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Obesity Discussion · 05-20-06, 02:34 PM

Book Review- Clinical Obesity in Adults and Children

Second edition. Edited by Peter G. Kopelman, Ian D. Caterson, and William H. Dietz. 493 pp., illustrated. Malden, Mass., Blackwell, 2005. $199.95. ISBN 1-4051-1672-2.

With 64 percent of adults in the United States now considered overweight or obese, physicians can no longer choose to ignore the problem, which presumably more than half their patients have. However, physicians still face several barriers to treating obesity, including lack of time to teach patients about diet and exercise as a result of busy clinical practices, lack of insurance reimbursement, and lack of knowledge. The lack of knowledge about obesity stems from what students were taught in medical school in the past. Nutrition was discussed in perhaps one or two lectures, and we learned that the fat cell just sat there passively and did nothing. This view has been changing slowly, however, and there are now several medical schools across the country that actually give nutrition and obesity the time of day and teach the current dogma: that the fat cell is an endocrine organ. In fact, obesity medicine has recently emerged as a new discipline.

(Figure)

View larger version (67K):
[in this window]
[in a new window]

Color-Enhanced Scanning Electron Micrograph of Adipose Tissue, Showing Adipocytes.
David Gregory and Debbie Marshall/Wellcome Photo Library.

Considering that backdrop, this textbook is well timed and much needed. What differentiates it from the other obesity textbooks available is that its contributors are from around the globe, which makes this a truly international work and reflects the worldwide problem that obesity has become. Other countries face increases in the prevalence of obesity that are similar to that in the United States. The book's references, tables, and figures that describe the prevalence and epidemiology of obesity in other countries are refreshing. I only caution readers to keep in mind that they may not always be looking at data from the United States. As an obesity expert, I am thrilled to see obesity data from other nations — they make me feel as if I am not alone.

Another differentiating aspect of this textbook is that it gives adequate coverage of childhood obesity, a discipline that is lagging behind that of adult obesity both clinically and in the laboratory despite the fact that 10 million children in the United States are now obese. Another plus is that one of the three editors, William H. Dietz, is arguably the most knowledgeable and well-known childhood obesity specialist in the United States.

Unique chapters in this textbook, including those on the social consequences of obesity and obesity and culture, reflect the diversity of the authors and the multicultural aspects of the development of obesity. The chapter on obesity and culture contains a superb discussion of the medicalization of obesity, in which the author writes that, although obesity is now considered a disease, obese people are still thought of as morally deficient. This discussion is important in understanding the obstacles that obesity medicine has faced in the past and still does to this day. Antiobesity medications are not covered by insurance; treatment programs for obesity are not covered by insurance; diagnostic procedures for diseases that are coded as "unspecified obesity" according to the International Classification of Diseases, 9th Revision, Clinical Modification, are not covered by insurance; and bariatric surgery has only recently become a respected procedure, having received mostly unfriendly media coverage in some areas of the United States.

Reflecting the new knowledge gained from recent advances in research, the book has excellent chapters on caloric requirements and energy expenditures of patients with obesity, eating behavior and the biology of hunger, and pharmacotherapy and surgery as treatments for obesity. Because the risks to health from adiposity may differ among ethnic groups, there is a separate chapter on obesity in Asian populations. Lastly, because of the ever-rising prevalence of obesity in most countries, efforts have been focused on prevention as the key to halting the epidemic — and this book contains a chapter that covers environmental and policy approaches to obesity, as well as one about the prevention of obesity.

In addition to these unique chapters, there are the expected chapters — on obesity and coexisting illnesses such as hyperlipidemia, heart disease, the metabolic syndrome, and diabetes — that are comprehensive and chock-full of figures and tables. A special chapter on hormones and obesity contains important information, of which all physicians should be aware, about interpreting the results of endocrine tests in patients who are obese.

In summary, this unique and comprehensive textbook on obesity has a distinctly international flavor and should be considered mandatory reading for any medical subspecialist or primary care physician who takes care of patients who are obese. The book is also comprehensive enough to be considered for medical students.

