Children and Young People: Obesity
(6 years, 6 months ago)
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Baroness Walmsley
To ask Her Majesty’s Government what steps they are taking to address obesity among children and young people.
Baroness Walmsley (LD)
My Lords, we have a childhood obesity epidemic in this country, with disadvantaged children significantly more likely to be affected. Nearly one in four children is overweight or obese in their first year of primary school, rising to more than one in three by the time they leave. Overweight children are more likely to become overweight adults, leading to heart disease, cancer, diabetes and stroke. Issues related to diabetes are a strain on the economy and on the NHS, so we need to address this at the earliest possible opportunity, while people are young—hence this debate.
Out of the mouths of babes and sucklings come truth and wisdom, so I thought that perhaps we should hear from the children themselves. It so happens that I recently received 30 letters from children at St Joseph’s Catholic Primary School in Burnham-on-Sea. These eight and nine year-olds are very aware of the dangers of obesity, such as heart disease and diabetes—although they did not mention cancer, even though 5% of cancers are thought to have a dietary link. They are not alone, since 85% of the population is also unaware of that link.
The children have been looking into the advertising of junk food on TV and wrote to ask me to do something about it. They said that 23 children out of their class of 30 had seen more junk food adverts than healthy food adverts. Here is what William had to say:
“As everyone knows fat is bad for you and surely our kids are being poisoned by too much. Firstly we should get good foods on our plates. Secondly we need to get bad foods off our plates. Thirdly fatty foods can block your arteries. I would draw your attention to the fact that 28 out of 30 children said adverts make us want to buy garbage. Therefore we must not let unwholesome adverts on TV every day, just on Mondays and Saturdays and moreover we must show more Fit4Life adverts. My evidence to support this is only 10 out of 30 kids have seen Fit4Life adverts which is not good. In summary we must stop this advertising problem. My final point is that you are responsible”.
George agreed, but he let out a little secret:
“Isn’t it the case that people like the taste of fat and if you keep eating junk you will get heart disease? Some eat a midnight snack under the bed, not often but it is probably junk food”.
Jared was concerned about the NHS. He said:
“Surely we can help the NHS. They are having too many customers”.
He must have read the 2016 report from the Food Foundation, which claimed that the current diet-driven crisis is crippling the NHS. The report said that NHS costs associated with being overweight or obese are £6.1 billion every year and £27 billion for the wider economy.
Ryan thinks you should have a balanced diet. He said:
“My view is balance. Get rid of some junk food but not all junk food because some people like it, including me”.
The new soft drinks industry levy, commonly known as the sugar tax, came into force recently, and that is a very good thing—although the children are not fooled. They have noticed that it is limited to sugary drinks. For example, Brac said:
“I would draw your attention to hidden sugars which are found in cereal, yoghurt, bread, smoothies and pizza”.
No fool, Brac.
So, on the children’s behalf, can I ask the Minister whether the Government plan to do anything about all the other hidden sugars in our food? I must say it is very heartening to hear that so many popular drinks have been reformulated, although I am sure they would not have done it without the levy. So it is important to monitor the effects of the sugar tax, and I hope the Minister will say how they intend to do that. Will he also tell us where the money is to be spent and whether local authorities, which now have the responsibility for public health, will have a say in the matter?
The Advertising Standards Authority’s Committee of Advertising Practice is about to carry out a review of whether the rules on advertising junk food during children’s TV programmes and on non-broadcast media are right. The children and I think the rules need changing, so I hope the reviewers will take notice of their opinion. For example, Emma said:
“In my opinion adverts about junk food are taking over and I can’t help noticing that they mostly do it when children are around. Clearly people are falling for things like, if you eat these delicious golden chicken nuggets it will make you happy and if you drink this Cola, you and your brother will get along forever”.
But Lillia was not taken in. She said:
“Bad food makes you fat and ill and in the end you just die”.
Manley agreed. He said:
“Don’t eat junk. It could give you a very bad tummy ache”.
Joshua had a solution. He said:
“Isn’t it clear preventable diseases aren’t being prevented? It’s not hard to prevent them yet we don’t. It’s quite sad don’t you think?”.
He wants cheaper fruit and vegetables. The Food Foundation agrees. It recommends:
“Subsidies that favour healthy food over unhealthy food”.
The ASA said in its briefing to us at half past two this afternoon:
“Currently, the evidence shows that advertising has only a modest effect on children’s food preferences and that there are multiple and complex factors, beyond advertising, that are instrumental in childhood obesity.”
The causes are indeed complex but the children of St Joseph’s and many other experts do not agree that advertising has only a modest effect on children’s food preferences. Their letters refer to the large number of junk food adverts on TV programmes—in “family time”, not just children’s programmes—but they do agree that there are other factors. Holly says:
“Surely the Government can make a law saying there should be a limit of junk food adverts”.
But she realises that it is not just about what you eat; keeping fit is also part of the solution, and it is fun. Tommy agreed. He wants more PE lessons.
Finbar described children’s sedentary lifestyles. He said:
“It seems to me that people are starting to get more lazier by the day. As I see it people finish school or work, go home then walk to their TV or games console. And might even have their dinner there”.
Ukactive, chaired by our noble friend Lady Grey-Thompson, promotes physical activity for children. It told me that half of all seven year-olds are failing to achieve the recommended 60 minutes of physical activity per day. NHS research in 2015 found that one in five children did no sport or physical activity at school. It would help schools to plan if the Government were clearer about their long-term plans for the primary PE and sport premium. This might be the responsibility of the Department for Education, but could the Minister from the health department enlighten us? As Finbar said, physical inactivity is a major cause of childhood obesity.
The children want to know what we are going to do about it. Cancer Research UK proposes a 9 pm watershed on TV advertising of junk food. This does not require legislation; Ofcom could be instructed to act. Will the Minister comment on that? It is a decade since Ofcom’s restrictions came into effect, and in that time viewing habits have drastically changed. Evening and family programmes, shown between 7 pm and 9 pm, are now most frequently watched by children and young people, yet they are not covered by existing regulations unless the advertisement is directly aimed at children. It seems that current rules are no longer fit for purpose. The Obesity Health Alliance found that more than half of food and drink adverts shown during family viewing would be banned on children’s TV under current rules.
Your Lordships might wonder whether there is any evidence that restricting the marketing of junk food could help in the fight against childhood obesity. Well, I have good news. There is evidence from Quebec that a ban on advertising junk food to children can work. Its strict rules since 1980 have resulted in a much lower level of child obesity there than in any other part of Canada. Will the Minister look at this evidence and act on it? Given that Public Health England advised the Government to include further advertising restrictions in the 2016 child obesity plan, perhaps the Minister will explain why the Government did not take its advice. Could he now tell the House whether they have seen the error of their ways? If so, I will be delighted to tell the children of St Joseph’s.
