Obesity Strategy 2020

Alex Norris Excerpts

Thursday 27th May 2021 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to open this important debate on behalf of the Opposition.

Obesity is a significant public health challenge in this country. It is a growing problem that compounds down the years in missed potential and accelerated poor health. I am glad the obesity strategy recognises that, as well as being a matter for individuals in their personal choices, there is a significant impact from our environment. As such, we have a responsibility in this place to do what we can to help people to maintain a healthy weight.

Almost two thirds of adults are overweight or living with obesity—I am one of them—and we have heard that a staggering number of our children leave primary school overweight. This is an unequally distributed problem, with hospital admissions due to obesity nearly three times greater in poorer communities than they are in the best-off communities. At a population level, it is clear that excess weight brings with it increased risk of diseases such as diabetes, cancer, heart disease, liver disease and, of course, associated mental health conditions. In 2019-20—this is such as staggering figure—there were over 1 million hospital admissions for which obesity was either the primary or secondary cause. That was up 17% on the year before, and represents a 600% increase on the previous decade. That is an extraordinary changing picture and one that should kick us all into action. We have also seen in the last year that living with excess weight makes us more vulnerable when fighting the effects of covid. As the Minister says, it is one of the risk factors we can actually make a direct and swift impact on. It is clear that we need to act.

I have said before when we have debated this topic that where the Government bring forward sensible proposals, we shall work with them to implement them in the national interest. Happily, the 2020 strategy contains many such proposals that we are very keen indeed to see implemented. The 9 pm watershed on unhealthy food adverts is prudent. Efforts to curb the promotions and prominent placements of things that we know are bad for us is a good idea, too. Sometimes, even when we are trying to make healthy choices it feels like we cannot escape reminders of those other options. An expansion of NHS weight management services is well overdue, and I hope we will empower such services to use all effective treatments and resource them to be able to do so, too. Traffic lighting is a valued and effective tool in understanding what our food comprises of. We will support proposals that strengthen and develop that system, and I hope we hear a little bit more about that later. A national-level publicity campaign is valuable and we will support its introduction. There is so much to agree with and I have consistently said so to the Minister. Indeed, the only addition I will contribute here is that we need to get on with it and that we do not have time to waste. There are elements, however, that I want to probe and seek reassurance on from the Minister.

On the total online advertising ban, I do not think it is a secret that the Government do not do online policy very well. I think the ever-running saga of the online harms Bill shows that. Online advertising is complex and sophisticated and is changing all the time. I am conscious of concerted efforts by those in the advertising industry to seek to offer the Government a way of delivering on this goal that reflects their expertise in this area. I hope to get an assurance from the Minister that officials are at least talking to them about that and taking it seriously.

On the restrictions on retailers, I hope that we will get a proper chance to understand and debate the qualifiers on square footage and staffing levels. I do not think we would want to be in a situation where this ends up affecting relatively few organisations, creating an unlevel playing field or promoting perverse outcomes, such as having fewer staff. I would be interested to hear from the Minister in that regard.

Crucially, we heard from the hon. Member for Bath (Wera Hobhouse) about calories on menus. I know that that has public support, and support from many campaigners, but if we effect that, it really must be done correctly and properly. I strongly do not believe that before they sought to publicise that and press on the Government have given enough consideration to those with eating disorders who will be negatively impacted.

[Richard Fuller]

I am grateful to the hon. Gentleman for cantering through his support for the Government. I just want to take him up on his first principles and the rationale, from his philosophical point of view, for why he believes the Government have a right and a responsibility to manage what people eat and how they look. Does he put obesity on the same level as the tobacco industry of the past? Obviously, health measures were taken because of the harmful effect that tobacco could have on people. If he does not put it on that level, what level does he put it on? Does he put it on the same level as alcohol, which causes a lot of poor health? If not, does he believe that we ought to be doing more on alcohol?

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[Alex Norris]

I thank the hon. Gentleman for that contribution. Philosophically, I believe that the state has a responsibility to act when we acknowledge evidence that we have an environment that promotes poor health in this way, so that it goes beyond our personal choices and the way in which we want to lead our lives to things that swamp us. I reject his characterisation of a hierarchy. I would consider the impact that it has on the public and, indeed, the pressures it creates. As for alcohol, I would absolutely support stronger alcohol strategy proposals from the Government, as I would an updated and refreshed version of the tobacco control plan, which we have been waiting on for many months. Again, I would not establish a hierarchy, but I think we can act in those areas and that we ought to.

The hon. Gentleman recognised the support that I had given so far, but I am afraid that that is now about to change—it is not just because of him, I promise. On calories on menus, we have seen the instrument. The impact assessment is comprehensive—it has five different options, 235 paragraphs, four annexes—yet eating disorders are afforded one mention covering three paragraphs before being discarded in a fourth. I do not think that that is sufficient or that due regard has been paid, and I hope that the Minister will revisit it. Alongside my hon. Friend the Member for Tooting (Dr Allin-Khan), I am seeking to bring together stakeholders who reflect a full range of views on this topic to forge a solution that realises important health benefits for one group but is not injurious to another section of society. I hope that the Minister is still in listening mode on the matter and might seek to do something similar.

