APPENDIX 13
Memorandum by the Nutrition Society (OB
24)
1. The Nutrition Society is the independent
and charitable learned society that aims to advance the scientific
study of nutrition and its application to the maintenance of animal
and human health. It has over 2,000 members, publishes world class
learned journals on nutrition and holds scientific meetings both
in the UK and (with partners) in Europe. As such the Society is
well placed to contribute to this Select inquiry and it is pleased
to assist the Health Committee.
The Committee's specific questions are in caps
and small caps.
WHAT ARE
THE HEALTH
IMPLICATIONS OF
OBESITY?
UK longevity could start to decline, between 1980
and 2000 UK obesity increased some three fold
2. Obesity defined as a Body Mass Index
of over 30 kg/m2 is detrimental to health and human well-being.
The health implications include (frequently a combination of)
increased risk of cardiovascular disease, type 2 diabetes, some
cancers, arthritis, gallstones, and mental problems. With regards
to the health implications for the nation, while throughout much
of the last century average UK longevity increased, if current
trends in UK citizens' body mass indexes continue to increase
then this first quarter of the 21st century could see the start
of a decline in UK longevity. The prevalence of obesity and being
overweight has increased dramatically in the past 30-50 years.
In 1980, the percentage of the UK population classed as obese
was 7%. By 2000 this had increased to 20%, a three-fold expansion.
Overweight subjects comprised about 20% of the 1980 population
but by 2000 this was about 45%. In the US the costs of obesity
in 1997 were estimated at around US$97 billion annually. In the
UK costs for 2000 were thought to by the National Audit Office
to be around £2.5 billion of which £0.5 billion in direct
health care costs to the National Health Service.
WHAT ARE
THE CAUSES
OF THE
RECENT RISE
IN OBESITY?
Individual's energy balance changes due to less
energy being expended compounded by more being consumed
3. Obesity results from an imbalance between
energy consumed and energy expended by an individual. Therefore
both diet and metabolic activity are important. In recent decades
the UK, in common with other Western nations, has seen profound
changes in the way its people live. The near universal availability
of mechanised tools to perform what were once labour intensive
manual activities has transformed people's daily routines. The
population is both housed in warmer dwellings and benefits from
greater accessibility to mechanised transport, primarily through
car use. The use of washing machines, escalators and lifts has
drastically reduced the need for people to expend energy in moving
about or in housekeeping. In addition leisure pursuits are dominated
by the inactivity of television viewing. These factors have reduced
physical activity levels to such an extent that a sedentary lifestyle
has become the default, and therefore the norm. At the same time,
the UK has also had unprecedented access to a plentiful and affordable
food supply which has become more energy dense over the last 50
years due to increasing reliance on fat and, especially in beverages,
on sugars.
WHAT CAN
BE DONE
ABOUT IT?
WHAT IS
THE RANGE
OF "LEVERS"
AND DRIVERS?
Energy balance and checks that evolved during
a history of food shortage do not work well compared to the regular
surplus we have only very recently experienced
4. There are three main components levering
and driving obesity. First and second, as alluded to above, the
ubiquitous availability of high energy food as well as a decline
in everyday activity. The third is a controlling factor in that
humans evolved in an environment prone to food shortages. Our
natural levers and drivers are geared to consuming more than we
need so as to lay down fat during times of shortage. Our natural
checks serve to respond to hunger and much less to excess. Consequently
the ready availability of energy dense food and decline in metabolic
activity both serve to drive obesity.
WHAT ROLE
CAN THE
FOOD INDUSTRY,
MARKETING AND
ADVERTISING PLAY?
TRANSPORT? SCHOOLING?
AND TO
WHAT EXTENT
CAN AND
SHOULD GOVERNMENT
INFLUENCE LIFESTYLE
CHOICES?
Marketing is probably important but is difficult
to study quantitatively effectively
5. Marketing and advertising: this is controversial.
The "common sense" view is that the heavy marketing
of high energy dense foods (especially to children) promotes consumption.
However this has been difficult to demonstrate convincingly. If
this consultation were taking place two or three decades ago and
were about tobacco consumption then industry's argument might
have been that the advertising did not promote consumption but
brand shifting and re-distribution of market share. However it
is now generally accepted that advertising does promote consumption
and indeed this is a major reason why industry invests so heavily
in promotion. Nonetheless in the context of food advertising (and
because food is a necessity whereas tobacco is not) it is difficult
to conceive an approach to study whether advertising promotes
consumption that would convince a sceptic. Even so marketing and
advertising is clearly one amongst a number of influences and
is probably important.
The school generation's lack of ability to cook
means that they are in less control of their food supply
6. Schooling. The lack of ability to cook
amongst the current school generation means that people are not
as in control of their own food supply as they might be. Nor are
they as familiar with food and nutrition issues on a practical
day-to-day basis.
