Book Review

Obesity Epidemiology

N Engl J Med 2008; 359:1299-1300September 18, 2008

Article

Obesity Epidemiology
Edited by Frank B. Hu. 498 pp., illustrated. New York, Oxford University Press, 2008. $55. ISBN: 978-0-19-531291-1

Obesity is ultimately the result of an imbalance between energy intake and energy expenditure, but this simplistic equation belies the fact that obesity is also a multifactorial disease with complex causes. The prevalence of obesity has increased globally, and research on obesity has proliferated in fields ranging from nutrigenomics to sociology to urban planning. Yet this surge of interest in obesity has not always been matched by a full appreciation of its complexity. Unraveling this complexity and understanding the many methodologic and analytic approaches to studying the causes and consequences of obesity form the basis of Obesity Epidemiology.

The book's chapters are organized into three parts. Part 1, “Study Designs and Measurements,” provides detailed background information while adding important insight into broad issues related to obesity epidemiology. Highlights of this section include discussions of causal inference, the unique biases stemming from obesity as a dynamic and visible condition, and the importance of obtaining accurate measures of underlying obesity-related behaviors such as diet and physical activity. Part 2, “Epidemiologic Studies of Consequences of Obesity,” presents current issues related to the health consequences and the societal consequences of obesity. Particularly noteworthy are the discussions related to viewing adipose tissue as an endocrine organ, decomposing the methodologic factors that can bias the relationship between obesity and mortality, and quantifying the economic costs of obesity. In part 3, “Epidemiologic Studies of Determinants of Obesity,” some of the more interesting discussions relate to the biologic mechanisms of sleep deprivation and its relationship to obesity, critical evaluation of the thrifty gene hypothesis, and gene–environment interactions. All three sections of the book will be valuable to researchers and clinicians, but the second and third sections are arguably more provocative and interesting than the first — the background information in this section may be more compelling to those new to the field.

Hu proves to be an intellectually agile author, providing insight and innovation as he moves from substantive and statistical issues to biologic mechanisms and genetics. Hu wrote most of the chapters in the book, with several leading scientists providing other chapters on specialized topics — such as the excellent chapter by Eugenia Calle on obesity and cancer. Woven throughout the book are discussions of current, cutting-edge methodologic approaches, such as structural equation modeling, propensity score methods, and principal components methods to adjust for population stratification. Hu extols the virtues of these new approaches but casts a careful and critical eye on what these methods can and cannot do.

The book is well balanced, with enough detail to satisfy researchers with substantial knowledge in specific areas of obesity research who may wish to learn more about other areas, yet written with a clarity that is basic enough for researchers new to the area of obesity. Although the book is not specifically geared toward treatment, clinicians will gain from its knowledge base. Key assets of the book include the outstanding tables, which provide summaries of obesity research on varied topics, an assessment of technical measurement issues, and the interpretation of weight-related measures in the context of statistical modeling frameworks. Another major strength is the way the book persistently delves into current controversies in obesity epidemiology, with attention to sources of bias, reverse causality, measurement error, and the analytic pitfalls that underlie these controversies.

Obesity, as Hu points out, is a dynamic condition, with social, behavioral, and biologic determinants. It is not possible to read the book without gaining an appreciation for the profound complexity of obesity. It sheds light on the analytic methods that will help to advance our understanding of the causes and consequences of obesity. Most important, the book is provocative, intellectually challenging, and sure to stimulate new ideas in the rapidly growing field of obesity research.

Penny Gordon-Larsen, Ph.D.
University of North Carolina, Chapel Hill, Chapel Hill, NC 27516
pglarsen@unc.edu

Citing Articles (1)

Citing Articles

1. 1

   Deepak Gupta. (2009) Moribund Obesity as a Palliative Care Diagnosis. Journal of Palliative Medicine 12:6, 515-516
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