Obesity: Covid-19

Andrew Selous Excerpts

Tuesday 10th November 2020 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

Unbelievable.

[Jim Shannon]

I was having Chinese takeaway five nights a week with two bottles of Coke. It was not the way to live life, but I had a very sweet tooth.

Until about a year before I realised I was a diabetic I did not know the symptoms. My vision was a wee bit blurred and I was drinking lots of liquids—two signs that should tell you right away that something is not right. I took a drastic decision to reduce weight and lost some 4 stone, which I have managed to keep off.

We need to look at our diet and our lifestyle. We all live under stress, and we all need a bit of stress because it keeps us sharp, but there is a point where we draw the line. I recall the day I went to the doctor and he told me, “We are going to put you on a wee blood pressure tablet.” I said: “If that is what you think, doctor, I will do what you say.” He added: “When you start it, you have to keep at it. You cannot take a blood pressure tablet today and then not take it next week, because your system will go askew.”

Obesity leads to high blood pressure and some types of cancer and is strongly associated with mental health and wellbeing, which is so important in the current crisis. There are strong links between the prevalence of obesity and social and economic deprivation. People living with obesity face extraordinary levels of stigma and abuse. We need to be careful and to be cognisant of other people’s circumstances, because they might have a genetic imbalance, which I will speak about later.

The outbreak of covid-19 makes the obesity epidemic more urgent. It is deeply concerning that obesity is a risk factor for hospitalisation, admission to intensive care and death from covid-19. The facts are real. People with a body mass index of 35 to 40 are 40% more likely to die from covid-19 than those of a healthy weight. In people with a BMI of 40-plus, it rises to 90%. That places the UK population in a very vulnerable position.

In the latest report from the Intensive Care National Audit and Research Centre, which audits intensive care units in England, Wales and Northern Ireland, almost half—47%—of patients in critical care with covid-19 since 1 September had a BMI of 30 or more. In other words, they were classified as obese. Those figures show that almost half the people in critical care had a lifestyle that they needed to address. That figure compares with the 29% of the adult population in England who have a BMI of 30 or more. People with obesity are much more likely to be admitted to critical care with coronavirus.

We also know that covid-19 has a greater impact among black, Asian and minority ethnic communities. Currently, 74% of black adults are either overweight or living with obesity. That is the highest percentage of all ethnic groups. That is a fact—an observation—not a statement against any group, but we have to look to where the problems are and see how we can reach out to help, because we need to reach those groups.

It is encouraging to see the Government setting out the steps that they will take to support people to live healthier lives and reduce obesity. Those steps will make a positive contribution to the environment we live in and will encourage people to make healthier choices, helping to prevent obesity. I will also speak about other groups, because it is sometimes those in a certain financial group who do not have the ability to buy the correct foods and are driven by the moneys that they have available.

The Government now have to implement their proposals and fund them adequately. Then they need to measure their success and to review what more can be done. Three childhood obesity strategies have been published since 2016, and the proposals have not yet been fully implemented. One reason we are here today is to see how those proposals can be implemented, and we need a timescale. I know we are on the cusp of finding a vaccine, but we also need to address the issue of obesity in the nation as a whole. Perhaps covid-19 is an opportunity to address it. We cannot afford a delay. It has to be an urgent priority for the Government and the Minister if we are to protect people from severe illness from covid-19.

Furthermore, we need to address the structural drivers of obesity. Inequality is a key element, as I mentioned a little earlier. Obesity prevalence in children is strongly linked to socioeconomic deprivation. Families with lower incomes are more likely to buy cheaper and unhealthier food because what drives them—let us be honest—is what is on offer this week and what budget is available to buy the food that is on the shelf. We do not always check the labels. Is it high in calories, sugar and salt? Those are things that we probably should check, but we do not, because the driver is money.

A report by the Food Foundation in 2018 found that the poorest 10% of households need to spend 74% of their income on food to meet its Eatwell guide costs. That is impossible for people on low incomes. When the Minister sums up, perhaps she will give us her thoughts on how we can address that issue directly.

I welcome the Prime Minister’s commitment to the support for schoolchildren and school meals. It is good news; it is good to know that the four nations in this great United Kingdom of Great Britain and Northern Ireland are united in taking action on that issue. Scotland is doing it, Northern Ireland is doing it, Wales is doing it and now England is doing it. That is good news, because by reaching out and offering those school meals we will help to address some of the issues of deprivation and how the mums and dads spend the money for food in the shop. This is a way of doing that. We all know that school meals have a balance as well, so it is really important over the coming school breaks and other times that children have the opportunity to have them. In Northern Ireland, the Education Minister set aside £1.3 million to help to provide school meals over the coming period.