Lord McColl of Dulwich (Con)
My Lords, I thank the noble Baroness, Lady Walmsley, for initiating this important debate. I do not need to repeat all the figures that she has so ably put forward. However, I shall ask a question: how on earth did we get into this mess in the first place? It is the worst epidemic for 100 years.
Now, many of us have managed to stay the same weight for 100 years—
Lord McColl of Dulwich
I will not say “Speak for yourself”, but there are a lot of people who have managed to stay the same weight.
The question is: how did they do it? They simply respected the various mechanisms that exist in the body for keeping the weight constant. What are they? They are very intriguing. One is to eat food that you have to chew. When you chew, the chewing muscles produce impulses that go to the brain telling it that you have had enough to eat. If that does not work and there is fat in the meal, when the fat goes through the stomach into the duodenum it releases a hormone that stops the stomach moving any further. We get a feeling of being full, so we stop eating. It is a very nice mechanism. Then, when the fat has been emulsified by the bile, the whole thing moves on and the stomach starts to move again.
At the end of food rationing the food industry was presented with a problem. It wanted to increase the amount of food that people ate, because we were all eating just the right amount—food rationing had sorted that one out. How was it to persuade people to eat more? The simple solution is to sabotage these beautiful mechanisms for keeping the weight constant. How did the industry do that? It demonised fat and got some unscrupulous members of the academic world to produce research that just happened to confirm its view that fat was the wrong thing. Then President Eisenhower had a heart attack and they found that what blocked his arteries was atheroma. As noble Lords will know from their Greek studies, atheroma is a Greek word meaning porridge. It might be Greek porridge, but it is not Scottish porridge, that is for sure. In fact it is not porridge at all: it is a cholesterol, fatty material. So they blamed that. Fat was demonised, so we had a low-fat diet.
The problem then was where to get the calories from, so they filled the diet up with carbohydrates. A low-fat, high-carbohydrate diet is tasteless because fat gives us a nice flavour. The food industry then faced the problem of how to get people to eat this terrible stuff. The answer is to pour in sugar. That makes it palatable. So was born the obesity epidemic: a low-fat, high-carbohydrate, high-sugar diet.
Then, just to make things worse, NICE said that all the calories we eat are expended on exercise. That was not true either: only a fraction of the calories we eat go on exercise. In fact, it is about a quarter. This idea that exercise is the answer to obesity led to hundreds of thousands of people pounding the pavements and roads wearing out their joints, so you had more and more joint replacements for the hip and knee. So the nonsense continued. Of course exercise is very important to general well-being and health, but not in terms of controlling weight. Then we insulted the children by calling them couch potatoes. Inactivity does not lead to obesity. Obesity leads to inactivity, but that is a different matter.
What is the answer? It is that we need an all-out campaign involving every man, woman and child, every institution, school, university and government department to try to reduce the obesity epidemic. When we were taking evidence from the experts in a recent Select Committee, we were told that all-out campaigns do not work. I pointed out that the AIDS campaign did. One of these experts said, “No it didn’t”, which surprised the Lord Speaker, Norman Fowler, because it was his campaign. It worked because he was absolutely honest and did not bother with anything politically correct. He said it as it was: “Don’t die of AIDS”; AIDS is lethal. So the campaign was successful. That is what we now need, because we owe it to our children. The obesity epidemic is killing millions and costing billions. The cure is free: eat less.
Lord Addington (LD)
My Lords, I thank my noble friend for bringing this debate forward. It is one we have dealt with for a while. It is also one where we can start by being a more cross-party group, because the Government have had a policy on this and they have done something. Indeed, I congratulate them. A warm waft of nostalgia came from my desk at about 2 o’clock this afternoon when I received an email telling me how we must not go too far, not to be excessive and everything else. It was from the Advertising Association. It reminded me so much of the stuff we got when we were discussing the ban on smoking. Shall we say that a record of past success seems to be being trodden by the Government here? Okay, they have not done it fast or thoroughly enough and anything else, but they seem to be taking the first few steps.
The noble Lord, Lord McColl, and I have differed slightly on the role of exercise in weight control, but he is right on one thing: a sugar-saturated diet is a great way to pile on weight. Some fizzy drinks are basically two litres of sugar-enhanced, carbonated liquid. The only way you can burn that off is by tramping across the Arctic in mid-winter, when you need that degree of sugar. I have also disagreed with the noble Lord on whether you burn up calories by rebuilding muscle after exercise, but let us not go into that now.
However, when it comes down to exercise, I ask the Government to remember one thing very clearly: the obesity epidemic is most pronounced in low-income bits of the economy. The highest degree of exercise is seen in the high-income bits of the economy; there is a divergence there. People who stay active or who are allowed to become active have the least problems. I would suggest that this is because those on higher incomes have better opportunities to take up activity. If you play a sport regularly, you are more likely to take some control over your diet. If you have not become terribly obese in the first place, you are more likely to take up your exercise. If the cheaper foods you are buying are not laden with fat, there is a relationship. It is statistically proven that the groups who take the most exercise have the least problems—there is no real argument about that.
What can the Government do to break into this? First, they should make sure that schools and those who provide sport to school-age children receive all the support they can, so that they can get on with the process of being physically active and having a reason to maintain their weight. At the moment, there is a problem. If you are dependent on the facilities of a local authority, and that local authority has closed down parks, gyms and sports fields, you are not going to be taking any exercise, are you? You just cannot; there is not the opportunity. If you are dependent on a private gym and cannot afford it, you do not go to the gym. If you have not established that exercise pattern, you will be a very unusual person if you then take that on.
However, we have one wonderful utility that we should go back to: the amateur sports structure of this country. I know that steps have been taken and we have talked about this, but unless we encourage those links and manage to get the whole of government—education, health and local government; it takes everybody, even the Home Office, which is involved in vetting coaching staff—actively to support such groups, things will go wrong. I am afraid that was the case with the school sport partnerships, where we more or less got rid of something which at least showed signs of promise.
Why is this so important? If one has links with clubs outside, you are not dependent for your sporting activity on educational institutions. They break down linkage between the stopping of sporting activity and the ages of 16, 18 and 21, when you leave educational establishments—the age of 16 is the biggest one. So you have to get in there. All governing bodies in sports should take seriously the job of educating to keep people involved, safe and fit, and of trying to get them to engage in participatory activity. We are not talking about elite-level sportsmen here; we are talking solely about the weekend warrior, as my entire sporting career was apparently spent. Unless government finds a coherent way to encourage that, we will not be utilising this wonderful resource which is available for free and wants to be given the job. I hope that the Government will look at this to make sure that we have a coherent strategy for using those who want to help.
Baroness Neville-Rolfe (Con)
My Lords, this debate takes place at dinner time, which is an ideal time if I may say so. I congratulate the noble Baroness, Lady Walmsley, on gathering us all together to discuss this important area.