That leads me to what I am saddest about with this strategy; the Minister knows about it, because I have raised it with her many times. Rather than having just an obesity strategy, we ought to have a healthy weight strategy. Eating disorders are increasingly common and can blight people for their whole lives, and their lives and voices are missing from the strategy. I have thought about this for a long time—since last July—and I think we can guess why that is: talking about eating disorders inevitably challenges us to talk about mental health services in this country, and of course, the Government are not keen to do that, as it would offer a reckoning of their leadership in this area over the previous decade. Access to high-quality mental health services of all kinds is too rare. People wait too long and the oft-repeated promises about a parity of esteem approach have not led to meaningful action. That gets worse when we talk about child and adolescent mental health services. The evidence is irrefutable that the root of challenging behaviours around food is at that time in life, but, as every right hon. and hon. Member knows, trying to get a young constituent into CAMHS treatment is simply too hard. We are failing a big and growing part of our population by not addressing that, too, so in that sense the strategy has missed a really important opportunity.

I turn to public health. As I say, I am glad that these proposals have been brought forward. It has to be said, though, that they follow a decade of the Government’s cutting services that improve the public’s health. I know that it is a core strategy of the current Administration to act as a new Government and run as far away as possible from their record over the last 11 years—I would want to do that if I were them—but they cannot do so.

The public health grant, even with the recent uplift relating to covid, is nearly a quarter lower in real terms than it was five years ago. I had responsibility for the public health grant in Nottingham for three years prior to entering this place. My experience was that, with the growing pressures for demand-driven services such as drug and alcohol services and sexual health services, added to the consistent cuts to local authorities, there just was not anything left for longer-term services such as those that deal with healthy weight. That has meant a withering of nutrition guidance, shared cooking programmes and specialist support. That has absolutely weakened our approach to taking healthy weight issues head-on in this country. These proposals should have included a commitment to reversing those cuts and, frankly, some humility for having imposed them in the first place. That point needs addressing.

Of course—I will make this my final point—this is an issue about poverty in this country, too. If we eradicated much of the poverty, we would take a lot of the obesity with it. As I said, there is compelling evidence that obesity is much worse in poorer communities. Again, that makes it all the more mystifying that those massive and ongoing cuts to local authorities have been targeted at the poorest communities, especially in the big cities. That is an extraordinary public policy disconnect and, again, it is something that we ought to address in the strategy if we really want an all-services approach, at all levels of government, to taking on this national issue.

This is a very important issue and it is right that the Government are seeking to act. We will support them to move at pace to implement evidence-based, effective interventions, but we will push them, too, to close the gaps in the strategy so that it becomes genuinely transformative. The stakes here are lofty, so our ambitions must be lofty too.

[Mr Deputy Speaker (Mr Nigel Evans)]

We will go, via video link, to Andrew Selous. Andrew, I have some great news for you; we have a bit more wiggle room, so you have four minutes.

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[Alex Norris]

With the leave of the House, I shall respond to the debate. The funny thing about opening and closing this debate for the Opposition is that I have already posed 10-minutes’ worth of questions to the Minister and now I am back for another round. I do want to hear the answers to my questions and to the many good questions posed by Members from all parties, so I shall not speak for long. I am not sure whether that is a kindness to the Minister, but we are keen to hear the answers.

I want to reflect on some of the contributions, because it has been a really great debate. I hope that the people watching—there is a lot of interest in this subject—will have seen the quality of the discussions. There have of course been differences of view, but that is a good thing, and I hope people will have seen the House at its best this afternoon.

I have worked a lot with the hon. Member for South West Bedfordshire (Andrew Selous) on modern slavery, and he always works with such compassion. The tone that he set on having a non-stigmatising debate was a very good one. The hon. Member for Strangford (Jim Shannon) picked up that theme too and I think we have managed to have such a debate. It is important that we continue that.

My hon. Friend the Member for Liverpool, Walton (Dan Carden) made some points on alcohol labelling, following his recent debate on the subject. It would be helpful to hear clearly from the Minister that the briefing that such labelling was to be dropped is wrong. I think that is what we heard from her, but it would be helpful is she was very clear that that briefing is inaccurate. Will she pick up on the idea of having a national alcohol strategy and say how she feels about bringing together some of the existing strategies to attack many of the commonalities—for example, in relation to mental health services?

