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Baroness Scotland of Asthal: I understand the sentiments and anxiety of the noble Lord, Lord Goodhart, which we do not share. We want magistrates to make full use of the new sentence of custody plus—with which the noble Lord has indicated that he is in agreement—up to its limit of 51 weeks, as well as to be able to impose a sentence of 12 months custody, which will be served half in custody and half under conditions in the community. Therefore, we do not wish to restrict the increase to 51 weeks as proposed in Amendment No. 161FA.

In Committee in the other place very similar amendments were tabled. A final decision on when sentencing reforms will be implemented has not been made. However, it is likely that elements of sentencing reforms will be introduced in phases over several years to allow the system to absorb new measures gradually without too much disruption and to enable the correctional services—in particular, the probation service—to reach the capacity necessary to implement them successfully. In particular, custody plus will create a large additional caseload for the probation service, which will need to be well planned so that it can deliver what is intended in a seamless way between the correctional services.

Therefore, we do not wish to be restricted by Amendments Nos. 161FB and 161FC, which would limit the introduction of new magistrates sentencing powers until the new short custodial sentences are available. Furthermore, the increase in magistrates' sentencing powers is closely tied in with the changes to allocation of offences between courts set out earlier in

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the Bill, both of which seek to encourage magistrates courts to retain more cases. We want to introduce these at the same time. Although I understand the noble Lord's anxiety, I hope that the way in which we propose introducing the provisions will meet his concerns without needing to have the restrictions proposed in the amendments.

Lord Goodhart: I am grateful to the noble Baroness for her reply. We shall consider what she said when deciding whether to bring these amendments back. Meanwhile, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 161FB not moved.]

Clause 146 agreed to.

Clause 147 [Consecutive terms of imprisonment]:

[Amendment No. 161FC not moved.]

Clause 147 agreed to.

Lord Davies of Oldham: My Lords, I beg to move that the House do now resume and, unless any noble Lord objects, that further consideration of the Fire Services Bill be postponed until after the Unstarred Question. In moving this Motion, perhaps I may suggest that we start the Fire Services Bill no earlier than 8.35 p.m.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.


7.35 p.m.

Baroness Finlay of Llandaff rose to ask Her Majesty's Government what action they are taking to tackle the threat that obesity poses to the health and well-being of the nation.

The noble Baroness said: My Lords, the World Health Organisation has called obesity a "global public health epidemic". The United Kingdom is a leader. I am most grateful to all Peers who wish to contribute today and to the many organisations concerned which have contacted me. Knowledge is ahead of policy. I call on the Government to take drastic action to improve the health of all. Obesity results from an excess of intake over energy expenditure—a simple equation. It is not just a health issue, but concerns farming and food production, food and drink marketing, transport, sport, education, employment and social security.

Obesity is when the body mass index—weight in kilograms divided by height in metres squared—is more than 30kg/m 2 . In the UK, obesity has trebled in the past 20 years. Now, more than one in five people are obese. Almost twice as many are overweight with a body mass index between 25 and 30kg/m 2 . Obesity shortens life by, on average, nine years. The Asian population is particularly vulnerable to developing

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diabetes at lesser levels of obesity. In the Afro-Caribbean population, obesity seems to foreshorten life by up to 20 years.

High levels of sugar may create an addiction-like endorphin response in the brain, making the obese person crave more sugar. High sugar foods can cause rebound relative hypoglycaemia, simulating hunger. These responses may account for the improved behaviour seen in some children when their diet is modified to exclude added sugar.

Obesity is linked to hypertension, heart disease, breast, colon and other cancers, osteoarthritis, back pain, asthma, sleep apnoea, diabetes, blindness and other conditions. But obesity, more prevalent in the lower socio-economic groups, is also related to low self-esteem and so may account for a large hidden morbidity in depression, failed social interaction and relationship breakdown.

When ill, obese people are harder to lift and, being less mobile, are at greater risk of pressure sores and skin infections. Obesity is a type of malnutrition; wounds heal poorly after surgery, particularly as the fat has very limited blood supply. If critically ill, venous access and artificial ventilation are much more difficult. The NHS is struggling as it is. Can we cope with the increased burden from obesity-induced illness? Current estimates are that obesity cost the NHS more than #2.5 billion last year, but that is rising exponentially. Many NHS staff are obese; the others avoid confronting obesity in patients, fearful of complaints and being politically incorrect.

We face 20 per cent of our NHS budget being consumed in treating diabetes and its complications by 2010. That doubling, from the current 10 per cent expenditure, represents the excess burden obesity will create as more people go on to get type 2 diabetes and develop it at an earlier age—even in childhood. Their constantly high sugar intake seems to create insulin resistance in the peripheral cells and literally exhausts the ability of the pancreas to produce enough insulin.

More than 10 per cent of six year-olds and more than 17 per cent of 15 year-olds are obese. These children are eating themselves to an early death. One in five eats no fruit, over half eat no green vegetables at all and most two to 12 year-olds eat biscuits, sweets or chocolates at least once a day. Low socio-economic status is associated with lower vitamin and mineral intake, making obese youngsters malnourished. They graze on high-sugar, high-fat and/or high-salt snacks and carbonated drinks, coupled with taking very little exercise.

