(6 months, 1 week ago)
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Baroness Jenkin of Kennington
To ask His Majesty’s Government what assessment they have made of the impact of ultra-processed foods on children’s health.
Baroness Jenkin of Kennington (Con)
My Lords, I thank all noble Lords participating in today’s debate, apologise that they have only four minutes each, and thank those who have provided briefing. I am grateful to the First Steps Nutrition Trust, which pointed out to me that the focus of today’s debate should really be on how diets high in UPF negatively impact children’s health, rather than focusing on individual products. Its report, published in June this year, has helped to shape the debate and inform us all.
Speaking in a debate in 2016 I cited a TV series called “Junk Food Kids” and highlighted how a poor diet was leading to poor outcomes. In 2017 I chaired a report for the Centre for Social Justice called Off the Scales: Tackling England’s Childhood Obesity Crisis. It all seemed bad then, but the situation today is so much worse. Fortunately, we now know more about what is driving it, thanks to more than a decade of research amounting to many hundreds of papers linking increased consumption of ultra-processed foods to bad health outcomes.
There continues to be a debate about the definition of UPF, but I do not intend to go too far down that rabbit hole. There is a definition accepted by UNICEF, the United Nations Food and Agriculture Organization, the World Health Organization, many foreign Governments including those of France, Canada and Belgium, and research groups at Cambridge, Harvard, Yale, Imperial, UCL and many other leading universities.
While the formal definition is long, a good working definition is that a food is probably ultra-processed if it contains at least one additive that you would not find in a domestic kitchen. But the additives are just part of the problem: these products are made by large corporations in a system in which all the incentives are financial. The additives signal a process in which every product is engineered to maximise consumption: the flavour, colour, taste, softness, texture and even marketing are all optimised to increase profit.
There are undoubtedly some ultra-processed products that are less harmful. I expect the Minister will mention wholemeal bread or baked beans in his response, but the evidence refers to a pattern of eating. People do not eat just one food; they eat diets, and the evidence is clear that a diet high in ultra-processed food and drink is driving not just a pandemic of weight gain but a huge number of other problems, from cancer and metabolic diseases to anxiety, depression, dementia and an early death.
Industrialised wholemeal bread does contain grains linked to good health, but it is also soft and energy-dense and contains emulsifiers, around which there are increasingly credible health concerns. No one is calling for these foods to be banned, but rather for the public to be made aware of the growing evidence around the risks and for non-ultra-processed versions of food and drink to be made affordable, accessible and convenient to everyone. No one in the UK should struggle to afford or access real food.
Global consumption of heavily processed products such as cereals, protein bars, fizzy drinks, ready meals and fast food has soared. In the UK, 60% of the average diet now consists of UPF and for some, especially people who are younger, poorer or from disadvantaged areas, including food swamps where it is hard to find a choice of food, a diet comprising as much as 80% UPF is typical. It should be the reverse, but no wonder this is the case when 70% of the UK’s largest food companies’ products are ultra-processed. What we eat is a reflection of what food companies make. If they make majority UPF, is it a surprise that our diets mirror that? These companies literally make most of what we eat: 75% of calories consumed globally come from six companies.
The hyper-palatability of food designed to appeal to children drives them to eat more. A recommended portion size of Coco Pops for an adult is 30 grams, basically a very large spoonful, but does anyone know a child who will stop at that? I doubt it. Does anyone actually weigh their child’s breakfast cereal? Similarly, a recommended serving of Pringles is 13. Has anyone in the history of eating crisps ever counted the number they eat? There is now very good evidence, including a paper published last week in the BMJ, that for many people these products are addictive. Try telling a child to eat a single bowl—it is like recommending to smokers that they stick to one cigarette. These products are designed and marketed to be consumed in excess.
As the recent Scientific Advisory Committee on Nutrition report says:
“The observed associations between higher consumption of (ultra-) processed foods and adverse health outcomes are concerning”.
Would anyone disagree? It would be interesting to know why the report did not recommend new actions to address UPF consumption given that many Governments have, including that of our nearest neighbour, France.
I turn to older children and young people, more than a third of whom now leave primary school with a weight classed as overweight or obese. Many children living in the most deprived areas are disproportionately affected. Many of these children experience stunting of up to 9 centimetres, so they are not just obese but shorter than ever before as a result of diet. These children and those older are exposed to junk food advertising all the time—bombarded, in fact. It pops up on their feeds hundreds of times a day via TikTok and other social media sites.
