Tuesday, March 19, 2002; Page HE01

She is thin now. Very thin and sleek in a black suit as she mounts the podium at the recent annual meeting of the Women's Center in Northern Virginia. She reviews her past succinctly: First she was fun, then she was fat.

Fat! Fat Fergie, the Duchess of Pork.

Not anymore. The Duchess of York divides her time between London, where she cares for her two daughters, and the United States, where she is a spokeswoman for Weight Watchers. "I'm just a single mum. I live in the air," she says. Just-Call-Me-Sarah, the divorced daughter-in-law in Britain's dysfunctional royal family, has reinvented herself to be a leader in the anti-obesity movement.

She spreads a very important message about weight control that often gets left out of news releases from public health officials: It's not just about food. It's the feelings, stupid.

"I used to eat my emotions," she told the crowd of 900 men and women jammed into a hotel ballroom in Tysons Corner.

Her waistline reflected her emotional state. The more stressed she was, the larger her circumference. She ate as though the cavity of insecurity inside her had to be filled with calories and outrageous behavior.

"So eventually what happened is, you know, divorce, near-bankruptcy," she explained. "Overeating and overspending and overdoing and overindulging and over-everything!"

Over the top. She had to get her life in shape, along with her body.

Don't we all.

The spreading obesity epidemic in the United States is a major public health hazard. Excess poundage causes more medical problems and exacts a higher health care bill than smoking or alcohol abuse, according to a study published last week in the journal Health Affairs. Being obese is like being 20 years older than you really are.

With a lifestyle of fast food, sit-down commutes and frustration, it's hardly a surprise that we eat more and exercise less than our grandparents did. "It's natural to become fat," says Roland Sturm, a senior economist at Rand Corp. and author of the report. "Overeating is easy. Under-eating is hard."

Obesity often begins in childhood. Another report released this month suggests that almost 14 million U.S. children -- 24 percent of the population from 2 to 17 -- are obese. In childhood, the obese enjoy the same good health as their more svelte peers. But in adulthood, obesity increases the risks of major killers, including heart disease and diabetes.

Sturm is skeptical of weight control programs that rely solely on changes in individual behavior. All these pep talks to cut down on cholesterol don't get at the systemic problems of obesity.

"Achieving lasting health behavioral change is difficult and rarely achieved by exhorting individuals to exercise more, eat healthier foods," writes Sturm. It takes changes in the environment to discourage overeating, he says. The narrow focus on diets "is not going to work," he says. "This is doomed to fail."

He points to the tobacco analogy. Smoking rates have dropped not because the surgeon general exhorted individuals not to smoke, but because of higher taxes on cigarettes, the establishment of smoke-free buildings and work sites, limits on tobacco advertising, the isolation of smokers in restaurants and other public places, a broad public education campaign on smoking hazards and, finally, a legal attack on tobacco companies. All these incentives have helped people kick the nicotine habit or not take it up.

In the struggle against obesity, incentives push us in the wrong direction. Sturm, for example, bicycles to work in Santa Monica, Calif., and for a while he used a one-way street with a bike lane. Then the city -- under pressure from the neighbors -- opened the street to two-way traffic so people could drive to work more easily. The bike lane was sacrificed.

What communities need are more bike lanes, not fewer. What Americans need to do is drive less and walk and bike more.

Public health officials should learn from the anti-tobacco movement and mount an equivalent campaign to help dieters beat the obesity epidemic. How? Fat-free cafeterias probably aren't in the cards. But what about an exercise hour to replace the lunch hour? How about treadmills in city parks along with benches? The government could tax junk food so that french fries would cost three times more than carrot sticks. More likely, Congress could find a way to make health insurance plans cover weight loss programs.

When David Satcher, the former surgeon general, released a report on obesity last year, he called on communities to address the problem. "When there are no safe places for children to play, or for adults to walk, jog or ride a bike, that's a community responsibility," he said.

But he doesn't go far enough. What about government subsidies to design walking and bike trails? Tax incentives for companies to provide exercise equipment and fitness breaks? For restaurants to offer certifiably healthy fare?

The obesity epidemic is broader than any one person's waistline. It requires a public health response and an investment of government dollars. But mostly what we hear from doctors and health officials is Let them eat vegetables! Certainly weight control is an individual's responsibility, but with obesity's threat to the nation's health, it's also a public one.

In this leadership vacuum, role models like Sarah Ferguson are very effective. She not only connects with thousands of men and women with her personal story; she also makes it clear that weight control is more than counting fat grams and going to the gym.

Keeping off the pounds is about managing eating along with other fundamental parts of your life. Eating is hard-wired in the primal psyche to make you feel good. But it's not the only way to feel good, as the duchess learned. And if you're feeling bad, it's better to deal with the pain than eat it.

Stress and sorrow are the same in Bethesda as Buckingham Palace. So is being overweight. So are the ways to manage eating in an overeating culture. As long as the social environment that fosters obesity is ignored, each of us is left to struggle against great odds. Fergie gives us hope.

Abigail Trafford can be reached by e-mail at trafforda@washpost.com. Join her Tuesday at 2 p.m. on www.washingtonpost.com for a Health Talk discussion on public health strategies for battling obesity. Her guest will be Roland Sturm of Rand Corp.