England 'the fat man of Europe'

LORNA MARSH To say the figures are shocking would be putting it lightly. While the government's battle to tackle the number of smokers in the country seems to have made inroads, escalating obesity levels have been declared the biggest challenge to public health.

LORNA MARSH

To say the figures are shocking would be putting it lightly. While the government's battle to tackle the number of smokers in the country seems to have made inroads, escalating obesity levels have been declared the biggest challenge to public health.

Since 1993 the proportion of clinically obese adults has shot up from 14.8pc to nearly a quarter, with a slightly higher jump for 11 to 15-year-olds in a shorter space of time. And the percentage of obese two to 10-year-olds has increased from 9.9pc in 1995 to 14.3pc.

Experts blame the rise on more convenience and junk food and increasingly sedentary lifestyles, and the government Health Profile of England report pinpoints higher percentages among northern regions.

However, the figures are not new: not only do the latest statistics relate to 2004, they were originally released in August. Now they have merely been compiled into a report with user-friendly at-a-glance maps showing obesity and smoking levels as well as life expectancy region by region.

The report, which reveals about average obesity percentages in Norfolk, north Suffolk and east Cambridgeshire, has given the government another opportunity to drum the healthy eating message home - and critics a second chance to accuse ministers of nannying us.

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Newly-appointed public health minister Caroline Flint said yesterday that people must change their everyday lifestyles to improve their wellbeing.

She added she wanted to see an NHS geared as much towards prevention as treatment, with comprehensive working between town planners, businesses and individuals to improve health, but it was clear the onus was ultimately on the individual.

The report reveals that northern areas have higher obesity rates, more smoking-related deaths and lower life expectancies, with men in northern counties dying on average two years earlier than their southern equivalents.

Boston in Lincolnshire had the highest obesity rate of any town in the country, while Saffron Walden in Essex had the lowest.

In Norfolk, Yarmouth suffered the highest percentage of obesity, with 26.2pc of adults having a body mass index of 30 or more.

Ms Flint said one of the issues the government was focusing on was "understanding better why it is that despite all the information and advice around healthy living, some people have that information and use it and some people do not".

She added: "What we have been trying to better understand is what the obstacles are that get in the way of people making these choices."

She said the government was providing local authorities with a profile of public health challenges in their areas in an effort to help them identify where they might improve their record.

And Ms Flint highlighted progress made by some local authority areas with the worst health and deprivation figures in making progress on life expectancy, suggesting that other areas might learn from their example.

A scheme piloted in Devon and Cornwall in which low-income families are provided with vouchers to buy fruit and vegetables would be "rolled out" nationwide later this year, she said, after it proved a success.

The document is designed to provide the most comprehensive picture yet of the state of the public's health across the country and it is hoped it will help areas measure their progress in tackling health inequalities and seek help from those performing better.

But critics have accused the government once again of nanny state-ism and it is an issue that Tony Blair is well aware of.

The prime minister told BBC Breakfast: "The difficulty for us, to be very frank about it, is trying to balance not becoming a nanny state and telling everyone what to do, with trying to educate people that there are real choices which you make, that make a difference to your health and fitness and that in turn makes a difference to the whole of the country.

"We can't really afford a decent healthcare system going forward, unless healthcare is not just about treating you when you are sick but also about looking after your fitness, your healthcare, and that requires people to take some personal responsibility for what they do."

However much we might dislike being told what to do by a central core of powerful people, no one can deny the cultural shift in recent years in attitudes towards smoking, thanks in large part to government efforts.

Ms Flint said ministers hoped to learn from that success in their battle against the obesity problem after the report revealed that 1.2 million people have stopped smoking since 1998.

"That campaign on regulation and then support to give up smoking, as well as understanding why people carry on smoking - I think there are lessons we can learn on what we are trying to do on obesity."

More recently a campaign to get us eating enough fruit and vegetables has infiltrated our lives to such an extent that discussions over whether we've had our "five-a-day" has become part of everyday water-cooler talk.

The overwhelming surprise success of Jamie Oliver's School Dinners programme suggests that most of us are concerned about our health and do want to be educated - as long as it is not shoved down our throats by the powers-that-be and we don't bear the brunt of the blame.

Health expert Dr Peter Brambleby, former director of public health for Norwich PCT, which recently became part of a Norfolk-wide trust, said there was a balance to be had between dictating people's lifestyle choices and ignoring the health risks and cost to the NHS that the problem brought.

"It is ultimately the individual's responsibility, but the government and NHS should try to make healthy choices easy choices and informed choices. It is a cliché, but it is a question of everyone having equal opportunity."

Anna Suckling, a paediatric dietician at the Norfolk and Norwich University Hospital, agreed, saying we live in an "obesogenic" society, one that has accepted and even encouraged obesity with its emphasis on junk food and leisurely lifestyles.

"Yes, people do know what healthy eating is now, but it is more complex than that - you need to show people how they can incorporate that into their everyday lives and how they can have their five portions of fruit and veg, and to get the message across that it is not expensive.

"You can leave people to make up their own minds as long as they have the right information."

But Margaret Duncum, spokesman for the Norwich branch of the Eating Disorders Association, which counsels people for compulsive eating as well as anorexia and bulimia, said in many cases the problem went deeper than simply taking the prescribed healthy option.

"We can only speak from our own experience, but it is clear that, with the majority of the people who contact us, healthy eating campaigns are not enough," she said.

"There are all sorts of psychological issues going on with relationships with food and it is essential that these are addressed for the people that we see."

It seems the government, whether nannying us or not, is at least taking its first steps in tackling what has become an epidemic.

And when parents are found to be feeding chips through school gates in a deliberate counter-move on healthier school dinners, it is clear that it is not enough just to let them eat cake.