Per Bjorntorp and Bernard N. Brodoff; eds. 805 pages. Philadelphia: J.B. Lippincott Company; 1992. $69.50.

The first law of thermodynamics is as far as some physicians progress in their understanding of obesity. Armed with this basic tool, hundreds of doctors entered the field of bariatrics during the 1980s in response to a phenomenal consumer demand. The demand has since subsided, but the problem of obesity will never again be relegated to the shadowed corners of medicine. Obesity is now recognized as a major public health problem, and the medical profession has attained a new appreciation of its complexities. Anyone who is serious about understanding or treating obesity should read this book.

This text is the most comprehensive on the subject published to date. Ninety-five researchers and clinicians from 12 countries on five continents contribute reviews covering energy and fat metabolism; body composition techniques; animal models of obesity; genetic, physiologic, and psychosocial aspects of obesity; hunger and satiety issues; medical problems associated with obesity; and treatment options.

The strengths of this text are discussions of metabolism and physiology. Several chapters are outstanding, including Heymsfield and colleagues' overview of body composition assessment, Flatt's review of the biochemistry of energy expenditure, and chapters on fat-cell metabolism by Lonnroth and Smith and by Himms-Hagen. Other well-written chapters of metabolic interest include a review of neurotransmitters, hormones, and eating behaviors, and a review of hibernation metabolism.

Bray draws from his vast experience to describe his approach to the classification and evaluation of obesity. Bouchard defines the role of heredity in human obesity. Gibbs and Smith contribute a review on gut peptides and satiety, and Cornford and Cornford explain blood-brain barrier regulation. Topics pertinent to clinical practice include treatment indications, weight cycling, exercise, and surgical and pharmacologic treatment options.

The major flaw of this text is the editing. A textbook intended for such a broad audience ("the basic researcher, medical clinician, nurse, dietitian and nutritional expert, social worker, house staff officer, medical student, and medical educator") should not begin with two dense chapters on intermediary metabolism. Four chapters devoted to techniques of body composition assessment encourages redundancy. The section titled "Associated Health Impairments" contains four overlapping chapters discussing obesity and the heart, hyperlipidemia, atherosclerosis, and hypertension but virtually ignores the relation between obesity and cancer. Other chapters could have been reorganized among different sections and one or two chapters could have been omitted entirely. Minor changes that would improve this book include outlines at the beginning of each section and for each chapter and consistent use of "summary and conclusion" sections at the end of each chapter.

Despite these editorial deficiencies, this book is worth reading for anyone with more than a passing interest in the areas of obesity or energy metabolism. The text contains a wealth of information here for experienced clinicians and researchers; and those entering the field will find many outstanding, readable reviews.