Wednesday, 12 September 2007

Fat chance

reposted from: guardian

Fat chance

The window of opportunity to tackle the obesity crisis is rapidly closing and the present token measures will be totally ineffectual.

Another Wanless review warns of dire consequences unless radical action is taken to aid the recuperation of an ailing health service and its clientele. Yet it should surprise no one that

obesity continues its remorseless upward trend and that this will impose an extraordinary burden - even greater than it already does - on the already stretched health system, the economy and, implicitly, on people's lives and wellbeing.

The latest report from Derek Wanless and his team refers to key determinants that have worsened since his 2002 review, "particularly the unforeseen rise in adult and childhood obesity". Unforeseen? This would depend upon which direction one is looking.

Evidence of the decline in healthy weight and the across-the-board increase in the average weight of the entire population and, with it, the continuing growth in obesity, has been monitored annually and headlined in government statistics ever since the Health of the Nation white paper

in 1992 established the improbable target to return adult obesity rates to the 6-8% level they were a quarter of a century ago.
The target was abandoned, but the alarm bells have continued to ring.

Sir John Bourn, comptroller and auditor general, presenting the National Audit Office's first report on obesity told parliament in 2001:

"Nearly two thirds of men and over half of women in England are now overweight or obese.
And the problem here is increasing faster than in most other European countries. If prevalence continues to rise at the current rate,
more than one in four adults will be obese by 2010
. This would significantly increase the incidence of associated diseases, such as coronary heart disease, and would cost the economy over £3.5bn a year by that date."

As a deliberately conservative prediction, this underestimated the scale and cost of the problem. Wanless notes higher levels of obesity predicted by 2010, when some 33% of men, 28% of women, and one in five boys and girls will be obese.
Even if the Department of Health's Public Service Agreement (PSA) target to halt the year on year increase in obesity in children under 11 is reached by then - and it won't be - it would mean accepting as some sort of achievement that only 20% of our children will be obese.

The consequences of failure to tackle obesity was made clear in the government's 2004 white paper Choosing Health, which forecast an 18% increase in heart attacks, 28% increase in hypertension, and a 54% increase in type 2 diabetes by 2023. Yet there seems to be little real political appetite to take more effective preventive measures that might avert this costly scenario and permit the next generation to grow up at a healthier weight than their parents.

The nod towards a healthier diet is little more than that - with the focus on lifestyle choices leaving individuals to take the initiative. We make do with small gestures such as free fruit for a few infants but not for all children, or an allowance - the equivalent to the price of a weekly cappuccino - for pregnant women to improve their diet, but not given until it is too late to make any difference to those in real need.

The fundamental need to make comprehensive improvements across the entire spectrum of the food on offer, and to protect children effectively from the promotion and availability of junk food has still to be properly addressed.

To halt the obesity trend requires more realistic and comprehensive approaches to improve the quality of the nation's diet - and activity.
We should recognise, as we did with smoking, that the external costs of continuing the unbridled promotion of a vast range of poor nutritional value products will be borne by all of us, not just in the enormous burden on health services, but in many other aspects of daily life.

The cost of obesity in the US already exceeds $125bn a year - and is rising. The UK is following the same downward spiral. The trends and consequences can no longer be called "unforeseen".

It is time to take much bolder steps in a different, healthier direction.

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