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Famous chefs may not thank me for saying this but I think cooking is not difficult. Certainly, following the many recipes you find in women's magazines and even newspapers is not too difficult. I cooked a soup from the weekend Guardian on Monday. I think the Sainsbury's Magazine in particular has done a fine job in showing that cooking can be easy, fun and accessible, and I would point out that you do not have to shop at Sainsbury's to read it. These magazines, if the recipes for family meals were followed, would certainly save a great deal more than their cover price for the family budget. In these times of recession, many magazines have concentrated on economical cuts of meat and other cheaper but nourishing ingredients. I think that it is more a matter of confidence than ability when people say they cannot cook. So how do we get over that?

We must certainly teach children to cook in school. How are the Government getting on with their pledge that every child will learn to cook? I heard an excellent programme on Radio 4 last week about school food. It talked about one particular school where the 11 and 12 year-olds were actually helping in the school kitchen to cook school lunches and food for the breakfast club. The health and safety issues had been overcome and the idea was being rolled out across the county. The cook was running after-school cookery clubs for parents, showing them how to make some of the dishes that were most popular with the children. There is now, I am pleased to say, a lot of this sort of innovation in schools. School dinner ladies and gentlemen have vastly improved their skills, and facilities have improved enormously under the Building Schools for the Future programme.

It is five years since Jamie Oliver, inspired by a particular dinner lady who has now taken a national role, called attention to the state of our children's school food, and enormous strides have been made since then. I pay tribute to him and the school caterers, the School Food Trust and the many schools that have put their minds to improving their food and attracting more children to choose it over packed meals. Mind

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you, there is nothing at all wrong in principle with a packed meal as long as it is healthy and balanced, though I would much rather have a hot one in this weather.

The advantages of children taking school meals are many. Apart from the new criteria on quality, balance and nutritional content, which are difficult to achieve in a packed lunch, they learn to socialise when eating, which is what they will do for the rest of their lives. They learn table manners and about green issues, such as food miles and GM, and about the food culture of other cultures, and, in the best schools, they are encouraged to be adventurous and try a little of something they do not get at home. There are lots of good reasons for making school food attractive to children so that they will choose it.

Some schools encourage children to bring in recipes that their parents cook at home. Some that have the space have started a school garden where the children grow fruit and vegetables and then cook and eat them. I heard about one school that displayed its very first lettuce from the school garden with such pride on the counter at lunchtime that I am not sure if anyone ate it. I understand that pride. My husband often laughs when I come in from the garden proudly laden with my own produce-he laughs and then he eats it. Unfortunately, many schools do not have the open space to enable them to grow food. Does the Minister know of any scheme whereby other land such as a free allotment might be made available for a school that wanted it?

Of course, many of us these days are so busy that we rush our food. There is a great danger of that in schools as well, since there is a limited time for lunch and hundreds of children to get through the system. It presents a great logistical problem. However, I am very concerned about one particular solution to this: the biometric solution whereby children are fingerprinted and pass through the till by putting their finger on a screen that then deducts the cost from the balance their parents have put into their account. Some schools have done this without asking or even telling the parents, and I feel that it is an infringement of the child's privacy. I have every sympathy with the need for a quick cashless system but I feel that a personal bar code would be more acceptable. Of course a cashless system also has the advantage of lacking stigma for those children on free school meals, but there are other ways of doing that.

There are also lunchtime clubs to which children want to rush off so they hate queuing in the dining room, which is an enormous challenge for the caterers. This is one of the most frequent reasons given by secondary-age pupils for not having school meals. The trouble is that their solution is often not a packed lunch but whatever they happen to buy at the nearest supermarket or fast food outlet.

That is why education for the pupils themselves about the importance of a healthy diet is vital for preventing obesity. In the end it is the child who will choose his food, but I strongly support those head teachers who make it a school policy that children do not leave the premises at lunchtime, particularly because of the social problems that it often causes in the

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neighbourhood when hordes of teenagers descend on the local chip shop. I realise that I will not make myself popular with the managers of chip shops by saying this.

As long as the school meals offer is attractive, good value and of high quality, and there is an option of a packed lunch, I see no reason why such a policy should not be enforced. Therefore, it is important that as many children as possible take school meals, now that they are usually of good quality. Price, of course, is an issue for hard pressed families. I am sure that you can put together a filling packed lunch more cheaply than a school lunch, but it may not be as nourishing. Only this week, the School Food Trust has suggested that schools should offer discounts or special offers on lunches for a limited period to encourage children to try school meals, just like a January sale. The trust says that such a move would dramatically increase take-up of healthy school meals as demand for school food is more sensitive to price changes than other foods. Research by London Economics has estimated that a 10 per cent increase in the price of school meals can lead to a fall in take-up of between 7 and 10 per cent. The trust adds that areas where discounts have been offered have successfully boosted demand. A three-week period of discounts in 2009 in York and Waltham Forest increased take-up by 22 per cent and 10 per cent respectively according to an analysis of the relationship between school meal take-up and prices.

