Parents are worried about obesity, but what can they do? Rebecca McQuillan goes in search of the best answers.

When Zoe Silver from Glasgow was 12 years old, she weighed in at 12 stone. "I remember thinking: is she going to go up a stone each year?" says her mother, Caroline.

Zoe is now 15 and in much better shape, but her mother has not forgotten how difficult it was to manage her weight. Zoe's problems began before she started secondary school, and were clearly making her unhappy. But helping an overweight child to slim down takes more than filling up the fruit bowl and feeding the chocolate biscuits to the dog.

"It's a struggle," says Caroline. "With our climate, children don't play outside as much as they should - and there are vending machines everywhere. Zoe was over-eating but under-active. Her body didn't need as much food as she was eating."

Anxious about Zoe's health, Caroline sat down and talked to her about the importance of healthy eating. "Zoe herself realised - and trusted me when I told her that if she carried on the way she was going, she would end up being very big," says Caroline.

Yet talking was one thing; achieving the desired results another. When Caroline found out about the Carnegie International Weight Loss Camp in Leeds, a residential opportunity for overweight children, she encouraged Zoe to consider it.

She thinks it was the best move she could have made. The summer camp takes a holistic approach in which children are encouraged to be more active and to make healthy food choices in a non-judgmental atmosphere.

"She adored it," says Caroline. "She goes every year. The first time it was a bit nerve-racking, but now she even goes down to Leeds for weekends."

Zoe, who is 5ft 5in, got her weight down to 10st, well within the healthy body mass index (BMI) range. She is happier as a result. For Caroline, it goes to show how important professional residential support is. "I would encourage people to go there before they reach a weight of desperate proportions," she says. "That is where they should go to be educated."

Inevitably, though, parents remain the first defence - and the question of how far they can influence their children's weight has come to the fore this week following a television programme about Tyneside schoolboy Connor McCreaddie, who is eight years old and weighed more than 15 and a half stone. One consultant paediatrician described Connor's situation as unintentional child abuse. Yesterday, a child protection conference decided against putting Connor into care.

His mother, Nicola McKeown, who suffers from depression and has spoken about her struggle to cope with her son's food demands, believes Connor now needs her more than ever, but she has her work cut out. Connor has lost a stone and a half in two months after getting help from a dietician, but his weight is still more than three times that of a typical eight-year-old.

So how far can a parent control their child's weight? Dr Richard Woolfson, child psychologist and The Herald's Parent Doctor, counsels caution about underestimating the issue. "We know it's not as simple as saying eat less'," he says. "It's about social demands, the availability of convenience foods, self-esteem, advertising - a whole range of things. Many parents are able to balance all these things, but for some it's a struggle.

"Is there something parents can do to resolve the situation? Yes, in most instances, but that doesn't mean it's easy or the parent necessarily knows what it is."

A parent's job is made harder by children's behaviour in the face of being denied the foods they want. A sulky mood, whiny demands for junk food and stubborn refusal to eat the meal that's been prepared for them can grind a parent down. But beware, says Dr Woolfson. "It shouldn't be give, give, give by parents all the time. In the long term that teaches children that if they make a fuss, they'll get what they want."

He advises parents to take a positive approach: always have healthy choices available to eat, but at the same time don't feel you have to deny your children treats altogether. Just ensure there is a balance, he says, and explain to your child why healthy food is important. You should pay attention to their physical activity - and, of course, set a good example yourself. "If you are out at a restaurant, are you ordering salad and grilled fish or the biggest pizza they've got?"

Ultimately, you cannot control what they eat outside the home, but you can hope that making healthy choices at home will translate to the outside world. Yet not all problems can be solved by parents alone - professionals have a role to play as well.

Peter Mackreth is a senior lecturer in physical activity and obesity management at Leeds Metropolitan University, and one of the leading lights of the Carnegie programme. Carnegie International Weight Loss Camps are run during school holidays, and the centre also runs community programmes in schools and leisure centres for children and their parents. The residential camp has helped close to 1000 children since 1999, while 250 children have been through the community programmes.

The not-for-profit organisation, which works in conjunction with primary care trusts, charges a fee for the service, which in some cases is paid for by local trusts. Mackreth is interested in extending the service to Scotland.

The ethos of both the camp and the community programme is non- judgmental and non-prescriptive, he explains. "Our whole society is very judgmental, especially about this issue," he says. "What we do is based on understanding where someone is at the moment and looking at how to change it."

In the community programme, for instance, if a child is going shopping with their mother, rather than pushing them to eat five portions of fruit and vegetables a day, Mackreth will encourage them just to look at the fruit and veg in the fresh produce section. The next time, he might encourage them to actually try something.

Mackreth believes there needs to be a range of services available to tackle obesity among children, starting with community schemes, then residential camps, and only then drugs and/or surgery.

He agrees strongly with Dr Woolfson that there is no single cause of obesity. "Every single part of our society has a role to play in the cause of it and the solution to it," he says. "People who say, These kids just need to exercise more and eat less' are probably people who don't have serious problems with their weight."

Connor McCreaddie, he says, has already done very well to lose a stone and a half. "We want to apportion blame. This week it's parents, last week it was McDonald's, before that it was the food industry in general. Let's stop apportioning blame and look at responsibility."

So what is on offer in Scotland right now? King's Camps, a Sheffield-based organisation, is running Easter and summer day camps in Aberdeen, Edinburgh and Glasgow based on physical activity, though not specifically aimed at overweight children. Much work on health promotion has been done country-wide in partnership with schools, and children's hospitals have dieticians who work specifically with children. In addition, pilot initiatives are under way in Glasgow that take a more holistic approach, dealing with a child's environment, family and friends as well as educating them about the importance of healthy eating and exercise.

Parents of children with a weight problem need support, says Caroline Silver. "Every single case has to be looked at individually," she says. "Neglect could be a factor, but there could be a million reasons for a child's weight gain. Some families may simply not know where to go."

www.carnegieweightmanagement.com
www.kingscamps.org/activity-camps

• Read Richard Woolfson in The Herald every Monday.
  
  A shake-up at McDonald's
  Prince Charles wants McDonald's banned - but it seems the chain itself is only too keen to change. After introducing a range of salads, sandwiches and yogurts, and announcing plans to cut trans fats from its foods, McDonald's is giving its entire image a major overhaul.

The change, spearheaded by its European boss, Denis Hennequin, will start with the chairs, lighting and tables, and lead on to menu additions. Changes to decor were first tried out by Hennequin in his native France, with the result that sales rose. The McDonald's cafe in Lyon's Part-Dieu shopping centre is a place of dark wood and modish furniture, where customers choose from a range of coffees and pastries and can listen to music on supplied iPods.

The chain - which responded that it was "disappointed" by Prince Charles's words - has long been targeted by healthy- eating campaigners. In the 2004 documentary Super Size Me, the American film-maker Morgan Spurlock spent a month eating nothing but McDonald's food and taking minimal exercise.

At the end of it, his cholesterol was up 10 points and his body fat by nearly half. The film also criticised the restaurant for targeting children.