Globally 2.8 million people die prematurely every year as a result of their excess weight, and in Britain half of adults are now obese or overweight. Professor of Endocrinology at Oxford John Wass sets out how we can solve this pressing health problem.

Professor Wass will explain how prevention and early intervention are key elements in tackling what is one of the fastest growing medical concerns in the world, and that joined up working with children in schools and through GP surgeries is the answer to Professor Wass believes that Britain has the potential to become the first country to meet the weight loss challenge  

By Olivia Williams

You may recognise Professor John Wass, author of the Oxford Handbook of Endocrinology, from his television series The Fantastical World of Hormones. He is a hormone specialist, which led to his fascination with treating the modern scourge of obesity. Now he and the rest of the Obesity Health Alliance are on a mission to get our collective weight back under control.

While he does not believe in a single cure, Professor Wass is confident that Britain has the capacity to become the first country to meet the challenge.  However, we are yet to spend the necessary money on intervention, he argues, even though obesity has the same economic impact as smoking, and a greater impact than alcoholism.RCPProfessor Wass, one the country's leading hormone experts, related the science behind the modern scourge of obesity

Professor Wass began his Royal College of Physicians talk with a little Shakespeare. He noted that Falstaff spotted a health problem in Henry IV that we should all keep in mind: 'Thou seest that I have more flesh/ than another man and therefore more frailty'. 
Professor Wass believes that recently we are still not quite getting the message about the dangers of being overweight. In the last decade he points out that there have been 66, 159 articles (and counting) on the subject, but we are lacking, even among health professionals, vital education on nutrition. A recent survey, for example, revealed that the government's recommended levels of physical activity is known only by 5 per cent of the public.

Manor Hospital 

In recent years it is a crisis that has really gathered momentum. The number of obese adult British men is roughly double what it was in 1993. Then the figure was 13 per cent, now it is 26 per cent. There is also a social element to the phenomenon, with a higher prevalence among poor people, and in the north of England (11 per cent) compared to the south (8.5 per cent).

Medically, the threat is clear and manifold. The list of associated conditions that Professor Wass outlines is extensive, among them: osteoarthritis, type 2 diabetes, cardiovascular disease, a fivefold increased risk of being hypertensive, dyslipidemia, gall bladder disease, fat deposits on the liver, infertility in women, and sleep apnoea. In terms of cancer, bowel cancer is increased by 24 per cent, breast by 12 per cent, particularly after the menopause, and uterus by 59 per cent.

What to do about it

The Obesity Health Alliance, of which Professor Wass is a member, is a coalition of over 30 organisations who have joined together to fight obesity. Among them are the Children’s Food Campaign, British Heart Foundation, British Medical Association and Royal College of Physicians. They are currently hard at work pointing out gaps in government policy.

Obesity Health AllianceTheir report Childhood Obesity: A Government Plan for Action was enthusiastically backed by David Cameron. Professor Wass thought that it would be Cameron’s legacy but he left just before it was published in August. Professor Wass and the rest of the Obesity Health Alliance are keen to keep the momentum going. 

In the next year or so he hopes that the so-called 'sugar tax' will come in. He points out that similar levies have worked in France, Denmark, Finland and Hungary. It should help children in particular, he argues, as  30 per cent of children’s daily sugar intake is from soft drinks. British children consume three times more sugar than recommended, and more than any other country in Europe. 

The Alliance is also working towards a ban on advertising food or drinks that are high in fat, salt and sugar before 9pm to avoid marketing influencing children’s choices. This would be operated alongside industry targets, with sanctions, to lower salt and sugar in food. Voluntary versions of this in the past have not been very successful. So measures need to be enforced, according to Professor Wass, who would like to see the industry challenged to reduce sugar in particular by 20 per cent by 2020.

Focusing on childhood obesity is a vital part of Professor Wass' early prevention angle. Nearly one third of children aged 2-15 are already overweight or obese, and 90 per cent of severely obese children go on to become obese adults. His main proposal is a joined up effort to monitor pupils'  BMIs (body mass index) at school, and for GP surgeries to intervene immediately if children are found to be gaining too much weight.

In cases when obesity has already taken hold among adults, Professor Wass suggests more spending on medication and surgery. Almost every week new drugs are being tried, and huge numbers are in the pipeline. In terms of surgery, gastric banding and bypassing start to work within a few days, and only very occasionally do patients need a follow-up operation. In the UK 140 000 patients would qualify but only around 7,500 operations annually go ahead, he lamented. 

