Obesity isn't just unattractive to look at it's a health crisis a point which, surprisingly, even some physicians need to be made to understand.

"Part of it is awareness, part of it is teaching the doctors and the nurses and people in the health care system that obesity is important and it's important to address it," said Jaye Hefner, associate medical director of Consult and Primary Care Services at Spaulding Rehabilitation Hospital, in Massachusetts, who spoke with physicians at King Edward VII Memorial Hospital on obesity.

"The mindset of many doctors is not to put prevention first," she said. "As doctors we are trained to work and focus on disease.

"I am a physician but I am also trained as a public health scientist so I see the world through a different lens.

"Doctors are seeing it at the end and the problem with that approach is 40 percent of people with the symptoms of heart disease [experience] sudden death.

So they are not even going to get a chance to get into the system, to use a nice centre or go to the doctor or use medication to lower cholesterol or blood sugar."

Obesity is a leading factor in what is called the metabolic syndrome.

Others include fat, especially in the abdomen, high blood pressure, blood fat disorders that cause build-up on the walls of blood vessels, and glucose intolerance where the body does not properly break down sugars.

People with the syndrome are at high risk for heart disease, diabetes and stroke.

"Getting people to just stop gaining weight may be the first step as treatment options for people," said Dr. Hefner, who added that the real goal should be to have people reduce their size.

Lori Mosca, head of Preventive Cardiology at New York Presbyterian Hospital was also on the Island recently as part of the Bermuda Heart Foundation's preparations for its cardiac intervention and prevention centre.

Dr. Mosca agreed that obesity is a serious problem. In her private clinic she stresses the importance of losing fat.

"You may end up weighing more. I don't worry about people getting on the scale.

"I try and teach people that it's not really about cutting weight, it's more about your composition, so we are focusing more on waist size and this is really important on this Island because this is what is associated with the metabolic syndrome," she said.

"If you get on the scale and you see that you are gaining weight when you are in an exercise programme it's very frustrating so I tell my patients not to do it. All I want you to measure is your waist circumference.

"And we see that even with a quarter of an inch there will be improvements in blood pressure, improvements in sugar control and improvements in their blood cholesterol.

"With five to ten pounds of fat loss we see major shifts in blood pressure."

Dr. Hefner said people have to want to lose the weight.

"It's recognition, it's doing an assessment of how ready are you to make a change in your life and if you are, what can we do, what's a positive thing we can do to help?"

And she said the advice and suggestions given to people should be attainable if any headway was to be made. She said she felt that this was where things ran amok in the US.

"In the US, the Surgeon General would say eat this many calories in a day and exercise this long but I don't know anyone who can do all the things they recommend.

"An hour-and-a-half of exercise four times a week? There's not many single parents that I know that have a full-time job and are supporting three children that can do this," she said.

"It's setting realistic goals and putting together a plan that makes that possible."

But Dr. Mosca said she felt everyone had enough time to exercise.

"I can attest to this being about choice, about prioritisation," she said.

And she said she always quotes the German philosopher Goethe to people who say they don't have the time: 'Things that matter the most must never be at the mercy at things that matter the least'.

"We are all very busy doing a lot of stuff but there is nothing more important in what we do than to keep ourselves alive because you will not be able to take care of those three children if you are dead," Dr. Mosca added.

She added: "The other important thing is to understand that [a mother] is [also] a role model and by her action is teaching those children.

"That's where we need to focus on this Island and everywhere the children.

"If you don't make it a priority they are going to learn it's not a priority.

"Your actions speak louder than your words. So if women don't do it for themselves, they might do it for their children."

But she admitted she's heard countless people say they do not have enough time to exercise.

She said she challenged the people that came to a prevention centre she ran at the University of Michigan to come up with excuses on why they don't have an hour a day.

"We wrote them all down and had a board full and it was really funny.

"But I took the number of hours in a week 168 subtracted things you absolutely have to do, like sleep seven hours a night, work ten-hour days, then subtracted an hour-and-a-half for eating.

"By the time you do it all, there are at least six or seven hours left in a day and all we are asking for is 30 to 60 minutes," she said.

And she pointed out that mothers do not have to be alone to exercise.

"If you have difficulty with children, take them with you, let them walk or ride their bikes, do it together as a family.

"It has so many benefits beyond the heart. It's great for family bonding and for stress reduction.

"And I tell them that when they say they don't have the time, that they are really saying that they are not important enough to take the time and I tell them: 'You need to deal with that'," she said.

Dr. Hefner said she believes that if people have government and community support, tackling obesity becomes more effective.

Taxing unhealthy foods and enacting laws that prohibit the sale of fast foods in school zones are some examples she gave of how government can help.