Examination of Witnesses (Questions 320-339)
17 JULY 2003
PROFESSOR ANDREW
PRENTICE, DR
TIM LOBSTEIN,
PROFESSOR ADRIANNE
HARDMAN, DR
SUSAN JEBB
AND DR
NICK WAREHAM
Q320 Chairman: Do you honestly think
that kind of labelling as it is at the moment will impact in the
way we hope the "Smoking Kills" message plastered on
the packets does?
Professor Prentice: Not of itself.
Q321 Chairman: We do see on some
products in this country that kind of labelling, but do people
generally look at it? You are going to be arguing, presumably,
that we could be much bolder about that kind of approach.
Professor Prentice: Yes. Many
people look at it obsessively. There are people who can tell you
the calorie content of a bar at 100 metres.
Q322 Chairman: Most do not.
Professor Prentice: I think it
will help. I would go back to the point that Dr Jebb made which
is that we need to attack this from every angle we possibly can.
There are certain levers we can pull now which are very obvious
things to do. If we can do many of those, then we start to impact.
Q323 Jim Dowd: Most pre-packaged
foods do have a label on them now—you know, so many kilojoules,
so much this—which are completely and utterly meaningless
to the vast majority of people. I think numbers are pointless.
Should we not have a much more simplified system? Whether we need
the Food Commission to rate every single substance in the country
as high fat or low fat or medium salt or sugar, do we not need
a much more simplified system conveying information about the
content of food?
Professor Prentice: Unfortunately
it is not simple. A lot of people have looked at the labelling
issues in a great deal of depth. If you do that, a lettuce comes
out as being a higher fat content per calorie than a Mars bar,
and there are all sorts of paradoxes and complications.
Q324 Jim Dowd: If it is true, it
is true.
Professor Prentice: It is true,
but that does not imply that the lettuce is less healthy, of course,
so that would introduce even more misunderstanding.
Q325 Jim Dowd: That is because you
are trying to introduce value judgements into it, because in your
mind it is much healthier to eat a lettuce than a Mars bar, but
if it is has high fat, it has high fat.
Professor Prentice: That would
come back to my energy-density point, in which case that would
absolutely sort out the lettuce from the Mars bar. I come back
to that: energy density is very powerful. If we can get that concept
across, it is actually a very powerful one. It may be too complicated.
Rather than asking a few experts for a quick sound-bite on this,
we do need again the Food Standards Agency and the Department
of Health to get really serious—and perhaps the EU will
beat us to it—in terms of sorting this out and having some
braver, more inspired labelling, and certainly issues such as
the labelling of fast-foods. In preparing that fast-food paper,
I sent my secretary around all the fast-food outlets close to
our office and it was virtually impossible for her to find the
information we required. It is all available on the internet,
beautifully—the companies will tell you that and it is true—but
it is difficult to get it at point of purchase.
Q326 Dr Naysmith: Could I ask you
about the system in the States. That is an idea which I think
could have a lot more running, where you put the average intake
for the average person is so much and this food contains more
than your average daily intake but of course lots of other things
as well. I think we could work on that in terms of getting the
message across. Is it a federal requirement or does it vary from
State to State or is it even a legal requirement in the States?
Dr Lobstein: As I understand it,
it is federal.
Q327 Dr Naysmith: So it is a government-imposed
regulation.
Dr Lobstein: If I could just add
a comment, I am not sure it has solved the problem of obesity
in America.
Dr Jebb: This discussion here
begins to get ridiculous because you are not expressing things
in relation to per serving. It does not matter if some people
have a bigger serving than that or not but it gives people a reference
point. When I am giving talks to the public, I often show them
the range of different Mars bars, for example, or of any confectionary
which is available from little-size ones through to the king-size,
and when I tell them that a king-size Mars bar provides more than
20%, more than one-fifth of the energy needs of a woman for a
whole day, people sit up and notice. That is the kind of thing
they remember. I think it is potentially a very useful thing.
I think labelling at the end of the day is not the answer. In
a way, it is a kind of last resort, because you have to have a
very motivated consumer who is actually at the point where they
want to read the labels. But when they do reach that point, they
need that information in order to be able to choose, and particularly
to be able to choose between products in the same category. If
you go to the ready-meal sector, for example, you can find two
different kinds of lasagne which probably if they had them they
would feel as equally satiated and so on, yet actually they may
be very different in fat content, very different in total energy,
so people do need that information and they need it clearly but
it is a long way down the line in terms of the interventions we
need to put in place to protect the broader public. But it is
an important step.
Q328 Mr Burstow: The other side of
this coin—which really comes back to the point that was
being made earlier on—is should we now be talking about
measures similar to the ones that have been deployed in respect
of tobacco? Questions therefore go on to issues of taxation and
regulation. Is there a place for such measures? Are they being
used anywhere else? Perhaps, Dr Lobstein, you could say a bit
about that and how they might play a role in this country.
Dr Lobstein: I do not know if
they are working—because it is in America, one would have
to say that they are probably not working—but there is a
snack tax and a fat tax in several of the States in America. They
are State-wide, they are not federal. They are in some of the
States and not others and, indeed, they have been dropped from
some States after pressure from the industry. It would be well
worth trying to find some evaluation of how well they are working.
