The rising prevalence of obesity among children and adults is one of the most significantthreats to our nation’s health as we enter the 21st century. Among a host of disordersassociated with obesity that affect multiple organ systems, the escalating prevalence oftype 2 diabetes and conditions associated with the metabolic syndrome and cardiovasculardisease are the most worrisome. For these reasons, it is increasingly important forclinical endocrinologists and other health care providers to be informed about breakthroughsin obesity research and to become engaged in the clinical care of the obesepatient. Although our medical journals and the popular press are including more and morearticles about obesity-related topics, there is a need to sort, synthesize, and interpret thisinformation into a single readable text. Thus, the primary purpose of this volume of ContemporaryEndocrinology, entitled Treatment of the Obese Patient, is to inform clinicians ofrecent scientific advances in obesity research and to provide an up-to-date review of currenttreatment issues and strategies. To provide the most useful and authoritative text, wehave selected chapter authors who are not only experts in their fields of study but whoare also able to translate important and emerging concepts to the practicing clinician.

 

    The volume is divided into two parts. Part 1 covers new discoveries in the physiologicalcontrol of body weight, as well as the pathophysiology of obesity. The mostexciting breakthroughs in obesity research over the past decade have come from a growingappreciation of the critical pathways that control food intake, energy expenditure, andperipheral nutrient metabolism including the emerging evidence of the role of adiposetissue as an endocrine organ. Each of these evolving areas is covered in its entirety in thisvolume. Chapters 1 through 3 address the neuroregulation of appetite, the role of gutpeptides in providing peripheral signals of nutrient balance to the brain, and the newbiology of the endocannabanoid system. In Chapters 4 and 5, the pathophysiology ofadipokines and role of free fatty acids, insulin, and ectopic fat in the metabolicdysregulation of obesity are reviewed. Chapter 6 examines the provocative role of fetalorigins and birth weight in the causation of obesity. Finally, Chapters 7 and 8 provide acomprehensive review of new developments in body composition in health and disease,and the role of alterations of energy expenditure in the development of obesity.

 

    In Part 2, we turn to a range of issues that are central to the clinical managementof obese patients. This section begins with an informative review of the socioeconomicaspects of obesity. Chapters 10 through 12 address the comprehensive assessment andevaluation of the obese adult patient, the pathophysiology and approach to the patientwith polycystic ovarian syndrome, and management of the obese patient with diabetes.Chapters 13 through 15 provide an excellent review and discussion of three dietaryapproaches that have been advocated in the treatment of obesity—energy density, glycemicindex, and low-carbohydrate diets. The role of physical activity is covered in Chapter 16.Communication, counseling, and motivational interviewing, keys to changing patientbehavior, are considered in Chapter 17. Chapters 18 through 20 turn our attention to newdevelopments in the pharmacotherapy of obesity, surgical approaches and outcomes, andmanagement of micronutrient deficiencies in the postbariatric surgical patient. Lessonslearned from individuals who have succeeded in losing weight and maintaining a reducedobese state long term: members of the National Weight Control Registry are discussed inChapter 21. Lastly, a succinct summary of evaluation and management of the pediatricobese patient is reviewed in Chapter 22.

 

    Treatment of the Obese Patient is a timely and informative text for all health careproviders facing the challenges of helping their patients manage their weight. Our intentionis to provide a resource that will both stimulate and engage clinicians to take partmore successfully in the obesity-care process. We hope we have accomplished this goal.

 

Robert F. Kushner, MD

 

Daniel H. Bessesen, MD