What the doc didn’t say

Even with report after report documenting the nation’s considerable girth and the perils of obesity, millions of men and women nonetheless remain blissfully unaware that they have a weight problem.

Those who do recognize it tend to underestimate its severity.

A National Consumers League survey conducted by Harris Interactive in 2007 found that adults consistently identify themselves as being less severely overweight than they actually are. Eighty-two percent of obese people surveyed considered themselves to be simply overweight; among those who were in fact only overweight, close to 1 in 3 believed that they were normal weight.

Similar patterns have been seen among school-age children and adolescents. In a study published in June, researchers at Johns Hopkins University questioned nearly 450 students in grades 5 to 8 about their weight. Sixty-two percent of the overweight boys and nearly one-third of the overweight girls thought of themselves as normal or even underweight.

Such numbers may seem surprising. But many people simply don’t understand how to determine if they’re overweight.

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Touchy health issue

Some of the blame can go to doctors. Many don’t properly evaluate patients to determine if they’re overweight, routinely failing to measure body-mass index. BMI takes height and weight into consideration and is thought to be a more reliable indicator of total body fat than weight alone.

Even when physicians do screen for obesity, many don’t discuss the importance of weight loss. A 2005 study released by the Centers for Disease Control and Prevention found that only about 40% of obese people are actually advised by their healthcare professional to lose weight.

“Physicians are reluctant to bring up weight because it’s such a loaded issue,” says Dr. William Dietz, director of the Division of Nutrition, Physical Activity and Obesity at the CDC. It’s a difficult and often emotional conversation to have with patients, so some doctors just avoid it.

Sometimes doctors feel they have little to offer in the way of a solution. Weight-loss counseling frequently proves ineffective, weight-loss medications produce only modest results and obesity surgery isn’t appropriate for most people.

Further, terms such as “overweight” and “obese” have come to mean one thing to the medical community and another thing to the layperson. “When people hear the word ‘obese,’ they think of someone who weighs over 300 pounds,” says Gary Foster, director of the Center for Obesity Research and Education at Temple University.

With two-thirds of Americans weighing more than they should, such confusion is understandable. Overweight has become our new normal.

Medically speaking, 10 or 20 extra pounds is all it takes to push someone into the overweight category. For a 5-foot-4 man or woman, 145 pounds marks the crossover point from “normal” to “overweight”; at 5 feet, 8 inches, it’s 164 pounds.

What’s important to understand is that these cutoff points between different weight categories -- “normal,” “overweight” and “obese” -- are not arbitrary. The numbers are based on data and correspond to points at which the risk of weight-related diseases jump.

At a BMI of 25 (the lower cutoff for “overweight”), the risk of diseases such as diabetes and hypertension is already substantially elevated. At a BMI of 30, the risk of obesity-related diseases, including cancer and stroke, begins to increase rapidly; the risk of death begins to climb as well.

The dangers associated with being overweight are now generally well recognized. But people are unlikely to personalize these threats if they don’t think they have a serious weight problem. Without the looming threat of death and disease, they’re less likely to attempt to lose weight and probably less likely to succeed if they do try.

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All in the numbers

Losing weight is a difficult thing to do. But the first step in the process is actually quite easy. It doesn’t involve anything as complicated as counting grams of fat or as strenuous as a 3-mile run. All that it requires are an accurate scale, a tape measure and, depending on your math skills, a calculator.

It also might require doctors to engage in difficult and often uncomfortable conversations with their patients, reminding them what “healthy weight” and “overweight” really mean.

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Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month.

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[email protected].

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(BEGIN TEXT OF INFOBOX)

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Learn if you’re overweight --

Are you overweight? Probably.

Two-thirds of the U.S. population is at least overweight, according to the most recent National Health and Nutrition Examination Survey, and a third qualifies as obese.

Still aren’t sure you qualify? Assess your body mass index. It’s the measure doctors use -- when they bother -- to determine a person’s weight category. BMI can be calculated in three simple steps:

Find the square of your height in inches (multiply your height times your height).

Divide your weight in pounds by that number.

Multiply that by 703.

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Or you could let the National Heart, Lung and Blood Institute’s website do the work for you at www.nhlbisupport.com/bmi.

Standard weight categories are based on BMI measurements:

* Underweight = BMI less than 18.5

* Normal weight = 18.5-24.9

* Overweight = 25-29.9

* Obese = 30 and above

Though the BMI provides important information, the institute strongly believes that waist circumference -- a measure of abdominal fat -- should be considered too. A high waist circumference is associated with an increased risk of diabetes, high blood pressure and cardiovascular disease, particularly in people who fall into the “overweight” category.

Waist circumference is not the same thing as waist size. To accurately measure waist circumference, place a tape measure around the abdomen at the level of the iliac crest, the uppermost point of the hip bone. The tape measure should be snug but not tight, and the measurement should be made at the end of a normal expiration.

Women who fall into the “overweight” category based on their BMI and have a waist circumference of more than 35 inches are considered to be at high risk of developing weight-related disease; overweight men fall into this high-risk category when their waist circumference exceeds 40 inches.

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Valerie Ulene