WASHINGTON -- Surgeon General David Satcher is calling for a national attack on fat.

He said so many Americans are so fat that obesity may soon knock tobacco out of the top spot as the country's leading cause of preventable deaths.

From schools to fast food, Satcher is calling for a full-on assault to trim waistlines, similar to the one federal health officials declared on smoking.

"People tend to think of overweight and obesity as strictly a personal matter, but there is much that communities can and should do to address these problems," Satcher said.

Among the recommendations are for schools to provide healthier food choices for students and physical education classes for every grade.

Satcher wants to see more walking trails in cities and he suggested that employers should provide time for workers to get physical activity on the job.

Some 60 percent of adults are overweight or obese, and so are nearly 13 percent of children. About 300,000 people a year die from illnesses directly caused or worsened by being overweight, compared to more than 400,000 deaths a year associated with cigarette smoking.

The total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in the year 2000.

Obesity among adults has doubled since 1980, while overweight among adolescents has tripled.

Only 3 percent of all Americans meet at least four of the five federal Food Guide Pyramid recommendations. And less than one-third of Americans meet the federal recommendations to engage in at least 30 minutes of moderate physical activity at least five days a week, while 40 percent of adults engage in no leisure-time physical activity at all.

Already, these trends are associated with dramatic increases in conditions such as asthma and in type 2 diabetes among children.

Satcher said failure to address overweight and obesity "could wipe out some of the gains we've made in areas such as heart disease, several forms of cancer, and other chronic health problems."

Definition Of Obesity, Overweight

The National Institutes of Health define obesity and overweight using a Body Mass Index, which is a calculation of a person's weight in kilograms divided by the square of their height in meters.

An overweight adult is defined as one with a BMI between 25 and 29.9, while an obese adult has a BMI of 30 or higher.

In children and adolescents, overweight is defined as a sex-and-age specific BMI at or above the 95th percentile, based on revised growth charts by the Centers for Disease Control and Prevention. There is no generally accepted definition for obesity for children and adolescents.

The risk of death, although modest until a BMI of 30 is reached, increases with an increasing BMI.

Obese adults have a 50 to 100 percent increased risk of premature death compared to adults with a BMI of 20 to 25. But even moderate weight excess -- 10 to 20 pounds for a person of average height -- increases the risk of death, particularly among adults aged 30 to 64 years.

Calculate Your Body Mass Index

Additional Resource:

• Surgeon General's Report