Cass Review

Baroness Jenkin of Kennington Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

First, I think I speak for the whole House in agreeing that no one, under any circumstances, should feel that they live in a hostile society —whatever case it is, whether it is transgender, race, sex or whatever. I totally agree with the noble Baroness there. I will absolutely clarify this in the follow-up in writing, but I know that, in this specific area, the NHS has already committed £18 million in this space. Of course, this is quite separate from the £2.3 billion that I mentioned before in the mental health space generally, which, from memory—and I will absolutely clarify this—is the provision of 350,000 extra places for young people, because we know how much the demand is out there.

[Baroness Jenkin of Kennington (Con)]

My Lords, I am grateful to the Noble Baroness for clarifying the Lib Dem position because, unfortunately, the page on the website has disappeared this afternoon. May I ask my noble friend whether the Government acknowledge that a conversion practices Bill would have a detrimental effect on the recruitment of clinicians to the new children’s services, as highlighted in the Cass Review?

[Lord Markham (Con)]

I must admit that I am not sure that I quite understood the question from my noble friend.

[Baroness Jenkin of Kennington (Con)]

There are a number of conversion practices Bills currently in play, and Cass has said that such a Bill would have a detrimental effect on the recruitment of clinicians, because they would feel a chilling effect before they would apply.

[Lord Markham (Con)]

Understood. Again, I will come back in detail on that point. One of the points made to me about the difficulties of trying to recruit to these eight new services was that, when this is such a toxic space, how do you get good-quality people? I think we agree we need that more than ever, because it is such an essential and sensitive area. So I will take that back and make sure that nothing we are doing, such as that legislation, should have that sort of chilling effect.

Prioritising Early Childhood: Academy of Medical Sciences Report

Baroness Jenkin of Kennington Excerpts

Monday 11th March 2024 Lords Chamber

[Lord Markham (Con)]

First, I add condolences from myself and this side of the House for Lord McAvoy.

Secondly, I am grateful for the direction of the report. I think that we all agree that early investment in childhood, and in young people, is vital. That is what our vision for the first 1,001 critical days is all about. A lot of the things in the report are helpful. I must admit that I did not recognise that particular stat, because rather than it being one in five children suffering from obesity at age five, the latest report—and it is an extensive study—shows that it is less than one in 10. It is the lowest number since 2006-07. So, in the area of obesity, we can show that our plans are working. I say again: we have the lowest level of obesity among reception age children since 2006-07.

[Baroness Jenkin of Kennington (Con)]

My Lords, the Food, Diet and Obesity Select Committee, which is one of the new ad hoc committees, took evidence last week from specialists in childhood, early years, and school food. The situation is grave, as the noble Lord, Lord Hunt, said. Some 80% of the food that children eat is ultra-processed—we have no idea what the long-term consequences will be. May I encourage the Minister to look again at the figures and the ultra-processed foods that we are feeding children—the health consequences of which are not yet understood?

[Lord Markham (Con)]

I assure my noble friend that the numbers are correct; they are the lowest since 2006-07. I can also assure her that free school meals are at their highest level ever, at 33%. The whole idea behind those programmes, as well as the Healthy Start in school and the five-a-day, is to give children healthy diets early on, exactly as my noble friend says.

Children’s Health: Ultra-processed Foods

Baroness Jenkin of Kennington Excerpts

Wednesday 25th October 2023 Lords Chamber

Asked by

[Baroness Jenkin of Kennington]

To ask His Majesty’s Government what assessment they have made of the impact of ultra-processed foods on children’s health.

[Baroness Jenkin of Kennington (Con)]

My Lords, I thank all noble Lords participating in today’s debate, apologise that they have only four minutes each, and thank those who have provided briefing. I am grateful to the First Steps Nutrition Trust, which pointed out to me that the focus of today’s debate should really be on how diets high in UPF negatively impact children’s health, rather than focusing on individual products. Its report, published in June this year, has helped to shape the debate and inform us all.

