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19 Jun 2007 : Column 406WH—continued
“There is no clear and consistent association between increased intake of added sugar and BMI”—
that is, body mass index. The hon. Gentleman alluded to that, and it is central to any debate about obesity and sugar.
Although the hon. Member for North Norfolk (Norman Lamb) was kind enough to say that I am an expert, I am not. It is important not to draw easy conclusions. As the hon. Gentleman said, relativity comes into it, but most of us as lay people probably feel that sugar does lead to obesity. Indeed, a core sugar has a calorific value, but so do many other substances. My intervention was aimed at establishing that we should not necessarily assume that sugar will lead automatically to obesity. If sugar is removed from the diet, what is it replaced with?
I hesitate to mention the Sugar Association because it clearly has an interest in a debate about sugar. Nevertheless, it points out legitimately that fats deliver more than twice the number of calories per gram than the carbohydrate sugar. Furthermore, and probably more importantly, fat is laid down while energy from other sources is quickly burned off. It would be beneficial to think a little more laterally about the contribution that sugar and other forms of energy-providing substances make to obesity.
When trying to work out what is fact and what is fiction, it is probably worth while reflecting on energy in and energy out. There has been a recent series of interesting results from academic institutions that have looked at the energy-out side of the equation. We cannot consider energy in—sugar—without considering energy out. The Minister will be aware of Plymouth’s prospective EarlyBird study and the recent cross-sectional study at Bristol university. On first examination, they appear to be contradictory, but when taken together
they show that there is a difficulty in the assumption that providing exercise for schoolchildren will alter behaviour in the long term.
I was disappointed to read the results of the prospective study from Plymouth because I would like to believe, as I am sure would the Minister, that providing sports facilities and exercise in schools will lead to a long-term change in people’s behaviour so that they enhance the energy-out side of the equation. Unfortunately, that research suggests that the pattern is more complex. I would like to know where we are with the “Choosing Activity, a physical activity plan” of March 2004, which was relaunched in August last year, particularly in the context of focusing on energy out and taking into account those two important studies, the results of which we had earlier this year.
The hon. Member for Middlesbrough, South and East Cleveland mentioned fruit juices and smoothies. Most of us assume that smoothies are a good thing. Certainly the packaging suggests that they are full of good stuff and sometimes that they contain as much as five pieces of fruit compressed into a little bottle. Therefore, they seem to be a good thing and an easy way of satisfying the Government’s insistence that we should consume five pieces of fruit or veg a day. They are, of course, high in good things such as antioxidants, but they may also be high in substances such as sugar, so how do we play one off against the other?
The hon. Gentleman also mentioned dehydration. I have had correspondence from various authorities on the subject, but I am having difficulty in working out what part dehydration plays, particularly as we live in a temperate climate. I am not aware that the Food Standards Agency has looked at the issue, and I would be interested to know what it makes of it and particularly what it thinks about reports that dehydration degrades people’s ability to do maths in schools.
The school fruit and vegetable scheme was launched three years ago at a cost of £77 million, and I understand that the Department of Health is reviewing that. Will the Minister comment on where we have got to with that review and with emerging reports that it has not significantly changed behaviour? I would be interested to know whether the Minister, on the basis of the evidence available to him now, intends to change the school fruit and vegetable scheme and, if so, in what way. While he is about it, perhaps he would comment on other initiatives that have been launched since the White Paper “Choosing Health”—for example, the teen life check and the obesity toolkit.
Initiatives introduced by the Government and their agencies often have unintended consequences, and I am thinking particularly of the FSA’s attack on salt, which I fully support. However, it seems that there is a conflict between salt and sugar. As I said about the competing benefits of various substances in smoothies and fruit drinks, we must compare and contrast, and work out what is for the best. Kellogg’s has been up front and said that it is adding sugar to some of its cereals because salt is being reduced, presumably because of pressure from the Government and their agencies.
We have heard about Special K, which I do not recall having had for a long time, but my parents and grandparents used to have it and it seems that it was a lot less sugary back in 1978 when the data started to be gathered for
the Widdowson textbook, which is the trade text. The sugar content has risen dramatically since then.
