NEW YORK (Reuters Health) - Around one fifth of overweight Americans may not realize they need to lose weight--and neither do many of their physicians, according to new research.

A team based in Baltimore found in a survey that 21% of overweight patients believed their weight was normal, and up to one quarter of physicians did not identify their patients' weight problems.

"If you don't recognize (your patient is overweight), you're not going to be able to counsel them to lose weight," lead author Dr. Suzanne M. Caccamese of Good Samaritan Hospital told Reuters Health. "Before it gets worse," she added.

Caccamese and her colleagues base their results on a survey of 679 patients and 37 doctors conducted in February 1999. Patients were weighed and their height was measured, and then doctors were asked to classify the fully clothed patient as overweight, normal or underweight.

A total of 526, or more than three-quarters, of patients were overweight, the report indicates.

In the study, Caccamese and her colleagues calculated patients' weight status using body mass index (BMI)--a measure of weight in relation to height used to gauge obesity. A person with a BMI of at least 30 is obese, while one with a BMI between 25 and 29.9 is overweight.

Although 22% of overweight patients in the study who believed they were of normal weight were actually obese, most of the patients were simply overweight. However, Caccamese's team notes that people who are obese used to be overweight, and the right counseling could keep patients from gaining extra pounds.

"The importance of focusing on overweight patients is also supported by research about the increased risk of developing several chronic diseases, including diabetes, hypertension, gallstones, and coronary heart disease, in adults who are overweight but not obese," the authors write in the June issue of The American Journal of Medicine.

Male physicians were less able than female doctors to accurately assess the weight status of patients, and overweight men misperceived their own weights more often than overweight women.

"It could just be that in society, it's more acceptable for a man to be slightly overweight than a woman," Caccamese offered, trying to explain the gender differences in weight perception.

Patients who were most likely to be misclassified by doctors were male, physically active, and believed they lived a healthy lifestyle.

Caccamese said that she recommends that all doctors measure a patient's BMI to determine who is overweight, for as these results show, simply looking at them isn't enough.

"Just by looking at the weight, or just by looking at the patient, you're going to miss a lot of people who are overweight," she said.

SOURCE: The American Journal of Medicine 2002;112:662-666.

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