Fad diets abound, offering a quick fix to obesity and profit to their proponents. Dietary change must be sustained change in input—food and drink—matched with energy output through exercise. Perversely, current food labelling is so precise about calories that it fails to be user-friendly. Many foods contain added sugar that is not identified on the label and hydrogenated fats to maintain their shelf-life. Food labelling needs to be simplified. The unit system used for alcohol is easily grasped and could be applied to

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food packets, portions, snacks and carbonated drinks. A ubiquitous unit of energy system that is simply understood would inform and educate about intake.

The consumption of fats and added sugars in the diet is increasing steadily. More people eat out, with 20 per cent of snacks and meals taken outside the home. A double cheeseburger with large fries and a chocolate milk shake would give me a staggering 90 per cent of my daily energy requirements. Portion sizes for snacks have increased. Many chocolate bars and crisp packets are actually bigger than they were in the 1980s. Not surprisingly, snack food manufacturers target the vulnerable—children—through TV advertising, collectable toys and so forth. Other links such as partner-profits from school and workplace vending machines result in subtle manipulation to promote the snack or fast food to the captive audience, completely undermining any healthy eating campaign. The placing of such vending machines in schools and hospitals truly raises ethical questions.

The UK adult population is decreasingly active. Exercise burns off excess energy and also protects against osteoporosis, which is another looming epidemic facing the NHS. The report, Sport and Active Recreation in Wales, points to a "physically illiterate" nation. The National Assembly for Wales aims to increase the proportion of under 65 year-olds taking adequate daily moderate exercise such as walking, dancing and cycling from a meagre 28 per cent today to match Finland's excellent 70 per cent by 2023.

Can we afford the increasing sickness absence—18 million days in 1998—from obesity-related problems? The Government's new Activity Co-ordination Team is part of an important strategy to improve opportunities for physical activity. Schools must go back to providing at least two hours of physical education per week. Many playing fields were sold off, yet children need activities like swimming, athletics, dance and ball or contact sports. They need space to play and to be able to learn to play together.

But that is not enough. Children must be able to travel to and from school safely on foot, bike, skateboard, roller-blades or scooter. What about a national network of dedicated cycle routes to and from every school, like bus lanes, that are cyclist-only in the morning and the mid to late afternoon? Every parent knows that the most dangerous points around schools are caused by those parents who drop and fetch children by car with flagrant disregard for any on foot or on a bike. No one will be coaxed out of a car. The routes have to be closed to cars to make them safe.

No one will stop the snacks being made and promoted, but they do not have to be sold in schools. No one will stop the computer games and TV that keep our youngsters super-glued to the sofa, but sport for youngsters and safe, car-free routes to schools will increase exercise. The excellent report, Tackling Obesity, may have underestimated the resistance to change. We cannot afford the costs that obesity poses.

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7.44 p.m.

Baroness Pitkeathley: My Lords, I am most grateful to the noble Baroness, Lady Finlay, for giving us the opportunity to debate this important issue. In my early life, I cannot remember seeing anyone who was obese. I saw a few who were perhaps a little overweight, but no more than that. But when I recall what we used to eat, that seems somewhat surprising. We ate cooked breakfasts, huge dinners, cakes, puddings and believe me, the native Channel Island food is pretty hearty. Guernsey gache, Guernsey beanjar and other specialities do not come cheap in terms of calories.

The answer was simple. We ate heartily with a fat and calorie-laden diet, but of course we also worked very hard physically. Growing tomatoes and flowers requires a great deal of physical effort. The ability to dig and to lift heavy weights was possessed by and expected from even the smallest children. No excuses could be offered, especially not the excuse of having too much homework, although I certainly tried.

No one in my family had a car and we walked everywhere. If it was too far to walk, we went by bike. If it was too far to go on a bike, I suppose that we did not go. But on an island only 9 miles long, nowhere was too far for a bicycle. However, that was a long time ago and life is very different now, as many noble Lords will no doubt remind us.

There are only two ways to tackle the major problem of obesity. The first is to change people's eating habits and the second is to encourage them to take more exercise. I should like to cite some examples of how funding from the National Lottery is contributing to bringing about some of these important changes.

First, we at the New Opportunities Fund are addressing the problem by trying to re-educate people's eating habits. In England, 65 primary care trusts have been funded to develop projects to back the Government's campaign to ensure that people eat at least five portions of fruit and vegetables a day. The areas were chosen because of their poor levels of health and social deprivation. Some #10 million has been made available by the fund to support community-based initiatives to promote the consumption of fruit and vegetables.

Our other programme is school fruit. In England, 860,000 children aged between from four to six are now receiving free fruit during the school day through a #42 million school fruit scheme. By the end of this year, 10,000 schools will be taking part. I have visited several of the schools participating in the scheme and spoken to children and their parents. Although we always assume that children want to eat only sweets and crisps, this may be because little else is on offer. It is extremely pleasing when parents report that children are now asking for apples or bananas to be included in their lunch boxes. Even a small change such as this will make a big difference to the future health of these children and their families.

The largest of the New Opportunities Fund programmes tackles the obesity problem from the other side, encouraging children to take more exercise and to develop the habit of exercise in early life. Our

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#750 million programme is focused on schools in the most disadvantaged areas of the United Kingdom and aims to provide space and facilities to give children opportunities for exercise, whether for traditional games or other activities such as swimming, dance, yoga, tai chi or any activity that gets them moving. At weekends and during the evenings, these facilities are to be open to the local community so that pupils can share activities with their families and so try to engage adults as well.

