Calorie Labelling (Out of Home Sector) (England) Regulations 2021
(3 years, 4 months ago)
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Lord Bethell
That the draft Regulations laid before the House on 13 May be approved.
Relevant document: 4th Report of the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, I beg to move that the draft regulations be approved.
Two thirds of adults in England are overweight or living with obesity, and one in three children leave primary school overweight or obese. Obesity has huge costs to individuals, families and the economy and is one of the few modifiable risk factors for severe Covid-related illness and death. This measure is a vital part of the Government’s healthy weight strategy and will contribute meaningfully towards achieving our ambition of halving childhood obesity by 2030. The instrument that we are discussing today concerns the introduction of mandatory calorie labelling in the out-of-home sector, such as restaurants, cafés and takeaways.
Before I outline what the instrument does, I encourage noble Lords to read the Secondary Legislation Scrutiny Committee’s fourth report, which draws these regulations to the attention of the House. I extend my thanks to the committee for its scrutiny and work.
The instrument requires businesses in England with 250 or more employees to display the calorie content of non-prepacked food and drink items, except alcohol, that are sold ready for immediate consumption. Calorie information must be displayed at the customer’s point of choice, such as on menus, menu boards, online menus, and display labels. To better help customers to understand and use calorie information, businesses are also required to display a short statement referencing recommended daily calorie intake. The wording of this statement is specified in the regulations and must be displayed where it can be seen by customers when making their food choices. As well as helping people make more informed choices, transparency about the calorie content of meals will also support efforts to encourage businesses to reformulate products and reduce portion sizes.
The requirement applies to food sold in England. Scotland, Wales and Northern Ireland have been engaged throughout the consultation process, and the Scottish and Welsh Governments are considering whether to introduce similar requirements in their nations. Subject to Parliament’s approval, the regulations will come into force from 6 April 2022.
We know that people are eating out or ordering takeaways more frequently and that when people eat out, the meals they consume are less healthy. Research suggests that eating out accounts for around one-quarter of adult energy intake and that when someone dines out or eats a takeaway meal, they consume on average 200 more calories per day than if they eat food prepared at home. I know that this is the case in my life.
Research shows that portions of food or drink that people eat out or order in as takeaway meals contain on average twice as many calories as equivalent retailer or manufacturer-branded products. In a supermarket, an average pepperoni pizza is 704 calories compared to 978 calories in the out-of-home sector. I would guess that homemade pizza is less than both.
People’s access to food served in the out-of-home sector is increasing through the accelerated growth of online aggregators such as Deliveroo and Uber Eats. Kantar Worldpanel data suggests that in 2020 these types of businesses grew in value by 172% and serviced 14.5 million shoppers.
Out-of-home calorie labelling supports people to make more informed choices when eating out and encourages businesses to reformulate their food to provide lower calorie options. Research shows that popular UK chain restaurants with calorie labelling serve items with less fat and less salt than those that do not display calorie information. Calorie labelling may therefore encourage businesses to offer healthier products altogether.
Evidence from the US, where calorie labelling in out-of-home settings already has come into effect, reinforces that calorie labelling delivers a small but significant reduction in calories purchased by consumers, who noticed and used the information. Increasingly, consumers want to know how many calories are in the food and drink they buy when eating out or ordering a takeaway. Surveys indicate that nearly 80% of people think that menus should include calories for food and drink items and that 60% of people would be more likely to eat at an establishment that offers calorie labelling on its menus.
Some businesses understand this and are taking the lead by voluntarily displaying calorie information. However, we can do more to ensure that this practice becomes more widespread and consistent across the sector. Previous attempts to encourage businesses to voluntarily display calorie information through the Department of Health and Social Care’s responsibility deal have proved insufficient at driving action on the scale required to make a substantive change to our food environment. That is why we are introducing a mandatory requirement for large out-of-home food businesses.
The importance of the out-of-home food sector to local communities and to the economy is something we are acutely aware of, as is how hard our hospitality sector has been impacted by Covid-19. By requiring only large businesses to calorie label, we are ensuring that smaller businesses which will likely find the requirement more challenging to implement are not impacted. Large businesses account for 49% of all turnover in the out-of-home sector and potentially there are more significant benefits. Our impact assessment estimates that the policy will have a net benefit to the economy of £5.6 billion over the next 25 years.
In conclusion, given the scale of the obesity challenge, we must take action to make the food environment healthier and promote transparency between businesses and consumers. I encourage noble Lords to review the helpful and informative briefing provided by Diabetes UK, which I would be happy to share. Its briefing highlights the importance of this legislation to help people with, and at risk of, diabetes. By taking action to improve our nation’s health, we will be happier, fitter and more resistant to diseases such as diabetes, cancer and Covid-19. I beg to move.
Baroness Bull
At end insert “but that this House regrets that they may not have their intended effect of addressing concerning levels of obesity in the United Kingdom; further regrets that their introduction will have negative and damaging consequences to those living with, or at risk of developing, eating disorders; further regrets that they do not reflect the views of experts and those with lived experience of eating disorders and do not take an integrated public health approach to obesity and eating disorders; and calls on Her Majesty’s Government to commit to timely reviews of the impact of these regulations not only on obesity, but on eating disorders, as such disorders have the highest mortality rate of all mental health illnesses in the United Kingdom.”
Baroness Bull (CB)
My Lords, I share government’s commitment to addressing obesity. My concern with these regulations is not their underlying intent; it is that they will have limited impact on reducing obesity while causing real harm to people with eating disorders.
If body weight was entirely under volitional control, this measure might be the answer to the obesity challenge, but obesity is more complex than that. Metabolism, poverty, environment and psychology all play a part, while hundreds of different genes influence our propensity to gain weight. The assumption that voluntarily eating less and/or exercising more can entirely prevent or reverse obesity is at odds with a definitive body of evidence developed over decades. They are not my words, but those of 100 obesity experts in a statement co-ordinated by the World Obesity Federation. Yet government’s obesity strategy turns a blind eye to this evidence and to the complex interface between obesity and mental health. I am astonished that the Minister did not mention this.
Eating disorders affect 1.25 million UK citizens and have the highest mortality rate of all mental illnesses. While some manifest in low body weight, others, such as binge-eating, lead to obesity. Obesity is not a mental illness, but the two often co-exist, with 30% of the extremely obese having a diagnosable eating disorder. Obesity measures will work only if they take these interactions into account. These regulations do not. While the impact assessment admits the poor quality of the studies supporting calorie labelling, the evidence for harm is strong. It drives people with anorexia or bulimia to eat less and those with binge-eating disorders to eat more. It leads to unhealthy weight control behaviours such as laxative use or vomiting, and it increases disorders in the wider population.
Calorie counting is an all-consuming obsession and a common trait in eating disorders. One person described her disorder as thriving off counting calories, while another said it ruined their life. Recovery is possible but fragile, with learning to eat in public a key part of the pathway. The affordable chains that these regulations affect are exactly the places where this happens. One sufferer described overcoming a terror of restaurants but said, “With calorie counts on the menu, I don’t think I’d have coped”. Given the complex and secretive nature of eating disorders, it is unduly cruel to insist that restaurants provide label-free menus only on request. Will the Government reconsider this, and can the Minister confirm that daily calorie requirements in the guidance now match what the NHS recommends?
