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Dr Sarah Wollaston (Totnes) (Con)
I thank the hon. Member for East Londonderry (Mr Campbell) for securing this important debate. I do not want to repeat his message about the economic cost of the problem, but I would say, having been a general practitioner for 18 years, that once someone becomes obese, it is extraordinarily difficult to regain their normal weight in the long term.
I would like the Minister to consider the following points. We need to focus on better identification of those who are most at risk, particularly children, and to target action on those high-risk children. A nudge will just not go far enough, and it is time for more of a bit of a shove. We need particularly to look at the role of liquid calories in obesity among children. I ask the National Institute for Health and Clinical Excellence to update its guidance and review the evidence.
Nearly two thirds of adults are overweight or obese, but they do not start out that way. Around one in five four to five-year-olds are overweight or obese, but by the time they reach 11, that figure will have risen to one in three.
The Minister of State, Department of Health (Mr Simon Burns)
On the point about NICE, may I give my hon. Friend a reassurance that might be helpful at this stage in her contribution? As she may know, NICE has recently consulted on whether now is the right time to review its original guidance. As a result of that consultation, it will be making a decision later this month.
Dr Wollaston
I thank the Minister for that helpful response and look forward to hearing the outcome of that.
Children at primary school and in the early years before they have reached school are among the really high-risk groups. Some 85% of obese children go on to become obese adults, whereas only 12% of normal weight children become obese adults, so it makes sense to focus on that group of children, but that can happen only if we have better early identification. We should introduce annual measurements of weight and height, so that we can see when children are starting to slip towards obesity. We should target our resources much better on that group.
Andrew Bingham
I was going to come on to other activities shortly. I will watch or take part in sport, but who sponsors it does not chime with me much. However, ideally it would be better for an active product to support a sport. Interestingly, leisure centres all have vending machines full of chocolate. I know from experience that when the chocolate bars are replaced with cereal bars and healthy alternatives, the spend drops, because people like chocolate.
I am fortunate to live in the High Peak, which is a fantastic area with a huge amount of outdoor activity to do, including walking and hiking—the woods to play in. I am lucky, but inner cities do not have a huge playground such as the one I and my constituents have to play in. It is vital that people use leisure centres, and that they are encouraged into them. We can talk about what the Government should or should not do to get people to do that. I agree that the nudge theory will work. We have been subconsciously nudged into the present situation, because people have gone to the quick, easy meal and have taken up a more sedentary lifestyle. We have heard about the PlayStation generation, and we all walk around with BlackBerrys. If texting was good exercise and made people fit, the present generation would be the fittest ever. With young people in particular it is text, text, text. However, that is not active.
Mr Simon Burns
I am very interested in what my hon. Friend says and have listened carefully to the interventions. A number of Members have talked about what the Government, the Department of Health, the Department for Education or local government should do, but it strikes me as slightly odd that there has been little recognition of the responsibility of parents.
Andrew Bingham
I think that the Minister has been reading my notes. The point I was coming to was that we have talked a lot about what the Government can or cannot do, but this is one of many issues on which responsibility lies with us and with the parents of young people. My generation’s parents taught us how to poach eggs, for example; it is all about education in the home. I know that I sound like a grumpy old man, talking about how it was in my day, with rose-coloured glasses—[Hon. Members: “No, Never”] I will concede on grumpy; old I will argue with, at the moment. We can discuss different demographics, but if people are brought up on balanced, home-cooked food they will carry that on through their lives. It worries me that the more ready meal-type culture we have, the more it will go on and the bigger the problem will get.
We can expect, or ask, the Government to do this, that and the other, but as with many things, responsibility lies with individuals and with the parents of young children. That is where we need to start, with people being responsible for their own actions.
We have a fantastic opportunity with the 2012 Olympics, when we will see athletes from across the world. I will wager that in a year’s time, when Jessica Ennis wins a gold medal—I hope she does—we will see children out doing long jump and triple jump, using their own resources to copy their sporting heroes. We must capitalise on that. I played football in the winter as a kid because that was what was on TV, I played cricket in the summer and we all played tennis for two weeks when Wimbledon was on. We can use the Olympics. We talk about the legacy Olympics, and I would like the legacy to be the starting point for people getting active again.
Mr Simon Burns
I have been listening carefully to the hon. Lady, who is making some valid points. The danger has to do with not simply the age of computer games but the age of television before that. For some parents—this is a generalisation—the easy option is to let their children spend hours watching television or playing games, because it involves less effort on the parents’ part. One must try to educate people that that is not only an easy option but an unfair one.