Obesity is a subject that I have grappled with since the early 2000s when, as a Tesco employee, I sat on the foresight obesity panel under the auspices of the business department and its Government Office for Science. This was in an era when, on the positive side, serious research and objective facts generally ruled in public policy. On the negative side, we came up with a report the most striking output of which was a vast spaghetti-style map—which I have with me if any noble Lords would like to see it afterwards. It mapped the causes and avenues of obesity, but it was so complex that it defeated the system and, perhaps as a result, gathered minimal attention.
I made a contribution later with colleagues at Tesco by introducing workplace initiatives such as free fruit and Race for Life—the noble Lord, Lord Addington, is right that mass sport is definitely a positive—and by pioneering traffic-light labels on food packaging. Indeed, broadly the same system was eventually adopted on a national basis by the then Secretary of State, my noble friend Lord Lansley. These labels are used for calorie counting, for avoiding sugar if you are diabetic, for keeping down fat if you have coronary risk and for encouraging manufacturers to reduce salt. I would be interested to hear whether the Minister knows of any evidence of the impact of this traffic-light measure, especially on the vital younger age groups that we are talking about today.
I do not want to go over the ground that others have already covered, but want to make a scientific point and a moral point. On the science of diet, there appears to be more disagreement than one might expect. Too many calories should obviously be avoided, but the relative merits, or demerits, of fat and carbohydrates seem still to be a matter of surprising disagreement—I was interested in what my noble friend Lord McColl said about low fat and sugar. My hunch as a past fan of Elizabeth David is that there is a lot to be said for the Mediterranean diet; that is, lots of fruit and vegetables, of vegetable oil and of fish. However, it would be helpful to be certain about it. These disagreements among experts are not helpful for progress.
My scientific point concerns another area, sleep, which, as it happens, did not appear specifically on our huge obesity map in 2007. There have been some serious advances in the science of sleep in recent years, but the vital point is that there is strong emerging evidence that poor, disturbed or insufficient sleep is a significant contributor to obesity, even if the precise mechanism is imperfectly understood. There are various ways to improve sleep, such as by avoiding white light and wearing a Fitbit-type device—which allows you to monitor your sleep pattern on your phone and go to bed at a more consistent time, apparently a key to success. More publicity about the advantages of better sleep patterns for weight reduction could help many who struggle with weight problems.
We have moved from a world where many people were short of food to one where, outside the most unfortunate countries such as North Korea or some in Africa, people have access to more food than is good for them. This has its own challenges. My moral point is that, whatever the scientific facts, obesity will not be tackled successfully unless those at risk can demonstrate self-control. It is no use blaming others, food manufacturers or the fears that prevent children walking to school, as I did every day from the age of five—it was quite a long way, for our own failings. The main fault, dear Brutus, lies not in others but in ourselves. As far as young people are concerned, we need to convince them that self-control is needed to avoid obesity—and for many other desirable outcomes. This is not a convenient conclusion—it is so much easier to blame others for our own shortcomings—but it is no less valid for that and is very important in tackling the obesity epidemic among our children and young people today.
Baroness Grey-Thompson (CB)
My Lords, I thank the noble Baroness, Lady Walmsley, for tabling this debate this evening and I declare an interest as chair of ukactive and also as vice-president of the Local Government Association.
I warmly welcomed the Government’s childhood obesity strategy when it was released. It is important to talk not just about what and how much children eat, but the impact that it then has as they grow to become adults. Of course, what we eat makes a difference, but it will be no surprise that I am going to talk about what we can do in terms of physical activity. I can perhaps answer the question of the noble Lord, Lord McColl, about maintaining weight. I know that when I was an athlete, training 12 to 15 times a week, 50 weeks a year, was very good for maintaining weight. You can eat quite a lot when you train that hard, but that is not very realistic. I know now how incredibly important physical activity is for my daily life, enabling me to push my own chair and lead an independent life.
We now have the least active generation of young people for 30 years. The fittest now would be among the least fit 30 years ago and we have a generation of children who are likely to die before their parents—nobody wants that. As noble Lords will imagine, I am a strong supporter of good-quality activity in schools, but there are 168 hours in a child’s week and just two of those are devoted to physical activity. In May 2015 ukactive produced a report called Generation Inactive which revealed that half of children aged seven were failing to meet the CMO’s 60-minute daily activity guidelines and called for Government to support head teachers to take a whole-day approach to physical activity and ensure that no child was left behind in the right to a healthy and happy childhood. An inactive childhood can shorten a child’s lifespan by up to five years and lead to long-term health problems, such as type 2 diabetes and heart conditions, and those trends go into adulthood. Inactivity costs our nation £20 billion a year.
I want to draw noble Lords’ attention to ActiveMiles. It is a fantastic way of getting children active. There are many different forms and I would happily facilitate a visit for anyone who would like to see it. It is incredible; it is cheap and it transforms how young people build their own confidence and behaviour, but linked to that are important lessons on healthy eating. We have to ensure that quality is a calling card of anyone wishing to work with schools and that there is a clear and consistent way through which schools can identify what will and will not work for them. Shockingly, the Government spend more on childhood obesity—£27 billion a year—than on primary education, which costs £26 billion a year. Inactive habits are becoming increasingly entrenched among today’s children and young people and if we do not take action now it will only get worse.
This is a complex issue. We need a holistic approach in order to improve the mental, physical and nutritional health of children nationwide. So I ask the Minister, with the soft drinks levy, while it is fantastic that a number of companies are looking to change their products, has he or his department recalculated what the figures might look like, and will he guarantee money available to schools? Can he update me on the sustainability plan for the premium beyond 2019? Research by ukactive has shown that British schoolchildren are losing 80% of fitness gained during term time through “inactive summer holidays”. These findings also demonstrate that the poorest 25% of primary school children experience a drop in their fitness levels 18 times greater than the richest 25% over the school summer holidays. That is why this summer we are running a pilot in 25 schools which will look at inactivity, but also at education, holiday hunger, learning loss, personal development and, very importantly, mental health in young people.
Finally, I would like Her Majesty’s Government to consider how we measure our children. We do it in literacy and numeracy, but a slim child does not automatically mean a fit and healthy child. We should measure children’s fitness. I am not talking about sticking a child on a treadmill and making them do a V02 test: I did that when I was an athlete and it is horrible. It is not about that but about actually understanding the starting point for our children. I believe that the Government should extend the national child measurement programme to measure cardiorespiratory fitness and examine data from Sport England’s active lives survey, which monitors children’s attitudes towards their health and fitness, in addition to the current measurement of BMI. While being informed by academic expertise and rigour, this should be developed in a way that is fun, inspiring and engaging for young people, with young people themselves central to its design, as opposed to people speaking on their behalf. That is why I was delighted that the noble Baroness, Lady Walmsley, had voices of children tonight: we need to understand what children want.