Public health always involves trade-offs, with small harms to a few the price of gains for the many. The risk of my mammogram is worth it because I am screened for a disease to which I am vulnerable, but can it be justified for a public health measure to hurt people with no risk of the disease? If labelling was really going significantly to impact obesity, this prioritisation of physical over mental health might be justified, but evidence suggests it will not. We need instead an integrated approach to weight-related issues across the spectrum, recognising the co-occurrence and shared risk factors for obesity and eating disorders, and involving both fields from the outset. These regulations are not that. Given the high levels of concern, I ask government to commit to reviewing their impact not just on obesity but on any rise in the rate of eating disorders.
My regret today is genuine. I regret the limited effect that the regulations will have on obesity and the distress they will cause to those with eating disorders, and I deeply regret that we have failed in our efforts to protect them. I regret that, despite so many people bravely speaking out and despite the efforts of charities and clinicians, it has not been possible to work together on a public health approach to obesity, an approach that would more effectively support one part of the community without causing lasting collateral damage to another.
The Deputy Speaker (Lord Brougham and Vaux) (Con)
I remind noble Lords that the time limit for speeches is four minutes. I call the noble Lord, Lord Brooke of Alverthorpe.
Lord Brooke of Alverthorpe (Lab) [V]
My Lords, I am grateful to the Minister for in effect taking up much of my speech, so I will not repeat it, because I would be speaking broadly in favour of what the Government are endeavouring to do, but arguing, as I have done in my amendment, that they have not gone far enough. The Government’s Achilles heel is that they do not yet move on labelling on calories in sugar and in alcohol, and the Minister quickly skirted around that topic.
Before coming to my arguments, I want to express that I greatly sympathise with many of the arguments that the noble Baroness, Lady Bull, has advanced. I have a lot of experience in this field; I have a friend whose daughter recently committed suicide and I have another friend who presently has a granddaughter seriously ill in hospital. It is a growing problem and is not easily resolved.
On the other hand, we have this massive problem with obesity, and we cannot deny it. Covid has driven it home more forcefully than ever before. Close to 130,000 people have died from Covid, many of them with underlying conditions linked directly to obesity and, in particular, to type 2 diabetes. NHS data indicates that 26% of those who have died had type 2 diabetes.
I speak as someone with a little experience; I am on the cusp of type 2 diabetes. The NHS has put me on a nine-month course to try and get me to change my eating habits, particularly in relation to the amount of sugar I consume. Part of that has been about me checking what I am eating and drinking, what its calorific content is, and what the sugar element is. So I welcome a step that moves towards greater openness and gives me the information I need to try to avoid becoming a type 2 diabetes patient. That is possibly on the cards if I do not take the appropriate steps.
There is no simple solution to obesity; I freely concede that. A whole range of measures have to be addressed in different ways. Small steps will make up a big leap forward. Regrettably, sometimes when we are trying to find solutions and we are all working with similar problems, we end up with contradictions and conflicts. Today we have a degree of conflict arising. It is not easy to find harmony and the only way we will do it is by continuing to talk to each other and trying to move forward in a friendly and comradely way.
I believe the Minister has fallen short with the regulations that he has produced. They do not go far enough. The Government know perfectly well that, of the calories obese people consume, 10% come from alcohol, yet they consistently resist displaying sugar and calorific content on labels for drinks. When this comes into play in February next year, you will be able to go into a restaurant and see what the calorific effect will be. You will be able to see what the calories are in food and in any non-alcoholic drink you may have—a fizzy or non-fizzy drink—and how much sugar is in it, but, if you pick up a pint of lager, you will have no idea what effect it will have on your health and well-being, or whether it is contributing to obesity. That must change. The Government must break their link with the powerful drinks industry—and before long they will have to. They know in their heart that they must do it, and the sooner they address the issue, the better for the country as a whole.
Baroness Parminter (LD) [V]
My Lords, it is a pleasure to follow the noble Lord, Lord Brooke of Alverthorpe, who has done so much in his own way to bring together those of us who speak with the eating disorder community and those who represent those with obesity. I wish the Government would take on his approach of encouraging yet more joint dialogue.
I support the Government’s ambition to make the nation healthier, but these regulations are to be regretted and I therefore wholeheartedly support the amendment in the name of the noble Baroness, Lady Bull. At best, there is weak evidence for their efficacy and there is insufficient attention paid to the impacts on extremely vulnerable people, and the growing number of people suffering from eating disorders.
First, the weak evidence. The Explanatory Memorandum makes it clear that the approach is based on the 2018 Cochrane review, which concluded:
“Findings from a small body of low-quality evidence suggest that … energy information on menus may reduce energy purchased in restaurants.”
It went on to recommend the need for:
“Additional high-quality research in real-world settings”.
So I ask the Minister: did the Government consider trialling this approach first?
Secondly, these regulations will create another place of fear for a vulnerable community of eating disorder sufferers, having the potential to impact on their often-fragile recoveries and shattering the chance of moments of connection with families and friends.
I want to explain what I mean by a “place of fear”. When our daughter, Rose, was in the depths of her eating disorder and was hospitalised, part of her specialist treatment over many months involved taking the eating-disorder patients into cafés and other eating venues to learn how to manage these frightening situations. For those suffering from an eating disorder, the stress of a restaurant is huge: fear of other people watching you eat, fear of people eating less than you and fear of not having safe foods on the menu. It means obsessing about it the day before and restricting food intake beforehand. Going is a known risk, but one that is taken to try to have a moment of joy and celebration, given that food is a way to strengthen all those positive social bonds of connection with family and friends.
Those in recovery—and to be clear, recovery is not a linear process for sufferers; many get dragged back down time and again—will be at greater risk once this measure is introduced. Seeing calories on a menu will be one more way, once they are seated at the table, of stacking the cards against them as they battle the demons in their head telling them exactly what they are allowed to eat. In short, it turns what might have been a manageable situation—a moment of all too brief happiness for a family eating out—into one that descends into a paralysing stand-off.
There is no logic in eating disorders, only triggers to letting the illness claim control of your loved one. Victoria, another eating disorder sufferer, described it to me like this:
“During my recovery, I found calorie labelling highly triggering as it held me back from rebuilding my relationship with food and my understanding of how to feed myself in a healthy way without being controlled by numbers ... Eating disorder recovery is very fragile and I am daunted by the prospect that calorie counts will be harder now to avoid”.
This is the reality of these regulations for eating disorder sufferers.
The Explanatory Memorandum refers to the concession that menus without calories will be permitted—but, when I asked about the guidance that businesses were being offered, the department confirmed that there will be no obligation to produce such menus. So there is no guarantee of one being available and no sanction if the restaurant just turns around and says no. Why does the guidance for businesses not at least strongly recommend that such menus are available on request?
So the noble Baroness, Lady Bull, is right. We must review the impacts of this legislation within 12 months of its introduction, including assessing fully the impacts on eating disorder sufferers. We all want to encourage more healthy eating, but interventions should be evidenced-based and consider the implications for other vulnerable communities.
Baroness Jenkin of Kennington (Con)
My Lords, I speak today in support of the amendment tabled by the noble Lord, Lord Brooke, and, while I have the utmost sympathy for those with eating disorders, to oppose that of the noble Baroness, Lady Bull.
