Examination of Witnesses (Questions 20
- 39)
MONDAY 23 APRIL 2001
MR NIGEL
CRISP, MR
ROBIN YOUNG,
SIR MICHAEL
BICHARD, KCB, MR
WILLIAM RICKETT
AND MR
GEOFFREY PODGER
20. Last June I did a publicity stunt here and
was told by the nurse to see my doctor immediately because I had
a high cholesterol. I went to the doctor who told me I had very
high cholesterol and that I would have to lose weight. I lost
one and a half stone. If I had not lost that one and a half stone
this dial would have made me obese. I am not obese. Am I obese?
(Sir Michael Bichard) There are some questions we
surely do not have to answer.
21. What I am trying to say is that I suspect
the so-called categories of people who are overweight and obese
are not really as bad as we are making them out to be. I was advised
to change my diet and I took the advice of the doctor. I changed
my diet, lost one and a half stone and frankly found no difficulty
in doing that. What annoys me about it all is that there is so
much going on. For example, there are five of you here this afternoon,
all on huge salaries, when it would be far better if you were
back where you are supposed to be doing your individual departmental
jobs. Here you are this afternoon, giving evidence to us on the
basis of trying to get people to lose weight and do some exercise.
Sometimes we do go over the top a little bit. Let us move on to
Part 3 of the report which is probably the most important part
of the report in my view, from paragraph 3.15 onwards. I was advised
by my doctor what to do, but should this not be the automatic
function of every general practitioner? We are told they only
have five minutes now to see a patient but in that five minutes
should they not be telling people in their surgeries that they
are overweight and perhaps the best thing to do is diet to lose
weight and do some physical exercise? Should that not be the role
of the doctor?
(Mr Crisp) The evidence presented here suggests that
that is precisely what very many general practices do do.
22. The evidence clearly shows that a lot of
them do not; something like 60 per cent actually do not.
(Mr Crisp) I take that point. You were maybe more
fortunate in that you were able to lose weight relatively easily
by the sound of it.
23. It is not very easy, it is hard, but you
have to change your diet and change your lifestyle, do you not?
(Mr Crisp) Yes, but there are some methods of persuading
people to do that which are perhaps more effective than others.
If we are interested in making sure that we do reduce the burden
on the NHS for obesity, we need to make sure that we are giving
high quality advice and that it is advice which is followed.
24. That is the point. Given the statistics
in the report, only 40 per cent of GPs actually identified those
patients at risk of being fat, two per cent did not even bother
to do anything, so they saw a big, fat, obese person coming into
their medical centre and they did not even comment on it, they
just let them walk out. Seventy-five per cent thought they could
not do anything about it and referred it to somebody else. That
seems to me to be passing the buck and just not doing their jobs
properly.
(Mr Crisp) The new arrangements under the National
Health Service Framework do require each health authority to have
plans for tackling overweight and obesity issues and those will
be primarily managed, in Health Service terms, through primary
care. We have the plans coming in now; they were due to be in
place at the beginning of April and that will no doubt require
more and more GPs to be doing things in a routine way as you have
described.
25. It is not difficult, is it, when you see
somebody come into the surgery who is overweight to tell them
they should lose weight and how to do it? I can do that. I was
going to be a doctor, but I did not have the patience.
(Mr Crisp) I am sure identifying the problem is not
the issue. The issue is how you deal with it. It describes pretty
well in this report the fact that GPs say they could do with some
guidance here. GPs are telling people to change their lifestyle.
In the case of a strong-willed person like yourself, maybe you
have been able to do it, but that has not always applied.
26. For a doctor to say he needs some guidance
on how to do it leaves me a bit astounded. The section clearly
shows me that GPs are failing to do this. Are you saying this
afternoon that health authorities are going to be instructed to
inform GP practitioners and family care groups that they must
take this much more seriously and they must give advice to their
patients? Or are you just going to leave it to the doctors?
(Mr Crisp) In effect that has already happened because
health authorities have been charged with providing plans and
those plans will primarily be around GPs, but not entirely, because
they also link in with the departments represented by other colleagues
here because the other side of this is more activity and more
opportunities for activity and so on. We do now have a process
which will involve all primary care trusts, all primary care groups
and therefore through them all GPs, in a process of tackling these
issues. It needs to be done professionally and well.
