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California Department of Health
Office of Clinical Preventive Medicine
PO Box 997413, MS 7005
Sacramento, CA 95899-7413
E-mail: swillia8{at}dhs.ca.gov
Given the fact that over sixty percent of American adults are either overweight or obese, clinicians are being confronted with increasing demands to assess and treat overweight and obese clients. George A Bray's book Office Management of Obesity is not only timely but also much needed. His book was originally published as an issue of Primary Care: Clinics in Office Practice but has now been expanded to a hard-copy version, in which the number of chapters has increased from 14 to 17. The updated version also includes new chapters on the control of food intake, the metabolic syndrome, and the surgical treatment of obesity.
Bray has enlisted the help of many experts in the field of nutrition and obesity to write each of the various chapters. Because this is a multiauthored text, it allows each author to contribute his or her expertise to a comprehensive discussion of the various topics, which range from body composition to bariatric surgery. Although the text seems to be targeted primarily to physicians, it is a valuable resource for dietitians, behavioral scientists, nurses, and even bariatric surgeons who desire to enhance their background knowledge in the field of obesity. It includes a thorough discussion of the evaluation of body composition and a very informative chapter on the etiology and genetics of obesity. However, note that an incorrect body mass index (BMI; in kg/m2) range is cited for the definition of adult normal weight. The upper limit cutoff for normal weight is 24.9, not 25.9. The book also highlights recent advances in our understanding of the metabolic syndrome and the management of obese diabetic patients. It also includes informative chapters on diets and herbal preparations used in the treatment of obesity. Although the book is primarily focused on adults, it also includes a good chapter examining some of the problems associated with childhood obesity; however, the chapter is limited in its discussion of treatment modalities for children. Note that the author incorrectly cites the definitions of pediatric at risk for overweight and of pediatric overweight from the Centers for Disease Control and Prevention (CDC). The author uses the 97th percentile as the cutoff for BMI. The correct CDC definitions for at risk for overweight and for overweight are a BMI (by age and sex) at or above the 85th percentile but below the 95th percentile and a BMI at or above the 95th percentile (by age and sex), respectively.
Bray himself authored a very informative chapter on the risks of obesity. Here, he reviews several of the landmark studies on factors contributing to excess weight and mortality from obesity. Bray also devotes several chapters to the main focus of his book, office management of obesity, including discussions related to recent clinical guidelines and protocols from the National Institutes of Health, as well as behavioral and exercise strategies. These sections of the text could be enhanced by including specific clinical tools such as a weight-history questionnaire, clinical assessment tools, and educational handouts for obese patients such as nutrient intake surveys, exercise diaries, and goal-setting tools. Clinicians need practical tools as well.
The book includes 2 chapters devoted to the only 2 weight-loss medications approved by the Food and Drug Administration for the long-term management of weight loss, ie, sibutramine and orlistat. These chapters review recent research regarding the pharmacotherapeutics, clinical efficacy, and safety profiles of these 2 drugs. The text would be enhanced by a more thorough discussion of all classes of drugs used for weight management, both for long- and short-term weight loss.
The final chapter is devoted to the growing field of bariatric surgery. It reviews clinical indications, various surgical procedures, risks, and postoperative complications. This chapter highlights the need for additional research and understanding in the area of severe obesity and superobesity. Overall Bray's book is highly readable, informative, and an excellent resource for clinicians to get background information on a rapidly growing field of knowledge in the area of obesity.