Tamworth in Staffordshire, a pleasant former market town 14 miles from Birmingham, has had its moments in the national limelight. It boasts a statue of Sir Robert Peel, whose constituency it was and who bred the Tamworth pig, and it is the home of the Reliant Robin, the three-wheel car invented in a back garden in 1935.

But, as of 2011, it has been trying to shake off the less welcome title (shared with Gateshead) of fattest town in Britain.

Just over 30% of people in Tamworth are obese, according to the National Obesity Observatory, Britain's official collector of such data. Gateshead and Tamworth have 30.7% adult obesity, while two other districts, Swale and Medway in Kent, have also for the first time nudged over the 30% line. By 2050, warned the seminal Foresight report of 2007, the UK could hit 60% adult obesity if nothing is done. Tamworth is halfway there.

To the visitor, the girth of Tamworth's inhabitants is noticeably large. The nearly one in three who are technically obese are not hard to spot. While some council members protest loudly at the tarring of their town as fattest in the land, contesting the accuracy of the data and pointing to all that they are doing to encourage the local population to get more active, Jeremy Oates, who sits in the council cabinet and has health as part of his remit, acknowledges there is a problem. "We can run around saying the figures are out of date, but the bottom line is there is still an obesity issue," he says.

Local GP John James, chair of the clinical commissioning group that will decide what NHS services the area needs, says people do not notice that others are overweight any more, because almost everybody is.

"I have been a GP for 30 years," says James. "We don't need the statistics. We have all seen it happen. But we normalise visually. We look around the room at other people and say, I'm fairly tall or I'm not very tall. So in a room full of overweight people, nobody thinks they are fat."

Oates, who is not overweight, is surprised at how far it has gone. "It's not just elderly but overweight people using mobility scooters," he says. He recently saw four men in early middle age with walking sticks. "I thought, when did walking sticks become fashionable?" And then he realised these were overweight people who needed sticks to be able to get around.

"We're almost on the verge of a lost generation – obese parents who aren't recognising that their children are obese. Getting parents to recognise that is quite tricky," he says.

Tamworth is not out of step with the rest of the West Midlands, which has an average adult obesity rate of 26.4%, just as Gateshead is within the general range of the north-east, where adult obesity averages 27.8%. The figures are a bit out of date, because they are based on 2006-08 data from the Health Survey for England, but that is the most up-to-date information there is. The names at the top of the league table will no doubt have changed by the time new National Obesity Observatory data is published, but it is a safe bet that there will be even more towns with more than 30% adult obesity – not fewer. This is not just Tamworth's problem – it is everybody's problem.

Tamworth's civic leaders have been doing what they can to cut obesity, including the installation of free gym equipment in the grounds of the town's castle. Photograph: David Sillitoe/The Guardian

Tamworth's civic leaders have been doing what they can – which is mostly to encourage and enable people to take up sport and become more active. The zumba dance-fitness classes the council organised took off. In the grounds of the town's Norman castle, it installed free outdoor gym equipment. There are now about 15 council-run exercise and fitness classes a week, including Nordic walking. It invested £17,000 in free swimming lessons at a local pool and subsidised the SnowDome, the first indoor ski slope with real snow.



The council has got results. In 2009 just over 9,000 adults in Tamworth were taking part in sport, but by 2011 this had risen to 11,000. With a population of 76,000, however, there is still a way to go. It is, says Rob Barnes, director of housing and health, "a really good community leisure offer" but people's thinking needs to change if more are to use it. "They have a perception that it is normal to be overweight, it is normal not to exercise and normal to smoke."

It would take something else to get the local people really moving, mused Oates. "What we're lacking in Tamworth is high-achieving sporting heroes. We haven't got a Jessica Ennis. It is a shame we haven't got a local connection with a role model."

Local people do not believe Tamworth is fatter than anywhere else. Anne Devenney, a consultant for Slimming World in Tamworth, says: "I do see people struggle with their weight, but I wouldn't say it was massively noticeable or that every person you see is obese or overweight. I can't understand that we have been labelled as the worst. There's nothing different in Tamworth. The zumba craze has gone mad in Tamworth and we have got cycle paths galore."

She says there are many reasons why people put on weight. "A lot of factors cause people to overeat. It could be depression, it could be not enough money to do exercise – slimming groups cost money and healthy food costs money. There are lots of other factors beyond overeating on fast food. There is lack of employment – it all has a knock-on effect for people nowadays. You get in the car much more easily. Everything is much more convenient. You don't necessarily walk to the shops any more. There is a big picture."

