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Who is fat? A new reccomendation from the National Institutes of Health says 55 percent of American adults are overweight. After this background report, Phil Ponce weighs in on the changes.

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LEE HOCHBERG: The number of overweight Americans has steadily increased since 1980 from 25 percent up to 40 percent this year. But new recommendations from the National Institutes of Health will change the definition for who is considered overweight. The new standards say 55 percent of American adults, 97 million people, are too heavy, making Americans the most overweight people on earth. Oregon Health Sciences University Professor of Medicine Roger Illingworth.

DR. ROGER ILLINGWORTH, Oregon Health Sciences University: In western societies the average weight of a person forty to fifty years of age is increasing. It's just excess calories. And there's a combination. It isn't just diet. It's less exercise, more cars, all those factors.

LEE HOCHBERG: The new guidelines are based on a fat measurement called Body Mass Index or BMI. A BMI of 25 is considered overweight. The figure is a mathematical computation involving height and weight. These people would now be overweight: A person who stands five foot six and weights 155 pounds; a person five nine who weights 169 pounds; a six footer who weighs 184. For the average person the new standards lower the threshold for what's considered overweight by fifteen to twenty pounds.

The new standards are based on an extensive review of body fat studies that find as BMI levels increase, so does the risk of illness, including coronary artery disease, heart attack, hypertension and stroke, diabetes, and certain forms of cancer. The new standards likely will cause a stir among Americans. Even before they were released, the NIH estimated 25 to 40 percent of Americans are trying to lose weight at any given time. Doctors say the 26 million people newly catalogued as overweight should increase exercise and reduce intake of fats-fatty meats and fried foods, cheese, and butter.

DR. ROGER ILLINGWORTH: So part of the reason for weight loss is to reduce the production of these-

LEE HOCHBERG: But Illingworth and other doctors fear the new standards will have several unintended effects. For one, the newly overweight may seek inappropriate medical solutions, like diet pills.

DR. ROGER ILLINGWORTH: There's pressure from patients who see these guidelines, see new guidelines now, and they're more aware that their weight is heavier than it should be and want some quick fix.

LEE HOCHBERG: The NIH recommends only the obese-people with BMI 30 or above-use diet pills. But the Federation of State Medical Boards reports many of the 300 violations it's issued to doctors since 1996 were for improper prescription of diet pills.

DR. JULES ALTFAS, Medical Weight Management Center: So you've been sticking with the Phentramine.

PATIENT: Yes.

DR. JULES ALTFAS: Is that working, seem to help any?

PATIENT: Oh, I think it helps a lot.

LEE HOCHBERG: At the Medical Weight Management Center in Portland Dr. Jewels Altfas says while he won't prescribe pills to patients with BMI's under 30, the new standards justify prescribing such medication.

DR. JULES ALTFAS: There's certainly logic in treating people earlier. Clearly, the risk is that people who come in with a Body Mass Index of 27 or 28 and have been gaining weight are going to continue to gain weight.

LEE HOCHBERG: While people try to deal with their weight, health care advocacy groups have another concern, that the insurance industry, looking to keep its risks to a minimum, will use the new standards to exclude people from coverage, or increase their premiums. Federal law prevents such action against those with group coverage, but individual policy holders could be subject to it.

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