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Only in the last two years has the government effort to combat rising obesity levels begun to take shape. Change4Life, with its various offshoots such as Start4Life, is a well conceived and worthwhile programme. It explicitly acknowledges that success in tackling obesity depends not only on the state, but also on industry and, crucially, families and individuals taking action. In this respect, the problem of obesity is different from the public health challenges that we faced in the past. The issue cannot be solved by passing laws, as we did with water sanitation in the 19th century and air pollution in the 1950s, because obesity originates in

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private space and does not impinge directly on the freedom or well-being of others. Any sustainable solution to the problem must start from that realisation. Only by changing people's attitudes and motivation will we be able to make a difference over the long term.

What does it take to do that? Of course there is a role for government: regulation is important. The Government's job is to provide leadership and an environment in which consumer tastes can be influenced and healthy eating choices made. The obvious examples of creating such an environment are food and alcohol labelling, making sure that there are consistent and clear public messages on nutrition, and making physical activity more accessible to greater numbers of people. However, if the key to the problem is changing people's motivation and attitudes, the trick is to encourage them to take responsibility for their own lifestyles and health. You do not encourage a sense of responsibility by nannying people and lecturing them on the negative consequences of being overweight. Instead, you provide them with positive messages about the benefits and enjoyment to be had from healthy living. You provide them with information with which to make choices, and examples and role models to follow. This applies to children as much as adults. Young people most of all have to feel empowered rather than put upon. We have to tap into their self-esteem.

One mistake made by the Government was their failure to recognise that when they introduced healthier school menus. Healthy meals can deliver benefits, but they will not do so if there is no motivation on the part of the children and their families. The introduction of those menus led to an increase in the uptake of packed lunches stuffed with crisps and chocolates. What was the Government's response? To impose another regulation to inspect school lunchboxes. We ended up with mothers feeding their children burgers through school railings. Thankfully, the Healthy Schools programme has come some way since then, including, I am glad to say, the introduction of cookery classes. I quite agree with what the noble Baroness, Lady Walmsley, said about that.

In fact, many of the decisions that people take about what they eat and drink are not really decisions at all; they are actions driven by force of habit-even compulsiveness, as the noble Lord, Lord Giddens, said. A lot of people damage their health without understanding what they are doing or how to put things right. In that context, the Minister may be aware of some research published recently by Volterra, which accounted for the rising obesity over recent years by reference to the phenomenon of peer acceptance. Peer acceptance is about people continuing to follow modes of behaviour because other people within their social group are behaving in the same way. People feel less pressure to change their actions and habits if their friends are not also doing so. It becomes socially acceptable to be fat. Volterra does not claim that that is the only factor that accounts for the rise in obesity-far from it-but it is certainly one that ought not to be ignored in any study of the subject. That takes us into an interesting realm: the psychology of human behaviour and the way in which societal norms are created and maintained. Those are difficult subjects for policy-makers, but ones that must be grappled with.



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I said that I am supportive of Change4Life, but if there is a difference between the Government's approach and that of my party, it relies in the split of responsibilities between the different stakeholders. My view is that regulation in areas such as food advertising has reached its limit of usefulness, apart from trying to put in place a consistent approach in all media channels such as the internet. On the other hand, the Government have taken too long to give a clear commitment on food labelling. The traffic light system may have the merit of simplicity, but its main flaw is that it characterises food as good or bad when what matters is whether a diet is good or bad. The EU Commission has said that we need to adopt a uniform system based on guideline daily amounts, combined with a colour indication system, and I agree. On interventionist measures, I also agree with what the noble Lord, Lord Giddens, said about urban design and the use of fiscal levers, particularly in relation to high-strength alcoholic drinks.

Looking at the wider agenda, the food industry is capable of taking on greater responsibility for promoting healthy living-not just in reformulating products, which it is already doing very successfully, but in initiating and sponsoring exercise and wellness programmes. Many large food manufacturers are doing great work along those lines in schools, in the workplace and in the community under the Business4Life banner. I have no doubt that we should encourage more businesses, including SMEs, to buy in to that sense of shared responsibility. We owe a debt to the Advertising Association and, not least, to its former chief executive, my noble friend Lady Buscombe, for having secured a commitment worth about £200 million from industry to resource those initiatives.