Speaking in a debate in 2016 I cited a TV series called “Junk Food Kids” and highlighted how a poor diet was leading to poor outcomes. In 2017 I chaired a report for the Centre for Social Justice called Off the Scales: Tackling England’s Childhood Obesity Crisis. It all seemed bad then, but the situation today is so much worse. Fortunately, we now know more about what is driving it, thanks to more than a decade of research amounting to many hundreds of papers linking increased consumption of ultra-processed foods to bad health outcomes.

There continues to be a debate about the definition of UPF, but I do not intend to go too far down that rabbit hole. There is a definition accepted by UNICEF, the United Nations Food and Agriculture Organization, the World Health Organization, many foreign Governments including those of France, Canada and Belgium, and research groups at Cambridge, Harvard, Yale, Imperial, UCL and many other leading universities.

While the formal definition is long, a good working definition is that a food is probably ultra-processed if it contains at least one additive that you would not find in a domestic kitchen. But the additives are just part of the problem: these products are made by large corporations in a system in which all the incentives are financial. The additives signal a process in which every product is engineered to maximise consumption: the flavour, colour, taste, softness, texture and even marketing are all optimised to increase profit.

There are undoubtedly some ultra-processed products that are less harmful. I expect the Minister will mention wholemeal bread or baked beans in his response, but the evidence refers to a pattern of eating. People do not eat just one food; they eat diets, and the evidence is clear that a diet high in ultra-processed food and drink is driving not just a pandemic of weight gain but a huge number of other problems, from cancer and metabolic diseases to anxiety, depression, dementia and an early death.

Industrialised wholemeal bread does contain grains linked to good health, but it is also soft and energy-dense and contains emulsifiers, around which there are increasingly credible health concerns. No one is calling for these foods to be banned, but rather for the public to be made aware of the growing evidence around the risks and for non-ultra-processed versions of food and drink to be made affordable, accessible and convenient to everyone. No one in the UK should struggle to afford or access real food.

Global consumption of heavily processed products such as cereals, protein bars, fizzy drinks, ready meals and fast food has soared. In the UK, 60% of the average diet now consists of UPF and for some, especially people who are younger, poorer or from disadvantaged areas, including food swamps where it is hard to find a choice of food, a diet comprising as much as 80% UPF is typical. It should be the reverse, but no wonder this is the case when 70% of the UK’s largest food companies’ products are ultra-processed. What we eat is a reflection of what food companies make. If they make majority UPF, is it a surprise that our diets mirror that? These companies literally make most of what we eat: 75% of calories consumed globally come from six companies.

The hyper-palatability of food designed to appeal to children drives them to eat more. A recommended portion size of Coco Pops for an adult is 30 grams, basically a very large spoonful, but does anyone know a child who will stop at that? I doubt it. Does anyone actually weigh their child’s breakfast cereal? Similarly, a recommended serving of Pringles is 13. Has anyone in the history of eating crisps ever counted the number they eat? There is now very good evidence, including a paper published last week in the BMJ, that for many people these products are addictive. Try telling a child to eat a single bowl—it is like recommending to smokers that they stick to one cigarette. These products are designed and marketed to be consumed in excess.

As the recent Scientific Advisory Committee on Nutrition report says:

“The observed associations between higher consumption of (ultra-) processed foods and adverse health outcomes are concerning”.


Would anyone disagree? It would be interesting to know why the report did not recommend new actions to address UPF consumption given that many Governments have, including that of our nearest neighbour, France.

I turn to older children and young people, more than a third of whom now leave primary school with a weight classed as overweight or obese. Many children living in the most deprived areas are disproportionately affected. Many of these children experience stunting of up to 9 centimetres, so they are not just obese but shorter than ever before as a result of diet. These children and those older are exposed to junk food advertising all the time—bombarded, in fact. It pops up on their feeds hundreds of times a day via TikTok and other social media sites.

We know that advertising is effective—otherwise, why would it exist? I quote two teenagers, supporters of Bite Back, on their exposure to such advertising. They said:

“Scrolling on UberEats and Pinterest late at night. The donuts look delicious and I wouldn’t mind grabbing a bite. These adverts are very enticing and they are making my mouth water”,


and:

“I saw this Magnum advert on Instagram and it made me crave ice cream. It made me feel a bit peckish and definitely activated the midnight cravings … I would definitely buy these if I saw them in the shops”.


