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This issue of the British Journal of Obesity describes some potentially exciting news from Public Health England (PHE) concerning the fight against obesity, alongside some encouraging clinical background.

Obesity is one of the Cinderella services. We all know that it is a major problem and yet no-one wants to take responsibility for providing the service. Obesity has been a growing problem for the past decades. Latest figures suggest that 25% of the population are obese and that the direct costs of obesity and its comorbidities are in the order of £6 billion per year.

A recent visit to one of my local Burger King outlets left me with bewilderment. It was before the time in the morning when the items served are changed from the breakfast menu to main menu. I was asked to purchase a regular cappuccino coffee and, whilst waiting to be served, and out of interest, I wondered how many calories would be in this. On the menu billboard above the cashier, it said that a regular cappuccino was 71 kcal and a large was 105 kcal. However, the tray menu said 308 kcal and 387 kcal, respectively!

Adults with intellectual disabilities (ID) not only experience a higher prevalence of obesity than the general population but also face barriers to accessing healthcare. Waist Winners Too (WWToo) is a weight management intervention for adults with ID, adapted from a current community weight management intervention, which was piloted in order to reduce inequalities in service access. In total, 29 adults with ID and BMI ranging from 28.6 to 54.3 kg/m² attended the intervention with carers. Recruitment was feasible and feedback positive. Attendance was good over 8 weeks but follow-up proved difficult. Statistical analysis showed statistically significant weight loss, but the intervention period was too short to achieve clinically significant weight loss of 5%. WWToo may be an effective intervention if held over a longer time period.

There is clear evidence from large clinical trials that type 2 diabetes can be prevented in high-risk individuals using intensive lifestyle change. The challenge for healthcare systems such as the NHS, however, is to translate these findings into routine clinical care and be as successful. We implemented a care pathway based on existing NICE guidelines for the management of people at high risk of type 2 diabetes at seven GP practices in Dorset. This 12-month intervention consisted of 16 group sessions, one individual appointment and participation in an already established community-based exercise programme. Twenty overweight or obese adults were enrolled in this pilot phase. In this article, we summarise our findings and provide evidence that diabetes prevention programmes can be translated and implemented in the routine primary care setting.

In March 2014, the consultation document Joined up Clinical Pathways for Obesity was published, exploring options for the future commissioning responsibilities of Tier 3 and 4 weight management services. What became apparent was the lack of reference to childhood weight management services (more so at Tier 3), which mirrors the scarcity of evidence-based research in this area. This article asks a number of key questions: who should provide Tier 3 services for children and young people (CYP), what does such a service look like and who should fund these services for CYP? Greater commitment is needed from the Department of Health to provide clarity for Tier 3 service providers. SHINE (Self-Help, Independence, Nutrition and Exercise), an established Tier 3 service for CYP with severe obesity, is an example of what a Tier 3 programme can look like. Finally, it is proposed that funding is better distributed across the Obesity Care Pathway to ensure that CYP with severe obesity can access appropriate treatment.

The prevalence of obesity in children aged 11–15 years was 37.8% in 2013. Since 2004 there has been a statistically significant increase of 2.6% in prevalence, compared with stabilisation in the under-11s. The aetiology of this is multifactorial. Adolescent obesity is linked with comorbidities such as type 2 diabetes, cardiac abnormalities and obstructive sleep apnoea, and the psychosocial impact is significant. Weight management in this age group presents particular challenges. In this article, the evidence base for various weight loss interventions in adolescents, including residential weight loss camps, individual and family-based behavioural therapy, technology such as texting and apps, and bariatric surgery, are reviewed. The real challenge, however, is the obesogenic environment; failure to tackle this will result in increasing prevalence.

Unfortunately, daily exercise is frequently not a habit in children, but there is a hint that it might become one after David Cameron’s “Framework to tackle childhood obesity” is launched in (possibly) January.

For many years the advice has been clear: if you have a decent breakfast, over the course of the day you are more likely to consume fewer calories overall and, therefore, it is better for weight management; in other words, “skipping breakfast can make you fat.”