This week a former colleague sent a video of herself in Thailand on the precipice of change. She was not embroiled in the military coup, but on an operating table in Phuket, about to get some new and considerably larger breasts.

While some of us pine for larger boobs, many are already well endowed. The world is growing bigger breasts. This week in the UK a British company, JD Williams, was trumpeting its Naturally Close bra as the world's largest strapless bra, at a gravity-defying 50 L. The Daily Mail reported that demand for larger bras was soaring - with 12 per cent of JD Williams' customers wearing J, K or L cups.

For my friend in Thailand at least only her breasts are growing. But for others, larger proportions all over are not such a good thing. Parts of the world are suffering from a crisis in obesity. New Zealand is in the thick of it. Julia Proverbs reports on page A16 today how the New Zealand Medical Association this week recommended a suite of measures to be considered as part of an approach to tackling New Zealand's obesity epidemic.

The warning is clear: obesity and its related complications are potentially the greatest public health threat we face over the next decade, says NZMA chair Dr Mark Peterson.

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The report predicts that obesity may supplant tobacco as the leading potentially modifiable risk to health by 2016. It is costing health boards hundreds of millions each year.

New Zealand is now the fourth most obese country in the OECD, with nearly two-thirds of adults overweight (34 per cent) or obese (31 per cent). The crisis is taking root in the young generation with one in five children either obese or overweight.

So we are a nation of fatties. Why?

The report gives a long, considered but waffling reason: obesity is caused by a chronic energy imbalance involving both dietary intake and physical activity patterns. Key drivers of obesity include the increased availability of cheap, palatable and energy-dense foods, persuasive and pervasive food marketing, and reduced physical activity.

Blah. In other words, we eat too much of the wrong foods and do not exercise enough.

Existing approaches to tackling obesity in New Zealand do not seem to be working, with the NZMA now calling for many sustained interventions at several levels.

Many of the report's recommendations make perfect sense - community nutrition and exercise programmes, a consistent and easy-to-understand food labelling system, and food and nutrition guidelines in school canteens.

I totally agree that nutrition should be included as part of the mandatory curriculum in schools and would extend it further that cooking classes be made more practical and compulsory.

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So often we hear the excuse from people that fast food is cheaper, but it is not. Knowing how to grow vegetables, buy in season and cook cheap healthy meals for all the family is a skill that children should be taught.

More controversial is the recommendation for the use of fiscal instruments as a means of influencing food consumption, with priority given to a tax for sugar-sweetened beverages. In other words, a tax on your cola.

While opponents may object to government intervention in personal freedoms, the same argument could apply for tobacco. Yet only super-high taxes and strong interventions have made smokers shift from hip to hobo.

Others object to a sugar tax saying it puts more pressure on cash-strapped families. Surely this is the point - to force people to buy healthier alternatives.

I also believe GST on fruit and vegetables should be removed and the cost of our own produced foods such as milk be protected.

The NZMA report makes a lot of sense and I hope the Government puts some, if not all, of the recommendations into play. Doing nothing is not an option.

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Yet these measures should not mean we give up on personal responsibility. The report says the obesity crisis is our collective responsibility.

There is a trend these days to protect the obese by saying it is about more than will power. Seductive marketing is blamed. But we have a choice to consume. Don't let's abandon ourselves to the market. We make the market. If the tidal wave turns for healthier food, just watch all the juice bars and Paleo restaurants that will spring up. We shouldn't need bras size 50 L.

Excluding the health conditions that can lead to people being overweight, becoming obese or overweight is a choice and we should not hide from that.

All the nutritional education and initiatives in the world and hefty taxes may not persuade someone who is hell bent on a diet of fries and fizz.

It may be un-PC to say it but perhaps it is time to serve up some harsh truths to the obese and overweight to jolt them into action. Seek help - there is a lot out there. People will be happy to help if you help yourself. See your GP. The local gym and trainers are a great and affordable place to start. It's not easy, as I myself know, but it's worth it.

Stop the excuses. Get off your butts. Stop eating all the pies.

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