Both doughnuts and Magnums are UPF.

The counterargument comes entirely from the industry making money from these products, leading to a pandemic of diet-related disease, and the people and institutions they fund. If you are on the same side as a charity funded by a soft drink manufacturer and a sugar producer, you need to ask yourself some questions. These groups propose that sugar, fat and salt are the only determinants, but we know that mixtures of just sugar, fat and salt are not very tasty. They need texturing, emulsifying, flavouring, colouring, flavour enhancing and marketing to drive excess consumption. These are just some of the ultra-processes that turn real food into addictive substances.

Those groups propose that processing is fine, which it is. Processing is ancient and has shaped our bodies. Humans have to process our food. Ultra-processing is what happens when transnational food corporations with obligations to investors need to generate financial growth. They say that a ban would be harmful. It would. This is, tragically, the only affordable available food for many people. They say that those who want to regulate the companies that make UPF want to ban brown bread and baked beans. These are straw man arguments. No one is calling for a ban. No one is that brown bread is poisonous. No one is advising against eating baked beans. But as a category of food, there is a huge amount of evidence that UPF is linked to negative health outcomes and that it needs some light-touch regulation, such as a marketing ban for kids, a warning in the national nutrition guidance and effective labelling.

The independent groups—scientists, NGOs and activists not funded by the industry—all agree that the science around UPF is robust. In the UK, we are so saturated in industry messaging that it seems that the science is controversial. It is not. Of course, there are many more questions to answer, but we did not need to understand how smoking causes cancer to warn the public that it does.

Many ultra-processed products are high in fat, sugar and salt, so the Government should absolutely continue implementing the current policies, including the HFSS advertising and promotion restrictions that have been delayed. We need urgently to follow other Governments globally who have included advice to reduce UPF consumption in their national nutrition guidance. Latin America presents a wealth of examples of how to do this. Given that the UK consumes most of its calories from UPF, there must also be viable alternatives for everyone. Making non-ultra-processed food and drink affordable, accessible and convenient to all is critical, and unleashing business incentives so that companies can profit sustainably from making non-ultra-processed products could be game-changing.

We are able in one hour only to scratch the surface of the problems of a diet rich in UPF. If the noble Baroness, Lady Boycott, and I are able to persuade the Liaison Committee of the merits of a special inquiry into the subject, we will have the opportunity for a much deeper dive. For those who would like to hear and question Dr Chris van Tulleken, author of the bestselling book Ultra-Processed People, I am delighted that he will be speaking to a joint committee of the APPG on Obesity and the Food and Health Forum on 21 November at 5 pm.

To summarise, for the past half-century, dominant strands of nutrition science and policy have focused narrowly on single ingredients as determinants of health. Within this reductive paradigm, nutrients are systematically decontextualised from the foods, dietary patterns, social contexts and food systems in which they are embedded. This perspective has singularly failed to curb rising levels of obesity and dietary ill-health. Research on UPF and related issues is beginning to reveal why. I look forward to noble Lords’ contributions and to the Minister’s response.

Ultra-processed Food

Baroness Jenkin of Kennington Excerpts

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

As I have said, the fact that something is processed is not a helpful definition. I would recommend that we focus all our activity on the contents of the foods—whether they are high in saturated fat, sugar or salt—and not on whether they are processed.

[Baroness Jenkin of Kennington (Con)]

My Lords, will my noble friend the Minister let us know what assessment the Government have made of food industry links with the Scientific Advisory Committee on Nutrition and whether this might have influenced the evidence and recommendations of the review?

[Lord Markham (Con)]

On any advisory body you clearly want to get experts in the field. Necessarily, they will often be experts from companies as well. It is vital that they abide by the principles of conduct in public life and make sure they declare any conflicts. As such, we are content that we have a proper expert panel.