I believe that the Olympic bid currently being made has the potential to make our whole population more health-conscious and more interested in taking exercise. Example does work: notice how many more people use the local tennis courts around the time of Wimbledon. However, it is vital to give as much encouragement to community sports and activities as to the pursuit of excellence in sport. Not everyone can be a champion, but all can be encouraged to eat a little less and move a little more.

7.48 p.m.

Lord McColl of Dulwich: My Lords, I too thank the noble Baroness, Lady Finlay, for introducing this debate and for dealing so expertly with many aspects, which I shall not repeat. I remind noble Lords that in 1939, one-third of British people were either underfed or ill-fed. The introduction of rationing changed that almost overnight. It was the most amazing experiment in public health. Suddenly everyone had exactly the right amount of food to eat, but not enough to become obese. It was a high-roughage, low-fat, low-sugar regime. Because it was not like the purified junk food of today, it satisfied the appetite. The health of the nation was probably at its peak. As children we used to point the finger at anyone who was obese, because the only way they could be overweight was to be on the black market.

The answer to obesity does not lie in fancy and fad diets which insist that people have a large breakfast or that certain foods must be consumed at a certain time of the day, along with other fashions such as the Atkins diet. They have no scientific basis to support them.

The obese person needs to want a permanent change in lifestyle and to then move on to the high roughage, low fat, low sugar regime with five portions of fruit and vegetables. This has to involve the whole family. The advice of a nutritionist is of great assistance in providing a tailor-made diet for a particular person.

My advice to one obese man whose wife was the right size was that he should eat the same quantity of food as his wife. Such are the pressures of family life that he remained the same weight but she started to put on weight.

How often we hear patients say, "I am not eating anything at all, doctor, but I keep putting on weight". Sometimes they are speaking the truth for they are consuming too many calories in what they drink. Three cocktails such as mai tais contain 1,000 calories; a bottle of red Bordeaux, 700; a pint of beer, 270; a pint of orange juice, 270 calories. Alcohol is not only a poison but contains many more calories than people imagine.

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Exercise is very important for health generally but, unfortunately, it does not seem to have much to do in reducing the weight of people who are already obese. The tendency for the obese person who starts exercising is an increase in appetite. Obese people need to want a change of lifestyle. We are what we eat.

7.51 p.m.

Lord Shutt of Greetland: My Lords, I thank the noble Baroness, Lady Finlay of Llandaff, for introducing the debate. I, too, have noticed that this topic has galloped to the top of many agendas. It clearly has something to do with food and drink.

Why should I speak about this? Some 35 years ago I worked with a young lady in an office in Halifax. She is now in her mid-50s and has suffered all her life from obesity. She has contacted me in recent times and asked for help in getting her story to others. She has written up her story—more than 200 pages—and she refers not only to her medical condition but to her social conditions and the stigma that has been put on her over the years.

She has had to work out for herself how to solve the issue and undertake her own trial and error diets. The conclusion she reached for herself is that she should eat a normal diet but eat after dark. This is because she believes she is descended from a hunter-gatherer. She has passed this on to others and she believes they have been helped by it.

She prays in aid a television programme—"That'll Teach 'Em" on Channel 4—in which youngsters who were given a 1950s diet lost weight. That was the traditional diet of those days, not the fancy foods that have been suggested.

She has not been able to get the medical profession to take an interest in her story. I suspect that there are many and varied ways of tackling obesity because so many people are so different. Does the Department of Health have a system for gaining ideas and evidence from sufferers? If not, will it look at all possible solutions, including those from sufferers themselves?

7.53 p.m.

Lord Chan: My Lords, I congratulate my noble friend Lady Finlay on securing this important debate. My focus will be on children, particularly young children in Wirral who were studied by a team from the University of Liverpool and the Wirral Health Authority. I declare an interest as a non-executive director of Birkenhead and Wallasey NHS PCT, which now has responsibility for most of these children.

Researchers Bundred, Kitchiner and Buchan analysed the routine assessment of six-week-old babies and the physical examination of pre-school children aged three to four years in 1989 and in 1998. Almost 43,000 children were included and their body mass index recorded. In a population with normally distributed weights, in 1989 about 15 per cent of children would be overweight and 5 per cent would be obese. Ten years later, 24 per cent of our children were overweight—a 60 per cent increase—and 9 per cent were obese, a 70 per cent increase. These

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findings are highly significant because they are among pre-school children, showing that obesity in our young children is doubling in a decade instead of in the 20 years observed in the USA.

The risk of obesity in adulthood increases among children who are overweight above the age of three years regardless of parental weight. More than 60 per cent of overweight children have at least one additional risk factor for cardiovascular disease such as raised blood pressure, raised blood fat levels or increased insulin levels, and more than 20 per cent have two or more risk factors. In the USA, more than 30 per cent of new cases of type 2 diabetes—a disease of overweight adults—occurs in children who are obese.

Childhood obesity is associated with poverty. In the USA in the past 30 years, obesity is associated with the consumption of fast foods, pre-prepared meals and fizzy drinks.

Parents strongly influence the food intake and activity of young children. Breast-feeding seems to lower the risk of obesity. Children who eat meals with their family consume more fruit and vegetables, fewer fizzy drinks and less fat in food both at home and away from home. Television advertising of food directed at young children may help explain why reduced TV viewing reduces rates of weight gain.