Recent reports have suggested that childhood obesity is levelling out. We need to treat those reports with caution, because some of them look only at averages. A team at University College, London, reported last month that obesity in children from wealthier backgrounds may indeed be improving, but that the problem is still getting worse-indeed, considerably worse-in children from lower socio-economic groups. Those are the people who should give us the greatest concern, and we should bear in mind, too, that hospital admissions of patients being treated for obesity have shot up over the last five years. Within normal value-for-money constraints, I believe we owe it to the Government to support them in any properly researched programme designed to combat obesity in the young. With an expanding buy-in from industry as well, it may at last be that we are on the right road to achieve results.

3.35 pm

Baroness Thornton: My Lords, I thank my noble friend for raising this important issue and congratulate him and other noble Lords on their usual informed and important contributions. It is of enormous regret that, due to the weather, the noble Baroness, Lady Finlay of Llandaff, has not been able to make what I know would have been an outstanding contribution to the debate. I understand that she will seek another opportunity in future and I very much look forward to that.



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I welcome the opportunity to update noble Lords on the progress we have made in tackling obesity. First, however, like most other noble Lords, I shall refer to the scale of the problem we face. In 2007, as the noble Earl, Lord Howe, mentioned, the Foresight team published its report entitled Tackling Obesities: Future Choices. It predicted that if action was not taken, the levels of obesity would rise by 2050 to 60 per cent in men, 50 per cent in women and 25 per cent in children. It also forecast that the direct cost of obesity and overweight to the NHS would double by 2050 from the already massive current figure of £4.2 billion. My noble friend Lord Pendry quite rightly mentioned the obvious health effects, such as the increase in childhood diabetes.

Obesity is a complex and long-term phenomenon, and no sensible analyst would pretend that there is only one answer or there is an easy one. A number of factors drive people towards overweight and obesity. Foresight has described the "obesogenic environment": the physical and social environment in which we are often encouraged to expend the least amount of physical effort while consuming a large number of calories. Noble Lords have given various descriptions of that in this debate. Of course it is essential that we eat healthily and exercise appropriately, but, as noble Lords have also said, simple exhortations telling people to engage in more activity or to exercise greater self-control are not enough. Indeed, that can be counterproductive when talking to the young and children. My noble friend Lord Giddens is quite correct that the homilies are not working.

In January 2008 we published our obesity strategy Healthy Weight, Healthy Lives, which set out how we will help people to reach and maintain a healthy weight. Further commitments were made in April 2009 when we published our One Year On plans. Our aim is to be the first major nation to reverse the rising tide of obesity, with the initial focus on reducing the percentage of obese children to 2000 levels by 2020. Our strategy has four essential strands for action which commit us to helping people to make healthier choices, creating an environment that promotes healthy weight, ensuring effective services are available for those at risk and strengthening the delivery system of their services. Our strategy is based on expert input from Foresight and is internationally recognised.

I am pleased that we have made some progress in the past year on a number of fronts in addressing obesity among children and young people. However, my noble friends Lord Pendry and Lord Giddens rightly say that this is about changing culture and changing habits. Noble Lords may be aware that child obesity rates are beginning to level out, so I would say to the noble Earl, Lord Howe, that this reflects some progress. New data published in December from the Health Survey for England for 2008 show that child obesity levels are the lowest since 2001. Among two to 10 year-olds, the reported figure for 2008 is 13.9 per cent compared with 15.5 per cent in 2007 and 2006. These figures are supported by data from the National Child Measurement Programme 2008-09. However, obesity levels are still too high, especially for teenagers

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and adults, and we certainly cannot be complacent. What we can say is that we have taken a tiny step towards progress.

We have been helping children and their families to make healthier choices, and many noble Lords have referred to the importance of recognising that parents remain the biggest influence on their children. There is a significant correlation between obesity in parents and their children. In families where both parents are overweight or obese, a child is six times more likely to be overweight or obese than a child in a family where the parents are both of a healthy weight. Nurture, not nature, is the main reason for this. What children eat and drink and how much physical activity they get is largely determined by the choices that their parents make for them. Therefore, last year we launched Change4Life, a highly innovative campaign which aims to help families to,

The campaign, aimed primarily at families with children aged five to 11, seeks to motivate individuals and families to make behaviour changes around diet and activity. More than 412,000 families have registered with the campaign and receive information and advice tailored to their needs on healthy eating and physical activity. At the national level, we already have the support of over 170 companies and organisations that are Change4Life partners and who promote Change4Life to the people who use their services. Noble Lords mentioned the importance of working with industry at all sorts of levels, and indeed that is exactly what we have aimed to do with the Change4Life campaign.

