that advocates greater acceptance of individuals regardless of their weight and defends the rights of the obese to be protected from job discrimination and social biases (Brownell and Rodin, 1994). The movement questions whether effective obesity treatments exist and points out the potential negative consequences of dieting on psychological and physical well-being. An International No-Diet Day has been organized each year since 1992 to encourage people to appreciate the varied sizes and shapes of human bodies (Tufts, 1994). We agree, of course, that there should be more appreciation and acceptance of diversity in the physical attributes of people, more discouragement of dieting in vain attempts to attain unrealistic physical ideals, and no obsession with weight loss by individuals who are at or near desirable or healthy weights. However, it is inappropriate to argue that obese individuals should simply accept their body weight and not try to reduce, particularly if the obesity is increasing their risk for developing other medical problems or diseases.

This chapter has laid the foundation for what is to come in the remainder of this report. While the bad news is that the prevalence of obesity in this country is increasing, the good news is that obese individuals do not need to return to some ideal, non-obese weight to improve the risk factors, including hypertension and hypercholesterolemia, that predispose them to developing a variety of chronic diseases. Several studies demonstrate that small losses in general (approximately 10 to 15 percent of initial body weight) help reduce obesity-related comorbidities and that improvements in these risk factors persist with maintenance of these modest weight losses. They are an important component of the foundation for a new perspective on obesity-treatment outcomes that we present later in this report. The following chapter provides some additional background on the types of obesity treatment programs currently available and discusses the broad approaches to treatment used by them.