The medical syndrome of obesity

Obesity is one of the most common medical disorders and perhaps the least responsive to usual medical therapeutic approaches. The syndrome is often defined as greater than 20 per cent above ideal body weight for height; however, vagaries in establishing this relationship result in significant differences in estimates of its incidence. The effects of obesity on health are broad indeed and include many disorders, hypertension being the most consistently associated and potentially most lethal. Despite this significance, the medical practitioner's ability to treat obesity is severely restricted by inadequate training in nutrition, the nearly complete failure of the usually prescribed caloric-restricted diet, and most importantly, the inappropriateness of the mode generally used in medical practice to address the complex interactions between diet, exercise, and behavior that are manifest in obesity. Failure on behalf of the medical community to address the problem has resulted in a commercial industry that consumes billions of dollars annually. Highly ethical, medically based alternatives to these commercial interests do not exist. Perhaps what is needed is the establishment of medical facilities that will provide practicing physicians, dietitians, nurses, and other health professionals with the capacity to bring to bear optimal dietetic intervention, exercise conditioning, and modifications of eating and exercise behavior as therapy for this complex medical disorder.