Dear Sir Liam Donaldson,

You've been alerting us to the obesity time-bomb for nearly a decade.

And quite rightly. Obesity is the manifestation of a food- and size-obsessed society that most shows us we are in trouble where eating is concerned. The latest information from the EarlyBird Diabetes study of 233 children from birth to puberty, published in the journal Paediatrics, shows that one in four children aged 4 to 5 in England is overweight despite normal birth weights. But, says Terry Wilkin, the study's lead researcher, it is difficult to know what is causing the upsurge.

Difficult? Well perhaps. But not that difficult. You don't have to be a psychoanalyst to know that childhood is formative and that one's earliest eating experiences - entwined as they are with our fundamental feelings of security, love, attachment and caring - form the basis of how we approach food and succour throughout our lives.

Mothers strive to and want to give their children all that is best and most reassuring. But in many cases, this doesn't happen because mothers themselves are troubled by erratic eating, fear of food, preoccupation with body size, frequent dieting, and its sister - bingeing.

Babies and children mimic. That is a crucial part of how they learn. So it is surely no wonder that if babies or toddlers pick up on a fraught atmosphere around feeding and eating, they will take that as the norm. And it shouldn't surprise us that when the children become more independent eaters they will reflect what they have learnt not only in their eating choices, but in the emotional feelings of safety, anxiety, fear, pleasure or satisfaction that go with food.

People don't eat compulsively because they are hungry. People don't eat excessively because they forgot to exercise or balance their calorie output against their calorie input. People don't eat more than they need because they are just plain ignorant or bolshie.

People eat when they aren't hungry because they are bored, anxious, angry, conflicted, nervous, sad or overexcited. They reach out for something cheap and tasty that feels momentarily like a treat; something that takes their mind off what hurts. The upset feelings don't get dealt with; they sit there and the next time they emerge, the person will again turn to food for soothing.

This behaviour is learnt when we are little - whether it is by being rewarded with food, by being given food to cheer us up after falling down or by observing a mother who is constantly dieting but then eats off a child's own plate. Food becomes not food but something imbued with magically comforting properties.

Sir Liam, you are calling for early interventions. Thank goodness. But is anyone in the Department of Health listening? Will they now? For at least ten years, I have been pestering the department (as, I imagine, have others) with economical, nay cheap, plans to provide support to help new mothers not pass their eating problems on to their babies. Helping mothers to come to grips with their own eating difficulties is surely the sanest and most effective way to help two generations in one go.

It's not difficult to see how to train midwives and health visitors to take a more nuanced and psychobiological approach to expectant and new mothers so that their eating attitudes, habits and psychological issues are addressed rather than their being told to feed on the right breast for ten minutes and then the left.

No disrespect to health visitors; I know that they want to help new mothers and their babies but at present they are undertrained and too rushed to take the time really to address what mothers and babies need.

But it needn't be so. Compared with the cost of treatments for obesity-related diseases later in life and what will inevitably become, in time, a lucrative pill for the pharmaceutical companies, it makes sense to spend some money now by employing more health visitors and extending their training so that they can underpin the crucial parenting job of introducing a child to food and eating in a relaxed manner.

Sir Liam, these are messages that the Government must take on board and work with alongside the often (but not always) sound nutritional policies that it disseminates. New mothers are keen to get it right for their babies. Let's help them to get it right for themselves and reverse their own, often unseen, eating difficulties.

And Sir Liam, about that taboo word obesity. I'm not so sure that you're right on why it rubs people up the wrong way. It could just be that calling obesity a disease rather than a description of size, castigating rather than understanding people's complex relationship to food and patronising them with oversimplified slogans about “energy in, energy out”, makes the kind of changes that you would like to see in our attitude towards weight seem unappetising.

So please, Sir Liam, can I talk to you about implementing some programmes that stand a good chance of addressing the eating problems that beset so many - and that are contributing to the epidemic in the next generation.

As Erasmus told us nearly 500 years ago “young bodies are like tender plants, which grow and become hardened into whatever shape you've trained them”. He wasn't wrong where it comes to food. So let's train people to relish it rather than fear or laud it.

Yours in frustration and hope, Susie Orbach

Susie Orbach is author of Fat is a Feminist Issue and Bodies, to be published by Profile in January

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