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he word epidemic conjures up alarming images: plague, pestilence, destruction, and death. We are not used to lumping obesity in with such disasters, but the recent increase in the global prevalence of obesity qualifies as an epidemic. Obesity claims an increasing number of lives worldwide; discouraging statistics abound in both the medical and popular press. This issue of Science also reports some of this bad news. We learn, for starters, that the obesity epidemic is recognized by the World Health Organization as one of the top 10 global health problems. Multiple social forces work against maintenance of a healthy weight, such as food availability, declines in traditional lifestyles, and sedentary living. The medical profession is reported to lack both the knowledge and the incentives (financial and otherwise) to combat this threat to health. All of us, particularly certain populations, have powerful genetic predispositions to retain excess calories in preparation for famine. The biological systems that manage our food intakecontrolling how often and how much we eat and making corrections when the long-term equilibrium is disrupted are extraordinarily complex and not yet well understood. Powerful biological control mechanisms spur calorie intake, but less powerful ones limit it. As-yet-unknown players are probably confounding researchers efforts to untangle this system. Clinicians have few tools with which to fight this epidemic; current antiobesity drugs are not highly effective and are fraught with side effects. But the articles in this issue also point to areas where we can expect to make real progress against this epidemic. The tools of molecular genetics have yielded a rush of new information about molecular signals that guide short-term decisions, such as whether to eat now or push away from the table. Other molecules take a longer view, monitoring fat balance (see the News story by Marx, p. 846). Information from basic research has identified numerous CONTENTS drug targets, as Guras News story (p. 849) points out. Several compounds are in human NEWS clinical trials now, and more are in develop8 4 6 Cellular Warriors at the Battle ment. Although Friedman (p. 856) outlines of the Bulge the enormity of the obesity problem in his Viewpoint, likening it to that of cancer, he 8 4 9 Obesity Drug Pipeline Not So Fat suggests that new molecular knowledge couHaving It All pled with an evolutionary view may give us VIEWPOINTS enough information to fight obesity productively. Science clearly has the potential to in8 5 3 Obesity and the Environment: form and perhaps help solve some aspects of Where Do We Go from Here? this intricate problem. What about social J. O. Hill et al. forces? Hill et al. (p. 853) argue in their View8 5 6 A War on Obesity, Not the point that it will take only a small reduction in daily net energy input to preObese vent further increases in obesity ratesan attainable goal, they believe. SoJ. M. Friedman cial change can also occur in the medical profession as physicians and other health care professionals learn more about how to treat obesity, as argued 8 5 9 A Clinical View of the Obesity Problem by Pi-Sunyer (p. 859). X. Pi-Sunyer Perhaps the biggest challenge is outlined by Nestle in her editorial (p. 781). When the interests of corporate institutions that control the distriRelated editorial on page 781 and bution of food and its advertisement (with the goal of maximizing food conScience's STKE on page 775. sumption) conflict with the public good, who is to intervene and how?
KATRINA KELNER AND LAURA HELMUTH

ObesityWhat Is To Be Done?

CREDIT: FRANCIS G. MAYER/CORBIS

www.sciencemag.org

SCIENCE

VOL 299

7 FEBRUARY 2003

845

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