Select Committee on Health Third Report

4 Conclusion

397. Often the purpose of a select committee inquiry goes beyond the simple 'tick box' approach of making recommendations to Government and seeing how many are accepted. We believe that the very fact of our holding this inquiry has contributed (alongside many other important reports and studies) to the huge publicity that the subject of obesity has prompted over the last year or two, and has helped to raise its profile. The Daily Telegraph offered 177 articles on obesity in the year leading up to our inquiry and 337 in the year of our inquiry.

398. One of our witnesses argued that it might be helpful if more stigma attached to obesity so that people made more effort to lose excess weight.[388] We totally disagree with this suggestion. Nevertheless, we have observed an odd tension in society. The world of popular culture, teenage magazines, film, music and sport is usually dominated by fit and slim people. It is generally accepted that these are role models and that people aspire to emulate them. Yet the average person is remorselessly getting heavier and moving further and further away from the ideal. It is as if the pressure to conform to the stereotype, and failing, is pushing people in the opposite direction.

399. We have posited a wide range of measures in our report which attempt to address the issue of obesity. As many witnesses who appeared before us acknowledged, no single measure is likely to reverse the tide of obesity; a wide range of different measures is more likely to have an impact.

400. The rapid rise in obesity is now leading to a proliferation of meetings, conferences and pronouncements on this subject. This is in part extremely welcome in that it raises the awareness of the public, health professionals and policy makers in respect of a vitally important subject. However there is a danger that this could lead to policy overload, as different emphases are given—now on exercise, now on diet. There is a danger that this issue is characterised only within a polemical debate, stressing only the role of a 'devious food industry' on the one hand or the evils of the motor car or gameboy on the other. The evidence we heard suggests both 'energy in' and 'energy out' must be addressed, and indeed, part of the policy confusion is that there is inadequate liaison of policy response between the two 'sectors' of the obesity business. This can easily be exploited by vested interests resistant to change.

401. Many of the measures we recommend relating to physical activity would take years to implement, notably our call for a fundamental cultural change in urban planning to facilitate active travel and active workplaces. It would take even longer to measure the impact of these measures. Nevertheless, we believe it is vital that Government takes seriously its responsibilities to help people become more active.

402. We have commended the commitment and funding now being devoted to organised sport and physical activity in schools. Many of our other proposals would involve substantial public expenditure, but the dire threat to public finances as well as public health if the obesity epidemic progresses unchecked persuades us that this expenditure is justifiable.

403. It would be very difficult to disaggregate the possible impact of any of the recommendations we make. We have argued for a coherent package of measures, addressing both sides of the energy equation. We believe they would have more chance of being effective if implemented in full rather than in a piecemeal fashion. However, it is clearly important that some steps are taken to monitor the effectiveness, and the cost-effectiveness of what we propose, in line with the recommendations of the Wanless report on public health. The National Audit Office undertook an influential and ground-breaking report on obesity in 2001. We know that they have maintained an interest in the subject thereafter. So we would like the National Audit Office to conduct further work on the value for money implications of measures taken to combat obesity, since this will be one of the greatest pressures on NHS resources over the coming decades. In calling for this, we also note the point made in the Scrutiny Unit analysis annexed to our report that there is a "severe lack" of official estimates of the costs of diseases relating to obesity. We recommend that the Department undertakes urgent work to establish better estimates of the cost of treating diseases to allow it to manage its resources more effectively.

404. We believe it is important to offer some perspective on the likely effectiveness of some of the short-term measures we propose in relation to food. One tool for doing this is provided by a substantial piece of research conducted by the investment bank J P Morgan. In a report published in April 2003, the bank investigated the possible impact of the growth of obesity on the food industry.[389] They looked from the perspective of the investor at the possible risks to the volumes of the food industry of greater regulation. Their findings are summarised in the table below:Table 7: J P Morgan analysis of the impact of regulation on the food industry
Possible action Likely impact on the food industry
Total ban on advertising of food and beverages to children on TV "We think volumes would suffer. This is because not only are children significant consumers of the segment themselves, through 'pester power' they also drive broader retailing of the category … manufacturers would be faced with the double challenge of shifting the portfolio to healthier products while also finding alternative and innovative ways of selling these to children."
Labels having to have better nutritional information "The US experience proves that labels containing more information about nutrition do not necessarily encourage people to adopt lower-calorie diets or reduce consumption."

"We feel that nutritional labels on European food products may not change consumption patterns."

Targeting of super-size products "These products carry a higher margin than regular products … were these products to become the target of regulators we believe it would have negative implications for volume growth."
Provision of warning labels for high-energy bars containing more than 500 calories eg Cadbury's Boost "We believe warning labels may eventually be imposed with a negative effect for the category."
Ban/Tax on Unhealthy Products "Moderate taxes may not necessarily lead to a decline in obesity rate but will probably help government to finance the costs of informing consumers and treating patients."

405. This analysis is restricted to the impact of possible regulation of the food industry, particularly that targeting so-called junk food manufacturers. It is interesting to note that labelling, which relies on giving consumers more of an informed choice, is seen as likely to have relatively little effect on volumes. Conversely, more draconian measures aimed at reducing the choices available, are seen as more likely to be effective.

406. This raises a question very much at the heart of the debate, and one that we explored throughout our inquiry: how much is obesity the responsibility of the individual making life-style choices; and how much is it the responsibility of Government? This is not simply a philosophical question. It has political ramifications. One reason it is very difficult for governments to intervene is that they risk criticism for operating a 'nanny-state', interfering in the lives of their citizens.

407. We fully accept that there is a degree to which obesity is the personal responsibility of individuals. This is clearly not so plausibly the case for children, who are usually deemed less able to make informed choices. Even here, however, we concede that parents do have a responsibility to try to feed their children healthily, though we acknowledge that, often, unhealthy food is cheaper than healthy options.

408. Whatever stance governments favour politically or philosophically they will inevitably have to deal with the consequences of the epidemic of obesity. If the very existence of the NHS in its present form is threatened by costs spiralling totally out of control it is hard to see that the Government will not, ultimately, be forced to intervene.

409. Overall in our report we have looked for positive solutions. We have noted the example of Finland, where the force for change came from a grass-roots consumer response which took Government with it, rather than vice versa. We have at several junctures recommended voluntary agreements rather than regulation. We have chosen to accept the word of many representatives of the food industry that they wish to be part of the solution as well as part of the problem. Our belief is that this is a line worth pursuing, not only because it is politically far easier, but also because it could achieve results more quickly than a protracted battle to implement regulation.

410. Other pressures will be brought to bear on the food industry. Consumers may start to demand healthier products once unhealthy ones are properly labelled. Litigation—which is already happening in the USA—may alter the products available and customers' perception of those products. The greatly increased media attention to the problem of obesity may ripple through society and produce a change in behaviour.

411. This is an optimistic way of looking at the future. However, the recent past trends in the growth of obesity and overweight across the population must temper such optimism. Our concluding thought is that the Government must be prepared to act and intervene more forcefully and more directly if voluntary agreements fail. 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.

388   Q195 (Professor Julian Peto) Back

389   J P Morgan, European Equity Research, Food Manufacturing: The Big Issue, pp. 15-21 Back

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