Book reviews

Obesity is now recognized as the most important nutritional problem of the richer societies but increasingly also of the third world. It is therefore not surprising that the literature on this subject is as massive as the problem. This is yet another textbook on the subject, so is it worth a second glance? Possibly yes. As usual this is a multiauthor book comprising 35 chapters subdivided into six sections. There are the usual expected chapters on the ‘global problem’, epidemiology, body composition, appetite control, macronutrient balance, exercise, energy expenditure, central obesity and treatment modalities. There are, however, some interesting new approaches to the design of this particular textbook especially relevant to healthcare delivery. Lindahl discusses screening of the population, especially in relationship to obesity and type 2 diabetes mellitus, providing worldwide examples and experiences of selective programmes. The waist measurement technique and its correlation with morbidity described in the chapter by Han and Lean may well be a useful simple device to use for population screening. ‘Social and cultural influences on obesity’ is another novel chapter and the addition of a complete section on weight gain in pregnancy and puerperium is comprehensive. Both are fascinating reviews, rarely discussed to this depth in textbooks and are to be welcomed. The editor (Per Björntorp) has a particular interest in stress and therefore the reader will not be disappointed for he has included a chapter on social status, social stress and their effect on fat distribution (albeit in primates) that illustrates the importance of environmental interactions. Besides the usually expected chapters on the role of neuropeptides, hormonal abnormalities and dietary fat, a review is included by Walker and Seckl on their interesting research on the cortisol–cortisone shuttle and its possible role in the development of central obesity. The section on complications provides in-depth reviews on the metabolic syndrome, cardiovascular disease, cancer, pulmonary conditions and gallstones. There is also a section on the risks of weight loss as well as the usual description of health benefits. In keeping with the modern way of thinking the editor has included a chapter on quality of life measures as used in obesity evaluation. The book ends with a short review on surgical treatments by Kral, and then a welcome update on the Swedish obesity trial on the longterm outcome of bariatric surgery compared to conventional therapy. So what is missing and should have been included? I would have liked to have seen a detailed review on health economics for all modalities of obesity therapy and prevention measures. With the rising prevalence of obesity in children a complete detailed description on this topic would have been welcomed. As obesity in the elderly is an issue in the rising incidence of type 2 diabetes I would have wished to read a more expansive discourse on obesity in the elderly rather than the few paragraphs provided. Overall, there are some interesting additions in this textbook which warrant its inclusion in the specialist’s library. However, a better option would be the introduction of website retrieval on a chapter by chapter basis as a more useful and cost effective method of acquiring those sections of interest to the specialist.