Views & Reviews From the Frontline

Inactivity and obesity

BMJ 2011; 343 doi: (Published 10 August 2011) Cite this as: BMJ 2011;343:d5093
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

The wine always disinhibits your inner voice: “Boring, boring, boring,” you yell. Dinner parties can be dull affairs. Suggesting that private schools are “socially elitist and divisive” is social Semtex to liven things up. Concerned and liberal middle class parents are put on the rack and bleat in pain, their moral joints pulled out of sockets as they seek to justify why they educate their children privately. Finally they rasp a choked “I just want the best for my children.” This position needs no defending.

The privately educated have a tight grip on all professional and academic institutions. It is obvious to everyone that the only way to reduce this influence is for the state sector to adopt the educationally conservative practices of private schools. And the difference is down to more than mere academic results, because private schools value sport and exercise. This is reflected in a doubling in childhood obesity rates across the socioeconomic classes ( Obesity is a matter of socioeconomic class.

There has been a near doubling of obesity in adults since 1993 to 24%, with a doomsday projection that by 2050, 47% of men and 36% of women will be obese ( Obese children tend to become obese adults; childhood experience is the behavioural DNA of life. Childhood obesity is about more than just health. Both anecdote and evidence indicate that obesity blocks progress in public life and in the professions (Obesity 2008;16:654-8, doi:10.1038/oby.2007.103). Obesity reduces social mobility. So we are passively witnessing a widening and compounding of the class divide. Emotional and physical welfare are interwoven, so what impact does obesity have on self esteem and mental health in the long term? Childhood obesity is the elephant in the room, and state intervention is an absolute priority.

Obesity’s cause and solutions are presented as complex, and fatalism prevails. One thing is certain though—activity can control weight. The Department of Health’s current guidance to increase activity among children is to be welcomed, but the recommendation of an hour a day for teenagers is inadequate (

The devil is in the implementation, however. Sport and activity are not priorities in state education, where the culture is hostile towards sporting competition. The widespread adoption of non-contested sports days and the demise of interschool leagues are a testimony to this. Private education places the challenge of sport and activity at its core, daily, compulsorily, and often after school. Medicine’s lack of effective advocacy on activity is bad medicine and has led to a comprehensive failure to protect millions of our poorest children from a lifetime of inactivity, obesity, and social immobility.


Cite this as: BMJ 2011;343:d5093

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