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By now we all know we're too fat. It's in all the media, and we see it at the mall, the airport and in our closets. We know it raises risk of serious diseases. What we may not know is what it means for our ability to get good care.

I read a lot of sonograms, and that's a good thing: ultrasound is noninvasive, not super costly and free of harmful radiation. Even after years in practice, I still feel magic as images spring in real-time from a slender wand moved across an abdomen. How amazing, to see so much so quickly and with so little effort!

These days, though, the degree of difficulty is increasing along with our collective waistlines. Ultrasound is great for thin people, but sound waves have trouble penetrating the abundant fat that more and more of us possess. This makes it hard to see what's going on, and that's not only frustrating, it can be downright dangerous. What you don't know can indeed hurt you.

One example is accumulation of fat in the liver, which interferes with liver function and can lead to serious problems. Fat in the liver, like the fat beneath the skin, resists the sound waves and masks what lies within. This condition, called "fatty infiltration," used to be uncommon, but now I see it several times a day.

Obesity poses problems for all diagnostic imaging, not just ultrasound. Bigger bodies require bigger radiation doses, and too much fat degrades image quality. In some cases, scans can't even be done due to equipment weight limits.


Being obese or overweight is complicated, to be sure. But if, like so many of us, you need more motivation to fight it, think forward to a day when you might feel that wand on your stomach, struggling to see inside. You -- and your doctor -- will want answers, not uncertainty.

With a Perspective, I'm Peggy Hansen.