27. The most important thing is to target children,
is it not? It seems to me that to target adults and parents does
not really work. There are those adults who are sensible enough
to do what they are told but the vast majority say that they do
not. Basically what you have to do is target children.
(Mr Crisp) It is a twin-track approach but that is
a very significant part of it.
28. Recently we saw in the newspapers and on
the news the most ridiculous case—perhaps you do not want
to comment on it—where a head teacher sent a note home to
a child's parents because the little girl was obese and the parents
were immediately up in arms, called the press and said it was
a violation of human rights and all this rubbish. How do you change
people's views and lifestyles who have attitudes like that?
(Sir Michael Bichard) One of the things you do is
to encourage head teachers to have the courage to do that if they
really feel there is a problem. I feel that head teachers should
do that.
29. You feel they should step in.
(Sir Michael Bichard) Absolutely; yes. It is something
which has to be done sensitively and carefully, but it does need
to be done in certain situations. The head teacher or teacher
does have a pastoral responsibility towards the children in their
care and if they become so concerned about a child that they believe
it is affecting their quality of life or their ability to be educated,
then they should quietly and sensibly mention it to the parent.
30. We really have to educate children so when
their parents say they are going to take them for a treat to McDonald's
the child is intelligent enough to say it is not a treat to be
taken there and in fact it is somewhere which could eventually
kill them if they have enough over the years. What is the Food
Standards Agency doing about this when it is clearly bad for health
to go to these fast food places?
(Mr Podger) We should be careful about saying that
it is always bad for health to go to fast food places.
31. It is.
(Mr Podger) No, with respect, it is not good for your
health to continually eat in fast food places and there is a distinction
which is very important for this debate. Individual food is not
actually harmful, it is the balance of the diet you have, both
in childhood and later, which matters. You are absolutely right
though, and I agree with you, that one of the issues the Agency
is very carefully looking at, which is very relevant to what you
just said, is the issue of advertising aimed at children in relation
to food and whether in fact that conveys a proper picture of the
results derived from eating that food or not. It is worth making
the point that 99 per cent of advertising aimed at children on
Saturday morning, which is obviously a peak TV viewing time, appears
to relate to foods which are high in fat, in sugar and in salt.
That indicates there is a problem there and it is partly about
feeding into the education programme where steps are being taken.
It is partly undoubtedly about educating parents and it is also
about trying to persuade the food industry, which we are also
seeking to do, to adopt slightly more responsible approaches.
32. That was the question I was going to ask
next. What action are you taking against these food manufacturers
who do supply this sort of food? How are you encouraging other
food manufacturers to provide food which is healthy, less fat,
less salt, less starch, whatever it is? Are you doing things to
encourage that?
(Mr Podger) We are. The first point I would make,
which if I may say so is relevant to your previous question, is
that we should not underestimate the extent to which people actually
want to change their diet. With respect, I do not think they have
all been as successful as you have been, but you only have to
look at the extent to which people engage in particular diets,
buy supplements and so on, to show the extent to which people
would like to change. What follows from that very clearly is that
we need to persuade the food industry—and we have been doing
this—that there are real market opportunities and real public
demand for products which are reformulated so they do not have
the adverse effects you are pointing to. There is some evidence
for example in Scandinavia that you can change products from being
high in saturated fats to low in saturated fats whilst actually
retaining their appeal to consumers. We do have discussions which
we have initiated with the industry on salt and fat and sugar
precisely with a view to trying to persuade the industry to make
further changes.
33. Why does the DfEE not also take some sort
of tough measures? Why do you not, for example, ban companies
or organisations which get into our schools to sponsor things
such a Walker's crisps and these sorts of people? Why are they
not banned? Why for example do you give local authorities and
schools the choice and not suggest what sort of foods they provide?
Why do you not say they cannot serve this in school meals, they
have to serve so and so and so and so which are healthy foods?
