Trailing down a Sainsbury superstore aisle, Debbie Oakley, 46-year-old mother of three, wore a glazed expression as she surveyed the range of cereals. Her six-year-old son, Matthew, began to clamour for two packets with free toys inside, and into the trolley they went. The sugary contents didn't seem to matter. It was Friday evening and she wanted to get home to cook dinner.

'If you've got young children and you work, you can't read the labelling because you haven't got time,' confessed Oakley, a secretary with a Bristol firm. 'If they package it clearly, then I don't mind, but if it has small print, then I don't have time to read the labels.'

She admits that her 16- and 18-year-old children still avoid the vegetables on their plate and fears that her youngest is heading the same way. 'Matthew picks things with lots of sugar and it's hard to get them to eat something without a sugar coating.'

So how much responsibility does Oakley bear for her children's health - and how much lies with the food giants who make billions pandering to the appetites of the young Matthews of this world for fatty, sugary, salty food? The battle over what we put in our trollies is rapidly becoming one of the most perplexing issues taxing the Government, which faces an unprecedented obesity epidemic. There has never been, in the space of a single generation, such a dramatic deterioration in public health caused by a single phenomenon. The twin evils of junk food and inactivity will inevitably leave thousands of Britons with disabilities, but diabetes and arthritis are the least of their problems. Fat people tend to die prematurely.

Obesity now affects 21 per cent of men and 23 per cent of women in the UK. A further 46 per cent of men and 33 per cent of women are overweight. At least two-thirds of our population needs to shed pounds - the exact opposite of a century ago when the same proportion of Britons were underweight through lack of nutrition. As for children, one in 25 is now classified as obese.

Nor is this an issue for the Western world alone. China now has 20 million diabetics, many of whom have sunk into chronic ill health and the prospect of an early grave as a result of abandoning their traditional diet of rice, fish and green vegetables. The Greeks, who pride themselves on their olive oil and fresh salads, nevertheless have high rates of obesity in children, who opt instead for hamburgers. The World Health Organisation has identified being overweight as a global problem, pointing out that more than 300 million people are obese. It is astonishing that in the space of a single generation non-communicable diseases, such as heart problems, diabetes, cancer and respiratory illness now account for more deaths each year around the globe than infections such as HIV and malaria. We are eating ourselves to death.

With obesity come metabolic changes which human physiology was never designed to withstand. Blood pressure rises, as do cholesterol levels and insulin resistance. The joints, particularly knee joints, have extra strain placed on them. Women become less fertile and men find it harder to sleep because breathing is more laboured.

The likelihood of developing Type 2 diabetes rises as the pounds go on. Around 85 per cent of the world's diabetics are Type 2, and 90 per cent of them are overweight. America and Britain have high rates but will be overtaken, if trends continue, by India and the Middle East within two decades.

Britain should be well placed to counteract this international medical phenomenon, with its national health service and strong tradition of public health measures aimed at helping the poorest. But how far can the Government go in regulating the food industry and coercing parents into giving children proper meals and lots of exercise? The man who must confront this problem is Sir John Krebs, chairman of the Food Standards Agency. Krebs has to tell Britain how it should tackle its 'ticking timebomb', as he describes it.

This weekend he has outlined a number of options in the agency's first report. Should advertising directed at children for sweets and high-fat foods be controlled? Should schools ban vending machines dispensing sugary drinks, salty snacks and sweets? Should companies be stopped from setting up promotions with schools to encourage children to buy more sweets (Cadbury's) or crisps (Walkers) in return for new sports equipment or books?

'If nothing is done to stop the trend, for the first time in 100 years life expectancy will actually go down,' Krebs warned. 'We increasingly rely on food prepared by others - that's just a fact of life nowadays when a lot of families are two working parents in a hurry.'

Krebs worries about how you enable people like Oakley to make the choices she needs to make. 'Our research shows that people would like some simple signposts. At the moment it might say on a chocolate bar that it contains so many kilojoules. What the hell do you and I know about kilojoules? If it said this is high or medium or low [in fat or sugar] that might be more helpful.'

But already the Food and Drink Federation, representing the industry, is going on the defensive. It issued a vehement press release today: 'Parents will take a dim view of any "Nanny State" type approaches to matters of personal choice. With an average UK supermarket offering some 30,000 products, the terms "healthier foods" and "less healthy foods" are meaningless in the context of a healthy balanced diet.'

Yet the public is clearly growing more distrustful of the way food is produced and the marketing devices used, such as the 'super-sizing' of chocolate bars, to sell more and more products.