I accept that it can be very difficult for caterers to keep quality up and prices down. However, there have been interesting experiments whereby local councils have made school meals available free to all pupils, not just to those who qualify for them. This increased uptake terrifically and, I believe, improved school discipline and learning, but it is hard for a council to offer such a programme in these constrained days. However, the results showed that the outcomes were very beneficial to both behaviour and learning. Do the Government have any plans to do their own experiments along these lines in order to inform national policy?

I end by giving your Lordships an example of what can be done given the will to do it. I found this case study, and many more interesting ones, on the School Food Trust website. In 2004, six Liverpool primary schools identified the need to improve the quality and choice of their food, so they set up a not-for-profit consortium called Food for Thought, an apt name given that children's ability to learn has often been reliably shown to be affected by what they have for breakfast or lunch. They brought in lots of partners including the local authority and the local Sure Start programme and invested their delegated budgets in it. Within a year they were delivering meals in all six schools, replacing processed food with homemade dishes from fresh locally reared and sourced ingredients. Meal prices remained fixed and were cheaper than the meals at other schools provided by the city council. Menus run on a six-week cycle, subject to pupil preference and the seasonal availability of produce.

Staff rotate across the schools and share best practice. Children are encouraged to experiment and get a more varied diet than before. They have open days when parents can come in and try the food with the children,

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and they are pleasantly surprised. Local NHS staff deliver training and taster sessions for parents, teaching them about diet and nutrition. They also have small groups of children helping in the kitchen to prepare the food. The result was a 67 per cent increase in uptake in one school and big improvements in the others. Children enjoy their food and look forward to it. Their director, Mike Carden, says:

"The solution to healthy food is to develop a service that actually cooks its own meals. It is only by adding value to fresh vegetables, meat and fish in the kitchen that real costs and real quality can be managed effectively".

I quite agree with him, especially in these days when, for so many families, cost is a real issue. We are what we eat. It is only by cooking from basic ingredients that you can feed a family on a tight budget, so we owe it to our children to teach them how to do it and to make sure that our schools have the facilities to do that.

2.34 pm

The Lord Bishop of Bradford: My Lords, I thank the noble Lord, Lord Pendry, for calling for this debate on childhood obesity. Your Lordships may think that I speak simply as an act of confession. My robes hide the fact that I suffer from central adiposity; in other words, I put on weight around my middle and therefore carry an increased risk of type 2 diabetes and cardiovascular disease, and when I look round the Chamber, I see that I am not the only one. Therefore, the topic for debate is close to home.

Obesity in this country has reached epidemic proportions and the trends in childhood obesity are so serious that we now expect life expectancy to be shortened by its knock-on effects. The cost to the economy is predicted to be £45 billion a year by 2050. The second reason why this debate comes close to home for me is that Bradford has a higher rate of obesity among children than the national average, and standards of healthy eating and physical exercise are among the lowest in the country. I suggest that in the battle against obesity we are focusing, so far at least in this debate, far too narrowly and that we are starting too late in a child's development. The message-I know that we want a message which is easy to understand-seems to be to children, and, yes, through their parents, to take more exercise, give up junk food and eat their five fruit and veg. It is an important message but it only goes so far. I asked my daughter, who is a paediatrician, what one thing she would like me to say in the debate. She said, "Educate the parents. Don't put blame on children for things they can't control. Get parents to think about what they want their children to be like as grown-ups".

The obesity epidemic has come about through a change of lifestyle: the availability of energy-dense foods; the plethora of fast-food outlets; use of microwaves; pre-prepared meals; decline in cooking skills; the fact that families do not eat together but graze on their own; and the decline in physical activity. These have been mentioned by previous speakers. Is it not ironic that there is so much sport and so many cookery programmes on television but we are so busy watching them that we do not exercise or eat properly? But these

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are lifestyle choices and they are adult choices, not children's choices. They are choices that adults make for their children.

Chronic stress leads to obesity as well. First, our bodies respond to stress by depositing fat around the middle rather than on the hips and thighs. Secondly, we turn more and more to comfort foods. Three years ago the Sun newspaper had a feature on child obesity. One child gained 15 stone in five years after his parents divorced. The stress is caused by the parents. In poor countries obesity is a disease of the rich but in the developed world it is a disease of the poor, as the noble Lord, Lord Pendry, noted. Wilkinson and Pickett, in their book, The Spirit Level, argue that this is more about relative wealth and poverty than actual wealth and poverty. They compare the Netherlands, a comparatively equal society where 7.6 per cent of children aged 13 to 15 are overweight, with the United States, the most unequal of rich countries, which has 25.1 per cent overweight. They also note that when the Berlin Wall came down and inequality increased dramatically in what had formerly been East Germany, there is evidence that the social disruption led to an increase in the body mass index of children as well as adults, although this could, of course, have been due to stress as well as to the greater disparity between wealth and poverty.

