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 - Parliamentary Under-Secretary (Department of Health and Social Care)
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 - Parliamentary Under-Secretary (Department of Health and Social Care)
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 - Parliamentary Under-Secretary (Department of Health and Social Care)
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 - Parliamentary Under-Secretary (Department of Health and Social Care)
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 - Parliamentary Under-Secretary (Department of Health and Social Care)
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 - Parliamentary Under-Secretary (Department of Health and Social Care)
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 - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they intend to promote personal calorie control as one of the main mechanisms for preventing obesity.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Lord McColl of Dulwich (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they have plans to collect data on the causes of obesity; and if so, when this will start.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
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 address low wholegrain intakes in England.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Currently in the United Kingdom, there is no agreed definition for wholegrain or wholegrain foods. Therefore, wholegrain consumption cannot be monitored in the National Diet and Nutrition Survey. At its horizon scan meeting in June 2022 the Scientific Advisory Committee on Nutrition (SACN) agreed that it would be useful to consider a definition for wholegrain and added it to its future work programme due to start Summer 2023.
SACN’s Carbohydrates and Health report published in 2015 provides strong evidence on dietary fibre and positive health outcomes, but for wholegrains and health outcomes the evidence was mixed and SACN has questioned whether any beneficial effect from wholegrain may be due to the fibre content. Fibre is found in a range of foods and is not exclusive to wholegrain foods. Based on SACN’s findings, Government recommends that adults consume 30 grams of dietary fibre each day and that this should be achieved through a variety of food sources.
Government dietary advice, as depicted by the UK’s national food model, the Eatwell Guide, is that we should choose wholegrain or higher fibre versions of starchy carbohydrates wherever possible. This advice aims to increase population intakes of fibre. This is because in the UK, there is no quantitative recommendation for dietary wholegrain consumption, whereas there is a specific Government recommendation for dietary fibre consumption. The Government continues to promote the Eatwell Guide principles through a variety of channels, including the NHS.UK website and our social marketing campaigns, Better Health and Healthier Families.
There are no current plans to introduce a public and private sector partnership aimed at increasing the consumption of wholegrain foods.
Authorised nutrition and health claims related to fibre can be used by food business operators on food products, pursuant to retained Regulation (EC) No 1924/2006, as amended by the Nutrition (Amendment etc.) (EU Exit) Regulations 2019 and the Nutrition (Amendment etc.) (EU Exit) Regulations 2020.
All authorised and rejected nutrition and health claims are included in the Great Britain Nutrition and Health Claims Register (GB NHC Register), other than those health claims authorised on the basis of proprietary data which will be recorded in a separate Annex to the GB NHC Register. The GB NHC Register, and the separate Annex, are available in an online only format.