I hope that the right reverend Prelate the Bishop of Bradford will be pleased to learn that on 1 January we launched Start4Life, a sister campaign to Change4Life. Start4Life is aimed at parents-to-be and parents of babies and children up to the age of two to encourage them to get their babies off to the best start in life through breastfeeding, effective weaning and active play. If we are to head off the obesity epidemic of the future, we need to begin with the parents and children of today. My native city of Bradford is clearly a target for this campaign. I was keen to learn what the right reverend Prelate had to say and I join him in expressing my concern for our city.

My noble friend rightly mentioned the work of the Sports Trust and other organisations with these campaigns and initiatives. I join with other noble Lords in paying tribute to all organisations, particularly in the third sector, which are active in this area. I mention in particular the sports and leisure trusts across the country which have fully embraced Change4Life in its various manifestations such as Swim4Life.

We have been trying to create an environment that promotes healthy weight. The Healthy Child Programme covers the first five years of life. This universal health visitor-led programme has a clear focus on promoting healthy weight, with more targeted support for those who need it most. In September, we issued comprehensive new guidance for the review that takes place when a child reaches the age of two. At the same time, we launched the new Healthy Child Programme for children and young people aged five to 19. Led by nurses working with families, schools and young people

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themselves, and in partnership with other providers, this means that we have for the first time a comprehensive programme to promote the health of all children and young people. The noble Baroness, Lady Walmsley, made a superb case for good food and cooking, and we would all agree with her that cooking is in fact easy. Indeed, I join her in paying tribute to Jamie Oliver as one of our celebrity cooks who makes the case that cooking is easy and something that everybody can do.

For children at school we have extended the statutory nutritional standards for the types of food that can be served in schools, and we have restricted choice to healthy options in maintained secondary schools and special schools so that all state schools are now covered. The regulations also ban high salt, fat and sugar foods from vending machines in schools. We are supporting schools with funding for new and refurbished kitchens and to train cooks to prepare healthier menus. We provided £220 million-worth of funding over three years from 2005-06 to help schools and local authorities manage the transition to the new standards, and a further £240 million over the following three years to 2010-11 to subsidise ingredients and other costs directly related to the cost of providing a school lunch. In all we have invested £650 million between 2005-06 and 2010-11 to support school food. We believe that this investment is paying off. The noble Earl may be right that this had a slightly unsteady start, but we know that the proportion of children eating school lunches is rising again. The latest figures show that nearly 44 per cent of primary pupils and 36 per cent of secondary pupils are now eating healthier school meals.

The noble Baroness, Lady Walmsley, mentioned new initiatives and the importance of the School Food Trust which, of course, is financially supported by the Government. Cookery classes are compulsory in primary schools and have been reintroduced into the curriculum at key stage 3, so that pupils aged 11 to 14 can learn the basics of cooking simple, healthy meals.

My noble friend Lord Pendry is known for his work promoting sport and physical education in schools, and he will be aware that nine out of 10 pupils aged 5 to 16 now take part in two hours of high quality PE and sport in the curriculum each week, but we need to go further. Our PE and sport strategy for young people sets out our ambition that this age group should be able to take part in five hours of sport per week. The noble Lord, Lord Moynihan, knows that we want to use the enthusiasm and interest that will be generated in the run-up to the Olympics in 2012. We are putting more professional coaches in schools, upgrading school sports facilities and providing more attractive sporting opportunities for the community, but I welcome the noble Lord's remarks and hope that he will agree that we are making some progress. I congratulate him on the work of the London School Board.

For 16 to 18 year-olds in education, schools and colleges will be expected to work in partnership with clubs and community groups to ensure that at least three hours of appropriate activity are available. For young people not in education, training or employment, community providers and local authorities should work together to provide access to affordable opportunities

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to take part in sport. In the eight years to 2012, we will have invested £2.4 billion in PE and sport for children and young people.

My noble friend Lord Rosser outlined the achievements of and challenges faced by Sport England; he is quite right that we have a huge problem of young people dropping out of sport in their teens, particularly girls. We should not think of physical activity only in terms of PE and sport, as the noble Baroness, Lady Walmsley, said. We are encouraging children and young people to be physically active in their everyday lives through travel, play and leisure. The Chief Medical Officer recommends that children and young people should undertake a minimum of 60 minutes of moderately intensive physical activity each day. We are reviewing these guidelines and consulting on new recommendations for infants, toddlers and pre-school children, with the aim of producing guidelines to help them. We also think that travelling to school is very important, and have invested £140 million in travelling-to-school projects which encourage schools to have travel plans to get children walking, using public transport or cycling to school.

