disorders in obesity. The chapter on genetics and common obesities briefly covers gene-environment interactions. It would have been helpful if the authors had tackled this in more detail. For example, why are genetically predisposed individuals so vulnerable in our current obesogenic culture? The subsequent chapter deals with the major environmental changes that have led to the obesity epidemic.

The main sections of the book deal with the health consequences of weight reduction, the assessment of the obese adult patient and treatment of adult obesity. I found the chapters that are written from a psychological perspective to be particularly well written, practical and relevant. For example, the overview of the behavioural assessment of the obese patient provides thoughtful tips for raising the issue in a primary care setting, gives examples of responses that could be used in speaking with patients and outlines the BEST (biological, environmental, social and timing factors) approach to assessment. Rena Wing's chapter on behavioural weight control is another gem, with a clear summary of the evidence behind the use of structured meal plans, home-based exercise programs, motivational strategies and the development of mediabased programs to increase access to interventions. Other excellent chapters cover such topics as popular diets for obesity treatment, drug treatment, exercise interventions, commercial weight-loss programs, surgical treatment, body image disturbance and strategies for long-term weight maintenance. All these chapters seem reasonably accessible to the non-expert clinician and each is written concisely and with helpful tables or diagrams.

While generally extremely good, there are some disappointing parts of the book. For example, there are only two chapters on paediatric obesity, and no coverage of the clinical assessment of the obese child or the treatment of the severely obese child. Other limitations of the book include fairly weak chapters on the health effects of intentional weight loss (no mention of obstructive sleep apnoea, polycystic ovarian disease or orthopaedic complications) and the medical assessment of the obese adult patient (no discussion of waist circumference).

Despite these limitations, the book provides a wealth of relevant and very readable information for any clinician with an interest in the treatment of obesity. It is suitable for both the expert with an intense knowledge of the field, as well as the general reader who wants an update on this important topic.

Louise A Baur

University of Sydney

Discipline of Paediatrics & Child Health.

The Children's Hospital at Westmead, NSW