so they crave water instead of food. Walnuts contain
serotonin, the brain chemical that tells the body it
has eaten enough. Dandelion (Taraxacum officinale)
can raisemetabolismand counter a desire for sugary
foods.
Acupressure and acupuncture can also suppress
foodcravings. Visualization and meditation can cre-
ate and reinforce a positive self-image that enhances
the patient’s determination to lose weight. By improv-
ing physical strength, mental concentration, and emo-
tional serenity, yoga can provide the same benefits.
Also, patients who play soft, slow music during meals
often find that they eat less food but enjoy it more.
Getting the correct ratios of protein, carbohy-
drates, and good-qualityfatscan help in weight loss
via enhancement of the metabolism. Support groups
that are informed about healthy, nutritious, and bal-
anced diets can offer an individual the support he or
she needs to maintain this type of eating regimen.
Prognosis
As many as 85% of dieters who do not exercise on
a regular basis regain their lost weight within two
years. In five years, the figure rises to 90%. Repeatedly
losing and regaining weight (yo yo dieting) encourages
the body to store fat and may increase a patient’s risk
of developing heart disease. The primary factor in
achieving and maintaining weight loss is a life-long
commitment to regular exercise and sensible eating
habits.
Prevention
Obesity experts suggest that a key to preventing
excess weight gain is monitoring fat consumption
rather than counting calories, and the National Cho-
lesterol Education Program maintains that only 30%
of calories should be derived from fat. Only one-third
of those calories should be contained in saturated fats
(the kind of fat found in high concentrations in meat,
poultry, and dairy products). Because most people eat
more than they think they do, keeping a detailed food
diary is a useful way to assess eating habits. Eating
three balanced, moderate-portion meals a day—with
the main meal at mid-day—is a more effective way to
prevent obesity than fasting or crash diets. Exercise
increases the metabolic rate by creating muscle, which
burns more calories than fat. When regular exercise is
combined with regular, healthful meals, calories con-
tinue to burn at an accelerated rate for several hours.
Finally, encouraging healthful habits in children is a
key to preventingchildhood obesityand the health
problems that follow in adulthood.
New directions in obesity treatmentThe rapid rise in the incidence of obesity in the
United States since 1990 has prompted researchers to
look for new treatments. One approach involves the
application of antidiabetes drugs to the treatment of
obesity. Metformin (Glucophage), a drug that was
approved by the Food and Dug Administration
(FDA) in 1994 for the treatment of type 2 diabetes,
shows promise in treating obesity associated with insu-
lin resistance.
Another field of obesity research is the study of
hormones, particularly leptin, which is produced by
fat cells in the body, and ghrelin, which is secreted by
cells in the lining of the stomach. Both hormones are
known to affect appetite and the body’s energy bal-
ance. Leptin is also related to reproductive function,
while ghrelin stimulates the pituitary gland to release
growth hormone. Further studies of these two hor-
mones may lead to the development of new medica-
tions to control appetite and food intake.
A third approach to obesity treatment involves
research into the social factors that encourage or rein-
force weight gain in humans. Researchers are looking
at such issues as the advertising and marketing of food
products; media stereotypes of obesity; the develop-
ment ofeating disordersin adolescents and adults;
and similar questions.Resources
BOOKS
Beers, Mark H., MD, and Robert Berkow, MD, editors.
‘‘Nutritional Disorders: Obesity.’’ Section 1, Chapter 5.
InThe Merck Manual of Diagnosis and Therapy.
Whitehouse Station, NJ: Merck Research Laborato-
ries, 2004.
Flancbaum, Louis, MD, with Erica Manfred and Deborah
Biskin.The Doctor’s Guide to Weight Loss Surgery.
West Hurley, NY: Fredonia Communications, 2001.
Pi-Sunyer, F. Xavier. ‘‘Obesity.’’ InCecil Textbook of Med-
icine. edited by Russel L. Cecil, et al. Philadelphia, PA:
W. B. Saunders Company, 2000.
PERIODICALS
Aronne, L. J., and K. R. Segal. ‘‘Weight Gain in the Treat-
ment of Mood Disorders.’’Journal of Clinical Psychia-
try. 64, Supplement 8 (2003): 22–29.
Bell, S. J., and G. K. Goodrick. ‘‘A Functional Food Prod-
uct for the Management of Weight.’’Critical Reviews in
Food Science and Nutrition. 42 (March 2002): 163–178.
Brudnak, M. A. ‘‘Weight-Loss Drugs and Supplements: Are
There Safer Alternatives?’’Medical Hypotheses.58
(January 2002): 28–33.Obesity