Memorandum by MRC Collaborative Centre
for Human Nutrition Research (WP 60)
MRC Collaborative Centre for Human Nutrition
Research (hereafter HNR) was established in 1998 to advance knowledge
of the relationships between human nutrition and health by providing
a national centre of excellence for the measurement and interpretation
of biochemical, functional and dietary indicators of nutritional
status and health. HNR conducts basic research in relevant areas,
focusing on optimal nutritional status and nutritional vulnerability
in relation to health, including the development of innovative
methodologies. HNR responds to the strategic priorities of the
wider scientific community by conducting research projects, within
the scope of HNR's activities, in collaboration with, and on behalf
of: other MRC establishments and groups, Government departments,
industry, national and international agencies, universities, research
foundations and charitable organisations. HNR also acts as an
independent, authoritative source of scientific advice and information
on nutrition and health in order to foster evidence-based nutrition
policy and practice. In light of the work carried out at the HNR
and the expertise of our staff, our comments are confined primarily
to the role of nutrition in securing good health for the whole
population.
1. Whether the proposals will enable the
government to achieve its public health goals?
1.1 In general terms we believe that the
"Choosing Health" White Paper is a useful step towards
establishing a framework for improvements in public health in
the UK. We look forward to the delivery plans which need to set
out more details of the procedures for monitoring, evaluation
and review, together with the resource implications. This is essential
if the good intentions are to be converted into concrete progress
towards public health goals.
2. Whether the proposals are appropriate,
will be effective and represent value-for-money?
2.1 The White Paper sets out actions in
relation to the major public health targets. HNR scientists have
a particular interest and expertise in food and health aspects
and obesity and our comments reflect this perspective.
2.2 It is difficult to comment on the proposed
actions in relation to nutrition until the details of the Food
and Health Action Plan are released. We look forward to further
engagement in the development of a Food and Health Action Plan
and being able to contribute independent and authoritative scientific
expertise in the links between nutrition and public health.
2.3 In broad terms, we welcome the commitment
to changing people's diet. However there is a real need to establish
some consensus around the dietary targets for action in order
to develop a coherent framework for public health nutrition. Additional
resources will be required to support solid research programmes
to evaluate dietary interventions.
2.4 We note with some concern that the priority
areas are all treated in a rather discrete manner, which ignores
the potential for synergistic activities. This is particularly
true for diet and physical activity. Physical activity impinges
upon nutritional requirements and there is a need to better understand
the integrated impact of diet and physical activity on public
health. Certainly in the context of obesity prevention (perhaps
more usefully considered as weight control) it would be appropriate
to consider the two lifestyle issues in an integrated manner.
2.5 We broadly welcome the PSA target to
halt the year-on-year increase in obesity among children under
11y by 2010 and the associated initiatives. However there is a
concern that 2010 is overly ambitious. There is a danger that
if targets are not achieved in this short time frame the efforts
to prevent obesity in young children will be abandoned whereas
they may yield significant benefits in the longer term.
2.6 We are pleased to note the recognition
that clear guidelines are required for the prevention and treatment
of obesity. However we believe that the development of guidelines
for the broad public health prevention of obesity will require
a paradigm shift for NICE and this may not be a workable solution.
Evaluating interventions for the prevention of obesity requires
a move beyond the traditional medical paradigm of RCTs.
2.7 The effective treatment of obesity requires
a range of different approaches including medical and surgical
interventions, underpinned by changes in lifestyle. We welcome
the decision to develop appropriate services and pathways of care
for the treatment of obesity, particularly in children. This will
require additional resources for training and specific medical
and surgical interventions, even to meet current NICE guidelines.
2.8 Until details of the delivery plans
are released it is difficult to comment in detail on the likely
effectiveness and value for money. Certainly money will have to
be found in the short-to-medium term to support the new initiatives,
and formal evaluations. However, as the Wanless report identified,
this may be expected to lead to cost savings in the longer-term.
3. Whether the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
3.1 There is a pressing need to strengthen
the expertise and infrastructure in public health research. We
welcome the new NPRI, but it represents a very modest investment
in behavioural research. It will be necessary to invest much more
heavily in research to evaluate the impact of interventions in
order to build the evidence-base in public health research.
3.2 There are a large number of local initiatives
on various public health issues underway. However they remain
uncoordinated and many are running on an ad hoc and unsustainable
basis. We would encourage government to take a lead on the coordination
of these initiatives within a framework which fosters and disseminates
best practice.
3.3 It is essential to ensure that health
professionals and others who are charged with delivering health
advice are appropriately trained and the structures are in place
to support continued professional development.
3.4 In the light of the existing skills
shortage within the NHS and the poor training of health professionals
in nutrition, consideration should be given to schemes to support
the training of a diverse range of health professionals and other
individuals in core nutrition skills, to help with the development
of accurate and appropriate information.
3.5 The development of NHS "health
trainers" will require a clear programme to ensure that they
are appropriately trained and competent to give advice and provide
support. This is a complex role given the clustering of adverse
health behaviours and the complexity of individual advice required.
3.6 We strongly believe that there is a
need for the government to champion the formal (British Dietetic
Association) and informal (Nutrition Society) registration process.
There is now a chronic shortage of registered dietitians nationwide
which has delivery implications to ensure that the proposals will
be implemented. Nutritionist remains an unprotected term and until
this is rectified the public cannot be adequately protected. As
the public increasingly recognises the importance of a healthy
diet it is vital that they have access to competent practitioners.
January 2005
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