When I came to this House over 10 years ago, my office-mate, my noble friend Lord McColl, was a lone voice asking questions about obesity and its consequences. We talked about it endlessly at our desks. In my case I was motivated as, after 55 years of being overweight, I had finally lost 28 pounds—and I have more or less kept it off. For years I struggled with my weight, so I know how hard it is, but I also know how important it is not only for my own long-term health but for the future—indeed, potentially the survival—of the NHS. Anything that we and the Government can do to help and support others in a similar position, with information that makes it easier to make informed choices, must be tried.
The rise in obesity and its related problems, including diabetes, heart disease and cancers, is a growing problem internationally as well as in this country. The relationship between our environment and health is becoming increasingly clear, and I very much welcome the part 2 of the national food strategy, which joins up the dots so clearly.
In 2017 I chaired a report on childhood obesity for the Centre for Social Justice. If previously I had not been aware of the severity of the crisis, I certainly was by the time that we had done the work and launched the report. Dr Chris van Tulleken’s current work on ultraprocessed foods—seemingly more chemicals than food—which now make up over 60% of the average Briton’s diet, is particularly alarming. He experimented on himself by eating a diet of 80% of these highly addictive foods for a month. What it did to his body was shocking: not only did he put on more than 14 pounds in weight, he suffered many other side-effects such as heartburn, sleep problems, loss of libido and piles. The food even altered his brain. The effect on our children’s health and their growing brains is horrible.
As the Minister said, nearly one-quarter of children in England are overweight or obese when they start primary school aged five, and this rises to one-third by the time they leave aged 11. Childhood obesity rates in the UK are among the highest in western Europe. Obese children are more likely to become obese adults; currently, around two-thirds of adults are overweight or obese, with one in four living with obesity. We know that regular overconsumption of a relatively small number of calories leads to individuals becoming overweight or obese.
The problem is clear: it is likely that eating out frequently, including eating takeaway meals, contributes to this gradual overconsumption of calories. Research suggests that eating out accounts for 20% to 25% of adult energy, and that when someone eats out or eats a takeaway meal they consume, on average, 200 more calories per day than if they eat food prepared at home. This all adds up. Data also tells us that portions of food or drink that people eat out or eat as takeaway meals contain, on average, twice as many calories as equivalent retailer own-brand or manufacturer-branded products. Some 96% of people eat out, and 43% do so at least once or twice a week—a huge increase on even a decade or so ago.
There is strong public demand for calorie labelling in the out-of-home sector. People want information so as to make better choices. Nearly 80% of respondents to a survey by Public Health England said they think that menus should include the number of calories in food and drinks. This thirst for information also applies to alcohol. An experiment conducted by the RSPH in 2017 showed that, on an evening out in the pub, those drinking with calorie labelling on the menu drank 400 calories fewer than those who were not aware of what they were drinking. The problem is huge, and every tool in the toolkit has to be used to tackle it. There is no time to waste.
Baroness Finlay of Llandaff (CB) [V]
My Lords, I declare that I chair the Commission on Alcohol Harm. We cannot ignore the obesity epidemic, and we must grasp the nettle of the crisis of eating disorders of all types. However, alcoholic drinks are a major contributor to national ill health and obesity.
In 2020, our commission took evidence on alcohol harms, and I want to focus on the evidence we heard about the obesogenic effect of alcoholic drinks. As the Institute of Public Health in Ireland told us, alcohol
“can make a significant contribution to levels of overweight and obesity in the adult population”.
Adults who drink get nearly 10% of their daily calorie intake on average from alcohol, but people are ignorant of the calories. Over 80% of people do not know, or underestimate, the number of calories in a glass of wine and, similarly, over 80% of people do not know, or underestimate, the calorific content of a pint of lager.
A 175ml glass of 12% alcohol-by-volume wine has about 158 calories. That is equivalent to more than three Jaffa cakes, and it is more than a 330ml can of Coca-Cola, which contains 139 calories. This means that, per ml, wine contains more than double the calories of Coca-Cola. The Government have recognised the obesogenic effect of fizzy drinks through their high calorie content but turned a blind eye to one of the most damaging substances to our economy. Yet 308,000 children currently live with at least one adult who drinks at a high-risk level in England. We worry about obesity and do nothing about the most harmful of obesogenic substances.
Alcohol is exempt from the labelling requirements for food and non-alcoholic drinks. Alcoholic drinks are only required to display the volume and strength, and some wines are required to include allergens. I suggest that the alcohol industry is happy to describe alcohol by volume content, because it knows perfectly well that the public do not understand what this means, either in daily consumption terms or in calories. Information on nutritional values, including calories, ingredients, health warnings and so on are largely absent from labels. In commenting on this, the professor of public health nutrition Annie Anderson, told us she is
“shocked how far alcohol is always kept out of nutrition policy”.
Today’s debate is an example of that.
I would like to quote Adrian Chiles, who explored labelling for “Panorama”. He said:
“It is absurd in a pub that you buy a pint, it doesn’t have to tell you how many calories are in it, but you buy a bag of crisps to go with the pint, by law, it has to give you the number of calories … on an alcoholic product you don’t have to provide nutritional information including calories … if you’ve got a Becks blue, which is the alcohol free one, it’s got all the nutritional information and how many calories on it, ordinary Becks, they don’t have to put it on there”.
If we are labelling food with calories, it is blatantly absurd and deeply irresponsible to ignore alcoholic drinks, both in the bottle and when served by the glass in all out-of-home venues. There is evidence, as we have heard from the noble Baroness, Lady Jenkin, that when calories are displayed on drinks, people drink less, thereby also decreasing their liver damage, their risk of injury, of a road accident or of fuelling their addiction, quite apart from reducing their calorie intake and the obesogenic effect. I could go on. I strongly support the noble Lord, Lord Brooke of Alverthorpe.
Lord Berkeley (Lab)
My Lords, I am very pleased to take part in this debate, and I certainly support my noble friend Lord Brooke of Alverthorpe’s amendment. Going back to the Question we had on Tuesday about the possible addition of salt and sugar tax, I thought that was a rather good idea, because there have to be as many different solutions to the obesity problem as possible. As many noble Lords have said, this is extremely serious, and I suspect the Government should be looking at a wide range of different solutions, which might include a salt and sugar tax—it is not much different to adding fluoride to water, I should say—but should also go ahead with this regulation.
It is a pity, as many noble Lords have said, that most alcohol seems to have been omitted from it. Looking at the Explanatory Memorandum and the comments about the government consultation, it is obvious that not everybody in the food and drink industry thinks this is a good idea. I think they have been fighting it hard, and we shall probably continue to have to fight if we are to get anywhere.
I have a few questions for the Minister on the document. The first relates to something that the noble Baroness, Lady Finlay, I think, mentioned: going to the pub and having a pint. I may go to the pub tomorrow night and have a pint and a fish and chips. As we know, beer is excluded. How do you put a label with the number of calories on it on a plate of fish and chips? You can put it on the menu, but the calories depend on the size of the fish, let alone how many chips they give you. The complexity of this regulation demonstrates just how difficult the Government have found it to put together.
I worry about the institutions that are included and excluded and what the limit of 250 employees means, because people have tried to work out franchises, where something such as McDonald’s adds up to well over 250 employees. I see plenty of arguments coming there. I wonder what the cost to each food authority will be to maintain the necessary register and monitor it, because we have heard so much about the Government not giving local authorities enough money to do that and whether they will actually do it when they get it.
