Eating and Its Disorders.

Abstract

This latest contribution (Volume 62) in the series of research monographs of the Association for Research in Nervous and Mental Disease covers mechanisms and disorders of eating. The 19 chapters are organized in three major sections: The first deals with basic neuroanatomic and chemical concepts, the second describes current physiologic concepts that underlie the regulation of body weight, and the final section reviews treatment of obesity, anorexia nervosa, and bulimia. Beginning with Stellar's of hypothalamic control, proposed 30 years ago, the complexities of neuroanatomic mechanisms that underlie hunger and satiety, the role of neurotransmitters, and the interaction of peripheral with central mechanisms that regulate eating are updated in light of research advances. The recent hypothesis of the relationship of postprandial satiety to cholecystokinin and also the regulating effects of dietary amino acids are reviewed by Smith and the Wurtmans. A section on the regulation of body weight deals particularly with the set-point theory of body weight maintenance. The roles of adipose tissue, lean body mass, and physical activity in the metabolic defense of weight are thoroughly reviewed. Herman and Polivy suggest a novel boundary model for the regulation of eating, which begins to consider the interactional complexities of biologic and psychosocial forces in different persons. The final section considers the treatment of obesity in adults, in children, and in adolescents, the treatment of anorexia nervosa, and the treatment of bulimia. Stunkard provides a reasoned account of the current status of treatment of excessive weight which is based on classifying obesity by its severity. The Wooleys provocatively challenge whether obesity should be treated at all, but their thesis has a polemic ring. Agras and Kraemer provide the beginnings of a much needed evaluation of the treatment of anorexia nervosa but maintain a surprisingly limited view of what constitutes recovery. An essay on the psychopathologic features of anorexia nervosa by Crisp furnishes a much broader perspective on treatment complexities. Two diverse approaches to the treatment of bulimia—cognitive behavior therapy and antidepressant medication—reflect the current limited understanding of this condition.