Poverty itself restricts choice. Some poor people do not simply have access to the nutritional foods recommended in the Sainsbury's recipes in the same way that most of us do. I could take you to a large council estate in Bradford where there is no greengrocer. There is nowhere for the people to buy their five fruit and veg which we would not be without. The local vicar saw the problem so he went to the wholesale market every week early in the morning, bought the fruit and veg and sold it in the church hall to everybody who came to the various clubs and so on. This enterprise has grown to such an extent that the wholesaler now delivers to the church. The point I am trying to make is that overcoming obesity is not purely a matter of individual exercise and diet. It is about the way we shape our society institutionally and corporately. I would add that educational programmes are too narrow and suggest that they start too late in a child's development.

My third and main local reason for choosing to speak in this debate is to commend to this House a wonderful piece of epidemiological research known as Born in Bradford. Fourteen thousand mothers are being recruited during antenatal care and 80 per cent are responding. Fifty per cent of these are of south Asian origin. Their family history is recorded and their child's growth and development monitored. As your Lordships will know, obesity leading to type 2 diabetes and CVD is particularly prevalent among south Asians in Britain. The aim of the programme-or at least the part of it relevant to our debate-as laid out in a grant application made in 2007 is as follows: to strengthen public health systems for monitoring excess weight gain in infants; to deliver new protocols and supporting tools to enable the identification of children who are at risk of obesity; to improve our understanding of the aetiology of childhood obesity in multi-ethnic populations; and to test new family-based

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solutions to prevent obesity in these populations. Twenty per cent of the 14,000 children in the project are monitored in detail.

A few months ago I had a preview of some of the early results of the project. Unfortunately for us they have not yet been published but they prompted me to wish to speak in this debate. Professor John Wright, the co-ordinator of the project, has allowed me to say that they have identified levels of obesity starting off in the first year of life common to white British and Asian babies. Yet the advice given by NICE on obesity in 2006 does not look at the evidence base for children under the age of two and, as far as I know, there is no advice available to health visitors in relation to obesity management for under-twos, in particular those in south Asian families where in-laws are an especially important influence on babies' diets. There is also the need to explore further what has for some time been known as the Barker hypothesis that those who are underweight at birth are more prone to cardiovascular disease later in life.

The noble Baroness, Lady Thornton, kindly gave me samples of booklets from the Change4Lifeproject. I am grateful to her. They are a valuable and attractive contribution to the battle against obesity. I suggest that materials such as CDs be prepared for those who are not comfortable with the written word and in some other languages besides English and I particularly urge that there be greater focus on the impact on childhood obesity of infants' experience in the womb and in the first year of life.

2.44 pm

Lord Giddens: My Lords, I begin by congratulating my noble friend Lord Pendry on initiating this debate. I commend him for all the excellent work that he does to support sport and physical well-being in this country.

The subject of this debate is much more interesting, consequential, and intellectually and practically challenging than might appear at first sight. Obesity among young people and adults is not just a problem for the UK but is a genuinely global issue. The WHO's international obesity task force estimates that in 2007 some 1.4 billion people in the world were obese or overweight using standard measures. This number includes a rapidly accelerating proportion of children and young people under 21. The scale is truly extraordinary. In Europe there are few countries reporting obesity rates below 10 per cent and in several European countries these rates are above 20 per cent, including the UK and countries as diverse as Germany and Finland. In fact, the most rapid increase of all is in this country, where rates rose threefold between 1980 and 2001. In the United States, famously, obesity affects one in three adults and reaches rates of 50 per cent among some groups. This touches on what the right reverend Prelate said because these groups especially include poor black American women. In Latin America, obesity rates are rising in many countries; they are more than 20 per cent in Paraguay, for example, and have reached 36 per cent of women in that country.

Similar figures pertain to Asia, where Japan is an interesting case. Japan was easily the longest-lived society in the world, largely as a result of the Japanese

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diet, but rates of obesity are climbing very steeply and have now reached more than 20 per cent among adults. They are climbing especially strongly among young people and the rates among those aged 15 to 21 are the same as for the adult population-20 per cent. It is a quite extraordinary secular change.

