WHAT HAVE YOU GOT TO LOSE? MORE DOCTORS SPECIALIZE IN FIGHTING FAT.

Byline: Mariko Thompson Staff Writer

As a medical school resident working long shifts, Dr. Sami Alskaf learned how hard it is to lose weight. Alskaf ballooned by 30 pounds and then worked to shed the weight. His own battle against the bulge sparked an interest in treating obese patients.

Today, Alskaf is a doctor of internal medicine and the director of the Metabolic Obesity and Nutrition Center at Kaiser Permanente in Panorama City. Though the Kaiser patients he sees are more than 30 pounds over their ideal weight, he can empathize with their struggles.

``It starts somewhere, by gaining 10 pounds, then 20 pounds,'' Alskaf says. ``It's the same mental process and analysis.''

At one time, many doctors viewed obesity as a weakness of character rather than a medical problem. That has all changed now that a staggering 64 percent of American adults are either overweight or obese. Today doctors understand that obesity is far more complex than just advising patients to drop the doughnuts and jump on the treadmill. This new understanding has spurred the once-obscure field of obesity medicine into the limelight.

``It requires an intense knowledge of biology and psychology to put it all together,'' says Dr. Peter Vash, executive medical director of Costa Mesa-based Lindora Medical Clinics, which offers weight-control programs. ``You sense a newfound respect for the treatment of obesity.''

Increasing knowledge of how obesity affects the body has fueled the shift. Doctors now call obesity a disease, noting that it has a genetic base and alters the body at the cellular level. Obesity in turn is linked to other chronic and life-threatening diseases, such as hypertension, type 2 diabetes and certain cancers. Adding even more urgency, a recent federal estimate found obesity-related health costs total $93 billion a year, rivaling smoking in its financial toll.

Doctors are responding to the call to battle. Organizations that provide training have noticed a surge in interest. The American Society of Bariatric Physicians, a professional organization, was founded in 1950. Over the past two years in particular, the association's ranks have grown and now number 1,100 members, says executive director Beth Little.

Acknowledging the trend, Harvard Medical School will investigate ``Obesity Medicine: An Emerging Discipline'' at its 18th annual obesity conference in late June. It's going to take a concerted effort by health care workers of all stripes - doctors, nurses, psychologists and nutritionists - to address the epidemic, says Dr. George Blackburn, associate director of the nutrition division at Harvard Medical School.

``The objective is for them to walk out the door with the tools, skills and science they need to be effective in meeting their patients' needs,'' Blackburn says.

In the weight-loss arena, much hoopla has centered on celebrities such as the ``Today'' show's Al Roker who have undergone gastric bypass surgery. But surgery is only one component of obesity medicine. Crossing a wide range of disciplines, obesity medicine encompasses primary care, endocrinology, cardiology, psychology and more.

Dr. Peter Pressman, an assistant professor at the University of Southern California's Keck School of Medicine, began his career as a clinical psychologist who specialized in eating disorders. Later he went to medical school to become an internist. Today Pressman combines his psychological and medical backgrounds, working with bariatric surgery patients before and after their operations. Pressman not only monitors his patients' high blood pressure but also addresses the psychological issues around food addiction.

``This group of patients is so humbling and inspiring,'' Pressman says. ``Every day we see these patients struggle with physiological and emotional challenges.''

Alskaf, the doctor faced with slimming down during his residency program, launched the Kaiser Permanente obesity clinic in Panorama City in 1997. The program, open only to Kaiser members, treats both adults and children. Patients have regular doctor visits, learn about nutrition, consult with exercise physiologists and attend classes that address psychology and behavior.

Susan Hammarlund, a 58-year-old Northridge resident, tried all kinds of weight-loss programs over the decades. Since enrolling in the Kaiser program two years ago, she has lost 110 pounds, down from 298 pounds.

``I feel good seeing a doctor regularly,'' Hammarlund says. ``I feel committed. That's why I keep going.''

Mariko Thompson, [phone]

mariko.thompson(at)dailynews.com

How fat are we?

Q: How many Americans are overweight or obese?

A: An estimated 64 percent of American adults are either overweight or obese. Among children and adolescents, 15 percent are considered overweight.

Q: Why is obesity a health concern?

A: Obesity increases the risk for heart disease, stroke, diabetes, certain cancers, sleep apnea and osteoarthritis. A recent analysis found that the cost of treating obesity-related illnesses totals $93 billion a year.

Q: How is an adult classified as overweight or obese?

A: The body mass index, a formula based on height and weight, is used to determine if a person is overweight or obese. An adult with a BMI from 25 to 29.9 is considered overweight. An adult with a BMI of 30 or more is considered obese.

Q: Is the same formula used for children?

A: The body mass index for children considers gender and age. A child is considered at risk of being overweight if the BMI falls between the 85th and 95th percentiles. A child is considered overweight if the BMI is at or above the 95th percentile.

For more information, visit the Centers for Disease Control and Prevention Web site at www.cdc.gov/nccdphp/dnpa/obesity/index.htm

CAPTION(S):

2 photos, box

Photo:

(1 -- cover -- color) NO DOUGHNUTS FOR YOU!

Doctors take a measured medical approach to fighting fat

Charlotte Schmid-Maybach/Staff Photographer

(2) Dr. Sami Alskaf's own trouble with weight during his medical residency inspired him to open the Metabolic Obesity and Nutrition Center at Kaiser Permanente.

Phil McCarten/Staff Photographer

Box:

How fat are we? (see text)