The government's health watchdog is set to recommend that severely overweight children at risk of developing life-threatening diseases should be offered radical weight-loss surgery.
The National Institute for Health and Clinical Excellence (Nice), which is currently under fire for rationing Alzheimer's drugs, will shortly publish its long-awaited plans for the treatment of obesity in adults and children.
The institute will recommend that severely overweight teenagers for whom other treatments have failed should be offered surgery, including 'stomach stapling', as a last resort to prevent them from developing diabetes, cancer and serious heart conditions. But the decision to give the go-ahead to the £8,000 procedures will be greeted with dismay by NHS officials and hospital bosses, as the health service, which is cutting jobs and restricting access to clinics, struggles to contain its £800m deficit.
The move is the latest in a string of difficult and controversial decisions made by Nice specialists about a series of treatments. The independent body is facing a public outcry over Alzheimer's drugs restrictions and a legal challenge by drug manufacturers, which want to know why the body decided to turn down proposals for NHS-funded medication for patients in the early stage of the disease.
It has taken two years to put together the report on obesity. It is expected to stress that far more should be done to prevent adult patients becoming overweight at an earlier stage, and will insist that GPs do far more to give more unambiguous advice to overweight adults, talking about diet but also prescribing exercise for them.
Workplaces will also be encouraged to provide tailored fitness programmes for employees, as well as the showers and the cycle sheds needed to encourage people to jog or cycle to work. Employers will be told they also have a duty to provide healthy canteen food, and weekend social clubs that encourage their staff to remain active.
Obesity specialists have told Nice that bariatric surgery - which involves restricting the stomach so that patients lose fat over time and learn to eat sensibly - is highly effective and good value for money, as it prevents patients needing more costly treatment later on. Studies have shown that it can reduce mortality by up to 30 per cent in patients for whom other drug treatments have failed.
Currently, most patients who might be eligible cannot be given surgery as most primary care trusts, which hold treatment budgets, refuse to pay for the £8,000 operation. Between 50 and 200 teenagers a year could get treatment.
The surgery for children would apply only to those who have a body mass index (BMI) of 40 or more. This would mean that most of the children would be aged between 15 and 16, when they had already gone through puberty and reached physiological maturity.
An individual's BMI is calculated by dividing their weight in kilos by their height in metres squared. An ideal BMI is 18 to 25; when it reaches 40 or more, patients are defined as 'morbidly obese'. A girl whose height is 5ft 4in and weighs 16½ stone would fall into this category and could be eligible for surgery if other treatments such as weight loss programmes had failed.
The issue of which treatments children should receive is difficult because there is little research to show the long-term effects of them on the under 16s. But the committee has been persuaded that surgery has worked in adults and should be extended to children.
Dr Nick Finer, an obesity specialist who works at both Addenbrooke's Hospital in Cambridge and the Luton and Dunstable Trust, said that Britain was offering very little surgery.
'Whatever people's prejudices about obesity, the reality is that there is a very real health problem here,' he said. 'If you are 14 years old and you have a BMI of 46, it isn't just your future that's bleak - your current existence is appalling. I am sure that there are children for whom this is appropriate, but the questions are how you select them, at what age, and which centres do the surgery? You would want to see it very carefully controlled and studied.'
Bariatric surgery involves either stapling the stomach or fitting a gastric band and is not without risks, but the radical measure is aimed at tackling the growing obesity epidemic in Briton, with one tenth of children predicted to be obese by the year 2010. Critics complain of children doing less exercise in school and of the increase of junk food in Britain's restaurants and shops.
Other obesity experts are worried about the approach taken by Nice. Dr Geoff Rayner, a public health expert at City University, said: 'We are medicalising something that is actually to do with how we live as a society. People become overweight because of their environment - because we take a car rather than walk - because we spend hours in front of the TV and because we are saturated by a junk food industry. If you take a purely medical approach to this, you start to normalise what is a deeply abnormal state.'
Few doubt the scale of the obesity problem facing the UK. Type 2 diabetes, which can be triggered by significant weight gain, is now being diagnosed in children; 15 years ago that was considered a very rare occurrence. Around 1,000 children are now thought to have the illness.
Around 20 per cent of children in Britain are overweight, and between 2 and 3 per cent are defined as severely overweight or obese.
