Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the written answer by Lord Markham of 17 May (HL4521), whether the recommended limit of 30g a day of fat contained in the Eatwell Guide is also based on the Committee on Medical Aspects of Nutrition Policy (COMA) 1994 report, and if so whether the guidance should be updated in the light of further, more up-to-date research.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government’s dietary recommendations are based on robust assessments of the scientific evidence by the Scientific Advisory Committee on Nutrition (SACN) and its predecessor, the Committee on Medical Aspects of Nutrition Policy (COMA). The Government’s advice on a healthy, balanced diet is encapsulated in the United Kingdom’s national food model, the Eatwell Guide.
The current Government dietary recommendation is that the total fat intake of the population should not exceed 35% of total energy from food. This would equate to a total fat intake of no more than 78 grams a day for women and 97 grams a day for men, based on a total daily calorie intake of 2000 kilocalories a day for women and 2500 kilocalories a day for men aged 19 to 64 years old.
This recommendation is based on evidence outlined by the COMA in its 1991 report, Dietary Reference Values for Food Energy and Nutrients for the United Kingdom, a copy of which has been placed in the House of Lords Library, due to the document size. This is further supported by recommendations made to reduce the risk of coronary heart disease in the COMA’s 1994 report, Nutritional Aspects of Cardiovascular Disease, a copy of has also been placed in the House of Lords Library, due to the size of the document.
Recommendations on saturated fat were updated in SACN’s 2019 report, Saturated fats and health, a copy of which is attached, which recommended that the dietary reference value for saturated fats remains unchanged, specifically that the populations average contribution of saturated fatty acids to total dietary energy be reduced to no more than about 10%. This recommendation applies to adults and children aged five years old and older. The report also recommended that saturated fats are substituted with unsaturated fats. It was noted that more evidence is available supporting substitution with polyunsaturated fats than substitution with monounsaturated fats.
It was noted that ‘this recommendation is made in the context of existing UK Government recommendations for macronutrients and energy’. The Eatwell Guide recommends that the average man should have no more than 30 grams of saturated fat a day and the average woman should have no more than 20 grams of saturated fat a day.
At its horizon scan meeting in June 2022, the SACN considered a paper on a potential approach to any future work on other fatty acids. The SACN agreed that omega-3 fatty acids were an area of high priority, particularly because of the recent evidence questioning the potential benefits of fish oils for some outcomes, such as cardiovascular disease. Members agreed to keep a review of omega-3 fatty acids as a high priority on the watching brief.
The SACN considered this again at its horizon scan meeting on 9 October 2024 and agreed to add omega-3 fatty acids to the SACN’s work programme when capacity allows. The meeting papers for the horizon scan meetings are available on the SACN webpage, in an online only format.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what current guidance they have issued about the maximum recommended dietary intake of (1) saturated, and (2) unsaturated, fat per day; and on the basis of what scientific evidence they made such a recommendation.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Government encourages everyone to have a healthy balanced diet in line with the United Kingdom’s healthy eating model, The Eatwell Guide, which shows that foods high in saturated fat, salt, or sugar should be eaten less often, or in small amounts. The Government’s dietary guidelines are based on recommendations from the Scientific Advisory Committee on Nutrition (SACN) and its predecessor, the Committee on Medical Aspects of Nutrition Policy (COMA), and based on comprehensive assessments of the evidence.
In its 1994 report, Nutritional aspects of cardiovascular disease, the COMA recommended a reduction in the average contribution of total fat to dietary energy in the population to approximately 35%, and that trans fats should provide no more than approximately 2% of dietary energy. In relation to unsaturated fatty acids, the COMA concluded that: monounsaturated fatty acids (MUFA) had no specific recommendation; for n-6 polyunsaturated fatty acids (PUFA), there should be no further increase in average intakes, and the proportion of the population consuming in excess of about 10% energy should not increase; linolenic acid provided at least 1% of total energy; and alpha linolenic acid provided at least 0.2% total energy. The report also included recommendations on saturated fats, which were updated by the SACN in 2019.
