Obesity has reached epidemic proportions, with one in five adults now dangerously overweight at a cost to the nation of more than £2.5bn a year in NHS bills and lost output, a report said yesterday.

Obesity has reached epidemic proportions, with one in five adults now dangerously overweight at a cost to the nation of more than £2.5bn a year in NHS bills and lost output, a report said yesterday.

Lazy lifestyles and fatty diets mean that 60 per cent of adults in England are now overweight, including 21 per cent of women and 17 per cent of men who are clinically obese. The figures from the National Audit Office show that obesity levels have tripled in 20 years and are rising faster than in most other countries in Europe. Unless more is done to tackle the problem, one in four adults will be classed as obese by the end of the decade, equivalent to the prevalence of obesity in the United States today. The cost would then rise to £3.5bn a year, the report said.

The audit office called for urgent cross-government action to promote the benefits of sport, walking and cycling; a bigger effort to improve nutrition; and national guidelines to tell doctors when to intervene.

Dr James Robertson, its director for value for money in health, said the problem needed a much higher profile and a change in attitude similar to the one that discouraged people from smoking.

He said: "We draw parallels with smoking, where over a 25 to 30-year period people became aware of the dangers of tobacco. This report is intended to start the debate. We will not turn everyone who is obese into their ideal body weight overnight. But even a 10 per cent reduction in weight can cause quite dramatic health improvements."

The report, called Tackling Obesity in England, said obesity was costing the NHS at least £500m a year in treatment for conditions such as heart disease, diabetes, high blood pressure and osteoarthritis. That was a "very conservative" figure because international estimates suggested the problem cost between 2 and 6 per cent of healthcare budgets, which would equate to £2bn for the NHS.

Lost output from 18 million days off sick and 30,000 premature deaths a year cost at least another £2bn to the wider economy, the report said.

High fat, energy-dense diets, made worse by the popularity of takeaways and eating out, were identified in the report as one of the main causes of the problem. Fatty, high-calorie foods did not satiate the appetite as quickly as foods rich in carbohydrates, leading to an "over-eating effect". The "extensive marketing of highly palatable, energy-dense foods" was also a factor.

Increasingly sedentary lifestyles meant children were spending less time each week playing sport and far fewer were walking to school.

The report added that services within the NHS for treating obesity were "patchy"; there was uncertainty about which interventions and treatments were effective; and GPs needed clear guidance on dealing with overweight patients.

This was particularly important because virtually all obese people started to show early symptoms of weight-related illnesses by the age of 40 and would need treatment before they were 60.

Among children, the problem was also acute, with 2.6 per cent of girls and 1.7 per cent of boys classed as obese.

David Davis, the Tory MP who chairs the Commons Public Accounts Committee, which oversees the work of the audit office, said: "The prevalence of obesity in England is alarming. The problem is serious, verging on an epidemic."

* A headmistress who banned pupils from eating biscuits and confectionery during breaks has been asked to meet officials from Norfolk County Council. Sylvia Trafford, head of Catton Grove first and nursery school in Norwich, prompted a revolt by parents after insisting that children eat only fruit or vegetables for break-time snacks.

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