Diets: Fat
Lord Krebs Excerpts(3 weeks ago)
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Lord Krebs (CB)
My Lords, I declare my interests as recorded in the register, in particular my work with the World Cancer Research Fund and the fact that I am a scientific adviser to Marks & Spencer. Like the noble Lord, Lord Brooke of Alverthorpe, I was a member of the Select Committee which reported last week on diet and obesity. I congratulate the noble Lord, Lord McColl of Dulwich, on securing this debate and his introduction to it.
The idea that eating a diet with plenty of fat suppresses appetite is not new. About 50 years ago, Dr Richard Mackarness published a book entitled Eat Fat and Grow Slim. However, like so many other dietary fashions, this one ran into the sands of evidence. I will mention just one study: a double-blind randomised control trial published in the journal Nutrients in 2018. The participants—older, healthy males—were offered one of three calorie-controlled drink supplements containing different amounts of fat, protein and carbohydrate, or a control drink containing virtually no calories. The results showed that adding fat to the supplements raised levels of the gut hormone cholecystokinin, to which the noble Lord, Lord McColl, referred, but did not suppress energy intake from a subsequent buffet meal with ad libitum food. The evidence does not support the idea that eating more fat suppresses appetite.
The National Diet and Nutrition Survey shows that the population-average intake of fat is close to the recommended guideline of 35% of daily energy intake. However, the intake of saturated fat is above the guideline of 11% of daily energy intake. Saturated fat, in particular animal fat rather than fat from dairy produce, is associated with an increased risk of cardiovascular disease and stroke. Therefore, dietary advice is, correctly, to consume less saturated fat, but not because of its contribution to obesity.
Turning to obesity, I will make three points. First, the best way to tackle the obesity crisis is to prevent people putting on excess weight in the first place. This is most effectively achieved, as the noble Lord, Lord McColl, said, by reducing calorie intake rather than by trying to burn it off with exercise—if you try to burn off the calories from one energy drink, you will find out how tough it is.
Secondly, the dramatic rise in obesity during the past 30 years has been driven largely by the increased availability of cheap, highly palatable, calorie-dense food, known colloquially as “junk food”. The report of the Food, Diet and Obesity Committee published last week recommends a raft of policies to deal with this challenge. The overarching theme is that there should be a switch from the 700 or so failed policies based on individual choice to policies based on regulation of the junk food industry and the junk food environment. Does the Minister agree with that general proposition?
Thirdly, it might be tempting to see effective weight-loss drugs such as Wegovy and Ozempic as a “get out of jail free” card. They will have an important role, but they are not the answer to treating the millions of obese people in this country and a much larger number around the world. At the moment they are very expensive, although it is possible, with many drugs in development, that the price will come down. More importantly, they require a lifelong commitment: it is not just about taking the drug for a few weeks; it is about taking it for ever. Recent data from the United States, where one in eight people has tried a weight-loss drug, show that two out of every three obese people give up taking the drug within a year and then regain the weight they have lost.
The Government have said they want to shift from treatment to prevention as one of the three pillars of reforming the NHS. Can the Minister explain to us in broad terms how she envisages this shift from treatment to prevention being applied to diet and obesity, the second-biggest avoidable risk of ill health? In this context, I want to cite one example and ask the Minister to comment on it. My local sports centre, owned by Oxford City Council and which I visit regularly, has an entrance packed with junk food—sugary drinks, ice creams, doughnuts, the lot. Does the Minister think that that is an appropriate way for a local council to run a fitness centre?
Bread and Flour Regulations 1998
Lord Krebs Excerpts(2 months, 1 week ago)
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Baroness Merron (Lab)
I assure the noble Baroness that that has already happened. As I am sure your Lordships’ House is aware, the proposal is to add 250 micrograms of folic acid per 100 grams of non-wholemeal wheat flour. I emphasise that this fortification would be in addition to the foods that are already voluntarily fortified, such as a wide variety of breakfast cereals, so we are not talking about just bread. The feeling among the experts, to whom we listen, and the committees to which the noble Baroness referred is that this is the right level at which we can provide reassurance, and so this is where we are focusing our efforts.
