A retrospective view of obesity

To gain a perspective on 'obesity in the nineties' requires an understanding of where the field came from during the 1980s. Three main themes seem to characterize much of the research during the 1980s. First there was completion of development of multi-disciplinary treatment programmes utilizing the best behavioural modification, nutrition education, exercise and on occasion pharmacological adjuncts. Most characteristic of all was the widespread use of very low calorie diets which first appeared at the beginning of the decade and peaked at its end. The second major development of the 1980s was the recognition of the importance of fat distribution in addition to total fat as a risk factor for the consequences of obesity. Finally, the 1980s saw the development of serotonin agents and the initial studies with beta adrenergic agonists for the treatment of obesity based on the concepts of nutrient partitioning and reduced sympathetic activity. As we enter the 1990s, three additional themes appear to be in the ascendancy. The first will be the emphasis on molecular mechanisms as an explanation for the genetic diversity of obesity, including fat distribution. The second will be the focus on strategies for prevention of obesity. The third will be the development of newer and more innovative techniques for treating that obesity which we cannot prevent.