I spoke about mental health services earlier, as did others, including my hon. Friend the Member for Sheffield Central (Paul Blomfield), whose points about treatment services for children were very well made. After a decade of real famine in this police area and the continued failures in CAMHS, there is a commitment in the strategy on investment in healthy-weight services; I am keen to hear from the Minister some extra detail about what form that is going to take. If she does not have those details today, will she say when we are going to start to hear some and when we will have a chance to debate what form that is going to take? My hon. Friend the Member for Sheffield, Hallam (Olivia Blake) and the hon. Member for Bath (Wera Hobhouse) picked up on a point I raised in my opening remarks about eating disorders and they strongly displayed just how people feel, certainly those who are working and active in supporting people with eating orders. We are very lucky to have those people still making that case after such a challenging year for their support services. I hope the Minister has heard that, because I strongly believe that the impact assessment does not pay prominent enough regard to it. I hope she will confirm that she is still in listening mode and perhaps give us a date for when we can hear about and debate that secondary legislation, now that it has been published. I hope she will use this time to seek to meet some of those concerns.

Let me turn to contributions from Conservative Members. I was struck by the one from the right hon. Member for Vale of Glamorgan (Alun Cairns) on knowledge and skills, because the cruelty in all this is that scratch cooking is not only better for us, but cheaper. It is one of the few things where doing the right thing really rewards us. If my wife was watching this—let’s face it, she’s not—she would roll her eyes and say, “It tastes better if you do it right.” She has tasted my cooking and scrutinised my app-based ordering late at night, so she might say that I am in danger of a bit of hypocrisy there, but nevertheless it is true that scratch cooking is cheaper and healthier.

The hon. Members for Keighley (Robbie Moore) and for Sleaford and North Hykeham (Dr Johnson) picked up on the idea of education programmes. Whether or not we characterise them, as he did, as a recommitment to home economics, these sorts of programmes are effective. It is not making a particularly aggressively partisan point to say that a decade of cutting the public health grant has meant that, in essence, these services have disappeared across the country, but they did exist and can do so again. I hope that we will see a reinstatement of them, and I do not think it is nannying to do that. When this is done intergenerationally as well, it can have a great social benefit. The evidence behind it was good, and I would love to see a report on it.

The point made by the hon. Member for Stoke-on-Trent Central (Jo Gideon) about public opinion was very important, as that issue has not been covered much. There has been a lot of talk about personal choice, to which I will turn shortly, but the public are ahead of us on this. On the vast majority of the interventions, even the ones I am most sceptical about, the public are more bullish than I am, so it is important that we do not lose that from the debate.

We heard contributions from the hon. Members for Woking (Mr Lord) and for Warrington South (Andy Carter) about the ad ban, which is not a silver bullet, as the Minister has said, although it is impactful. I might argue that the vigour with which those who oppose it say it is a bad idea shows why it might be a good one. Nevertheless, I hope the Minister will again demonstrate that she is in listening mode. When the industry comes together with proposals that meet the Government’s stated aims, I hope they will be given a fair hearing—that is entirely reasonable.

The right hon. Member for Forest of Dean (Mr Harper) made very good points about reformulation, which is the big goal here; whatever we do with menus, what we have seen from the sugar tax is that once firms really put their shoulder to the wheel on this, we can do some incredible things. The progress made in the past decade or so, certainly in the soft drinks industry on reformulation, is a really good sign. I did not quite agree with the point he made on demonising products, as I do not think that that is the purpose. For me, the goal here should be informed choice, which all Members have talked about, and our knowing what is in those products. I do not think manufacturers would fear that, and they should not either. The point about informed choice was also raised by the hon. Member for Buckingham (Greg Smith), who talked about “overreaching”. I would think the proposal we are talking about is quite modest; there are no bans in here, certainly not of products—it is just about ensuring clarity of what is in them, and we should do that.

I want to come to the point about free choice, as it was made by many Members, including the hon. Members for Northampton South (Andrew Lewer) and for North East Bedfordshire (Richard Fuller). If this is genuinely a matter of free choice—this is the thing I just cannot get past on this issue—why does obesity happen disproportionately on the same streets and estates, year after year, generation after generation, even though the people in those houses change? If this was purely a matter of free choice it would not happen that way and would be much more evenly distributed across the country, but all the evidence tells us that that is not the case, so I cannot quite accept that point, I am afraid.

I was not going to do this, but I thought the hon. Member for North East Bedfordshire was a bit unkind to me by suggesting I had offered “breathless” support to the Government. I might have been breathless but was trying to get a lot in and wanted colleagues to have a chance to contribute too, and I think there was balance in what I said. I know the hon. Gentleman now differentiates what is being proposed today from the sugar tax, but I remember even though I was not a Member at the time that he was very publicly and prominently against the sugar tax, saying it would not work. I do not think that has been borne out by the facts since then, and I gently say I think he is wrong again in the same way today.

I have now given a quick canter around all the contributions, which were very good, even the ones that perhaps I would not agree with and that were made by Members who might not have agreed with my contribution. We have got the strategy—we have had it since July—and what I want to hear from the Minister now is a real emphasis on delivery and implementation and on recognising the concerns raised by Members and those outside this place, and a real sense of how we will work together to implement it. As I have said, where that is done in an evidence-based way, we will be supportive, because this is a very big prize indeed.