We know that advertising is effective—otherwise, why would it exist? I quote two teenagers, supporters of Bite Back, on their exposure to such advertising. They said:
“Scrolling on UberEats and Pinterest late at night. The donuts look delicious and I wouldn’t mind grabbing a bite. These adverts are very enticing and they are making my mouth water”,
and:
“I saw this Magnum advert on Instagram and it made me crave ice cream. It made me feel a bit peckish and definitely activated the midnight cravings … I would definitely buy these if I saw them in the shops”.
Both doughnuts and Magnums are UPF.
The counterargument comes entirely from the industry making money from these products, leading to a pandemic of diet-related disease, and the people and institutions they fund. If you are on the same side as a charity funded by a soft drink manufacturer and a sugar producer, you need to ask yourself some questions. These groups propose that sugar, fat and salt are the only determinants, but we know that mixtures of just sugar, fat and salt are not very tasty. They need texturing, emulsifying, flavouring, colouring, flavour enhancing and marketing to drive excess consumption. These are just some of the ultra-processes that turn real food into addictive substances.
Those groups propose that processing is fine, which it is. Processing is ancient and has shaped our bodies. Humans have to process our food. Ultra-processing is what happens when transnational food corporations with obligations to investors need to generate financial growth. They say that a ban would be harmful. It would. This is, tragically, the only affordable available food for many people. They say that those who want to regulate the companies that make UPF want to ban brown bread and baked beans. These are straw man arguments. No one is calling for a ban. No one is that brown bread is poisonous. No one is advising against eating baked beans. But as a category of food, there is a huge amount of evidence that UPF is linked to negative health outcomes and that it needs some light-touch regulation, such as a marketing ban for kids, a warning in the national nutrition guidance and effective labelling.
The independent groups—scientists, NGOs and activists not funded by the industry—all agree that the science around UPF is robust. In the UK, we are so saturated in industry messaging that it seems that the science is controversial. It is not. Of course, there are many more questions to answer, but we did not need to understand how smoking causes cancer to warn the public that it does.
Many ultra-processed products are high in fat, sugar and salt, so the Government should absolutely continue implementing the current policies, including the HFSS advertising and promotion restrictions that have been delayed. We need urgently to follow other Governments globally who have included advice to reduce UPF consumption in their national nutrition guidance. Latin America presents a wealth of examples of how to do this. Given that the UK consumes most of its calories from UPF, there must also be viable alternatives for everyone. Making non-ultra-processed food and drink affordable, accessible and convenient to all is critical, and unleashing business incentives so that companies can profit sustainably from making non-ultra-processed products could be game-changing.
We are able in one hour only to scratch the surface of the problems of a diet rich in UPF. If the noble Baroness, Lady Boycott, and I are able to persuade the Liaison Committee of the merits of a special inquiry into the subject, we will have the opportunity for a much deeper dive. For those who would like to hear and question Dr Chris van Tulleken, author of the bestselling book Ultra-Processed People, I am delighted that he will be speaking to a joint committee of the APPG on Obesity and the Food and Health Forum on 21 November at 5 pm.
To summarise, for the past half-century, dominant strands of nutrition science and policy have focused narrowly on single ingredients as determinants of health. Within this reductive paradigm, nutrients are systematically decontextualised from the foods, dietary patterns, social contexts and food systems in which they are embedded. This perspective has singularly failed to curb rising levels of obesity and dietary ill-health. Research on UPF and related issues is beginning to reveal why. I look forward to noble Lords’ contributions and to the Minister’s response.
Baroness Walmsley (LD)
My Lords, I agree with every word of the noble Baroness’s excellent speech, as noble Lords will hear. We humans have evolved, along with our diets and our gut microbiome, over millennia. Ultra-processed foods, however, are the new kids on the block, and their availability and ubiquity in our diets correspond exactly to the increase in diet-related diseases. Figures show that 60% of the UK diet is UPF, and it could be worse for children. That corresponds with serious concerns about height and weight revealed by the UK child measurement programme. It is pretty obvious that something is going wrong.
Whenever I raise the topic of ultra-processed foods with the Minister, he replies that the Government cannot take action because it is difficult to define them, since brown bread is an ultra-processed food. I would like to tackle that head on. Brown bread could be ultra-processed, but it does not have to be—it certainly is not in my kitchen. So let us look at definitions. You could say that UPF contains things you would not find in a normal kitchen. That is helpful, but not enough. More helpful is the NOVA system, which puts foods into four categories, only the fourth of which is ultra-processed. Brown bread is not always found in that group.
NOVA provides a framework for assessing the degree and purpose of processing, and the relation between dietary patterns and health outcomes. It should be seen as complementary to nutrient-based approaches. Some national Governments have already begun to introduce policies informed by NOVA.