A joint SACN and Committee on Toxicity report, Advice on fish consumption: benefits and risks published in 2004, endorsed the recommendation that the population, including pregnant women, should eat at least two portions of fish per week, one of which should be oily. Two portions of fish per week, one white and one oily, contains approximately 0.45 grams per day of long chain n-3 PUFA. This recommendation represented an increase in the population’s average consumption of long chain n-3 PUFA, from approximately 0.2 grams to approximately 0.45 grams per day.
The SACN’s 2019 report on saturated fats and health recommended: the dietary reference value for saturated fats remains unchanged, and the population’s average contribution of saturated fatty acids to total dietary energy be reduced to no more than approximately 10%, which also applies to adults and children aged five years and older; and that saturated fats are substituted with unsaturated fats, as it was noted that more evidence is available supporting substitution with PUFA than substitution with MUFA.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what is the total cost of treating patients who are obese and overweight; and what are the associated costs of treating (1) type 2 diabetes, (2) cardiovascular disease, (3) cerebrovascular disease, (4) musculoskeletal diseases including joint replacers, (5) cancer, and (6) dementia.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The department has reviewed and uses cost estimates published by Frontier Economics in 2022.
A study by Frontier Economics estimated that in 2021 obesity related ill-health cost the National Health Service £6.5 billion annually. This estimate includes costs associated with the following obesity related diseases: colorectal cancer; oesophageal cancer; kidney cancer; ovarian cancer; pancreatic cancer; coronary heart disease; stroke; type 2 diabetes; hypertension; knee osteoarthritis; endometrial cancer, and breast cancer.
The disease costs associated with obesity are calculated from the total annual costs per case, as shown in the following table:
Disease | Cost per case per year (2021) |
(1) Type 2 diabetes | £ 827.33 |
(2) Cardiovascular disease - Coronary heart disease (CHD) | £ 1,557.25 |
(2) Cardiovascular disease - Stroke | £ 247.55 |
(2) Risk of Cardiovascular disease - Hypertension | £ 453.91 |
(4) Musculoskeletal disease - Knee Osteoarthritis | £ 27,798.40 |
(5) Cancer - Colorectal cancer | £ 520.13 |
(5) Cancer - Oesophageal cancer | £ 545.06 |
(5) Cancer - Kidney cancer | £ 1,662.88 |
(5) Cancer - Ovarian cancer | £ 14,990.93 |
(5) Cancer - Pancreatic cancer | £ 7,447.27 |
(5) Cancer - Endometrial cancer | £ 520.13 |
(5) Cancer - Breast cancer | £ 545.06 |
The annual costs per case includes direct health-care costs including hospital care (both inpatient and outpatient), primary care, and medication, and they are not exclusively related to obesity associated cases. Indirect and social care costs are not included, which means the exclusion of these costs will probably underestimate total costs of disease events overall.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 17 February (HL5559), whether individuals who do not have (1) a BMI of less than 18.5 kilograms/m2, (2) unintentional weight loss greater than 10 per cent within the last three to six months, or (3) a BMI of less than 20 kilograms/m2 and unintentional weight loss greater than five per cent within the last three to six months, are therefore not defined as malnourished or undernourished; and whether there are any other scientific measurements or criteria that would justify obese individuals not being defined as malnourished or undernourished.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
There is no agreed scientific nor universal definition of overnutrition, however the National Health Service refers to overnutrition as getting more nutrients than needed. Excess intake of macronutrients will mean an excess intake of energy, leading to weight gain and obesity. Excess intake of individual micronutrients may be associated with specific adverse health outcomes depending on the vitamin or mineral. Population prevalence of obesity is monitored by the Health Survey for England and data on population average energy and nutrient intakes are collected by the National Diet and Nutrition Survey. However, at an individual level, healthcare professionals may assess and monitor a patient’s weight and/or nutritional status depending on clinical need.
Although there is no formal assessment of malnutrition at a population-level, NHS Digital collects data on finished hospital admission episodes of malnutrition in England, based on International Classification of Disease (ICD-10) codes. The cause of malnutrition is not presented in the Hospital Episode Statistics.
