Are we sitting too comfortably?

A couch-potato lifestyle is breeding an obese nation. Drastic changes are needed, says Liz Hunt

It is unfortunate, but true: we are a nation of fatties, condemned to a bleak future of indolence and ever-worsening health.

A government report leaked to journalists over the weekend spells it out: the percentage of obese people in Britain has doubled since 1980, and is predicted to increase by another 50 per cent within a decade. By 2005, it says, a quarter of all British women and nearly a fifth of men will meet the clinical definition of obese. With this increase in the national girth comes the unwelcome consequences of a high-fat diet and minimal activity: even more heart disease, strokes, diabetes, cancer, and arthritis.

Health ministers, it seems, tried to protect us from the awful truth, withholding the report completed a year ago by the Nutrition and Physical Activity Task Force. Perhaps the apparent failure of their health policy so far was behind their reluctance to publish. The report says that government targets identified in its Health of the Nation White Paper -only 6 per cent of men and 8 per cent of women designated obese by 2005 - cannot possibly be met.

Other critics have suggested that ministers are running scared of issuing prescriptive advice, of telling us what to eat and what to do for our own good. Guidelines issued last year dictating how many potatoes, slices of bread, and bars of chocolate we should eat each week, met with widespread ridicule.

But ministers rarely suffer from such sensitivity to the electorate's perceptions of their pronouncements. We have heard dire warnings about the state of the nation's health before, and if nothing else they are guaranteed to generate acres of newsprint and publicity for the politician bearing the bad news. And as for prescriptive advice, well this government is big on disease prevention, and how else can that be achieved except through a list of do's and don'ts?

The most likely reason behind the suppression of this report is that it would expose the Government's failure to take on the vested interests which have a direct impact on the nation's health: the tobacco industry, the food and drinks sector, car manufacturers and the construction lobby.

Because, aside from providing the facts and figures on the British obesity epidemic, Professor Philip James, the report's principal author, and his colleagues are calling for a radical overhaul of every aspect of daily life to encourage healthier habits. This, they argue, is the only way to reverse the epidemic of obesity and reduce its toll on health. They have issued a direct challenge both to ministers and the lobby groups, demanding that if they really care about people's health, they should put up or shut up.

The task force looked at schools, the workplace, home life, town planning, and the role of the health service, and have compiled what is probably the most comprehensive analysis to date of the health problems arising from the "junk-food, couch-potato, car-dependent" existence of much of the Western world.

That this has been recognised by the World Health Organisation emphasises its significance. Alarmed by the UK findings, the WHO is now funding an international task force headed by Professor James, who is director of the renowned Rowett Research Institute in Aberdeen, to complete a similar study on their behalf.

Professor James has declined to comment on the Government's reaction - or lack of it - to the findings and recommendations of the task force, but admits that it is "a novel report in showing that we have taken an inappropriate approach to policy in the past. In practice, we are talking about changes in the whole of society."

The report says that schools must become centres of physical activity for the community, and there should be a shift of emphasis away from competitive and team sports which focus on the elite school athletes, to encouraging every pupil in some form of activity. Doctors should be able to refer patients to a health club or gym if they feel this would be beneficial, so that exercise becomes a prescribable therapy and is recognised as a treatment for some health problems. Employers should provide changing facilities and showers for their workforce who want to walk or cycle to work, or exercise at lunch time.

More controversially, the task force recommends the end of car-oriented planning, which has lead to the growth of large areas of towns and cities that are inaccessible by foot. "We are becoming one big parking lot like Los Angeles, where people walk from their homes to their cars to the shopping mall, and that is the sum total of their activity," said one source involved in writing the report.

Professor James and his team are also calling for far tougher reductions in the proportion of energy that comes from fatty foods. The Health of the Nation target is 35 per cent of food energy from fat by the year 2005, compared to the 30 per cent called for in the new report, a figure which is backed by the WHO. Professor James proposes a "fat audit" by the food industry, and argues that its preoccupation with innovation and technology should make it easy to comply with more restrictive fat contents of foodstuffs.

That such changes can be achieved - and would be beneficial to the population - is not in doubt, according to Professor James. He cites the experience of Scandinavian countries, which have put the health of the nation first over vested interests and have had a major impact on public health.

In Norway, farmers are paid to produce leaner meat, and they are no longer paid by the fat of their livestock. The Norwegian government has invested in sporting facilities and cycle-ways and there are financial incentives to employers to provide showers and changing facilities in the workplace. Strict guidelines regulate public catering, and free vegetables and salad are included in every restaurant meal. Over 15 years, Norway and Finland have reduced the proportion of food energy from fat from 42 per cent to 34 per cent. In Finland, vegetable intake has been trebled. Blood cholesterol levels have dropped markedly in a large percentage of the population; blood pressure has been dramatically reduced, and the stroke rate has dropped.

"The health of these countries has been transformed," Professor James says. "This has been achieved by a coherent health strategy that has permeated every aspect of everyday life." To Stephen Dorrell, the new Secretary of State for Health, the message is clear: the patient is in a terminal condition, and only drastic measures will help him survive.