Lord Krebs (CB)
My Lords, I am delighted to hear that the Minister has confirmed that folate fortification of bread flour will proceed. However, I want to ask her about members of our population who do not eat white bread flour because, for example, they are coeliacs or gluten intolerant, or because they come from ethnic groups who get their main carbohydrate intake from other sources such as rice. In the United States, rice, maize and flour are all fortified with folate and have been since 1998.
Baroness Merron (Lab)
The noble Lord raises an extremely good point. Before we speak about the groups to which the noble Lord referred, I want to point out that fortification will not be enough in any case. We need to continue our encouragement for women to take daily folic acid supplements before conception and in the first 12 weeks of pregnancy, because doing so can prevent up to seven out of 10 cases of neural tube defects—I want to emphasise that. I will take on board the noble Lord’s very important point and ensure that it is part of our considerations.
Children’s Health: Ultra-processed Foods
Lord Krebs Excerpts(1 year ago)
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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”.
Children’s Health: Sugar
Lord Krebs Excerpts(1 year, 2 months ago)
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Lord Markham (Con)
I think one of the things that, hopefully, I have learned in the almost year that I have been answering Questions is when I know the answer to a question and when I do not. I am afraid this is one of the examples of the latter. I will happily look up the Canadian example of the use of whole milk and write to the noble Lord on it.
Lord Krebs (CB)
My Lords, I declare my interests, as recorded in the register. I was very pleased to hear the Minister refer to the soft drinks industry levy, which has been a very successful way of reducing sugar consumption in soft drinks. Therefore, do the Government have plans to extend that levy to other products that contain a lot of sugar? That would be a very effective way of reducing sugar consumption.
Lord Markham (Con)
The noble Lord is correct; that has been a success story. Overall, we have seen a 46% reduction of sugar, while at the same time sales of drinks in that category have gone up by 21%—that is 60%-plus if you combine the two. We are now looking at other moves that can help. The movement of product positioning to remove the so-called “pester power” is a key step forward in this. Of all the modelling that has been done, that is the thing that it is thought will reduce calories by the most—by 96%. That is the current focus; it has been in place for almost a year and early evidence is that it is working, but as ever we must keep everything under review.
Ultra-processed Food
Lord Krebs Excerpts(1 year, 4 months ago)
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Lord Markham (Con)
Absolutely. Some of the foods are not healthy at all, and we totally want to discourage them. We have taken a lot of steps in that space. The whole product positioning strategy, whereby you cannot now put such foods in places where there will be so called pester-power influences, is beginning to have an effect. We are already seeing healthier foods outgrowing non-healthy foods from that. Those sorts of actions were modelled to show that they were effective for 96% of the things that we are trying to target to reduce in terms of calories.
Lord Krebs (CB)
My Lords, I declare my interests as listed in the register and I hate to disagree with my noble friend Lady Boycott but, on this occasion, I do. Does the Minister agree with the conclusions of the nutritional advisory committee of the five Nordic countries, published on 20 June 2023? It says:
“The … committee’s view is that the current categorization of foods as ultra-processed foods does not add to the already existing food classifications and recommendations”.
Does he also agree with the Brazilian scientists who coined the notion of ultra-processed food when they say that their classification is a good way to understand the food system, but not individual foods?
Lord Markham (Con)
Yes, the noble Lord is absolutely correct and makes the point that I have been trying to make but far more eloquently; I thank him. That is precisely the point. Some ultra-processed foods are very unhealthy and we should be doing everything we can to discourage them. Others, such as wholemeal bread or baked beans, are totally fine.
Childhood Obesity
Lord Krebs Excerpts(2 years, 1 month ago)
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Lord Markham (Con)
I thank and agree with my noble friend. He is correct. The cost of obesity to the NHS amounts to around £6.5 billion a year; obviously, this is in addition to not being very good for the people concerned in terms of healthy lifestyles. That is why we have a programme of action, as I outlined. This is something we feel it is important for us to get on with, not just for children but, as the noble Lord referred to, to help adults in this area as well.
Lord Krebs (CB)
My Lords, last year, the Government published a report on the promotion of food. I shall quote a few sentences from it:
“Although promotions appear to be mechanisms to help consumers save money, data shows that they increase consumer spending by encouraging people to buy more than they intended to buy in the first place … The latest data shows that we buy almost 20% more as a direct result of promotions. Consumers typically do not stockpile these extra purchases to take advantage of the lower price, instead they increase their consumption.”