Government recommended levels of pushical cacitbity known only by 5 percent of peopleIn his talk, Professor Wass argued that medical leadership is essential, and that we need a more co-ordinated government effort  

Professor Wass' wishlist

Individual BMI limits to be measured and documented for everyone

Food and alcohol labelling to make the nutritional value of the product  even clearer

Education of both the public and doctors on nutrition and exercise

More cooperation between GPs and schools for children with weight problems

One minister, or public health committee, to coordinate between governmental departments such as health, transport, education and environment 

Healthier food options within the public sector, hospitals and schools, and the NHS staff to lead by example in cutting down high rates of obesity

Children to be encouraged to do an hour a day of physical activity 

The talk was given at the Royal College of Physicians in London. Researchers across the University of Oxford are also working through a raft of new studies funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC).
Images: Royal College of Physicians, Oxford University Images, Shutterstock, BBC


By Clive Sherlock

Professor Wass' work and advice is important and welcome. However, drugs and surgery are costly and not without serious risk. Knowing that 'prevention is better than cure' we should do all we can to tackle the problem of obesity at its source. We only become obese because we eat and drink more than the body needs and so excess is converted to and stored as fat.
Training people to exercise regularly and to eat and drink healthily and no more than the body needs leads to their remaining at healthy weights and, when already over weight or obese, it leads to their losing weight.
We have found that this can be achieved safely, effectively and cost-efficiently by training in people in self-discipline.
Dr Clive Sherlock

By Sir Charles Jessel

Having practised as a nutritionist for 20 years in the past, I can say that everyone needs their own individualised diet, and possibly supplements, as well as exercise, to overcome the problem of obesity. I find it disappointing that diet is still not taught properly to physicians, so they can offer nothing new to the problem. The NHS does not help, as it pays for only drugs and surgery, rendering good dietary solutions more expensive to those who cannot afford the right foodstuffs.

By Dom Camus

It's surprising to me that this sort of approach is seemingly still the state of the art in obesity research. There is constant emphasis on obese people eating too much and exercising too little. However, slim people frequently eat the same food and get less exercise. Every time I see references to "self-control" and economic impact it makes me wonder if the focus here is really on the patient at all. Why must my overweight friends spend their lives at the gym and subsist on 1500 calories per day when the rest of us need not? Is this question not of scientific interest?

By Willim Hughes (...

The new Sport England Strategy should help. It now emphasises access to physical activity, active recreation and sport across the life-course, from the age of five onwards. One of the primary aims is to help inactive people to become more active. The Strategy involves a major shift of resources to support this aim, and it is a brave and courageous redirection for SE in the post-Olympic period.

By Julia Aston Smi...

I lost a lot of weight,unintentionally, when I became a widow and reverted to the eating patterns of my childhood - a good breakfast and lunch and scant evening meal. I think too, that many women tend to serve up portions of equal size to their husband's, not realising that they probably don't need as much.
Julia Aston Smith

By Jennifer Cubitt...

I agree with Dr Clive Sherlock's comments. I suggest people watch Jason Vale's film 'Super juice me!' at to see the effects of healthy eating and exercise on obese people.

By Cristina

Individual-level interventions and raising awareness are fine for those who actually have the luxury to be able to implement such needed modifications in their lives; but as long as there are extremely powerful structural determinants in place - including lack of access to quality food, lack of time to cook from scratch and exercise, high stress levels due to job instability and fierce competition, etc - awareness raising or preaching/scolding about eating well and exercising will not work for the vast majority of the population. In other words - have the Powers That Be tried actual poison? It's more effective and works quicker.

By Alexander

There's a lot of information publicly available about what one should change about lifestyle and eating patterns. But what is missing in this article is the psychological determinants for being able to change behaviour and sustain new, healthier behaviours. Professor Wass has much to say about what one is supposed to do. But has he examined how to get compliance and make the healthy behaviour sustainable? Looking at his photograph in this article suggests to me that his BMI may be above what would be healthy for him. Is he missing a piece of the weight management puzzle? There is a story of Gandhi refraining from counselling someone how to eat less sugar until he had managed to overcome this problem in himself.