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Tackling the Rise of Obesity

Speech given to the Fabian Society, Bournemouth

Thank you for the invitation. It is a pleasure to be here.

I want to say a little about me by way of introduction, a little bit about how our parliament functions, a little bit about scrutiny, then maybe something more substantial about Select Committees in general, the Health Select Committee in particular – and then finish off by saying something about our most recent large inquiry on Obesity.

My background is as an academic – a medical scientist, immunologist.
I have worked in three medical schools as a researcher and teacher over the last 35 years, so I am in favour of evidence-based medicine and evidence-based politics.

Before becoming an MP in 1997 I chaired Bristol City Council’s Health & Environmental Services Committee. I have been on two different Community Health Councils, and a Family Practitioner Committee, and various other health-policy related bodies.

Since 1997 I have been the Labour and Co-operative MP for Bristol NW – and I love it. If you have political interests, Parliament is the place to be – clash of ideas – major decisions – exciting events – ALL TRUE. But I hate the yah-boo stuff. Take, for example, the current Tory policy of denigrating the NHS – because, despite all the criticisms, it is manifestly improving.

I still love Westminster – but recognise that it is not perfect. One of the major ways it fails is through lack of proper scrutiny. For instance, many Bills leave the Commons (to go to the Lords) with whole clauses, sometimes bigger chunks, totally undiscussed. The Lords often provide that scrutiny function (though it pains me to say it). Pre-legislative scrutiny, introduced as part of the modernisation of House of Commons procedures, is leading to improvements in some instances.

Departmental select committees also contribute to scrutiny, as well as exercising the right to initiate inquiries of their own. Probably the best known are Transport, Foreign Affairs and Health. All to some extent hold ministers to account – but they could do much better with more resources. The Government must reply to select committee reports and their recommendations.

The Health Select Committee has 7 Labour members, 2 Conservatives, I Liberal Democrat and Richard Taylor, the independent MP for Wyre Forest.

Last year we carried out 9 inquiries and issued 9 reports. Best known probably are those on Foundation Trusts, the new regulations on Pharmacy, and the Sexual Health one [EXPAND]. It is particularly strange that there are no complaints from patients about sexual health services.

Perhaps it is time to turn to the Health Select Committee’s most recent report published just over a month ago – on obesity. In the weeks since it was published it has been causing quite a stir.

I am not surprised by the effect the report has had – certainly the biggest initial impact of any Select Committee report since I became a Member of Parliament.

I am not surprised, because I think – although it may not be the weightiest tome on the subject – it is almost certainly the most comprehensive, in that it deals with:

1. a clear statement of the problem
2. its causes – both those due to poor nutrition and due to lack of physical activity, and
3. what can be done about it, which involves the different roles of government, the food industry, and individuals. And what needs to be done about it involves facing up to a number of powerful vested interests.

We took evidence from a large number of specialists and health-related bodies, as well as visiting the USA, Finland and Denmark to take evidence and to see what we could learn that might usefully be applied here. Incidentally, the usual assumption about the USA - that obesity is a far bigger problem there than it is here – is true. But it is also true that we are catching up, and that there have been some successes in the USA in limiting and even reversing the trend – for example, the excellent Public Health programme called “Colorado on the Move”.

And in Denmark and Finland we learned useful lessons about town planning for healthier living, that diet changes affecting the whole population are possible, and the importance of food labelling. We also consulted the EU Commissioner for Health and Consumer Protection in Brussels.

After more than a year of taking evidence, reading submissions, seminars with a distinguished panel of advisers, and arguments and discussions amongst ourselves, we finally produced the report. It contains 69 recommendations – some of them very simple and some quite complicated.

I obviously cannot deal with all 69 of our recommendations in the time available - I shall list later what one of our advisers, Geoff Rayner, called the top ten. Meanwhile I want to say a little more about the background to the problem. Clearly it is about food and healthy eating, but it is also about exercise and physical activity. Much of the controversy in this area comes from different views about where the balance between these two should be.

Just to illustrate where much of the problem comes from, have a look at an average child’s lunch box, which he or she takes to school. More often than not it will contain a bag of crisps, a large chocolate bar and a can of fizzy drink or orangeade. There couldn’t be a more graphic illustration of the problem – too much sugar, too much fat, too much salt and too many energy-dense calories.

And of course obesity is not just about calories in, it’s about calories out as well. Physical activity and exercise play a part too – increasingly important in today’s sedentary world. But it is important to note that it doesn’t have to be 30 violent minutes in the gym!

Obesity rates in adults already exceed 22 percent and another 45 per cent are overweight. Obesity brings with it markedly increased risks of a whole range of conditions, including high blood pressure, raised cholesterol, heart disease, type 2 diabetes and mental illness. After smoking, obesity is recognised as the biggest preventable cause of cancers, including breast, colon, and bladder cancer, and is already the cause of more chronic ill health in this country than smoking. The number of diabetics already tops 1.5 million, but is predicted to increase to three million within a decade, because of the obesity epidemic. Those dying of obesity-related disease will on average die nine years too early. Today’s overweight children are tomorrow’s obese adults and are already showing signs of developing diseases previously thought of as occurring only in middle age, causing some to claim that we are, for the first time in history, about to see children being outlived by their parents as a frequent occurrence.

