Select Committee on Public Accounts Minutes of Evidence


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 cessation—coping 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 cessation—reasons 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 gate—getting the fruit to the schools;

    —  School gate to child's hand—distributing the fruit within the school; and

    —  Child's hand to mouth—encouraging 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 areas—Leicester, 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:

    —  National purchasing;

    —  Health Authority purchasing using DH Approved Supplier;

    —  Health Authority purchasing selecting own supplier; and

    —  School caterers purchasing.

Further Pilots

  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:

    —  Alcohol—£75 thousand;

    —  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 consumption—eg 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 not—ie 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.

NHS Executive

13 June 2001

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