Select Committee on Health Minutes of Evidence


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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