Joan Smith: A portly nation is no laughing matter

A couple of weeks ago, on a station platform in the north of England, I counted at least four morbidly obese adults. One of them was a mother with a toddler, who was already showing the same tendency. So I wasn't surprised to discover last week that British children are near the top of a new table showing the extent of childhood obesity in 27 European countries. Scottish boys and girls are at number two, with a third weighing more than they should, while their English counterparts are not far behind; almost 30 per cent of English girls are overweight, putting them at number four in the table, while English boys are in sixth place.

These children will be at risk of diabetes, heart disease and premature death as they get older, and a leading paediatrician said last week that desperate remedies such as stomach-stapling may be necessary for primary school children in the foreseeable future. Steve Ryan, medical director of Alder Hey Children's Hospital in Liverpool, said that "significant numbers" of children as young as two and three are now classed as obese; they've even started to suffer from adult breathing disorders, such as sleep apnoea.

For many years now, I've watched British eating patterns follow those of the US, and the latest figures are as inevitable as they are disheartening. The obese consume so much, The Lancet said last week, that they are pushing up the price for the genuinely hungry. The reasons for the epidemic among adults and children are not difficult to establish, but nearly two decades of warnings have failed to halt the trend. Obese people are suffering from a toxic combination of junk food, inertia and the decline of fixed mealtimes, which encourages grazing.

In the Baltic states, where the austerity of decades of Soviet domination has only recently been relaxed, this lifestyle is aspired to but still beyond the reach of most people; while Lithuanian food is among the heaviest in the world, only 3.5 per cent of girls are overweight, putting them at the bottom of the European obesity table. Sadly, it's certain that this will change as families become more affluent and Westernised; American fast-food chains such as McDonald's already have branches in the restored baroque splendour of the capital, Vilnius.

Here, tackling the epidemic isn't made easier by shrill cries of "Nanny state!" whenever the Government announces even a modest initiative, as though it's no business of ministers if millions of people choose to eat themselves into an early grave.

And while health campaigners warn of the danger of stigmatising overweight people, we still haven't abandoned our national habit of treating fatness as a subject for mockery. When I was a child, there were far fewer overweight adults in the general population and they tended to be regarded as a joke; seaside postcards were full of fat ladies and weedy husbands, simultaneously amusing and caricaturing the British working class.

These days, obesity is anything but a joke, but a feeling that fat people are funny and pathetic persists, not least because severe weight problems are unevenly distributed in terms of class. In gatherings of affluent, health-conscious people, I hardly ever see obese individuals, but bus stations and cut-price supermarkets are full of them. I am struck by their evident physical discomfort and embarrassment, as they try to fit themselves into seats and spaces designed for healthy people.

What I'm not aware of is a widespread sense that obesity is a serious, incapacitating illness which needs to be regarded with the same gravity as cancer and heart disease. Overweight parents bring up overweight children, and there's nothing funny about three-year-olds who are so fat they can't breathe.