KEY POINTS:
This time last year, Anna's family ate takeaways every second day.
Anna (not her real name), who was then 15 and in year 11 at McAuley High School in Otahuhu, weighed 138kg. Her father, then 62, took pills daily for diabetes.
A Samoan family, they were part of the appalling statistics which give New Zealand the developed world's sixth-highest adult obesity rate at 25 per cent, and Pacific Island New Zealanders an even higher adult obesity rate, 64 per cent, than the fattest group in the world's fattest nation - Afro-Americans in the United States.
At McAuley High School, a Catholic girls' school, nurse Beverley O'Loughlin says 97 per cent of the students are Pasifika and 80 per cent of each year 9 intake has someone in her immediate family with diabetes.
"We have quite a few students who have lost a parent in their 30s and 40s through obesity-related disease," she says.
No school could ignore such tragedy in its community, and McAuley High has picked up the challenge.
Not only has it banned soft drinks and takeaways, in line with a Labour Government edict to sell "only healthy options", an instruction reversed this week by the National Government. It has also introduced two unique programmes which earned the Auckland District Health Board's top community innovation award late last year.
The first was "McCheetahs" - a name the girls chose for a group of 20 in each term last year who met for an hour a week for exercise and nutrition education.
"The name came from 'cheetah', an animal that was fast and slim and quick, and they wanted 'Mc' from McAuley, and then they realised it sounded like 'cheating McDonald's," O'Loughlin says.
The programme has changed Anna's shape dramatically - she has lost 36kg, partly because of an illness. It has transformed her family. "We only have takeways every two months now," she says. "I'm going on runs, doing my own exercise. Dad goes on runs with me."
She also introduced the idea to her church, which started evening cooking classes. The 21 women who attended the first classes last year are still cooking in each other's homes and go walking together.
In a second innovation, McAuley High invited all family members of its students to join students in evening sessions for aerobics and cooking classes organised by Donna Frost of Diabetes Auckland.
But this good news story has a fragile future - and so does New Zealand's whole struggle with obesity.
The school's two programmes were funded by a $12,000 one-off grant from the Health Ministry's Nutrition Fund, with support from Diabetes Auckland and a private charity, the Kelleher Trust. But the Nutrition Fund does not provide ongoing money.
O'Loughlin is using the $5000 award from the district health board to run one more evening class series for families this term but she has had to can McCheetahs. "I spend a lot of my time looking for funding," she says.
Lobbyists such as Wellington endocrinologist Dr Robyn Toomath of Fight the Obesity Epidemic fear that setbacks like this are about to become much more common after the National Party won the November election partly on a campaign against Labour's "nanny state".
On Thursday Education Minister Anne Tolley cancelled Labour's instruction to schools to make only healthy food available in their tuckshops. Health Minister Tony Ryall told the Weekend Herald he would also scrap clauses in a Public Health Bill that would would have allowed regulations if the food industry failed to reduce fat and sugar contents in foods and keep advertisements for "bad food" off television before 8.30pm.
National signalled a dissenting view in a parliamentary committee inquiry on obesity two years ago, stating it was "not in favour of food and drink policies in public facilities and workplaces that remove individual choice. The emphasis should be on practical approaches that change attitudes to food and exercise. The necessary changes in diet and exercise habits will not occur through Government pressure."
It did, however, acknowledge that "obesity and type 2 diabetes are serious medical problems contributing significantly to rising healthcare costs".
Although there are signs that obesity may be levelling off (see story, B2), the figures are still frightening. Two-thirds of Kiwi men (65 per cent) and more than half of Kiwi women (55 per cent) are now officially overweight or obese.
The numbers classed as "obese" have more than doubled in the past 30 years, from 10 per cent to 25 per cent.
Our genetic makeup hasn't changed in that time. So there is general agreement that the obesity "epidemic", here and internationally, has been caused by unprecedented lifestyle changes.
After thousands of years chasing wild animals and tilling the soil, we have in just two generations become sedentary city dwellers, sitting in shops or offices, in the car between home and work and then again at home in front of the TV or the computer.
Somehow we have also lost the time, and often the skills, to prepare fresh food, succumbing to the convenience of packaged foods and takeaways often stacked with unhealthy fats and sugars.
This process has gone furthest in the countries most influenced by American consumer culture. The top six obesity rates in the OECD are in the US (32 per cent), Mexico, Britain, Greece, Australia (22 per cent) and New Zealand (still listed at 21 per cent).
In contrast, the rates are still below 10 per cent in Italy, France, Austria, Norway, Switzerland, South Korea and Japan.
