You must have have spent the past few weeks eating chocolates under the duvet to have missed the headlines. Obesity is a clear and present danger to the nation's health. Rates among children are rising fast, and today's obese youngsters are tomorrow's NHS patients.
There are strong links between obesity and a range of costly chronic conditions: coronary heart disease, diabetes and some cancers, as well as depression and other forms of mental illness. All these make heavy demands on healthcare resources. Failing to address the problem will pile up trouble, not only for individuals who are seriously overweight, but for all of us who want to sustain a viable NHS in years to come.
Public health experts have been warning about obesity for years, but until recently it has failed to attract much media attention. At last the evidence is shocking enough to make "news". Obesity now affects 8.5% of six-year-olds and 15% of 15-year-olds. Last week's report on obesity management from the Health Development Agency and this week's Obesity Forum in London have helped create a sense of urgency, begging the question - what can be done?
Poor diet and physical inertia are major causes of obesity. But it is not just a matter of personal or family responsibility. What we eat and how much exercise we take are strongly influenced by income, class and culture. Poor children are more likely to be obese. And those who grow up in poor neighbourhoods or in socially excluded groups are more likely to stay that way. So it is the responsibility of us all, and of government on our behalf, to find ways of tackling the problem at source and severing the link between social disadvantage and obesity.
There is no great mystery about what measures would make a difference. Healthier, more appetising and affordable school meals. No more sales of crisps, sugary drinks and sweets on school premises. Clearer labelling on foods, and health warnings where necessary. More healthy, affordable food shops in poor neighbourhoods. More pressure on supermarkets to promote healthy eating.
On the physical side, more sport in schools and changes to the curriculum to promote physical exercise in ways that appeal to all children. Safe routes to school to encourage walking and cycling for children of all ages. More public space for children to play and do sports of all kinds. And in the NHS, consistent guidelines and strong incentives for GPs and community nurses to identify and treat obesity with all the commitment that now goes into smoking cessation - with appropriate funding to make it happen.
Why, then, if so much is known about what could help to tackle obesity, has so little been done?
One reason is that Britain simply does not have a public health culture, or a health system that gives priority to tackling the causes of ill health. An obsession with "fixing" the NHS overshadows the more complex challenge of how to stop people becoming NHS patients in the first place. While policies to cut waiting times are energetically promoted, consistently pursued and properly resourced, obesity attracts only sporadic interest (such as the prime minister's recent call for more sports facilities) and little strategic planning.
A second reason is that the Department of Health is engulfed in a major restructuring that is ripping much of its public health capacity out of the centre and "devolving" it to strategic health authorities and primary care trusts. When - if ever - the process is complete, the department may be better at managing the NHS, but may be no better (and possibly worse) at working with other sectors to address the social and economic causes of ill health.
A third reason is the government's apparent fear of being accused of nannying, which makes it nervous of measures that impinge on private lifestyles. This doesn't add up. Why shouldn't publicly-owned schools provide pupils with a healthy diet, or publicly-owned parks, roads and pavements provide safe spaces for walking, cycling, play and sport, or food be properly labelled, or GPs treat obesity as a serious health problem? In any case, this seemingly unassailable government should be able to rise above cheap jibes and get on with the job.
The Health Development Agency estimates that the costs of obesity, mainly due to sick leave and healthcare, run to £2.6 bn a year and look set to rise by another £1bn by 2010. This calls, surely, for a national obesity strategy, with serious funds behind it, to bring together all aspects of prevention and treatment to steady and reverse current trends.
It would include strong and consistent leadership; more funds for school meals, sports, safer roads and playgrounds; new incentives for food industries and advertisers to promote products that are appealing, nutritious and affordable; new protocols for health professionals; more obesity specialists and more resources to enable the NHS to give the problem urgent attention. It would be well worth the investment.
Anna Coote is director of health policy at the King's Fund and co-author of Health in the News: Risk, Reporting and Media Influence. The King's Fund is at www.kingsfund.org.uk
