There was a time, not so long ago, when weight gain in psychiatric patients was a matter of passing note, something unexceptional in the lists of adverse effects of psychotropic medications (usually quite far down) or, with resignation, attributed to ‘poor lifestyle’. How things have changed! Obesity and its metabolic associations have come to occupy a prominent place in the psychiatric literature. While this undoubtedly reflects wider concerns such as the ‘obesity epidemic’ and healthcare inequalities, for psychiatry interest was initially stimulated by the realisation that the miracle many attributed to so-called ‘atypical’ antipsychotics might be tainted. Enter Gerald Reaven's concept of metabolic syndrome (‘syndrome X’, as was), a concept underpinning an intricate set of observations with potentially profound implications. As a number of studies (including the Clinical Assessment Trials of Intervention Effectiveness (CATIE), in one of its few findings to be accepted uncritically) prevalence alone, at over 40%, justifies concern.

This book provides a detailed overview of metabolic syndrome and comes with powerful endorsement from prominent figures in American psychiatry. The author, a psychiatrist with a research background in neuroendocrinology, demonstrates an awesome knowledge of the fields of metabolic and nutritional medicine and the comprehensive and up-to-date reference lists are tribute to both his knowledge-base and the speed of publication. Potential readers should, however, note the title. This book ‘does what it says on the tin’, not restricting itself to conceptualising metabolic syndrome as a consequence of psychiatric illness or its treatment, but speculating on ways in which metabolic disorder may itself contribute to the progression, if not development, of a range of psychiatric disorders. At one level this is innovative and fascinating; at another it diminishes the scholarship of the work by diluting fact in a deal of speculation. This, combined with brief outlines of psychiatric disorders preceding detailed discussion of metabolic points (irritating to the specialist reader), an absence of illustrations (essential for visually reinforcing dense metabolic material) and frequent resort to the first person, create the impression of a personal memoir whose primary constituency might lie beyond psychiatry.

The observations underpinning metabolic syndrome are tantalising, providing a framework for vague concepts such as stress and inflammation, and reinvigorating research disciplines such as neuroendocrinology that have hitherto not fulfilled their potential, all of which is lucidly outlined here. It is ironical, however, that as psychiatry delves ever-deeper, general medicine seems to be retreating, with an increasingly intense debate on not only the value of metabolic syndrome, but its very validity. For clinical psychiatrists, the concept can still have merit in emphasising that obesity is not just a cosmetic issue and that the doctor in us is responsible for overall patient welfare – including the consequences of our treatment decisions. For those psychiatrists who still value the doctor in them, the bigger points and general message of this book are just reward for the read.