Health: Obesity
Lord Rennard Excerpts(2 weeks, 2 days ago)
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Lord Rennard (LD)
My Lords, does the Minister agree that one of the major problems with tackling obesity in the UK is that we are second only to the United States in our consumption of ultra-processed foods? While the steps she announced are welcome, do we not need further measures, such as providing free, healthy, nutritious school meals as an alternative to the unhealthy fast food shops close to many schools?
Baroness Merron (Lab)
I certainly agree with the noble Lord about the need for favourable alternatives, and to educate people, particularly at a young age, about what healthy eating can look like, but it is also important to create the right environment and circumstances, and not everybody has that to hand. The provision of free school meals in the way the noble Lord referred to is of course a matter for local government to decide. I can say that the Scientific Advisory Committee on Nutrition has reviewed the evidence about ultra-processed foods and believes that further research is needed, which we have commissioned. Importantly, the committee has added UPFs to its watching brief and many are covered by existing legislation, because there are regulations on foods high in fat, salt and sugar which are applicable to ultra-processed foods.
Fracture Liaison Services
Lord Rennard Excerpts(1 month, 2 weeks ago)
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Lord Rennard (LD)
My Lords, it is a great pleasure to take part in a debate in which there is such strong consensus. The noble Lord, Lord Black of Brentwood, is again to be congratulated on raising this vital issue of fracture liaison services and asking the new Government about progress towards achieving the previous Government’s target of 100% coverage by 2030. In 2021 we were given the figure of 51%—or 63 out of 123—NHS trusts across England having fracture liaison services. There is now 100% coverage in Scotland, Wales and Northern Ireland, so it is disappointing if the figure is still the same 51% for England.
We have heard how osteoporosis affects 3.5 million people in the UK, causing more than half a million fractures each year, and that, according to the Royal Osteoporosis Society, two-thirds of the people who need treatment are missing out, leaving them vulnerable to further life-altering fractures—and we have heard how women are disproportionately affected. Both the Sunday Express and the Mail on Sunday have been mentioned for partnering with the Royal Osteoporosis Society to campaign for an end to the postcode lottery that leaves so many people without fracture liaison clinics.
The new Government have promised to roll out a plan to ensure that every part of the country has access to FLS. All the main parties in the general election promised this, but we have heard tonight that investment needs to be made now if the Government are to achieve the target by 2030.
We have heard how the Royal Osteoporosis Society has estimated that just a £30 million investment in fracture liaison services could prevent 74,000 fractures, including 31,000 hip fractures, over five years—but, we are all asking, will this expenditure take place and will it be soon? The issue of providing universal cover for fracture liaison clinics may not create such big headlines as those about cancer treatments or accident and emergency waiting times, but, as we have heard, the issue affects so very many people. The political will really must be there if we are to address the need to reduce the number of hip and other fractures.
I have always advised people that whichever party wins an election, the Treasury stays in power, and that the Treasury often adopts a very short-term approach demanding a rapid return on any investment. This approach needs to change across the health and care sector if we really want to move towards more prevention and needing less cure. As the noble Baroness, Lady Bull, said, fracture liaison services provide a relatively rapid return on that investment.
There are still considerable challenges. The clinical workload of those expected to undertake roles within the services is immense. Rheumatology services were hit enormously by Covid and years of underinvestment. We can work with multidisciplinary teams and new technologies such as AI in order to streamline care, improve efficiency and help clinicians to manage growing demand, achieving economies of scale, but technology alone is not the answer; we also need meaningful investment in preventive services.
Type 2 Diabetes: Continuous Glucose Monitors
Lord Rennard Excerpts(2 months ago)
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Lord Rennard
To ask His Majesty’s Government how they intend to monitor access to continuous glucose monitors for people with type 2 diabetes; and how such monitoring will take account of any inequalities based on deprivation and ethnicity.
Baroness Merron (Lab)
I could get used to that reception, but I am not sure that I will get used to three Questions and a repeat UQ. However, I thank your Lordships’ House.
More than 200,000 eligible people living with diabetes currently benefit from real-time CGM, or continuous glucose monitoring. CGM data-reporting systems are being developed to aid the delivery of rollout by integrated care boards. Alongside this, the data is collected as part of the national diabetes audit. From 2025-26, NHS England plans to publish that data routinely on the audit’s quarterly dashboard, which will provide the insights that ICBs need, including data on CGM uptake, variation and health inequalities.
