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“You have told the Chairman that obesity is at the top of the agenda in terms of public health.”
So where do we stand now? The Government have recently made two announcements, which, as ever, caught the headlines. The first concerned tackling childhood obesity. We had a great opportunity to do that when our report was published four years ago. Much as I applaud the fact that the four supermarkets are going to work together to tackle childhood obesity, I want to hear a little more from the Minister to convince me that this is not gesture politics and that there will be a sustained follow-up to that announcement. Then we had the healthy towns initiative. Will the Minister explain how those towns were chosen? Were they invited to bid? Do I need to tell off my own town of Southend for failing to put in a bid? It is a great idea, but are these pilot schemes, and how will the Minister decide whether they have been a success?
We drew a number of conclusions in our report, saying finally:
“While we have tried wherever possible to take the food industry at its word, and seen it as ‘part of the solution’, we recommend that the Government reviews the situation in three years”—
it was published in 2004, so we were recommending that it be reviewed last year—
“and then decides if more direct regulation is required.”
On one of the Committee’s trips, we went to America, where we met people from all the big names in the food and drink industry. McDonald’s, Nestlé, Coca Cola—you name it, we met them. To a woman and to a man, they were in total denial that the responsibility was theirs. All they wanted to emphasise was physical activity. I do not want any of my colleagues to boo from a sedentary position, but I am an unashamed enthusiast for the Olympic games. The Minister for the Olympics is reported to have said at a dinner earlier this week that if we had known then what we know now, perhaps we would not have bid for them, but I am delighted that we are going to have them, because there will be a sustained focus on physical activity. We debated the legacy a couple of weeks ago. I hope that the physical activity will not end with the closing ceremony and that people will continue to run, jump, swim, dance and all the rest of it. That is splendid.
We do not die if we do not take physical exercise, but we do if we do not drink and eat. The nature of the human beast is that we are all sinners. We all like to drink and we all like food. We like our taste buds to be triggered in some way or other. The key is to get the food and drink industry to take seriously the fat, salt and sugar content of the things that we eat and drink. In trying to get the supermarkets to agree on what we recommended in terms of traffic light labelling, we have ended with a shambles. It is no good having two systems—we are all very busy, and when we go round the supermarket the additives have to be clearly identified. I go back to what I said to Melanie Johnson during the inquiry.
We now have a Labour Government who say that they do not want to have a nanny state nor do they want to tell people what to do. However, a general review has not worked—I am not even convinced that that is happening—and having targets has not worked. We need action and leadership from the Government. I
want them to assure me that obesity is at the top of their health agenda, because I am not convinced that it is. There are no quick fixes, but what we have are all the gestures that the Government participate in, seemingly every six months or in a year.
When the Select Committee visited a town in Europe, however, we saw a fantastic project—no motor vehicles were allowed in the town, and everyone was riding a bike. I suppose that it was a little bit like Cambridge. Since the publication of our report, I see no evidence that the Government have set any sustained target for wider involvement of the public. We had the BBC’s “Fat Nation” for a while, but we seem to be going in and out of the process of involvement.
I applaud the latest two initiatives, but I want tangible leadership from the Government. If they had accepted every one of the Health Committee’s recommendations, the Minister of State would be able to stand at the Dispatch Box and say, “We are actually treating this problem seriously and we are determined to defeat obesity.”
2.10 pm
Mr. Andrew Pelling (Croydon, Central) (Ind): It is important to give every opportunity to people to take responsibility for their own health, but we must also be cognisant of the important issue of stigma. It is very much the Government’s approach to ensure that no stigma is applied to the obese in initiatives to combat obesity. It is important that we recognise that many people suffer from obesity for reasons of genetics or metabolism rather than greed. It is not acceptable for us to take the approach of bullying the school fatty, or for society to hold a view that implies that obesity means slowness of gait, or of wit or mind. Recently, I was the subject of criticism by the Sri Lankan Government because I took an interest in the peace process in that benighted isle. They made many criticisms of me, but one—that I was fat—may well have some truth. That is a sign that accusations concerning size are a matter of stigma, attack and derision.