It went on to say that the latest data
“shows that shoppers who buy more of their food and drink on promotion tend to purchase more HFSS”—
high-fat, sugar and salt—
“products, in greater volume, and are more likely to be overweight or living with obesity.”
Does the Minister agree with this analysis, published by his Government last year? If so, what are the Government doing about it in policy terms?
Lord Markham (Con)
I thank the noble Lord. The figures to which he refers are a mixture of the pricing of these so-called “buy one, get one free”-type promotions and their positioning in a supermarket. In fact, the data shows that as much as a 50% increase in sales can be driven by where these promotions are placed in a supermarket. That is why the focus now is on what changes will be made on 1 October to reduce the purchase of a lot of the types of food groups we are talking about by moving them away from prominent areas. Once we see the results of those changes, we will be in a position to review some of the pricing and promotions to which the noble Lord refers.
Food-related Crime
Lord Krebs Excerpts(3 years, 9 months ago)
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Lord Bethell (Con)
I am enormously grateful to the noble Baroness for her support in this matter. I reassure her that we are focused and working on it, and I will bring forward an update as soon as I reasonably can.
Lord Krebs (CB) [V]
My Lords, detecting food crime often depends on trading standards officers and public analysts. Does the Minister consider that the current number of trading standards officers and public analysts is adequate to give the public confidence that food crime is being detected in a timely and comprehensive way? Could he also tell us what progress has been made on detecting honey fraud? It is estimated that about 15% of honey on sale in Europe is adulterated, and it is now over a year since Defra held a seminar on detection methods.
Lord Bethell (Con)
The noble Lord undoubtedly knows that, since January 2021, the FSA has been running a 12-month pilot of the new model of working with local authorities on trading standards in order to improve the work between the FSA and trading standards to address any gaps there may be in that collaboration. On the noble Lord’s question about honey fraud, I completely endorse his shock and outrage that the honey that we buy in the supermarket may be adulterated. It is sometimes said that there is 10 times the amount of manuka honey on sale than could ever be possibly made by the bees of New Zealand. There are challenges on nuclear magnetic resonance spectroscopy allocations, as the noble Lord undoubtedly knows. We are working extremely hard with both Defra and the Laboratory of the Government Chemist to put pressure on international authorities to align the data needed in order to investigate honey more closely.
General Food Law (Amendment etc.) (EU Exit) Regulations 2019
Lord Krebs Excerpts(5 years, 8 months ago)
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Lord Krebs (CB)
I add my congratulations to the noble Baroness on her appointment as the Minister in the Lords for health and social care. I would like to pick up on a point mentioned by the noble Baroness, Lady Walmsley, and to reiterate the point made by the noble Lord, Lord Rooker. I am also a member of the EU Sub-Committee on Energy and the Environment, chaired by the noble Lord, Lord Teverson. We heard evidence this morning from the Minister for Public Health and Primary Care and from Heather Hancock, the chair of the FSA. The point that I want to pin down here is the one concerning risk management because we have heard contradictory statements over the past six to nine months about who is going to be in charge of risk management after Brexit day. What we learned is that at the moment, the arrangement is that EFSA produces the risk assessment, the risk management decisions are taken by the standing committee, on which the UK is represented by the Food Standards Agency—and on only rare occasions are decisions on risk management escalated to the Council of Ministers.
Heather Hancock has proposed, and indeed has set up an equivalent arrangement for post Brexit, so there will be an equivalent of the standing committee in which the FSA on behalf of England, Wales and Northern Ireland, and Food Standards Scotland will make the risk management decisions. That is her proposal. On the other hand, we have been told on numerous occasions that Ministers intend to take risk management decisions in relation to food safety and standards, which of course would take us right back to the old days before the FSA was set up when Ministers got themselves in a tangle when confronted with having to make difficult decisions about risk management and they sometimes got them wrong. I will not go into detail, but we are all aware of the mistakes that were made in the 1990s. I would like to get confirmation from the Minister of what Steve Brine told us this morning; namely, that it is his intention—I do not believe I am putting words into his mouth—that risk management decisions on most issues will be delegated to the Food Standards Agency. I would like confirmation that that is indeed the Government’s position because we have heard contradictory points of view.
