Britain’s medicines cost watchdog has for the first time recommended weight-loss surgery for exceptionally obese children.

The National Institute for Health and Clinical Excellence (NICE) said operations should be considered for obese young people who were past puberty and at risk of developing life-threatening diseases.

NICE also urged the National Health Service to consider surgery as a last resort to help save severely obese adults from diseases like diabetes and high blood pressure.

Many NHS trusts, struggling with a lack of resources and funding, have been reluctant to offer surgery like stomach stapling that reduces the appetite and helps patients lose weight slowly.

The average obesity operation costs 10,000 pounds.

NICE’s recommendations were made in the institute’s first ever national guide to the prevention and treatment of obesity, which together with overweight conditions costs the economy as much as 7.4 billion pounds a year.

“Some of the treatment options we are recommending in this guideline such as offering anti-obesity drugs, and in extreme cases, surgery, to children will be seen as highly controversial,” said Professor John Wilding, Professor of Medicine at Liverpool University’s Aintree hospital.

“But it is right that the NHS is given the go-ahead to take radical action when faced with such a major threat to the health of our children,” he told reporters.

The number of overweight or obese people in England has trebled during the past 25 years.

About two-thirds of the adult population, or 24 million people, were classified as overweight or obese in 2004.

The obesity rate for children between two and 15 was 16 percent in 2003 with another 14 percent classed as overweight.

Dr Colin Waine, Chairman of the National Obesity Forum, welcomed the new guidelines, saying surgery tended to be very effective at helping long-term weight loss.

“We agree that it is a last resort. There are children at high risk and if it could prolong their life then it has a place,” he said.

“I think it’s an indication of the pretty desperate plight we’re in with the levels of obesity in children.”

The British Medical Association, which represents doctors, predicts that by 2020 more than one quarter of children will be obese and have a shorter life expectancy than their parents.

The BMA said it supported the guidelines but stressed they were useless without the necessary resources.

“Public health capacity must increase. The government must work with food manufacturers and advertisers to help people improve their diets,” the BMA’s Dr Vivienne Nathanson said.

NICE also issued wide-ranging advice on ways to tackle the underlying causes of obesity, urging health professionals to look at the psychology behind over-eating and advise on lifestyle choices.

It called on schools, local authorities, employers and town planners to make it easier for people to exercise, blaming Britain’s car culture for some of the drop in people’s physical activity over the past few decades.

“The twin evils of cheap, calorie-rich food and low activity levels have occurred simultaneously, resulting in an obesity epidemic with costs for us and the economy,” said Glasgow University Professor Jim McEwen, who chaired the groups that drew up the guidelines.

The NHS Confederation’s Jo Webber said health services and local government had to tackle the growth in obesity together.

She forecast a 16 percent rise in diabetes between 2001 and 2010 if current rises in obesity continued.