More seriously, I would like to speak from personal experience about the important dovetailing of the issues of obesity and mental ill health. I went through a period of mental ill health that coincided with significant changes in weight between 72 kg and 104 kg, which is a range of 44 per cent. I had an illness, followed by purposeful use of antidepressants to improve on my lowered weight, but we must recognise that antidepressants have an unintended effect on the weight of many of those taking them, which can have a significant effect on their willingness to continue to take them. One of the most significant reasons for non-compliance in the taking of important antidepressants is unintended weight loss.
The Government have been supportive in their provision of additional resources for mental ill health, and in my locality, we benefit greatly from the South London and Maudsley trust, which is an excellent, world-beating provider in the area of mental health. Nevertheless, there is a lack of sufficient resources to provide the counselling, advice and therapy for those with mental ill health, and for those who might need such support
in the context of deciding not to continue with their medication because of concerns about the side effects of antidepressant use.
I would like to mention briefly the way in which combating obesity links to diabetes. My local primary care trust in Croydon has undertaken important initiatives in that area, but I still believe that additional steps could be taken to identify a number of different causes and symptoms of diabetes. It is a particular curse for the large south Asian community in my constituency, and it is most appropriate that we are debating this issue just ahead of world diabetes day.
Another important link between this subject and ill health is eating disorders, which have already been referred to by other Members. They particularly affect young ladies, who can be oppressed by social and peer pressures. I was impressed by the work done by the Greater London authority. Dee Doocey, who is a Liberal Democrat Member of the London Assembly, and Boris Johnson have considered the matter, and asked whether funding should continue for London fashion week when there is such an obsession with size-zero models. Such models put pressure on many young girls and young ladies to believe that they are fat or obese when that can hardly be the case. It is fair to say that I have some doubts about my ability to be a judge in the “Miss Croydon Advertiser” contest that will be taking place this evening at House of Fraser in Croydon, but the good news about that contest is that it is about the style, poise, intelligence and attitude of real people. I know who the finalists are, and they are between sizes eight and 12. It is good to see that people recognise that there is beauty to be found in young people of all sizes, and in all of us.
I would like to touch briefly on the comments made by the hon. Member for Southend, West (Mr. Amess) about the important role of food companies, particularly as there is a great temptation in times of great economic stringency for people to buy cheaply, but wrongly—to buy food that might not be nourishing, but which is more likely to add to their obesity. Despite the rather ill-judged reputation that one company in Croydon has, I am pleased to say that Nestlé UK takes a responsible attitude by ensuring that it sells good food to its customers. It is a very good Croydon company.
We often make fun of ourselves and the Government by mocking the cross-cutting approach taken across Departments to deal with important social issues. It is ambitious of the Government to pursue proper co-ordination among Departments and between different public sector bodies. It is therefore important to see how the annual report will bear out matters next year in its measurement of providing the most effective co-ordination between Departments, and the extent to which it has been possible to inculcate an absorption policy in local authorities and local schools.
A number of Members have mentioned the importance of sports. An area of cross-cutting governmental co-ordination I find of interest is the extent to which the Building Schools for the Future programme has taken cognisance of the danger of trying to secure capital receipts and therefore compromising the provision of school playing fields. I am a former chairman of education, and it is fair to say that I have sold playing fields myself, so I plead guilty to that, but I hope that the Government are resisting that temptation.
It is also important to have joined-up government in the areas of social services and sports provision. I would like to highlight the good practice, which I am sure is being pursued elsewhere, that was taken up as an initiative by Croydon council before the Government took a more national approach. The council saw that there were significant savings to be made in social services care for senior citizens by providing free swimming. Free swimming, at little extra cost, means that many of our senior citizens enjoy a better quality of life, through more active minds and bodies. I congratulate Councillor Steve Hollands on Croydon council on making that policy judgment.
It will be interesting to note in next year’s annual report the extent to which there has been an early trend towards a fall in obesity levels. Perhaps we can also hope for some early savings and a reduction on pressures on the NHS budget as the result of Government initiatives.
