If you’re reading this you’re probably thinking what has cross promotional marketing to do with children. Personally when I first heard the term I was thinking what exactly is it?

Simply, cross-promotional marketing is the act of strategically aligning businesses that target the same market but do not directly compete with each other. Whenever two organizations join forces to attract their mutual customers they can more than double the number of prospects they each reach.

For example, in 1996 MacDonalds and Disney signed a ten year deal to cross-promote. Get it? Same market, but not in direct competition and double the reach. A subsequent survey by Eric Schlosser of US schoolchildren found that the only fictional character with greater recognitions than Ronald MacDonald – who had 96% recognition – was Santa Claus. Oh, by the way, MacDonalds operates more playgrounds – designed to attract children and their parents to its restaurants – than any other private entity in the US;

This sort of promotion is also seen with film tie-ins such as Burger King and Toy Story.

Sorry to be a spoilt sport, but given the obesity epidemic - currently 10% of children worldwide are either overweight or obese - it’s time to rethink cross-promotion.

Beware; next time you are out and about, particularly if you have children, you will start to see cross-promotion all around you.

After smoking, alcohol is the next public health behavioural challenge of our generation. There have been moves at national and international level to recognise and tackle the problem of alcohol misuse. Its consumption is increasing, particularly among younger adults.

Alcohol consumption increases risk of liver disease. However, levels and patterns of alcohol consumption do not fully explain the rises in liver disease mortality that have occurred in some countries.

A recent Scottish study showed that body mass index(BMI) is related to liver disease, suggesting that the current rise in overweight and obesity may lead to a continuing epidemic of liver disease. Looking in the same cohort of men in Scotland, the same authors found that raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two. This led the study authors to suggest that BMI-specific "safe" limits of alcohol consumption may need to be defined. In the same issue of the BMJ, a study of 1.2 million middle-aged women in the UK showed that 1800 of the women developed or died from liver cirrhosis during follow-up. Increasing BMI was associated with increased liver cirrhosis, with a 28% increase in risk for every 5 unit increase in BMI. In addition to the effect of BMI, the absolute risk of liver cirrhosis increased as alcohol intake increased. The authors estimated that 17% of liver cirrhosis is due to excess body weight, compared to 42% due to alcohol.

An accompanying editorial makes the point that “compared with the risk of cardiovascular events in middle aged people, an absolute risk of one case per 1000 people over five years for liver cirrhosis seems low. However, this absolute risk still represents a substantial burden of illness for the patients concerned and for the health service”. The upshot is that alcohol and obesity in combination cause liver cirrhosis, another negative consequence of unhealthy lifestyle. Reductions in alcohol consumption and obesity are currently the only way we can prevent non-viral liver disease.

If you search PubMed for articles relating to body-mass index, obesity, and mortality you will see an explosion in the number of articles in the last 5 years, as scientists try to characterise and explain the long-term effects of obesity. Perhaps the most impressive data came from an analysis from Oxford, which collaborated data from nearly 900 000 patients in 57 trials. It found that BMI above 25 increases the risk of death, predominantly due to vascular diseases, like coronary heart disease. A BMI of 30-35 reduced survival by 2-4 years; and a BMI of 40-45 reduced survival by 8-10 years, which the authors compared to the effects of smoking. I have written before about the huge public health cost of obesity, estimated at £3 billion per year in the NHS.

Now search PubMed for “anti-obesity” and “weight loss” and you will get 2544 and 71550 hits respectively. This tells you about the research going into finding a cure for obesity and the potential profits from such a cure. These two search terms in Google will give you literally millions of hits from dietary fads and “mandometers” to prescription pills promising to shed those pounds.

This week, two stories relating to fat have dominated the headlines. Firstly, a Royal College of Surgeons conference heard that around one million people meet NICE criteria for weight loss surgery (also known as “bariatric” surgery) with around 240,000 wanting surgery yet only 4,300 NHS weight-loss operations were carried out last year. The Medical Defence Union has also reported a rise in the number of claims against doctors whose patients have suffered complications of obesity-related surgery.

The second story relates to sibutramine (“Reductil”), the weight loss pill that the European Medicines Agency suspended, and the US Food and Drug Administration restricted from its list of licensed drugs. The reason for these decisions is that sibutramine causes a 14% increase in the risk of heart attacks and strokes, compared with placebo. The way in which these decisions have been made raises concerns about the discrepancies between judgments of different drug regulating authorities and how quickly such data should be made available to these regulating authorities. As the BMJ notes, European doctors are now left with only one anti-obesity pill, orlistat (“Xenical”), for use in the treatment of obesity.

It is high time for a dose of reality. Whilst I agree that unequal care to any treatment across the NHS is unethical, we are never going to be able to provide a quarter of a million people bariatric surgery, or to provide everybody with weight-loss pills in a tax-funded, public healthcare system. We need to have a proper debate about personal versus social responsibilities for health and for healthcare, and start talking about the simple public health measures of diet and exercise again.