The criteria referred to are from the National Institute for Health and Care Excellence (NICE) clinical guidelines CG32 ‘Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ and are recommended as indications for when nutrition support should be considered. This NICE guideline also states that nutrition support should be considered in people at risk of malnutrition, defined as those who have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer; a poor absorptive capacity and/or high nutrient losses; and/or increased nutritional needs from causes such as catabolism. Healthcare professionals might use other screening or assessment tools, or their own clinical judgement regarding additional signs and symptoms, to assess whether someone is at risk of malnutrition.
In the NICE guideline CG32, the term malnutrition is not used to cover excess nutrient provision (overnutrition). However, someone can be a healthy weight or have a body mass index in the overweight or obese categories but be identified through the NICE definition as potentially requiring nutrition support. Hospital Episode Statistics (HES) are also reported for scurvy and rickets, conditions which result from nutrient deficiencies, but these are reported separately to the HES for malnutrition.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 17 February (HL5559), how many people in England are deemed to be malnourished; and what proportion of those are caused by (1) undernutrition, and (2) overnutrition.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
There is no agreed scientific nor universal definition of overnutrition, however the National Health Service refers to overnutrition as getting more nutrients than needed. Excess intake of macronutrients will mean an excess intake of energy, leading to weight gain and obesity. Excess intake of individual micronutrients may be associated with specific adverse health outcomes depending on the vitamin or mineral. Population prevalence of obesity is monitored by the Health Survey for England and data on population average energy and nutrient intakes are collected by the National Diet and Nutrition Survey. However, at an individual level, healthcare professionals may assess and monitor a patient’s weight and/or nutritional status depending on clinical need.
Although there is no formal assessment of malnutrition at a population-level, NHS Digital collects data on finished hospital admission episodes of malnutrition in England, based on International Classification of Disease (ICD-10) codes. The cause of malnutrition is not presented in the Hospital Episode Statistics.
The criteria referred to are from the National Institute for Health and Care Excellence (NICE) clinical guidelines CG32 ‘Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ and are recommended as indications for when nutrition support should be considered. This NICE guideline also states that nutrition support should be considered in people at risk of malnutrition, defined as those who have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer; a poor absorptive capacity and/or high nutrient losses; and/or increased nutritional needs from causes such as catabolism. Healthcare professionals might use other screening or assessment tools, or their own clinical judgement regarding additional signs and symptoms, to assess whether someone is at risk of malnutrition.
In the NICE guideline CG32, the term malnutrition is not used to cover excess nutrient provision (overnutrition). However, someone can be a healthy weight or have a body mass index in the overweight or obese categories but be identified through the NICE definition as potentially requiring nutrition support. Hospital Episode Statistics (HES) are also reported for scurvy and rickets, conditions which result from nutrient deficiencies, but these are reported separately to the HES for malnutrition.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 17 February (HL5559), what is the scientific definition of overnutrition; and how this is measured and monitored in obese individuals.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
There is no agreed scientific nor universal definition of overnutrition, however the National Health Service refers to overnutrition as getting more nutrients than needed. Excess intake of macronutrients will mean an excess intake of energy, leading to weight gain and obesity. Excess intake of individual micronutrients may be associated with specific adverse health outcomes depending on the vitamin or mineral. Population prevalence of obesity is monitored by the Health Survey for England and data on population average energy and nutrient intakes are collected by the National Diet and Nutrition Survey. However, at an individual level, healthcare professionals may assess and monitor a patient’s weight and/or nutritional status depending on clinical need.
Although there is no formal assessment of malnutrition at a population-level, NHS Digital collects data on finished hospital admission episodes of malnutrition in England, based on International Classification of Disease (ICD-10) codes. The cause of malnutrition is not presented in the Hospital Episode Statistics.
The criteria referred to are from the National Institute for Health and Care Excellence (NICE) clinical guidelines CG32 ‘Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ and are recommended as indications for when nutrition support should be considered. This NICE guideline also states that nutrition support should be considered in people at risk of malnutrition, defined as those who have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer; a poor absorptive capacity and/or high nutrient losses; and/or increased nutritional needs from causes such as catabolism. Healthcare professionals might use other screening or assessment tools, or their own clinical judgement regarding additional signs and symptoms, to assess whether someone is at risk of malnutrition.
