As
a practicing bariatric surgeon and as part of the team that has redesigned
the Kaiser Permanente Northwest (KPNW) program for weight management
and severe obesity, I found much of value in this primer on obesity.
For those who are interested in a comprehensive review of current thinking
on this topic, this compendium of 624 pages is well written and well
organized. However, it will not be useful as a guide to developing an
obesity treatment program.
The
contents of this handbook follow a clear path from etiology of obesity,
its consequences, and its prevalence to assessment, treatment, and prevention.
For those practitioners who have not had substantial exposure to past
and current thinking about obesity management, this book will provide
a clear and concise overview. The numerous contributing editors are
from varied disciplines, including psychiatry, psychology, medicine,
surgery, molecular biology, pediatrics, epidemiology, nutrition, diabetes
education, neurobiology, behavioral medicine, and research. Differences
in writing style are invisible in this collection.
The
chapters on etiology, consequences, and prevalence include exploration
of genetic influences, the universal nature of obesity, and the tension
between individual and public health views of obesity. The long-term
physical health consequences of this disorder are enormous, especially
for a health care entity. The psychologic aspects are reviewed extensively
and reinforce the current health care financing dilemma that results
from not all therapeutic options being covered by insurance. The medical
and behavioral health assessment section is complete, though somewhat
disappointing because it does not review differences between the overweight
population and the morbidly obese population.
The
chapters on treatment provide practitioners an excellent review of published
experience with exercise, popular diets, medically supervised care,
drug treatment, and bariatric surgery. I read with particular interest
the surgical chapter and found it to be current but poorly illustrated.
Discussed in this chapter is the recent increase of the medical community's
faith in bariatric surgery as the answer for the obesity problem. This
chapter deals with the success of surgery but does not explore or analyze
the complex psychosocial factors that initially led to the condition.
In addition, the book does not mention appropriateness of candidacy;
readiness and contraindications for surgery; or elements of the comprehensive
program needed for care of patients who have surgery. The authors tie
performance failure of gastric restrictive operations to poor surgery,
continuous nibbling of food, and lack of exercise. Missing is any discussion
of the relation between surgical outcome and the patient's impaired
response to life stressors. Constant eating and lack of exercise are
widely recognized as factors that lead to weight regain and thus to
"failure of surgery," but this view of surgical failure is
needlessly simplistic and reflects a psychologic form of tunnel vision.
Chapters
cover commercial weight-loss programs, maintenance of weight loss, and
even a good review of treatment of patients from ethnic minorities;
however, this last topic is excluded from the assessment section of
the book. The book also discusses body image, eating disorders, and
nondieting approaches to weight loss and concludes by focusing on childhood
obesity and obesity prevention, with a review of the literature. A public
health view is explored through discussion of interesting interventions
in microenvironments (eg, worksite, cafeterias and restaurants).
The
complex and counterintuitive aspects of obesity management necessitate
broad background knowledge. This book covers a substantial breadth of
information and is recommended reading for clinicians who wish to explore
our newest public health problem. As a surgeon, I would not have been
able to find this information without using many texts; however, I found
that the sections within my expertise were weak and prejudicial.
