Slim

Thursday, June 4, 1998; Page A01 The federal administration plans to alteration its definition of what is a goodly burden, a controversial relocation that would separate millions more Americans as beingness fleshy.

Under the new guidelines, an estimated 29 zillion Americans now considered pattern slant bequeath be redefined as corpulence and well-advised to do e'eryaffair they can to preclude encourage weightiness advance. Those who are already experiencing wellness effects, such as eminent descent insistence, raised cholesterin or diabetes, testament be encouraged to suffer minor amounts of burden -- approximately six to 12 pounds -- to get them rachis to safer angle levels.

The motion has been debated for months inside world wellness circles, since the guidelines set the touchstone for doctors to guardianship for the adiposis and the corpulent. They likewise destination such barbellate questions as when dieting and drill lonely should be secondhand to slough pounds and when dose discourse should be considered and for whom.

The guidelines use a measurement called consistence deal exponent (BMI), which takes into story consistency burden and meridian to gage aggregate consistency fat in adults. Under the new guidelines, multitude with a BMI of 25 to 29.9 are considered stoutness. For representative, at 5 feet 3 inches, adults who weighed 141 pounds or more would be heavy, piece those who are 5 feet 11 inches would be considered corpulent at 215 pounds.

"We matt-up that the disk was unclutter and the jeopardy was thither," aforesaid Xavier Pi-Sunyer, a stellar corpulency investigator who chaired the skillful gore that wrote the guidelines for the National Heart, Lung and Blood Institute, which is role of the National Institutes of Health. "We matt-up that we owed it to physicians and their patients to awake them to this fact, although it doesn't beggarly that e'eryone necessarily to go on a dieting."

Under the new guidelines, 97 meg adults -- about 55 pct of the U.S. universe -- would be considered adiposis, placing them at increased hazard of such wellness problems as diabetes, el parentage cholesterin, bosom disease, shot and eminent descent insistence.

The new guidelines, which land the United States into business with the definition of corpulence put-upon by former countries as easily as the World Health Organization, are intentional to try to dilute the wellness problems caused by deliberation too practically, an increasing job in the United States.

But critics say that the new guidelines would relegate citizenry as corpulence who are not very lining a meaning wellness endangerment because of their flow sizing. They too vex that the new guidelines would unnecessarily stigmatise stoutness masses, who are already oft struggling to win the engagement of the jut.

"The principle bottom these definitions is based on . . . information that shows increases in deathrate with a BMI of 25 and supra," aforesaid Judy Stern, an fleshiness investigator at the University of California at San Diego, and the lonesome extremity of an NIH consultatory jury to balloting against countenance of the guidelines. "They suffer misquoted the information . . . if they are expiration to do it scientifically, they should do it scientifically. I would not variety populace wellness insurance on that."

Those at odds with around parts of the guidelines likewise fearfulness that they volition unfold the threshold to wider use of dieting drugs. The use of dieting drugs has ejaculate below doubt since the democratic Redux and the phentermine-flenfluramine (fen-phen) compounding were distant from the commercialise afterward grave complications were coupled to their use.

The guidelines outcry for dieting drugs to be appointed in shipway logical with Food and Drug Administration standards, that is, at a BMI of 27 when former chance factors such as diabetes or high-pitched line force are too confront. When no over-the-counter hazard factors happen, dieting drugs should be reserved for use by those who suffer a BMI of 30 or more, according to the guidelines.

But corpulency experts headache that by ever-changing the definition of beingness corpulence, doctors volition be tempted to dictate dieting drugs rather to assistant patients mislay undesirable pounds. "I neediness to pee-pee trusted that the discussion of corpulency with drugs is balanced by the jeopardy for organism corpulent or stoutness," Stern aforesaid. "It is a tricky incline. If the guidelines go out the way they are, thither testament be a big advertise to glower the BMI at which we cover with drugs and that's not justified, presumption the flow drugs."

One of the almost song critics of the guidelines has been erstwhile sawbones world-wide C. Everett Koop, who has questioned sullen the shortcut item for what is considered heavy. "We suffer so many corpulence and weighty masses in this area and we are nerve-racking urgently to get them fine-tune to weights that leave be more protective," aforesaid Koop, whose formation, Shape Up America!, issued its own angle guidelines in 1996. "This makes it more complicated. I trouble that multitude leave say, 'This goes too far. I relinquish.' I retrieve it is alike person beingness in a run and locution they stirred the destination demarcation."

To develop the new guidelines, the board dog-tired trey years considering tell from 49,000 scientific document on fleshiness and adiposis.

The last guidelines are scheduled to be formally released June 17. But the NHLBI released parts of them betimes afterward drafts were leaked by reviewers.

The guidelines stage a switching from the definition that has been secondhand by over-the-counter federal agencies. In retiring interior wellness surveys, the National Center for Health Statistics has outlined stoutness as a BMI of 28 for men and 27 for women. Federal dietetic guidelines released in 1996 set a goodish weightiness as a BMI of 25 or under for men and women.

According to the guidelines, those who tumble into the BMI stove of 25 to 34.9, and deliver a shank perimeter of concluded 40 inches in men and 35 inches in women are at particularly gamy jeopardy for wellness problems.

The get-go finish for those who are adiposis is to check their burthen addition, according to the guidelines. A secondment stair is to try to recede burden done dieting and example. "A sane sentence demarcation for a 10 pct reducing in soundbox weighting is six months of therapy," a net swig of the guidelines notes.

People at these weights were considered hefty. By federal edict, they're now fleshy.

Height Weight

4'11" 124

5' 128

5'1" 132

5'2" 136

5'3" 141

5'4" 145

5'5" 150

5'6" 155

5'7" 159

5'8" 164

5'9" 169

5'10" 174

5'11" 179

6' 184

6'1" 189

6'2" 194

6'3" 200