Cincinnati's love affair with fatty food is a fatal attraction. The leading causes of death in the region are heart disease, stroke, diabetes and some forms of cancer. Obesity directly contributes to all of them.

        Nationwide, 33.7 percent of adults are at risk for health problems because they are overweight. The Tristate ranks higher than the national average — 35.9 percent in Ohio, 36.7 percent in Kentucky and 34.1 percent in Indiana.

        Eight out of 10 adults are at risk for health problems because of a lack of physical activity or exercise.

        Obesity and lack of physical activity are emerging health problems in the community, especially for men over 30, according to the Greater Cincinnati Community Health Status Survey for 2000.

        Gary Weiler, a behavioralist at Jewish Hospital Weight Management Center in Evendale, sees the impact of obesity daily when he counsels clients whose weight problems leave them unable to walk down the basement stairs, or in extreme cases, get out of bed.

        There is no up side to obesity. “It's eventually going to be fatal, and it's going to make you miserable in between,” Mr. Weiler says.

        Eating a balanced diet, regular aerobic exercise and weight training are the cornerstones of healthy living, experts say.

        Obesity is an important health issue but few people take it seriously, says Hamilton County Health Commissioner Tim Ingram.

        “It may not seem important that a person is overweight or obese, but it is important, and it can't be ignored,” he says.

        “People may think that being overweight is a matter of looks, but in actuality it's a matter of health. Lifestyle choices are an important factor in a person's overall health.”

Health problems
        It often takes a major health event - high blood pressure, a heart attack, or diagnosis of diabetes - for people to get serious about weight loss and exercise.

        Kerry Brown knows a lot about weight loss. Since 1994, she's lost 30 pounds three times. She made up her mind — the last time — to lose weight when her blood pressure hit “the high end of normal.”

        “I just made up my mind that the yo-yoing thing is not good for you. That did it,” she says.

        Now that she's lost the 30 pounds she needed to drop, she watches what she eats and exercises. And she became a group leader for Weight Watchers, encouraging others to fight the battle of the bulge.

        “I want to live to be 100,” she says. “That's why I did it.”

        Ms. Brown, 44, of Avondale says her family tends to be heavy. Her siblings are overweight, and so were her parents.

        In the summer, she walks. Now that it's cold, she uses a Jane Fonda exercise video at least four days a week.

        Elizabeth Becker, 69, of Southgate had begun an exercise program to help ease the pain of her osteoarthritis when she started having chest pains in April. After an angioplasty, her cardiologist referred her to a dietitian. She's eating healthy and losing a pound or so a week, slowly getting to her goal weight. She lives on 1,300 calories a day and three trips a week to the gym.

        This isn't Ms. Becker's first major weight loss. About 10 years ago, she lost 100 pounds “but I gradually put it back on.”

        This time she is more focused because she is worried about her health.

        Health problems make it easy to concentrate on weight loss, she says, “particularly when a cardiologist tells you to.”

Fat science
        Obesity seems like a simple equation: Too many calories plus too little exercise equals too many pounds.

        “If you could just think of eating as a way of fulfilling your body's need for energy, and everyone has a certain amount of energy that they need every day which is dependent on some combination of their age and their height and their weight and their level of activity,” says Dr. Stephen Goldberg, medical director at Jewish Hospital Weight Management Center.

        “Therefore, the amount that a given person has to eat at a given age is going to be different. As soon as your intake exceeds that amount, you're going to store up that energy.”

        But underlying causes of overeating and consequences of obesity are a complex stew of physical and psychological factors.

        Emotional issues such as depression and stress trigger binge eating. Biological issues — such as insulin resistance and slow metabolism — make losing weight difficult.

        Lifestyle issues play a major role. Oversized portions served at restaurants, careless eating habits and lack of knowledge about nutrition make it hard for people to make good choices about how much they eat. Busy people rely more on carry-out than planning and preparing their meals. And people simply don't move as much. Sitting at computers, talking on portable phones and using remote controls has created a sedentary nation.

        So Americans spend $33 billion a year for pills, equipment, gym memberships and diet clubs in an effort to lose weight. But all that money hasn't changed the fact that six of every 10 Americans is overweight — a statistic that's been on the rise since the 1950s.

Diets don't work
        There's an argument to be made that Americans are overweight because they're always on diets. Diets, most dietitians will tell you, don't work. People have to exercise regularly and learn to eat moderate portions of food, with plenty of grains, fruits and vegetables and not too much salt, sugar or fat, they say.

        A good weight-loss plan will cover two phases: losing weight and maintaining the new weight.

        Maintenance is where most dieters, and most diets, fall down on the job, says Janet Bohne, a community dietitian with Mercy Health Partners in Western Hills.

        Popular weight-loss plans like the Zone, Sugar Busters and the Atkins diet focus on eliminating food components like sugar, carbohydrates, fats or proteins.

        But most people aren't going to stick for long with a diet that lets you eat bacon and eggs three times a day, but no toast or hash browns, though they will lose weight quickly.