Foods and diets are of course complex. Lots of HFSS foods—high in fat, salt and sugar—are UPF, which is often called junk food, and lots of UPF are HFSS, so it is important to untangle the two. One piece of research did that neatly. Two groups of people were given diets for a week that were comparable in fat, sugar, salt and quality and told they could eat as much as they liked. One diet was made of minimally processed foods and the other UPF. Those on UPF ate 500 calories more than the others and gained weight. When they swapped the two groups around, the same thing happened. Dozens more studies have controlled for fat, salt, sugar and diet quality and have still found ultra-processed diets to be strongly associated with poor health. Other research shows that UPF are designed to make people eat more. They are soft and easily digested, taste good, are energy dense and, as has been said, some people become addicted to them.
Not every UPF is bad; it is the quantity and the overarching dietary pattern that matter. Our priority should be rebalancing the diet as a whole, and that is where government dietary guidelines come in. In the UK, reformulation has long been the focus of policy but, given the overlap between UPF and HFSS, reformulation should be only a first step to addressing the health outcomes associated with ultra-processed dietary patterns.
Part of the issue is profit maximisation. The business model is this: you take cheap commodity ingredients, deconstruct them and put them together in a different way, bind them with cosmetic additives and then brand and market the product with the aim of increasing sales and normalising consumption. In a capitalist economy, financial resources flow to the sectors that are the most profitable, and UPF is hugely profitable.
So what to do? Research definitively demonstrates that existing guidelines are inadequate—there is not a word about UPF in government guidelines—so will the Government amend their guidelines to promote the consumption of minimally-processed foods, improve the food in schools and public settings, and implement the existing legislation on advertising junk food on TV and online and relating to “buy one, get one free”? Many people on lower incomes rely on cheap UPF, so policy should not place further burdens on them.
Lord Krebs (CB)
My Lords, I declare my interests as recorded in the register.
I shall start by saying what I agree with in relation to the previous two speakers: namely, that unhealthy diets are a major cause of ill health in the UK, estimated to cause 90,000 deaths a year. The risk is increasing—for example, obesity levels have doubled in the last 30 years—and is strongly linked to deprivation. Children at the age of 11 are twice as likely to be obese if they are in the poorest decile of the population than if they are in the richest decile.
The key question for this debate is: what is the cause of dietary ill health? Is it the content of certain foods—too many calories, too much fat, sugar and salt, and not enough fibre—or the way in which they are made? The UPF concept says it is the latter, but I beg to disagree. Although the noble Baroness, Lady Jenkin, said there is agreement in the scientific community, that is simply not true. I have studied a number of the original papers and shall highlight two problems.
First, numerous studies have shown that there is no agreement on what UPF is. For instance, in a study published in 2022, a panel of nutrition experts agreed on classification on the NOVA scale for only four out of 231 foodstuffs that they were presented with. Even when the experts were given the ingredients of those foods, they agreed on only three out of 120 items.
Secondly, there is no scientific evidence to show that processing is harmful to health. Most of the evidence that claims to show this comes from epidemiological studies following a large cohort of people over many years and looking for correlations between diet and health outcomes. Correlation does not prove causation, of course, so there are criteria, known as the Bradford Hill criteria, that have to be met before one can infer causation.
I have looked in detail at recent very large epidemiological studies conducted in the UK, France, Spain and the United States. Although they all show correlations, they do not meet the Bradford Hill criteria for inferring causation of a link between consumption of ultra-processed food and ill health. Furthermore, these studies, which were set up many years ago—sometimes decades ago—were not designed to look at UPF, so the dietary records of participants did not include references to it. The researchers had to retrofit a categorisation, and I have said how little agreement there is on the NOVA classification scheme.
The noble Baroness, Lady Walmsley, also cited an experimental study carried out by Kevin Hall, but when one reads the paper that study does not show that UPF is harmful. It shows that when people are offered unlimited hyperpalatable food that is high in fat, salt and sugar, they overconsume. They consume more calories; no one disagrees with that and it is hardly surprising, but it has nothing to do with UPF. I therefore agree with the Minister, who has said many times that the real danger in our diets is HFSS, not UPF. For me, the real pity is that the Government, having correctly identified the problem, are doing so little to tackle it. Here I agree with the points made by the noble Baroness, Lady Walmsley.
Finally, I have tried to take a dispassionate look at the evidence, and one should always be open to the possibility that the evidence will change. But for now, I conclude that UPF is a red herring in the diet and ill-health debate. Since the noble Baroness, Lady Jenkin, mentioned addiction, the paper published in the British Medical Journal on 9 October does not say that the UPF category in NOVA is addictive. First, it acknowledges that the DSM-5 manual—the standard manual for mental health problems—does not recognise food addiction. Secondly, it says:
“The UPF category … captures foods that may be unlikely to have strong addictive potential”
and that homemade foods, such as homemade cookies,
“may … be addictive but would not be considered a UPF based on the NOVA classification”.