As the noble Baroness, Lady Bull, mentioned, there are some serious issues with the regulation, but on the other hand, as I said on Tuesday, this country of ours is the second most obese in the world after the US. If this calorie-count idea and these regulations follow the US, it is probably because so many of our food producers are owned by US companies. It is a start, but I do not think it is sufficient. We can see from the Explanatory Memorandum that there was no support for an independent voluntary arrangement. That says a lot about where the food industry—and the brewing industry—is coming from. I hope that the Government will come back with something a bit stronger in future.
My final question may seem a bit silly but paragraph 7.17 of the Explanatory Memorandum states that international aircraft, trains and ferries are excluded but presumably, if one wants to buy a sandwich on a train, all the relevant documentation will be needed. I am sure that the Government will come up with some more ideas—
Lord Parkinson of Whitley Bay (Con)
I am sorry to interrupt the noble Lord, but his time is up.
Baroness Walmsley (LD) [V]
My Lords, we are living in an unhealthy food environment in which an obesity epidemic sits alongside eating disorders, hunger and malnutrition, and consumption of damaging amounts of ultra-processed foods. We need an integrated public health approach to food. My attitude to these regulations is cautious but optimistic that they might do some good if implemented as part of a wider strategy, and with compassion for those who are concerned about their effects. I share the Minister’s hope that they may result in reformulation by restaurants and takeaways, as the sugar tax has done already. We all know why action is needed.
We heard the figures on childhood obesity from the noble Lord, Lord Bethell. UK childhood obesity is almost the worst in Europe. He also reminded us that two-thirds of adults are overweight and 28% are obese. That matters because obesity ruins and shortens lives. It leads to type-2 diabetes, heart disease, high blood pressure, cancer, liver disease and skeletal problems. We have also seen to our horror how obesity affects a person’s probability of dying from Covid-19. The issue is complex, the numbers are enormous and the cost is eye-watering.
On the other hand, we hear that 1.25 million people suffer from eating disorders. Those are acknowledged to be mental health issues requiring expert therapies that are not sufficiently widely available. I hope that all noble Lords will acknowledge that mental health is also an issue for people living with obesity. It can be either a cause or an effect, and similarly require emotional support. It is no use just giving an obese person a diet sheet and telling them to get on with it.
Therefore, both problems endanger life and we must find a balance. In what way could these regulations help or hinder? I should emphasise that they must be only a tiny piece of the jigsaw. Let us look at the facts. We know that 96% of people eat out regularly, many of them families, and that number is rising. We know that the calorie content of restaurant and takeaway meals can be twice that of the same meal bought from a shop or home-cooked. How could knowing the number of calories help an obese person? It fills a gap in their knowledge. Most overweight people have no idea how many calories are in meals from a takeaway or restaurant. Knowing can help them to choose something lighter if they are trying to reduce their weight. Information is power.
On the other hand, people with eating disorders usually already know exactly how many calories are in every food because they have been limiting them for years. Therefore, putting figures on a menu tells those people nothing that they do not already know. But it is a difficult situation for them. I understand the concern that just seeing the amount of those calories might trigger a relapse for those who are valiantly fighting an eating disorder. I therefore hope that all restaurants will make a non-calorie-labelled menu available. However, the primary need for such people is expert support in order for them to make those difficult food choices. That is the crux of the matter—the need for expert therapies for eating disorders, and information and support for obesity.
I realise that, unfortunately, it is impossible to have a pilot for this measure. However, the three years quoted in the regulations is too long before reviewing them to see whether they meet their objectives or, conversely, do harm. I therefore share the concern of the noble Baroness, Lady Bull. The regulations must be reviewed after a year and the concerns of those with eating disorders taken seriously. I also share the concern of the noble Lord, Lord Brooke, and sincerely hope that the Government will add alcohol calorie labelling when carrying out an early review of this measure.
Lord Moynihan (Con)
My Lords, this September sees the launch of the Government’s new office for health promotion to drive the improvement of the health of the nation. Its function is to lead national efforts to level up the health of the nation by tackling obesity, improving mental health and promoting physical activity. It will be an important part of the consideration given to the forthcoming health and care legislation and should be key to co-ordinating policy across Whitehall, working, inter alia, with local authorities, which will play a key role in monitoring these regulations. Should the regulations pass into law, they will require very close co-ordination between government and local authorities, and I would be grateful if the Minister confirmed that the office for health promotion will be fully engaged in delivering this policy change.
I agree with the noble Baroness, Lady Finlay, about the labelling of alcohol.
I now move to the critical issues affecting these regulations. I fully appreciate that there are many important, nuanced and competing arguments to consider, including those so clearly and persuasively made by the noble Baroness, Lady Bull, regarding eating disorders, which I have consistently argued deserve a far higher priority in the NHS. However, the number of people with eating disorders who would be directly and negatively affected by the requirement for restaurants, takeaways and cafes with 250 or more employees may be considerably fewer than the number who are obese—people whom I believe, on balance, would benefit from this information.
The NHS Health Survey for England 2019 found that 16% of adults screened positive for a possible eating disorder. It is reasonable to deduce from that statistic that many in that category would not be negatively impacted. Even if all were so impacted, the same survey found that 64% of adults in England were overweight and/or obese, with conditions associated with an increased risk of a number of common causes of disease and death, including diabetes, cardiovascular disease and some cancers. What is more worrying is that in recent years there has been a marked increase in the proportion of adults who are overweight or obese.
That contrast is a powerful factor in weighing up the pros and cons of these regulations. The consultation exercise demonstrated the demand for the provision of information on calorie content, and that information should not rest exclusively on calorie counts, which, as the noble Lord, Lord Berkeley, said, is by no means a perfect standalone guide to a healthy diet. Take Itsu: one reason I regularly buy lunch there and take it back to my office is that it takes a holistic approach to the quality of the food it serves. It is high in protein and low in fat. It indicates the percentage of daily vegetable allowance providing potassium, iron and fibre to maintain healthy immune and digestive systems. It lists omega-3 content and products which contain zinc, iodine, potassium and vitamins, as well as the calorific value.
The labelling of nutrition will never be perfectly accurate. There will be complexities in implementing these regulations, including the resources required for local authorities. The Minister drew our attention to the report from the Secondary Legislation Scrutiny Committee, and its conclusion is persuasive:
“It appears that this is a situation where there is no ideal solution, but DHSC’s policy is one it believes will benefit most people. Although the evidence of success is equivocal (for example, Beat cites evidence that some of the dietary changes made by individuals in America in response to a similar campaign were small and short-lived), the obesity problem is so widespread that DHSC sees these Regulations as part of a campaign to raise awareness of calorie intake not only for individuals but also the hospitality industry.”
I believe that, on balance, these regulations will be for the greater good of the population and should be approved by the House today.
Baroness Bennett of Manor Castle (GP) [V]
My Lords, I am in favour of both regret amendments and commend the noble Baroness, Lady Bull, and the noble Lord, Lord Brooke of Alverthorpe, for tabling them. I recognise that at first glance, backing both these amendments might appear contradictory. One regrets the regulations while the other seeks to expand them, but what we are talking about here are two different sets of products. Eating is something we all have to do and need to do collectively in a far healthier manner than we do now. I hardly need to rehearse our place as world-leading in obesity and subsequent morbidities and mortality. It is one league table we certainly do not want to be high-ranking in.
