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Last Updated: Tuesday, 11 September 2007, 12:46 GMT 13:46 UK
Why the NHS struggles with obesity
By Nick Triggle
Health reporter, BBC News

Obesity has once again been pinpointed as a major problem facing the country.

Former NatWest bank chief Sir Derek Wanless, who has already carried out two reports for the government on the NHS, is now warning the issue could overwhelm the health service. What can be done?

burger
The availability of convenience food is linked to obesity

Much of the best work on obesity is being done by community-based programmes.

One of the most successful is the Mend Programme run by the Institute of Child Health in London.

The nine-week course involves the whole family and aims to improve diet, levels of exercise and behaviour.

Overweight children are encouraged to exercise regularly, while parents are taught how to choose nutritional diets for the family.

Research earlier this year showed the initial improvements made were sustained a year afterwards, paving the way for it to be rolled out nationally to over 300 sites.

But it is one of the few schemes to enjoy such a wide reach.

In his report, Sir Derek said there were lots of good projects on the ground, but they were mostly locally based.

Officials have been able to expand the programme due to funding from the Lottery, Sainsbury's and support from the NHS. But not all schemes are so lucky.

Cuts

Obesity was made one of the key priorities in the 2004 public health white paper.

Ministers promised they would allow individuals to take control of their lives by introducing food labelling, restrictions on advertising and access to health trainers.

While these are all under way, ministers did not ring-fence public health funds leaving many of the individual projects the white paper also said were important vulnerable.

Dr Tim Crayford, president of the Association of Directors of Public Health, said: "Unfortunately, public health budgets are one of the first to suffer when there are cuts.

"It means we can't always do what we would like to."

But Dr Crayford said the solution does not just lie with the NHS.

"It is very hard to unpick the causes of obesity.

"The problems we are now seeing are to do with changes in society - the levels of car ownership, availability of convenience food.

The problem is that tackling obesity cuts across so many areas... but there is no one joining up the response
Dr Ian Campbell, of Weight Concern

"We need to make it easier for people to make healthier choices, for example, that means having better cycling and walking networks."

And it seems the complexity of the issue is proving difficult for government to surmount.

Obesity is on the rise. Nearly a quarter of adults are obese after rates rose by nearly 50% in 10 years.

Obesity in children has risen even more quickly, leaving the government struggling to meet its target to halt the year-on-year rise for under 11s by 2010.

It means the UK has one of the worst rates in Europe and has left the economy picking up a bill of nearly 4bn - a third of which falls on the NHS in treating the ill-health associated with the condition.

Obesity is directly responsible for 9,000 premature deaths a year in England.

However, its burden reaches much further contributing to the numbers with heart disease, diabetes and high blood pressure.

Timebomb

Research published at the end of last year in the British Medical Journal even went as far to say that obesity could bankrupt the NHS in the future.

It is a theme that was taken up by Sir Derek, who warned unhealthy lifestyles needed to be tackled if NHS costs were not to soar beyond the point the health service could cope with.

There are signs the public is waking up to the timebomb.

Rates of physical activity and dietary patterns are improving, but the progress has been slow and is still below recommended levels.

Adults and children are still failing to meet the five-a-day target, eating little over three portions of fruit and vegetables a day.

The number of adults doing regular physical activity has seen significant improvements since 1997.

But two thirds of men and three quarters of women still do not do the recommended 30 minutes exercise five times a week.

Dr Ian Campbell, medical director of Weight Concern, said: "We are not making enough progress.

"The problem is that tackling obesity cuts across so many areas - local government, central government, the NHS - but there is no one joining up the response.

"It is going to need much more coordination and recognition of what works if we are going to have an impact."




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