The group ukactive is currently working on a number of policies to address childhood inactivity and has recently launched a major new consultation. We will be reporting on that later in the year. It is not too late to change the opportunities that we give young people and help to produce a better life expectancy, but we have to do something now.
Baroness Mone (Con)
My Lords, I too congratulate the noble Baroness, Lady Walmsley, on securing this timely debate. There is much to welcome in the Government’s plan to tackle childhood obesity. It is of grave concern to me that those most affected by the obesity epidemic are among the poorest in this country. I am sure I share the belief of all noble Lords that people should not be at a higher risk of obesity and cancer just because they are on low incomes.
I grew up in the East End of Glasgow. I did not learn anything about food and nutrition until I started my business and my entrepreneurial career. I was eating really badly and put on lots of weight. My children too were eating unhealthily. Once I learned the basics of nutrition, I changed what I ate, lost tons of weight and started to work out. I became a lot happier and healthier and my children followed me. It is far too easy for people to point the finger at low-income parents and criticise them for not feeding their children properly, but I think we are putting the blame in the wrong place. When you are on the breadline, your focus is, “I just need to feed my kids”. You will reach for a tin of spaghetti hoops, pre-packed, convenient ready meals or fish fingers and oven chips, thinking that you are providing a decent meal for your kids. We put a lot of trust in manufacturers and supermarkets, believing that they are selling us food that is healthy and nutritious, but that trust is misplaced.
The fact is that the food industry, both manufacturers of processed food and supermarkets, can make billions of pounds selling high-sugar, high-salt, low-nutrition foods at cheap prices, regardless of the impact it has on childhood health. Essentially, the Government are subsidising the food industry to the tune of £5 billion-plus per year—the cost to the NHS of the obesity health epidemic. These trends, unless stopped, will cost the NHS tens of billions in the coming years. Changing behaviour around food at childhood, teaching in schools and educating parents on the dangers of what they are eating will prevent lifelong problems. We can save billions of pounds and live healthier, more productive lives.
We have been here before on many different matters of public health. We eventually banned lead from paint when we realised it was killing people—although 86 years after Australia. Wearing a seatbelt became the law when we realised that not wearing a seatbelt meant we were more likely to die in a car crash. And we put health warnings on cigarettes when we realised that smoking caused cancer, although it took 50 years to achieve this. How long do we wait to act on obesity? At what point do we accept that our food manufacturers and supermarkets are selling food that is slowly killing their customers? It must be made clearer to families that a diet of kebabs, chips, chocolate, burgers, sugary drinks and convenient ready meals does not constitute a healthy, balanced diet just because these products are sold in supermarkets and available at takeaways. We must act when less healthy foods are three times cheaper than healthy foods, and foods with red traffic light labels are 20% more likely to be on promotion.
We can change food labelling once we are out of the EU. How should we do this? First, we must apply health warnings. As the Royal Society for Public Health has advised, high-fat, salty and sugary foods, which are linked to obesity and cancer, should carry a clear health warning, as cigarettes do.
Secondly, food labelling must be simple and easy to understand. The “recycle” symbol is one of the most recognised in the world. In the same way, a positive food choice should be instantly recognisable at the supermarket. Australia’s Health Star system rates foods out of five stars. The more nutritious the food is, the more stars it gets. It is simple. If we can get a similar system, and do it right, this sort of labelling will help families make positive choices.
Change is possible. The food industry has responded amazingly to the “Blue Planet” documentary, which shifted our attitudes and practices around plastic almost overnight. Iceland is working to reduce the use of plastics in its packaging to save dolphins. It is banning palm oil in its own products to save rainforests. But what are Iceland and the other supermarkets doing to end the supply of goods that fuel childhood obesity and illness? Let us work hard in this House to challenge the food industry to make it easier for hard-pressed families to make positive food choices, by getting real about the health risks of cheap, processed foods, adding health warnings to packaging, and devising simple labelling to help families make informed choices. Together, we can end the £5 billion-plus NHS grant to the food industry, and stop this obesity epidemic now.
Baroness Benjamin (LD)
My Lords, I, too, congratulate my noble friend on securing this important debate and welcome the opportunity to contribute. It is not the first time—and certainly will not be the last—that I will speak on this subject, which is of tremendous importance to children today, their children and their children’s children. As I always say, childhood lasts a lifetime and the effects of obesity in childhood are progressive. One-third of our children, two-thirds of adult men and just over half of adult women are overweight or obese. These statistics on obesity, physical activity and diet from the Department of Health illustrate that the UK faces a health crisis related to poor diet and inactivity.
Since 2014 the All-Party Parliamentary Group on a Fit and Healthy Childhood, which I co-chair, has published nine reports, in which we expose the extent of the child obesity epidemic and recommend ways in which policymakers might address it. As has been said, what is needed is a holistic approach, driven by a properly funded strategy and overseen by a Secretary of State with sufficient authority to ensure that changes which are absolutely necessary to policy, budgets and guidance actually happen. We want a holistic approach that involves everyone: government, industry, parents and carers, local authorities, health and education specialists, community interests, media and advertising. It is no one sector’s responsibility. Unless we act collectively, we will never combat the detrimental human and economic costs of obesity, so that the UK can thrive as a properly fit, healthy and productive nation—because the effects of obesity are psychological, as well as physical.
Our all-party group welcomed the child obesity strategy in 2016, as well as the recently announced second stage of the process, in addition to other government actions such as free infant school meals—of which we were the first enthusiastic advocates—and the sugar tax. But there is so much more to do. We believe that the benefits of free school meals would be greater if they were extended to all school-age children. I ask the Minister: will this happen? Will all school-age children receive school meals? Also, schools must be given strictly ring-fenced funding for school kitchens and properly trained catering staff. Ofsted needs to ensure that the primary sports premium money allocated to schools is actually spent on making children more active, rather than plugging other gaps in overstretched school budgets.
Measures in stage 2 of the child obesity strategy aimed at cutting the calorie content of fast food will not be effective unless they are complemented by policies to increase children’s physical activity levels—not forgetting good old-fashioned play for very young children. I salute those food and drink companies that have taken advantage of the responsibility deal to make reformulation changes, such as lowering calories and removing added sugar from own-brand fruit juices and saturated fat from own-brand products.
However, I ask the Government to seize the opportunity and convene a summit with industry to see how much further we can go, building on evidence already before us to make progress, by adopting ambitious sugar, fat and calorie-reduction targets. These have already been delivered successfully on salt. The Government have said that they expect the food and drink industry to set the best example possible. Our all-party group expects the Government to now play their part and make use of their legislative powers, following due consultation with all relevant concerns. This is what many in the food and drink industry want.
