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Futility and Avoidance: Title and subTitle BreakMedical Professionals in the Treatment of Obesity FREE

Arthur Frank, MD
[+] Author Affiliations

Reprint requests to the George Washington University Obesity Management Program, Suite 208, 3 Washington Circle NW, Washington, DC 20037 (Dr Frank).


JAMA. 1993;269(16):2132-2133. doi:10.1001/jama.1993.03500160102041
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TWENTY years ago, I changed course in my internal medicine practice and decided, rather deliberately, to work on the problem of obesity. My friends, my colleagues, and my family thought I was crazy. The warnings were clear. "Don't risk your credibility and your career." "Don't venture into a part of medicine that no one takes seriously." "Don't move into the world of quacks and charlatans." My brother, a thoughtful, professorial cardiologist, assessed the situation in most negative terms. "The guys who deal with obesity are the sleaziest guys in medicine. Pills and shots!" he shouted. Another friend, also comfortably cloistered in academia, could not imagine how I could possibly want to spend my time working with fat, middle-aged ladies: "What on earth is there to talk about?"

Taking the Plunge  Even in my naive youth I was not oblivious to the risks involved in dealing with obesity. Although my credentials

REFERENCES

Stunkard AJ, Wadden TA, eds. Obesity: Theory and Therapy . 2nd ed. New York, NY: Raven Press; 1993;.
Colditz GA.  Economic costs of obesity. Am J Clin Nutr . 1992;;55( (suppl) ): 503S-507S.
NIH Consensus Development Panel.  Health implications of obesity. Ann Intern Med . 1985;;103:1073-1077.
Harris RB.  Role of set-point theory in regulation of body weight. FASEB J . 1990;; 4:3310-3318.
Dallman M, Bray G, eds.  Neural and endocrine regulators of ingestive behavior (symposium). Fed Proc . 1986;;45:1383-1409.
Reid LD.  Endogenous opioid peptides and regulation of drinking and feeding. Am J Clin Nutr . 1985;;42:1099-1132.
Morley JE, Levine AS.  The role of endogenous opiates as regulators of appetite. Am J Clin Nutr . 1982;;35:757-761.
Levine AS, Atkinson RL, eds.  Opioids in the regulation of food intake and energy expenditure (symposium). Fed Proc . 1987;;46:159-181.
Rothwell NJ, Stock MJ.  Regulation of energy balance. Ann Rev Nutr . 1981;;1:235-236.
Himms-Hagen J.  Thermogenesis in brown adipose tissue as an energy buffer. N Engl J Med . 1984;;311:1549-1558.
Ravusssin E, Lilloja S, Knowler WC, et al.  Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med . 1988;;318:467-472.
Roberts SB, Savage J, Coward WA, Chew B, Lucas A.  Energy expenditure and intake in infants born to lean and overweight mothers. N Engl J Med . 1988;;318:461-466.
Flemyng M. Cited by: Bray GA.  Obesity: historical development of scientific and cultural ideas. Int J Obes . 1990;;14:909-926.
Stunkard AJ, Reader J.  The management of obesity. N Y State J Med . 1958;;58: 78-87.
NIH Technology Assessment Conference Panel.  Methods for voluntary weight loss and control. Ann Intern Med . 1992;;116:942-949.
Pettigrew J, ed. Robert Browning: The Poems . New Haven, Conn: Yale University Press, 1981;;1:643-650.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Stunkard AJ, Wadden TA, eds. Obesity: Theory and Therapy . 2nd ed. New York, NY: Raven Press; 1993;.
Colditz GA.  Economic costs of obesity. Am J Clin Nutr . 1992;;55( (suppl) ): 503S-507S.
NIH Consensus Development Panel.  Health implications of obesity. Ann Intern Med . 1985;;103:1073-1077.
Harris RB.  Role of set-point theory in regulation of body weight. FASEB J . 1990;; 4:3310-3318.
Dallman M, Bray G, eds.  Neural and endocrine regulators of ingestive behavior (symposium). Fed Proc . 1986;;45:1383-1409.
Reid LD.  Endogenous opioid peptides and regulation of drinking and feeding. Am J Clin Nutr . 1985;;42:1099-1132.
Morley JE, Levine AS.  The role of endogenous opiates as regulators of appetite. Am J Clin Nutr . 1982;;35:757-761.
Levine AS, Atkinson RL, eds.  Opioids in the regulation of food intake and energy expenditure (symposium). Fed Proc . 1987;;46:159-181.
Rothwell NJ, Stock MJ.  Regulation of energy balance. Ann Rev Nutr . 1981;;1:235-236.
Himms-Hagen J.  Thermogenesis in brown adipose tissue as an energy buffer. N Engl J Med . 1984;;311:1549-1558.
Ravusssin E, Lilloja S, Knowler WC, et al.  Reduced rate of energy expenditure as a risk factor for body-weight gain. N Engl J Med . 1988;;318:467-472.
Roberts SB, Savage J, Coward WA, Chew B, Lucas A.  Energy expenditure and intake in infants born to lean and overweight mothers. N Engl J Med . 1988;;318:461-466.
Flemyng M. Cited by: Bray GA.  Obesity: historical development of scientific and cultural ideas. Int J Obes . 1990;;14:909-926.
Stunkard AJ, Reader J.  The management of obesity. N Y State J Med . 1958;;58: 78-87.
NIH Technology Assessment Conference Panel.  Methods for voluntary weight loss and control. Ann Intern Med . 1992;;116:942-949.
Pettigrew J, ed. Robert Browning: The Poems . New Haven, Conn: Yale University Press, 1981;;1:643-650.
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