Health Improvement and Food Production

Baroness Jenkin of Kennington Excerpts

Thursday 7th July 2022 Lords Chamber

[Baroness Jenkin of Kennington (Con)]

My Lords, I am grateful to the noble Baroness for procuring today’s debate. She and I have long been two of a handful of parliamentarians who have taken an interest in obesity, concerned not only for those struggling with it but with the cost to the taxpayer and the NHS of the consequences of the unstoppable increases in adults and children, exacerbated as a result of lockdown.

During the pandemic, I wrote an article, “Hunk, Chunk or Drunk?” Unfortunately, many more people became the second or the third, rather than taking the opportunity to get fit. Today’s debate gives me the opportunity to raise concerns about the increased prevalence of UPF—ultra-processed food—to expand on what the noble Baroness has said and to discuss the effect on the nation’s health.

UPF has a long, formal scientific definition but it boils down to this: if it is wrapped in plastic and contains stuff that you do not typically find in a domestic kitchen, it is UPF. Flavours, flavour enhancers, colours, emulsifiers, artificial sweeteners, thickeners, foaming agents, bulking, carbonating, gelling and glazing agents—these additives are not the only ways that the food harms us but they are all harmful. Let us be clear: what we are talking about is not actually food. It is a set of substances reconstituted from commodity crops, processed and marketed to be addictive. Its sole purpose is financialised growth by transnational corporations that have repeatedly proven that they are unable to self-regulate. The entire food system is now built around UPF.

In our drift towards a diet based on these edible food-like substances and away from real food grown in the soil or reared in the fields, we risk losing the connection between soil, plants, animals and people for the health of our food and our planet. I reiterate that what characterises ultra-processed foods is that they are so altered that it is hard to recognise the underlying ingredients. These are concoctions of concoctions, engineered from ingredients that are already highly refined, such as cheap vegetable oils, flours, whey proteins and sugars, which are then whipped up into something more appetising with the help of industrial additives such as emulsifiers.

UPFs now account for more than half of all the calories eaten in the UK and US, and other countries are fast catching up. These foods, now simply part of the flavour of modern life, are convenient, affordable, highly profitable, strongly flavoured, aggressively marketed and on sale in supermarkets everywhere. Over half the energy from food eaten in the UK now comes from these products. They lead people to eat more and to put on weight at a time when already one in four adults and one in five children aged 10 to 11 in the UK are estimated to be obese.

Last year, to conduct research about the effects of UPF, Dr Chris van Tulleken did an experiment on his own body. He wanted to find out what would happen if he followed a diet high in ultra-processed food, and how it would interact with his body. He increased his usual intake of 30% UPF to 80% for four weeks, a diet which one in five people in the UK eat every day. We should be grateful to him for sharing what happened. It should be a wake-up call to us all.

After the month was over, Chris reported poor sleep, heartburn, unhappy feelings, anxiety, sluggishness and a low libido. He also had piles from constipation. “I felt 10 years older”, he said, “but I didn’t realise it was all about food until I stopped following the diet.”

Chris gained almost 7 kilos in the four weeks and moved from a healthy weight to being overweight. “If the weight gain continued at that rate for six months, I would have gained six stone,” he said. It did not stop there. Brain activity scans showed that the areas of his brain responsible for reward had linked up with the areas that drive repetitive, automatic behaviour. “Eating ultra-processed food became something my brain simply told me to do, without me even wanting it,” he said, adding that this is a similar brain response to taking substances we consider classically addictive, such as cigarettes, alcohol and drugs. The changes in brain activity were not permanent, but if UPF can do that much damage in four weeks to his 42 year-old brain, what is it doing to the fragile developing brains of our children?

We do not know exactly why ultra-processed foods have these effects, but most hypotheses come down to a combination of the physical act of processing and their nutrient make-up. Dr Kevin Hall of the National Institutes of Health tested two diets matched in terms of fat, sugar, salt and fibre content, but one was made up of unprocessed foods and the other of around 80% ultra-processed foods. The participants were able to eat the foods on offer until they wanted to stop.

