(Edited by Peter G. Kopelman and Michael J. Stock. Malden, MA: Blackwell Science, 1998; 631 pp; $189.00)

This distinguished international textbook focuses on clinical and practical aspects of obesity and its treatment, while not neglecting the biological bases of these conditions.

Among the 23 well-written, easy-to-read, and generally well-illustrated chapters, there are many highlights. One chapter concerns the assessment of obesity and body composition, discussing the limits as well as the values of the body mass index (BMI) and stressed the utility of other measures of fat reserves and fat-free cell mass.

Another highlight was an elegant review of animal models, challenging several previous theoretical pillars, including set-point theory and diet-induced thermogenesis (for humans).

Molecular genetics continues to reveal new genes relevant to obesity almost week by week, and, although providing an excellent introduction, a textbook chapter on genetics is inevitably outdated before it is even printed. Several chapters focus on “fat topography,” the health implications of different patterns of fat distribution.

Direct clinical concerns are addressed in chapters related to cardiovascular disease, cancer, women’s health, pulmonary function (particularly disordered breathing, daytime sleepiness and sleep apnea), childhood obesity, and diabetes. (Here’s a take-home pearl: rates of non-insulin dependent diabetes are 80 times greater for individuals with a BMI >35 than among those with a BMI<23.)

Treatment sections respect real-world difficulties of achieving sustained improvement, and examine dietary, cognitive-behavioral, exercise, and pharmacological options (currently limited but very hopeful for the future), and increasingly safe and effective surgical methods for serious obesity.

A review of the benefits versus the risks of weight loss (one of whose authors is a Professor Lean!) concludes that benefits accrue from even modest weight loss, and there are few negative effects. The difficulties of promulgating pertinent public health programs at community levels bring us down to earth. Overall, this is an excellent text, although the price may be too rich for many students’ diets.

— J.Y.