CHICAGO (Reuters) - Americans' losing battle against the bulge also bears a burgeoning price tag, with the amount of money spent treating obesity-related health problems increasing tenfold over 15 years, a study said on Monday.

Between 1987 and 2002, private spending on obesity-linked medical problems mushroomed from $3.6 billion, or 2 percent of all health spending, to $36.5 billion or 11.6 percent of spending, the study, published in the journal Health Affairs, found.

Obesity is a major risk factor for many chronic illnesses, including diabetes and heart disease. With about 30 percent of U.S. adults now obese, treating these conditions is a leading driver of double-digit health care insurance premium hikes.

"These are very expensive patients," said Ken Thorpe, professor at Emory University's public health school and author of the study. "If insurers and employers are serious about reining in health care spending, then obesity prevention should be at the top of their agenda."

Researchers studied data for about 28,000 privately insured individuals comprising a nationally representative sample.

About 60 million Americans are obese, according to the U.S. Centers for Disease Control and Prevention. And the surge in costs is primarily due to those rising numbers, as opposed to rising treatment costs per patient.

In 2002, obese individuals dominated the category of adults treated for the top 10 medical conditions contributing to medical spending, including arthritis, asthma, back problems, diabetes and heart disease.

These data suggest that health insurers' current cost-cutting strategies, such as boosting co-payments for patients, are aiming at the wrong target. Such measures tinker around the edges of the health cost burden but do not address the problem's roots, Thorpe said.

"We're going to have to tackle this they way we did smoking - with a variety of big strategies," Thorpe said.

With tobacco, that included taxes on cigarettes, an aggressive push for new products like the nicotine patch and a big role for government.

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ALPHARETTA, Georgia (AP) -- When Kelley Belkeir joined a gym a year ago, she went once and never returned. It was too intimidating for the out-of-shape 44-year-old.

All around her were uncomfortable stares from sleek, toned hard-bodies. She felt no one at the gym would help her.

Months later, she tried again -- this time at her local YMCA, taking advantage of its customized Coach Approach program. Offered at only 14 YMCAs around the country, including some in Indianapolis, the program seeks to keep exercise novices from dropping out by providing a scientifically-based regimen that matches the difficulty of workouts with a participant's tolerance.

The approach has worked for Belkeir. By sticking to her workout routine, the stay-at-home mom has dropped a pants size, avoided cholesterol medicine, and now can keep up with her 3-year-old son, Phillip, without losing her breath.

"It's important to me that I just feel better. You carry yourself better when you exercise," said Belkeir, who had stopped routinely exercising when she was pregnant with Phillip.

Coach Approach was created three years ago in Atlanta by Jim Annesi, a former tennis pro, because so many people quit traditional fitness programs not long after they join. Up to 65 percent of new gym members drop out in the first six months, according to the most recent data, a U.S. study published in 2003 in the European Journal of Sports Science.

Annesi began working on this problem a decade ago as an exercise science and sports studies researcher at Rutgers University in New Jersey. Fitness club owners came to him, puzzled by all the people who join and then quit merely after a few weeks.

To stay in business, gym owners were forced to repeat a tired cycle of continually replacing dropouts with new enrollees.

"Dropouts continued to be cited as the number one concern for wellness facility managers year after year," said Annesi, now director of wellness advancement for the Metro Atlanta YMCA.

The problem, he said, is that most fitness clubs focus on what works best for the 20 percent of club members who need no prodding. That means pushing many exercise sets and repetitions.

"It was an emphasis on getting quick physiological results and basically leaving people to their own resources," Annesi said. "With Coach Approach, we're trying to first build the exercise habit, then looking to physiological change that could last for a lifetime."

But too much exercise too quickly easily wears novices out, quickly discourages them and makes exercise a dreaded task instead of the enjoyable pursuit it should be, Annesi said.

Coach Approach is designed to satisfy novice exercisers so they stick with it beyond six months. YMCA officials say the program's dropout rate is half that of traditional programs -- with only about 30 percent quitting within six months.

"It helps to have people engaged," said Madelyn Fernstrom, director of the Weight Management Center at the University of Pittsburgh Medical Center, who is not affiliated with the YMCA program. "If it was so easy, people would be thin and fit and running to the gym. Short of that, people say, 'I like a little reinforcement. It's nice that people are interested in my progress."'

YMCA has been expanding the program to about three cities a year, and Los Angeles, Indianapolis, Philadelphia and Washington are among those that now offer it.

Under the program, YMCA officials assess a new member's tolerance of exercise pain, self-management ability and the support the person has to help him continue.

Then they set exercise goals that are regularly are tweaked based on levels of fatigue, stress and exhaustion afterward.

The trick, Annesi says, is to provide a level that challenges but doesn't discourage someone from continuing.

"What we're really trying to do initially is build a sense of competence and you want to pair exercise with pleasant after-exercise feelings," Annesi said.

Electronic displays on treadmills and other machines keep track of a participant's goal and serve as reminders of how much to shoot for that session. Members get friendly e-mails celebrating accomplished goals or reminders if they've missed workouts a few times in a row.

The YMCA helped Belkeir figure out the best time to exercise: The mother of two used to arrive in the evenings, but found it too stressful when she had other worries, such as what to plan for the dinner. Now she exercises three mornings a week.

And she's carried her fitness routines home, where she has small weights and regularly uses the family treadmill, which once served as a glorified clothes rack. "I even exercise on vacation," she says.

The fitness habit has extended to Belkeir's 15-year-old daughter, Chelsea, who has started exercising at the YMCA and at home.

More important, the Alpharetta, Georgia, mom she feels better.

"If I come in sluggish and not jazzed, I find my energy level has increased immediately" after a workout, she says, as she sets the controls to a YMCA treadmill and putting the earbuds of her iPod in place. "I'm not Superwoman on a treadmill -- I just want to get my heart rate elevated. That is what is most important."

http://www.cnn.com/2005/HEALTH/diet.....ap/index.html