The US healthcare system is not serious enough about tackling the rapidly growing "obesity epidemic." Experts call for better doctor training and, perhaps, government regulation of the food industry.

It is ironic that obesity, the most easily observed and measured risk factor for cardiovascular disease, has not been taken seriously by a majority of physicians. As a result, the health problems associated with obesity, including cardiovascular disease and diabetes, continue to grow.

The investigators suggest that the US government, physicians, insurance companies and the food industry all bear responsibility for ignoring the seriousness of the national obesity problem.

The authors stress that the dimensions of the problem are hard to overstate. Current estimates put the number of Americans now either obese or overweight at about 97 million.

The researchers point out that since 1997, the World Health Organization, the American Heart Association, the National Institutes of Health, the US Surgeon General and the US Centers for Disease Control and Prevention have all issued statements and nutrition guidelines highlighting the grave health risks associated with obesity.

Excess weight is a major risk factor for high blood pressure and diabetes. Along with sedentary lifestyle, obesity is associated with more than 300,000 deaths due to heart disease each year in the US.

Despite the fact that US consumers spend more than $33 billion on diets each year, they are getting fatter. This is particularly true among those 18 to 29 years old.

The fact that US doctors don't typically initiate discussions on nutrition and weight control may be at least partly behind the nation's failure to trim its bulging waistline.

Physicians tend to focus more on the drug management of a patient's high blood pressure, rather than working with patients to lose the extra pounds that may be responsible for the problem. Most obese persons have not been advised by their physicians to lose weight.

The lack of insurance coverage for patient-doctor consultations, obesity programs further undercut any incentive for an obese patient to seek help. This problem is compounded by the limited range of healthy food options found in the restaurants many Americans patronize, particularly popular fast-food chains.

The authors propose a serious public health discussion on the feasibility of establishing either voluntary or government food industry regulations. They suggest that doing so could have a public health impact similar to that of laws governing seat belt and tobacco use.

An urgent "plan of action" is required to help people combat obesity, based on cooperation among scientists, insurance companies, healthcare professionals and the government.

American Journal of Hypertension 2002;15:655-659