In her case, it was emotional distress. Her fourth child, Cameron, was diagnosed with a very rare blood disorder when he was 15 months old, after four months of tests. He needed a bone marrow transplant and luckily all three of his siblings were a match, but he suffered complications after the operation and eventually died.

"He was in Birmingham children's hospital for virtually six months," she says. "It became ready meals and hospital meals and never leaving the room because he was in isolation. [We parents] called it the mum's shuffle – wandering down the corridor in your slippers."

Devenney's weight went up to 103kg (16st 4lb) and she had to wear size 20 clothes. She used to order two big breakfasts at the McDonald's drive-through and eat both. "I can't face even one now. You get a little bit embarrassed because you feel disgusted that you did that.

"People don't necessarily understand how difficult it can be. Even now I can still have bad days. I'm still in danger of reaching for the chocolate. I don't think that will ever leave me."

There came a point when she knew she had to do something. She was ashamed of having to struggle up the six flights of stairs to the hospital car park. And she had her other children to think of.

"It was a good few weeks after we'd lost him. I was eating a lot and down with everything. Then it was a sudden realisation that I didn't want a tragedy for the others. I looked at myself and felt awful."

With the support she got from her Slimming World group, she ate better food, took up running and is now size 10 and weighs 67kg (10st 8lb).

Michelle Wright went to see her GP last year with pains in her feet and joints. She was 1.67 metres (5ft 6 in) tall and weighed more than 108kg (17st). "My doctor didn't even say to me I was overweight," she says. "He just started me on steroid injections. He didn't advise me to lose weight or anything."

She knew herself that she was too heavy. "At Christmas last year I was in size 22s. My Christmas present under the tree was the biggest parcel there and when I opened it, it was a coat," she says. It was huge. She did not feel good about herself.

Wright started trying to cut the calories in the food she ate on her own, but then saw adverts for Weight Watchers in the new year and joined up. "When I lost about three stones, the pain stopped in my feet," she says.

She thinks the epidemic of overweight is down to the pressures on consumers. "You only have to sit down and watch TV. There are the special offers, buy one get one free, boxes of Maltesers in the supermarket for £1. But also people are making the wrong choices. It is down to willpower as well. You choose what you put in your mouth."

Obesity rates rise with deprivation, most research shows, but there are studies that suggest the area in which you live may be more important than the amount of money you earn. So those less likely to be obese include people who do not use cars, because they cannot afford them or live in a town with a cycling culture, those who have fresh fruit and vegetable shops nearby and not just an abundance of takeaways and corner stores selling processed food, and those in places where the norm is not to be fat.

It is very complex, says Jonathan Topham, district public health lead, but searching for reasons for obesity in Tamworth, he points to lower levels of activity than average for England – three in five men and women say they are completely inactive – and low consumption of fruit and vegetables (22% eating five a day compared with 29% on average in England), which is a marker for a healthy diet.

"We do have issues around lifestyle and behaviours," he says. "We have lower levels of physical activity than you would expect. It looks like the levels of healthy eating are not as good as they should be. There is probably a correlation with obesity."

The town also has low educational attainment at GCSE – fewer than half its students get A*-C GCSE grades (including English and maths) – and there are high levels of teenage pregnancy compared with the rest of Staffordshire.

In some areas people can buy fish and chips, a meal heavy in saturated fat, for £1. Photograph: David Sillitoe for the Guardian

It is just as complex in Gateshead, where director of public health Carole Wood talks of activities and school initiatives, including encouragement to the older generation to pass on recipes and cooking skills to the younger ones.

But they are stumped for answers to one of the biggest local problems – how to stop more fish and chip shops opening. There is such a density that in some areas people can buy fish and chips for £1. It's a meal heavy in saturated fat.

"I don't think we have one fish and chip shop or hot takeaway shop that would cook in vegetable oil rather than beef dripping," she says. But it's a planning nightmare, pitching health against jobs in the local economy.

It is, as the Foresight report said in 2007, the "obesogenic environment" that is to blame, and that has to be tackled on many fronts at the same time – food, transport, activity levels, planning and, importantly, education.

Both Tamworth and Gateshead say they are doing what they can, but they can't do it alone. Tackling social and cultural issues, as well as practical matters like food labelling and advertising, requires a lead from central government.