(Sir Michael Bichard) One thing we need to remember
is that there are very few bad foods: it is a bad diet we are
concerned about, it is the balance of the diet. Therefore we should
be reluctant to ban, in those terms, a particular food, crisps
or whatever. What we are trying to do is educate children on the
choices which are available and the implications of having a badly
balanced diet on their health. We are trying to educate parents
at a much earlier stage, through things like the Sure Start programme,
to understand the importance of these choices and we are trying
to ensure that in the schools there are nutritional standards
which are applied. On 1 April we just introduced nutritional standards
for the very first time in 20 years in this country, minimum standards
which we expect to see applied in schools and which we will randomly
monitor. We are doing quite a lot to educate people but not banning
particular foods.
Mr Burns
34. Sir Michael, may I just pick up an area
slightly at a slant to what Mr Steinberg was just raising and
draw your attention to an earlier answer you gave where you said
that head teachers rightly have a responsibility, if they are
concerned about a child being obese and their performance and
health being affected at school, to draw it to the attention of
parents. I suspect no-one would disagree with that view. Is there
not a slight conflict of interest in that more and more schools
in this country are gaining sponsorship and other benefits from
crisp manufacturers and soft drinks vendors installing vending
machines in schools? Is that not a conflict?
(Sir Michael Bichard) The decision as to what sponsorship
schools accept is a matter for schools. Guidance has been produced
by the National Consumer Council which is now being updated by
the NCC and the Consumers' Association with our help. One of the
things that asks schools to reflect upon before they accept any
sponsorship or allow the sale of products in their school is whether
or not the governors are happy for those things to be consumed,
whether they are happy for the product to be consumed. At the
end of the day it is a matter for schools.
35. It is certainly a matter for schools if
you are talking about the narrow legal definition, of course it
is. However, is the principle not contradictory if one is encouraging
on the one hand products to be readily available in schools in
return for sponsorship in whatever shape or form that conceivably
have an adverse health effect and encourage obesity amongst children
consuming the product?
(Sir Michael Bichard) I go back to the point Mr Podger
was making and I was underlining: if all you ever eat are crisps
then you would have a problem, but crisps are not by definition
a bad food. What we should be targeting are bad diets and we should
be educating people to understand the importance of a good diet.
That is what we are trying to do. It is for individual governors,
individual schools, to take a view on whether they are doing that
effectively and whether or not they are content for particular
products to be sold in the school to their children or content
to accept particular forms of sponsorship. People would be pretty
concerned if we were to dictate from the centre on an issue like
that to every school in the country.
36. I do not know whether you have had an opportunity
to see the Health Select Committee report recently published on
public health which in some way overlaps this report because it
deals with sport and the role that sport has to play in enhancing
the health of the nation both amongst children at school and also
adults. Is there not a slight anomaly that the Government involvement
in sport and encouraging sport is placed in the Department for
Culture, Media and Sport and not in the Department of Health?
Surely if you see a key role of sport as to enhance a healthy
lifestyle, then surely the Department of Health is the better
Department to sponsor and spearhead that than the DCMS?
(Mr Crisp) An enormous amount of cross-governmental
work is going on around sport. We are engaged with the Department
for Culture, Media and Sport on a whole set of issues to do with
sport, dealing with sport strategy, the Government plans for sport,
so we are working across anyway and you always end up with boundaries
somewhere.
37. Have you read that report?
(Mr Crisp) Yes, I have looked at it.
38. And the section on sport?
(Mr Crisp) Yes, I have read it.
39. We were a bit surprised by the evidence
from the Minister for Sport who seemed to suggest that she did
not have much liaison with the Department of Health.
(Mr Crisp) There is a considerable number of areas
where we do work very closely together and instances are given
in this report as to where we do that. I am not sure that the
placing of where the particular departmental responsibility lies
particularly affects that.
(Mr Young) On the issue of which Department is responsible,
sport in this country has moved around between ministries. Some
years ago it was in the Department of the Environment, it moved
at the end of the last Government[1]
to the Department for Education and then to the Department of
National Heritage as it then was and is now DCMS. Just as a matter
of interest I have checked, having seen the Health Committee's
report, with the other EU countries. Only two of them, the Netherlands
and Belgium, have accommodated sport within their Health Ministry.
1 Note by Witness: The move happened in 1990,
not at the end of the last Parliament. Back
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