Opportunities for spontaneous play, particularly outside the home, will increase the physical activity of young children and also reduce the amount of time they watch TV. For this to become common again in our communities, the safety of children has to be improved by better play equipment and supervision to prevent adults who prey on children having access to them.

Will the Minister support families living in poverty through reliable information and practical help to feed their young children with health-promoting food, both at home and in schools? Should we not improve their environment so that children can play in safety and remain healthy?

7.57 p.m.

Baroness Rendell of Babergh: My Lords, I am grateful to the noble Baroness, Lady Finlay of Llandaff, for introducing this much-needed debate.

It has been said that when the United States sneezes the rest of the world catches a cold. To put it more appositely, when the United States overeats, or eats unwisely, the rest of us, particularly the United Kingdom, it seems, put on weight.

By 1996, Americans were spending 40 per cent of their food expenditure on meals eaten away from home. A child who never eats at a fast-food restaurant and does not eat fast food at home averages an intake of less than 2,000 calories a day, while one who eats fast food three or four times a week consumes 2,700 calories a day.

The Soil Association report released today shows that children in our schools are fed largely processed food, laden of course with fat and sugar, and twice as much is spent on prison meals than on school meals—approximately 60p per meal per head against 30p.

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Combined with, in some cases, a total lack of exercise, this is leading to obesity in our children. They watch television to an excessive extent and are taken everywhere by car, partly due to the perhaps quite natural reluctance on the part of parents to allow them to walk to school and back for fear of the danger on our streets.

Obesity, as we have heard, is not merely disfiguring and exhausting to the sufferer. In the United States physicians have seen the phenomenon of a 15 year-old dying from an enlarged heart. Osteoarthritis of the knee is another likely result of gross overweight, as is type 2 diabetes, leading to the chance of gangrene and sometimes amputation, retinal damage and possibly to blindness. A study at the University of Arizona has shown that obese girls between the ages of six and 11 were seven times more likely to develop asthma than those of normal weight.

To redress the apparently relentless slide towards widespread obesity, steps will have to be taken. It is not enough continually to warn us of the consequences of excessive fat and sugar consumption.

Two areas spring to mind in which some control should be exercised. For a start, some form of restriction should be exercised in the matter of fast-food brochures from local restaurants and manufacturers. At least one of these is put through my front door every day of the year. One recently was the real thing—a vacuum-packed slice of deep pan pizza. Children pick up these fliers and samples and are of course more affected by them than their parents are. Supermarkets should be discouraged from placing sweets and chocolates by their checkouts specifically to tempt children queuing with their parents. Sweets, chocolates, crisps and fizzy drinks might carry health warnings along the lines of those on cigarette packets to alert parents, if not children, to snacks that can damage health. My noble friend Lady Pitkeathley outlined the schools' fruit scheme. Bananas and apples at supermarket checkouts, instead of sweets, might not be too unrealistic a concept.

Finally, we might have a campaign that explains that healthy eating itself leads to weight loss. As the noble Lord, Lord McColl, pointed out, there is no need for diets, fashionable fads or regimens; healthy eating may be effective on its own.

8 p.m.

Lord Moynihan: My Lords, the World Health Organisation recently stated:

    "Obesity is the dominant unmet global health issue, with western countries topping the list".

Children are most at risk from obesity, and 15 per cent of all British citizens under 15 are regrettably overweight or obese. It is a long time since the initiative successfully advocated in the early 1960s in America by President Kennedy, who stated:

    "We do not want our children to become a nation of spectators. Rather, we want each of them to be a participant in the vigorous life".

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Regrettably, many of those initiatives, which were copied here, are no longer to be found. Sadly, we, like the Americans, have moved away from a culture of broadbased participation in physical education and sport to fitness as an individual pursuit.

In Fat Land, Greg Critser says:

    "Unlike the old P.E., where group participation and peak performance were goals, the underlying premises of the new fitness boom were individualistic and medical. The risk of private gyms and celebrity exercise videos was a natural outgrowth. One exercised for specific ends. Many are, of course, purely cosmetic ends. Others are health-based . . . people exercise to 'reduce health risks' or 'feel better about oneself'".

Regrettably, in the States and to a great extent here, as Critser says,

    "the new unspoken truth was simple . . . fitness was to be purchased, even if you were a child".

There are major challenges for our sedentary society, a society that too often does not believe that it has time to exercise and where too often television and the gameboys eat away time that is better spent participating in sport and recreation. In 1999, French exercise scholar Jean-Francois Gautier wrote:

    "Children are naturally very active, but their parents are restraining them. Children are only allowed to be physically active if adults decide it is appropriate".

That is our duty. That is the point that I would make to my noble friend Lord McColl—we need to focus on children to prevent obesity.

What should we do? We should consider a more comprehensive system of fitness testing for all our children—first and foremost for medical reasons but, secondly, to identify talented young sportsmen and women within a universal framework. That should be radical, new and far reaching, and include clubs, schools, local authorities, governing bodies and government. We must minimise the element of luck in our policy for developing young sporting talent while, simultaneously, we must encourage an awareness of diet and the value of fitness among our young people to prevent obesity in the future.

8.3 p.m.

The Countess of Mar: My Lords, I am grateful to my noble friend for introducing this debate tonight for very good reasons. Looking at the list of speakers, I note that, with one exception, none of them could be described as obese. Indeed, I doubt that any of them could be described as even overweight. The exception is me, but I can assure your Lordships that I will soon be joining your ranks.