His study found that those eating the ultra-processed diet ended up eating more than 500 calories per day more and gained almost one kilo of body weight over two weeks. Blood tests showed an increase in the hormone responsible for hunger and a decrease in the hormone that makes us feel full among the participants eating the diet high in UPF. These results were consistent with Chris’s experience. His hunger hormone increased by 30% during his experiment, which may have encouraged overconsumption. Dr Hall also found that participants on the UPF diet ate much more quickly than those on the minimally processed diet, which may also have contributed to the consumption of more calories. Chris experienced this too, as many of the foods are so easy to chew and swallow. Previous studies have suggested that eating slowly decreases hunger.

Chris found himself craving food much more often. Research has previously found that some foods, including ultra-processed pizzas, chocolate, crisps and cakes, can elicit cravings, loss of control and inability to cut back. There is evidence that foods high in carbohydrates and fat, as many ultra-processed foods are, can trigger the centres of the brain responsible for reward, emotion and motivation. A brain-imaging study suggests that the more often you experience reward from foods, the more you have to consume to sustain the same enjoyment. Many UPFs have also gone through focus groups to make them perfect. The taste, level of saltiness, mouthfeel, how much they need to be chewed and even the sound they make when eaten will have been fine-tuned.

Foods can be categorised as minimally processed or unprocessed, such as fresh tomatoes; processed, such as tinned tomatoes; and ultra-processed, such as store-bought tomato pasta sauce. Some ultra-processed foods are healthier than others. Wholegrain breakfast cereals, wholemeal sliced bread, tinned baked beans and unsweetened soy or plant-based drinks are all ultra-processed but have some nutritional benefits. Similarly, ready-made pasta sauces, ready meals, spreads and sliced meats can be reasonably healthy. Some pre-prepared foods are not ultra-processed, but any that include additives and chemicals not used in home cooking probably are. The availability, convenience and marketing of ultra-processed food makes it almost impossible to eliminate.

Chris’s experiment has been backed up with clinical studies and lots of laboratory work. The clinical study undertaken by Kevin Hall confirmed that the epidemiological findings were true: you can have those two diets matched for salt, sugar, fat, carbs and fibre and the UPF one will drive weight gain whereas the wholefood one will not. The problem is that it is now very normal for children and young people to eat 80% of their calories from UPF for the first two decades of their life. UPF now comprises 60% of what we eat in the UK and the US.

To sum it up, this is how UPF works. It is dry, which prolongs shelf life but also increases calorie density. It is soft, which increases speed of consumption, which is itself closely related to obesity. Flavour enhancers signal protein that never arrives. Artificial sweeteners prepare the body for sugars that do not arrive, and all the gums signal fat that never arrives. It contains additives that affect the microbiome and inflammation, as well having direct effects on the brain. It has addictive properties and is designed in a way so that the products that are most readily consumed and desired are the ones that succeed in the marketplace.

UPF is the cause of the childhood obesity pandemic. It is one of the leading causes of environmental destruction and climate change. I hope that I have persuaded noble Lords of the dangers of these so-called foods. What are they doing to our population? We need to act now, with urgency, before it is too late for the next generation.

Health and Care Bill

Baroness Jenkin of Kennington Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Jenkin of Kennington (Con)]

My Lords, 63% of people in England live with obesity or are overweight. At last obesity is recognised as a significant health challenge that needs to be addressed. The figures are stark: none of the obesity strategies published by Governments since 1992 has successfully reduced the prevalence and inequalities of obesity. Researchers from the University of Cambridge studied why this was the case. They analysed England’s 14 obesity strategies and 689 obesity policies proposed by Governments over the past 28 years, and found that obesity policy has been largely unfit for purpose.

Around 76% of all policies had no plan to monitor or evaluate whether they were working. A further 81% were published with no cited evidence, for example on whether the policy was likely to be effective, while 91% included no cost or budget for implementing policies. Just 8% of the policies that the academics looked at included all the necessary details about how the strategy could readily be implemented. A total of 43% of the policies they studied required people to make changes to their lifestyle, such as diet or exercise, which, sadly, we know do not work. Just 19% of policies focused on making it easier for people to be healthier by shaping the choices available to them.

That is where this Bill, specifically Schedule 17, comes in. Every child has a right to be healthy, no matter where they live. It should be a simple principle to follow that we make it as easy as possible for children to access healthy, nutritious and delicious food to ensure that they get the best start in life. We want them to grow up fit and healthy in an environment where picking the healthy option is the easy option.