This weekend Sainsbury's will announce a drive to cut salt in its products. Salt matters as much as sugar and fat because excessive amounts cause thousands of heart attacks and strokes each year. Sainsbury's three-year drive will see levels reduced in pizzas, soups and sandwiches, but not by nearly enough to satisfy the physicians.

Professor Graham MacGregor, head of cardiovascular medicine of St George's Hospital Medical School, said an immediate cut of 10 per cent in salt in the average diet would save 5,800 lives over the next year and is unhappy that this is not being forced upon manufacturers. 'The industry tells us that they can't cut salt levels immediately because the customers won't like the taste, but lots of studies show that such a reduction wouldn't be detectable. I find it astonishing that a train operator can be held accountable if he causes deaths in a rail crash but we don't hold the manufacturers responsible for these many thousands of preventable deaths because so much salt is hidden in processed food.'

At a meeting tomorrow public health Minister Melanie Johnson will push for further cuts in salt levels, yet her position typifies the Government's strange relationship with the industry. She will call on them to do more, warning that they have until February to show progress. Yet the Government is reluctant to impose regulations on an industry which is so powerful. All the talk is of voluntary codes, not compulsory rules.

Meanwhile the Health Select Committee, an influential group of MPs, is holding its own inquiry into obesity. In two weeks' time it will summon the heads of the major food corporations. Julian Hilton-Johnson, vice-president of McDonalds, Martin Glenn, president of PepsiCo UK, and Andrew Cosslett, managing director of Cadbury Schweppes, will sit in a row in front of the committee to explain why they are not responsible for the surge in obesity.

One of the MPs questioning them will be Paul Burstow, Lib Dem spokesman on health. Last month he flew with the rest of the committee to Coca-Cola's headquarters in Atlanta, Georgia. 'They had gone to the trouble of bringing in a dietician from California, who gave us a mantra about how exercise was the problem. My jaw dropped as I listened to her. The idea that you can burn off all the calories from a high-fat diet just through exercise is potty. I hope in our next meeting that the companies will put forward some solutions.'

Many people think of obesity as akin to smoking, both being major causes of chronic illness, disability and early death, and both seen as the creation of marketing men who have learnt to indulge our cravings. But whereas even one cigarette is harmful to the body, the same cannot be said for a chocolate bar or burger. Obesity expert Dr Susan Jebb points out: 'No one food, in itself, is dangerous - it is a prolonged excessive amount of

high-fat, high-sugar food which creates the problems.'

We live in what nutritionists call an obesifying environment. Some people are genetically more predisposed to weight gain than others, but the food has to be available in the first place. As one expert put it: 'If your genes load the gun, then it's your environment that's pulling the trigger.' And in a world where food is cheaper and more accessible than ever, a moderate consumption becomes increasingly hard to achieve.

The issue plagues all Ministers, especially Culture Secretary Tessa Jowell, who now has to decide whether to do more to ban food adverts targeted at children. 'All the efforts have to be driven by a profound cultural change,' she said. 'We all cut corners, we all buy processed food. Now we have to identify the areas that are the role of government and those that are for industry and those to do with parental behaviour.'

A major aim is to raise levels of physical activity, and Jowell has seen many schools where they are trying to do this: 'I have seen the impact in areas where they have brought in partnerships,' she said. The Observer, as part of its Fit for the Future campaign, has argued that all children need two hours of sport in school each week, but many schools are unable to offer even that. Jowell said parents can help: 'You have to persuade them of the value of taking children to sport on a Saturday morning. If they won't do that, you have to look at offering sport before school or more sport after school. But there's a lot of pressure on teachers, so we want to get more coaches to come in and help.'

And as if anyone needed reminding, she said: ' It takes a long time to secure change. It's not going to happen overnight.'

The facts about flab

* One in 40 women in the UK is now morbidly obese, meaning that their health is at very serious risk from their weight.

* In Thailand, 15 per cent of children are obese, up from 12 per cent just two years ago.
* In Chinese cities, one in five adults is now obese.
* It takes one-and-a-half hours of running to burn off the calories contained in a supersized Mars bar.
* A boy aged eight is the ideal customer for soft drinks companies, according to an industry journal, as he has 65 years of consumption ahead of him.
* Coca-Cola increased its sales by 7 per cent in 2001 when it teamed up with Warner to promote the film Harry Potter and the Philosopher's Stone.
* Almost £452m was spent on food advertising in the UK last year. McDonald's spent £42m of it.
* More than half the world's population fails to do 30 minutes of moderate activity a day.

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