Eating out, eating in the community with friends and family, can and should be healthy, happy occasions but we know, as the noble Baroness, Lady Bull, has powerfully outlined, that for those with eating disorders—between 1.25 million and 3.4 million people in the UK—they can easily be fraught, difficult and immensely stressful. There is strong evidence that calorie labelling will only add to that. There is little evidence of the effectiveness of calorie labelling in tackling our obesity crisis, as the noble Baroness, Lady Parminter, outlined.
The science tells us that counting calories in food consumption is a far from exact or useful approach. We need a nutrient-rich, calorie-appropriate national diet based on vegetables, fruit, and wholegrains, giving us a range of important nutrients, as the noble Lord, Lord Moynihan, just outlined. A calorie label tells us nothing about that. All calories are not equal and the values of two servings of food with identical calorie counts could be at opposite ends of the health scale. An artificially sweetened, flavoured and coloured dessert may be very low calorie but it also has virtually no nutritional value, and increasingly we understand that artificial sweeteners, as well as raising serious questions about their safety, contribute to increased risk of metabolic conditions such as type 2 diabetes and heart disease, even if the mechanism for that is as yet poorly understood.
We also increasingly understand that the thermic effect of food depends on a whole range of consumption factors, such as the size of the meal, the pace of eating and the time of day. Relying on counting calories is a simplistic—potentially dangerously simplistic— approach to achieving a healthy diet. There is also the issue of our microbiome—damaged and reduced by our national diet of ultra-processed pap that is 68% of the calories that we consume—that we are increasingly understanding has a significant impact on appetite and consumption. We need a joined-up public health approach to tackling our obesity issue, as the noble Baroness, Lady Bull, said.
I was very tempted to use this debate to deplore the Government’s immediate, negative, knee-jerk, populist reaction to Henry Dimbleby’s excellent and important proposed national food strategy which proposes such an approach while also taking account of the disastrous environmental impacts of our broken food system. However, I decided that there was not really the proper space to do that, but I must note a question that I asked during the passage of the Agriculture Bill debates: what constitutional place does Mr Dimbleby occupy? We kept being told throughout that debate when issues of food and public health came up to “wait for Dimbleby”. How can Ministers say that about something they are signalling that they plan to ignore, essentially?
On the simple proposition that if we have calorie labels on food, they should also be on alcohol, even if we did not, alcohol is of limited nutritional value; however, most drinkers do not understand how it might contribute to obesity, as the noble Baroness, Lady Finlay of Llandaff, outlined. I declare an interest, as I do drink alcohol. I try to drink in moderation and take account of the energy intake from it. What the Government are regulating here is inconsistent between alcohol and food. We know that the alcohol sector has a large amount of lobbying muscle, as seen in its resistance to advertising restrictions. Unfortunately, we are seeing this effect further here.
Baroness Wheatcroft (CB)
My Lords, it is a pleasure to follow the noble Baroness, Lady Bennett of Manor Castle, and her sensible comments on nutrition.
I support the amendment tabled by my noble friend Lady Bull. She is absolutely right: these regulations are misguided and will be counterproductive. If calorie labelling were an effective way of curbing obesity, sales of crisps would not have grown by 4.6% in volume last year. Neither would biscuit manufacturers have been able to enjoy a bumper year, with sales up 7.2% to almost £3 billion. Among the top 10 biscuit brands, only two failed to register growth—they were the ones in the healthier category. The best seller, McVitie’s chocolate digestive, has 86 calories. That may not sound a lot, but those prone to obesity find it hard to stop at a single biscuit.
These regulations are intended to hit in particular those who frequent fast-food outlets, but no one in Britain can be unaware that a Big Mac and fries will not win favour at Weight Watchers. In fact, together they add up to 845 calories. Throw in a caramelised frappe and you have 1,164 calories. Spelling it out on the menu will not reshape the eating habits of those intent on a quick and relatively cheap hunger fix, and it is the cheapness that is important. Obesity is strongly linked to poverty. A study of children in 2018-19 found that the incidence of childhood obesity was more than twice as high in the most deprived areas of the country as in the least.
Insisting that calorie numbers are on the menu will not deal with the obesity problem, but it will feed the problems of those suffering from eating disorders, the numbers of which are rapidly increasing. Only today it has been reported that hospitalisations of young people with eating disorders rose by 50% last year, and many more are queueing up to try to access treatment. Someone with anorexia nervosa will be as fixated on these calorie lists as a heroin addict on getting the next fix.
The regulations will make the struggle of trying to persuade an anorexic to eat something—anything—even harder than it is now. I know this because I spent many hours trying to persuade my desperately sick daughter to eat. It was sometimes easier to try to do this in a restaurant rather than at home, where she could take flight to her bedroom. As the noble Baroness, Lady Parminter, said, these trips were often very stressful for the anorexic and for all concerned.
My daughter nearly died. Had it not been for the brilliant Professor Janet Treasure and a year in hospital, she almost certainly would have done. Instead, she is a happy mother who has just produced her second child. Before making this speech, I asked if she would mind me talking about her, and she was keen that I should, because she wants to add her voice to those who counsel against insisting on this calorie labelling measure. She agrees that it would have added to the agonies of those sessions when she tried to find the least worst, in her demented view, item on the menu. Anorexics see calories as the enemy. I have been so fortunate that my daughter managed to overcome this pernicious illness, but these regulations will make it harder for others to do so while achieving very little positive.
While I realise that the Minister will not be swayed from his decision to go ahead with these regulations, may I add Lucy’s plea to that of my noble friend Lady Bull that he agrees to a timely review of their effects on everybody?
The Deputy Speaker (Lord Brougham and Vaux) (Con)
I now call the noble Baroness, Lady Fall. This debate is running out of time—four minutes, please.
Baroness Fall (Con) [V]
My Lords, all crises give way to opportunity, the chance to reassess and adapt, and Covid is no different. Eighteen months on, we are confronted with some really difficult issues. Among these are the growing reality that some have fared better than others in terms of their health, livelihood, prospects and mental health. It is right that the Government should focus on the reasons for these disparities and seek to find some answers.
One such issue is obesity. We have been shocked to see the growing evidence of how Covid has adversely affected those deemed overweight or obese, and Covid is not the only vulnerability for this group. They are susceptible to type 2 diabetes, heart disease and many types of cancer. Recent surveys have talked about 64% of our population being overweight or obese, and childhood obesity is among the highest in western Europe. This is a substantial group, and alarm bells should be ringing. It is certainly the time for a national conversation about how we address this problem. We have heard much in recent days about initiatives to improve the nation’s diet, a sugar and salt tax, or getting the nation to eat more fruit and veg. While Ministers consider whether any of these proposals should make it to the statute book, we have an immediate task of assessing this one, the calorie labelling legislation, today.
I am very sympathetic to the intent here. I see the urgent need to raise awareness of the effect that obesity has on health, but we need to do this in a way that takes account of some of the complexities of the issue and does not miss the mark. With this in mind, I draw attention to three concerns. First, I fully support the objective of increasing transparency around what we eat, especially aimed at larger establishments and chains, which greatly impact the eating habits of our nation. People will not choose healthy unless they know what they are eating, and in many cases they simply do not know. But calorie counting is a blunt instrument to crack a complex issue. Calories also impact different people in different ways and take no account of the energy they use. So why not flag a healthy or unhealthy option or operate a traffic light system instead?
