Bermudians are probably even fatter than September's shocking survey revealed, one of the Island's leading health experts warned yesterday.

Reports in the UK this week suggested only three major countries in the world have a higher proportion of obese people than Bermuda — the US, Scotland and Mexico.

Health Promotion Coordinator Jennifer Attride-Stirling said the true picture could be even worse as latest statistics — showing 23 percent of Islanders are obese and a further 38 percent overweight — are likely an underestimation.

Dr. Attride-Stirling said the Bermuda Health Survey was based on self-reported information, meaning people can mislead researchers by overstating their height and understating their weight.

A new study is planned, in which people will undergo health examinations — a more accurate method used in the US and the UK which experts say reveals higher obesity levels.

The US topped this week's table with an obesity rate of 30.6 percent, with Scotland scoring 25.5 percent and Mexico 24.2 percent. Bermuda was not included in the table of 30 countries, but the 23 percent revealed this month in the Bermuda Health Survey suggest it would have been fourth.

"I guess it's not surprising to see us fourth, but we're likely to be higher up, unfortunately," Dr. Attride-Stirling told The Royal Gazette. "This report makes me even more anxious to get concrete figures for Bermuda.

"Countries like England and the US base surveys on actual measurements as opposed to self-reports."

The table, compiled by the Organisation for Economic Cooperation and Development, shows some countries are managing to keep their obesity levels at a respectable level.

The rate in both Japan and Korea is just 3.2 percent, while Austria, Denmark, France, Italy, Norway, Sweden and Switzerland all have less than ten percent.

Dr. Attride-Stirling said simply copying initiatives in other countries might not prove worthwhile.

"There are things we can look at; what they are doing right and what we are doing wrong," she said.

"But Bermuda is so different from Scandinavian countries, for example. And in Singapore children are weighed and measured every day in school. Could we implement that?"

Explaining that a general change in attitudes was the way forward, she said: "The thing that keeps coming out at me is that people don't associate obesity with themselves.

"They think obesity is 300 pounds or more. In fact, it can be something much lower than that. We talk about big boned, and full figured, and baby fat. We (health professionals) need to start using the terms people use on themselves.

"We don't fully understand what is going to get the population to change their behaviour. We need to really understand how people talk in their day to day life; what they eat; what motivates them. A very large proportion of people are putting on a few pounds every year.

"If they have breakfast every day, it might be a massive bowl of Coco Pops. The reason they buy that might be because it's two for the price of one. How can we move them away from that behaviour? We have to see the motives behind their behaviour — a lot of it is cultural."

The doctor returned to the Island yesterday following a conference in England, where she was told cameras are being put in obese people's homes so health chiefs can identify behavioural trends.

Asked if such a project could be introduced here, she replied: "It's something that needs to be thought about and considered very seriously."

Last month, Government announced a Healthy Weight Action Plan to tackle obesity, with recommended measures including increasing tax on fatty food and cutting it on healthy food.

In one scheme launched this week, health workers are taking advantage of lengthy waiting times at TCD by encouraging frustrated motorists to take part in health screenings and have their blood pressure, blood sugar, waist measurement and body mass index calculated. It runs on Tuesday and Thursday.

People will be taking part in a series of sessions aimed at improving their health habits.

The Coronary Health Improvement Project (Chip) will be one of the first projects run from the new Diabetes Resource Centre in Beacon House, Hamilton.

It will attempt to get across the message that people need to keep their weight and blood pressure in check, do more daily exercise and quit smoking.

Organisers say three quarters of western diseases are lifestyle-related — brought on by rich diet, lack of exercise, smoking, alcohol, caffeine or stress.

Heart disease, stroke, diabetes, hypertension, gout, impotence and gall bladder disease are among the illnesses which can be brought on by lifestyle.

The initiative, scheduled for mid-October to mid-November, will include 40 hours of lessons on good health, with heart screening at the beginning and end to see how much difference it makes.

It will culminate with graduation ceremonies at Bermuda Underwater Exploration Institute.