Book Review

Eating Disorders and Obesity: A comprehensive handbook

N Engl J Med 1996; 334:804March 21, 1996

Article

Eating Disorders and Obesity: A comprehensive handbook
Edited by Kelly D. Brownell and Christopher G. Fairburn. 583 pp. New York, Guilford Press, 1995. $55. ISBN: 0-89862-850-4

The introduction of a new “comprehensive handbook” stirs up curiosity and expectation among clinicians striving to keep pace with the rapidly evolving world of diet, body image, eating disorders, and obesity. Epidemiologists advise us that up to a third of the U.S. adult population is substantially overweight. Meanwhile, the popular press repeatedly touts the promise of appetite control and weight regulation through yet another newly discovered neuropeptide or hypothalamic receptor, often before the medical journal reporting the finding arrives in the mail.

The scope of this new compendium is impressive, with 101 chapters contributed by a distinguished roster of internationally recognized investigators and clinicians. descriptive titles guide the reader through nine major sections.

The first three sections present background material from clinical and preclinical investigations. “Regulation of Eating and Weight” succinctly reviews the fundamentals of appetite regulation and energy balance, from studies of neurotransmitters to genetics. “Dieting and Body Image” covers social and cultural influences on body weight, body image, and dieting. “Measurement” discusses the assessment of body composition, food intake, energy expenditure, physical activity, and the psychopathology of eating disorders.

Chapters related to the eating disorders bulimia nervosa and anorexia nervosa are grouped in the next four sections, and obesity is covered in the final two. These clinical units cover diagnostic classification, historical perspectives, cause and physiology, psychiatric and medical coexisting conditions, natural history, and treatment. There are 15 chapters in the unit on the treatment of eating disorders, and 20 chapters on the assessment and treatment of obesity. Virtually every major approach to treatment is summarized, from nutritional counseling to cognitive behavioral therapy and from psychodynamic therapy to pharmacotherapy.

The user-friendly nature of the book is apparent in the readability of the individual chapters. Each is self-contained, resembling a brief encyclopedia article, and reflects the experience and point of view of an expert in the field. The chapters are remarkably consistent in format and style. Given the semiautonomous nature of chapters in a handbook, there are unavoidably some areas of overlap. The definition of body-mass index is repeated a number of times, for example. There are remarkably few areas of substantive duplication in coverage, however, and these are carefully cross-referenced.

A distinctive feature of the handbook derives from the editors' instructions for each contributor to avoid the use of specific bibliographic references and instead to list up to 10 sources for further reading. This strategy fits excellently with the handbook concept, although occasionally the discussion of a specific study may seem incomplete without an accompanying reference. The listings of sources that conclude each chapter are comprehensive and up to date, and it is particularly helpful that each citation is accompanied by a brief annotation.

Looking back over the book, I am reminded of the editors' comments in the preface regarding “the regrettable separation of the eating disorders and obesity fields.” They observe that “the fields have different emphases, with the obesity field being dominated by medical perspectives and concerns about physiology and health risk, and the eating disorders field having stronger roots in psychology, psychiatry, and the social sciences.” For clinicians and investigators, this outstanding handbook should help to bridge the historical gap between those fields.

David C. Jimerson, M.D.
Beth Israel Hospital, Boston, MA 02215