Freedom of choice conflicts with Government's
health responsibilities but there are precedents for internalising
product's health externalities
7. Government's responsibility to lifestyle
choices is limited by over-arching responsibilities to protect
individuals' freedom of choice. However, notwithstanding this,
Government has a responsibility to ensure that the nation's citizens
live in a social and economic environment conducive to health
and a responsibility to actively to remove obstacles to the above.
The Government has, as with the example of tobacco mentioned above,
a duty to internalise externalities (in that example the health
costs through taxation). With regards to environmental pollution,
successive Governments have adopted the "polluter pays"
principle. So there is arguably precedent for similar action to
tackle obesity.
HOW COHERENT
IS GOVERNMENT'S
NATIONAL AND
LOCAL STRATEGY?
The need for cross-Departmental strategy has already
been identified but there is still no clear let alone well-resourced,
strategy
8. The 2001 National Audit Office report,
Tackling Obesity in England noted that there were five
key Government Departments and Agencies with responsibilities
impinging on obesity. It identified the need for creating a cross-government
strategy to promote the health benefits of physical activity.
The implication here was clear, that no such strategy existed.
Two years on and there may be more awareness of the need for both
inter- and pan- departmental activity arising out of a cross-governmental
strategy, but there is still no clear, let alone well-resourced,
strategy.
ARE INSTITUTIONAL
STRUCTURES IN
PLACE TO
DELIVER AND
IMPROVEMENT?
The nutrition society is professionalising nutrition
to facilitate the provision of sound nutritional information
9. There are some structures in place. The
Nutrition Society is best qualified to inform of developments
within the UK nutritionist community. The society has been aware
for some time that there is a considerable quantity of information
on food and food related issues available to the public. However
a significant body of nutrition information and guidance comes
from those who may call themselves nutritionists but who have
neither the necessary academic qualifications nor the professional
experience. The Nutrition Society is attempting to address this
through establishing professional registers. To this end it has
already created two registers: one for nutritionists and one for
public health nutritionists. It is currently investigating the
need and feasibility for a register for those concerned with sport
and exercise nutrition. Government support for this activity would
be most welcome and it will undoubtedly play a part in the implementation
of any cross-departmental strategy that the Government may devise
to tackle obesity.
There are almost no resources for identifying
effective interventions
10. The key problem is that almost no resources
are devoted to identifying effective interventions. Decisions
tend to be driven by the biomedical/pharmacological model and
not towards the socio-environmental aspects. One instance is that
key drivers of Government transport policy are sustainability
on greenhouse (fossil fuel) and congestion related issues. Transport
health issues (other than from transport generated pollution)
barely have any profile.
Effective treatments are required as well as prevention
from individual to national level
11. The Department of Health has responsibilities
both for treatment of existing obesity and for preventing the
development of obesity. Clearly the DoH needs to ensure that the
UK has effective treatment services in place: in fact even this
is far from the case. However this alone is not sufficient and
should not be the sole focus of any strategy tackling obesity.
The available treatments for obesity have only limited long-term
efficacy, and any sensible strategy to address the increasing
burden of obesity needs to address prevention, at individual,
community and national levels. At the same time it is essential
that these different levels are coordinated to aid efficacy.
Obesity is an issue that will be a disaster for
the UK
12. Obesity, as the 2001 National Audit
Office report concludes, is an issue that cuts across Departmental
boundaries. This is an issue that will be a disaster for the UK
as a whole, and for its citizens individually and for the economy.
We need only look to the US to see where we are going, and the
problem there has yet to plateau. The proportional spread of obesity
in the US is currently three to four years ahead of the UK.
HOW CAN
GOVERNMENT'S
STRATEGY BE
IMPROVED?
Through research into interventions and into how
to decide to fund a successful strategy
13. Both the NAO report and the subsequent
Public Accounts Commons Select report, Tackling Obesity in
England, have identified many of the elements a successful
strategy will need. However research into effective policy is
desperately required as is research and consultation as to how
a successful strategy will be funded. How will the economically
the factors causing obesity that are currently externalities be
internalised? This will necessitate addressing some difficult
questions relating to personal choice and there will undoubtedly
be heavy lobbying from those with commercial interests in the
human food chain as it now exists.
Openness
14. The Nutrition Society hopes that this
evidence helps the Select Committee in its deliberations and is
happy for this evidence to be public. The Society requests the
Select Committee's permission similarly to make this evidence
publicly available through its web site. Finally, the Society
would be pleased to answer in greater detail any aspect of this
evidence should the Committee wish. In the first instance the
Committee should address any questions to: Jonathan Cowie (Executive
Secretary), The Nutrition Society, 10 Cambridge Court, 210 Shepherds
Bush Road, London, W6 7NJ.
April 2003
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