You have noticed your obese friend suddenly slimmer. You want to know what shes doing, but you dont want surgery or side effects.

My Miami patient Marcia weighed 303 pounds. She noticed newly trim, formerly 325 pound Kim walking the golf course, and asked her how shed lost weight. Marcia now weighs 190, has quit smoking and a year later, has gained control.

Labeling Marcia and Kim as diseased only makes them victims, and medicalizes their problems. Deciding obesity is a disease stigmatizes the obese, as if they didnt feel enough unwanted attention already.

The disease label is about money, not health. Its about getting insurers, including Medicare, to pay for remedies. Its about creating a so-called fat tax. Its about tariffs on fast food sales and food production. And its about promoting expensive lifestyle drugs, still being tested. Many doctors do not recommend any obesity drugs, and are worried about their side effects.

Some people think that fat is in their genes. And genes are everythingfor infants. For people over age 50, however, 80% of your health is your choices. What you eat changes the proteins your genes make, and help your body protect itself against actual diseases to which youre susceptible, such as heart disease and cancer. Knowing whats in what you eat and finding nutrient-rich, calorie-lean food are personal responsibilities.

The science of obesity is new. Olympian Maurice Greene (59 176#) is overweight, because his Body Mass Index is over 25 kg/m2. Although muscle weighs more than fat, he would be labeled overweight: an insurance risk. Lenders, employers and insurers may use that diagnosis against you unfairly. Weight distribution and body fatnot pounds alone--should be measured before labeling people.

Neither Marcia nor Kim thought they had a disease when they came to see me. They felt well. Actually, very few obese patients feel ill. Yet they haveand now controlhigh cholesterol, high blood pressure, diabetes and osteoarthritis. They do it with their personal choices, including individualized diets, self-monitoring, accountability, and structured, step-by-step fitness.

Understanding the risk of overweight comes one person at a time. Obesity is not a disease of deranged genes, willpower or pseudoscience. Obesity is a problem of planning. Thats what my patients Marcia and Kim needed. You need a plannot a label--to succeed.