Caroline M. Apovian, M.D.
Boston University School of Medicine
Boston, MA 02118
caroline.apovian@bmc.org

05-20-06, 02:34 PM	#1 (permalink)
Obesity Discussion Administrator Join Date: Jan 2005 Location: Phoenix, AZ Posts: 7,874 Weight Statistics 8/1/2006 Start Date: 185 lb Start Weight: 152 lb Current Weight: 155 lb Goal Weight: -33 lb Weight Loss: 5/1/2007 Goal Date:	Book Review- Clinical Obesity in Adults and Children Book Review- Clinical Obesity in Adults and Children Second edition. Edited by Peter G. Kopelman, Ian D. Caterson, and William H. Dietz. 493 pp., illustrated. Malden, Mass., Blackwell, 2005. $199.95. ISBN 1-4051-1672-2. With 64 percent of adults in the United States now considered overweight or obese, physicians can no longer choose to ignore the problem, which presumably more than half their patients have. However, physicians still face several barriers to treating obesity, including lack of time to teach patients about diet and exercise as a result of busy clinical practices, lack of insurance reimbursement, and lack of knowledge. The lack of knowledge about obesity stems from what students were taught in medical school in the past. Nutrition was discussed in perhaps one or two lectures, and we learned that the fat cell just sat there passively and did nothing. This view has been changing slowly, however, and there are now several medical schools across the country that actually give nutrition and obesity the time of day and teach the current dogma: that the fat cell is an endocrine organ. In fact, obesity medicine has recently emerged as a new discipline. (Figure) View larger version (67K): [in this window] [in a new window] Color-Enhanced Scanning Electron Micrograph of Adipose Tissue, Showing Adipocytes. David Gregory and Debbie Marshall/Wellcome Photo Library. Considering that backdrop, this textbook is well timed and much needed. What differentiates it from the other obesity textbooks available is that its contributors are from around the globe, which makes this a truly international work and reflects the worldwide problem that obesity has become. Other countries face increases in the prevalence of obesity that are similar to that in the United States. The book's references, tables, and figures that describe the prevalence and epidemiology of obesity in other countries are refreshing. I only caution readers to keep in mind that they may not always be looking at data from the United States. As an obesity expert, I am thrilled to see obesity data from other nations — they make me feel as if I am not alone. Another differentiating aspect of this textbook is that it gives adequate coverage of childhood obesity, a discipline that is lagging behind that of adult obesity both clinically and in the laboratory despite the fact that 10 million children in the United States are now obese. Another plus is that one of the three editors, William H. Dietz, is arguably the most knowledgeable and well-known childhood obesity specialist in the United States. Unique chapters in this textbook, including those on the social consequences of obesity and obesity and culture, reflect the diversity of the authors and the multicultural aspects of the development of obesity. The chapter on obesity and culture contains a superb discussion of the medicalization of obesity, in which the author writes that, although obesity is now considered a disease, obese people are still thought of as morally deficient. This discussion is important in understanding the obstacles that obesity medicine has faced in the past and still does to this day. Antiobesity medications are not covered by insurance; treatment programs for obesity are not covered by insurance; diagnostic procedures for diseases that are coded as "unspecified obesity" according to the International Classification of Diseases, 9th Revision, Clinical Modification, are not covered by insurance; and bariatric surgery has only recently become a respected procedure, having received mostly unfriendly media coverage in some areas of the United States. Reflecting the new knowledge gained from recent advances in research, the book has excellent chapters on caloric requirements and energy expenditures of patients with obesity, eating behavior and the biology of hunger, and pharmacotherapy and surgery as treatments for obesity. Because the risks to health from adiposity may differ among ethnic groups, there is a separate chapter on obesity in Asian populations. Lastly, because of the ever-rising prevalence of obesity in most countries, efforts have been focused on prevention as the key to halting the epidemic — and this book contains a chapter that covers environmental and policy approaches to obesity, as well as one about the prevention of obesity. In addition to these unique chapters, there are the expected chapters — on obesity and coexisting illnesses such as hyperlipidemia, heart disease, the metabolic syndrome, and diabetes — that are comprehensive and chock-full of figures and tables. A special chapter on hormones and obesity contains important information, of which all physicians should be aware, about interpreting the results of endocrine tests in patients who are obese. In summary, this unique and comprehensive textbook on obesity has a distinctly international flavor and should be considered mandatory reading for any medical subspecialist or primary care physician who takes care of patients who are obese. The book is also comprehensive enough to be considered for medical students. Caroline M. Apovian, M.D. Boston University School of Medicine Boston, MA 02118 caroline.apovian@bmc.org __________________