Some people say that with a phenomenon such as obesity we can apply the post-modern argument that you cannot judge; that there are many different kinds of people's bodies and we should not sit in judgment over what size they might be. That argument is demonstrably wrong for reasons which have been alluded to by my noble friend Lord Pendry. There are deep connections between obesity-and, indeed, being overweight by the standard measure-and dramatic health consequences, the most important one of which is type 2 diabetes. In the United States it has been noted that 45 per cent of children with newly diagnosed diabetes have type 2 diabetes and almost all of them are radically overweight or obese at the time of diagnosis. Looking at the United States healthcare system, some people argue that it could be overwhelmed by the prevalence of type 2 diabetes some 15 or so years down the line simply because of the implications of this. As my noble friend said, these problems converge with a range of other harmful effects.

A phenomenon this profound and on this scale is not going to be dealt with by homilies such as we should take more exercise, eat less or eat more healthily; it will not be dealt with by public health programmes. I support what the Government are doing, what my noble friend said and the importance of education and health programmes, especially those aimed at young children, but a phenomenon which is this deep-rooted and global will not respond significantly to such endeavours and we will have to look elsewhere if we are seriously going to confront it.

I hope your Lordships will forgive a slight digression. A few years ago I wrote a book on anorexia, the rise of which in modern societies correlates more or less directly with the expansion of supermarket culture. Once you have supermarkets there are no longer local diets; you cannot follow a local diet. Everyone has to decide what to eat in relation to how to look and how to be. At this point there is a tremendous acceleration in compulsive or addictive eating patterns, not only here but across the world. It occurs mostly in the affluent parts of the poorer world as well as in the developed world. Anorexia is obviously the opposite of obesity but the two often go in tandem. For example, you will sometimes find young girls who will starve almost to the point of death and six months later they are really fat; you get an alternation between the two.

The scale of this phenomenon and its expansion show that we are dealing with addiction or compulsiveness. When you have strong addictive or compulsive elements it is difficult to alter them. We will have to be much more radical and structural if we are to get to terms with the impact on our society to which obesity and being radically overweight, and eating disorders in general, should be closely linked.

There is an interesting overlap between the issue of obesity and being overweight and the more general debate around the issue of well-being. The two matters

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are closely connected and have common policy implications. I disagree with the right reverend Prelate because, to me, obesity across the world is by and large a phenomenon of affluence. It is certainly heavily class biased-it tends to be concentrated among poorer groups-but it is mainly in those countries which are becoming richer where obesity takes off in a radical way. We are, by and large, dealing with the phenomenon of affluence, even though it is heavily related to inequality for well known reasons.

If your Lordships take the point that obesity often has a strong component of addictiveness or compulsiveness about it, let me offer three observations on a more radical and structural approach to the issue. First, certainly in the UK and in many other countries too, alcohol consumption is significantly related to obesity. It is also strongly addictive, not only physiologically but socially and morally. When we consider the issue of obesity, we should take on board what the Chief Medical Officer is saying about alcohol because the two are intimately related. Quite apart from whatever you eat, if you consume enough alcohol it makes you fairly robust; it follows the similar fast food addictive pattern of behaviour. The Chief Medical Officer says- and I agree, although it was very controversial when it was announced recently-that we should radically curb children's access to alcohol, eliminate the availability of cheap alcohol and regulate the siting of alcohol in shops and supermarkets.

Those are the kinds of interventions that I feel we need, not just because of the direct overlap with obesity, but because of the obvious relationship between commercial sales, obesity and being overweight. In a supermarket, where do they put the sweets. They put them where you leave the shop, knowing that is where you make impulse buys. That is also the case in other kinds of shop. I am not going to mention the name of the shop, because I am speaking in the House of Lords, but you go out of the House of Lords, you get into the Tube station and there is a well known paper shop there. You buy a paper and they offer you an enormous chunk of chocolate, reduced in price by 60 per cent. That is ridiculous. You need some kind of structural regulation of the sale of certain kinds of food goods, and you need to break the pattern that is initiated by an organised consumer culture. That is essential both for alcohol and for food related to obesity and being overweight.

Secondly, by all means do what my noble friend Lord Pendry is suggesting, which I strongly support, and encourage young children and young adults to take more exercise. We hope that the coming of the Olympics to this country will have some positive impact on that. Indeed, my noble friend mentioned the progress that has been made. But again, we are talking about massive social changes here, which underlie the phenomenon of obesity. This is essentially the transformation from an industrial, agrarian society, which happens with affluence, to a service-based society, a post-industrial society. A life of physical labour sustained the health of a large number of working people-although it sometimes also broke their health in coalmines. Now only 10 per cent of the population are involved in physical labour, and mostly it is not of the old kind.



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A post-industrial society is a car-based society. It has been mentioned that not many children cycle to school. Well, hardly any parents walk their children to school anymore; they drive them. So you are talking about a whole form of social organisation that underlies these patterns. A significant interventionist aspect of coping with obesity is actually intervention in urban design. That is the only way we are going to resolve these issues in a satisfactory way.


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