So what's wrong with being fat?

This is question that my 55-year-old patient asked me in clinic last week. This was not the first time that I had heard this question. Indeed, obesity has become so commonplace in the United States that the asthenic individual has become the exception rather than the rule. With the increasing prevalence (and incidence, too, for that matter) of obesity in our society, patients have come to perceive this state of body habitus as the norm rather than the exception. ‘What’s the matter with being a little overweight?’ my patients frequently ask, ‘Everyone in my family is fat, so why not me? What difference does it make?’ I begin my ‘fat’ talk once again. It seems that I am doing this ever more frequently and probably I am. In this little sermon on obesity, I stress the many health risks inherent in carrying around excess poundage: coronary risk factors, gallstones, diabetes, colonic adenomas, degenerative joint disease, sleep apnoea, and so forth. I emphasize the importance of modest and gradual weight loss as compared with the ‘ping pong’, up and down, nature of so many of my patients’ weight loss programmes. ‘Bouncing your weight up and down may even put you at greater risk for heart disease’ I continue, hoping that my patient will take the message to heart. ‘Regular exercise such as daily walking is a great help in losing weight. Try to cut back on carbohydrates and saturated fat in your diet. Would you like a consultation with one of our dieticians?’ My daily preaching often goes unheeded and leads me and my colleagues to become cynical about the possibility of ever getting our patients to lose weight. This is the price to be paid in a society that gratifies itself with every conceivable type of food taken in excess alongside of widespread physical inactivity. In this issue, Ashton and colleagues have given me further ammunition to use in the battle against excess poundage. These authors report on the findings of a large, on-going, epidemiological trial involving more than 14 000 employed English women between the ages of 30 and 64 years. Each of these women underwent an examination that included a questionnaire followed by the collection of certain physical exam and laboratory data. From this information,