Obesity is becoming the new smoking - at least in terms of its known contribution to increased health care costs. And as such, it should be treated seriously by insurance companies and private employers offering health insurance as well as the federal government.

Part of that strategy will probably involve health insurance discounts for people who are not overweight and who demonstrate other healthy-lifestyle habits such as regular exercise. The flip side of those discounts will likely involve charging higher rates to people who are significantly overweight, much like the premium charged to smokers in many health insurance programs.

The evidence continues to mount that obesity related illnesses are growing faster and contributing more to escalating heath care costs. Being significantly overweight increases the likelihood of arthritis, diabetes, heart disease, gallstones and stroke.

A recent study by a professor of public health at Emory University found that from 1987 to 2002, private spending on obesity related illnesses grew from $3.6 billion to $36.5 billion - a 1,000 percent increase. The study looked at 28,000 people covered by private health insurance and approximately 30 percent could be considered obese, and afflicted with all the associated illnesses.

The study revealed that about 12 percent of all health care spending in 2002 was directed at severely overweight patients. And the extra medical treatments required for obese patients is increasing the costs for everyone else.

While some people dispute the finding that nearly one-third of all Americans are obese (30 pounds or more overweight), a simple stroll through a nearby shopping mall or Wal-Mart will reveal the extent of the obesity problem. And to the medical community, those people are walking time bombs. It's only a matter of time before they need costly medical treatment and no doubt suffer a decrease in their quality of life.

Type 2 diabetes is the fastest growing illness hitting overweight Americans. And treatment for diabetes-related illnesses alone have been estimated to nearly $2,000 a year per patient.

To a large extent, most of these health problems - and their associated costs - are preventable. While some cases of obesity are rooted in genetics, most overweight people can reduce their health risks with improved diet and a program of regular exercise.

But the current trends are not encouraging. The Centers for Disease Control and Prevention (CDC) has labeled obesity an epidemic and reports that 59 million Americans are obese - a 60 percent increase over the past 10 years. Still more troubling is the fact that over the past 25 years, the rate of obesity in children has doubled while the rate found the in adolescent population has tripled.

Unless major changes are made, it's clear this health care time bomb will explode in the coming decades.

Given the massive amount of money involved in treating obesity related diseases - $61 billion in direct costs and $56 billion for indirect costs - there is great incentive to create societal changes to reduce the rate of obesity.

There should be a combination of approaches, both carrots and sticks.

It is appropriate, based on predictable lifetime medical expenses, to charge higher health insurance fees to people who are seriously overweight and to offer discounts to those who are more fit.

On the carrot side of the equation, there should be financial incentives offered by insurance companies or employer-sponsored health plans to move overweight members into healthier lifestyles including changes to diet and regular exercise. Financial inducements and marketing campaigns to bring down obesity rates would be money well spent, considering the billions of dollars that will eventually be spent treating these people for diabetes, heart disease, arthritis and other ailments directly related to their condition. Money spent to reduce obesity can reduce money spent treating diabetes, heart disease and other related illnesses.

If attacked on many fronts and in a sustained fashion - government, health insurance, employers and individual households - progress can be made on trimming the fat in America. The time to start is now.