Every night before Sara-Jane Perryman goes to bed, she has to put on a mask. The device blows air continuously down her windpipe, preventing her throat muscles from collapsing and suffocating her while she sleeps.
Her condition, known as sleep apnoea, may seem alarming but it is one which will become increasingly common in Britain over the next decade. The rising rate of obesity among teenagers is producing symptoms hitherto unseen in children. There are at least 20 children in the UK who rely on such devices to keep them alive, but probably many more who need them and have not yet been identified as at risk by doctors.
The report on obesity, which was produced last week by the health select committee, was greeted with unprecedented, almost hysterical, coverage of the issue of fat. The MPs were highly critical of the government's 'lamentable' lack of action over obesity and made more than 69 recommendations for action. The headlines the next day focused on the news that a three-year-old child, from a Bengali family in east London, had died from heart failure, caused by her six stones of weight.
But why has this issue crept up on ministers when paediatricians, scientists and public health campaigners have been warning for the past two years of the impending crisis?
In September 2003, The Observer launched its Fit for the Future campaign, calling on the government to show it was serious about helping children remain healthy. Backed by sports stars such as Paula Radcliffe, the campaign advocated that every pupil in Britain should be able to enjoy at least two hours of sport at school a week by 2006. It seemed a modest proposal but ministers said it would be impossible to achieve within that timeframe. They may now think again, following last week's hammering by MPs and the media.
Our campaign attracted considerable interest from readers who were clearly more exercised than policy-makers about the difficulty of keeping children fit in a society that is scared of allowing them outdoors or of giving them space to play. Many wrote and rang in to suggest measures needed to make it easier for families to curb their sedentary instincts and enjoy a more active life.
Education Secretary Charles Clarke and chief medical officer Sir Liam Donaldson acknowledged that higher levels of physical activity among children were essential if they were to begin to tackle the effects of the obesity epidemic. They had become convinced that the costs to society of tackling obesity were going to be immense if nothing was done.
But as the campaign rolled on, the tactics of the food industry became more apparent. Their intensive lobbying of government, right up to private seminars in Downing Street, was exposed. Faced with new EU regulations that would mean food labels having to show nutritional value, they fought a successful campaign to delay the scheme. Chocolate manufacturer Cadbury came to The Observer with a proposal for a 'good news' story about how it was helping schoolchildren become much healthier. Its Get Active Campaign encouraged them to collect tokens from chocolate bars in exchange for sports equipment. It had managed to get the scheme endorsed by no less than Richard Caborn, the sports minister, apparently with the backing of Tony Blair. But, as we revealed, it became clear that you would need to buy thousands of bars to get any equipment. This cynical approach appalled teaching organisations and health campaigners, and last week was still the subject of huge controversy within government.
In the past four months, there have been numerous reports on obesity. The Royal College of Pediatrics and Child Health produced its own guidelines, the Food Standards Agency recommended curbs on the aggressive marketing of food to young children, and Gordon Brown's adviser, Derek Wanless, spelt out that the costs of treating obesity-related illness would be very high .
To counteract the increasing public hostility towards food manufacturers and the supermarkets, the industry started to show signs of changing its stance. Although Kevin Hawkins, the head of the British Retail Consortium, was talking tough last week against the need for clearer labelling of food, he was undermined by Tesco, which announced that it would bring in a 'traffic-light' scheme for its own products, with those high in fat or sugar marked red, and the healthiest products marked green.
More than half the population of England is now overweight or obese. The number of overweight or obese children increased by 25 per cent between 1995 and 2002, and those who are obese have a life expectancy reduced by nine years on average.
Much of the controversy in recent years has centred on how much blame can be laid at the door of the junk food manufacturers and how much is down to sheer laziness. Currently in Britain, just 40 per cent of men and 26 per cent of women take enough exercise - defined as 30 minutes of moderately intense physical activity on five or more days a week. In Australia and Finland, levels of physical activity are higher.
But the food industry has taken the biggest hammering, and when McDonald's recently announced it was ending the super-sizing of its portions, campaigners began to feel they were getting somewhere. Dr Susan Jebb, who runs the Medical Research Council's human nutrition research programme, believes there are signs that the industry is beginning to change.
'We're going to look back and see last week as a pivotal moment,' she said. 'What the MPs did during the inquiry was expose the chief executives of companies such as McDonald's to unprecedented questioning and scrutiny over their marketing and content of their products. It forced these guys to think very hard about what they were doing. What the government must do now is show it is serious.' She believes they could start by insisting on school meals being more nutritious.
Experts say there is a lack of reliable data to show what kind of intervention works. Research has looked at the impact of more sport and of encouraging the eating of more fruit and vegetables, but there has been no long-term pilot of a community-wide scheme to show the impact of a combination of small initiatives.
The family of Sara-Jane is one of the few to benefit from the expert help that is finally being offered to such teenagers. She is under the care of the Royal London Hospital, where specialist dieticians, gastroenterologists, nurses and doctors aims to change the lifestyle of patients to make it possible for them to lose weight, not just over a few weeks, but for the rest of their lives.
Sara-Jane attends a weekly gym class run by the council, and keeps a food diary to monitor her eating habits. It is small changes such as these that will help to transform both her appearance and her life chances. But there are many like her on the waiting list; the doctors cannot offer immediate appointments to all the teenagers whose parents are desperate for help.
Dr Nigel Meadows, a consultant at the Royal London who cares for Sara-Jane and others, is often overwhelmed by the scale of the task. He told The Observer in December: 'We see children who are grossly obese with huge medical problems. Most have difficulty breathing at night and some are so bad that they run the risk of sudden death at night.
'About a year ago, we had one girl who was brought into us.' Her breathing had stopped and they could not save her. 'It was due to obesity which is tragic,' he said. 'That prompted us to do a screening to make sure others were not at risk.'
Most of the children they see who suffer from sleep apnoea have some kind of obstruction; it might be that the muscle is floppy or that it forms some kind of constriction. 'We also have a huge number of children who are pre-diabetic. They have insulin resistance and are at risk of developing full-blown diabetes.'
But for Meadows, it has taken a while to get the problem recognised, and they cannot deal with all the children who need specialist help. 'We only see the tip of the iceberg, when they already have medical problems. There are many who never get to us at all.'
Dr Penny Gibson, childhood obesity adviser to the Royal College of Paediatrics and Child Health, said: 'The select committee's report was right to say that the NHS is not equipped to deal with a problem on this scale, but it is difficult to know what to do.' She pointed out that the committee advocated giving children an annual weight check that would allow them to monitor weights nationwide 'but this isn't really useful unless you can give parents real advice and help to tackle it'.
She added: 'There is also a big difference between the families who really want to do something and those who don't think there is anything wrong. Much as I would like to encourage people to have a healthier lifestyle, I'm not sure we know how to do that.'