My second concern is that we need to deliver a strategy that does not look like an attack on those with limited budgets. Tone is important here, and a real understanding of choice and the financial reality of stretched household budgets. Real choice means that affordable healthy options are available. We should be putting pressure on companies to lower sugar and salt content in their products rather than taxing consumers, which hits low-income families.
My third concern is the focus of this short debate; that is, the effect of this initiative on eating disorders, which are sky high, especially among the young, and which destroy lives and blight many others, as many have said, especially the noble Baroness, Lady Wheatcroft. I therefore have sympathy with some of the reservations raised by the noble Baroness, Lady Bull, today. Young people have been shut up at home, missed exams, missed each other and have had their prospects blighted, so it is no wonder that eating disorders have rocketed, and we already had a grave problem before. We have no evidence or data to suggest what impact calorie labelling will have on eating disorders but it does not take a huge jump of imagination to work it out. We should not have a tin ear to these concerns. Good policy should be creative and targeted and should not disregard the plight of a minority who are adversely affected just because a greater number are set to gain.
I support the Government in their endeavour to tackle the difficult but important issue of obesity. I do not speak in regret, but I ask the Minister to take note of some of the concerns raised today.
Baroness Greengross (CB) [V]
My Lords, I speak in favour of the calorie labelling regulations being set by the Government and, with some difficulty, against the amendments to the Motion tabled by the noble Baroness, Lady Bull, and the noble Lord, Lord Brooke. I do so as someone who had severe anorexia as a teenager, before it was even fully recognised; later, one of my teenage daughters had a similar disorder. These two episodes profoundly affected the whole of my life, and certainly represent the most difficult time of my life, as they do for my daughter. The noble Baronesses, Lady Parminter and Lady Walmsley, described very movingly the sort of effect this kind of illness can have on the whole family and on many others.
It is important that we as a society talk about these issues openly and honestly, as they do in many schools now. For people with eating disorders, it is important that they have access to full information, especially if they can see that the calories for healthy food are in fact quite low. If young people are fully informed, they will eventually know the difference between a healthy, balanced diet and one that puts you on track to make you abnormally thin. Its only through providing all the information in a balanced way that people of all ages can eventually make rational and healthy choices. We should not be withholding information or creating a situation where people are not given all the facts. Much of the information we receive about food products at present is in fact advertising or marketing, so what is needed for everyone, of all ages, is full and accurate information at all times.
Although I do not support the amendment to the Motion in the name of the noble Baroness, Lady Bull, I agree with the second part of it, which calls for timely reviews of the impact of these regulations for both obesity and eating disorders, as both have such serious consequences. A significant proportion of the adult population is living with obesity or is overweight, according to research from Public Health England in 2019. By the age of 55, 70% of adults in the UK have at least one obesity-related health issue, as the All-Party Group for Longevity recorded in 2020. In the UK, obesity-related conditions currently cost the NHS £6.1 billion a year, as Public Health England recorded a few years ago. We desperately need a strategy to tackle eating disorders and obesity.
I conclude by asking the Minister for an update on the Government’s strategy of supporting people to live five extra healthy years by 2035. Are these regulations part of this strategy, and what other actions will the Government be taking in terms of food labelling to support it? These experiences profoundly changed my life, and I want other people’s lives to be profoundly changed too, by knowledge, understanding and full information at all times.
Lord McColl of Dulwich (Con) [V]
My Lords, my noble friend Lady Jenkin has already mentioned that for many years in this House we have been calling for action to deal with the obesity epidemic, mainly with the slogan, “The obesity epidemic is killing millions, costing billions and the cure is to put fewer calories into their mouths”. This will save a great deal of money and reduce the strain on the NHS, as has already been mentioned.
It will probably come as no surprise to noble Lords that I support these draft calorie labelling regulations. There are a few problems, which I think can be ironed out quite easily. First, fat, preferably unsaturated fat, acts as an important brake on how much we eat, as does whole milk. This was demonstrated by scientists in Canada and, recently, Danish scientists showed that whole milk actually reduced the level of cholesterol in the blood. We need to remind ourselves that fat produces twice as many calories as protein and carbohydrate, so this needs to be taken into account in calorie labelling and working out what to buy and eat.
These regulations, as has been mentioned, can present problems for those with eating disorders. I hope that it will help them to have menus available that have no mention of calories at all, and I hope that it will be essential for restaurants to have those menus available.
On average, 2,000 calories per day is mentioned, but of course the total number of calories one should eat will vary substantially from person to person, according to occupation, age and weight. It is worth reminding ourselves that the all-powerful food lobby was the culprit in causing this obesity epidemic in the first place. It wanted to get people to eat more food but realised that it was the fat they were eating that slowed the stomach emptying and made them feel full and satisfied early on in the meal. So the lobby demonised fat and insisted on a low-fat diet, which is so tasteless that it then had to add a great deal of sugar to make its manipulated food palatable. It pilloried those who opposed it, including Professor John Yudkin, who was sacked from his university chair of nutrition in London for warning against the high-sugar, low-fat diet. So much for the so-called independence of universities. We need to counter the anti-people’s lobby, which wants to stop people from having whole milk and healthy fat because these villains know that fat reduces appetite and reduces their ill-gotten gains.
It was gratifying to see reference at the end of the document warning against the potentially fatal combination of Covid and obesity. People should take note of that, especially in both Houses of Parliament—that obesity is one of the problems causing high mortality from Covid. I wish more people would join the Prime Minister’s campaign to tackle the obesity epidemic with his slogan, “Don’t be a fatty in your fifties”.
Baroness Redfern (Con) [V]
My Lords, I am pleased to have this opportunity to speak in support of the draft Calorie Labelling (Out of Home Sector) (England) Regulations 2021, noting the requirement for labels to be displayed by April 2022. This is another step forward in addressing obesity, which, as we know, is one of our biggest public health challenges, as our food environment continues ever to change. It is targeted not only at the eating-out sector, but also at the consumption of on-the-go snacks. More than a quarter of adults and one-fifth of children eat food from out-of-home outlets at least once a week. The regulations include bakeries, caterers, supermarkets and entertainment venues, so this is an important tool in guiding customers and making informed choices much easier for everyone.
I welcome the response to the consultation about concerns expressed by individuals living with eating disorders. It is important to note that appropriate provision is being made in the regulations to allow businesses to provide an alternative menu without calorie information, if the customer so wishes. That also endorses the Government’s commitment to playing their part in engaging with eating disorder charities in offering continued support and guidance, with a commitment to timely reviews of the impact of these regulations, not only on obesity but also on eating disorders.
Calorie labelling in the out-of-home sector applies to English businesses with more than 250 employees operating outlet foods that are prepared for immediate consumption. Smaller businesses are exempt, but I hope that many more outlets will come forward to offer their support and contribute meaningfully in the coming months so that they, too, can inform their customers and show that they want to be part of this drive to encourage even more people to make healthier food choices.
Feedback has shown overwhelming public support for calorie labelling on menus. Unfortunately, childhood obesity continues to be one of the major health problems faced by this country. Nearly one-quarter of children in England are overweight or obese when they commence primary school. Statistics also show that three out of five children are overweight when they leave primary school. Obese children are more likely to become obese adults, adding to their vulnerability. This further impacts on their life outcomes, in developing the increased likelihood of heart disease and cancer. Significantly, we are seeing more people at the relatively young age of 40 suffering from type 2 diabetes, with numbers almost reaching a staggering 5 million. All this can have a negative impact on mental health as well.