Ms Abbott
I am loth to agree with the Minister, but I think that he is right on that point. A particular interest of mine is the education of urban children and the challenges of getting them to achieve their educational potential. As part of working with parents, especially in urban communities, we must teach them that just putting their children in front of a television set is not necessarily the best thing for their health or their education.
I agree entirely with what has been said about exercise and sport, but we also need a particular focus on girls and exercise. Statistics show that girls give up exercise younger; after they leave school, they do not continue to exercise, as boys do. I was interested to hear about, was it ice hockey—
The Minister of State, Department of Health (Mr Simon Burns)
It is a pleasure to serve under your chairmanship, Mrs Riordan, during this extremely interesting and thoughtful debate, to which there have been a number of erudite and imaginative contributions across the range.
I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing the debate and giving us the opportunity to discuss one of the major public health issues of modern times. He has spoken repeatedly on the subject in the House and should be congratulated on doing so. He knows, of course, the scale of the problem. Most adults in England, 61%, are overweight. Sadly, one third of those are clinically obese, giving us one of the highest obesity rates in the world. As for children, almost a quarter of four to five-year-olds are overweight or obese, rising to one third in 10 to 11-year-olds. I am sure that we all agree that those figures are genuinely shocking. The hon. Gentleman will be aware that the scale of the problem in Northern Ireland, to which he alluded during the course of his remarks, is similarly daunting, with 59% of adults and 22% of children overweight or obese.
As recently as the 1980s, obesity rates among adults were a third of what they are now. Although figures for the last few years show that levels of obesity may be stabilising, that is simply not good enough, because excess weight has serious consequences for individuals, the NHS and the wider community. Not only does it cause day-to-day suffering such as back pain, breathing problems and sleep disruption, but it is a major risk factor for diseases that can kill. An obese man is five times more likely to develop type 2 diabetes, three times more likely to develop colon cancer and two and a half times more likely to develop high blood pressure than a man with a healthy weight, and women face equally serious risks. That is not to mention liver disease, heart disease, some cancers and miscarriages, all of which are linked to excess weight.
Although the real and present danger of obesity in terms of immediate health risks is seen largely in adults, obesity also has significant effects on children and young people, as many hon. Members have mentioned. Obese children are likely to suffer stigmatisation, and there are growing reports of obese children developing type 2 diabetes. We also know that if a child is obese in their early teens, there is a high chance that they will become an obese adult, with related problems later in life.
As waistlines expand, so does the amount of money that we spend on the issue. As a number of Members have said, excess weight is a burden of approximately £5 billion each year, and costs billions more through days of work and incapacity. Neither can we ignore the link between obesity and health inequalities. Data from the national child measurement programme show a marked relationship between deprivation and obesity. The Marmot review in 2010 showed the impact that income, ethnicity and social deprivation have on someone’s chances of becoming obese. As things stand, the less well-off a person is, the more likely they are to be carrying excess weight, so we are talking about an issue of social justice, as well as a narrow health issue involving exercise and healthy living.
The hon. Members for East Londonderry and for Hackney North and Stoke Newington (Ms Abbott) both asked, in effect, whether the Department of Health should work with companies that produce and sell products that contribute to the nation’s obesity and alcohol problems. Up to a point, it is the responsibility of the individual how much they consume and what they consume. How do we make sure that people know what they are eating—the calorie, salt and fat content and so on? To my mind, that means clear, easily understandable labelling, and education about what is healthy and what is the best approach.
On the narrow point of the issue mentioned by both hon. Members, improving the health of the public is clearly a priority for the Government, but we need a whole-society approach to tackle the health problems caused by poor diet, alcohol misuse and lack of exercise. To change people’s behaviours, we need to make the healthier choices the easier choices for everyone.
Commercial organisations have an influence on and can reach consumers in certain ways that Governments cannot. They have a key role in creating an environment that supports people to make informed, balanced choices that will enable them to lead healthier lives. Through their position of influence, they can address some of the wider factors that affect people’s health, such as how healthy our food is and how easy it is to access opportunities to be more physically active. Through the work on the public health responsibility deal, despite what the hon. Member for Hackney North and Stoke Newington has said, we are tapping into that unrealised potential to help improve the public’s health.
Mr Burns
I will give way in a moment. It is also important to say that, if we can get an agreement with commercial companies to change the way they behave and some of their practices, it will be far quicker to achieve that and put it in place than to wait for the heavy hand of Government legislation, which can take a minimum of a year and sometimes years. Why wait for the heavy hand of legislation that might take a long time, if we can get a voluntary agreement that will work quicker and more effectively to start dealing with the problem?
