Handbook of Eating Disorders and Obesity
A handbook that is intended to cover clinical research and practice in the area of eating disorders and obesity should be representative of the field, provide critical guidance, and be accessible to the nonspecialist. According to these criteria, this handbook succeeds. It accurately portrays progress and problems. In the chapters that involve science -- such as genetics, the epidemiology of risk factors, diagnosis, and therapeutic outcomes -- the writing is clear and critical. In the chapters in which science is thin or nonexistent, the authors acknowledge that fact while advocating various therapies (e.g., interpersonal, cognitive and dialectical-behavioral, family, feminist, and pharmacologic), an increased awareness of cultural differences, the need to combat the "toxic environment" of fast foods, the importance of childhood sexual abuse, the psychological and economic issues related to cosmetic surgery, and the role of the media in shaping the perception of desirable bodies. Four of the 35 chapters concern disturbances in body image and body dysmorphic disorder. The discussions in these chapters are based on the plausible idea that dissatisfaction with one's body is a predictor of eating disturbances and that "internalization of the thin ideal [mediates] between sociocultural pressures and body dissatisfaction." Given that most, if not all, adolescents have some complaint about their bodies, research must identify the specific links among body dissatisfaction, eating disorders, and obesity. Research should also clarify why so many of those who are dissatisfied with their bodies and live among media-generated fantasies of thinness, "fat talk," and fast foods do not have anorexia nervosa, bulimia nervosa, or severe obesity. The factors that protect young people from these disorders may be the most useful source of new information for the development and implementation of effective preventive measures. Three chapters discuss eating disorders and obesity in childhood and adolescence. The large increase in childhood obesity in the past decade is ominous, and so is the lack of a robust research effort in this area. It is a truism of public health that the earlier detection and intervention occur, the bigger the payoff for the afflicted person in terms of personal satisfaction, social function, and physical health. The savings in costs of health care and increased economic productivity are much larger than any that can be gained by intervention in the case of adults. A final point: this handbook reflects the field's baffling failure to use test meals to understand the disorders of eating. One of 750 pages of text mentions test meals, cites a statement from 1990 that test meals are "the quintessence of behavioral assessment of eating disorders," and then notes that "test meals do not appear to be used widely as an assessment tool." This is like being interested in the diagnosis and treatment of sleep disorders without measuring sleep. A reader could not learn from this handbook that test meals had been measured under laboratory conditions in research involving people with eating disorders or obesity. Given that test meals are an unambiguous, quantitative, and defining phenotype and are a proven bridge for translation between the clinic and animal models, the resistance to their use requires analysis.Gerard P. Smith, M.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.