Children and young people have a life outside school. In the Children's Plan we announced a new agenda for supporting play, with the biggest ever investment in play by the Government. We have put in £225 million over three years, and an additional £10 million was pledged in April 2008, underlining the importance of play and why it should be taken seriously by every council in the country. We have consulted on our play strategy, which sets out a commitment to deliver 3,500 new or refurbished play spaces, and 30 new staffed adventure playgrounds, so that there is one in every neighbourhood in the country.

I have already mentioned the work that we are doing to improve the quality of food in schools. We agree with the noble Baroness, Lady Walmsley, about the need to increase the number of children taking school lunches. We are also promoting healthier food choices in a number of other ways.

The noble Earl referred to advertising. Working with Ofcom, we have placed restrictions on the broadcast advertising to children of foods high in fat, salt and sugar. Ofcom has reported a 34 per cent reduction between 2005 and 2007 in children's exposure to adverts on television for foods that are high in fat, sugar and salt. We will conduct a further review of the impact of these restrictions during 2010. We have committed to look at developing a set of voluntary principles to underpin all marketing communications about food to children, and we will be working with stakeholders on this over the coming months.

Front-of-package nutrition labelling is now widespread in the UK. The noble Earl asked how that would be taken forward. I agree with him that the FSA will need to resolve this issue; indeed, the intention is that that should happen in the course of this year.

Much of our focus is on preventing problems arising in the first place. We are also working to meet the needs of those at most risk of becoming obese, including those who are already overweight. We know that weight management services can play an important role in helping overweight or obese children to move towards

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and maintain a healthier weight. This is very important; nothing makes a young woman more miserable than being seen as and called "plump" during her teenage years. As well as the physical impact of these issues, we should not underestimate their impact on young people's mental health. In this financial year we are therefore providing PCTs with funding of £69 million within overall allocations that are about commissioning more weight management services.

I turn to specific issues raised by noble Lords. The noble Baroness, Lady Walmsley, raised the issue of cookery classes. As I said, they are already compulsory in primary schools and will be compulsory in secondary schools from 2011. The Cook4Life pilot programme aims to train Sure Start children's centre staff to run cookery activities for families with children, and the aim of the pilot is to develop skills, inspire and give confidence to parents with young children to cook healthy and nutritious food. That is an example of the kind of programmes that we are taking up.

The noble Baroness also raised the issue of the take-up of free school meals. We know that the take-up is increasing but we have commissioned the Child Poverty Action Group to report on the stigma of free school meals. It found that not all parents are aware of their entitlement and others do not know how the system at their school works, so we are also aiming to tackle it from the point of view of the amount of information that is available to parents as well as how the school handles those issues.

The noble Baroness raised the issue of biometric systems and barcodes for cashless food payment. I took her point about that, but she will know that these arrangements are made locally.

The right reverend Prelate raised several issues. I want to refer particularly to the Born in Bradford research that is going on, which I think is going to be very important and informative. I hope that he will take the opportunity of his presence in your Lordships' House to bring that information to us at a time when he is allowed to do so. He made an important point about the lack of money and the availability of healthy food in poorer communities.

The right reverend Prelate asked about NICE guidance for the under-twos. The evidence base for obesity in that age group is still quite small and not conclusive, but obesity in children may well begin in habits picked up from birth. We are therefore giving guidance to health visitors about what happens at the review at two years old. I suspect that the research from Bradford is going to assist us with this issue.

The Change4Life material is on DVD. Leaflets and information in languages for the black and ethnic minority community are expected to be available from February this year.

My habits from being a student at the LSE die very hard, and I nearly took up my pen and started making notes while my noble friend Lord Giddens was speaking. His analysis was spot on. I very much take the point about anorexia and obesity going hand in hand and about the issues of addiction and compulsion. We

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hope that some of the work that we are doing will address these problems. I think that he recognised that. I totally took his point about alcohol.

My noble friend Lord Rosser made a very important contribution about the work that he has been doing through the Parliamentary Sports Fellowship Scheme. It is one of those activities that I have always intended to do but never quite managed due to time constraints.

The noble Lord, Lord Addington, never bores the House silly on these issues. He is part of the expertise available in this House on these matters. Many of our programmes are working. I say to the noble Lord that it is not a choice of parks, clubs, change for life or allotments; we have to work across government. It is the responsibility of the whole of government, but also of all of us, to take these issues forward.

Lord Addington: What I am really calling for is a government analysis of the best way forward in the various fields of physical activity because I am absolutely sure that a lot of such activity is wasted or is not as good as it could be.

Baroness Thornton: I take the noble Lord's point about the need to monitor and assess these activities to see which is the most effective. That is built into these programmes. We will be monitoring and assessing them. That is why they are often changed.


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