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Book Reviews   |    
The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance; Nutrition in Institutions

The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance
by Sylvia R. Karasu., and T. Byram Karasu.; Washington, D.C., American Psychiatric Publishing, 2010, 518 pages, $66

Nutrition in Institutions
by Maria Cross. and Barbara MacDonald.; Oxford, United Kingdom, Wiley-Blackwell, 2009, 440 pages, $109.99

Reviewed by Daniel L. Breslin, M.D.
Psychiatric Services 2012; doi: 10.1176/appi.ps.20120p190
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The reviewer reports no competing interests.

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The book The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance, is dedicated to the authors' fathers, both of whom struggled with obesity throughout their adult lives. One died at age 56, and the other, despite health risk factors in addition to his obesity, lived to the age of 91, a disparity illustrating in the authors' view “how much we still do not know about the complex subject of weight.” The paradoxical longevity of one father highlights the loss of the other, inspiring the Drs. Karasu to “explore particularly why, for most people, it is so difficult to lose weight and maintain that loss.”

There is a tremendous amount of information in this book, and a surprising proportion—for a clinical guide—is basic science research data. The initial chapters are devoted to an overview of the research methodology, epidemiology, and medical consequences of obesity; the basics of food chemistry; and the “Psychology of the Eater.” Separate chapters survey the weight implications of various psychiatric disorders and medical conditions, the latter chapter including a section on the weight effects of psychiatric and other medications. There is detailed consideration of the research that is slowly disentangling the complex neuroendocrinology and physiology of appetite, satiety, and circadian rhythms. There are voluminous references to both basic science and clinical research literature.

The research evidence is both fascinating and disconcerting, and it ultimately supports an empathic understanding of why reducing an unhealthy body weight is a goal that few attain and fewer sustain. This empathic resonance of the data is of clinical value, and I think the judgment to include so much of it was sound. Although the authors aspire to a sophisticated, “synthetic” understanding of “the complex psychological and physiological aspects of the mind, body and brain” that bear upon body weight, the writing style is accessible and not highly technical.

The heart of the book as a clinical guide is represented by chapters on exercise; diets; psychological and psychotherapeutic strategies for weight loss, including self-help and commercial approaches; and pharmacologic and surgical treatments for obesity. Encouraging evidence is presented that some obese people, utilizing many different approaches, eventually succeed in achieving and maintaining a healthy weight and moreover, that even modest success in weight reduction has benefits for health and longevity. The book's scope should make it of wide interest, not only to psychiatrists and other clinicians specializing in the treatment of overweight patients but also to general psychiatrists, primary care clinicians, dieticians, nurses, and students of all health-related fields.

Although the authors accentuate the timelessness of the problems of weight by their many quotes from Hippocrates, the cumulative sense they convey is that progress is being made in the research and that the efforts of patients and clinicians are worthier than ever. These messages are enhanced by an appreciation of the diversity of options for weight loss and maintenance described in this guide.

In Nutrition in Institutions, authors Maria Cross and Barbara MacDonald present a detailed historical survey of “large-scale institutional feeding” in the United Kingdom, an endeavor that “has its roots in the workhouse.” (Those with an appetite for British humor will relish such Dickensian garnishes as the “Dyett Appointed” by the governing body of St. Bartholomew's Hospital in April 1687, by which Sundays were graced with “10 ounces of Wheaten Bread, 6 ounces of Beefe boyled without bones, 1 pint and a halfe of Beef Broth, 1 pint of Ale Cawdell, 3 pints of 6 shilling Beere.”)

The survey covers five settings in depth: schools, hospitals, care homes for the elderly population, prisons, and the armed forces. This is a well-researched, well-written, useful, and surprisingly entertaining book. Because the challenges mealtimes present are timeless and universal, this book's interest and value extend beyond the United Kingdom and the obvious audience of dieticians and nurses. The section on hospitals underscores that the consistent provision of appetizing and appropriate meals demands coordinated action by virtually every department of hospitals, clinical and nonclinical alike; it should be required reading for hospital executives and management teams, in addition to the leadership of every clinical department. The same could be said of the relevant chapters for the leaders of the other institutional settings.

“Feeding people in institutions is always a complex logistical exercise in which those responsible have to cater for large numbers of people within strict budgetary controls.” And yet, “regardless of the policy ideology behind food provision, the fact is that people eat primarily because they are hungry and because they enjoy eating, not because they want to stave off heart disease, or be better behaved.” Indeed!

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