2.20 pm
Dr. Howard Stoate (Dartford) (Lab): Not only the scale of the problem—the hon. Member for North-East Bedfordshire (Alistair Burt) set out the statistics well—but the speed and trajectory at which it is becoming a major disaster for Britain and the wider world are shocking. My friend Dr. David Haslam of the National Obesity Forum spoke of a time bomb; he said that there is no obesity time bomb because it has already exploded and that we are now suffering its aftermath. We are dealing with the effects of a disaster.
We have already heard about the effects of obesity, including the huge increase in diabetes. An obese person has approximately 30 times the risk of diabetes compared with somebody of normal weight. As we all know, diabetes can significantly shorten life; it causes heart disease, strokes and vascular problems, not to mention the damage to eyes, nerves and kidneys. It is a multi-system disorder, which can cause significant problems. Type 2 diabetes is almost exclusively related to obesity. It is unusual to find somebody who is not obese with type 2 diabetes—the link is that great.
We have also heard about the link between obesity and cancer. Several cancers are directly related to obesity, as are heart disease and degenerative diseases such as arthritis. Obesity shortens life and causes misery. It has been estimated that obesity can knock nine years off life. I do not exaggerate when I say that, if the trend continues, a generation of young people will pre-decease their parents. That would be the first time in the civilised world that a generation had pre-deceased its parents through non-war-related effects. The position is that serious.
We have heard about the reasons for the increase in obesity. We eat far more refined food, which, almost by definition, is more calorie-dense than non-refined food. For example, a bag of crisps has a far higher calorie density than a pile of mashed potato. People experience more problems because they eat more processed food.
One of the big debates about obesity is whether calorie intake, lack of exercise or a combination of both causes it. The obvious answer is that it is a combination of both. However, a misleading statement that we often hear from several quarters is that people are not eating more than they did. People say that because they completely ignore food that is eaten outside the home.
Mike Penning (Hemel Hempstead) (Con): The hon. Gentleman is right to say that we must examine calories and exercise, but we must also consider salt and fat, which do not necessarily fall into calorie content, but are just as dangerous and cause obesity.
Dr. Stoate: The hon. Gentleman is right about fat. Salt in itself does not cause obesity—it can cause other problems, such as high blood pressure, and it has a significantly damaging effect on health. Fat is the main problem because it is the most calorie-dense food. It has approximately nine calories per gram, whereas carbohydrate and protein have approximately four to five calories per gram. Fat is, therefore, almost twice as calorie-dense as carbohydrate and protein. Anything people can do to switch from fat to carbohydrate will reduce their calorie intake. It is difficult to determine the scale of the problem in terms of what people are eating simply because it is hard to measure what people eat outside the home. Many surveys ask what food people have eaten and bought in the supermarket, but that ignores the bag of crisps, the bag of sweets and so on.
Although we have labelling on foods bought in a supermarket, there is no such requirement for food in a restaurant. Many restaurants simply do not give information about the calories in their foods. When I tackled McDonald’s about the matter, it said that the information was available if one looked for it and that it was also on the website. However, people queuing to buy a Big Mac are not simultaneously checking the website to find out the number of calories it contains.
Some fast-food outlets and restaurants provide such information, but it is not uniformly available. If one goes out for a curry, one has no idea how much fat, salt and sugar and how many calories it contains. It is therefore almost impossible to measure calorie intake because the information for reaching a conclusion is unavailable.
Dr. Pugh: When I was a lad, school dinners were not under-caloried, if I may put it like that. There were no tuck shops in those days, but children ate an awful lot of sweets, and did not seem to get obese, which inclines me to the view that lack of activity rather than calorie intake is the principal cause of obesity.
Dr. Stoate: I hate to disagree with the hon. Gentleman, but he is wrong. People eat more calories—they can afford more food than they could in the past. There was a tuck shop at my school, but I could not often afford to buy anything from it. Food, like alcohol, has become relatively cheaper over the years and that means that it is more available.
However, it is interesting and paradoxical that obesity in this country is a disease of poverty. People who are poor are far more likely to be obese simply because poorer people tend to buy more energy-dense foods, which are cheaper—people can fill their children up for less money. The children are thus more likely to become obese.
