Weight loss management: a path lit darkly.

This article reviews recent research on the prevalence and virulence of obesity as a causal risk factor for mortality and morbidity. The prevailing assumption that obesity, by itself, is a chronic disease or a primary risk factor for health is challenged. A historical perspective is used to analyze the efficacy of various medical and educational approaches that have attempted to alter body size in the pursuit of enhanced physical health. The motivational discrepancies between society's media-induced desire for thinness and the health field's risk reduction approach to weight loss are outlined. Finally, ethical issues are raised in relation to current weight control measures, implications for future educational efforts are discussed, and potential guidelines for future weight management programs are presented.