I wholeheartedly support the British Society of Paediatric Dentistry, which has made such a persuasive case that children’s oral health should be integral to a child obesity strategy. This includes brushing in all schools and early-years settings to reduce dental decay, pain and suffering to children and the unnecessary cost to the NHS of increased hospital admissions, mainly because of high sugar intake.
The only way to combat child obesity is by investing in every aspect of a child’s life, from the portion sizes of their meals to the way their school encourages good nutrition, play and physical activity. Child obesity cannot be addressed just in nutrition classes within the national curriculum. The challenge for the Government is to be a champion for our children by turning the arguments that have been highlighted into policy and acting now. Some might say this smacks of a nanny state but surely the duty of the state is to safeguard the nation’s health and well-being.
I pledge that my All-Party Parliamentary Group on a Fit and Healthy Childhood will support all strategies that aim to defeat the scourge of obesity as part of a holistic plan that secures our children the healthiest foundation on which to build their lives. I look forward to hearing the Minister’s response.
Lord Balfe (Con)
My Lords, I thank the noble Baroness, Lady Walmsley, for initiating this debate. I declare my interest in the register as president of the British Dietetic Association, which is the TUC-affiliated union that organises the 10,000 dieticians who work mainly in the National Health Service, and which is looking forward to meeting the noble Baroness, Lady Walmsley, whom it has invited to meet it.
I mention in passing that the biggest problem faced by dieticians is malnutrition among the elderly, a group that is often forgotten, but we welcome the government strategy on childhood obesity, published in August 2016, particularly the action to reduce sugar intake, such as the recently introduced sugar tax, and the guidance on the reformulation of high-sugar foods and calorie-reduction programmes.
I do not want to rain on the parade, as they say, but I would like to add a bit of context to the debate. The numbers are often misinterpreted. We often hear the fact that 65% of men and 58% of women are overweight or obese. That is because we like to confuse “overweight” and “obese”. They are two very different things. Only 27% of those people actually have a BMI in excess of 30—and, as the noble Lord, Lord McColl, will tell you, it is your weight, not your BMI, that matters anyway. But it is also notable that of the children who were obese, 48% of their mothers and 43% of their fathers said that their child was “about the right weight”, so it is not necessarily identified by the carers that they are obese.
I would like next to mention something from the Minister’s own department. The Minister has had a varied ride at my hands but tonight he might actually be pleased because in 2016, his department produced and published a study done by the Office for National Statistics. I am very fond of the Office for National Statistics, which often comes out with things that are rather controversial but generally held to be true. Let me read what it had to say about childhood obesity. It said:
“Compared with the general increase in childhood obesity from 1995 to 2005, the obesity rate has subsequently levelled off. The prevalence of childhood obesity has varied little in recent years. This is consistent with international evidence that childhood obesity rates in developed countries are stabilising and that they may be declining”.
That is our Office for National Statistics, which generally gets it right. Even for parents, while there has been a gradual drift upwards, it said that,
“the trajectory of overweight and obesity has plateaued, as there has not been a statistically significant increase since 2010”.
Those are ONS figures in an ONS report published by the Minister’s own department, so I am just saying that we need to keep it in context.
That does not mean to say that we do nothing because clearly there are problems and we need to address them. In particular, and I rely on the British Dietetic Association for this as my own family experience is somewhat out of date, there is the promotion of breast-feeding. Dieticians have much evidence that this has a protective effect against obesity and cardiovascular disease in later life; therefore, the BDA strongly recommends that HMG’s obesity strategy should include initiatives to promote and encourage breast-feeding. I am sure that that is correct.
We also look for strong controls on the promotion, marketing and advertising of unhealthy food and drink, with particular attention given to limiting price promotions. These are apparently much more prevalent in the UK than in other European countries. Public Health England has shown that price promotions increase the amount that people buy by around 20%, and the amount of sugar purchased as part of these foods by around 6%. There is also a school of thought, supported by the BDA, that advertising should be restricted until after the 9 pm watershed. I take the point about leaving the EU but Scandinavia has a pricing policy which basically forbids predatory pricing. In other words if something is 200 grams in weight, it should cost twice as much as something that weighs 100 grams and not one and a half times as much. That policy could be introduced.
There is no magic bullet in this area. There clearly is a strong link between poverty and obesity. Twice as many children in the lowest 20% are obese as in the highest 20% and we look to address this. What I am saying is that if we can keep the problem in perspective, we might find solutions. If we constantly look for high numbers that look good on the front of newspapers, the likelihood is that we will not solve the problem but go away, throw our hands up in horror and say, “It’s too big for us to do anything about”. Within reason, we have a chance of solving this problem and moving forward.
Baroness Jenkin of Kennington
My Lords, some 18 months ago I was asked by the Centre for Social Justice to chair its working group, which last December produced a report entitled Off the Scales: Tackling England’s Childhood Obesity Crisis. I urge noble Lords who are interested to take a look at that report, or at least its summary and recommendations. I for one would have liked to go further but the stresses between representatives of the food industry and food campaigners on the committee proved challenging, to say the least.
The topic might not seem a natural fit for the Centre for Social Justice but, as other noble Lords have mentioned, it is clearly a matter of social justice. By the age of five, children in poverty are twice as likely to be obese as their least deprived peers and by the age of 11 they are three times as likely. Children living in poverty are more likely not only to be obese but to experience a combination of acute social problems over their lifetime. Other identified barriers to families in deprived areas living a healthy life—in practice, healthy behaviours—include being more likely to live in an area with more takeaway and fast-food outlets, more likely to live in poor, unsuitable or overcrowded housing, and more likely to experience a combination of family breakdown, stress, mental health issues and financial problems. They are more likely to be judged and negatively influenced by social disapproval of their deprivation and obesity. These conditions make it challenging for families in poverty to practise healthy behaviours and difficult for policymakers to know where to begin, especially when education and awareness are not enough.
Since we started working on the report, further evidence and a plethora of similar reports have emerged on a regular basis. This includes one reported today from the University of Warwick about lack of sleep leading to obesity, as my noble friend Lady Neville-Rolfe mentioned. Not only is our children’s health at serious risk but our health service and our country is, too.
No child wants to be fat. I was a chubby child and a plump adult until I lost 28 pounds around seven years ago—and having put half of that back on again, I know just how difficult it is to lose weight and keep it off. I came to this subject and report not as an expert, but as a lay person who simply could not stand by and let things get any worse. We all know that living in an obesogenic society means that it is hard for most of us to resist temptation and maintain a healthy weight but it is especially hard for those living in poverty, whose choices are limited by circumstance.