In the NICE guideline CG32, the term malnutrition is not used to cover excess nutrient provision (overnutrition). However, someone can be a healthy weight or have a body mass index in the overweight or obese categories but be identified through the NICE definition as potentially requiring nutrition support. Hospital Episode Statistics (HES) are also reported for scurvy and rickets, conditions which result from nutrient deficiencies, but these are reported separately to the HES for malnutrition.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to ensure equity in the provision of glaucoma care (1) across the country, and (2) in different health settings.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Government recognises that innovation is crucial to drive improvements in clinical care and improved outcomes for people living with sight-threatening conditions. Integrated care boards (ICBs) are responsible for commissioning services to meet local needs. In making commissioning decisions, we would expect ICBs to take into account the National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of glaucoma which NICE keeps under review, to ensure that it reflects developments in medical technology and clinical practice.
The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England, and this includes independent sector providers. CQC monitors, inspects and regulates services and publish what it finds. Where CQC finds poor care, it can use its enforcement powers to take action. This sits alongside guidance issued by NICE for the treatment of glaucoma and any professional standards issued by the Royal College of Ophthalmologists, which we would expect National Health Service commissioners to have regard to when commissioning services from the independent sector.
NHS England’s Getting It Right First Time Programme is also working with providers across the country to reduce unwarranted variation in care across a range of eyecare subspecialties, including glaucoma.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to improve glaucoma care in independent sector treatment centres.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Government recognises that innovation is crucial to drive improvements in clinical care and improved outcomes for people living with sight-threatening conditions. Integrated care boards (ICBs) are responsible for commissioning services to meet local needs. In making commissioning decisions, we would expect ICBs to take into account the National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of glaucoma which NICE keeps under review, to ensure that it reflects developments in medical technology and clinical practice.
The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England, and this includes independent sector providers. CQC monitors, inspects and regulates services and publish what it finds. Where CQC finds poor care, it can use its enforcement powers to take action. This sits alongside guidance issued by NICE for the treatment of glaucoma and any professional standards issued by the Royal College of Ophthalmologists, which we would expect National Health Service commissioners to have regard to when commissioning services from the independent sector.
NHS England’s Getting It Right First Time Programme is also working with providers across the country to reduce unwarranted variation in care across a range of eyecare subspecialties, including glaucoma.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to increase the use of innovative medical technology in the treatment of glaucoma.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Government recognises that innovation is crucial to drive improvements in clinical care and improved outcomes for people living with sight-threatening conditions. Integrated care boards (ICBs) are responsible for commissioning services to meet local needs. In making commissioning decisions, we would expect ICBs to take into account the National Institute for Health and Care Excellence (NICE) guideline on the diagnosis and management of glaucoma which NICE keeps under review, to ensure that it reflects developments in medical technology and clinical practice.
The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England, and this includes independent sector providers. CQC monitors, inspects and regulates services and publish what it finds. Where CQC finds poor care, it can use its enforcement powers to take action. This sits alongside guidance issued by NICE for the treatment of glaucoma and any professional standards issued by the Royal College of Ophthalmologists, which we would expect National Health Service commissioners to have regard to when commissioning services from the independent sector.
NHS England’s Getting It Right First Time Programme is also working with providers across the country to reduce unwarranted variation in care across a range of eyecare subspecialties, including glaucoma.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the causes of obesity; in particular, (1) food addiction, (2) genetics, and (3) other factors.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
Obesity is a complex problem, and the causes are multi-factorial, including biological; physiological; psycho-social; behavioural; and environmental factors. There are no plans to collect data on the causes of obesity and no specific assessment has been made on the causes of obesity.
Government advice on a healthy, balanced diet is encapsulated in the United Kingdom’s national food model, the Eatwell Guide. The Eatwell Guide shows the proportions in which different types of foods should be consumed to have a healthy balanced diet, including average calorie intakes for men and women. The Eatwell Guide principles are communicated through a variety of channels, including the National Health Service website, Government social marketing campaigns, and guidance on healthier catering. For example, the Better Health campaign encourages adults to introduce changes that will help them work towards a healthier weight, including guidance on healthier food choices, calorie intake and portion control.