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Food for thought.

We must heed the Gospel according to Saint Jamie. Jamie Oliver's new role as nutritional health promoter extraordinaire inevitably turns the spotlight onto school meals and obesity. Obesity first registered with me as a serious public health issue in 1980 when I visited the United States. I was struck by many things but particularly by the seeming existence of two nations - not black and white, but fat and thin.

In Boston, Massachussetts, where I stayed, about 30% of the population were obese or grossly so, and another 30% were not only thin but fit thin - they looked as if they took a lot of regular exercise.

Now the obesity epidemic has hit the UK and on current trends could soon match that in the US.

There are, interestingly, two differences between its manifestation in the two countries.

Firstly, the contrast between the fat and the thin is not so extreme here, but then the US is par excellence the country of extremes.

And we do not seem to have the same addiction to exercising. Would that we did.

As the recent Health Select Committee report demonstrates this epidemic has caught all government departments with their pants down, including the Department of Health which Melanie Johnson confessed was caught 'slightly unawares'.

The immediate causes of this epidemic are over consumption of energy rich foods accompanied by too little physical exercise.

So, the obvious immediate solutions are to reduce the one and increase the other by appropriate health promotion programmes and regulation.

What would this mean in practice? In the realm of physical exercise it would mean reinstating PE and sport in school, making all forms of physical exercise and sport more accessible, promoting top class sporting activity and performance and, of course, by improving public transport and significantly increasing the costs of what might be termed amenity motoring.

And, in the realm of nutrition, it would mean banning the advertising of processed foods, imposing fat, salt and sugar taxes to make unhealthy foods less accessible, subsidising healthy foods out of the proceeds of these taxes, and making them more available and preferably locally produced; reinventing the art of home cooking, and last but not least, by making school meals free and an example of a balanced healthy diet with junk food banned.

This is to be supported by education on nutrition and cookery lessons for pupils; and by training on nutrition for school catering staff.

The recent announcement of an increase in the ingredient cost allowance in England seems like a step in the right direction, albeit very small.

My experience of school meals is limited - two samplings only in the 1950s when, though not appetisingly presented, they were probably quite healthy. And grammar school pupils were not allowed to 'waste their time' on cookery or nutrition education unless it was part of the biology or chemistry syllabuses.

In short, we need to follow the French example where food is seen as an important part of national life and figures in the school curriculum.

And we need to respond positively to the lead given by Jamie Oliver. He has done more to raise the issue of the negligent approach to our children's diet than all the politicians, civil servants and health promoters put together.

But such measures, though necessary and long overdue, will not be sufficient. For obesity is a class issue with the underlying cause being poverty and social exclusion.

Unless we tackle the root causes of poverty and social exclusion we will never eliminate obesity.

For the great truth of public health is that everything that does not directly tackle the inequalities issue is merely tinkering at the edge.

Dr Paul Walker is chairman of PHA Cymru, the Welsh Public Health Association
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Date:May 9, 2005
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