Lord McColl of Dulwich (Con)
My Lords, in this debate it is very important to consider the science and history of the obesity epidemic. The history is that the food industry in the 1960s promoted a low-fat, low-fibre diet, which makes people eat more and become obese. Science has exposed the errors of the food industry; the science is that when fat enters the duodenum, it releases from the duodenal mucosa a hormone called CCK, which delays the emptying of the stomach and makes the patient feel full early on in a meal. It is a beautiful mechanism for preventing obesity, which is why the food industry hates that mechanism and keeps on recommending a low-fat diet, which is so tasteless that it had to add large quantities of sugar to entice people to eat its rather tasteless products.
A recent study from Canada revealed that thousands of children fed on whole milk, with plenty of fat, were much less likely to be obese than those who were not so fed. Unfortunately, the Department of Health seems to be obsessed with low-fat diets, in spite of the evidence. I even had a letter just last month from a Parliamentary Under-Secretary for Health, who again recommended a low-fat diet.
The removal of fat and fibre, in the form of wholemeal bread and vegetables, increases appetite and obesity. That is why we must ensure that food contains plenty of fibre and the right kind of fat. Highly processed foods appeared many years later than the beginning of the obesity epidemic and much more work needs to be done to determine exactly how appetite stimulators are supposed to work.
Another important misleading aspect is the great emphasis on telling obese people that the whole subject is so confusing, difficult and multifactorial. It is just telling them, “Well, it’s just one of those things, and you don’t need to bother too much”. They say anyway that it is genetic. What do they mean by that? It does not matter what your genetics are, there is only one way of becoming obese: by putting too many calories into the mouth. We need much more scientific work to reveal how much genetics could increase obesity. There has also been an attempt to glamorise obesity, stating that you can be “fat and fit”. The paper that purported to make that claim is very superficial and incomplete.
In summary, we need to emphasise the fact that the removal of fat and fibre and the insertion of sugar has caused the obesity epidemic. We do not need complicated formulae like BMI. It is best to keep things simple. A simple slogan is: if your waist measurement is more than half your height, you are eating too much of the gross national product and you are on the road potentially to a premature death from a variety of very unpleasant diseases.
Baroness Bennett of Manor Castle (GP)
My Lords, I thank the noble Baroness, Lady Jenkin, for securing this short debate and for her excellent introduction. Since very soon after I came into your Lordships’ House, I have been working on a project: to get a Minister to say “ultra-processed foods”. I have hope that we may see that project delivered today, as that is the subject of the whole debate.
I have thrown out a large amount of what I was going to say, because I want to directly respond to the noble Lord, Lord Krebs, for whom I have the greatest respect. However, I entirely disagree with a large part of what the noble Lord said. We know that there are significant problems with the peer-reviewed research process. We know this from what happened with big tobacco and pesticide companies. We have a huge problem with commercial interests in the research process. If you look behind where most of the attempts to challenge and question the NOVA classification system comes from, you do not have to look very far to find commercial interests.
As one of example of that, just last month in London the Science Media Centre hosted an event questioning whether there was any problem with ultra-processed foods and if they are all absolutely fine. The Guardian looked into this and discovered that three of the five participants on the panel had either received financial support from UPF manufacturers or hold key positions in organisations funded by them. They include companies such as Nestlé, Coca-Cola, Pepsi and Unilever.
I point the noble Lord, Lord Krebs, to a specific recent study. The noble Lord suggested that we were talking about either the nutritional content or whether food was ultra-processed. This is a study that covers both areas. The study is by Julia et al in the European Journal of Nutrition. It is based on the French NutriNet-Santé cohort study, so it is an observational study. The conclusions say that
“nutritional quality and ultra-processing should be considered as two correlated but distinct and complementary dimensions of the diet”.
So, yes, the amount of fat, lack of micronutrients and nutritional quality is a problem, but ultra-processing is a problem too. This is a very solid 2023 study demonstrating that.
Very briefly, I want to focus on young children, as the noble Baroness, Lady Jenkin, has pointed us to. We have a huge problem with the diet of young children in the UK. That is now demonstrably obvious in all the health dimensions, whether obesity or height. We are not giving children the chance to develop in the way they should.
I will pick out one deeply shocking figure. Think about the size of child between a year and a half and three years old—quite small. Some 65% of one and a half to three year-olds in the UK drink, on average, one adult-sized can of soft drink a day. One of the things that has not been focused on enough is that, as has been said, this is nutritionally attractive and, arguably, addictive—the paper is strong on that. But you are filling a child up with empty calories or, if the drink is low calorie, with no calories at all, and there is no space for the child to eat the vegetables and fruit that they should.
