There is little doubt that obesity has reached epidemic proportions in the United States. Although it is associated with multiple pathologic states, the pathogenesis of obesity and its causal relation to multiple risk factors have not been elucidated. As simple as it may appear, even the definition of obesity has not been uniformly agreed on. For example, a direct correlation between upper body adiposity (rather than simple adiposity) and cardiovascular diseases, gout, and diabetes was reported as early as 1947 but was ignored for years. Thus, if one is to deal with adiposity in any detail, the criteria for the establishment of obesity and regional adiposity must be of major concern. In addition, one needs to examine the recent provocative studies on the role of various genes and hormones. Finally, because most medical and dietary interventions so far have met with failure, new approaches must be evaluated in detail.

Readers should therefore welcome any work that deals with, or attempts to deal with, such topics in obesity. Although this book attempted to cover these three areas, it does not do so as thoroughly as one would have hoped. Little attempt is made to define obesity in light of newer methodologies, particularly in reference to body topography as "android" or "gynoid" habitus. In that regard, one cannot define these two terms without extensive discussion of the more recent evaluation methods of imaging techniques. Unfortunately, the chapters on these topics are limited.

In the area of pathogenesis, although the role of the endocrine glands has been described in some detail, the work cited is essentially limited to that of local investigators. Thus, the more exciting and provocative topics on the role of ob/ob genes in both animal and human obesity are missing. Furthermore, the intriguing subject of the ß₃-adrenergic receptor gene in regional adipocytes, which appear to be important in certain high-risk minority groups, is not mentioned at all.

A chapter on obesity in African Americans is of interest. However, similar discussions about other minority groups, such as Native Americans, Hispanics, and Asian Americans, who may have closely related problems and challenges, are completely missing. The discussion of therapeutic management is limited to monotherapy with certain agents, although the combined therapy that appears to be more effective is not discussed in detail. For example, the most recent work on the combined therapy of ephedrine and caffeine, which has been successful on a long-term basis, is totally ignored. It was interesting that surgical intervention, the only technique successful in the long-term management of obesity, is not addressed.

Despite the above shortcomings, certain commendable chapters are of great interest. These include chapter 10, on therapeutic weight loss and the need for guiding principles to protect fat-free mass during weight reduction; chapter 15, on multidisciplinary approaches to weight loss; and chapter 20, on the evolutionary aspects of diet and the composition of fatty acid diet and their relation to insulin resistance. The chapter titled "Food Control Training as a Successor to Dieting" was interesting, but little experimental evidence was cited to document the success of such a method.

In conclusion, it was difficult to recognize the audience to which this text was targeted. It is not comprehensive enough to satisfy investigators in the field of obesity but could possibly provide guidance for nutritionists in that field.