The potential impact on the health service of this trend is huge. The National Audit Office estimates that obesity costs the NHS roughly £500 - £750 million a year, and the wider economy roughly £3.3 to £3.7 billion a year. Taking obesity and overweight together, the annual cost is about £7 billion. Those are almost certainly conservative figures and growing fast.

So we have to ask the question – why are so many children eating too much of the wrong things?

There is no simple answer – but one part of the jigsaw must be the way that food is promoted and advertised to adults and children. Children are bombarded with messages encouraging them to eat foods that are high in fat, sugar and salt. The Food Standards Agency commissioned research which showed that such advertising does indeed affect what children eat: not just brand loyalty, but different kinds of food as well.

It is very hard to quantify exactly such effects, but they are backed up by advertising to parents who are often subjected to similar influences. And, to me at least, it is quite obvious that firms would not be spending very large sums of money promoting their products if advertising didn’t work!

One big change over the last 20 years is the move to eating much more food that has been prepared for us by others. In the USA, 40 percent of all meals are eaten in a restaurant, or as a take-away. And the UK figures cannot be far behind. It is interesting that surveys suggest significant numbers of younger people do not know how to cook meals from fresh ingredients – despite the great popularity of TV cooking and celebrity chef programmes.

Eating snacks, fast foods, prepared meals and dining-out mean it is harder to control the balance of what we eat.

If we look at salt, for instance, we can see this very clearly. On average, we eat 9.5 gms per day, but there is expert evidence to suggest we should aim for no more than 6 gms per day (correspondingly less for children). If we could reach this target – it would reduce markedly the incidence of heart disease and stroke.

But cutting down on salt is not so easy, because about 75 percent of most people’s daily salt intake comes from foods and meals prepared by others – and some of them contain astronomical amounts of salt.

Because of all this the Government (through the Department of Health) is asking the food industry to lower the salt content of its products voluntarily. And there have been some good signs, for instance with reductions in bread and soups. But there is a long way to go. The food industry, in giving evidence to our committee during the obesity inquiry, constantly argued that - whether they were part of the problem or not - they certainly wanted to work with the Government to provide a solution. They also argued that there is no such thing as unhealthy food – only unhealthy diets – manifest nonsense in my book. As I said there is a long way to go.

Maybe I should list what has been called the Health Committee’s ‘top 10 tips’ for effective obesity prevention:

1. It needs an integrated, government-wide and long-term strategy, requiring its own cabinet committee and the setting up of a council of nutrition and physical activity to improve co-ordination and inject independent thinking into the strategy.
2. A new health promotion campaign – as strong as that for tobacco and with proper funding – should identify high-risk food and drinks, including alcohol.
3. The government should introduce a ‘traffic lights’ system for labelling foods, based on energy density.
4. Supermarkets must introduce pricing strategies that support healthy eating, phasing out price promotions which favour unhealthy foods and halting all product placement.
5. DfES should introduce strong guidance for schools on unhealthy foods, including vending machines, and should adopt ‘nutrition based’ standards for school meals.
6. Children in school should be engaged in three hours of physical activity each week and be subject to Ofsted inspection.
7. The Department of Health should have a strategic input to transport policy and promotion of physical activity should be made a requirement of major planning and transport projects.
8. PCTs should become more active in preventing obesity and should be given the capacity to do so.
9. Treatment services must be properly funded and strongly prevention-orientated, with a new Obesity National Service Framework.

And then we come to number 10:

10. Voluntary prevention initiatives by industry should be given three years to run. If they fail, direct regulation may be needed.

This point reflects the very last paragraph in the main body of our report (on page 121). It says: “We recommend that the Government should allow three years to establish those areas where voluntary regulation and co-operation between the food industry and government have worked and those where they have failed. It should then either extend the voluntary controls or introduce direct regulation”.

I suspect it is this recommendation which has given rise to the usual fears of the “Nanny State” and headlines in newspapers such as “Nanny can’t wait to slap our chubby wrists”, “Big fat lies on obesity (that) we swallow whole”, “Choking on the facts” and “Eat crisps and read The Sun: two easy steps to becoming a menace to society”.

Headlines (and articles) like these do a disservice to both our report and to the readers of their newspapers. I think the journalists who wrote them are basing their stories on tabloid accounts and not on our report at all. It is part, I think, of a deliberate political strategy – almost certainly involving elements of the food industry - to try to discredit the report.
Already the British Retail Consortium is saying that a traffic-light labelling system will be counter-productive. The strategy is to bring pressure to bear on the Government to convince them that any action to legislate for safer food is bound to be politically unpopular, and unnecessary anyway. A certain amount of unpopularity on this count is inevitable, but it can be grossly exaggerated.

In any case, we shouldn’t be afraid of what would be contemporary public health measures: public health measures such as the Victorians introduced (no doubt supported by the early Fabians) to ensure that clean drinking water was made available, and the clean air legislation to get rid of smog in London and other cities – which as recently as 1952 killed 4,000 people in London. Each of these measures was resisted by vested interests at the time – and is now widely accepted and uncontroversial. As, too, are more recent examples such as seat belts, drink-driving legislation and motor-cycle helmets. And there is increasing evidence that limiting smoking in public places would be popular with around 80% of the population.

So my message to the Government, and to John Reid as he contemplates this autumn’s Public Health White Paper, is to be brave, and remember the huge benefits that Public Health has achieved in the past.