Ms Abbott
On changing commercial practices, when will the Government do something about the practice of so many supermarkets whereby they place rows of sweets next to the checkout? If a parent has fought off their children and not bought sweets on their way around the supermarket, the children then have 10 minutes to whine while the parent waits to pay for their shopping.
Mr Burns
I understand the hon. Lady’s point, because the charge has been made on a number of occasions and I have considerable sympathy with it. The supermarket at which I shop each week—I shall not name it, because I do not want to advertise for it—does not do that any more. I think that the hon. Lady will find that, throughout the country, the responsible supermarkets have stopped that practice, for the very reasons that she has mentioned.
Dr Poulter
Does my right hon. Friend agree that we need to be careful about introducing regulation for alcohol and other relevant products? It could be a very crude measure and have unforeseen consequences. For example, on alcohol, we may be concerned about the cheap sale of white cider, but the bigger issue is that introducing legislation may impact on brands that market themselves responsibly to responsible drinkers. We have to be careful about that sort of thing.
Mr Burns
My hon. Friend makes a valid point.
I will address a number of issues that some of my hon. Friends have raised. My hon. Friend the Member for Totnes (Dr Wollaston) talked about the important issue of weighing and measuring children. I hope that she will be reassured by the national child measurement programme. It measures children in reception class—four to five-year-olds—and in year 6. Those measurements and weights are fed back to parents, so that they can not only know the information, but make informed choices about the lifestyles of their children.
My hon. Friend the Member for North Swindon (Justin Tomlinson) made some valid and good points about the planning regime and open spaces that enable parents and children to exercise. His points were well made and sensible. It would be worthwhile for local government, which has responsibility for the issue, to read what he has had to say, particularly, as the hon. Member for Hackney North and Stoke Newington has said, because certain inner-city areas do not have the advantages of some of the more rural and smaller town constituencies, which have far more access to open spaces.
As a Government, our general approach to tackling the problem is based on the latest scientific evidence on the underlying issues and causes of obesity, as well as what has worked best previously. Ultimately, there is a simple equation: people put on weight because they consume more calories than they need.
Mr Burns
No, I will not, because I have only three minutes. People need to be honest with themselves. We need to recognise that we are responsible for controlling our weight. That means eating less, drinking less and exercising more.
We are also calling on the food and drink industry to play a much bigger role in reducing the population’s calorie intake by 5 billion calories a day, to help close the crucial imbalance between energy in and energy out. That will build on commitments that businesses have already made, through the public health responsibility deal, on things such as eliminating trans fats, reducing the amount of salt in food, and proper calorie labelling.
Of course, it is for each of us to make our own decisions about how we live our lives. The best and most sustainable changes come not when people are ordered about, but when they are given the tools to change, given the justification and then take responsibility to do it themselves. That is why we need to work together to make sure that the healthier choices become the easier choices. Everyone has a role to play—the food industry, the drinks industry, the many organisations that encourage physical activity and sport, employers who can support the health of their employees, and the local NHS staff in talking to people more about obesity and its consequences.
Under the new public health system, local leadership will be critical. We want to move away from the days when legislation and demands came down from Whitehall like thunderbolts from Mount Olympus. Local authorities will be supported by a ring-fenced budget and will bring together local partners, including the NHS, to provide the most effective services for their communities. We will support local people and local authorities by making sure that they have access to the best possible data and evidence.
We will not shirk our duty to provide national leadership where it is necessary—by working, for example, with business and non-governmental organisations, and making sure that Government Departments work together in supporting better health. That is already happening. The Department for Transport is providing more than half a billion pounds of funding for local authorities to increase sustainable travel such as walking and cycling. The new teaching schools programme, led by the Department for Education, will explore how schools can support and encourage children’s health and well-being. We will also continue to try to inspire people, young and old, to embrace a healthy, active lifestyle, via, for example, Change4Life. Moreover, the London Olympics, as many of my hon. Friends have mentioned, give us the golden opportunity to perpetuate that legacy after they have finished.
The new national ambitions provide a clear goal that we can all aim for. We should all play our part in raising awareness. Once again, I congratulate the hon. Member for East Londonderry on securing this debate, and I hope that he sees the benefits in our strategy. I hope that he supports it and that he will continue to be an advocate for his constituents on the matter.
Mrs Linda Riordan (in the Chair)
Order. Mr Bryant has withdrawn his debate, so the sitting is suspended until 4.30 pm.