The Government need to work more closely with the food and drink industry as well, to make the healthy option the easiest option. However, while we need to support healthier choices and behaviours, there is no point in seeking to make individuals’ behaviours healthier if the environment in which they live is not suited to healthy behaviour. It is okay to say these things, but how do we make them happen? We need to look further at the social factors that lead to obesity, and we need to address them to make them more conducive to healthy living. To give just two examples, eating more fruit and vegetables and walking, which gives the opportunity to be out and about, are among the things that we need to look at.

There is a long-term process, which involves planning, housing, the workplace, the food supply, communities and even the culture of life in the places that we live in. It is about the groups of people we live with and the people we have everyday contact with. Earlier, I mentioned genetics, which is also an important factor in causing obesity. Again, it is a fact of life that there are people who may carry extra weight because of their genetics. Indeed, it is suggested that between 40% and 70% of variance in body weight is due to genetic factors, with many different genes contributing to obesity. Again, I am sure the Government have done some research on that issue, working with the bodies that would have an interest and even an involvement in it. It might be helpful to hear how those people who have a genetic imbalance, for want of a better description, can address it.

Without going into the motivations and challenges faced by people living with obesity, and particularly those living with severe obesity, it is clear that it is not always easy for them to lose weight. Let us be honest: it is not easy to lose weight. Some people say, “Well, what do you do? Do you stop eating? Do you cut back on your eating?” But if someone enjoys their food—I enjoy my food, although in smaller quantities, I have to say—and overeats, we have to address that issue as well.

We want to encourage people to improve their wellbeing and mental health and to have the willpower. There are a lot of factors that need to be part of that process. I was therefore pleased that the Government strategy sets out plans to work with the NHS to expand weight management services. Again, perhaps the Minister will give us some idea of what those services will be.

Support for people to manage their weight can range from diet and exercise advice to specialist multidisciplinary support, including on psychological and mental health aspects, and bariatric surgery. We have the National Institute for Health and Care Excellence guidance on these treatment options, which sets out who should be eligible for them, yet they are not universally commissioned, which means that many patients cannot access support even if they want to. Given the urgent need for people to reduce weight to protect themselves against covid-19, we need to make these services more accessible by increasing their availability and the information provided about them to patients and the public.

Over the years, I have had occasion to help constituents who probably had a genetic imbalance and were severely overweight. The only way forward for those people—men and women—was to have bariatric surgery. On every occasion that I am aware of involving one of my constituents, bariatric surgery was successful. It helped them to achieve the weight loss that they needed and it reduced their appetite. That made sure that their future was going to be a healthy one.

We have strict acceptance criteria in the NHS for obesity treatment that are not found with other conditions. If a person has a BMI of 50, they must follow diet and exercise advice and receive a multidisciplinary specialist report. These services are otherwise known as tier 2 and tier 3 services. We are almost sick of hearing of tiers 1, 2 and 3, but they are a fact of life for obese people before they are even eligible for surgery.

If a patient does not complete those courses, they must start again, which can make some people lose motivation. The lower levels of support are absolutely necessary and effective for the appropriate patients, but it would be better to remove the loopholes and duplications. That would allow more people to achieve the appropriate support, even before additional resource is provided.

Currently, the United Kingdom performs 5,000 bariatric surgeries every year, which represents just 0.2% of eligible patients. If more people had the opportunity to have that bariatric surgery, they would probably take it. Can the Minister indicate what intention there is to increase the opportunities for surgery? We lag behind our European counterparts when it comes to surgery for obesity, despite it showing benefits in terms of cost, safety and the ability to reverse type 2 diabetes.

Many reports in the papers in the last few months have indicated how people can reverse their type 2 diabetes and the implications of that. Talking as a type 2 diabetic, I am ever mindful that if people do those things and reduce their weight, it helps, but it may not always be the method whereby type 2 diabetes can be reversed. When I lost that weight, I found that my sugar level was starting to rise again after four years, and I moved on to tablets and medication, which controls it now. Ultimately, the control will be insulin, if the level continues to go the wrong way.

The British Obesity and Metabolic Surgery Society has recommended that the number of surgeries should increase incrementally to 20,000 a year—a massive increase from 5,000, but we believe it will heal some of the physical issues for the nation. This is a small proportion of the total number of people with obesity, but they would also benefit the most. This debate is not about highlighting the issues, but about solutions. I always believe that we should look at solutions and try to be the “glass half-full” person rather than the “glass half-empty” person, because we have to be positive in our approach.

For people who require nutritional, exercise or psychological advice, face-to-face services were closed during the first wave of the pandemic. I understand the reasons for that. While digital and remote services can provide help to vulnerable people during lockdown, these new ways of working cannot reach everyone. How do we reach out to all the people who need help? That is vital as the country moves through future stages of the pandemic. We hope we have turned the corner, but time will tell in relation to the trialling for the new vaccine. Obesity continues to be a priority, and services should remain available.

