WEIGHT - OBESITY

Alex Vass BMJ

Most adults in England are overweight, and one in five - around 8 million in total - is obese, says a government report. If the current trend continues, by 2005 a quarter of women and a fifth of men could be obese.

Currently 30 000 deaths a year are linked to obesity. The cost to the NHS is estimated at #500m ($700m; 800) a year.

The report, by the parliamentary public accounts committee, says people responsible for health care, education, transport, sport, and recreation and for the labelling and marketing of food should work together on an "integrated approach." A focus on helping people to avoid becoming overweight and then obese - as much as on helping people who are already obese - is needed, the report recommends.

The report found that most general practices promoted healthy eating and physical activity through general information. However, few sought to identify patients at risk of obesity.

It adds that GPs have been "hampered by the lack of evidence-based evaluation and guidance on the range of interventions they might use, ranging from diets, drug therapy, surgery, and innovations such as exercise on prescription."

The National Institute for Clinical Excellence should follow up its guidance on the anti-obesity drug orlistat (Xenical) with further evaluations of possible treatments, the report says.

It adds that the Department of Health acknowledged that it had not made enough effort to equip GPs with adequate resources and information to deal with the problem.

Childhood obesity is also on the rise, the report warns. It calls on the government to fulfil its pledge to entitle all children to at least two hours of high quality physical education and school sports a week. Other government initiatives to prevent an increase in obesity in future generations include a plan to supply every child aged 4-6 years with a free piece of fruit each day by 2004.

According to the committee the increase in obesity reflects changes in lifestyle, the increasing mechanisation of modern life, people being more sedentary, and a diet richer in energy dense foods. The prevalence in England is lower than that in Germany and the United States, but there has been a big increase that parallels the trend in the United States.

Public health minister Yvette Cooper said: "There are clear links between obesity and our biggest killers, heart disease and cancer. The NHS Plan, the national cancer plan, and the national service framework for coronary heart disease include action to address obesity, diet and nutrition, and physical activity. Work on guidance on prevention and management of obesity at a local level is already under way."

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