The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance

In their book The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance, psychiatrists Sylvia R. Karasu, M.D., and T. Byram Karasu, M.D., have provided a volume designed to elucidate the complexities that explain why weight management is so difficult. In the service of this ambitious goal, the authors attempt to integrate findings from numerous domains of scientific inquiry to provide the reader with an inclusive resource for understanding obesity.

As rates of obesity have increased dramatically, with attendant increases in obesity-related morbidities and health costs, research in this area has burgeoned. The current obesity literature encompasses work in fields that range from macroeconomics to molecular biology. In this context, it is perhaps impossible for one book to summarize extant data, and as noted by the authors, information is out-of-date almost before reaching readers. Nevertheless, the authors present a densely packed tome, which includes an almost bewildering array of findings to illustrate the manifold factors that affect energy balance in humans.

Because eating is central to survival, the protection of adequate nutrition is guarded by numerous and overlapping central and peripheral processes that promote eating, which may no longer be adaptive in an environment characterized by an abundance of highly palatable, energy-dense foods and a decreased need for expending physical energy. This book is a good resource for an overview of the multiplicity of factors implicated in the etiology and maintenance of obesity, although the lack of an overarching conceptual framework for considering obesity as well as the density of the prose make it difficult to locate specific topics easily.

This reader would have welcomed a more cogent and compelling exposition of the important association between psychiatric dysfunction and weight problems from the perspective of practicing psychiatrists. A substantial and growing body of evidence has documented the relationship between obesity and a variety of psychiatric diagnoses, including mood and anxiety disorders, attention deficit hyperactivity disorder, binge eating disorder, and personality disorders. Moreover, and perhaps related to shared or overlapping etiologic factors, the use of many psychiatric medications is associated with weight gain and metabolic morbidity. Finally, we live in an era when problems with weight and eating have become a national obsession, and the topics of diet, eating, body shape, and weight pervade the media and occupy a prominent position in daily conversation and national discourse. Thus, a scholarly and nuanced synthesis of the existing literature and implications for psychiatric practice would be especially welcomed.

For example, in the chapter “Psychological Treatment Strategies and Weight,” the authors list numerous interventions, including psychodynamic approaches, interpersonal therapy, neurolinguistic programming, gestalt therapy, and cognitive-behavioral therapy, as potentially useful interventions for the management of obesity without a meaningful effort to distinguish among them in terms of available scientific evidence. Similarly, throughout the book, there are places where the point of view of the authors as psychiatrists comes through (e.g., in a brief discussion of how personality traits might affect dieting [pp. 116, 117]), but the observations seem conjectural rather than scholarly.

In summary, the strengths and weaknesses of this book are related. In the notable effort to provide a comprehensive resource, the volume provides a starting place for the clinician to become familiar with the range of ongoing work in the obesity field. However, the book does not provide an original synthesis of current knowledge or the unique and critically important role of psychiatry in understanding and treating obesity.