A few months ago I started to get very painful knees. I went to see my GP, who offered me painkillers. I am what might be called a non-compliant patient. As I was leaving, the doctor congratulated me on remaining a non-smoker and asked whether I had gained the statutory stone as a result. "Yes", I said, "and the rest". As I drove home, I realised that he had planted a seed in my mind. I resolved to be kind to my knees.

I visualised 14 kilo bags of sugar, for that is the amount of excessive weight that I was carrying. No one with any sense would spend all day carrying that amount of sugar, would they? That was in June. I have

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now dropped 12 of those bags of sugar, and I still find it hard to believe the side effects. I have no more pain in my knees. My breathing has improved enormously, I am full of energy, and no longer feel tired without good reason. I am comforted by the thought that my not entirely healthy cardiac system does not have to work as hard as it did although, with the extra energy, it is now being healthily exercised. I am delighted that I will be saving the NHS huge amounts of money. There is also the added bonus in that I am able to get into clothes that I have not worn for years.

My husband, who was also carrying rather too much weight, saw how well I was and has lost all of his excess. The noble Lord, Lord McColl, said that we should involve the family. We both used the much-maligned Atkins diet and we intend to stick to the principles for maintaining our weight outlined by Dr Atkins.

We all have different metabolic rates, different tastes and purses of varying depth. It does not matter what diet the overweight adhere to as long as it works and they do not get into the vicious cycle of feast followed by famine. We get fat because we regularly eat more food than our bodies need for repair and energy. What we who tend to grow outwards need is the motivation to lose weight. Perhaps we need more GPs like mine.

8.6 p.m.

Baroness Greengross: My Lords, I welcome the debate, and should like to congratulate my noble friend for introducing it.

As we have heard, adult obesity rates have tripled in 20 years, and the National Audit Office estimates that the average obese person pays for their obesity with nine years of their life. We do not always recognise that obesity is as lethal as tobacco smoking, but we really need to do so.

I often speak in this House about the tremendous implications of rising longevity for our society as a whole. Today is one of those rare occasions when the issue provides the potential for a reduced lifespan rather than a longer one. Some of today's young people may well not live as long as their parents, just at the time when many other young people can expect to live longer than ever before.

What will be the impact on health inequality of the obesity that is growing among us? Will those inequalities be made worse by it? I believe that they may well be. On Wednesday this week, the International Longevity Centre in this country will be considering, in a conference, young people's attitudes to the new longevity and how they will cope as a minority among older people. It is also important to look at this issue from a whole lifecourse perspective. One of the speakers at the conference will be Howard Stoate MP. I pay tribute to the huge amount of campaigning that he has undertaken on this issue.

In America the International Longevity Center has also done much work in this area. Its president, Dr Bob Butler, distributes pedometers to encourage

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people of 50 and over to walk. He asks people to take 10,000 steps every day—that is about five miles. Perhaps we ought to do the same here.

What the WHO has termed "globesity", as we have heard, must be checked. An article in The Economist of 27th September stated that the "obesity industry" is "big business", for example, hand-held computers at restaurants calculating calories and fat in food, not the bill! However, it is not a solution for pharma and biotech companies to find a "cure" for obesity or to discover ways to mitigate the effects of over-eating; we need to tackle the underlying causes. That is why the role of government in issuing public health messages, and the kind of initiatives that the noble Baroness, Lady Pitkeathley, outlined, are important. They have done a great deal to promote healthy eating. However, more could be done to pull all this work together—especially work between the Department of Health and the DfES—for example, the report that has been mentioned about the quality of school food which describes it as "muck off a truck", better food labelling, more PE at school and consideration of a ban on advertising directly to children, as has occurred in Sweden.

In conclusion, we must take a lifecourse approach. As Howard Stoate said in another place,

    "wrong lifestyle choices during childhood and adolescence can prove devastating in later life".—[Official Report, Commons, 22/1/03; col. 130WH.]

We all want disability-free later years; obesity can render that impossible and condemn us to a later life riddled by disease and pain. It must be checked.

8.10 p.m.

Lord Rea: My Lords, my noble and professional friend Lady Finlay has chosen a topic that is very much in the news. The large number of speakers, reducing each of us to a mere soundbite—though a very wise one—is an indication of its importance. The initiatives taken already by the Government are well described in the evidence of the Department of Health to the House of Commons Select Committee on Health, which is at present inquiring into this very topic.

So far, however, the evidence is that despite these worthy government initiatives, the epidemic is relentlessly and steadily increasing. I suggest that, apart from the fact that changing people's dietary habits and lifestyles is a long-term task, like altering the course of a 100,000 tonne tanker, the Government's efforts are being undermined by a skilful barrage of influences persuading people, particularly children, to go in the wrong direction nutritionally. The importance of getting children on to the right track is that childhood habits persist into adult life—I echo the noble Baroness, Lady Greengross—as does the likelihood of suffering from the chronic diseases associated with obesity.

The Jesuit saying—forgive me if I have it wrong—goes:

    "Give me the boy and I will give you the man".

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I think that there are several other versions of that saying, but that is the most succinct. If anyone doubts the importance of getting children on to the right path early—and here I am talking about healthy lifestyles rather than a particular approach to the deity—I recommend that they read A Lifecourse Approach to Coronary Heart Disease Prevention to be published by the National Heart Forum next week, the outcome of its three-year Young @ Heart programme. Here I declare an interest in giving this plug because I am honorary secretary of the National Heart Forum. I am sure that the Department of Health will pay attention to that publication, not least because it substantially funds the National Heart Forum.