Various other foodstuffs were discussed by the hon. Members for North Norfolk and for Middlesbrough, South and East Cleveland, and I shall not repeat what they said, but I am a little alarmed to find that fruit and even vegetables are now being bred to enhance their sugar content. The carrots that I ate in 1978 contained 5.4 g of sugar per 100 g, but that increased alarmingly to 7.4 g of sugar per 100 g in 2002 to match consumers’ palates.
Waitrose soup has been mentioned but, unlike the hon. Member for North Norfolk, I do not eat it as I do not have a Waitrose near my house. I have an Asda, and its sticky chilli chicken contains 19.2 g of sugar per 100 g. Tesco’s crispy beef and sweet chilli sauce contains 23.1 g per 100 g, which is a remarkable amount of added sugar. Neither of those products appeals to me, but clearly they cater for consumers’ tastes. If other palatable ingredients, such as salt, are driven down, inevitably they must be replaced with something if the company is to continue to sell its products. I am slightly concerned that in forcing down one ingredient, we are driving up others without having first assessed which ingredient is more damaging.
It seems that the link between sugar and obesity has not been established, so the FSA might reasonably take the view that salt, which is proven to be harmful, must be its prime focus, rather than sugar.
Norman Lamb: My impression is that the FSA has moved on to sugar. Is the hon. Gentleman saying that it is not wise to do so, and that it ought to stick with salt? The FSA gives the impression that it must tackle sugar.
Dr. Murrison: I am not sure that the FSA has moved on, and I hope that it does not move on as the hon. Gentleman suggests, because that would be the wrong way to consider the problem. We cannot leap from one substance to another; we must consider the issues holistically. That is the guts of what I was trying to put across.
There is, however, clear and largely uncontroversial evidence to link high salt content with various forms of ill health, hypertension and the sequelae of that. We hear from various authorities that the link between sugar intake and increased BMI is not so well established, and it would be a pity if in chasing down sugar, we drove up salt, which is uncontrovertibly linked to ill health. That would be a dangerous thing indeed.
The question is about balancing one with the other, and I am not sure that even the FSA—sage organisation that it is—would have either the answers or the ability, given our knowledge about the subject, to strike a reasonable balance between the two. I accept that it is important for the FSA to consider sugar, and that it tries to improve our evidence base, but I am pretty clear that its chief target recently has been and continues to be salt. If that is true, that approach is entirely rational.
I suspect that there is a link between sugar content and cost, and I should be interested to know the Minister’s view on that. The hon. Member for Middlesbrough, South and East Cleveland referred to Professor Jack Winkler of London Metropolitan university, who blames European trade reforms for making sugar cheaper and
for contributing to obesity. He has made the link between sugar and obesity; others may be more cautious about doing so. However, I need no encouragement to attack the evils of the European Union and its doings, and I should be interested to hear whether the Minister shares Jack Winkler’s concerns about its impact on the price of sugar, and therefore, according to Professor Winkler, on obesity in this country.
The hon. Member for Middlesbrough, South and East Cleveland mentioned sweeteners, and like me he has received a briefing from Ajinomoto about aspartame. Does the Minister believe that low calorie sweeteners of the sort referred to by the hon. Gentleman and approved by the European Food Safety Authority in May 2006 are to be encouraged? If so, how does the Minister think they might be used as a replacement for sugar, sucrose and dextrose in the UK diet?
Advertising is important in the debate. The Minister called on the Committee of Advertising Practice in February to put in place rules governing the advertising of food high in fat, sugar and salt in non-TV media, and the hon. Member for North Norfolk referred to that. I believe that rules concerning magazines and cinema will come into force in a few days’ time, but I am less clear about rules relating to the internet, computer games and mobile phones. I should be interested to hear whether the Minister’s call on the committee a little while ago has resulted in the drafting of any rules for the advertising of products high in fat, sugar and salt to children through those novel media.
In the large amount of time remaining to me, I shall mention briefly the impact of labelling. It is important for people to understand as fully as possible what they are buying and consuming. The Food and Drink Federation wrote to me, essentially supporting the guideline daily amounts method of front-pack labelling. I suspect that it wrote to other hon. Members, too. It provided many obliging statistics, and pointed out that
“50 per cent. of UK retail food and drink packs now carry this”—
“information.”
