The fat kids' capital

WHEN Peter Kelly was a young lad growing up in Middlesbrough, back in 1974, there were no end of places to play. "I can remember I would be out with my mates playing for hours and hours. There were eight tennis courts near where I lived and they were always crowded with kids playing." recalls Peter.

"It was free and a great place for football when it was wet."

Fast forward more than 30 years and Professor Peter Kelly, director of public health at Middlesbrough Primary Care Trust, says things have changed beyond recognition.

"Now those same tennis courts have got a ten foot fence around them. This is the sort of thing we need to look at if we are going to do anything about preventing obesity in children."

Prof Kelly was reminiscing before an audience of health professonals and academics at the first major international conference on obesity to be held in the North-East.

Organised by the Association for the Study of Obesity, the conference at Teesside University was intended to examine why obesity is often a particular problem among poorer and less advantaged people.

Speakers examined the evidence that intervention could reduce levels of obesity in individuals and communities.

The conference also gave notice of an ambitious plan to get the entire population of Middlesbrough interested in taking more physical exercise and eating more healthily, a project to be known as Middlesbrough On The Move.

The delegates, from all over the UK and including guest speakers from America and Holland, were all too aware that obesity is now an epidemic affecting almost every country in the world.

Worryingly for Britons, the UK has the third fastest growing obesity rate of any country in the world. Even more worrying for the North-East, this region has the highest rates for obesity in England, with more than one in four adults in County Durham and the Tees Valley officially classed as obese.

Obesity is linked to many health problems, including diabetes, raised blood pressure, heart problems and arthritis.

Before Tuesday's conference the event was being billed by the organisers as being held in the "childhood obesity capital" of England.

But the full scale of the problem facing health officials on Teesside was revealed when Prof Kelly published new details on the extent of weight problems among Middlesbrough children.

Health officials went into ten schools in the borough last year and weighed and measured more than 1,300 11 and 12-year-olds, representing more than half of all Middlesbrough children in that age group.

They found that 34 per cent were overweight and 19 per cent were classified as obese.

Prof Kelly says: "I think that is really scary. One in three children are overweight. One in five are obese."

If the figures were extrapolated to include the 90,000 or so five to 16-year-olds in Middlesbrough it would mean there are currently 30,000 overweight and 17,000 obese children.

"Even if the study's figures were twice as high, there is still a massive problem," Prof Kelly says.

Professor Martin White, from Newcastle University, told the conference the underlying problem which was fuelling obesity throughout the developed world was that most people did little physical work to burn up the excess calories most of us were eating.

Most of us consumed more fatty, energy rich foods than we used to, including many convenience foods and snacks, and weight gain appeared to be relentless.

Despite the gloom there are high hopes that Middlesbrough On The Move will have an impact, but the history of initiatives to control weight is littered with dead ends and failures.

This was emphasised by American academic, Professor Shiriki Kumanyika.

Prof Kumanyika is particularly interested in African Americans, who, along with other ethnic minorities, have one of the worst records in the US for weight gain and obesity. Attempts to run community-based weight loss schemes tailored to the needs of black Americans had had little success, she told delegates.

It was particularly depressing that the fact that young black Americans spent the most time watching television - a staggering seven and a half hours a day - meant that food manufacturers targeted them with fast food adds.

Prof Kumanyika, who has founded a new group of African-American researchers, reported that a scheme which encouraged supermarkets to open up in poorer areas of Philadelphia had got underway in an effort to increase access to healthier foods.

The Philadelphia-based academic predicted that "the equivalent of major tobacco legislation" might be needed in the US to curb weight gain and deter people from eating junk food.

Prof White revealed the results of a detailed study of consumer shopping habits in Newcastle. The study was designed to show whether the notion of "food deserts" contributed to the poor diet of underprivileged people.

But after surveying 5,044 consumers and 560 shops he came up with some surprising conclusions.

Full-price and discount supermarkets were found throughout the city and 77 per cent of people shopped in these outlets, but many people used neighbourhood greengrocers to buy fruit and vegetables, which were generally cheaper than those sold in supermarkets.

"Paradoxically, poorer people tended to live closer to places which sold a wider range of food items but they were more likely to shop where prices were low. Food choices are more driven by choice than availability," he said.

"Our conclusion was that we did not find access was an issue. Food shopping was driven by cost and healthy eating was most strongly predicted by dietary knowledge."

Prof White says this suggests that health education could play a vital role in helping consumers make healthier choices when food shopping.

The power of Tesco, Britain's leading supermarket chain, was illustrated by a graph showing journeys by food shoppers. The majority of black lines converged on the huge Tesco store at Kingston Park, Newcastle.

Dutch academic Professor Johannes Brug gave a presentation which showed that efforts to persuade people to reduce weight had had little success in the Netherlands despite high-profile TV campaigns.

"The longer term effects of obesity treatment are disappointing," he said. "I believe the prevention of weight gain should be given a much higher priority to fight the obesity epidemic."

A slightly more optimistic note was sounded by Charles Foster, an obesity researcher from Oxford University.

After studying a number of campaigns designed to encourage people to take more exercise in the UK and abroad, Mr Foster said there was evidence that this could have a positive effect on people's behaviour for at least six months.

A study which encouraged people to use stairs instead of escalators at a Glasgow railway station had a measurable effect. But he lambasted contradictory UK legislation, such as local bylaws which prevented people cycling in some city parks.

Professor John Wilkinson, from the North-East Public Health Observatory on Teesside, said the number of obese men outnumbered women in the North-East, while the opposite was true for the rest of England.

He also highlighted Government plans to measure and weigh all schoolchildren at a primary care trust level.

Currently, 12 North-East PCTs are already collecting information. "Measuring childhood obesity needs to be handled with great care because of concern about stigma," he added.

Winding up the one day conference, Prof Kelly pointed out that the rise in obesity levels in Middlesbrough children affected better off children as well as less advantaged children.

"It doesn't seem to make any difference if you are one of the posh kids or one of the poor kids," he said.

The hope is that an evaluation of initaitives in Middlesbrough could provide a blueprint for the rest of the country.