Select Committee on Public Accounts Eighth Report

1  Progress against the PSA target

1. Obesity is a serious health condition. It is defined as carrying too much body fat for your height and sex. A person is considered obese if they have a body mass index or BMI (weight in kilograms divided by the square of their height in metres) of 30 or greater.

2. In the Spending Review of 2004, the Departments of Health, Education and Skills and Culture, Media and Sport agreed a joint Public Service Agreement target to:

    halt, by 2010, the year-on-year increase in obesity among children under 11 in the context of a broader strategy to tackle obesity in the population as a whole.

3. The most recent data available (published in April 2006) on the prevalence of child obesity are from the 2004 Health Survey for England, which showed that there had been an overall rise in obesity amongst children aged 2-10 from 9.9% in 1995 to 13.4% in 2004. Because this data is two years old the three Departments are unable to assess what progress they have made since the target was established.[3]

4. The Committee's report on Obesity in 2001 identified the need for more effective joined up working and a clarification of responsibilities.[4] Since the PSA target was established in 2004 the three Departments have been planning to tackle the problem through a complex set of delivery arrangements (Figure 1) but it is not clear whether such complexity is either necessary or the best way of getting children to lead more healthy lifestyles.[5] With responsibility not yet clearly assigned between different organisations at each level of delivery the three Departments recognise that more clarity is needed to meet the target.[6]

5. The Departments acknowledge that much more could have been done more quickly.[7] It took them over a year to hold their first joint Programme Board meeting, key parts of the Delivery Plan were still not published at the time of the Committee's hearing in May 2006 and a planned obesity social marketing campaign to raise awareness among children and parents will not be launched until 2007.[8] This campaign will have a reduced effect compared with what might have been achieved had it been up and running in the first two years of the target. Similar types of campaign have been run recently without such delays, such as that to raise awareness of the dangers of excessive salt intake and the Five-A-Day message to encourage increased consumption of fruit and vegetables by children.[9] The Departments' example of how, through reducing calorie intake by consuming just one less chocolate biscuit a day (typically 80 calories) children can lead themselves out of obesity, offers the potential for a simple and clear message to be targeted at parents and children.[10]

Figure 1: The delivery chain for tackling child obesity

6. As a joint target, shared between three Departments, strong leadership is needed to galvanise effort and get the message across to children and their parents that obesity is a serious health issue.[11] The Senior Responsible Owners for the PSA target in each Department have many other responsibilities and competing demands on their time, while the Programme Manager (based in the Department of Health) does not have the necessary seniority or authority to lead and co-ordinate the many programmes and organisations involved.[12]

7. Action to tackle other public health issues, such as smoking or heavy drinking, has been characterised by direct action by Departments, be it the banning of smoking in certain places or taxing harmful products such as cigarettes.[13] Foods, especially snacks such as crisps, chocolate and fizzy drinks are particularly price sensitive because of the fact that most children have limited funds.[14] The Departments have not, however, explored options to raise the price of foods and drinks that are high in fat, salt and sugar because they believe there is insufficient evidence to show that this would have a beneficial effect on levels of child obesity.[15]

8. In March 2006 the National Institute for Health and Clinical Excellence published draft guidance, for consultation, on the prevention and treatment of obesity which they plan to publish in December 2006.[16] In addition the Department of Health published, in April 2006, a care pathway and a weight loss guide which was sent to general practitioners and other healthcare professionals.[17]

3   Q 10 Back

4   Committee of Public Accounts, Ninth Report of Session 2001-02, Department of Health: Tackling Obesity in England, HC 421; C&AG's Report, Tackling Obesity in England, HC (2000-01) 220 Back

5   Qq 7, 21, 38 Back

6   Q 7 Back

7   Qq 69, 115 Back

8   Qq 12, 13, 48, 74 Back

9   Q 85 Back

10   Q 42 Back

11   Qq 114, 115 Back

12   Qq 115, 116 Back

13   Q 117 Back

14   Q 120 Back

15   Qq 117, 118, 120-121; C&AG's Report: Tackling Obesity: First Steps, HC (2005-06) 801, para 1.9, page 27 Back

16   National Institute of Clinical Excellence, Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children, Draft for Consultation; March 2006 Back

17   National Health Service, Your weight, your health. How to take control of your weight. April 2006; National Health Service, Care pathway for the management of overweight and obesity, April 2006 Back

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Prepared 25 January 2007