Around two-thirds of the population of England are overweight or obese. Obesity has grown by almost 400% in the last 25 years and on present trends will soon surpass smoking as the greatest cause of premature loss of life. It will entail levels of sickness that will put enormous strains on the health service. On some predictions, today's generation of children will be the first for over a century for whom life-expectancy falls.
Obesity is associated with many health problems including coronary heart disease, diabetes, kidney failure, osteoarthritis, back pain and psychological damage. The strong association between obesity and cancer has only recently come to light.
We estimate the economic costs of obesity conservatively at £3.3-3.7 billion per year and of obesity plus overweight at £6.6-7.4 billion.
Determining the causes of obesity is central to tackling it. The exact extent of the relative responsibility of diet and activity remains unclear and it is crucial that both sides of the 'energy equation' are addressed.
At its simplest level, obesity is caused when people overeat in relation to their energy needs. At the same time as energy expenditure has dropped considerably, environmental factors have combined to make it increasingly easy for people to consume more calories than they need. Energy-dense foods, which are highly calorific without being correspondingly filling, are becoming increasingly available. And while our evidence suggested that people are, generally speaking, aware of what constitutes a healthy diet, there are multiple barriers to their putting this into practice. In the absence of practical cookery lessons, children and young people are growing up without the skills to prepare healthy meals, compounding reliance on convenience foods, which are often high in energy density; healthy-eating messages are drowned out by the large proportion of advertising given over to highly energy-dense foods; other types of food promotion, as well as pricing also make buying unhealthy food more attractive and economical than healthy alternatives; and food labelling, a key tool to help consumers choose healthy foods, is frequently either confusing or absent.
Turning to the role of physical inactivity, only just over a third of men and around a quarter of women achieve the Department of Health's target of 30 minutes of physical activity 5 times a week. Levels of walking and cycling have fallen drastically in recent decades, while the number of cars has doubled in 30 years. Children are also increasingly sedentary both in and out of school. A fifth of boys and girls undertake less than 30 minutes activity a day. Television viewing has doubled since the 1960s, while physical activity is being squeezed out of daily life by the relentless march of automation.
Solutions to the problem of obesity need to be multifaceted, recognising the true complexity of the issue, must address environmental as well as individual factors, and should be designed to bring about long-term, sustainable change, rather than promising overnight results. Obesity is also an issue which demands truly joined-up policy-making, and to ensure this we have recommended the appointment of a specific public health Cabinet committee, chaired by the Secretary of State for Health, to oversee the development of Public Service Agreement targets relating to obesity across all relevant government departments.
It is vital to ensure that the public are fully aware of the dangers of obesity and the importance of healthy eating, and that they also have the practical skills and information they need to implement these messages in their daily lives. To this end we have recommended a sustained public education campaign, improved practical food education for children and young people and, crucially, legislation to promote a simple food classification and labelling system which makes choosing healthy foods easy.
The promotional efforts of the food industry are frequently directed towards children. While we recognise that it is entirely appropriate for parents to retain control over their children's diet, we were shocked to find evidence that in its campaign for Walkers Wotsits, Abbot Mead Vickers advertising agency deliberately aimed to undermine parental control by exploiting 'pester power', despite this practice contravening the Advertising Standards Authority code of practice. We have recommended tighter controls on the advertising and promotion of foods to children, though we favour a voluntary approach in the first instance. We have also recommended that children's nutrition in school be improved, both through a move away from the promotion of high-energy density foods within schools, and through the introduction of better standards for school meals.
The Government has recently undertaken work with industry to reduce salt levels in foods, and we have recommended that work should be undertaken to reduce overall energy-density levels. We have also recommended that industry should undertake healthy pricing schemes, to make healthy foods a realistic choice for consumers who are buying food on a budget. Underpinning this, we believe that agricultural policies should also be reformed to take account of the public health agenda
Solutions to the problems of physical activity will demand a cohesive approach across many Government departments. We commend the funding and commitment now being devoted to organised recreation both in schools and in wider society though we note that fewer than half of school children are meeting the target of 2 hours of physical activity per week. This target itself we regard as inadequate and recommend instead a target of 3 hours physical activity a week for children. In order to involve those children traditionally 'turned off' sport we recommend that imaginative ways are found to broaden the physical activity agenda to include areas such as dance or aerobics. We also recommend that schools have in place effective strategies to counter bullying and elitism. Given the proven link between physical and academic achievement we recommend that Ofsted incorporates physical activity criteria in its school inspections.
Probably more important than organised recreation is the role of physical activity incorporated into the fabric of everyday life. We describe as scandalous the failure over 10 years of the Department for Transport to produce its promised walking strategy, and recommend that this is now included in a broader anti-obesity strategy. We also call on the Department of Health to have a strategic input into transport policy. We note the superior conditions for cyclists in other European countries, and whilst not offering detailed prescriptions for boosting cycling and walking levels, commend the Danish town planning we witnessed, notably in respect of proper segregation of cyclists and other road users. A key recommendation we make is for a health impact assessment to be made on major planning proposals which takes due account of the physical activity aspects.
We note the absence of evidence from business to our inquiry and call on the Government to generate awareness of obesity in the business community and on the Treasury to consider fiscal incentives to make the workplace more active.
While environmental solutions are clearly key to tackling obesity at a population level, we also feel that the NHS has an important role to play, both in the prevention and treatment of obesity, but our evidence suggests that this has not been as high a priority for PCTs as it should have been. We have heard of GPs being asked to limit the prescription of NICE-approved obesity drugs, of specialist obesity services with closed waiting lists, and of pioneering local projects threatened with closure due to lack of funding. To address this, we have recommended the establishment of a strategic framework for preventing and treating obesity within the NHS, drawing on existing National Service Frameworks. This should be underpinned by stringent public health targets, and must include the expansion of services to treat obese patients within both primary and secondary care. A full range of treatment options should be open to obese patients, including behavioural or lifestyles approaches, counselling, drug therapy, and, as a last resort, surgery. In particular, children must have access to appropriate services, and should be screened for overweight and obesity annually within a school setting.
In conclusion we note that it is difficult to establish the impact of any individual measure to combat so complex and challenging an issue as obesity; this is not, in our view, an excuse to delay and measures must be taken to tackle the nation's diet and its levels of activity. We acknowledge the responsibility of the individual in respect of his or her own health but believe that the Government must resist inaction caused by political anxiety over accusations of "nanny statism". Government will, after all, have to pay for some of the huge costs that will accrue if the epidemic of obesity goes unchecked. While we have tried wherever possible to take the food industry at its word, and seen it as 'part of the solution', we recommend that the Government reviews the situation in three years and then decides if more direct regulation is required.