of diet and exercise. Despite efforts to improve the efficacy of treatments for obesity, no methods have emerged that offer a substantial chance of long-term weight loss except for surgery among the extremely obese. The fact is that despite the billions of dollars spent, few people reduce their body weight to a desirable or healthy level and even fewer maintain the weight lost beyond 2 or 3 years.

Chapter 3 describes the abundance of weight-control services, programs, and products currently available, which range from popular books and over-the-counter diet aids to medically supervised weight-management programs, drugs, and surgery. For practical purposes, we have grouped the options into three major categories of programs: do-it-yourself, nonclinical, and clinical programs. We also identify and describe five broad approaches to treatment used by these programs: diet, physical activity, behavior modification, drug therapy, and gastric surgery. The related Appendixes A and B provide examples of assessment instruments that might be used in obesity treatment in clinical and research settings.

Chapter 4 presents a simple conceptual overview of the factors relevant to decisionmaking, in this case, by a person making decisions about weight loss. It consists of the individual's choosing one or more weight-loss programs, undertaking the program, and experiencing the outcome of the undertaking. Three criteria were developed to be used by individuals in evaluating weight-loss programs: (1) the match between the program and consumer, (2) the soundness and safety of the program, and (3) outcomes of the program. Together, these criteria provide guidance for consumers to increase their chances of success at weight loss and for weight-loss programs to increase their ability to help individuals lose weight.

Criterion 1, the subject of Chapter 5, pertains to the match between the individual and the program (i.e., trying to predict, with some degree of precision, which individuals will succeed in a given program). We describe many factors that influence the program choices of individuals and review a number of matching schemes proposed by others. Chapter 6 addresses Criterion 2, the soundness and safety of the program. A sound weight-loss program should give attention to diet and physical activity, be as safe as reasonably possible, and encourage clients to have some knowledge of their weight-related physical health and psychological status. Chapter 7 presents Criterion 3, the outcomes of the program. Here we identify the psychological and physiological factors associated with long-term success at weight loss. This chapter also presents a new concept of obesity treatment focused on the achievement or maintenance of health rather than on simple weight reduction. The concept is based on the scientific literature documenting that obese individuals do not need



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