• The start of a campaign It is unprecedented that the medical royal colleges and faculties have come together on such a high-profile public health issue. We have done so because we recognise the huge crisis already happening and believe that current strategies to reduce obesity are failing to have a significant impact.

• We are absolutely determined that this report doesn’t just sit on the shelf and gather dust. In fact, it marks the start of our campaigning activity. The Academy and its members will be doing everything we can to push for these changes that we believe will have a positive impact on the UK’s obesity levels and prevent generation after generation falling victim to obesity-related illnesses and death. But we will not achieve it alone. Only through the commitment and efforts of a wide range of organisations and individuals will these recommendations be achieved – and as healthcare professionals who experience and treat the effects of obesity on a daily basis, we are determined to lead the way.

Obesity is one of the largest public health threats facing many of the wealthiest nations in the 21st century. Every day doctors treat people, young and old, who are facing the health consequences of being overweight or obese, such as high blood pressure, type 2 diabetes, heart disease, strokes, depression, and some major cancers. These illnesses are putting our nation’s health – and the budget of the NHS – under strain, and the contributions of overweight and obesity are growing.

Such is the severity of the problem, with just over a quarter of men and women in the UK classed as obese, and almost a third of nine year olds overweight or obese – that we can ill afford to sit back and not take action.

Obesity is a thoroughly well documented problem. So the aim of this report is not to continue setting out the scale of the problem but instead concentrate on what we can do to resolve it. That is why the UK medical profession has come together to speak out with one voice on the measures that we think society as a whole needs to take to prevent the obesity crisis becoming unresolvable. It is these measures that we set out in this report. We also recognise that these recommendations are not exhaustive, but are ones that we consider achievable, pragmatic steps towards tackling the problem.

While our belief that the obesity crisis needs to be averted is single-minded, the solutions we propose are multi-faceted. Obesity affects doctors and healthcare professionals in day-to-day clinical practice and costs the NHS an estimated £5.1 billion a year.  It has devastating effects on not only health, but also on quality of life. Because of these far-reaching effects, we suggest an approach that is society-wide, and our recommendations go beyond the clinical role that doctors themselves play, important as that is.

We are under no illusion that with today’s obesity crisis, we are faced with a far more complex challenge, as shown by the now familiarly crowded, map in the Foresight report. The solutions proposed are so numerous that they could, as one commentator put it, represent a ‘policy cacophony’. If there were a silver bullet solution it would have been found and fired by now.

Throughout our inquiry, we have heard evidence from a range of individuals and organisations and have been repeatedly reminded that there is no single answer. But we also, universally, took the view that the best must not be the enemy of the good.

Most obesity is the result of slow weight gain in adults over 20 to 40 years of age.9 Many of our proposed solutions are therefore long-term; some look to build on existing successful schemes for both preventing and treating obesity whilst others will require policy makers to be bold. But what the solutions have in common is that they require simultaneous, committed action on a number of fronts.

The obesity problem invites comparisons with campaigns against tobacco in the last century. It was the advocacy work of the Royal College of Physicians (RCP), and their presentation of the overwhelming evidence in Smoking and Health10 published in 1962, that provided a catalyst for the huge successes that we have seen in tobacco control and policy in the last fifty years. The wider population is reaping the benefits of those doctors’ actions now.

Like those doctors who realised that smoke-filled homes and offices of the 1950s were creating a health time-bomb, we demand action today. Just as the challenge of persuading society that the deeply embedded habit of smoking was against its better interests, changing how we eat and exercise is now a matter of necessity.

This report represents the start of the Academy’s goal to achieve change. Our hope is that we set down a clear position – this is what the UK’s doctors’ support – and prompt others to join us in implementing some of these measures.