This lifecourse approach is why the research review on food advertising to children, commissioned by the Food Standards Agency and published two weeks ago, is so important. It is a very careful, wide-ranging and systematic study. The authors, based at Strathclyde University, reviewed every relevant study published in English throughout the world since 1970. It reached the following summary conclusions. First, there is a lot of food advertising to children—measured, not simply anecdotal. Secondly, the advertised diet is less healthy than the one recommended by the Department of Health. That, of course, is an understatement typical of the modest style of the whole report. Thirdly, children enjoy and engage with food promotion. Fourthly, food promotion is having an effect, particularly on children's preferences, purchase behaviour and consumption. This effect is independent of other factors and operates at both brand and category level. The report continues,

    "This does not amount to proof of an effect, but in our view does provide sufficient evidence to conclude that an effect exists. The debate should now shift to what action is needed and specifically to how the power of commercial marketing can be used to bring about improvements in young people's eating".

I hope that the FSA and the Government, when they come to give their response, will decide to take firm action to achieve that final aim, even if that means tighter controls on the food and advertising industry which may require regulation and legislation. Only in that way are we likely to turn the corner in tackling this unpleasant and dangerous epidemic. It will not be sufficient to rely on voluntary agreements, as we found to our cost with the tobacco industry over many years. There are many working in the food industry who would welcome such regulation, since it would require them to use their promotional expertise to market healthy alternatives and it might avoid the looming danger of possible litigation against the industry.

8.14 p.m.

Lord Clement-Jones: My Lords, this has been an excellent if rather over-snappy debate, I suspect. The noble Baroness, Lady Finlay, has set out the obesity crisis extremely well. What can we do about it? First, we can encourage children to take more exercise. In that context, the Government's local exercise action pilots—designed to give all school children two hours of sport per week—must be welcomed. By 2006, 75 per

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cent of all school children should have two hours of sport per week. Presently, only one secondary school child in three is achieving that. However, let us not stop at two hours per week; that is not particularly ambitious. In Sweden, school children are involved on average in 10 hours of sport per week. So let us not over-congratulate ourselves.

Diet is the second issue. The Government certainly need to do more on this issue, particularly with schools, to promote a balanced diet and healthy eating and to counteract the weight—as the noble Lord, Lord Rea, mentioned—of advertising by food manufacturers of what are often sugary and fatty foods. The average 11 to 16 year-old is eating fewer than 13 portions of fruit and vegetables per week. Consequently, we must welcome the national school fruit scheme and the five-a-day programme. However, as the noble Baroness, Lady Rendell, pointed out, we are not doing very well in mainstream nutrition. The Soil Association's report today showed that prisoners are eating more nutritious food than school children.

Thirdly, we need proper food and exercise education in schools. A survey by the Doctor Patient Partnership found that one quarter of children eat sweets and crisps for breakfast. What we want, as the noble Baroness, Lady Pitkeathley, described, is some really good projects in schools. Recently, I came across a project developed by Linda Dawson called "Poppy and Co" which is designed to educate children positively on all aspects of food, fitness and the psychology of eating. I hope that that type of project can become part of the national curriculum and aim particularly at key stage 1 and 2 children.

Fourthly, a particular responsibility of government must be to ensure that children do not receive mixed messages in schools. Particularly unhelpful, I thought, was the endorsement by Richard Caborn, the Sports Minister, of the Cadbury "Get Active" programme. Questioning of an Education Minister in this House on that subject elicited the response that that is a,

    "good example of a carefully crafted corporate social responsibility initiative".—[Official Report, 7/4/03; col. 10.]

I disagree.

It is hardly surprising that in these circumstances there is a call to ban advertising of junk food for children and for health warnings to be placed on crisps and sweets. Three-quarters of children's television advertising is for food, and 95 per cent of those advertised products are high in fat, sugar and salt. Like the noble Lord, Lord Rea, I very much welcome what the FSA is doing on this subject and the review by Gerard Hastings and others at the University of Strathclyde. I very much look forward to their conclusions and recommendations to government. We then need a Europe-wide solution to the question of children's advertising of food.

Finally, we need more training for doctors, practice nurses, health visitors, midwives and school nurses who have a direct interface with parents and school children in this area. That is extremely important.

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8.18 p.m.

Lord Skelmersdale: My Lords, I shall not repeat the horrendous figures that the noble Baroness, Lady Finlay, gave us in her excellent introduction to this debate. Suffice it to say that the Government have come very late on to the scene and we are now faced with a tidal wave of obesity threatening an epidemic of secondary diabetes, to say nothing of more strokes, heart attacks and a host of other medical conditions. Unless we can crack it, the NHS will be swamped. Noble Lords are quite right. The reason for obesity is simple: too many calories ingested and not enough expenditure thereof.

So how can we change people's habits? The Opposition's position is that it all comes down to education, and that means education at all ages and positions in work and in society. At government level, we intend when in office to create a public health commissioner to highlight problems across government departments. Education and sport are obvious examples, but less patent are the responsibilities in home affairs, work and pensions, trade and industry and the NHS, as the noble Lord, Lord Clement-Jones, has just said. The Prison Service has been mentioned and even Defra should be involved, with its sponsorship of country parks.

