LOS ANGELES—A report published Monday in The New England Journal of Medicine warns that the nation's obesity epidemic has reached a new level of crisis, with many overweight Americans' increased girth rendering them physically unable to end their own, fat lives.

Americans who have no choice but to keep on living.

"We've known for some time that obesity can cause heart disease, diabetes, strokes, and other potentially life-threatening illnesses," said report author Dr. Marjorie Reese, director of UCLA's Obesity Pathology Clinic. "But the fact that obesity impedes suicide is truly troubling. It appears that the more reason people have to die, the less capable they are of doing so. They are literally trapped in their grotesque, blubbery bodies."

Of the one-third of Americans classified as obese, the report estimated 29 percent are too heavy, immobile, or both for suicide to be a viable option. This figure is up from 18 percent in 1996.

A full 70 pages of the report focus on suicide methods that are taken for granted by persons of normal weight but often present insurmountable challenges to their corpulent counter- parts.

For example, hanging oneself is most often out of the question. The report notes that a disturbing percentage of the obese are too large to ascend a footstool, too inflexible to kick it out from under them, and even if they could, are too heavy to remain atop it long enough to put their giant, flabby necks through a noose before the footstool shatters into splinters under their massive girth. Plus, as Reese writes, "even if all other variables were eliminated, the weight of these enormous individuals would probably break any indoor light fixtures or attic roof supports to which they might tie a rope."

Overdosing on narcotics is also impossible, according to Reese.

"Body fat absorbs toxins, so fat people simply cannot ingest enough bottles of sleeping pills to have any effect, much less stop their hearts," Reese said. "And slitting one's wrists in the bathtub is not an option if you can't find a butcher knife thick enough to reach the arteries under your rolls of wrist flab, or can't fit into the bathtub in the first place. All the self-loathing in the world is not going to help the obese get their meaty index fingers through the trigger guard, nor give them the flexibility to raise the pistol to their head. It's heartbreaking."

The report included detailed illustrations of extremely overweight people unable to bend over far enough to fit their heads into ovens, bobbing like corks while attempting to drown themselves, and becoming too winded scaling stairs to reach heights from which they could hurl their enormous bulk with fatal results. Another researcher at the Obesity Pathology Clinic has developed a computer model which demonstrates that even if the obese were able to jump off a skyscraper, their bodies would be "more likely to bounce than splat."

Yet health experts say that there is hope for these hulking individuals.

"The fat need to improve their eating habits and commit to a modest exercise regimen, even if it starts with just walking from room to room inside their houses," said Dianne Evans, a specialist at the Johns Hopkins Center for Public Health. "If they keep that up for six to 12 months, most of these people could lose enough weight to be able to kill themselves with relative ease."

But Evans warned that losing too much weight too fast could have serious repercussions.

"What you want to avoid is a situation where someone comes down from 320 pounds to 240 in the span of a single year, and suddenly does not have the suicidal urges they once did," said Evans, who explained that the "sweet spot" of self-hatred and physical suicidal ability is extremely small. "If they mistake their all-but-meaningless improvement for a legitimate reason to live, their fat, revolting lives may be prolonged indefinitely."