As others have said—I was going to major on this more—look at all the products in supermarkets directed at children, with cartoon characters all over them, and with messages about health directed at the adults. We are profoundly misleading parents about what their children should be eating—by “we” I mean the multi- national food companies, which are making massive profits from making our children ill.
Lord Evans of Rainow (Con)
My Lords, I ask noble Lords to keep note of the four-minute speaking time, please. We still have to hear from the Front Benches and the Minister.
The Earl of Dundee (Con)
My Lords, I join in thanking my noble friend Lady Jenkin for introducing this debate. I will mention a few aspects: the low-cost food shopping paradox, what the Government should now further do, and the shared threat of ultra-processed foods both here and abroad.
On overweight in childhood, there is a well-known paradox: due to cheap, high-calorie nutrition, food insecurity and obesity come together. That is because, so far, our national food system lacks sufficient incentives for healthy eating for those on low incomes, and it equally fails to provide enough disincentives against unhealthy eating in the first place.
Following this anomaly, inferred government action might appear to be fairly obvious: make healthy and sustainable food affordable, stop the junk-food cycle and invest competently in children’s diets.
As my noble friend Lady Jenkin implied, the Government have to restrict, to a far greater extent than at present, advertisements promoting unhealthy food. On the balance between disincentives and incentives, a good idea would be to increase tax on ultra-processed foods and use this revenue to fund healthy-eating vouchers for low-income families—vouchers that can be traded only for fresh food and vegetables.
The Government must insist on clear and legible shop label warnings against unhealthy foods, including those with hidden sugars. Brazil has warning labels on foods that contain an excess of salt, sugar and saturated fats. We could do the same, with a particular warning on all ultra-processed foods, or at least on those with excesses of salt, sugar and saturated fats—such warnings would, therefore, cover most ultra-processed foods in any case.
The Government ought to invest now in healthy food to be provided by all schools. Current guidelines on school lunches should become stricter, with less ultra-processed foods, or at any rate a reduced availability of foods high in salt, sugar and saturated fats. Then, as has been done in other countries, the Government must update national dietary advice to emphasise fresh or minimally processed foods.
To replace the present negative trend with a positive one, these are just some of the measures that we ought to adopt, along with other relevant expedients. First, does my noble friend the Minister agree that we should do so now and early on in the new Session, and, secondly, within the international community? In thus starting competently to address this shared problem, thereby and to the benefit of so many, the United Kingdom can then provide an example of proper common sense and good practice.
Lord Bird (CB)
My Lords, it is interesting that the noble Baroness, Lady Jenkin of Kennington, has got this discussion going. I am a bit confused about who we are talking about. I can imagine people who eat poor food—I know them. I come from those people, and they are therefore familiar to me. I have a large extended family where people eat all sorts of muck. I just cannot see where any of the advice I have heard today would fit in.
For instance, I do not know many people, particularly poor people, who would read the back of a packet and make a decision. The reason why they are eating poor-quality food is largely because they are stuck in poverty. The Government could, for instance, invest an enormous amount of money in good food, which could be distributed or made available, a bit like what used to be done after the Second World War—to give people milk, which is what I was brought up on, and capsules and orange juice, which was imposed while you were at school. However, I cannot really see the poor going down the road and picking up their food, unless of course it was cheaper or there were other things that made them think.
What we are always missing, not just in this House or in the other place, is the fact that we do not know how to bring all the elements together to dismantle poverty. One day we have a discussion about the impact of food on poverty, and a discussion about the impact of obesity and where it comes from. That is really interesting. Then another discussion would be about the fact that we know that if your education system is not working then you produce poor people, because you do not skill people away from poverty. The fact is that 80% of all the money spent on poverty in the world is actually to maintain people in the crisis of poverty and make them cope. Very little is spent on prevention or on cure.
If you really think about it, you need a different view of poverty and people who are the victims of poverty. Across the road, for instance, 50% of the people who use St Thomas’ Hospital, if it is an average hospital, will suffer from food poverty. The British Medical Association says that 50% of people who present with cardiac arrest actually suffer from food poverty. I am really glad to be a part of this discussion, but I cannot see how the fracturing down and breaking d will work unless there is unity around getting rid of poverty. That is why I will have a Bill in the next Session calling for a ministry of poverty that will bring everything together: education, housing, food, et cetera.
The Earl of Effingham (Con)
My Lords, I thank the noble Baroness, Lady Jenkin of Kennington, for raising this key debate. I am sure that many noble Lords are familiar with the phrase “gut instinct”. The gut is our second brain. It uses the same chemicals and cells as our main brain. It helps us to digest, but also alerts us when something does not feel right. What we put into it is critical.
