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The big issue

Schools can make a difference in the fight against obesity, but ministers have to shape up, says Stephanie Northen

Little Johnny's mum is ordering his favourite dinner. "Burger, fries, and a small chocolate milkshake, please. And make it fast. Johnny's got to fit in two hours of rugby before bedtime to work off this lot."

A kiddie meal in a burger bar contains roughly 800 calories - the milkshake alone accounts for 400. There's no way not-so-little-Johnny will squeeze in enough vigorous exercise between the literacy hour and EastEnders to counteract that.

He's putting on weight and risks joining the 14 per cent of obese under-11s at risk of developing diabetes, asthma, cardio-vascular disorders and joint problems.

As MPs wrangle about banning junk food TV advertising, a debate that has been going on for more than a decade, children carry on getting fatter.

"Excess body weight" is the most common childhood disorder in the European Union, according to the International Obesity Task Force (IOFT). Rates are rising in every EU country and 70 per cent of these obese youngsters will grow into very large adults.

Ministers came to Johnny's rescue back in 2004, vowing to halt the rise in obesity among younger children by 2010. It is a sizeable challenge, though easier than helping the over-11s, a quarter of whom are already obese, according to the most recent research.

But little happened until the recent rash of headlines in the national press about an obesity "epidemic" which forced the Government on to the defensive.

Suddenly, its healthy schools programme, its investment in school sport, meals and free fruit and vegetables for infants, all became soldiers in the war on weight.

"It staggers me to see what the Government has outlined as its strategies.

Most of them are initiatives that were already in place," says Paul Gately, who runs Europe's only weight loss management programme for children, based at Leeds Metropolitan university.

What is more, he says, three million overweight and obese youngsters prove these strategies have already failed. Take the healthy schools programme.

About three-quarters of schools have signed up to the scheme that "promotes sport, physical activity and healthier eating" since its launch in 1999.

Yet the proportion of obese children has risen faster since the start of the scheme than it did in the five years previously.

Then there's school sport. By this year, the Government was aiming to have 75 per cent of pupils doing two hours sport a week. Yet the Qualifications and Curriculum Authority admitted last year that only a third of schools had met the target.

Professor Gately says: "We also know that the two hours of quality PE a week is nowhere near enough."

Then there's the free fruit and veg for infants, backing up the five-a-day message. "Five a day will never tackle child obesity," Professor Gately says. "Evidence from America shows that it has no impact whatsoever on the weight of children. This doesn't mean it is not beneficial, but it will never have an impact on weight."

As for pound;235 million for school meals, he says, that was earmarked long before television chef Jamie Oliver came along. Simply improving lunches will also not have a massive impact on weight because children consume most of their calories at other times.

One new initiative also has its critics. Last month the Government announced that all reception and Year 6 children were to be weighed.

Dr Tim Lobstein, coordinator of the obesity task force's childhood and adolescent research, says he would be reluctant to "do wholesale screening with nothing significant to offer children or their parents to help them prevent obesity. You just make them feel bad, and they are more likely to fail in their attempts to fight the obesogenic environment, making them feel even worse."

While Professor Gately praises the decision to collect the data, he says it will not be available at least until early 2008, leaving just two years to turn the tide. Similarly, guidance for schools from the National Institute for Health and Clinical Excellence is only out for consultation now, with publication not expected until late this year.

The Government has shown a "lack of leadership" in tackling the "unprecedented rise" in child obesity, says a report published earlier this year by the Audit Commission, the National Audit Office and the Healthcare Commission. Anyone wanting examples of good practice needs to look to local efforts.

Hull, unfairly labelled "fat capital" of England in 2004, might be a good place to start. The city council is in its second year of Eat well, do well, a Pounds 3.5m scheme that offers all its 22,000 primary children a free breakfast, lunch and afternoon snack at school. Award-winning menus are trialled and checked exhaustively. (Carrot cakes were renamed sticky buns.) The aim is to alter children's perceptions of meals, to raise self-esteem and change lifestyles. Take-up has been high, up to 95 per cent in a few schools.

"It's a holistic approach," says Derek Colquhoun of Hull university who is evaluating the scheme. "It's not just about physicality, but looks at learning, behaviour, health, weight, and also the social aspects of food.

Dining rooms are really important places."

On the back of this scheme, Hull has been selected as the only UK city to take part in Shape up, an EU programme to tackle child obesity.

Again this is more a social model than a biomedical one, says Professor Colquhoun. At its heart is a Danish whole-school approach called IVAC - imagination, vision, action, change. The idea is to empower children by getting them to identify problems and then solve them.

An ideal challenge, he says, would be the parent selling burgers and chips from a van outside a school he visited recently. "We have to change the culture in which that can happen." But it won't be easy or cheap, says Professor Gately.

Since 1999, his Carnegie residential camps have helped more than 600 overweight youngsters slim down through changing their lifestyle.

"The camps are the perfect holistic environment to understand kids' needs.

The kids are not that bothered about being told they're overweight. They know that. They're told by their peers every day that they're fat, ugly and not acceptable. What is important is how we make them aware of opportunities to lose weight - that is the sensitive issue."

Schools can make a massive difference, he says. A few are using the Carnegie approach (see box), but ministers need to help. "They haven't got off their backsides and learnt anything about it," says Professor Gately.

"We have been delivering the most successful programme anywhere in the world for years and they haven't spoken to us. We've invited them, but they haven't visited us.

"They may not want to invest in our programme because we get results and in order to get results you have to do intensive work. The Government obviously wants to do it the cheapest way possible, but that will not get results."

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