Obesity: Low-fat Diet

Baroness Wheeler Excerpts

Thursday 9th June 2016 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I congratulate the noble Baroness, Lady Jenkin, on securing this debate on this important but highly confusing subject. The scale and enormity of the obesity crisis facing the UK and the rest of the world has been underlined, and it is clear that the Government’s long-awaited strategy, particularly in respect of providing clarity over dietary guidance, is desperately needed. I hope that the Minister will be able not only to give us some headline information on the content and direction of travel of the strategy, which we assume must now be in an advanced stage of development, but to be much more specific about the publication date for the strategy than just the timetable of “over the summer” that we have been given so far. I hope she fully realises the urgency and seriousness of the situation and the need for the Government to get to grips with the country’s obesity epidemic. The noble Baroness, Lady Jenkin, in particular graphically and thoroughly underlined the challenges we face.

The recent report from the National Obesity Forum and the Public Health Collaborative has led to even greater confusion about what we should and should not eat to help us lose weight or keep our weight in check. To quote one comment article on the report:

“If you’re not confused, you’ve not been paying attention”.

The same article, by Archie Bland in the Guardian, underlined the important need for clear messages on food, such as a simple five-a-day mantra, however much we place our own interpretation on it, and came to the same conclusion on the need for clear, straightforward guidance on tackling weight gain that has been supported here today—that is, eat less and move more. Regarding noble Lords’ comments on the Government’s advice on diet, the British Obesity Society’s 11 tips for 2016 seem pretty sound and cover the full range of issues we have been discussing today.

As we have heard, the report’s findings and conclusions have been fiercely challenged by key medical bodies, including the Royal College of Physicians, the Academy of Medical Royal Colleges, the Faculty of Public Health, the British Heart Foundation and of course government public health bodies. We also now have the bizarre spectacle of half the board of the National Obesity Forum resigning over a lack of consultation, involvement and input into the report. Regrettably, instead of contributing to the debate, the dramatic statements in the report, and particularly those surrounding its launch, have served only to polarise and confuse the debate still further in a very unhelpful way. They have also detracted from the effective debate and discussion of some of the report’s valuable findings and observations, as a number of contributors have pointed out. The dismissal of Public Health England’s Eatwell Guide as a “metabolic time bomb”, for example, and the description of the discouraging of eating low-fat foods as,

“perhaps the biggest mistake in modern medical history”,

were over-the-top statements not backed up by evidence in the report itself.

In his response to a Question about the report from the noble Baroness, Lady Jenkins, on 26 May, the noble Lord, Lord Prior, gave assurances to the House that the Government’s obesity strategy would clearly address the confusion and muddle over dietary advice. It is clarity and simple language that are needed, and that is what makes the need for the strategy ever more urgent.

There have been excellent points and questions from noble Lords to the Minister on low-fat and dietary issues, which I will not duplicate. I look forward to her response, particularly regarding this week’s Spanish research, which has found that the Mediterranean diet, with high-fat content from olive oil, does not cause people to put on weight. Confusion reigns. I hope she can reassure the House that the overall strategy will provide an accurate, evidence-based estimate of the current costs of obesity services to both the NHS and social care. Simon Stevens’ estimate is an alarming current cost of £9 billion a year to the NHS alone. We also want realistic forecasting on the future costs and scale of the epidemic, and on what funding is needed for the services to be able to cope.

Will the Minister acknowledge the importance of making sure that the strategy includes actions to ensure cross-departmental government planning and working, particularly for tackling childhood obesity? Recent figures show that over 28% of children aged two to 15 are obese, and thousands of children are being admitted to hospital because of their weight. We know how difficult it can be to achieve cross-government working, so can the Minister assure the House that the new strategy will address this issue? The Royal College of General Practitioners recently called for a COBRA-style workforce to be set up. Does she agree that this would be an important way of achieving the required joined-up approach that extends beyond the Department of Health?

In the time left, I want to raise two key issues on the strategy. First, looking at all the background information and briefing on obesity, the paucity of data about the extent of obesity among, and its impact on, ethnic-minority communities was particularly striking. NICE has underlined its concern that millions of people from ethnic-minority groups who may be at risk from weight-related diseases are not showing up under current tests. The body mass index test simply does not work for some groups, and NICE has called for BMI fatness thresholds to be lowered to ensure that up to 8 million people of African, Caribbean and Asian descent in the UK are covered in order to help identify those at risk of diabetes and heart disease. Do the Government support that view, and what action are they taking to address this problem? Different ethnic groups are associated with a range of body shapes and different physiological responses to fat storage. In terms of public health action, it is particularly important for south Asian populations in the UK, for example, to be aware of the health risks associated with an increased BMI and waist circumference.

According to Public Health England information, apart from the 2004 Health Survey for England data, there are few nationally representative data on obesity prevalence in adults from ethnic-minority groups in the UK, and data for many smaller ethnic groups are scarce or non-existent. Will the Government ensure that their strategy includes actions to investigate and gather information and data on key ethnic-minority groups so that their needs can be assessed as part of the strategy?

Secondly, do the Government acknowledge and recognise the importance of ensuring that the obesity strategy addresses the key issue of obesity among people with disabilities? Again, there are very limited data on this. People with disabilities are more likely to be obese and to have lower rates of physical activity than the general population, for obvious reasons. Children who have a limiting illness are more likely to be obese or overweight, particularly if they have a learning disability. Being both overweight and underweight are issues for people with learning disabilities. Obesity is associated with the four most prevailing disabling conditions in the UK: arthritis, back pain, mental health disorders and learning disabilities.

UK obesity rates have trebled over the last 30 years; the UK has the highest level of obesity in western Europe, ahead of France, Germany, Spain and Italy; and the alarming prediction is that, on current estimates, more than half our population could be obese by 2050. The scale of the problem makes the need for an ambitious health and social care strategy to address the challenges ever more urgent. I look forward to the noble Baroness’s response.