The problem of obesity poses a serious threat to the future of the NHS in England, a landmark report warns.
It is five year's since Wanless's first report on the NHS
Sir Derek Wanless - whose 2002 report paved the way for record rises in the NHS budget - said too little was being done to tackle the problem.
He said the growing numbers of obese would place an increasing burden on limited NHS resources.
The former NatWest bank chief also warned vast sums spent on extra pay had failed to realise sufficient benefits.
He warned that without action the NHS in England would struggle to become "world class".
Sir Derek said current predictions of obesity rates - a third of men and 28% of women are likely to be classed as obese by 2010 - were worse than even the worst projections his report made in 2002.
Small scale success
Good schemes to tackle obesity had been introduced - but they tended to be small scale and locally based.
He said: "Doctors are only just learning what the effects are of obesity and it does look worse all the time in terms of diabetes, cancers, heart disease.
"Nobody quite knows how big the bills are going to be but they do look very frightening."
Sir Derek's report, which was commissioned by the King's Fund health think-tank, analyses how the NHS has performed over the past five years as well as looking at what it should be doing in the future.
It comes after his 2002 study for the Treasury recommended big increases in the NHS budget.
HEALTH FUNDING FACTS
£43.2bn in additional funding over five years from 2002
£18.9bn spent on higher pay and prices
UK spends 9-10% of GDP on health
NHS employs 1.3m people
Total health spending in 2007/8 £113.5bn
Source: Our Future Health Secured?
It was a report which proved key to Gordon Brown's decision later that year to award the health service a record five-year spending pledge.
He followed that up in 2004 with another paper which warned of the growing problems to do with public health.
In his latest report, he concludes that the increases in funding have delivered noticeable improvements with more staff and equipment, shorter waiting times and better cancer, heart and mental health care.
He praised progress on issues such as smoking but said there was still not enough being done over obesity.
Pay draining increases
Sir Derek also pointed out that nearly half of the £43bn extra the NHS was getting compared with 2002 had gone on staff pay, mainly through new contracts for GPs, consultants and nurses.
And he also said the biggest increase in hospital activity had been in emergency admissions - a key sign of ineffeciency as the NHS is not doing enough to prevent ill-health.
He said if the NHS was going to keep providing the range of services it currently does it would need increases of 4.4% from next year when the record rises of nearly 8% come to an end.
But if issues to do with productivity and obesity were not resolved funding may need to increase by even more.
He said: "Such an expensive service could undermine the current widespread political support for the NHS and raise questions about its long-term future."
Or he added the alternative was that the service does less, but this would be interpreted as the NHS failing behind other European countries again.
"What is clear from this review is that we are not on course to deliver the sustainable and world-class health care system, and ultimately healthier nation, that we all desire."
THE COST OF OBESITY
In 2005, 21% of English adults classified as obese
Predicted to rise to 33% of men and 28% of women by 2010
58% of type 2 diabetes cases and 21% of heart disease cases related to excess fat
Reduces life expectancy by an average of nine years
Costs NHS £1bn a year
Source: Department of Health
King's Fund chief executive Niall Dickson said: "If the NHS is not only to catch up but keep up with other European health care systems then we need to find new ways of making the health system more productive with better clinical outcomes."
And Peter Carter, of the Royal College of Nursing, said the NHS was at a "crossroads", while Jonathan Fielden, of the British Medical Association, said the government had been so determined to balance the books that it had prevented innovation.
A Department of Health spokesman agreed more needed to be done to improve productivity and tackle lifestyle issues and this would require above inflation growth in the health budget.
"These issues will be central to decisions made in the next few weeks as part of the government's comprehensive spending review and the long-term review of the health service being conducted by Lord Darzi."
But shadow health secretary Andrew Lansley said: "Value for money has not been delivered by this government."
Lib Dem health spokesman Norman Lamb said: "Ministers cannot ignore these recommendations."