Lastly, in future, obesity services should not be cut as part of difficult funding decisions. I understand very well the conditions in the country and the responsibility that falls on the shoulders of the Health Ministers not just here in Westminster, but in Scotland, Wales and Northern Ireland. It is vital that the inequity in access to these services is corrected to ensure that people can access support, no matter where they are in the country. What discussions has the Minister had with the regional Administrations—with the Northern Ireland Assembly and particularly with the Minister, Robin Swann, and with our colleagues in Scotland and Wales? If we have a joint strategy, it will be an advantage for everyone. I would like to see the person in Belfast having the same opportunities as the person in Cardiff, Edinburgh, London and across the whole of this great nation.

I have three asks of the Minister, along with all the other questions I have asked throughout my speech—I apologise for that. Can she reassure us of the continued political prioritisation of the prevention and treatment of obesity? I call on the Government to implement, evaluate and build on strategies to reduce obesity. Can the Minister tell us how have discussions on that been undertaken with the regional Administrations across the UK? I also call on the Government to work with local NHS organisations and local authorities to ensure that services are available to our constituents who wish to manage their weight.

In summary, given the range of secondary conditions caused by obesity—this also applies to covid-19—would it not be more prudent to address their underlying cause before they occur? I always think that prevention, early diagnosis and early steps to engage are without doubt the best way forward, and it would be helpful for the nation as a whole if those things were in place. I believe that would help to reduce the impact of conditions such as type 2 diabetes, heart disease, kidney disease, high blood pressure, stroke, sleep apnoea, many types of cancer and more. The problem with covid-19 is that although our focus should rightly be on covid-19, we must not forget about all the other, normal—if that is the right word—health problems that people have, because dealing with those is very important for our nation to move forward.

The NHS currently faces huge demands, but reducing obesity now would significantly reduce demand on wider NHS services. It is a question of spending now to save later, if we are looking at the financial end of it. It is not always fair to look at the financial end, but we cannot ignore it, because there is not an infinite budget available to do the things we want to do; we have to work within what our pocket indicates. And we have to do that while also protecting people who are vulnerable to coronavirus.

I commend the Minister and our Government for their focus on obesity. I very much wish their new obesity strategy success. How it will work across the four nations is important, but we need to do more, in both the short and long term, to prevent and treat obesity, and we must do so with adequate funding, which is crucial to enable the operations, strategies, early detection and early diagnosis to be in place.

I hope that our future strategies to reduce obesity will continue to focus on how people can also be supported to live healthily. When it comes to these things, we have to be aware that it is not just one person who is living with the obesity; the family also live with it. Sometimes we forget about the impact on children, partners, wives, husbands and so on. Whenever someone sits down for a meal, is their meal the same as what the rest of the family are having? It would be better if they were all eating the same food, in terms of diet and content. I believe that if we can achieve that, we will find a way forward.

May I thank in advance all right hon. and hon. Members for taking the time to come to this Chamber and participate in the debate? Like me, they are deeply concerned about how covid-19 is affecting those with obesity issues. Today is an opportunity to address this issue, and I very much look forward to hearing other contributions; I am leaving plenty of time for everybody to speak.

--- Later in debate ---

[Andrew Selous (South West Bedfordshire) (Con)]

I congratulate the hon. Member for Strangford (Jim Shannon) on bringing this important debate before the House.

When the Prime Minister announced the improvements to the child obesity strategy a few weeks ago, he made the point that the UK is unfortunately an outlier, in that we are the most overweight nation in the whole of Europe, after Malta. Sometimes I think we do not quite realise how serious our national situation is or the implications it has for people’s lives. To me, this has always been a social justice issue, because it significantly adversely affects the poorest people up and down our country.

I was struck by some information in the House of Lords Select Committee on Food, Poverty, Health and the Environment report, “Hungry for change: fixing the failures in food”, which is a very good read, for any Members who want to take the issue further. It points out the reason we are the most overweight nation in Europe, after Malta. It is not difficult to see. On page 19 the report states:

“In the UK, more than half (50.7%) all total dietary energy from purchases came from highly processed foods”.

That compares with Italy, where the figure is only 13.4%, and Portugal, where it is only 10.2%. In other words, our diet is five times worse than that of the Portuguese. All the figures are going in the wrong direction. Despite all the strategies, it continues to get worse. The debate today needs to be a national wake-up call on this issue. Well done to all the Members who are here. I know the Minister gets it, and I know the Secretary of State gets it, but this is a combined national effort. It is not just up to the Government. It is up to food retailers, local authorities and schools—and, yes, it is up to us as families, parents and individuals to do the right thing. Everyone needs to pitch in and do the right thing.

