Bistrian1 has called attention to the continuing increase in degree of obesity in the United States for more than 100 years. Obesity is known to exacerbate risk factor abnormalities for cardiovascular disease, namely, hypertension, diabetes, and hyperlipidemia. Obesity per se becomes a risk factor for increased mortality at body weights greater than 130% of ideal.2 Brownell and Stunkard3 have recently observed a favorable effect of weight reduction on plasma lipoprotein levels in obese subjects.
Over the last decade, there has been a proliferation of commercial weight-reduction clinics to serve this expanding market. These clinics have brought the promise of relatively inexpensive treatment for the masses; 1 million people in the United States participate in group weightloss programs each week.4 However, physicians5 and behavioral scientists6,7 have failed to develop a treatment regimen that is effective and long-lasting for the majority of those treated. Since one