The other major means of providing such information is through the traffic light scheme that the FSA has been—up to this point—very keen on, has been trialling, and, we understand, will be reviewing to determine whether it needs to alter its tack or remain on its set course. Whichever scheme ultimately emerges as the victor, it must be the one that is most user-friendly, most likely to alter people’s purchasing preferences, and thereby the products that are available on predominantly supermarket shelves.
However, I sound a cautionary note about nutrient profiling, for all the predictable reasons. We have heard about the red-lighting of dairy products such as milk and cheese, and of other products such as Marmite and tomato ketchup, which is based on the nutrients that they contain in 100 g of product. I do not know about you, Mr. Hood, but the last time I consumed 100 g of ketchup or Marmite at one sitting was a very long time ago. Such information does not seem to be terribly relevant to what people actually consume and how they actually behave. That is one of my chief problems with nutrient profiling.
In 2005, “Commissioning Obesity Services: PCTs’ Services and Strategies” was published. Its methods for tackling obesity do not appear to have been rolled out terribly well, and I should be interested to hear how the Minister feels about the prescription of various forms of weight reduction, such as those that Weight Watchers and Slimming World provide, which appear to be cost-effective when compared with the cost of medication for dealing with obesity.
How is the quality and outcomes framework being used to tackle obesity? GPs get very few points for addressing obesity through the QOF, and given the scale of the problem, which we heard about from the hon. Members for Middlesbrough, South and East Cleveland and for North Norfolk, it seems strange that a mechanism that was set up to improve health should fail so signally to address one of the biggest public health problems that we face today—obesity.
11.58 am
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this Adjournment debate and on campaigning on the issue for a long period. As well as being my hon. Friend, he is a very good friend, and he says quite rightly that, usually, he praises fully the Government’s achievements. Today, however, he has raised some extremely important issues that are worthy of serious consideration.
The Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), who leads on public health issues, would welcome the opportunity to meet my hon. Friend, and anybody else whom he felt useful, to discuss the issues that he has raised. It is always good to offer meetings on behalf of colleagues; whether they thank me for it is an entirely different matter. However, it would be useful if such a face-to-face meeting were to take place.
All hon. Members who have contributed to this debate have defined the scale of the problem. It is serious for the individual affected and a major challenge for families in this country. It also presents new questions for our society and raises significant issues for our economic well-being going forward. Tackling such issues must, however, be a shared responsibility. There is no one partner in society who alone can tackle and resolve these fundamental and profound issues. The Government must of course fulfil their responsibility, but so must parents, in the case of young people. In the case of older people and adults, there is a responsibility on citizens. There is also the question of the role of the regulatory authorities and the behaviour, in respect of both self-regulation and corporate responsibility, of industry and the private sector in those regulatory regimes. Every partner needs to play their full part if we are to have a chance of tackling the issue on a long-term and sustained basis.
To turn to some of the progress made, this country’s strategy is acknowledged internationally as being progressive and positive. Progress has been slow, but it has been significant. There has undoubtedly been a positive change in people’s awareness of the importance of healthy living, and there are signs that children and adults are beginning deliberately to adopt healthier eating and
physical activity habits. The fact that we as a society debate the issue, as well as the fact that people reflect on their behaviour and the impact that it has on their health, the quality of their lives and, in the most extreme cases, their life chances, is an important advance. A few years ago, such issues were not at the forefront of people’s minds or anywhere near the public policy agenda, so we have made significant progress.
There are also many statistics that reinforce that belief. For example, there has been a 7.7 per cent. increase in expenditure on fruit and vegetables, which is the biggest increase for more than 20 years, alongside a 6.1 per cent. decrease in expenditure on confectionery. In 2006, 72 per cent. of people were aware that they should eat at least five portions of fruit and vegetables a day, which was an increase from 51 per cent. in 2002. In 2005-06, 80 per cent. of schoolchildren did at least two hours of school sport a week, which is up from an estimated 25 per cent. in 2002. The figure is also higher than our target for that period, which was only 75 per cent. There is also no doubt that children’s fruit and vegetable consumption is increasing, with 17 per cent. consuming at least five portions a day in 2005, which is up from 10 per cent. in 2001. There is therefore evidence that significant progress is being made.
