The Metabolic Syndrome and Obesity

1. Front Matter

   Pages i-xi

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2. The Problem

   1. Front Matter

      Pages 1-1

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   2. Definitions and Prevalence

      Pages 3-29

   3. How Do We Get Fat?

      Pages 31-66

   4. Costs, Pathology, and Health Risks of Obesity and the Metabolic Syndrome

      Pages 67-91

   5. Natural History of Obesity

      Pages 93-119

3. The Solutions

   1. Front Matter

      Pages 121-121

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   2. Evaluation, Prevention, and Introduction to Treatment

      Pages 123-145

   3. Diet

      Pages 147-172

   4. Behavior Modification

      Pages 173-184

   5. Physical Activity and Exercise in the Obese

      Pages 185-201

   6. Pharmacological Treatment of the Overweight Patient

      Pages 203-256

   7. Should We Treat the Metabolic Syndrome or Its Components?

      Pages 257-272

   8. Surgical Treatment for the Overweight Patient

      Pages 273-290

4. Back Matter

   Pages 291-303

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Thirty years ago, I published my first monograph on obesity (Bray, 1976). Many things have changed in these 30 years, but many have remained the same. Preparation of The Metabolic Syndrome and Obesity has given me a chance to survey the changes to the field and to present an update of the scientific information. In retrospect, I conclude that a major component of the current “epidemic” of overweight is not medical, not genetic, not psychological, and will not be effectively treated by “lifestyle” changes that require individual choices. We are all influenced by the prices of the goods we buy. With the reduction in food prices and distortion of commercially profitable products resulting from federal subsidies of corn, sugar, and rice, the food industry has been able to produce cheap, good-tasting, energy-dense foods and can sell them cheaply in large portion sizes. In contrast, foods like fruits and vegetables receive little in the way of subsidies, and are thus more expensive; thus we buy less. Providing more “healthy” food alternatives, as some advocate, will put items with “higher costs” on the shelves and is, in my view, unlikely to alter consumer choices as long as good-tasting, energy-dense foods remain cheap. HISTORICAL CONTEXT FOR OBESITY Obesity was already a problem before my first monograph was published. Between the writing of that monograph and The Metabolic Syndrome and Obesity, I was fortunate enough to find a short book in French, written by an American from Cincinnati named Worthington.

• amines
• health
• obesity
• prevention
• surgery
• diabetes

From the reviews:

"This book provides condensed coverage of the findings from basic and applied human research on obesity and the related disorders of diabetes … . The potential audience for this book includes biological scientists, behavioral scientists, health professionals, and interested individuals … . This is an excellent, up-to-date book on the causes and treatments of obesity. … it is possible to cover a broad area of obesity knowledge in a modest number of pages and thus is ideal for cover-to-cover read." (Dale A. Schoeller, Doody’s Review Service, April, 2008)

"Bray’s book, The Metabolic Syndrome and Obesity, would serve as a pragmatic tutorial. … Each chapter begins with a helpful list of take-home messages and ends with a rich supply of references. … The author also summarizes the weight-loss effects of a number of drugs approved for conditions other than obesity … ." (Eric Colman, Journal of the American Medical Association, Vol. 301 (15), April, 2009)

• Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge

  George A. Bray

Policies and ethics