For anyone who was around for the now-famous 1964 Surgeon General's Report on Smoking and Health, this week's report by the current surgeon general -- "Call to Action to Prevent and Decrease Overweight and Obesity" -- may seem like deja vu. Back then, smoking was the number-one health hazard, and yet the majority of Americans didn't consider cigarettes dangerous. Today the fastest growing threat to health is obesity, yet most of us still consider fat a personal problem. And just as nobody in 1964 could conceive of restricting citizens' God-given right to smoke, few Americans today can imagine regulating something so personal as the way we exercise and eat.

We may not have a choice. Obesity is epidemic, as Surgeon General David Satcher noted this week. More than 120 million Americans are classified as either overweight or obese. Obese people are twice as likely as those of normal weight to develop Type 2 diabetes, 50 percent more likely to develop heart disease and 86 percent more likely to get colon cancer. Last year obesity cost the nation $92 billion, according to federal figures.

Since 1970 the percentage of the U.S. population that is obese has increased by 60 percent. At that rate, we risk wiping out the tremendous gains made in the past 25 years against cancer and heart disease by the middle of the 21st century.

So what are the institutions responsible for protecting the nation's health doing to help Americans keep from getting fatter? Not very much, as the federal budget shows. This year Congress gave the Centers for Disease Control $100 million for tobacco control and a mere $16 million for programs designed to prevent obesity. The National Institutes of Health will spend $226 million for obesity research, and $2 billion on studying cardiovascular disease and diabetes, two diseases for which obesity is a principal risk factor.

Even doctors ignore obesity. More than half of physicians do not urge their patients to lose weight until those extra pounds have already helped bring on another disease, according to a study in the Journal of the American Medical Association. The trouble is, doctors don't know how to help people slim down. Only a third of medical schools require students to take nutrition classes, let alone teach them how to counsel overweight patients.

That's because doctors, like the rest of us, still think of fat as a failure of will. Sure, lack of will power is partly at fault, but the larger problem lies with the environment. We are surrounded by tasty, cheap, high-fat food, while fruits and vegetables are comparatively more expensive and less readily available. Our suburbs are built without sidewalks, our kids buy candy and soda in the hallways at school, and our sense of portion size is so out of control that we think a 600-calorie cinnamon bun (about a quarter of the total calories the average man needs per day) is a snack. We could not have designed an environment more conducive to getting fat.

Surgeon General Satcher wants individuals to take responsibility for preventing obesity, but changing America's fat-producing environment is going to take government help -- such as requiring all chain restaurants and fast-food outlets to prominently display the calorie and fat content of their foods; subsidizing the price of fruits and vegetables; offering incentives for communities to build parks and walkways; and taxing sugar. A 1-cent tax on every 12 ounces of soda could raise nearly $1.5 billion a year for nutrition education.

It's a pretty good bet that the food industry is not going to like these ideas. Restaurateurs and food and soft drink manufacturers have already taken a page from the tobacco industry's playbook, maintaining that eating less is the individual's responsibility, even as they pile on the portions at restaurants and "supersize" soft drinks. Sugar, fast-food and soft-drink companies have recently joined forces to launch an ad campaign called "Be Active America!" The central message: You can eat as much junk food as you like, as long as you exercise.

But the food industry risks being demonized the way tobacco has been, especially if it insists on fighting efforts to reduce obesity in children. It was tobacco advertising to kids that finally swayed Congress to dramatically increase regulation of that industry. Now legislators are trying to restrict advertising of high-fat, high-sugar food on children's television and banish vending machines and fast food franchises from schools. The reason? Rapidly escalating rates of obesity among children, and studies showing that the majority of toddlers can recognize the word "McDonald's" before they can read their own names. It's beginning to sound like Joe Camel all over again.