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Health: Experts Revise Guidelines On Obesity

Washington, 5 June 1998 (RFE/RL) -- In the same week that doctors declared obesity to be a major risk factor for heart disease, a new standard for determining when a man or woman is obese is at the center of a public health controversy in the United States. Also in this week's health file is a report from psychiatrists on a new cause for concern -- addiction to the Internet.

Government Revises Guidelines On Obesity

Washington -- U.S. government health experts have long said Americans are too heavy, warning of an epidemic of obesity -- that is, having a bodyweight that is unhealthy and could be dangerous. Now, new government guidelines due for publication in two weeks will classify even more Americans as being heavy enough to warrant medical attention.

The guidelines are not scheduled to be released until June 17th, but word of their conclusions has set off a public health controversy, with critics saying the new guidelines are too strict and that they will do little to help people achieve a healthy weight.

A panel of 24 experts commissioned by the U.S. National Heart, Lung and Blood Institute drafted guidelines on the identification, evaluation, and treatment of overweight and obesity in adult Americans. Obesity can contribute to heart disease, some types of cancers and the type of diabetes that develops in adults. Overweight is defined as being from five percent to 20 percent above ideal bodyweights and is the condition that precedes obesity.

The guidelines say that a measurement called the Body Mass Index (BMI) should be the standard method for determining when a person is obese, and they lower the threshold for declaring when bodyweight should be a concern.

The BMI measures weight in relation to height and experts say it correlates very well to body fat, the culprit in obesity. BMI is obtained by dividing weight in kilograms by height in meters squared. For example, someone who weighs 65 kilograms and is 1.6 meters tall would have a BMI of 24.5. Someone who weighs 79 kgs and is 1.78 meters tall would have a BMI of 25.

Under the new U.S. guidelines, anyone with a BMI of between 25 and 29.9 is overweight. A BMI of 30 or higher is considered obese. Using those new guidelines, about 97 million American adults, about 55 percent of the population, would be considered overweight or obese.

Earlier studies had defined a woman with a body mass index of 27 or a man with a BMI of 28 as overweight. And dietary guidelines released by the federal government in 1996 defined anyone with a body mass index of 26 or above as overweight. But officials from the heart and lung institute lowered the threshold, concluding that health risks can begin with a body mass index as low as 25. The experts contend that as body mass index levels go up, blood pressure and total cholesterol levels also rise, increasing the risk of heart disease, diabetes and some cancers, the researchers said.

The new standards will bring the U.S. closer to World Health Organization measurements. The WHO also classifies obesity as a BMI of 30 or higher, but the WHO divides obesity into three classes. Class two, which is a BMI of 35 to 39.9, is considered dangerous, 40 or higher is life threatening.

The U.S. guidelines are designed to give patients and doctors ways to measure when a person's weight is hazardous. They recommend that overweight people exercise and eat healthier foods to keep from gaining additional weight. The guidelines say medication for weight control should be reserved for those with a BMI of 30 or over.

Obesity Now Recognized As Major Health Risk Factor

Washington -- The U.S. has also joined the World Health Organization in recognizing obesity as a major health risk factor in its own right. According to the American Heart Association, new evidence makes obesity just as dangerous to a person's health as smoking, high blood pressure, high blood cholesterol and a sedentary lifestyle.

A study published in the May 29, 1998, issue of the journal Science found that 54 percent of all U.S. adults are overweight, an increase of about 33 percent since 1978. The study published in Science also found that more than 25 percent of the nation's children are overweight or obese.

Dr. Robert Eckel, vice chairman of the heart association's Nutrition Committee, says "obesity itself has become a lifelong disease, not a cosmetic issue, not a moral judgment -- and it is becoming a dangerous epidemic." He says the upgrading of obesity from a "contributing risk factor" to a "major risk factor" for heart disease is the result of strong scientific evidence that obesity increases heart attack risk. It also was prompted by the increasing prevalence of obesity in the U.S. population.

Eckel says that one reason for the prevalence of obesity in the U.S., "is that although Americans are eating a lower percentage of total calories from fat, they are eating more calories overall." He says other significant factors include increasingly sedentary lifestyles among adults and children, according to Dr. Eckel.

Obesity is not just a U.S. problem. The WHO concluded last June that there is an epidemic of obesity around the world, even in the poorest countries. The WHO said the prevalence of obesity in adults is 10 percent to 25 percent in most countries of western Europe, rising to as high as 40 percent -- among women -- in eastern Europe and the former Soviet Union.

Experts Think Internet 'Addicts' Manifest Other Problems

Washington -- A new study concludes that people who spend an inordinate amount of time on the worldwide computer hookup known as the Internet frequently show signs of other psychiatric disorders.

In a presentation to the American Psychiatric Association convention last week, Dr. Nathan Shapira of the University of Cincinnati College of Medicine said people who appear to be "addicted" to the Internet reported having five different psychiatric disorders at some point in their lives. He said it is not clear whether the obsession with spending time on the Internet should be considered a disorder or just a symptom of something else, or whether certain disorders promote the excessive use.

Shapira and colleagues studied 14 people who had spent so much time with their computers that they were facing problems like broken relationships, job loss and dropping out of school. One of the subjects said he spent more than 100 hours a week at his home computer. Some of the recognized disorders the subject had been treated for included manic depression, eating disorders, inability to control emotions and alcohol or drug abuses.

Shapira said the excessive computer use by the study participants would qualify as a disorder of impulse control, in the same category as kleptomania or compulsive shopping. In fact, he suggested the Internet problem be called "Internetomania" or "Netomania," rather than an addiction.