OBESITY IDEAS PETER HOLLINS AND ALEX MARKHAM

Published: 02/09/2004, Volume II4, No. 5921 Page 16 17

The impact of obesity on rates of heart disease and cancer has pushed the problem up the health agenda. Peter Hollins and Alex Markham suggest ideas to cut the national girth - starting with canapés at the Health Hotel

The party conference season usually tempts politicians, delegates and exhibitors to indulge in a waistline-busting menu of deep-fried buffet food.

However, at the Health Hotel events this autumn, party members and delegates will be offered healthy alternatives.

As members of this initiative, The British Heart Foundation and Cancer Research UK will encourage policymakers to discuss how to counteract the damage that obesity is doing to the nation's health - over lowfat canapés.

Heart disease and cancer together account for a nearly half of all UK deaths and obesity is a prime cause of both diseases.

The BHF/Cancer Research UK Health Hotel fringe meetings - entitled Defusing the Obesity Timebomb: Solutions for Better Health - will give scientists, epidemiologists, health spokespeople and delegates the opportunity to consider how to prevent more people, especially children, from reaching an unhealthy weight; and how to encourage those who are already overweight or obese to adopt a healthier lifestyle.

The impact of this modern epidemic is clear. During the past ten years, the percentage of obese adults in the UK has increased from 14 per cent to 22 per cent.

Nearly two-thirds of us are either overweight or obese.

This supersizing of a nation has serious implications for our health. Obesity is the biggest preventable risk factor for cancer after smoking: if no one in the UK were overweight or obese, there would be 10,000 fewer cancer cases a year.

Obesity is also one of the key risk factors for coronary heart disease, directly responsible for an estimated 7,000 deaths a year.

Experts are concerned that obesity levels in the UK are just five to 10 years behind the US, and increasing at the same rate.

Policymakers are listening to health professionals, parents and lobby groups, who are calling for targeted solutions to help stop the rise in obesity levels. This autumn's public health white paper offers the perfect opportunity for the government to bring solutions to the table.

Health ministers need to strike a balance between government 'nannying' and personal choice.

Health is a personal responsibility, but when more than 270,000 people die each year from cancer and heart disease the government needs to act.

As individuals, we may choose to ignore sensible advice: is there a case for policymakers to introduce regulation that empowers us all to take control of our eating and exercise habits and to attain healthier lifestyles?

The government has an important role to play providing information and advice.

Our genetic make-up determines whether we are more likely to gain weight, but diet and physical activity are key factors.

Research shows that physical exercise, aside from its role in weight loss, can reduce the risk of heart disease and colon cancer but experts do not yet know how this works.

University of Bristol department of exercise and health sciences researchers analysed data from 15 studies on physical activity and cancer prevention, and found that in addition to colon cancer, exercise throughout your life can also help to reduce the risk of breast cancer in women after the menopause and could potentially have a role in preventing endometrial, lung and prostate cancer.

Physical activity halves the risk of developing heart disease, and offsets some of the key risk factors. It can help lower high blood pressure, reduce the risk of type 2 diabetes, and help to control weight.

It is estimated that around 9 per cent of deaths from CHD in the UK could be avoided if people who are sedentary or have a low level of physical activity increased their activity to a moderate level.

Dreams of raising generations of sporting superstars might be too ambitious.What we need are realistic goals. Central and local government need to make sport and exercise appealing to children and adults while ensuring there are safe and accessible facilities for all - especially in deprived areas.

Schools have a valuable role to play in getting children active.

Organised physical activity in primary schools should play a more prominent part in the curriculum.

Not everyone wants, or feels they have time, to play sport. The BHF is working to emphasise that there are significant benefits to be had from everyday active living such as walking, gardening and climbing stairs. The Walking the Way to Health Initiative (WHI) promotes walking as one of the simplest ways to exercise and improve heart health.

Most of us do not eat enough fresh fruit and vegetables, and the proportion of fat, salt and sugar in our diet is much higher than healthy recommendations.

Clearer food labelling would help people make informed decisions about their diet. This is especially relevant for food directed at children.

Other areas of food marketing needing attention include content, price and availability.

Salt, sugar and fat levels in some foods need to be reduced and everyone deserves access to affordable healthy food.

Education about diet is essential and healthy eating messages must be consistent. It is counterproductive to teach children to eat healthily and then fill the school canteen with chips.Vending machines should offer healthy alternatives to the customary high-fat, high-sugar snacks.

Cancer Research UK and the BHF strongly support a code of advertising practice, including a ban on the promotion of unhealthy food during children's TV programming.

We need more research into what works, with which groups, and how. Studies following up the period after intervention are particularly important.

Funding and support are needed for large cohort studies, and we would greatly benefit from a national funding organisation for obesity research, to obtain more detailed UK data on obesity (most data presently comes from studies in the US).

At the very least, schools could help to track trends in childhood obesity and monitor overweight children.

Reintroducing school nurses would enable public health bodies to gather information on children's health including an annual measurement of children's size and weight, with the nurses also responsible for delivering health messages to children and their parents.

Health promotion specialists and charities organise a variety of programmes aimed at encouraging adults to meet the chief medical officer's recommendation of at least 30 minutes of moderate activity five times or more a week. But efforts to reduce obesity must also come from government, local authorities and the media.

The BHF and Cancer Research UK now look forward to this autumn's white paper on public health, and hope that the paper will include strong proposals to coordinate the assault on obesity between government departments.

For example, the white paper might propose the Department of Transport works harder to prioritise safe and physically active travel to schools; the Department of Education and Skills might issue guidance to school governors on vending machines selling unhealthy food, and the Department of Work and Pensions might give employers more incentives to create opportunities for staff to become more active.

Above all, central and local strategies should be appropriate, targeted and based on reliable prevention research.

Peter Hollins is director general of the British Heart Foundation and Professor Alex Markham is chief executive of Cancer Research UK.