Dietary recommendations need to be based on solid evidence, but where can you find this information? The British Dietetic Association and the publishers of the Manual of Dietetic Practice present an essential and authoritative reference series on the evidence base relating to advanced aspects of nutrition and dietetics in selected clinical specialties. Each book provides a comprehensive and critical review of key literature in the area. Each covers established areas of understanding, current controversies and areas of future development and investigation, and is oriented around six key themes:

• Disease processes, including metabolism, physiology and genetics
• Disease consequences, including morbidity, mortality and patient perspectives
• Clinical investigation and management
• Nutritional consequences of disease
• Nutritional assessment, including anthropometric, biochemical, clinical, dietary, economic and social approaches
• Nutritional and dietary management of disease

Trustworthy, international in scope, and accessible, Advanced Nutrition and Dietetics is a vital resource for a range of practitioners, researchers and educators in nutrition and dietetics, including dietitians, nutritionists, doctors and specialist nurses.

Obesity, which is often described using terms such as fat, stout or corpulent, is in fact derived from the Latin word obesus. Obesity is a disease, and as such has had an International Classification of Disease code since just after World War II. Despite having the status and recognition as a disease, obesity treatment has often been overlooked as a regular component of medical management. Comorbidities associated with obesity, such as type 2 diabetes, hypertension and hyperlipidaemia, have themselves been treated, while interventions that aim to reduce body weight are less rigorously and consistently employed.

The first clinical guidelines for obesity were published in 1996, advocating roles and responsibilities for a range of health professionals – including doctors (general practitioners/family physicians), nurses and dietitians – to manage obesity. In the light of these clinical guidelines, researchers sought the views of health professionals whose practice was either in the community (primary care) or in a speciality based in a hospital (secondary care). Hospital consultants across all specialities agreed that effective weight management could, without exception, improve treatment outcomes. However, none had a treatment protocol in place, suggesting that obesity management was ad hoc. A majority felt unable to resource weight management, suggesting that community (primary care) and general practice were more suitable as locations for treatment. General practice staff, general practitioners and practice nurses also felt that reduction in body weight would improve the health of many adults who consulted them. Once more, they themselves felt unable, for the same reasons, to address the need for weight loss as part of their care. Many considered obesity an inevitable result of aging, an intractable and persistent condition and a time‐consuming issue that they were unable to treat effectively. Any treatments they considered were long term, resource intensive and only poorly effective. Sadly, these data from the 1990s have been replicated many times.

Advanced Nutrition and Dietetics in Obesity takes on the huge task of describing the aetiology of obesity across the life course. There are large sections devoted to the disease in children and in adults. Treatments including surgical, pharmacological and lifestyle interventions are considered. Prevention of weight gain and obesity, the role of the environment, new town design and transport policy too are discussed. The occurrence of obesity has reached epidemic proportions worldwide, and this text aims to provide the reader with a broad understanding of the multifactorial causes of excessive and unwanted weight gain. After reading this book, I hope the reader will feel that obesity is not a simple problem, but a global phenomenon that is multifactorial in nature, requiring a multidisciplinary approach for management and prevention. Much effort, commitment and research are still required to challenge this chronic and persistent disease.

This book is aimed at all those whose work embraces any aspect of obesity. This includes clinicians, researchers, public health experts, educators and health economics specialists. Those undertaking further studies in health and disease too may find this a useful reference and resource.

This book is the third title in a series (Advanced Nutrition and Dietetics Book Series) commissioned as part of a major initiative between the British Dietetic Association and Wiley. Each book in the series provides a comprehensive and critical review of the key literature in a clinical area. Each book is edited by one or more experts who have themselves undertaken extensive research and published widely in the relevant topic area. Each book chapter is written by experts drawn from an international audience and from a variety of disciplines as required of the relevant chapter (e.g. dietetics, medicine, public health, psychology, biomedical sciences). A future title in this series will cover nutritional support.

The editor and I are proud to present the third title in the series, Advanced Nutrition and Dietetics in Obesity. We hope that it will impact on health professionals’ understanding and application of nutrition and dietetics in the management and prevention of obesity. Effective weight management improves the health of both adults and children. Prevention of the chronic weight gain of adulthood in many parts of the world are essential, and approaches to address this issue so far are discussed.