Our Health Ministry puts the direct costs of obesity to the health system at about $500 million a year and says: "Dietary patterns and lifestyles are major and increasing causes of preventable disease, disability and death in New Zealand."
Like Governments in many countries, Helen Clark's Labour made the issue a priority. Apart from regulating school tuckshops, Clark used the mere threat of regulation to jawbone the food industry into cutting the fat and sugar content of chips and other foods and scaling back TV commercials for unhealthy foods in children's viewing times.
Labour pushed one of the two big supermarket chains, Progressive, into installing at least one confectionery-free checkout in every outlet, while the other, Foodstuffs, promised to increase its confectionery-free checkouts by the end of last year.
District health boards have been given extra staff to promote a programme called "Healthy Eating, Healthy Action" and to support programmes in schools and preschools.
Free fruit has been provided to the poorest schools since 2005 and is due to extend to the poorest fifth of all primary and intermediate schools from April.
A "green prescription" scheme where doctors can refer patients to regional sports agencies for exercise programmes has been expanded from 1000 prescriptions in 1999-2000 to 26,000 in the year to last June, with a target of 50,000 by next year.
"Preventative health is core business now for GPs," says College of General Practitioners president Dr Jonathan Fox. "If we find someone whose lifestyle is unhealthy, in my practice we book them in with one of our nurses for what we call a lifestyle discussion. The nurse looks at height and weight and talks about diet and exercise and maybe sets them goals."
But there are still huge gaps. At the most basic level, even in Auckland's affluent Meadowbank where Fox works, there is a desperate shortage of dietitians to refer people to unless they pay high fees to go privately.
"There are dietitians in the public hospitals, but the last time I tried they could only see people once they had an illness associated with weight," Fox says. "You may get a man or a woman in their early 20s and you know they really need more than just a bit of finger-wagging from their doctor or nurse, but there isn't any public funding for them."
At Otahuhu College, where 70 per cent of the students are overweight or obese, health clinic manager Catriona Lawler has lobbied for years without success to get funding for a dietitian to share with other South Auckland schools.
Dietetic Association president Julie Carter says there are only 550 dietitians in the country and many primary health organisations (PHOs) don't have any. "Some PHOs may have advertised for a dietitian and not been able to fill that position so they have become disheartened and explored other avenues," she says.
But potentially the biggest changes could be made well before the dietitian becomes necessary if we could deal with what the experts call our "obesogenic" environment - the sweet, tasty foods that we see on every TV screen and in the supermarkets, and the cities designed for cars rather than walking, cycling and sport.
Parliament's committee inquiry back in 2006, chaired by Green MP Sue Kedgley, called for a 55-point plan including a ban on advertising unhealthy food and drink on TV before 8.30pm and a simple "traffic light" labelling system, as used in Britain, with good foods labelled green, bad ones red, and those that are okay to eat sometimes labelled yellow.
Even Labour has so far steered clear of the TV ban. It decided food labelling was a transtasman issue because of joint food safety regulations and officials are due to provide draft guidelines to Australian and New Zealand food ministers at their next meeting in May. Kedgley is not impressed. "We made 55 recommendations. I don't think any action has been taken on virtually any of them," she says.
Meanwhile, new governments have been elected on both sides of the Tasman and seem to be pulling in opposite directions.
Australia's Labor Government shows every sign of being as activist on obesity as it is on the economy. It has set up a taskforce which has produced a discussion paper proposing not just labelling on retail products but potentially forcing restaurants and takeaway bars to state the calories in every item on their menus.
It proposes tax breaks for parents paying children's sports fees and for employers paying workers' gym memberships, matched by higher taxes on "energy-dense" foods - which led the food industry to hit back this week with a claim a tax could threaten the national icon, salt-rich Vegemite.
The taskforce also suggests regulating fat, sugar and salt levels in foods and banning advertising of energy-dense foods on TV before 9pm.
National will not have a bar of the idea, insists Health Minister Ryall. "Restaurants and other food retailers will not be required to put calorie counts on their menus. There will be a greater emphasis on the physical activity side of the obesity issue, and there will be more announcements once plans have been firmed up.
"We will fulfil our pledge to remove the nanny state provisions in the Public Health Bill."
He made only one concession to Kedgley's agenda, promising to revive a ministerial committee to drive obesity policy. Labour established a committee but National has yet to do so. "The Government does plan to have a cross-ministerial group supported by advisers," Ryall says.
"There will be more announcements in due course."
