Obesity Management

A quarter of UK and a third of US adults are now defined as obese, and the trend has been growing steadily. In the past 20 years, researchers have amassed evidence that obesity, which once was primarily a matter of aesthetics, increases the risks of diabetes, arthritis, heart disease, cancer and a range of other serious diseases. The metabolic health of future generations depends on achieving environmental changes that can halt - and ultimately reverse - the obesity epidemic. In the meantime, there is a huge demand for treatment from those who are already obese.

A glance through the advertisements in many newspapers might suggest that we have obesity treatment sewn up. But despite the burgeoning popularity of commercial obesity treatments, it is a different story inside the healthcare system. The task of delivering treatment falls to a mixture of dieticians, physicians, psychologists and nurses. The greatest challenge comes from the fact that treatment outcomes are modest at best. Even the most successful treatments rarely achieve weight losses above the 5-10 per cent range, and many patients lose no weight at all; treatment is frustrating to patients and clinicians.

Obesity Management, launched early last year, aims to provide health professionals with information, inspiration and support in managing obese patients. It is a publication from the Centers for Obesity Research and Education (Core) in the US. The editors, scientist James O. Hill and physician Holly Wyatt, have distinguished research records, and are supported by an editorial board that is a list of the great and the good in obesity research. The journal's mission is to keep clinicians apprised of developments in the aetiology, treatment and prevention of obesity that have implications for day-to-day work in the clinic. The journal presents a positive, clean-cut image, with a trio of smiling, confident members of the editorial team or authors on the front cover of each of last year's issues.

The format for each issue is a mixture of simple science, an interview - so far rather anodyne - with a prominent investigator, and tools and tips for obesity management. There are also book reviews, sections for reports from constituent Core members and an invitation for readers to send in their own experiences of delivering care. There is not yet a section for "service users" (in this case, obese patients), who might add an interesting perspective.

The general tenor is sympathy for the plight of overweight people combined with a positive attitude towards treatment. The cynic might fear that the journal could be an organ of the pharmaceutical industry, designed to persuade physicians to prescribe more drugs and swell industry profits, but at least in the first volume there has been a balanced emphasis across treatment types. Bariatric surgery gets a sympathetic hearing, but rightly so, as it is the only treatment to produce real long-term success, albeit with a risk of rather serious side-effects. Most of the emphasis so far has been on the so-called gold standard approach, which consists of nutrition and exercise advice given in the context of evidence-based strategies for behaviour change. One of the trickiest problems for health professionals in this field is the tension between the modest outcomes of established treatments and the extravagant claims of the snake-oil salesmen peddling cures along the line of "eat as much as you like and still lose weight", "stick electrodes on while you watch TV and see the fat melt away" or "rub cream into your thighs and lose up to 10 inches".

Health professionals themselves are sometimes persuaded to pen dieting manuals, which show some of the same tendencies. The journal deals with these issues by gently chiding the authors of bestselling "scientific" weight-loss books for their more dramatic claims. It might be useful to speak up more strongly in this area, and a tougher "bad obesity science" section in the journal would not go amiss. "Political" (but with a small
"p") issues are also dealt with gingerly, and the article by Kelly Brownell in which he takes the food industry to task is given a health warning. But we can be pleased that it appears in the journal.

This journal certainly fills a gap. There are many high-quality specialist journals catering for scientists but they have an emphasis on genetics and, while this may represent the pinnacle of scientific progress, it is hardly useful for someone trying to run a weight-loss service.

Obesity Management aims to pass on what is clinically useful from the scientific journals, along with ideas from other clinicians. As someone running a research unit that includes clinical intervention research, I find the journal valuable. It is cheap, so most clinicians could afford it. Obesity Management should prove extremely useful to clinicians in this area, combining well-informed practical advice with a much-needed dash of encouragement and support.

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Jane Wardle