        And they'll regain the weight just as quickly, says Ms. Bohne. “They didn't learn any new habits,” she says. “They didn't learn to eat pasta in moderate portions.”

        Good nutrition takes learning. But most overweight people have forgotten what it feels like to be hungry, or even what it feels like to be full, Ms. Bohne says. They're used to eating until they're stuffed, and when that feeling goes away, it's a cue to eat more.

        Portion sizes, which keep growing at many restaurants, are a big part of the problem, she says. After years of wolfing down fast food value meals and having lunch super-sized, many Cincinnatians have no idea how big the serving size for a particular food really should be.

        And when they do learn, it's often a shock, Ms. Bohne says. “A serving of ice cream is half a cup,” she says. “Who eats half a cup of ice cream?”

        If people are surprised by how much - or how little - they should be eating, they're more surprised by how much they really are eating. “A lot of clients are really in denial” about the amount of food they eat each day, Ms. Bohne says. And it's easy to forget a few cookies, a handful of chips or a donut. But the calories add up.

The food addict
        All cities have more than enough dangerous delicacies to go around. But Cincinnati's luscious local favorites - Graeter's ice cream, Skyline and Gold Star, Montgomery Inn ribs and Frisch's Big Boy sandwiches - are packed with fat and calories as well as flavor. A half-cup of Graeter's vanilla ice cream has 250 calories and 16 grams of fat. A Skyline five-way has 790 calories and 42 grams of fat.

        The key, Ms. Bohne says, isn't vowing to never again have a five-way for lunch.

        “You can eat anything. It's how much you eat and how often you eat it,” she says.

        People eat for all kinds of reasons: Hunger, boredom, anger, sadness, loneliness, frustration, habit. Anyone who's ever come home from a bad day at the office and taken a swan dive into a gallon carton of Aglamesis Bros. chocolate ice cream understands how easy it is to substitute eating for healthier emotional or physical outlets.

        Teaching people to figure out how much to eat and what kinds of foods are best is one part of the battle against obesity. Teaching them to understand why they're eating is another key component, says Mr. Weiler.

        Mr. Weiler divides overweight people into three types:

        • The 5 percent or so who have a thyroid disorder or some other medical condition that causes their weight problem.

        • The 30 or 35 percent who have fallen into a sedentary lifestyle and gained their extra poundage over several years of inactivity.

        • And that leaves six out of 10 overweight people who are compulsive overeaters — food addicts. They eat too much, too often when they're under stress.

        “You could argue that it's our nation's largest addiction,” says Dr. Susan McElroy, a psychiatrist with the University of Cincinnati's weight management program.

        For compulsive overeaters, food is as addictive and as dangerous as alcohol or cigarettes or any street drug, Mr. Weiler says, and beating an addiction is hard work.

        Many compulsive overeaters have followed a cycle of losing weight, regaining it and going on yet another diet. By the time they get to Jewish Weight Management Center, which is known for its liquid diet Optifast — the diet Oprah used — many are facing serious health consequences because of their weight.

        Following a structured food plan helps compulsive overeaters focus on why they eat instead of what their next meal will be. Identifying the stresses that trigger binges and learning new ways to deal with those stresses goes a long way toward solving the weight problem, Mr. Weiler says.

        “Taking the weight off is not the problem. The problem is really stress,” he says.

        Exercise, hobbies and phone calls to friends are all good replacements for eating, Mr. Weiler says. But teaching a compulsive overeater to eat normally is “like asking someone to sign their name with the wrong hand,” he says.

Putting it all together
        Joyce Mulroy, 53, of West Chester was shopping one day and caught sight of herself in a store window. It was a shock.

        “I never saw myself as that heavy, and then I walked by that storefront,” she says.

        “That time, the beginning of June, something when I saw myself, it just clicked, like, oh my gosh, I am so obese. I had never considered myself that way.”

        By July, she was a client at Jewish Hospital's Weight Management Center. She lost more than 77 pounds the first five months, but it isn't easy: She drinks five Optifast shakes a day totaling 800 calories and at least 80 ounces of water.

        While she's losing weight, she sees a nurse weekly, a clinic doctor every other week, and either a dietitian, a behavioral counselor and a fitness trainer weekly.

        She attends classes on healthy eating, including learning what a proper portion size is and how to read food labels to check for calories, sodium content, sugar and carbohydrate content and fat grams.

        She also exercises. Like Weight Watchers or Jenny Craig, the Jewish Hospital plan emphasizes aerobic exercise at least three times a week. Also, two days a week of weight training is recommended. While cardiopulmonary exercise burns off calories, weight training increases the body' calorie-burning metabolism by creating lean muscle mass.

        Her goal is to reach a healthy weight. Already, the weight loss and exercise have alleviated the need for medicine to cope with high blood pressure and a stomach ailment. Her husband, Mark, is on the fast while their teen daughter, Lisa, eats regular meals.

        “After the first race I was in, Lisa came up to me and said, "Mom, you have climbed your Mount Everest. I'm so proud of you,'”

        Mrs. Mulroy says: “That's worth a million bucks.”

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