Preface to the Second Edition

The publication of the first edition of the Handbook of Obesity occurred just as the Food and Drug Administration requested the recall of fenfluramine and dexfen-fluramine. Each drug alone and in combination with phentermine had been associated with a rash of valvular heart disease. These cases were similar to some seen with the carcinoid syndrome that secretes serotonin. There was an accumulation of material on the aortic valves in the heart that made them leaky. The good news is that many of these valvular lesions have been reversible when the drugs were discontinued, and there are no cases known to us of progression after the drugs were stopped.

Thus, at the time the first edition of the Handbook of Obesity was published, the chapters dealing with fen-fluramine and combination therapy were already out of place. In addition, there were few drug treatments on the horizon.

In spite of this negative impact, the scientific advances preceding the publication of the first edition had been substantial. As we began to plan the second edition, we reviewed each of the 49 chapters in the first edition. The major changes were in the therapeutic area where many new drugs were under evaluation and where new strategies for prevention of obesity were being evaluated.

Based on these advances in the therapeutic area, we added 12 new chapters, which made a substantially longer volume with 61 chapters. We thus decided to divide the handbook into two separate volumes. The first deals with the prevalence, etiology, and consequences of obesity. In the second volume we have included the chapters dealing with evaluation, prevention, and treatment.

In this volume we cover the history, definition, prevalence, etiology, and pathophysiology of obesity. The prevalence of obesity continues to increase rapidly (Chaps. 4, 6, and 7). At present more than 60% of adult Americans are overweight and more than 30% are obese. Important ethnic differences led to the addition of a chapter dealing with this important subject (Chaps. 2 and 3). We also have a new chapter on the fetal origins of obesity and the impact that the intra-uterine environment has on future risks for developing obesity. The costs of obesity have become more important for individual nations, and the chapter on this subject has been expanded (Chap. 8).

Genetic and molecular biology are important areas for research and are promising the pharmaceutical industry new approaches to the problem (Chaps. 9 and 10). The importance of animal models has resulted in the addition of a second chapter on this area (Chap. 12). The regulation of food intake in animals and humans provides important new insights into the ways they choose and regulate their energy intake (Chaps. 1316). The epidemic of AIDS has added a new variety of fat accumulation associated with treatment with proteases and we have added a chapter to cover this area (Chap. 19). The importance of visceral and total body fat continues to expand. One of the key new developments of the 1990s was the recognition that the fat cell is one of the most important endocrine cells in the body. We have recognized this with several chapters on adipose tissue (Chaps. 17,18,20,21, and 22). We have also recognized the importance of obesity in the function of the classical endocrine glands such as the adrenal, thyroid, pituitary and gonads (Chaps. 25, 26, and 27). The other side of the energy balance from food intake is energy expenditure. This subject too receives substantial discussion in several chapters (Chaps. 23, 24, and 28). Muscle metabolism and nutrient partitioning are the final two chapters in this section.

Obesity has a myriad of effects on the health of human beings. Obesity increases the risk of death, as discussed in Chapter 31. The metabolic syndrome, as a collection of findings that predict health risks, has become considerably more important in the past decade and has been discussed by one of the scientists who originated this concept (Chap. 32). We have also invited chapters dealing with the cardiovascular system, blood pressure, lipoproteins, diabetes, gall bladder disease, pulmonary function, arthritis, and pregnancy. To end this volume we have included a discussion of the role of physical activity in health and the effect of obesity on the quality of life (Chaps. 42 and 43).

We are indebted to a number of people for this volume. Ms. Nina Laidlaw and Ms. Heather Miller at the Pennington Biomedical Research Center have provided able assistance to the editors. At Marcel Dekker, Inc., Ms. Moraima Suarez has taken the principal role. We are both indebted to each of these three people. Without the excellent writing from each of the authors and their collaborators, we would not have the superb chapters that make up this volume. We thank all of them.

George A. Bray Claude Bouchard a

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