In conclusion, putting calorie labelling on menus and offering information for families will assist them in making better-informed, healthier choices when eating out. It will be another step towards complementing the Government’s healthy weight strategy, which was published last year. I support these draft regulations.
Baroness Brinton (LD) [V]
My Lords, today’s debate on calorie labelling regulations has demonstrated how complex and sensitive this subject is. At face value, the idea of labelling calories on the menus of large chains of food outlets may appear sensible and easy. On behalf of these Benches, I thank all those organisations that have sent us briefings, including Diabetes UK and Beat Diabetes, which have helped our thinking on what is not at all an easy subject. This is a complex issue with competing demands from vulnerable people on both sides who need help and support. Helping one group may cause serious problems for another.
We know that there are many people who have or who are at risk of developing type 2 diabetes and obesity. As a number of noble Lords have mentioned, more than a quarter of adults are obese and 66% are overweight. These two conditions provide the basis for a high risk of developing other serious disease, requiring much treatment and possibly leading to early death. This is a serious crisis for our country. The noble Lord, Lord Brooke of Alverthorpe, and the noble Baroness, Lady Jenkin, set that out well in their contributions.
Obese people need support and information to change their lives. Calorie labelling could be a tool in that. Can the Minister answer the noble Lord, Lord Brooke, and the noble Baroness, Lady Finlay, as to why the Government have decided not to put calorie labelling on alcohol? These are rightly described as empty, hidden calories. Is the noble Lord, Lord Brooke, correct that this is because of the alcohol lobby? Doing this would seem more obvious than putting calories on menus.
The amendment in the name of the noble Baroness, Lady Bull, sets out the equally serious problems that well over 1 million, mainly young, patients with eating disorders face and how calorie labelling could exacerbate their illness, whether in withholding food or binge-eating. Even though eating disorders are primarily classified as a mental illness, the reality is that a patient’s reaction to controlling their food intake is at the heart of it. Some will always choose the least calorific option; for others, it is the opposite. Labelling for this group acts as a signpost, supporting their control of their intake. As my noble friend Lady Parminter said, calories on menus could bring young people with eating disorders to a “place of fear”. She spoke movingly and eloquently from family experience, a reality that most of us just cannot understand. But we need to listen, as we also need to hear the testimony from the daughter of the noble Baroness, Lady Wheatcroft.
My noble friend Lady Walmsley made a thoughtful contribution highlighting the need for an integrated public health approach to food that takes account of these wider issues relating to diet and well-being, rather than just focusing on calorie labelling. We believe that public policy should always be evidence-based and we are struggling with the Government’s lack of any compelling evidence on or an impact assessment of mandatory calorie labelling on menus at some restaurants and take-aways. As worryingly, there is little evidence of serious effort to consult experts and stakeholders on all sides of this debate. There has been no formal review of similar initiatives and no attempt by Ministers to trial a pilot scheme or to draw from the evidence from those restaurants that choose already to list calories on their menus, which would have been a useful resource.
As outlined by others, there is limited evidence to suggest that this legislation would even have its intended outcome. A Cochrane review found that there is only a small body of low-quality evidence supporting the idea that calorie counts on menus lead to a reduction in calories purchased. A more recent study found that calorie labelling in American fast-food restaurants was associated with a 4% reduction in calories per order but that this reduction diminished after a year, suggesting that any small differences that may occur are not maintained.
The Minister mentioned reformulation of supermarket products. The 2020 sugar reduction report said that supermarkets had indeed started reformulation and that there were some reductions but that there was still a long way to go before the food industry meets the targets in 2024. That means that evidence is being assembled, but it is not there yet.
Both eating disorders and obesity are extremely important illnesses, which are severely damaging the health and well-being of millions in the UK. On these Benches, we remain committed to tackling both issues. We have long argued, also, that mental health should be considered in every government policy and that it should be treated with the same urgency as physical health.
I agree with the noble Baroness, Lady Bull, and my noble friends Lady Walmsley and Lady Parminter: given the concerns expressed from a large number of speakers during the debate, please will the Government commit to reviewing the regulations’ impact, both beneficial and adverse in 12 months’ time to ensure that they are fit for purpose and not wait the proposed three years?
Baroness Merron (Lab)
My Lords, the need to tackle obesity and to support people in so doing is crucial to the health and well-being of individuals as well as the health and well-being of the nation. Excess weight directly impacts how well—and how long a life—we live, carrying a higher risk of heart disease, diabetes and cancer. It places limits on us at work, at home and in our social lives. It is a growing challenge that exacerbates inequalities. There are nearly three times as many hospital admissions due to obesity in the poorest communities as in the better-off.
It is demonstrably not the case that everyone knows how to manage their weight or that it is simply a matter of exercising a choice as to whether we do so or not. The challenge of maintaining a healthy weight and lifestyle requires information, knowledge and support, as well as personal effort, as was illustrated by the noble Baroness, Lady Jenkin of Kennington.
The Department of Health and Social Care cites evidence that one in four children and adults is now obese and that restaurant or takeaway meals contribute to the overconsumption of calories because they contain, on average, twice as many calories as the equivalent retailer own-brand or manufacturer-branded products. We know that voluntary compliance on labelling has not worked, and the pandemic has certainly been no friend to healthy weight levels, making this an ever more pressing situation to address.
This statutory instrument offers one step along the way, with many more steps needed, matched by proper investment and a strategic approach. As the display of calorie information and the recommended daily calorie intake is required only of larger businesses—those with 250 or more employees—does the Minister agree that there is greater value to be gained from this measure through the reformulation of products and portion sizes? The sight of a 2,000-calorie meal on a menu may well drive a provider to address that. Can the Minister explain what plan is in place to lever this opportunity for a bigger prize of change?
As we heard, the Government’s impact assessment gives a best estimate of net benefits amounting to over £5.5 billion over the next 25 years. The impact assessment makes it clear that most of the benefits come from a change in personal decision-making, but it seems that the evidence base on reformulation is stronger. It is particularly important that an evidence base around personal choices is acquired, so that we can have full, informed conversations as we look forwards. I hope the Minister will take note of this.
As we have heard in this debate, calories are a very crude measure of what we put into our bodies. It is crucial that we understand the nutritional content of what we consume. Will the Minister explain what consideration was given to a model much closer to what we see on packets in supermarkets? That does not seem to have been considered in the options appraised in the impact assessment. Is extending the scope of these measures being considered and, if so, on what sort of timeline? Will the research base be grown before action is taken?
The amendment in the name of my noble friend Lord Brooke of Alverthorpe rightly highlights that obesity is also impacted by alcohol consumption. It is right that the noble Baroness, Lady Finlay, and my noble friend Lord Berkeley laid down a challenge to the food and drink industry to step up to the mark. We on these Benches will return to this during consideration of the Health and Care Bill.
I am very grateful to the noble Baroness, Lady Bull, for bringing real insight to this debate and to the noble Baronesses, Lady Parminter, Lady Wheatcroft and Lady Greengross, who all spoke movingly and personally about the reality for those living with eating disorders. To follow this through, before implementation, will the Minister continue to engage with those who have legitimate, very real concerns about the draft regulations and seek to address them?
