news focus - Around 8 million adults in the UK are classified as obese.Of particular concern is the rising incidence in children.Now, the National Audit Office is stepping in. Ann McGauran reports

Published: 31/01/2002, Volume II2, No. 5790 Page 18

Why do you never see advertisements for cauliflowers during children's television? That was one of the questions put to delegates at last week's National Audit Office conference in London on tackling obesity - a condition that now costs the NHS at least£500m a year.

The aim was to join up all parts of government and the NHS to focus on practical solutions to a problem that now affects one in five adults in England, and costs society as a whole£2bn annually.

The particularly shocking rise in childhood obesity was a key theme, and trends in what is a global epidemic were examined - along with consideration of the huge burden in related problems, such as coronary heart disease, hypertension and type-2 diabetes.

Commons public accounts committee chair Edward Leigh said there was a 'clear need for more proactive approaches from GPs' - working as a 'crucial link in the chain, but alongside the wider primary care team'. He also criticised the fact that only 12 specialist obesity clinics exist in the whole of England.

Obesity treatment receives funding of less then£10m a year, he pointed out, and with 8 million obese adults in England that means there is roughly '£1 spent on each prospective patient'.

During one of his committee's hearings, Mr Leigh explained, the unfortunately named chief executive of the Food Standards Agency, Geoffrey Podger, confirmed that 'he had never seen a cauliflower advertised' during children's television programmes.

Mr Leigh then underlined one of the report recommendations - that the FSA should work with the food industry to develop a code of conduct on the amount and type of food advertising aimed at children.

Could Ant and Dec be put to work promoting fruit cocktails?

That image provided light relief, but overall the reality was grimmer, suggesting that combating obesity will make smoking cessation seem a breeze.

Themes included the lack of resources, uninterested GPs and a need for both genuine referral options and more comprehensive national clinical guidelines.

Innovative approaches were shared (see box) and there was a strong emphasis on joined-up local strategies. As the NAO report on obesity stated a year ago, 'the NHS cannot by itself be expected to 'cure' the problem', when part of the answer lies in preventing people from becoming overweight in the first place.

Sue Campbell, adviser on physical activity in schools to both the Department for Education and Skills and the Department for Culture, Media and Sport, pointed to the£580m of New Opportunities Fund cash for sports facilities in schools, and said there was a 'real opportunity for those in primary care trusts to engage with local authorities to pull in the external community' and 'lock agendas together'.

The PAC report stressed the importance of preventive strategies based on a joined-up approach across government to education, physical activity and healthy eating.

But the conference delegate list indicated that there is a long way to go.

It was dominated by dieticians - with only three GPs and three nurses and few people from education.

President of the faculty of public health medicine Dr Sian Griffiths said that the failure of traditional approaches to health promotion and education have been partly caused by continued 'silo' thinking, rather than making links across health, education and sport - as well as simply ignoring the obvious.

One route, she said, would be to take the limited evidence about obesity that does exist and consider it when deciding which interventions to promote. For example, breastfeeding is associated with lower rates of childhood obesity, weight loss is better achieved in group sessions and people without the use of a car tend to pay more for their food at local shops.

The hope is that with the conference and NAO's two reports - the most recent earlier this month - obesity's time in the sun has finally come. Public health minister Yvette Cooper said she has asked the Health Development Agency to review 'what works' for obesity. The government has realised that it is unlikely to meet its key NHS plan targets for the big killers unless it stops the obesity epidemic in its tracks. l Weighing up the options: what already works During the conference, the primary care award for excellence in weight management was presented to senior receptionist Pauline Twist and practice nurses Glenys Proffit and Joanne Jones of Madryn House Surgery in Rhyl, Wales.The three - with the two nurses working unpaid - set up a weightreduction clinic for one hour a week.Two audits have shown that all the clients are losing weight.Seven have lost 10 per cent of their body fat and 16 have lost 5 per cent.Rhyl is an area of high deprivation and 24 of the patients are on a heavily subsidised exercise referral scheme, funded by Denbeighshire local health group.Each session costs 50p.The pilot scheme will finish at the end of this financial year.

Dance for Life Project director Cathy Middleton inspired delegates with her success over 10 years in Bradford with a joined-up strategy to provide dance-based exercise targeted mainly at teenage Asian girls, in an area with very high rates of coronary heart disease.A total of 15,000 young women have used the scheme.

Older people suffering from obesity and arthritis have been referred by GPs, and the scheme is supported by a host of partners, including Bradford council, Bradford health authority, Heartsmart and the regional arts board. It is run by a steering group of funding providers.

Ninth report of the Public Accounts Committee: tackling obesity in England .

www. parliament. uk/commons/selcom/pachome . htm Tackling Obesity in England . National Audit Office. February 2001.

www. nao. gov. uk