During the process of writing our report, we came to understand how it is that no country around the world has been able to reverse its obesity trend on a national scale, although I urge the Government to look carefully at the work being done in Amsterdam through a city-wide, whole-systems programme that has kids weighed regularly and tested for balance and agility. I have visited the programme, and I think the Health Select Committee in the other place is going in the next few weeks. It is early days but, thanks to the deputy mayor’s political commitment, the city’s numbers are improving, showing a 12% drop in obesity over a three-year period and even more in the poorer areas. The case study of the Amsterdam healthy weight programme demonstrates the power that political leadership can have in bringing people together, seeking change and driving it through.
I do not underestimate the political courage needed to make that change and to take on many vested interests, but although childhood obesity is a complex and contentious issue, it is not impossible to address. Many key steps have already been taken. The childhood obesity plan is a welcome start to the conversation, and much good work is already being done across England by local authorities, charities, NGOs and universities among others. However, the system is fragmented. Without a joined-up approach, these efforts are at risk of being eclipsed by the growing scale of the epidemic. It requires robust and persuasive political leadership, cross-party and cross-sector commitment, a long-term vision, a whole-systems and targeted approach and consistent monitoring and evaluation.
I am lucky enough to spend many of my weekends with two great-nephews aged two and four. They run everywhere. Children are designed to run. You do not see small children walking. I would like to have the opportunity to talk about the daily mile, which fits in with what the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Addington, were talking about, but time is short. Today you are sadly more likely to see children strapped into buggies for hours on end, in front of a tablet with a bottle of sugary, teeth-rotting juice and a sausage roll—sometimes called a Greggs dummy—to keep them quiet. The average child eats its own weight in sugar every year. Those kids simply do not stand a chance.
People think that being overweight is an abnormal response to a normal environment. That is not true at all. It is a normal response to an abnormal environment. Political will is needed to effect the change we so desperately need. I urge the Government to be bold, and I look forward to the Minister saying, “We can, and we must, end childhood obesity”. We really have no other choice.
Lord Berkeley of Knighton (CB)
My Lords, I am very grateful to be allowed to speak briefly in the gap. What I wish to say extends and amplifies what other noble Lords have said. In the area on the border between mid-Wales and England where I spend a lot of time, I have noticed that the provision of leisure centres is crucial to families, especially less privileged families who can take children to learn to swim. We know that swimming is a very fine way of keeping fit, but it is also important that children are able to swim. My question to the Minister is simply this: does he feel that the provision of leisure centres is important in the Government’s fight to prevent childhood obesity?
Lord Storey (LD)
My Lords, I, too, thank my noble friend Lady Walmsley for initiating this debate. It is interesting that in today’s press there are a number of articles on childhood obesity, including one on teaching pupils how to be healthy parents and one, which the noble Baroness, Lady Grey-Thompson, mentioned, on how sleep deprivation increases the risk of childhood obesity.
It is with considerable sadness that I rise to speak in this debate. In a perfect world such a debate would not be necessary. In a perfect world we would certainly not be discussing child obesity in England when in too many other countries children and young people are literally starving to death.
One of the most disappointing and weakest documents produced by this Government recently was Childhood Obesity: A Plan for Action, which was published in August 2016. It had been seriously diluted from what we had expected and had few teeth. It had that in common with too many children, who have few, if any, teeth left but far too many pounds—in weight, of course.
While we must do all that we can to educate children about eating proper meals, not snacking continuously, not drinking fizzy drinks and taking proper exercise, we cannot just leave it to children to make the right choices. From birth it is parents who set eating patterns for their children: patterns that can be in stone—not weight—at a very young age. If parents are not well informed about eating habits and exercise, how can they ensure that their children are neither overweight nor minus their teeth?
In addition to making sure that parents are properly educated, we should recognise that there are a number of other key influencers whose interest seems to lie in developing unhealthy eating habits purely for profit. How many of us have heard young children demanding the chocolate that is placed conveniently at trolley height at supermarket checkouts, or the bargain chocolate bars that are always on the counter in major newsagents? Can anyone have escaped those adverts for a fast-food chain that encourage you to play Monopoly to win a bigger burger? I assume Park Lane is a Big Mac slathered with tomato ketchup. How many big bags of fries do you have to eat to get an Xbox, which will ensure that you eat more chips while becoming more of a couch potato? I still have horrible memories of children in my family demanding another Happy Meal so they could collect yet another plastic figure.
By the time children get to school, the die—I use the term advisedly—is already cast. Running round the playing field and having your lunchbox inspected will have little effect if you have spent your early years consolidating a junk food diet. Too many young children’s diets are totally lacking in fresh fruit or fresh vegetables, and the chicken and fish will be covered in breadcrumbs and deeply fried.
Coincidentally, a series of papers was published today in the Lancet, dealing with nutrition and lifestyle in the pre-conception period and its importance for future health. To quote from the introduction:
“This Series … makes the case for preconception health as a key determinant of pregnancy success and next generation health”.
Earlier today I was in touch with Professor Judith Stephenson of the UCL Institute for Women’s Health, the lead author of the Lancet papers, who said:
“Mothers (and fathers) who have a healthy weight before becoming pregnant have smoother pregnancies and healthier children. Across the globe, obesity and poor nutrition are rife, but maternal motivation to improve health in the period before conception can be very strong. We call for better resources and leadership at all levels to help women achieve a healthy weight for the benefit of all family members”.
Keith Godfrey, professor of human development at the University of Southampton, said:
“Socioeconomic disparities are hugely concerning in the child obesity epidemic and scientific evidence points to more than 80% of these disparities arising around conception through parental smoking and obesity. Engaging with children and teenagers to promote preparation for healthy parenthood offers a real opportunity to reverse one of the most pressing problems of our time. If we grasp the opportunities in schools and communities we can improve the health of the next and future generations”.
If we start early enough and develop the principles and practice of healthy eating, the next generation will at least inherit a better lifestyle from their parents—an inheritance that is of course tax free. The obesity strategy that we expected was in fact a plan of action that in all honesty looks more like a plan of inaction. As we have heard today, there is an abundance of evidence about the extent of child obesity and its causes. The noble Baroness, Lady Mone, is right: we need to ensure that parents are educated. Sure Start centres are one way of educating young parents about the importance of a healthy diet for young children as they grow up. With 1,000 children’s centres gone, how many hundreds of thousands of young mothers, fathers and young children have not benefited from such advice?
We need a proper government-wide strategy that takes a co-ordinated approach to tackling obesity. A bit of education here, a bit of sugar tax there and a bit of preventive health now and again is not the answer. We need to look at some key factors. I am sure that if we do that we will see a real change.
I will end on the question of teeth. I am sure that the Health Minister is concerned about pressures on the National Health Service. We know that one-quarter of five year-olds get tooth decay and that 90% of that is preventable—nearly 26,000 young people being admitted to hospital. So I have three questions for the Minister. First, why do we not bring back dental inspections in schools? Secondly, when are we going to get the assessment on children’s centres? Thirdly, does he not think that we should go back to the days of two hours of timetabled sport in primary education?
