Gastroenterology is at the forefront of the battle against obesity. The incidence of obesity is increasing at an alarming rate in the US: the Centers for Disease Control and Prevention (CDC) suggested it had reached epidemic proportions over a decade ago, when it estimated that there were 300,000 premature deaths due to Americans being overweight—second only to tobacco-related deaths. At that time, 17.9% of adults were obese (>30% above ideal bodyweight). In 2004, the National Institutes of Health (NIH) quoted figures that showed 65% of US adults (129.6 million people) were either overweight or obese, and estimated the cost to the nation at $117 billion. In 2003, Surgeon General Dr Richard H Carmona indicated that one of every eight deaths in America was caused by an illness related to overweight or obesity.

The American Gastroenterological Association (AGA) believes that gastroenterologists should play a central role in attempts to reverse these distressing figures. Obesity directly affects diseases and disorders of the gastrointestinal (GI) tract, including gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), pancreatitis, and GI cancers such as colorectal, esophageal, and pancreatic cancers. Unfortunately, there is no clear leadership from any medical or surgical specialty to provide a broadbased approach to the treatment and cure of obesity. Based on the importance of the issue, the AGA has developed an educational initiative to identify the gaps in education, increase awareness within the specialty, and provide members with the necessary tools to assess, treat, and manage patients appropriately.

Basic and clinical researchers in the field will play an important role in unraveling the pathophysiology of control of appetite and bodyweight. A clearer understanding of how the gut communicates with the nervous system will be key to achieving that goal. Maintaining adequate food intake is essential for survival, and the body has developed multiple redundant systems to ensure this, making the study of hormonal and neural control of appetite difficult because of its very complexity. An extensive orchestra of gut hormones important to appetite control has been identified. Complex systems have been uncovered whereby the gut signals to the brain how efficiently it is handling the digestion and absorption of food. Disturbances in these signaling pathways can disrupt the body’s ability to maintain ideal bodyweight and can lead to obesity. As new research investigates the causes and more data are published, prevention of and treatments for obesity and the role played by the GI tract are becoming better defined. This information will lead to novel endoscopic, pharmacological, nutritional, and personalized therapies for obesity, as well as changes in policies and societal practices related to obesity.

Due to the GI tract’s role in nutritional absorption and bodyweight regulation and the effects that obesity and nutritional deficiencies have on GI disorders, gastroenterologists need to incorporate obesity management into their practices to oversee and co-ordinate the care of moderately and morbidly obese individuals. It is likely that transoral endoscopic gastroplasty, in one form or another, will become the treatment of choice for obese individuals. This reflects the belief that behavior modification will have limited long-term efficacy without the development of effective and safe drug therapies. The alarming rates of obesity in children (particularly in minorities), as discussed by Kinne et al. in this edition of US Gastroenterology & Hepatology Review, indicate that the US faces a healthcare crisis that will only get worse with time. Gastroenterologists should be at the forefront of this crisis, investigating what causes the failure of normal control processes that limit food intake and developing novel therapies to treat obesity and its complications