Noble Lords will also be familiar with the phrase “you are what you eat”. Eating nutritionally balanced and healthy food encourages good bacteria, which in turn affects the production of good chemicals. When production is optimal, our brain receives messages clearly and distinctly, and we experience a positive mental state. Food changes our mind and our mental health. We should actually say that food is medicine. There is a direct correlation between healthy diet and cognitive learning.
It is crystal clear that it is of the utmost importance for our children to have a healthy, balanced diet. It is therefore a concerning statistic that ultra-processed food accounts for almost two-thirds of what toddlers in the UK eat, and it becomes progressively worse the older they get.
While it is acknowledged that not all ultra-processed foods are harmful, there is agreement that they are typically high in saturated fat, salt and sugar. That is the type of food that can contribute to long-term illness, by changing the micro-composition in the gut, which can then lead to cancer, diabetes and cardiovascular disease. Research out early this week suggests that high-fructose corn syrup actually causes biological changes to the body that make it easier to put on weight and harder to lose it. Another worrying statistic shows that, in the past 47 years, average consumption by UK households of ready meals has increased by 549%, while consumption of certain fresh fruit and vegetables has decreased.
That goes some way to explaining the obesity levels in our children. Some 10% of four to five year-olds were obese in 2021; that increased to 23% of 10 to 11 year-olds in the same timeframe. We owe it to our children to give them the best start in life—but having a fit and healthy young population is essential to reducing pressure on the NHS. Obesity currently costs us £6 billion per year, set to rise to £10 billion by 2050. By trying to tackle the issue of our children and ultra-processed food consumption, we will in part tackle childhood obesity and further issues in later life.
Another concern is absenteeism from school due to illness. Almost one in 10 secondary school pupils missed school in the last week of September after sickness absence doubled in just two weeks. Those lost days over the course of a child’s education can have a material impact on their learning and development. If we are able to reduce in some way illness absence through healthier eating, that must be a positive.
If we are to protect the health of our children and prevent diet-related disease and complications, we should be reducing consumption of ultra-processed foods, and combining that with eating more lean meat, fruit, pulses and vegetables. What are the Government doing to educate children in healthy eating and cooking? Education must be key. If people really understood the harm that they are doing to themselves by eating foods that are high in saturated fat, sugar and salt, they might be able to adapt their buying patterns.
Baroness Redfern (Con)
My Lords, I thank noble Lords for allowing me to speak in the gap—and my thanks to the noble Baroness, Lady Jenkin, for introducing this debate, which raises challenging issues. The importance attached is that the focus should be on trying to eliminate at the earliest opportunity addictive products that create poor outcomes for our young people and to designate clear information, particularly on labelling on snacky and on-the-go foods that are high in fat, sugar and salt. Good advice labelling, with a typeface large enough to be read, can be really good for families, helping them to make informed choices—and not with a tiny typeface so that it is hidden. This poses a question that needs an answer, of whether there is a case for revisiting our food labelling laws.
The facts are stark, when one in three children leaving primary school is obese. The statistics are truly shocking, particularly when it is noted that evidence found that 64% of school lunches with high calorific value come from ultra-processed foods. There is an opportunity for change—an open door beckons for our young pupils—for schools and public settings to create a ripple effect for new alternative healthy and attractive choices.
The Government have reaffirmed their priority of continued action to reduce the consumption of these highly calorific foods, with their advertising proposals of a watershed of 9 pm on television and UK on-demand programmes. Those restrictions were originally due to come into force in January 2023, but they are now not due for a further two years. Delays are not something that we should be contemplating. Online advertising of unhealthy food and drink products is a further outlet attracting a younger audience.
As we have heard, there are many arenas in which change for good can be made in helping to reduce the number of obese children and reduce sugar content for better oral health, better to minimise the number of teeth extractions that have to be carried out in hospital settings, which can be very upsetting.
If industry does not change, government must dig deep to intervene sooner, as time is ticking on our obesity figures, which are alarming, and the cost for the NHS speaks for itself.
Lord Allan of Hallam (LD)
My Lords, I am grateful to the noble Baroness, Lady Jenkin, for prompting this debate. I shall use my brief remarks to make a modest proposal that I hope will offer the Minister a creative way to address issues related to food quality and health. In short, this is that we should require large retailers to make data about food purchases available, within a controlled framework, to support research and policy development.