That was my main point. My only other point is that I picked up this morning some difficulty over who is in charge in ministerial terms between Defra and the Department of Health and Social Care. I would like confirmation that it is indeed health Ministers who are accountable to Parliament, even if they are not making decisions. The current situation is that the FSA through the standing committee makes the decisions, but health Ministers account for them in Parliament if necessary. They are a kind of conduit from the Food Standards Agency to Parliament. I would like to hear confirmation that that will remain the case after Brexit and that responsibility will not somehow be split between Defra and the Department for Health and Social Care.
Lord Teverson (LD)
My Lords, I will make some brief comments. I too welcome the Minister to her position. I also particularly welcome the noble Lord, Lord Rooker, coming back to the Opposition Front Bench. I remember great times when he was a Defra Minister and the work he did when the climate change Bill went through.
I will raise two points that relate in many ways to what has been said by the noble Lord, Lord Krebs. Although these SIs make technical replacements to make sure that the regulations work, which I accept and understand, subject to my noble friend Lady Walmsley’s question about what has been left out, the whole crux of this comes back to how the structures that enforce and flow from these SIs will work. Is the Minister satisfied that the Food Standards Agency will be sufficiently independent of political influence when it comes to important decisions about consumer safety, food safety and agriculture? At a time of major incidents, decisions taken by Ministers can be very difficult in their effect, in particular on the food processing industry and indeed the agriculture industry.
The other area concerns our meeting with the Minister this morning at the sub-committee. I was very impressed by the chair of the FSA, Heather Hancock, and what she has achieved over time to put all the systems and people in place, but I was not convinced by the liaison between Defra and the Department for health over these negotiations. It seemed that on the question of systems the Minister was not entirely in touch—I do not mean this over-critically—with the negotiations in this area that Defra has undertaken. It is that liaison on which I would like some assurance.
Diesel Emissions
Lord Krebs Excerpts(5 years, 11 months ago)
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Lord O’Shaughnessy
The noble Baroness is quite right: it is one of the biggest public health problems that we face. It is associated with around 30,000 deaths a year, and that gives us a sense of the scale of the problem. I mentioned the clean air strategy but two specific important pieces of research are also taking place. One is called the Exploration of Health and Lungs in the Environment, which is a London-based study looking at the links between pollution and children’s lung health. The Department of Health and Social Care has also commissioned a review of adverse birth outcomes and early-life effects associated with exposure to air pollution. Therefore, we take this problem seriously and are commissioning research to know not only the consequences but what to do about it.
Lord Krebs (CB)
My Lords, it is my understanding that much of the responsibility for delivering the clean air strategy will be delegated to local authorities. Can the Minister confirm that local authorities will be given both the necessary legal powers and the resources to deliver that strategy?
Lord O’Shaughnessy
The noble Lord is quite right that local authorities will have a critical role. The clean air strategy is supported by the Department of Health and Social Care and Public Health England, but it is Defra’s responsibility. I am not able to say any more than that at the moment, but it is clearly a very important strategy being led by the Government, and we will make sure that we support local authorities to do their bit.
Health: Flour Fortification
Lord Krebs Excerpts(10 years, 10 months ago)
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Earl Howe
On my noble friend’s last question, we are slightly jumping ahead of ourselves because we need to decide on the principle before we decide on which types of wheat might be fortified. However, I recognise my noble friend’s main point. Indeed, the Scientific Advisory Committee on Nutrition, in recommending mandatory fortification of flour with folic acid, sought to highlight the benefits of fortification as well as the risks. It was a balanced recommendation. We value it and we will look at the advice very closely indeed.
Lord Krebs (CB)
My Lords, what has the Minister’s department made of its evaluation of folic acid fortification in the many countries that have implemented it, including the United States, as has already been mentioned, Canada and Australia? What has been the balance of risk and benefit in those countries?
Earl Howe
I am aware that we have looked at the experience of other countries, but, as I am sure the noble Lord will accept, we need to take a decision on this that is right for all of our population rather than another country’s population. That is why we want to make the decision evaluating risks and benefits based on the most up-to-date data of the folate status of our own population.