QUESTION (Continued from last week): Last week I discussed the question of "how fat is too fat" and reviewed some of the ways fat is measured both in the research laboratory and in fitness centers and spas. I mentioned how difficult it is to determine if you were really too fat because of the wide range of normal values in the population.

I introduced the idea of body mass index because scientists have used this index to determine what is "too fat" in terms of health. The formula for this index is weight in kilograms (kg) divided by height in meters, squared. (Weight in kg is equal to weight in pounds divided by 2.2, and height in meters can be calculated by multiplying height in inches by 0.0254. The height is then multiplied by itself to get height, squared).There is some disagreement among experts as to the exact index level that constitutes a risk, but it seems clear that risk begins to increase at levels around 27 and increases as the ratio goes up.

Another factor is the question of how fatness relates to the distribution of fat. Several major studies have found that upper body fat is more dangerous in terms of health risk than lower body fat. Those people who tend to get a protruding belly (large amounts of fat in the abdominal region) have higher rates of cardiovascular disease, hypertension, some types of diabetes and certain cancers than those whose fat accumulates in the hips and upper legs.

One way to determine risk from fat distribution patterns is to look at your waist-to-hip ratio. Measure around your waist where it is smallest (usually about at the umbilicus) while standing relaxed and without pulling in your stomach. Then measure around your hips where they are largest. Divide the waist measurement by the hip measurement to get the ratio. For example, if a man has a 38-inch waist and a 36-inch hip measurement, his ratio would be 1.05 (38/36 = 1.05). A healthy ratio is below 0.85 for women and below 1.0 for men.

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So what do you do if you determine that you are too fat as the result of using a technique discussed in these columns? So many different weight control programs are available that it is sometimes difficult to decide which to use.

Books have been written that recommend rotating between high and low caloric intakes, separating certain foods from other foods and emphasizing one certain food as the answer to your fatness problems. Hospitals and medical groups offer a very low-calorie liquid diet to be administered under physician control. Various liquid diets and diet pills are available at pharmacies and the supermarket. Some physicians offer synthetic thyroid to increase metabolism. Exchange lists are available for changing the type and amount of food you eat. Commercial weight-loss programs can be found at every corner in your hometown.

The question is, which of these work best, and which should you use if you want to lose weight successfully?

Next week I will evaluate some of these approaches to weight control and tell you which approach I think works best.

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