Concerns are mounting over rising obesity, but is enough being done to slim down the problem, asks Liz Kendall

Barely a day goes by without some mention of the 'size zero' debate. It seems we cannot get enough of stories of stars starving themselves into ever more unrealistic shapes.

But we must not be distracted by the current obsession with all things celebrity. The real problem is not how thin we are - it is precisely the opposite.

According to the Health Survey for England, 22 per cent of men and 23 per cent of women are currently obese - that's 9 million people in total. A further 43 per cent of men and 33 per cent of women are overweight.

Childhood obesity is a particular cause for concern and is set to increase. Obesity among children two to 10 years old has risen from around 10 per cent in 1995 to almost 15 per cent in 2004.

Based on current trends, the government estimates around one in five children will be obese by 2010.

The cost of obesity, to individuals and society as a whole, are considerable. Obesity is a key risk factor for serious health conditions including joint problems, diabetes, heart disease and asthma. It is also linked with mental health problems like depression and low self-esteem.

Estimates suggest that treating obesity costs£1bn a year. Add to this the impact on the wider economy - including£1.4bn in sickness absence and£1bn-£6bn on benefits - and the scale of the challenge is clear.

The government acknowledges it must tackle the problem. It has set an ambitious public service agreement target, shared between the departments of Health, Education (now Children, Families and Schools) and Culture, Media and Sport, to halve the year-on-year rise in obesity among children aged 11 by 2010.

Steady progress

Action taken so far at the national level includes better food labelling and restricting advertisements of high fat, salt and sugar foods to children. National guidance for the NHS and local government has been produced by the National Institute for Health and Clinical Excellence.

Primary care trusts are working with local authorities through local delivery plans and local authority children and young people's plans.

And the Healthy Schools Programme, including new guidance on school meals, the '5 a day' campaign, and more time for school sport, is being rolled out.

All of this is clearly heading in the right direction. But does the strategy go far enough, fast enough? And is it really getting to the root of the problem?

Two key challenges must be addressed. The first is to better engage parents. Children are more likely to be obese if their parents are, and overweight children are likely to remain so into adult life. Yet many parents are unaware that either they, or their children, are overweight. Attempts to better assess levels of childhood obesity are often met with resistance from parents who fear their children will be stigmatised as a result.

The second challenge is to more effectively target services and support in disadvantaged areas. While obesity exists in all parts of the country and among all social classes, children in inner cities are more likely to be obese than those living in any other area. And obesity rates are set to increase faster among children who live in manual households.

So what should be done? It must be acknowledged that the UK is not alone in facing rising obesity rates, and no country has so far found a solution for effectively tackling the problem. But a way forward is beginning to emerge.

Evidence from this country and others suggests the best way to tackle the problem is to start young, and to target support in disadvantaged areas. For example, frequent and intense home visits from trained health professionals during the earliest months of a child's life can make a real difference in better engaging parents and improving child health. Increasing breastfeeding rates, for example, can help reduce weight problems in later life, and better preparing families for parenthood can help increase awareness about the importance of healthy diet and exercise.

The most effective programmes tend to start during pregnancy, are regular and intense, take account of multiple factors, develop alliances with parents, target the most needy, relate help to need, are home-based and use well-trained support.

Police state

All this suggests that in future midwives and health visitors will need to better address the social and emotional needs of new parents and their children, as well as the physical ones. To avoid such an approach being seen as judgemental or 'policing', health visitors and midwives will need to strengthen partnerships with communities. Such skills will need to be given more emphasis in midwifery and health visiting training.

Children's centres provide the perfect vehicle for delivering this new type of support. Children, Families and Schools secretary Ed Balls has been given joint responsibility for child health alongside the Department of Health. He will need to work hard to drive this work forward.

His priority should be to ensure the review of health visiting currently under way in the Department of Health sets out a clear vision for the profession, and that the NHS is fully engaged in the development of children's centres throughout the country.

But what of Labour's wider NHS reforms? Are they redundant in tackling obesity and other long-term conditions, as some commentators suggest?

Far from it. A clearer separation of commissioning from provision, and greater choice, diversity and contestability, will be vital in securing the shift towards more preventive, community-based services - services that will be vital in the fight against obesity.

Strengthening commissioning is at the top of the agenda. PCTs must get better at identifying the health needs of their populations and commissioning more effective services. Too often these fail to acknowledge, let along meet, the long-term health needs, particularly of disadvantaged communities, and obesity is a prime case in point.

More and better data, and new commissioning skills, will be crucial in turning this round. GPs also have an important role to play, and practice-based commissioning should provide a strong incentive for them to develop services to prevent as well as treat obesity.

There are many examples of excellent and innovative obesity services being delivered by the NHS, often in partnership with local councils.

But there is much that could be learnt from other providers, including the voluntary and private sectors and social enterprise, in how best to tackle the problem. Opening up community services to new providers will bring in new ways of working and challenge existing providers to raise their game.

None of this will be easy. But action must be taken if we are to tackle the obesity time bomb on which we are all sitting.

Liz Kendall is a public policy consultant and was a special adviser to former health secretary Patricia Hewitt.