By SusanOkie . Published by Joseph Henry Press , Washington DC , 2005 . Paperback, 322 pages with index. RRP $29.95 . ISBN 0309101980. .

Reviewed by Boyd Swinburn, School of Exercise and Nutrition Sciences, Deakin University, Victoria

The burgeoning epidemic of childhood obesity has triggered a large number of scientific reports and articles in the past five years. However, the number of books that have tried to translate this information for public consumption is relatively few. Fed Up! is a book that attempts to do just this with an audience of parents and the interested public in mind. The author, Dr Susan Okie, was herself an overweight child and now as a family physician, a medical reporter for the Washington Post, and a mother, she is well positioned to undertake this challenge of converting the scientific evidence into a coherent story in layman's terms. In this, I believe, she succeeds very well, although the complexity of some of the metabolic material may lose a few readers. Okie is not an obesity researcher herself but she has obviously thoroughly investigated the area, read all the main reports and spoken to many of the top United States (US) researchers in the field. The science is liberally illustrated with human stories to bring the issues to life and the whole book is very readable and clear.

One of its main limitations for an international reader, however, is that the book's scope lies between the west and east coasts of the US. The examples, the environments, the solutions, and the culture are all US. While childhood obesity has many commonalities across countries and cultures, there are also important differences that are not well acknowledged. The biomedical and individualistic paradigms that are dominant in the US are also evident in the book. A social determinants approach to aetiology may have avoided statements like “the cause of the obesity epidemic is a mystery so far” and “researchers have not pin-pointed which aspects of the modern environment are most responsible for rising rates of obesity” as if there are a handful of yet-to-be discovered ‘causes’ of obesity that apply across all environments and cultures. A reliance on the metabolic researchers’ view of obesity gives the impression that obese people have a ‘disorder of a regulatory system’ and that the hypothalamus, with its control of multiple neuropeptides and so-called body weight ‘set point’, has gone awry. A more public health view of the epidemic would have given a very different etiological picture, but population research in obesity is miniscule in the US compared with biomedical research.

In most of the middle parts of the book, Okie translates the various US studies into implications for parents and schools. This she does very well and provides plenty of examples to illustrate her points. In the course of her research for the book, she visited many of the leading-edge US programs to help obese children and their families and investigated the reality of junk foods in public schools. The proportion of US schools that have contracts with soft drink companies (38–73% depending on school type) and the proportion of those with built-in incentives for greater sales (92%) is frightening and in part explanatory of the US childhood obesity situation. This level of commercialisation of schools is (thankfully) not present in schools in Australia and New Zealand and the school food systems are also quite different, leading to different sets of solutions.

Policy issues are unfortunately not brought together into a coherent chapter but are rather highlighted in several places. For example, the US National School Lunch Program is administered by the US Department of Agriculture, which has another, sometimes conflicting, goal to maximise food production through subsidies and other programs: “For decades, beef, pork and dairy producers have successfully lobbied Agriculture Department officials to include large quantities of meat and dairy products among the foods that the program buys and donates to schools.” Okie's analysis of the policy landscape around school food provides ample explanations for the failure of most US schools to comply with the requirements for the nutritional content of school lunches.

The final chapter, ‘Action for Healthy Communities’, highlights three key issues for grass roots advocacy: reducing unhealthy food marketing to children; creating walkable, play-friendly neighbourhoods; and better access to healthy food choices (especially for low-income families). This last point is one of the few areas discussed with a focus on equity – remembering that, for a very wealthy country, the US harbours enormous health inequalities.

Overall, this is a very readable, reliable, and informative book that translates the scientific evidence for a lay audience. Its strengths are its thorough research and referencing as well as its clear and well-illustrated writing style. Its weaknesses are its singular focus on the US and the dominance of the biomedical paradigms in explaining obesity and suggesting solutions. Despite these drawbacks, this book would be a very valuable resource for interested lay readers to come to grips with the background science and potential solutions for childhood obesity.