At the other end of the scale, education starts in the home. Every parent conducts potty training, presumably because to neglect this means more work for the parent. Would that we could say the same for diet training. Frequent answers to, "I'm hungry, Mummy" are, "There's a biscuit in the tin" or "There's a sweet in the jar" rather than "There's an apple in the bowl"; or, as my noble friend Lord Moynihan, whose comments on sport were most apt, might say—although I have not asked him—"Dinner's nearly ready. Where's that skipping rope Aunt Ethel gave you for Christmas?". Anything for a quiet life, I suppose. There is a lack of any thought by parents, who themselves were not educated in this when they were at school.

What is the Minister's answer to this? Indeed, what are the Government doing about the time bomb of obesity in general? The Health and Social Care (Community Health and Standards) Bill will start its grind through the Committee stage in your Lordships' House tomorrow. It seeks to reform and replace the wartime welfare food schemes. The extension of the provision of tokens for milk and vitamins to mothers and their children under five to include fruit, vegetables, cereal-based food, and so on, is clearly welcome. So, too, if my understanding is correct, is the extension of the scheme to families with children on means-tested benefits. That is all very well, but the Government do not appear to have grasped the problem in the rest of the population. Do they know—indeed, will the Minister tell us—what proportion of these children suffer from being overweight, compared with those not on means-tested benefits?

The health action plan mentioned by the noble Baroness, Lady Rendell, may well seek to promote healthy eating, but will it actually work? Based on our

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experience so far of changing people's eating and health habits, the prognosis is not good. To my mind, the most effective long-term solutions are the various initiatives in schools to improve the diet for the children including, as has been said, the five-a-day programme, to increase intake of fruit and vegetables.

Regrettably, my time is up, but the basic question we must ask, to misquote Professor Higgins, is, "Why can't the English teach their children how to eat?"

8.22 p.m.

Lord Warner: My Lords, we are all grateful to the noble Baroness, Lady Finlay, for raising this important issue of action on obesity today, and for her excellent analysis.

The Government take this issue very seriously indeed. How could we not, when the Chief Medical Officer has described obesity as a veritable health time bomb? I welcome also the attention being given to obesity by the Health Select Committee. I will attempt to persuade the noble Lord, Lord Skelmersdale, that we have a strategy for tackling the problem.

The latest health survey for England shows that around 22 per cent of adults—over a fifth of the adult population in the country—are obese. Studies also suggest that obesity is increasing in children, as many noble Lords have suggested. Many children eat more than the recommended levels of fat and sugar. Obesity is responsible for 6 per cent of all deaths, compared with the 10 per cent that are caused through smoking. I must point out to the noble Baroness, Lady Greengross, that obesity is not quite as lethal—yet—as smoking. It costs the NHS and the wider economy at least #2.5 billion a year.

The UK is not alone in experiencing a rapid increase in obesity. Virtually every developed country has shown increases in obesity over the past two decades. Having just come back from a holiday in the USA—weighing, I should add, less than when I went, all due to the Warner diet—my unscientific observation is that the US literally has a bigger problem than we do.

I want to emphasise that the Government are committed to tackling the problem of obesity in terms of both prevention and management. We have a range of measures in place or in prospect across health priority areas. Many of the initiatives I will outline are in England, but I am aware that substantial action is also being taken by devolved health departments across the United Kingdom. I can assure the noble Lord, Lord Shutt, that these initiatives are based on the evidence of individual experience.

Of course, the Government recognise that prevention is the best long-term approach to dealing with obesity, particularly in children. We know that the increase in the number of overweight and obese people is most likely to have been due to adverse changes in lifestyle, as the noble Lord, Lord McColl, and others have suggested. We know that the majority of people in the United Kingdom do not adhere to sensible recommendations on physical activity. Only

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four out of 10 men and three out of 10 women undertake enough physical activity for it to be beneficial to their health.

Furthermore, more than 50 per cent of adults have high fat intakes, between 40 per cent and 50 per cent have high intakes of added sugars, and around only 15 per cent eat the recommended five portions of fruit and vegetables each day. Government action, therefore, focuses on improving the overall balance of the diet and increasing physical activity levels.

We also recognise that the opportunities that people have to develop a healthy lifestyle may be influenced by their environments. For example, some communities do not have easy and ready access to affordable fruit and vegetables, or pleasant open spaces to walk and play in. As the noble Lord, Lord Chan, said, the link between poverty and obesity is strong. Therefore, much of the action that we are taking seeks to improve access to healthy choices. We have to recognise, however, that it is not always easy to persuade people to change their lifestyles when attractive influences, including advertising, point them in other directions. Accusations of state nannying are all too quickly used to describe sensible public health messages.

Two new initiatives will be key in fostering healthier lifestyles. The Department of Health is leading on the development of a cross-government food and health action plan. It will pull together the issues that influence what we eat and will address food production, manufacture and preparation, access to healthier food choices, and providing information for consumers about healthy eating and nutrition.

In terms of promoting physical activity, the DCMS Game Plan strategy will lay the foundations to deliver the Government's sport and physical activity objectives. Through Game Plan, the Government aim to increase participation significantly in sport and physical activity, and to reflect the significant health benefits that people can enjoy by participating in such activity. We accept many of the arguments put forward by the noble Lord, Lord Moynihan.

