The growing epidemic of child obesity has prompted the National Health Service to open its first clinic to deal with the problem.
Following revelations last week that an 11-year-old girl weighed 20 stone, doctors yesterday called for parents to be given much more detailed instructions on how to manage the diet and exercise patterns of their children.
Obesity in the young is now seen as a soaring health crisis, with one in five of all nine-year-olds estimated to be overweight, and one in 10 obese - a rate that has doubled in the last two decades.
For some unhappy children, the cure can be drastic. Leeds schoolgirl Gemma Taylor revealed last week how she may need a stomach-stapling operation to curb her food intake. She weighs 20 stone and has to buy size 30 clothes. Her parents, who are also overweight, are worried that she could be badly bullied at school, and that she faces life-threatening problems if she cannot have the necessary surgery.
If the doctors decide she is too young for the surgery, Gemma might find help at the clinics being planned by Dr Mary Rudolf, the paediatrician who has helped the initiative with the East Leeds Primary Care Trust.
'We have to start tackling this in childhood before lifestyle habits are set for ever,' said Rudolf, who last year published research showing high rates of morbidly obese children in her district. 'Our approach is to make people aware of what they are eating, and their level of physical activity or lack of it. We may use diaries so that they can keep a record of their habits, but we need to give them practical suggestions of what they can do. It's no use making them worried if we can't offer achievable solutions.'
Her clinic will start in January and, uniquely, will not be staffed by health professionals but by workers trained to talk to families. It will involve working with school nurses, doctors, the local leisure centre and dietitians to provide a week-by-week course of action for around 70 children a year.
If this pilot scheme is shown to be a success, it could be replicated around Britain. But reversing the long-term trend is going to be one of the biggest challenges facing society.
Rudolf said: 'This problem stretches right across Britain. It's down to a lack of physical activity as children no longer play outside but watch TV or play on computer games instead.'
No one should be in doubt about the potentially devastating consequences of child hood obesity. It has led to the first cases of Type 2 diabetes being seen in the UK among teenagers. In children, as in adults, carrying around many extra stones of weight causes hypertension (high blood pressure), an increased tendency of the blood to clot and a cluster of different cardiovascular problems. It is linked to difficulties in breathing during sleep, asthma and serious liver and kidney conditions.
Some research has been carried out on whether there is a genetic basis for obesity. So far five specific genetic mutations have been identified affecting children. But a predisposition to obesity appears largely to be caused by a complex interaction between as least 250 obesity-associated genes. Other factors, such as what food mothers eat during pregnancy, or a decision not to breastfeed, are now being studied for their relevance.
A more insidious factor is also being blamed for the rise in overweight children. American and British children are exposed to around 10 food commercials for every hour of television that they watch. Most of the commercials are bright and jazzy and sell fast food, soft drinks, sweets and sugar-sweetened breakfast cereal.
Because of concerns over the ads, the Food Standards Agency is to commission research which will look at the promotional activities carried out by the food industry and how they are linked to children's eating habits. This follows increasing disquiet both in Europe and in the United States about the aggressive marketing tactics used to sell junk food. In the United States, doctors recently singled out the promotion of Spiderman cereal, McDonald's Happy Meals and Pepsi Cola campaigns for exploiting children's desires.
The language being used against the food industry is getting stronger. Michael Brody, chair of the American Academy of Child and Adolescent Psychiatry's media committee, said recently: 'Just like paedophiles, marketers have become child experts.'
Yet there are few signs that the British Government wants to take any restrictive action, such as banning TV adverts in children's TV time, or curbing promotion of sugar-filled food. The only positive measure has been a plan to provide each child aged four to six with a free piece of fruit at school by 2004.
A spokeswoman for the Department of Health said: 'Nothing is being ruled in or out in future efforts to tackle obesity, but we are not currently considering restrictions on food advertising for children.'
The following correction was printed in the Observer's For the record column, Sunday November 17 2002
We said above that the first clinic to deal with the problem had opened in Leeds, Yorkshire. However, for the past 18 months an NHS clinic for childhood obesity has operated in Chichester, West Sussex. New L.E.A.F. (Lifestyle, Eating, Activity, and Fitness), which provides clinical, dietary, physiological and activity advice after referral, is a joint partnership between St Richard's Hospital, Chichester and University College, Chichester.