Dr. Murrison: What would the Minister say to the National Foundation for Education Research and the university of Leeds, which seem to think that the schools fruit and vegetable scheme has not succeeded in its stated intentions?
Mr. Lewis: The hon. Gentleman raised that issue earlier, which I shall deal with head-on in a few moments. It is as though he would be pleased if what he has described was the case, which I find alarming for an hon. Member trying to make a mature contribution to the debate. However, I shall deal with the point directly in due course.
A lot of changes have been made. For instance, the Ofcom changes have restricted TV advertising of food and drink high in fat, salt and sugar to children, while new rules from the Committee of Advertising Practice will come into effect on 1 July. Tougher nutritional standards for school food have been announced and front-of-pack labelling now makes it much easier for consumers to understand the nutritional value of processed foods. NICE published guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children in December last year. There has also been partnership working with the National Heart Forum on revising its toolkit, “Lightening the load: Tackling overweight and obesity”, which aims to support local areas in developing local strategies to tackle overweight and obesity in children and adults.
There has also been the new “Healthy Start” scheme, as well as new care pathways for NHS primary care professionals and self-help guides for patients. The Government launched the national step-o-meter programme, which has trained 4,000 primary care health professionals across 220 PCTs in motivational interviewing and the use of pedometers as a motivational tool. Nearly 20,000 schools have volunteered to be “Healthy Schools” or are working towards becoming one, which is more than 85 per cent. of schools in this country. That is incredibly important, if we think about the
potential for long-term and sustained change that it gives us. There is now also a coalition of 150 organisations in the public and private sectors, working together and using social marketing techniques to develop a deep understanding of the drivers of families’ food and physical activity habits. Significant progress has been made, but it is important to acknowledge, as hon. Members have done, that we still have a long way to go in tackling the challenge.
I should like to turn to some of the points that my hon. Friend and other hon. Members made about sugar, drinks and obesity. There is limited scientific evidence regarding intakes of sugar-sweetened drinks and weight gain, and it is unclear whether an association exists. It is hard for me as the Minister to relate to that, but that is what the scientific evidence suggests and we cannot afford to ignore that scientific and expert evidence.
Dr. Kumar: Has my hon. Friend the Minister commissioned studies through his Department or is he relying on external research work? If he is saying that he cannot see the evidence, surely the sensible thing, given the size of the Department’s budget, is to commission its own research work. That would keep the researchers occupied for a long while.
Mr. Lewis: I should like to refer to other research that has been conducted on the issue. For example, the World Health Organisation report on chronic diseases, which was published in 2003, did not directly link sugar with weight gain, but suggested that a high intake of free sugars in soft drinks possibly promotes weight gain, which is an important nuance. The Food Standards Agency considers there to be insufficient evidence to make a judgment on sugar-sweetened drinks and obesity, but continues to monitor the evidence as it emerges, which is important.
Norman Lamb: The Minister mentioned the Food Standards Agency, but as The Sunday Times reported in May:
“The Food Standards Agency...which launched a crackdown on salt two years ago, wants companies to reduce the amount of added sugar in food products and is even considering imposing legal limits.”
Does he fully support the FSA in pursuing the level of sugar in some products or is he saying that there is insufficient evidence for us to adopt a precautionary approach and seek to reduce levels?
Mr. Lewis: I agree entirely with the hon. Gentleman, who made the point about the precautionary principle in his earlier contribution. That is why we as a Department are working with the FSA and the industry to reduce sugar in a range of foods. The Department for Education and Skills and the School Foods Trust are also working to take the issue forward. I agree with the hon. Gentleman’s point that we should proceed on the precautionary principle. I support what the FSA has said recently; its point is that we need to assess evidence as it emerges and adjust our strategy accordingly. We need to proceed by using the precautionary principle as the basis for moving forward.
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