Published: 04/03/2004, Volume II4, No. 5895 Page 14 15

Fat is more than an aesthetic issue. The impending health crisis set to befall the country has been well documented. And as an ex-banker, Derek Wanless will be happy that it has also been well costed. If present obesity trends continue, by 2010 the annual cost to the economy would hit£3.6bn.

For those tasked with halting the epidemic, there is a more worrying concern.More than 20 per cent of the population is now clinically obese compared with around 7 per cent in 1980. The big problem, as Mr Wanless points out, is that 'no other country has managed to reverse these trends'.

What will alarm ministers as they draw up their white paper is that Mr Wanless goes on to say that the government has actually achieved so little - even to the point of failing to create an integrated policy to tackle the issue.

There are no national targets on obesity, for instance.And much of the prevention work rests on elements of the national coronary heart disease and cancer programmes and a couple of the national service frameworks.

These all have at their core the values - and cash - of the acute sector rather than anything to do with public health.

The Wanless report adds: 'Past statements of intent have yet to be acted upon and there is very little evidence on what works.

Achieving the Health of the Nation targets [the former Conservative government's pledge to cut obesity rates in men to 6 per cent and women to 8 per cent] could no longer be seen as a sensible objective.'

It is a bleak picture. But he suggests that progress can be made through the levers familiar to any Old Labour die-hard:

taxes, subsidies and regulation.

The report calls for a national framework to engage health professionals and the community. It stresses that the government should 'assess obesity objectives immediately' and set new ones for 2007, and four years later in 2011.

It also claims that if primary care trusts and local authorities agree joint targets, the problem can be addressed at local level in line with national guidelines.

The burden of achieving local objectives will fall on primary care trusts, Mr Wanless says.

Strangely for a report stretching to 220 pages, there is no discussion of the hottest political topic in the obesity debate: junk food advertising to children.

The Consumers'Association, which published an angry 12point health challenge to the government last week, believes restrictions on such What Wanless missed 'One thing the report has not covered is the issue of sexual health.Health protection is part of public health and has not been emphasised enough throughout the debate.

Smoking and obesity are important, but we need to look at sexual health as well.

'Sián Griffiths, president, Faculty of Public Health 'No mention has been made of the social and economic causes of ill health and health inequalities.There is a big gap in the health inequalities of different social groups which is implied but not directly addressed.

'Anna Coote, public health programme director, King's Fund 'The report could have been tougher on the macro determinant issues of health which the government can be tough on and it can be up to the government to do something about.

'Professor David Hunter, chair-designate, UK Public Health Association 'The report is weakest in addressing the engagement of the individual and communities to make choices in the own health, major cultural change is needed.

'Chris Drinkwater, public health lead, NHS Alliance