We know that eating disorders in the UK have increased during the pandemic, while services are simply not good enough, particularly failing children and adolescents. Will the Minister commit to a national strategy, matched by proper investment? Improving access to treatment and support is crucial. We will further press this home through amendments to the Health and Care Bill.
Will the Minister also commit, as a starting point for local authorities, to reinstate the resources already lost to the improvement of public health? The evidence favours interventions that promote a life of healthy choices, while cuts to public health over the past decade have put pressure on local authorities and worked in the opposite direction. I hope these regulations can offer a step forward.
Lord Bethell (Con) [V]
I thank noble Lords for their participation and thoughtful and moving contributions to today’s debate. As I have said, helping more people to achieve a healthy weight is one of the greatest public health challenges that we face as a nation.
My noble friend Lady Jenkin spoke movingly about her own battles with her weight. I completely identify with this personal struggle. I have a constant struggle to keep my own BMI in the green zone, which is about the best thing that I can personally do to live long enough to see my children grow into adults. There must be many who feel the same way.
The out-of-home food environment has an important role to play as an increasingly growing contributor to the food that we consume. People are already accustomed to seeing nutritional information on prepacked food that is typically sold in supermarkets. We want to see clear calorie information when we are eating out or getting a takeaway. This instrument plays an important role in helping to make our food environment healthier and to make healthier choices easier.
On the amendment regarding alcohol, the noble Lord, Lord Brooke, is right that excessive alcohol consumption is by far the biggest risk factor attributable to early mortality, ill health and disability among 15 to 49 year-olds in the UK. It is estimated that each week 3.4 million adults consume an additional day’s worth of calories just from alcohol. The noble Baroness, Lady Finlay, is entirely right that the public are utterly unaware of the calorie content of alcohol. Like the noble Baroness, Lady Bennett, I like the occasional drink, but surveys show that up to 80% of adults have a hazy understanding of the calorie content of common drinks, and I confess that I am probably one of them.
Transparency is key to support consumers to make better choices. However, nutrition labelling requirements are currently voluntary for alcoholic drinks; the example of a bottle of alcohol-free Becks makes that point pretty well. I accept that this makes it more challenging for businesses to list calorie information for alcoholic drinks on their menus. I give the noble Lord, Lord Brooke, the noble Baroness, Lady Finlay, and all those who have expressed concern about the issue this commitment: the Government will be consulting shortly on whether calorie information should be mandated on prepacked alcohol and alcohol served in pubs and restaurants. Covid-19 makes it more important than ever to support the nation to achieve a healthier weight, and the Government are taking action to help people to lead healthier lives.
On the amendment in the name of the noble Baroness, Lady Bull, I completely understand the concerns about the impact of these regulations on those living with eating disorders. In particular, the noble Baronesses, Lady Parminter and Lady Greengross, and my noble friend Lady Wheatcroft spoke movingly, with highly relevant personal testimony. I reassure the noble Baroness, Lady Bull, that these experiences and evidence-based reservations make Ministers stop and think very carefully about the regulations. They reminded me of the experiences of my loved ones who have struggled with eating disorders, and of my friends whose parents have struggled with the heart-breaking battle of loving children who are dogged by these torments. That is why we want to ensure that people have access to the right mental health support in the right place and at the right time.
To the noble Baronesses, Lady Walmsley and Lady Greengross, and my noble friend Lord Moynihan, I make it clear that improving eating disorder services is a key priority for the Government and a vital part of our work to improve mental health services. We recognise that eating disorders are a serious, life- threatening condition. With that in mind, we have to be careful to consider the views of mental health charities and experts, and we did so as we developed our regulations.
We have consulted widely throughout the development of the policy. We heard from key medical groups, including the British Medical Association and the Royal College of Paediatrics and Child Health, which highlighted the importance of tackling obesity and support for the introduction of mandatory calorie labelling in the out-of-home sector. We also studied carefully research in the UK that found that menu labelling is associated with serving items with less fat and less salt in popular UK chain restaurants compared with those that do not display calorie information.
I say in response to my noble friend Lady Fall that research suggests that mandatory enforcement of calorie labelling will encourage reformulation.
We have also engaged with and listened to feedback from those representing the views of people living with eating disorders, including the eating disorder charity, Beat. In response, we have put in reasonable adjustments to help mitigate any unintended consequences.
I therefore reassure the noble Baroness, Lady Bull, with the following commitments. First, following feedback on our consultation, we have decided to exempt food that is provided in schools and other educational establishments due to some concerns about displaying calorie information in school settings. Secondly, as the noble Baroness, Lady Walmsley, has noted, we have also included a provision in the regulations which permits businesses to provide a menu without calorie labelling at the request of the consumer. I would welcome any suggestions from the noble Baroness or any other noble Lords on how this can be done in the most sensitive and effective way possible as we draft the detailed guidelines.
Regarding those guidelines and regulations, I reassure the noble Lord, Lord Berkeley, that we are working closely with business and local authorities on guidance to support implementation of the policy to ensure that it can be implemented smoothly, including in relation to the practical dilemmas he rightly highlighted such as the labelling of irregularly shaped fish and chips.
My third reassurance to the noble Baroness, Lady Bull, is that we will continue to evaluate the impact of calorie labelling across the population, including on people with disorders. I reassure the noble Baroness, Lady Brinton, that, as required under the regulations, the Secretary of State will review the regulations at between three and five years. I make the commitment now that this will be done with the full engagement of all those concerned about this important but delicate regulation.
The noble Baroness, Lady Bull, is right: every public health measure is a trade-off. Obesity is a massive challenge we face as a nation. We cannot duck it, but this does not diminish the Government’s determination to ensure that people living with eating disorders have access to the support they need.
In response to the question about the evidence available to support this policy, I highlight that the Government’s impact assessment estimates that 174 billion fewer calories will be consumed in England per year as a result of this policy.
Consumption of fast food and takeaways is particularly prevalent among families. Evidence from 2016 showed that 68% of households with children under 16 had eaten takeaways in the previous month, compared with only 49% of adult-only households. We have a role and a responsibility to support parents, particularly in the most deprived families and areas, to help their children have the best start in life.
The noble Baroness, Lady Greengross, is right to emphasise that transparency in our food environment and giving people information they need about their food and drink purchases is important in delivering our ambition to halve childhood obesity by 2030. There is a lot to gain by helping more people to be the right weight, and it is vital for us to work together to achieve this. I commend the regulations to the House.
Baroness Bull (CB)
My Lords, time is very tight, but I want to express my gratitude to everyone who supported my amendment, especially those who shared such moving and personal stories. I am grateful to the Minister for his invitation to engage with further suggestions and for his words on impact reviews—there is no time to explore them today, but I shall read them in Hansard and he can be sure that I will follow them up when the Recess is over.
I have no illusions about my ability to prevent the regulations passing. My intention today was to ensure that the unheard voices of those with lived experiences were on the record, and that we have achieved. I have learned the lesson of King Canute and I shall not divide the House. With regret, I beg leave to withdraw the amendment in my name.
Lord Brooke of Alverthorpe
At end insert “but that this House regrets that the Regulations do not extend to alcohol, even though mounting evidence shows that it is a significant contributor of co-morbidity and obesity, one of the major underlying causes of the nation’s 128,481 COVID-19 deaths, the highest number in Europe; and calls on Her Majesty’s Government to require the publication of the calorie content of alcohol by the end of 2021 in order to improve the people’s well-being and good health.”