I suspect they are mostly used to raise extra revenue for the
State which it can then claim it is using to treat obese patients,
but that is a bit of a situation of "after the horse has
bolted": you are collecting money to do something later.
I think the marginal extra on the can of Coca-Cola or Mars bar
would not be sufficient to prevent people buying them. That said,
I think it is well worth exploring fiscal remedies. The Mayor
of New York wants to introduce a 1% tax on ice-cream and soft
drinks at the moment and presumably he is doing so on the basis
of paperwork that says it is worth doing. As I say, whether it
is worth doing for his treasury's benefit or for the benefit of
the health of New Yorkers I am not clear.
Q329 Jim Dowd: In California, if
I remember, have they not agreed to take all soft drinks machines
out of schools?
Dr Lobstein: Yes I believe they
have and several other areas too.
Q330 Jim Dowd: Although we should
not confuse California with the real world.
Dr Lobstein: Well, Californians
are not quite as fat as people in some other parts of the US so
you could argue there is a role there. Before we go down the route
of the vending machines or not, it is interesting that one of
Kraft Inc's promises was that it would withdraw advertising promotions
within schools as part of its anti-obesity drive, so even the
industry is beginning to recognise it. There is little point in
tinkering at the edges of schools—food, access, things like
that—unless you have a school nutrition policy. If you have
a school nutrition policy you can allow industry in, you can have
vending machines in but they have would have to conform to the
school nutrition policy. It seems to me that would be a more constructive
approach than trying to ban companies in schools. Once you have
started with nutrition policy you are then looking at how it is
taught, how lunches are devised, the catering contract and perhaps
a physical activity policy attached to that.
Q331 Chairman: Dr Wareham, can I
welcome you to the Committee. We are very pleased to see you here.
You have been referred to in your absence and I am sure colleagues
would like to ask you questions in more detail. Would you like
to briefly introduce yourself to the Committee.
Dr Wareham: Apologies for lateness;
it was beyond my control. I am a clinical epidemiologist from
the University of Cambridge. My research is mainly into how genes
and the environment interact to cause obesity and diabetes. I
am shortly to take up an appointment as Director of a new Medical
Research Council epidemiology unit in Cambridge.
Q332 Dr Taylor: Going on to tackling
sloth and starting with Dr Wareham straightaway, we have been
told you have got an interest in Europe; how does England compare
with European countries for physical activity?
Dr Wareham: The first thing to
say is it has been incredibly difficult until recently to have
directly comparable data between different European countries.
There has been a problem with the methods for assessing physical
activity between populations and that is something that needs
redressing. Recently there has been a development of an international
physical activity questionnaire which has been validated in different
countries and that has recently been administered throughout the
European Union. Unfortunately, the United Kingdom as a whole would
be in the bottom quartile in terms of proportion of the population
who engage in at least 150 minutes of activity a week. I think
it is no surprise when one looks at countries at the top end of
that, that is countries like Holland and Scandinavia, that those
are the countries where the rate of increase in obesity is not
anywhere near what we see in this country.
Q333 Dr Taylor: 150 minutes per week
of any particular grade of exercise?
Dr Wareham: Moderate. I am afraid
I do not have the numbers to hand but I can gladly supply them
later. They have not been published yet, they have recently been
put together.
Q334 Dr Taylor: Do you know when
the questionnaire is going to be published?
Dr Wareham: It is part of something
called Eurobarometer. I am afraid I do not know the publication
date.
Q335 Dr Taylor: But it could be within
the foreseeable future?
Dr Wareham: Yes, it could be.
Q336 Dr Taylor: Again, we have been
told it is sedentary jobs in this country that lead to the problem,
more so than in other countries; is that right?
Dr Wareham: I do not have any
direct evidence that the proportion of people engaged in sedentary
activities in their occupation is any different in European countries.
That may be the case but I do not know that for sure. Occupation
is clearly one major aspect of the decline of physical activity
in recent years but it is only one aspect of it.
Q337 Dr Taylor: Is there anything
government agencies could do to persuade people to take time for
exercise during their jobs? This is to Professor Hardman as well.
Dr Wareham: It is perfectly possible,
for occupational health reasons, to speculate that people would
benefit not only in terms of their overall health long term but
also in terms of short-term concentration. Given that most people
are engaged in activities involving computers, that one should
have a statutory break from sitting down at one's computer every
hour for a certain number of minutes, I do not see how that is
beyond the wit of man.
Q338 Chairman: Or a Committee session!
Professor Prentice: Why not, yes.
Professor Hardman: I think firms
can make a contribution in this regard. Some of the American firms
earlier on had all sort of systems—flexitime and a gymnasium
available in the facilities. To be honest, I do not think that
is the right approach. I think we might encourage more energy
to be expended by providing a couple of showers and some facilities
for safe bicycle storage, this sort of thing. The countries that
do come out high in physical activity levels, particularly Finland,
the other Scandinavian countries and Holland, have a culture where
personal transportation is much more about walking and cycling.
I think that makes a big contribution, it is regular, it is frequent,
it is over years.
Dr Wareham: Can I come back on
that. I took the opportunity last night of looking at the decline
in cycle miles in the UK. It was 23 billion kilometres in 1952
and it is now four, so it has really dropped precipitously.
Q339 Dr Taylor: Of dedicated cycle
track?
Dr Wareham: No, the number of
kilometres cycled overall for people in this country.
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