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How Best to Tackle Weight Problem? : Lifestyles: Those extra pounds we're carrying weigh heavy on the minds of experts. But they can't agree on how to get us to improve our health.


NEW YORK — Despite a plethora of dieting and the kaleidoscopic weight-loss industry, Americans are gaining weight, not losing it. And since overweight contributes to diseases such as arthritis, hypertension, colon cancer, diabetes and coronary heart disease, the problem has become a public health crisis of epidemic proportions.

So said a panel of 18 experts who collaborated on a set of "healthy weight" recommendations issued after a daylong American Health Foundation round-table conference held here earlier this month.

"Compared to Europe, obesity is a disgrace in this nation," said Dr. Ernst L. Wynder, foundation president. "Weight is a major factor in disease and preventive medicine begins in part with a healthy weight. We need a campaign similar to the anti-smoking effort of the '80s and the cholesterol awareness program."

Added former U.S. surgeon general Dr. C. Everett Koop: "Television and commercials have really contributed (to obesity) and it also stems from psychological and spiritual sources. To our shame, we've done almost nothing about this threat to our health."

The recommendations, issued in the form of a consensus statement, provide a healthy-weight table based on the Body Mass Index--a scientific measure calculated from height and weight. Overweight people are also advised that even modest weight losses can lead to a "healthier weight."

Still, some experts question the idea of putting more pressure on a society already plagued with a largely unsuccessful diet frenzy. They also question the value of publicizing more weight tables, which they say could confuse consumers and cause more harm than good.

"I'm really shocked and disappointed," said Healthy Weight Journal Editor Frances Berg, who attended the conference as an observer. "This isn't like quitting smoking. There are many health risks associated with losing weight and already a national obsession with thinness."

Berg, who is also a nutritionist and adjunct professor at the University of North Dakota School of Medicine, said the foundation's healthy-weight numbers--which are stricter benchmarks than some other tables that show a range of acceptable weights--are a "step backward" and will do damage, especially to women.

"I see four dangers here," Berg said. "(They) create greater potential for eating disorders, harm from dangerous weight-loss methods, prejudice against large people and abuses of the kind already seen from the weight-loss industry."

Not so, counters Johanna Dwyer, a Tufts University School of Medicine professor and member of the foundation panel.

The recommendations, she said, "are a release from (social) pressure. The emphasis is to get your weight lower even if you can't reach perfection. We're saying any modest weight loss is positive rather than negative, and that an emphasis should be on not gaining more weight. There are a lot of people out there who haven't gotten that message."

Added fellow panel member Sachiko St. Jeor, a professor of clinical medicine at the University of Nevada: "The point is to get a simple and practical message out there that takes a stand and isn't wishy-washy. We're setting a healthy weight goal, an upper limit associated with the least disease."


The debate about what constitutes healthy weight isn't new, nor is the notion of guidelines.

Karil Bialostosky, a U.S. Department of research fellow for nutrition policy, said the term "healthy weight" was coined in 1990 by an advisory committee.

"They wanted some word other than the term 'desirable weight,' " she said. "The word healthy makes the concept less ambiguous and connects it more properly to a health-based use."

Still, precisely defining "healthy weight" was difficult, so the committee recommended an interim definition that included three components: weight, distribution of fat and health status.

Those and other recommendations resulted in the agency's 1990 Dietary Guidelines for Americans, a 27-page pamphlet that is being revised by a newly formed advisory committee and will be reissued in December, 1995, Bialostosky said.

"There is some confusion and controversy with the 1990 healthy-weight guidelines because people focused only on the weight table instead of all three components," she said.

Of the American Health Foundation recommendations, Bialostosky said Health and Human Services has no official position. "It's a real tough and controversial issue that many people have questions about," she said.


So just how overweight are we?

One study--the ongoing Behavioral Risk Factor Surveillance System, conducted by the Centers for Disease Control and Prevention--reports an overweight rate of about 26%, with Arizonans being the least overweight (20%) and Mississippians the most overweight (32%). Californians log in around the middle, at about 25%.

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