A cross-government activity co-ordination team, jointly led by the Department of Health and the DCMS, has been established to take that work forward. As a former chairman of the London Sports Board, I assure noble Lords that the work is not only about more Olympic champions, although we would all like more of those; it is about driving up physical activity participation rates, particularly in some of our most deprived communities, through concerted action at a national level and better local partnerships. From my experience, I can say that the need for better local partnerships, particularly in London, is a major issue.

We recognise that tackling obesity is not a job for a single government department in isolation. Joint Food Standards Agency and Department of Health work with industry is particularly relevant. A current priority area is our work with industry to reduce salt levels in processed foods, in order to reduce salt intake across the United Kingdom. Discussions on fat and

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sugar levels in food will follow. It is clear that not nearly enough progress is being made by the food industry, and average salt intakes have actually increased since the 1980s. We have to do better.

We are holding an industry stakeholders' meeting later this month to discuss further action that can be taken. The Food Standards Agency is also addressing the issue of consumer understanding of food labelling, including tackling confusing claims and advertising, such as "fat free". I am sure that it will look carefully at the thoughtful ideas of the noble Baroness, Lady Finlay, on the issue.

Our action on obesity addresses all stages of life. Prevention starts at birth. Breast-fed babies may be less likely to become obese later in life than formula-fed babies, and breast-feeding may also help their mothers return to their pre-pregnancy weight. As around only 70 per cent of women breast-feed at birth, we want to increase the proportion of babies breast-fed at birth by two percentage points each year over the next three years.

We are moving ahead on commitments to reform the Welfare Food Scheme under the Health and Social Care (Community Health and Standards) Bill. I hope that noble Lords will support those changes, which will impact on at least 800,000 mothers and children. Our Healthy Start proposals will ensure that children in low-income groups have greater access to a healthy diet, as well as providing increased support for breast-feeding and wider parenting issues.

We know that increased consumption of fruit and vegetables not only helps to reduce risk of heart disease and some cancers, but may help the maintenance of a healthy weight. As the noble Baroness, Lady Pitkeathley, said, as part of the five-a-day programme to increase access to and intakes of fruit and vegetables, the New Opportunities Fund has provided #10 million in funding for community initiatives targeting more than 6 million people in England. Community initiatives such as provision in local shops, setting up food co-ops, local campaigns and initiatives in school and workplace canteens have previously been shown to result in the lowest consumers of fruit and vegetables increasing their intakes by around one portion a day. This may not sound a lot, but this level of increase can lower blood pressure and reduce the risk of stroke and heart disease.

Providing consistent messages to children on healthy lifestyles is vital. I assure my noble friend Lord Rea that we will carefully consider the Food Standards Agency's recently published thoughtful review on the promotion to children of foods that are high in fat, sugar and salt and assessing the policy implications. We strongly encourage the industry to act more responsibly when promoting to children foods that could have health risks.

A range of action, already implemented in schools, aims to encourage a healthy diet, increase physical activity and provide consistent messages to pupils. For example, the NOF is providing #42 million to expand the national school fruit scheme. More than 800,000 children in four regions are currently receiving free pieces of fruit and the scheme should reach all four to

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six year-olds in England by 2004. Here I want to pay tribute to the work done by my noble friend Lady Pitkeathley and her colleagues at the NOF.

Other activities include the development of national nutritional guidelines for school meals, the Food in Schools programme and the National Healthy Schools programme, in which two-thirds of schools are now involved. I recognise that there are still concerns about school meals, but the Food Standards Agency is working with the DfES to look at how standards in schools are operating.

Increasing levels of physical activity, particularly among children, is a key priority across government and substantial investment has been made to date. For example, #459 million is being invested by DfES and DCMS to transform physical education, school sport and club links over the next three years. The work with clubs is important in giving many more people access to physical activities and sports. This programme is already proving successful, with 220 school sport co-ordinator partnerships now operational.

We inherited a situation where many school playing fields had been sold off, but we remain committed to preserving them. Last year, we published new planning guidance for open space, sport and recreation.

It is essential that we increase levels of physical activity for all ages across the population. In partnership with Sport England and the Countryside Agency, we have set up a programme of nine local exercise action pilots to test community approaches to increasing physical activity among priority groups. For example, Great Yarmouth primary care trust is working with a range of partners, including its local council, education action zone and a private leisure company to deliver weight-management, walking and community outreach programmes.

Finally, in addition to the action I have outlined, primary care has a particularly important role in the prevention and management of obesity. Local action is being delivered through national service frameworks and the priorities and planning framework, which specifically addresses obesity.

In a new project, the NHS will distribute 10,000 pedometers, already used in the USA, to primary care trusts in areas of high deprivation as a motivational tool to encourage increased walking. The National Institute for Clinical Excellence, in conjunction with the Health Development Agency, is developing guidance on the prevention and management of obesity. This will supplement the NICE guidance already available on surgery and prescribing of obesity drugs Orlistat and Subutramine. Guidance is also available on exercise referral and identifying and treating children suffering obesity.

This has been a good if slimline debate on a critically important subject. I have tried to pick up the concerns of many noble Lords. I hope that I have assured the House that the Government are committed to reversing the current trend of increasing overweight and obesity. Even with the action being taken, we are far from complacent because success depends on

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people changing their lifestyles in large numbers. The Government will continue to keep under active review what further action can be taken.

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