The argument for this will be familiar to anyone following the regulation of online services, where we are responding to concerns about the diet of information being served to people and how this may lead to various kinds of harm. The logic for this approach is as follows. Policy-making should be evidence-based, using data both to predict the impact of new measures and to evaluate the effectiveness of previous interventions. Where there is a significant public interest in making policy interventions in an area, this creates the case for requiring organisations to make useful data available. There is a major public interest in understanding the relationship between food consumption and health outcomes for both adults and children in the United Kingdom. Major retailers have very sophisticated and comprehensive datasets about food purchases that would be of enormous value to researchers and policymakers.
Any concerns about commercial confidentiality can be resolved within a sensible framework, just as they are in other areas, such as banking and online services. Similarly, we can look at good practice elsewhere to ensure that useful data can be provided, while not compromising the privacy of individuals. Companies may be willing to share data in the public interest, and such a voluntary approach is worth exploring in the first instance. If that proves insufficient, a regulatory requirement should be considered. We have many examples to build on of where regulation requires private businesses to provide data to support public safety goals; we can look at financial services and the pharmaceutical industries to see that working well today.
The models that are being developed right now for online services may be especially useful for a read-across to food retailers, given the similar nature of the challenge: we are seeking to identify patterns of harmful behaviour within a very high volume of normally benign activity. I hope the Minister will agree that it is worth some of his department’s time and effort to explore the benefits of this approach. If we can move from anecdote to well-sourced evidence, this will help us in all our work in this place on measures related to health and food consumption. If we are able to take retailer data about food purchasing practice and match that up with health data, which I know the NHS has in abundance, we can start to draw valid conclusions. Whether you are with the noble Lord, Lord Krebs, or the noble Baroness, Lady Bennett, in terms of your starting assumptions, having that data will allow us to have a much better-informed debate. I hope that this is a useful modest proposal that the Minister will look upon kindly.
Baroness Merron (Lab)
My Lords, I start by congratulating the noble Baroness, Lady Jenkin, on securing a debate on what is clearly an extremely live issue, as we have heard in the many contributions from noble Lords today. There is one point of agreement, at least in the Chamber, and that is that rising obesity is damaging our children’s health and their chances in life. In 2021-22, more than one in 10 four to five year- olds were obese, while a further 12.1% were overweight. Nearly one in four 10 to 11 year-olds was obese, with a further 14.3% being overweight. Those from deprived areas are more than twice as likely to be living with obesity compared with the more affluent, and this is not an acceptable state of affairs.
We know that balance is essential to a healthy diet and that, for most people, cutting out ultra-processed foods entirely is not realistic. As we have heard, people need to be supported to make informed, healthier choices, and wider social determinants—most notably poverty, as the noble Lord, Lord Bird, said—need to be addressed, particularly in the current economic crisis, but the Government have missed some tricks here. They have delayed the ban on junk food advertisements targeted at children and scrapped the health disparities White Paper.
Can the Minister explain how the Government’s decisions will contribute to tackling childhood obesity and improving the health of the nation? In delaying these key measures, have the Government instead got any plans for further policies to address this issue?
In July, the Scientific Advisory Committee on Nutrition published the findings of a review into the potential impact of ultra-processed foods on children’s health. It cited limitations in available evidence and recommended that further research should be undertaken in several areas, including in assessing and developing a classification system that can be applied reliably to estimate processed food consumption. As the noble Baroness, Lady Jenkin, said, the First Steps Nutrition Trust found a strong inverse correlation between the consumption of ultra-processed foods and the nutritional quality of diets. It said also that those who eat a diet rich in UPFs were consuming more calories, mainly due to larger portion sizes, which resulted in weight and body-fat gain. These are important points and I ask the Minister for the Government’s response to these findings, and when can we expect it?
The Health Minister Neil O’Brien MP said that the Government would not hesitate to take action if the evidence suggested that it was needed. In July, the Minister told your Lordships’ House that it was unclear whether UPFs were inherently unhealthy or whether the issue was instead that such foods were typically high in calories, saturated fat, salt and sugar. As the Minister clearly considers that there is uncertainty, what steps will the Government take in order to take action, rather than relying on inaction?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I too add my thanks to my noble friend Lady Jenkin for bringing this debate forward, and I thank all noble Lords who have contributed to what I feel has been a very interesting debate. We have seen a wide range of different views, which shows that this is a highly complex area. I know we all agree that there are many bad things about ultra-processed foods, but there are many things we do not agree on, such as whether ultra-processed food per se is bad. As brought up by the noble Lord, Lord Krebs, there is plenty of evidence that it is not the ultra-processed element that is bad; it is the fact that many of the things inside the foods are bad, namely high levels of fat, sugar and salt. At the same time, some of the things we are putting forward in the Eatwell Guide, such as some breakfast cereals and wholemeal bread, would also be caught under the definition of ultra-processed food.
