Nutrition and obesity: prevention and treatment.

The increased risk of morbidity and mortality from obesity, central body fat, and weight gain, and the beneficial effects of weight reduction argue that the cost associated with obesity could be beneficially affected by prevention of weight gain or induction of weight loss. Genetic, metabolic, and demographic predictors of weight gain have been identified that allow selection of high-risk individuals. Among the metabolic predictors are a low metabolic rate, insulin sensitivity, and a high respiratory quotient. Demographic predictors include current smokers, certain dieting behaviors, lower socio-economic class, a low level of education, use of contraceptives, status post-partum, and rapid weight gain in childhood. Several studies suggest that weight gain can be prevented. Targets for such strategies might be high-risk families, current smokers, those who are planning to stop smoking, and those with a low metabolic rate. For those who fail primary prevention, treatment may be appropriate. The greater the degree of excess weight, the greater the risk and the more appropriate treatment becomes to reduce body weight.