Lord Rennard (LD)
Many more people with type 2 diabetes could benefit from this technology. People living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes, are less likely to receive essential diabetes care and experience worse health outcomes. However, according to Diabetes UK, only 24 of 42 integrated care boards in England have a policy for continuous glucose monitoring for people with type 2 diabetes that is in line with guidance from NICE. How will the Government ensure equal access to such monitors for people with type 2 diabetes?
Baroness Merron (Lab)
The noble Lord makes a very fair observation. Work is going on in a wider equality monitoring programme exploring how to keep an eye on equality repercussions, including ethnicity, by reference to protected characteristics in the Equality Act 2010. Importantly to the point he raised, the review includes consideration of how NHS ethnic group categories can be updated. The outcome of the review—this is the point I really want to emphasise—will ultimately guide a process of reducing inequalities, but I accept his challenge and his point.
Diets: Fat
Lord Rennard Excerpts(2 months, 3 weeks ago)
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Lord Rennard (LD)
My Lords, I am a type 2 diabetic. I overcome some embarrassment about my weight to say that I have lost more than 30 kilos over the past 30 years. More importantly, I have kept it off.
Self-evidently, however, I need to lose more weight. My diabetic control has been very difficult and required major lifestyle changes, but they were not enough. So, in the past four months, I have been assisted in improving my diabetic control and reducing my weight by a further few kilograms with the help of Mounjaro, a drug from Eli Lilly. Since being diagnosed with diabetes in 1994, I have always had great support from St Thomas’ Hospital. It advised me a few years ago that a typical type 2 diabetic like me, in their 50s and 60s, can be expected to put on an average of between one and two kilos every year. Over a decade or two, that gain of between 20 and 40 kilograms is likely to have catastrophic health consequences requiring significant and costly medical intervention.
For many people struggling with their weight and diabetic control, these new injections give great hope, but we should not see any of the different injections becoming available as a silver bullet to achieve weight loss. We should recognise first that they are helpful in improving diabetic control, which can be very difficult, as your pancreas becomes less and less effective at producing insulin and your sugar levels rise. The associated weight loss with these drugs is also helpful, but such treatment is far from appropriate as a first resort and some people struggle with unpleasant side-effects from them.
However, we should never accept an approach towards obesity or diabetic control which says little more than, “Pull your socks up, make yourself eat much less, but eat more fat”. This approach will lead only to the obesity crisis in many of the more affluent countries becoming even greater. It will result in great damage to the health of their populations, their health systems and their economies. The Atkins diet is now widely discredited after the demise of the author of the books on it.
The British Dietetic Association says that fat plays an important part in our diet and that people need a small amount of it. But it has warned against a high intake of saturated fats, which are often found in processed foods and associated with weight gain, making diabetic control harder, causing joint problems and some cancers.
The questions for us to discuss should be about how to take strong steps to help prevent people becoming obese in the first place and how to help them achieve and maintain healthier lifestyles, manage their diets better, and adopt healthier lifestyles, including regular exercise.
As the excellent report from the Select Committee on Food, Diet and Obesity, chaired by my noble friend Lady Walmsley, suggested last week, we need a broad range of measures to tackle the obesity crisis. I would begin with healthy, nutritious, and free school meals and stopping the proliferation of fried chicken and burger shops in close proximity to schools. We need, as the Select Committee says, to reduce the prevalence of marketing and advertising of unhealthy ultra-processed foods, especially to children. We need also to promote health education and physical activity in schools and after school.
Poverty must also be recognised as a significant factor in many people having unhealthy diets and suffering from health inequalities. Poor parents struggle to provide healthy diets for their families. Healthier foods are more than twice as expensive per calorie as less healthy foods. One of the most important poverty-relieving measures would be to scrap the two-child limit for universal credit or tax credits. I am disappointed that this was not in yesterday’s Budget.
In conclusion, we need to follow medical advice and look at evidence over time about the use of injections assisting diabetic control and weight loss. We cannot simply let people think that they can just resort to expensive weekly injections provided by the state. But nor can the state ignore the tremendous costs of obesity and diabetes.