Supplementary memorandum submitted by
the NHS Executive (PAC 00-01/168)
Stopping smoking is often associated with a
weight gain of between 5-10 lbs. The reasons for this are complex
but nicotine appears to suppress appetite and the cigarette may
in some way provide oral gratification which, on quitting, is
replaced by food. The weight gain may be offset whilst nicotine
replacement therapies are used, and is delayed and reduced but
not prevented completely, by the use of the new anti-depressant
smoking cessation aid Zyban.
Smoking cessationcoping with weight gain
Concerns about weight gain are given, particularly
by weight conscious young women, as a reason not to stop smoking.
Supportive counselling of prospective quitters should cover the
relative health risks of the small weight gain compared with the
risks of continuing smoking, which are far greater. It would also
be pointed out that, once the addiction to nicotine has been overcome,
increased physical activity and healthy eating will assist in
re-establishing the previous weight.
Smoking and stress
There is a myth that smoking relieves stress.
Smoking relieves the stress created by reducing blood levels of
nicotine, the psychoactive drug in tobacco on which smokers depend.
The report of the Royal College of Physicians "Nicotine Addiction
in Britain" published in February 2000, concluded:
"Objective evidence suggests that the only
improvements in mood resulting from smoking are those arising
from the relief of withdrawal symptoms", and "The major
psychological motivation to smoke is the avoidance of negative
mood states caused by withdrawal of nicotine."
Smoking cessationreasons for failure
Smokers trying to quit have a high relapse rate.
The background un-assisted quite rate is in the order of 1.5 to
2 per cent a year. Amongst reasons for failure of a quit attempt
a smoker may mention concern over weight gain. However, the major
underlying cause of failure is more likely to relate to the difficulty
experienced in overcoming a physical and psychological addiction,
lack of preparation, lack or inappropriate use of smoking cessation
support and therapies and socio-cultural influences.
The Department of Health is currently conducting
a series of pilot schemes across England. The aim is to identify
the most effective way to implement the scheme with minimum disruption
and burden to schools. Key organisational issues are:
Farm to school gategetting
the fruit to the schools;
School gate to child's handdistributing
the fruit within the school; and
Child's hand to mouthencouraging
children to eat the fruit.
Autumn 2000 Pilots
Parliamentary Under Secretary of State for Public
Health, Ms Yvette Cooper, launched the first pilots on 16 November
2000. These covered 33 schools in three areasLeicester,
Hackney, and Lambeth, Southwark & Lewisham. The evaluation
is concentrating on the "gate to hand" issues.
Spring 2001 Pilots
Secretary of State, Rt Hon Alan Milburn, launched
the second wave of pilots on 26 February 2001 at a school in Peckham,
extending the scheme to 510 schools and over 80,000 children in
25 areas across England. These pilots focus on the "farm
to gate" issues, with each area piloting one of four purchasing
and distribution models. The models developed in discussion with
representatives from Fresh Produce Consortium, National Farmers
Union and school caterers are:
Health Authority purchasing using
DH Approved Supplier;
Health Authority purchasing selecting
own supplier; and
School caterers purchasing.
The next stage of piloting, which will take
place during the next academic year, will focus on the "hand
to mouth" issues.
The results of the evaluation of the current
pilot schemes will be available in early summer, and will be disseminated
widely. Early results have indicated that the scheme is being
extremely well received by schools.
Department of Health spending on health promotion
publicity in 2000/01 was as follows:
Drugs£1.2 million of
which £480 thousand was for a national radio advertising
campaign to publicise the National Drugs Helpline;
Sexual Health£430 thousand
of which £250 thousand was for a national TV advertising
campaign on safe sex to reduce the risk of infection of Chlamydia.
Diet and physical activity are both key factors
in obesity and therefore it is difficult to look at diet in isolation.
Diet and physical activity are in turn influenced by several other
factors eg socio-economic status, cultural, age and sex.
Obesity develops when there is a continued imbalance
between energy intake and expenditure. However, the National Diet
and Nutrition Survey for British Adults (1990) found no significant
regional differences (within England) for either sex in total
energy intake or percentage energy from fat. It is therefore unlikely
that the regional differences that exist in obesity, is related
to energy intakes.
When food consumption is looked at, the most
striking difference is that of consumption of fruit and vegetables.
For example, in the North East region, average total fruit consumption
is 827 grams per person per week, whilst in the South East, the
average is 1252 grams. Consumption of vegetables is also lower
in the North than in the South. (National Food Survey 1999). A
number of factors can create regional difference in fruit and
vegetable consumptioneg access to shops, availability of
produce, price, awareness about the health benefits, cooking skills,
local preferences and taste preferences. The five-a day pilot
projects are looking at the feasibility of increasing consumption
of fruit and vegetables by a number of interventions. The evaluation
from these projects will be available at the end of the year 2001.
Cross-sectional, population surveys (such as
the Health Survey for England and the National Diet and Nutrition
Surveys) have shown relations between the prevalence of obesity
and factors such as social class, income, smoking, activity level
and alcohol intake. However, the surveys have not investigated
the influence of these factors on regional differences in the
prevalence of obesity.
Longitudinal studies assessing the development
of adiposity from childhood to adulthood have been carried out
in the UK. However, these have not addressed regional differences
in the prevalence of obesity. The longitudinal studies (such as
the 1958 British birth cohort) have shown that it is not entirely
clear why some individuals become obese and others do notie
what factors cause obesity in individuals.
In conclusion, the relative role of diet and
activity on recent obesity trends per se remains unclear,
let alone their impact on geographical and regional differences.
13 June 2001