DOCTORS DON'T AGREE ON IDEAL WEIGHT.

Byline: Carol Bidwell Staff Writer

Are fit and fat mutually exclusive terms? Can you be overweight and still be healthy?

These are questions medical experts are still debating.

Doctors who push hard for their patients to lose weight point out that excess poundage poses an increased risk for heart disease, diabetes, high blood pressure, stroke and even some types of cancer.

``The No. 2 cause of preventable death in America is obesity,'' says Dr. Michael Hirt of Tarzana, an internist board-certified in nutrition. ``Americans have been getting bigger and bigger. And they haven't been getting fitter and fitter.''

Other doctors say being more than 20 pounds overweight isn't the hazard it's been made to seem and that judgmental doctors actually perpetuate one of the last permissible prejudices, putting down people who don't measure up to standardized height-and-weight guidelines.

``You can be healthy and you can be fat, there's no question about it, as long as you're fit and get some exercise like dancing or gardening or even housecleaning,'' said Dr. Michael Chapman, a Beverly Hills internist. ``A lot of doctors will say, `Well, that man died because he was fat.' But what they don't say is, `He was afraid to go to the doctor because he knew he'd get a lecture about his weight, so he was unhealthy and he died.' ''

There's no doubt that, even in an era of fat-free foods and salad bars, Americans are packing on the pounds.

According to new guidelines set in 1998 by the National Heart, Lung and Blood Institute (a branch of the National Institute of Health), 97 million American adults are now considered overweight or obese.

Medical experts agree that losing weight lowers blood pressure and reduces other disease risks. But the NIH says they're also beginning to acknowledge that taking off pounds is very hard, something our bodies actually rebel against, fighting to stay at an internal weight ``set point'' determined largely by our genes and our body type.

At any one time, 15 percent to 35 percent of the country is on a diet, the NIH estimates. But continued dieting slows down metabolism and saps morale, Hirt and Chapman agree.

No matter how successful the weight-loss regimen, more than 90 percent of those who lose regain that lost weight, usually adding extra pounds as well, according to the New England Journal of Medicine.

``We're trying to hold ourselves up against a standard that doesn't exist,'' said Northridge clinical psychologist Andrew Yellen. ``And it just plays havoc with our self-esteem. You go on a diet; you go off a diet; you're a failure - again.''

Still, many Americans continue to try to look like the TV and movie stars they admire, spending $30 billion to $50 billion every year on diet clubs, fat-free foods and over-the-counter diet aids, according to the New England Journal.

And diet can turn into obsession: About 7 million women and 1 million men suffer from anorexia or other eating disorders, according to the National Association of Anorexia Nervosa and Associated Disorders.

Too-zealous attempts to lose weight have led to depression, gall bladder disease, ulcers, anemia, menstrual irregularities, gout, infertility, kidney stones, osteoporosis and even death, according to the Sacramento-based National Association to Advance Fat Acceptance.

In a January 1998 editorial in the New England Journal urging people not to resolve to diet in the new year, Dr. Jerome P. Kassirer and Dr. Marcia Angell emphasized that healthy eating is more important than deprivation.

``We should remember that the cure for obesity may be worse than the condition,'' the doctors said. ``We should also speak out against the public's excessive infatuation with being thin and the extreme, expensive and potentially dangerous measures taken to attain that goal.''

If you're overweight, eating sensibly and finding an exercise you enjoy and will keep doing is the best way to bring your weight into an acceptable range, say doctors. It won't happen overnight, but then, you didn't put those pounds on overnight, either.