Alistair Burt:
I am grateful to the hon. Gentleman, who has been generous in giving way. I confess to running a tuck shop when I was at school—it was part of the prefects’ duties. Before he moves from calories, will he explain why he believes that when we have a lot
of information about calories—people can find out about calorific content and the risks of food if they want—people ignore it? Statistics from the Department of Health and other sources show that. Why does he believe that so many people ignore the information and blithely go on in their own way?
Dr. Stoate: That is an interesting question, which I can answer. The Select Committee on Health, of which I am now a member, is undertaking an inquiry into health inequalities. Last week, Jamie Oliver came to talk to us about that very issue. I take issue with the hon. Member for Southend, West (Mr. Amess), who said that there were two labelling schemes—there are three. One is guideline daily amounts without traffic lights, one is GDA with traffic lights and the other is traffic lights. There are three competing schemes. I told Jamie Oliver at the Health Committee sitting last week that I did not understand the GDA system, and he said that he did not, either. I then asked, “If I’m a mother with three young children and I pick up a packet of something in the supermarket, which says, ‘This packet contains 13 per cent. of the GDA for this particular nutrient’, what does it mean?” He said that he did not know. This morning, I tackled the Food Standards Agency about the matter, and it could not give me the answer.
We must have a far more robust mechanism whereby people can receive information quickly. We have the eight-second rule in politics: if we put a letter through someone’s letter box, we have eight seconds to convey our message. That is the time it takes to pick up the letter off the floor, take it to the bin and throw it away. That is what happens to political leaflets. People probably have less time than that in the supermarket. If they are busy and trying to buy food for their kids, they pick up a bag of whatever, and think, “Yes, oven chips—in the basket.” We must forget the idea that someone can digest a range of nutritional information such as GDA percentages per 100 grams, per half a pack and so on, at the same time as doing the weekly shop with two children in tow. It cannot be done. People do not deliberately avoid or misunderstand the labelling—it is simply opaque and obscure. I have been a doctor for a long time and I do not understand it, so I cannot assume that anybody else does. That is why, frankly, the current voluntary system that food manufacturers and vendors are operating is not working. Voluntary systems did not work with smoking, and in the end we had to legislate. Voluntary systems are not working with food labelling, and we will probably have to legislate on that, too. I ask the Minister to consider that carefully in her response.
I know that time is pressing and I do not want to detain the House for too long, but we have to take robust action. We need far more robust action on advertising and on point-of-sale labelling and information, so that people have a much better idea of what they are eating and understand exactly what is in it. We must work with the food production industry to ensure that the salt, fat and sugar levels in food are lower wherever possible and to encourage it to transfer from saturated to non-saturated fats. All those things can be done, I hope not by forcing the industry, but by persuading it to do them on its own initiative.
We also need to do more for people in their communities. Many people come to see me as a GP. I am very pleased that we are now measuring body mass index as part of our quality and outcomes framework, so that we at least have records of it. In addition, the Prime Minister’s welcome announcement on vascular screening this year means that we are not only weighing a far broader section of the population, but measuring blood pressure and cholesterol levels far more.
However, it is one thing to identify people with a problem—raised cholesterol, body mass index or whatever it might be—but another to sort it out. I make a plea to the Minister for far more support in general practice, so that when we pick up someone with a problem, we have the resources to address it, instead of just saying, “Get a diet sheet from the nurse” or “Take tablets.” I do not want to go down that road. I want to ensure that we have enough information and community resources to refer people to an appropriate service where needed, whether it is a slimming club, a dietician or whatever. It is common to see obese children now, but it is much more difficult for GPs to send them down an appropriate avenue to deal with that obesity.
Obesity is a serious issue and I am pleased that the House has found time today for this debate. If we do not keep returning to the issue, it might slip off the agenda, and that would be a disaster for us all. I am therefore very pleased indeed that the Government have called this debate and that hon. Members have joined in. I am impressed by hon. Members’ information and knowledge about obesity. In other words, everyone is aware of the issue; tackling it is the problem.
We probably all agree in our hearts that obesity is down to a combination of diet and exercise. Obviously we can disagree about the exact contribution that each makes, but it would quite wrong to assume that one is more to blame than the other. Both are responsible. As a society, we ignore the problem not just at our peril, but at the peril of our children and grandchildren, because if we do not sort it out, it does not bear thinking about.
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