Baroness Thornton (Lab)
My Lords, I thank the noble Baroness, Lady Walmsley, for initiating this debate and for her patience—she has got it at last. I thank all noble Lords for their contributions, and I thank the many organisations that have sent us briefings about this important subject: the LGA, the BMA, Diabetes UK, Cancer Research UK, the Faculty of Dental Surgery, the Daily Mile and the Obesity Health Alliance. As other noble Lords have mentioned, we also received one late today from the Advertising Association, which seemed to make the argument that there is no need to have a ban on high-fat, salt and sugar advertising before the watershed at 9 pm because there is no evidence that it would have any impact. As someone who proposed a Private Member’s Bill about 10 years ago saying exactly the opposite to that, I am afraid that, like the noble Baroness, I was not in sympathy with that argument. I am sorry if I have left anyone out of the thanks for all the briefings that we have received. This amount of interest seems to be a sign that people recognise that there is a health emergency that our children and young people face.
The House of Commons Select Committee March 2017 follow-up to its 2015 report tracked the action, or inaction, of government in tackling the problem of child obesity. It commented on the Government’s child obesity plan that was published in 2016, which, like many noble Lords here, we found disappointingly modest, given the proposals of the 2015 Select Committee. It showed a lack of urgency that I am afraid is still apparent.
I am not going to repeat all the facts that many noble Lords have mentioned, but the fact that 30% of our children are overweight or obese and many will remain that way into adulthood is not good. And yet, in 2016 UNICEF estimated that 10% of children in the UK are living in severe food insecurity, which means that they do not have enough to eat. Frank Field’s Hungry Holidays report estimated that as many as 3 million children could be at risk of going hungry over the school holidays. I am sure that your Lordships will recall that at a recent teachers’ conference we heard reports of grey-faced hungry children turning up at school who cannot learn because they have not eaten.
Food poverty and obesity coexist in some of our most deprived communities. Children living in the most deprived areas are more than twice as likely to be affected by obesity as those living in the least deprived areas. Families from deprived communities have the poorest diets, as noble Lords have mentioned, high in saturated fat and low in fruit, vegetables and fibre.
Can the Minister assure the House that the Government are taking a comprehensive approach to this issue, which is also about how to support parents to make the right choices, the right decisions? It is about ensuring that children can still have access to free school lunches. It is about looking at how families can afford decent food. As the noble Lord, Lord Storey, said, it is about Sure Start centres, it is about providing support in the communities where children are most at risk. If I may add, it is also about not selling off school playgrounds.
I was struck by the briefing we received from the LGA, because since the responsibility for delivering public health transferred to councils in 2015, local government has spent more than £1 billion tackling child and adult obesity and physical inactivity. Against a backdrop of reductions to the public health budget, councils report a 50% increase in spend in the years between 2013 and 2017 on childhood obesity and a 60% increase on childhood physical inactivity in the same period.
Surely it is counterproductive to continue to cut public health budgets in this context. Public Health England’s sugar reduction programme should be extended to include salt, saturated fat and overall calories. Is the Minister prepared to ensure that compliance with these targets should be regularly monitored and backed by meaningful sanctions for companies failing to make progress?
As many noble Lords have mentioned, the Government should close existing loopholes to restrict children’s exposure to junk food marketing across all the media to which they are exposed. The rules currently apply to only 26% of children’s viewing times and still allow adverts for food and drink high in fat, sugar and salt to be shown during family viewing time—between 6 and 9 pm—when the number of children watching TV is at its highest. These rules are failing to protect our children. They deserve to be protected from exposure to adverts for food and drink that we know can influence their food preferences, choices and intake.
The noble Baroness, Lady Mone, made a great speech about what needs to be done, but the point about her analogy with seatbelt usage is that we needed legal compulsion to make people wear seatbelts because they would not do it voluntarily and the car industry was not going to install them unless the law made it comply. If we are to follow that analogy, perhaps some lessons need to be learned about compulsion.
We need a comprehensive strategy that tackles all those issues. If we fail to have that, we fail a generation of children and young people, to great personal cost to them and great public cost. The noble Baroness, Lady Jenkin, hit the nail on the head when she said that political leadership is what is required.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)
My Lords, I start by congratulating the noble Baroness, Lady Walmsley, not only on securing the debate but on opening it in a way I had not previously experienced—through the voices of children. I must say that if every debate started that way, this would be both a happier place and a more informative one. I genuinely thank her for the approach that she has taken and the time that she obviously took with those children. I thank all noble Lords for their, as ever, wise and challenging contributions and will attempt to answer as many questions as I can.
I do not disagree with the characterisation of what we are discussing as an epidemic, because childhood obesity is undoubtedly one of our top public health challenges. We have heard some data about the prevalence rates, but the simple fact is that a quarter of children entering primary school start off overweight or obese—I am conscious of the distinction that my noble friend Lord Balfe makes—but that rises to a third by the time they leave. Something is happening during those years. There is also a generational aspect to this. Cancer Research UK has shown that the millennial generation is on course to be the most overweight in history. Given the lack of housing and other things they are grappling with, we must address this issue.
As my noble friend Lord Balfe said, there is some encouragement and hope in the plateauing of obesity rates: it is not a cause for despair. However, the evidence shows that, as several noble Lords have mentioned, there is a deprivation gap and this is increasing. The costs of this are mental as well as physical. My noble friend Lady Mone and the noble Baroness, Lady Benjamin, talked about the mental health impacts, including depression, that come from obesity. Other risks that we face are type 2 diabetes, heart disease and an extra likelihood of common cancers such as bowel and breast cancer. It is also a major risk factor for non-alcoholic fatty liver disease. These represent a cost, not just to individuals, but to all of us as taxpayers. The figures used today talk about a cost to the NHS of £5 billion annually. The cost to society is perhaps between five and 10 times that amount.
We all know the scale of the problem and agree that it is complex. It will not be solved overnight. The noble Baroness, Lady Thornton, spoke about the importance of urgency. We need urgency, but it will take time to see results. I am pleased that the mood of this debate is a determination to work together to solve the problem.
What have the Government been doing? As several noble Lords have referred to, we launched our childhood obesity plan in 2016, informed by the latest evidence and research in the area. At the heart of the plan is a desire to change the nature of food that children eat and make it easier for families to make healthier choices. The plan poses challenges for us all to play a role in reducing childhood obesity levels: national government, local government, business, the NHS, schools and families. Some of the key measures that have been talked about today include the soft drinks industry levy, the sugar reduction and wider reformulation programme—which I will return to—and helping children to enjoy an hour of physical activity every day.