The real problem is that I have not yet heard—and I am very happy to discuss this—how we could find a workable definition here so we can take the sort of action that we take in other places. What do you try to do when something is bad? You try to tax it, as we did with the sugary drinks levy. You try to restrict product placement and advertising and you try to educate and label—but you can do that only if you have a definition that everyone understands.
The problem is that if on the one hand there are some ultra-processed foods that you are saying you are going to tax so people will eat less of them but on the other hand there are some that you are trying to promote in the Eatwell Guide, I do not see how that is a manageable system or something that people can understand. What we all totally agree on is the need for education, so that people understand what we are trying to encourage and discourage. What I would like to concentrate on, which is something that we all agree on and that my noble friend Lord Dundee said we need action on, is those foods that are high in fat, sugar and salt, many of which are ultra-processed.
As my noble friend Lord Effingham said, this starts with education. We have got some good examples there. I hope this will answer some of the points made by the noble Lord, Lord Bird, on our schools. Our free school meals are at the highest levels ever, which we know not only addresses food poverty but makes sure that those children are receiving a balanced diet. The fact that all infant school children now receive this is a huge step forward and, as I say, the level of roughly a third of all children receiving free school meals is huge as well.
The other initiatives, such as Healthy Start, helping kids get their five-a-day, are very important to this. Equally, in terms of education, I remember being taught years and years ago at school how to make shepherd’s pie and apple crumble. The advice on teaching children to cook six healthy meals is far more useful than a lot of things we receive in our education; it was definitely far more useful than my very poor efforts at woodwork and metalwork at the time. So I totally back those.
I would also like to talk about the action that we have taken on the bad elements of foods, such as those high in salt, sugar and fat, which really is working. Noble Lords will have heard me mention the sugary drinks levy, which has reduced average sugar levels in these drinks by 46%. Just this weekend, going out to eat Sunday lunch, I swapped from eating a chicken pie, which looked pretty tasty and had more than 2,000 calories in it, and saw that the roast beef had only 1,400—and I did not eat the Yorkshire pudding, so I had even less than that. So, again, these are useful ways forward that help to educate people.
The product placement and positioning steps that we are taking are really tackling 94% of the estimated reduction in calorific intake, and 78% of people are in favour of them. It is early days, because the measures have not been in for long, but what we have seen in early data is that foods that are not high in fat, sugar and salt have gone up by 16% and foods that are high in sugar, salt and fat have gone down by 5.7%. These are early signs, but those product placement steps are working. Those are the things that are impacting 94% of the data. The noble Baroness, Lady Merron, asked about what we were doing about other things such as “buy one get one free”. We all talk about evidence and data: the modelling showed that this would account for less than 5% of our estimated reduction in calorific intake. And there is more to boot, because we are working with industry on this and Sainsbury’s and Tesco have already agreed to do that voluntarily. That means that it accounts for even less. Surely that shows that what we are about is trying to tackle the big things that make a difference.
Mostly importantly of all, as some noble Lords have said, the real prize of course is the reformulation of food. We know that companies are starting to change this. I apologise because I have mentioned this before, and noble Lords will probably hear me say it again in answer to tomorrow’s Question on ultra-processed food, but Mars, Galaxy and Snickers have all changed their formulation. Mr Kipling’s “exceedingly good” cakes are now compliant in their formulation. All these things are making a difference at the industry level.
However, I agree with the helpful suggestion from the noble Lord, Lord Allan, that we need to be data driven. I hope that, by sharing some of the statistics, I have shown that we are focusing on the 94% of things that really hit the reduction and that we are data driven. I definitely want to take his suggestion further; perhaps we could meet after the debate. Many people know that Steve Rowe, a former CEO of M&S, has been giving the department some advice. I hope he will help us to convene a round table with relevant CEOs so that we can talk about what might be manageable, because we should be data driven.
I also agree with the noble Lord, Lord Bird: we need to look at this holistically and bring all the elements together. The best example I have seen through my work in different departments was the troubled families work I saw early on when I was a non-exec director at what is now DLUHC. It looked at what really had an impact on troubled families—be it something they could do or something in the social, education, health or police space—and tried to look at things across the board. We have to consider some of those ways. So, although I am not quite sure and need to understand more about the work of the Minister with responsibility for poverty, I agree that we need to work in a joined-up fashion.
As ever, if there are any questions I did not manage to answer, I will try to follow up on them in a more detailed letter. I look forward to seeing tomorrow most of the noble Lords who are here today—probably asking me similar questions on ultra-processed food. We are all violently in agreement on the objective: stopping the consumption of unhealthy food. We need to do a bit more work between us on making sure that we really know what we are trying to stop, and the definitions, so that we ensure that any action is evidence-based and makes a difference. At this point, I thank everyone for their input.