Further into the report, on page 20, I found it completely shocking that 47% of primary schoolchildren’s dietary energy comes from products that are high in fat, sugar and salt. That is nearly half, and it just is not good enough. It does not have to be like that. There is healthy, nutritious food that will help our children to grow and develop as we all want them to. The figures show that a fifth—one in five—of children born today are on a trajectory to have type 2 diabetes by the time they are 65, with all the limiting implications that has for their lives and what they will be able to do, as the hon. Member for Strangford said.

At the really gruesome end of the statistics is the average number of diabetes-related amputations over the last three years, or from 2015-16 to 2017-18. The NHS undertook 9,155 amputations because of type 2 diabetes, with taxpayers’ money. Of those, 27%—more than a quarter—were major amputations, or above the ankle. People are losing their feet because of a lifetime of bad diet. It is a bit grim to spell it out this early on a Tuesday morning, but we cannot tiptoe around the issue. It really is that serious, and we need to do something about it. Yet a number of things are still going in the wrong direction.

I am a massive fan of the Food Foundation, which is run by our wonderful former colleague Laura Sandys CBE. Its “Broken Plate 2020” food report shows that 14% of local authorities in the last 18 months saw a more than 5% increase in the number of fast food takeaways. What were the directors of public health doing in those 14% of local authorities, where things were clearly going in the wrong direction? Indeed, fast food takeaways in the local authority areas with the highest number make up some 40% of all food outlets in those areas. We really can do better than that.

We need to hold the food industry to account, as the Obesity Health Alliance has said, to meet its targets to reduce sugar and overall calories from everyday food. Yes, there has been some progress in children’s breakfast cereals—so thank you for that; well done—but not nearly enough progress on a huge range of food.

I often quote the Dutch supermarket Marqt, which is a private business looking to make a profit, but its whole raison d’être is to sell healthy, nutritious food; it is not part of its philosophy to sell food that will be bad for its customers. If Marqt can do it, as a commercial business in the Netherlands, come on Sainsbury’s; come on Tesco; come on Asda; come on Morrisons: step up and show that you can do that too. Colour coding on front-of-pack labelling will be mandatory from next year. We can do more of that, which would make it easier for people to pick up the right, healthy things.

I find it surprising that the quality and outcomes framework for our GPs does not include a specific incentive for them to do anything about children being overweight or obese. That has to change. We pay our GPs to do lots of very good things. If this is a national priority—and I think everyone here thinks it should be—then for goodness’ sake let us align the financial incentives for GPs with what we are all trying to achieve and deal with this issue early on, in the right way.

Overall, if we want a strapline for what we are trying to do, we want healthy food to be the easiest option for people, and it also needs to be affordable. Amazingly, in Europe, healthier food is often cheaper than the less healthy food—this is according to the 2019 Food Foundation report. It does not have to be the case that unhealthy food is cheapest; in other parts of Europe, it is not the case. We could align the financial incentives to make it easy on people’s pockets, when money is tight, to put healthier things in their shopping baskets. We also need to stop the stigma in this area. Some of our press do not report this issue well, and that is not helpful. Further, we need to ensure enough bariatric surgery to help people who have become severely overweight or obese.

I have a few questions for the Minister. Can she give us an update on menu labelling? The Government say that they will use the powers in the Food Safety Act 1990 to lay the legislation before Parliament in 2020. There is not much of 2020 left, so can the Minister tell us when that will happen?

The consultation on the labelling of alcoholic drinks has not been published yet. When can we expect that? The consultation on promotions of products that are high in fat, sugar or salt has not been published yet. When can we expect that? The long awaited 9 pm watershed has not been published yet. When can we expect that? The “What Next?” proposals include eight additional policy proposals with limited information about who is responsible, so it would be good to have some more detail on that. I would like to see schools gripping this issue. They do a good job now in providing healthy and nutritious food, but they should have more of an emphasis on teaching children about the importance of healthy nutrition throughout their lives and about how to cook well, which is also extremely important.

All our healthcare professionals have a role. Every contact is supposed to matter, and this issue is supposed to be mentioned in every contact between a healthcare clinician and a patient. Dr Susan Jebb from Oxford has done lots of good work on how to do that well. We can copy the great work that has been done in Amsterdam to bring down child obesity in particular.

There are even little things that we can do. Dr Jebb said that when we fill up at the petrol station, we should sometimes pay at the pump because there is an array of temptation when we pay in the shop. It seems a trivial thing. Lots of us pay at the pump because of covid, so perhaps that will help a bit. There are lots of things that we can do. This strategy is very urgent, and I look forward to hearing from the Minister how we are going to take it forward.