Obesity (Key Disease series). (Book Reviews).

Editor: Barry Gumbiner, MD

Publisher: American College of Physicians 

With so much information on obesity readily available on the internet, in medical journals, and in the popular press, one may wonder whether there is a need for a book on this topic. Only three years ago, the National Institute of Health published its Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, and four years ago the World Health Organization published its report, Obesity: Preventing and Managing the Global Epidemic. There is a plethora of papers on obesity in medical journals, and the subject is a favorite one in the lay press.

And yet, although there is a great deal of information available on obesity, and especially ways of losing weight, relatively little information is based on sound scientific foundations. Most is based on anecdotal evidence, hearsay, and "personal experience." Because of their status, physicians are often asked questions about the safety and efficacy of various ways to lose weight.

It is sobering to consider that 54.9% of the adult population in the US is overweight, with 22.5% being obese (NHANES III). The percentage for African-Americans and Hispanics is even higher: 67% of adult African-American and Hispanic women are overweight. Obesity is not a benign problem: it is associated with significant morbidity risks as well as profound psycho-socio-economic implications. Regrettably, in the US there has been a 30% increase in the age-adjusted prevalence of obesity between 1980 and 1994. Obesity is a major health problem that needs to be urgently addressed.

The book Obesity, edited by Barry Gumbiner, MD, translates the current state of knowledge about obesity into clinical practice and provides a framework for its management in the primary care setting. The text is 331 pages long and is divided into 12 chapters. The text is well spaced; headings, and subheadings facilitate its reading. Key points listed at the end of each chapter further emphasize the main points and facilitate future reference to the text.

The first three chapters discuss the epidemiology, etiology, and implications of obesity. The fourth chapter, perhaps one of the most important chapters, reviews the medical complications of intentional weight loss. This is a topic that is often overlooked. The medical assessment and treatment of obese patients are discussed in the fifth chapter. Each of the following five chapters is devoted to a different treatment strategy: nutritional intervention, physical activity, behavioral treatment, pharmacological therapy, and surgery. Chapter 11 lifts the veil on possible future therapeutic modalities. The last chapter discusses weight loss recidivism and relapse prevention. Three case histories are discussed at the end of the book.

The hands-on experience of the various authors is transparent. The text is concise, filled with practical information, and very well written. It is targeted to the practicing clinician but will also be useful to a number of health care professionals. The magnitude of obesity is such that this condition will be curtailed only if there is a concerted interdisciplinary effort to address it. This book is a mustread for all health care professionals.