Real progress has been made since the plan was published. The soft drinks industry levy has come into effect and PHE has formulated a comprehensive sugar reduction programme with the aim of a 20% reduction in sugar in key foods by 2020, including a 5% reduction in year one. Industry has responded to these frameworks and that gives us cause for hope. There is sometimes a sense that industry will not respond, but companies such as the makers of Lucozade and Ribena, Kellogg’s, Waitrose and Nestlé have been leading the way by removing millions of tonnes of sugar from products. Through my noble friend Lady Neville-Rolfe, I commend the action of Tesco. We enjoyed the services of Tesco Extra in the Isle of Wight over the weekend. Its offer of free fruit for children was extremely welcome; it stopped them fingering packets of Haribo and other things instead. These little things do make a difference.
We now expect almost half of all drinks that would otherwise have been in scope of the sugar levy to have been reformulated as a result. That is a cause for celebration. We know that there was scepticism about the levy when it was introduced, but I think most people would agree that it has been a success. We believe that there is a philosophical reason for acting in this way. Children do not always make their own choices and they certainly do not always make choices with a full suite of information. Government has a history of intervening to protect them; insisting on children using car seats is one example. Children need protecting from the effects of sugar and obesity, for their current and future health. It is right to act to develop good habits. I reassure noble Lords that we believe that to be the case. We do not have an ideological problem with acting in this area to tackle obesity.
An area that I thought might be touched on this evening which I want to highlight is the consumption of energy drinks. These often have a high sugar content and are linked to poor sleep. Again, this is an area where we have seen industry responding positively as regards restricting sales. I have personally seen the havoc that these drinks can wreak in schools and in diets. We are continuing to focus on this area. Therefore, these are a number of areas we are taking forward under the banner of reducing the impact of sugary soft drinks.
On the other things we are doing now, I will just step outside my brief and stress the role of schools. First, the levy is funding a doubling of the primary school PE and sport premium, and providing £100 million in 2018-19 for a new healthy pupils capital fund, with appropriate distribution for the DAs under the Barnett formula. I can reassure the noble Baroness, Lady Grey-Thompson, and other noble Lords that regardless of the income from that levy, the funding is guaranteed for the coming year; off the top of my head, I think it is £320 million. I will ask for confirmation from the DfE about what the plans are for that. However, it is not a true hypothecation, so that funding is there regardless of the income that comes in.
It is also important to say that as a consequence of the levy we are also investing £26 million in breakfast clubs. These are particularly focused in about 1,500 schools in opportunity areas, which are areas that have been targeted for government action because of poverty. An important issue that has come out of this debate, highlighted by the noble Lord, Lord Addington, the noble Baronesses, Lady Grey-Thompson and Lady Thornton, and my noble friend Lady Mone is the direct link between poverty and obesity. As I said at the beginning, the gap is still growing. We are therefore conscious, as my noble friend Lady Jenkin said, that this is an issue of social justice and that there is a need to act. The breakfast clubs have been focused in the opportunity areas because that is one way we are trying to address that issue.
We have said that schools are well-placed to support action. After a coalition policy we introduced free lunches in reception, year 1 and year 2. I have to disappoint the noble Baroness, Lady Benjamin, that at this point there are no plans to extend the free lunches for all pupils beyond those year groups, but of course children on benefits are able to get free school meals throughout their school life. We have other routes by which we can encourage good habits. I focus on PSHE, for example, and cooking classes, and in the primary curriculum lessons on healthy eating. The children of St Joseph’s had obviously taken on board many of those lessons.
One of the things we also have to do is to provide education about personal responsibility. My noble friends Lady Neville-Rolfe and Lord McColl made the point that this is about taking responsibility based on information. As a child, you are inevitably impulsive, but becoming an adult is about developing good habits, and schools have a critical role to play in this. They also have a role in educating parents, and the best schools get parents in to give them these kind of lessons to make sure that they are able to support their children as well.
The noble Baronesses, Lady Walmsley and Lady Thornton, talked about advertising. There has of course been a ban on adverts and I know that there is a call for further bans on advertising across all media. Any policy must be evidence-based. We are of course always open to that evidence, and it is important to view these kind of actions as one way in which we can help parents. I reassure noble Lords that we are keeping it under consideration. The noble Lord, Lord Berkeley, asked about swimming. It is part of the national curriculum, so I can assure him that we consider it important.
I also stress that the obesity plan is not just about school-aged children but about the early years foundation stage, when children not only learn about healthy eating—play is a key part of that. For smaller children going to formal childcare settings, that will become more part of their everyday life. We have been clear that we have considered a number of different policies, we will continue to consider other policies, and we will focus on those which will have the biggest impact on childhood obesity. I stress that we want to follow an evidence-based approach.
My noble friend Lady Jenkin talked about the work that she has been doing with the CSJ. I thoroughly commend her for that work and for the elucidation she has brought to what is happening in Amsterdam, which I believe she visited with my honourable friend the Parliamentary Under-Secretary of State for Public Health. We are trying to learn the lessons from that.
One of the opportunities that we have here concerns devolution. We recently passed a statutory instrument to give more public health powers to Manchester as part of its devo deal. Manchester is often in the lead in these kinds of issues. We see an opportunity at a city-wide level—mirroring the Amsterdam example—to get all the agencies around the table to act. Greater Manchester has introduced #GMMoving: The Plan for Physical Activity and Sport 2017-21. It involves the Greater Manchester Combined Authority, the NHS in Greater Manchester and Sport England. It is exactly that kind of partnership that we need to see more of.
Partnership working is of course at the heart of what we are doing, and I pay tribute to the many organisations that are active in this area—not just the ones that have sent briefings to noble Lords but those that are spending a great deal of money to raise the salience of these issues, such as Diabetes UK, Cancer Research UK and others.
I want to finish by touching on a couple of other issues that noble Lords have raised. The reports and data that we publish on progress will be open to scrutiny. We will be absolutely transparent in the work that we are doing, including Public Health England’s assessment of progress on the sugar reduction policy, which will be published this spring. We are also funding a new obesity policy research unit and will be publishing the details of its projects. That will give us the evidence base that we need to act.
Many other issues were raised. I thoroughly recommend Malcolm Gladwell’s “Revisionist History” podcast, which deals with a fantastic set of issues concerning how fat became the enemy and sugar the friend, and how that has driven changes in eating policy, probably for the worse. I also thoroughly recommend a book called Why We Sleep. This radically transformed my attitude towards sleep. It would not surprise me if at some point in the not-too-distant future we had a government sleep strategy—and I am not just referring to me droning on as a way of helping people to get to sleep. The consequences of poor sleep are very dramatic and, frankly, terrifying. We do need to get more sleep.
On the basis that we want to get home and get some sleep, I shall finish by saying that we are continuing to act in this area. We should focus on smoking. We have not banned it but we have had a thoroughgoing and comprehensive policy which has reduced smoking on a voluntary basis. It is that attitude that we need to take towards obesity, and the Government will continue to work on many fronts to do that. I look forward to working with all noble Lords so that we can start to reduce childhood obesity.