This book is a very timely synthesis of the dimensions of the problems of obesity and how to manage them in what is rapidly now becoming the most intractable issue in both clinical management and public health across the globe. This book, written by contributors from the UK, Europe and throughout the world, comes at a time when it looks as though politicians are finally waking up to the fact that health services are already overwhelmed by the numbers of people with multiple obesity‐related conditions. As healthcare professionals become ever more sophisticated at coping with the immediate risk factors of type 2 diabetes and cardiovascular disease, we still see most clinical teams neglecting obesity as the underlying driver, with all its proximal causes. Given the magnitude of the currently escalating health burden, it is timely that this book, essentially geared to the clinical teams involved in obesity prevention and treatment, is now published. The descriptions cover the full range of new ideas and evidence of both the underlying pressures on the majority of our population and how to begin to effectively manage such a challenging organisational and multidimensional problem.

Many of these expert contributors have decades of experience in trying to establish effective approaches to the management and prevention of obesity. The historical account emphasises the struggle that has gone on for decades, with the first semi‐official reports on appropriate clinical schemes for managing the problem only emerging 20 years ago in both Scotland and the USA. Much of the drive, as is usual in medical management, has come with the search for suitable pharmacological strategies; nevertheless, as other chapters emphasise, the neglect of the transformation of both the dietary modification and physical activity required necessitates not only an understanding of the underlying features of appetite control but also the need for routine physical activity incorporated into most individuals’ normal habits. There are very authoritative accounts of the genetic, endocrinological and clinical aspects of the epidemic in adults as well as in children, in whom obesity only emerged in the last 20 years as a major burden in paediatric practice. Although the childhood obesity epidemic seems to be slowing in many European countries, the overall prevalence of childhood overweight and obesity are still horrifying. Hence, we can expect to see vicious combinations of genetic and epigenetic influences as these children and the next generation enter adulthood, with their clinical care becoming ever more difficult. Thus, young overweight women now entering pregnancy seem unaware of the challenges that new research suggests lies in wait for their families and family practitioners. With rapidly rising rates of gestational diabetes, especially in Europe’s ethnic minorities, we are already witnessing far earlier onsets of adult abdominal obesity and type 2 diabetes, with its sustained challenges for maintaining medical care of chronically sick patients. The chapters on the co‐morbidities should therefore help to amplify a broader approach to the management of an array of risk factors, and this book benefits from adding musculoskeletal and psychological comorbidities to the traditional cardiovascular foci of concern.

There are very appropriate chapters first on the diagnostic criteria that should be used in both screening and monitoring clinical progress in children and adults, followed by a comprehensive description and analysis of dietary approaches that have been tried and progressively evaluated. Then come assessments of the value of pharmacological and surgical management, as well as interventions to improve physical activity levels.

Fitting all this together with the issues of obesity prevention and how this can link into clinical practice is a real challenge. This book therefore gives us both an overview and the detail that is so necessary if we are to engineer a revolution in clinical practice. One just wishes that the many integrated contributions could have been produced a decade ago, but then we would not have benefitted from so much of the new research and analyses that are presented here.

Catherine Hankey PhD RD
Catherine Hankey is a Senior Lecturer in Human Nutrition in the School of Medicine at the University of Glasgow. Her research investigates clinical and public health aspects of obesity and weight management. Examples of research include the optimization of weight management during smoking cessation and in those with intellectual disabilities. Dr Hankey was a group member for the Scottish Intercollegiate Guidelines Network (SIGN) guideline for the Management of Obesity and the update of the SIGN prevention and management of cardiovascular disease. She is the author of the Weight Management chapter in the Manual of Dietetic Practice and is co‐editing the forthcoming version of the ABC of Nutrition.

Kevin Whelan PhD RD FBDA
Kevin Whelan is the Professor of Dietetics and the Head of Department of Nutritional Sciences at King’s College London. He is a Principal Investigator leading a research programme exploring the interaction between the gastrointestinal microbiota, diet and health and disease. In 2012 he was awarded the Nutrition Society Cuthbertson Medal for research in clinical nutrition and in 2017 was appointed a Fellow of the British Dietetic Association. Prof Whelan is on the editorial boards of Alimentary Pharmacology and Therapeutics and the Journal of Human Nutrition and Dietetics and is the Series Editor for the British Dietetic Association Advanced Nutrition and Dietetics book series.