George A. Bray 
The Metabolic Syndrome and Obesity 

Thirty years ago, I published my first monograph on obesity (Bray, 1976). Many things have changed in these 30 years, but many have remained the same. Preparation of The Metabolic Syndrome and Obesity has given me a chance to survey the changes to the field and to present an update of the scientific information. In retrospect, I conclude that a major component of the current “epidemic” of overweight is not medical, not genetic, not psychological, and will not be effectively treated by “lifestyle” changes that require individual choices. We are all influenced by the prices of the goods we buy. With the reduction in food prices and distortion of commercially profitable products resulting from federal subsidies of corn, sugar, and rice, the food industry has been able to produce cheap, good-tasting, energy-dense foods and can sell them cheaply in large portion sizes. In contrast, foods like fruits and vegetables receive little in the way of subsidies, and are thus more expensive; thus we buy less. Providing more “healthy” food alternatives, as some advocate, will put items with “higher costs” on the shelves and is, in my view, unlikely to alter consumer choices as long as good-tasting, energy-dense foods remain cheap. HISTORICAL CONTEXT FOR OBESITY Obesity was already a problem before my first monograph was published. Between the writing of that monograph and The Metabolic Syndrome and Obesity, I was fortunate enough to find a short book in French, written by an American from Cincinnati named Worthington.

Table of Content

The Problem.- Definitions and Prevalence.- How Do We Get Fat?.- Costs, Pathology, and Health Risks of Obesity and the Metabolic Syndrome.- Natural History of Obesity.- The Solutions.- Evaluation, Prevention, and Introduction to Treatment.- Diet.- Behavior Modification.- Physical Activity and Exercise in the Obese.- Pharmacological Treatment of the Overweight Patient.- Should We Treat the Metabolic Syndrome or Its Components?.- Surgical Treatment for the Overweight Patient.