The reality today makes this hard. At school, on the street and on their screens, young people are overwhelmed with unhealthy food options: canteens selling cakes, doughnuts and cookies, while failing to provide enough fresh fruit and vegetables; fried chicken shops and other cheap, unhealthy fast-food options opening up on every other street corner; and a bombardment of advertisements for unhealthy food on TV and online, beamed into children’s eyes all day every day. With unhealthy food so regularly in the spotlight, it is no wonder that it plays such a starring role in children’s minds.

This food environment has resulted in a public health crisis. One in three children leaves primary school overweight. Childhood obesity is increasing at an alarming rate made even worse by the pandemic. Recent NHS data shows the biggest year-on-year increase in childhood obesity on record. The problem is not just getting worse; it is getting worse faster.

An unhealthy diet is linked to many negative outcomes in life. It is a path that leads to a higher risk of preventable conditions such as type 2 diabetes, tooth decay, heart and liver disease and cancer, and leads to poor performance at school, bullying and mental health issues. It results in many potentially avoidable deaths, including the likelihood of hospitalisation, even death, from Covid if the person is overweight, and costs our NHS in excess of £6 billion a year—and climbing. The impacts are not shared evenly across society. Children from deprived areas are more than twice as likely to have obesity than their more affluent counterparts.

I support the restrictions on advertising unhealthy food and drink on the television, on-demand programme services and online. I commend the Government on bringing these proposals forward. Advertising is very different today. It is no longer confined to just a billboard in town, the back of a newspaper or a 30-second spot on television. Marketing companies can now reach us all day every day online, through our phones, tablets, computers and more. The young people at Bite Back 2030 published research earlier this year reporting that children in the UK see nearly 500 online junk food adverts per second. They see endless streams of advertisements for unhealthy food on their social media channels, saying that it is “overwhelming” and “like the wild west”. They feel hopeless against the narrative that junk food is the only option.

Marketing is manipulating young people to crave more, buy more and eat more unhealthy food. Between 2010 and 2017, spend on food and drink advertising increased by 450%, yet just 2.5% of total food and soft drink advertising spend goes towards fruit and veg. The other benefit of these restrictions is that they will level the playing field, incentivising the marketing of healthy foods and giving businesses that want to prioritise child health more of an opportunity to be innovative and creative in the way they put healthy food in the spotlight. These restrictions are regarded by many as an opportunity for companies to innovate and champion products that benefit, rather than harm, public health.

Children’s health must come first. The legislation does that by making it easier for young people to live without the constant reminder that they could eat a burger, order some chips or grab an ice cream. That is a good thing and very much a step in the right direction.

COVID-19: Type 2 Diabetes

Baroness Jenkin of Kennington Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

I am sure that noble Lords will agree that it is really important that we tackle these issues and respond to the weight increases over the Covid-19 lockdowns. In March, the Government announced £100 million of extra funding for healthy weight programmes to support children, adults and families to maintain a healthy weight. Additionally, more effort has been put into providing access to information.

[Baroness Jenkin of Kennington (Con)]

My Lords, currently one in 10 people in the UK are suffering from type 2 diabetes, a figure which has doubled in the past 15 years. It already gobbles up an unsustainable 10% of the NHS budget. As my noble friend said, it is preventable and treatable through maintaining a healthy weight, diet and exercise; there is no need for expensive medication. Can my noble friend continue to encourage systematic support so that people can achieve these objectives?

[Lord Kamall (Con)]

I thank my noble friend for that question and recognise the work she did with the Centre for Social Justice on this issue. The Government are keen to drive the NHS diabetes prevention programme, which plays a pivotal role in supporting those at risk of developing diabetes. During 2018-19, over 100,000 people took up the programme. In 2019-20, NHS England delivered the long-term-plan target, supporting around 120,000 people on the programme.

Health: Type 2 Diabetes

Baroness Jenkin of Kennington Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I take a personal interest in diabetes; I have two very close family members with diabetes, one type 1 and one type 2. I noticed during the Covid lockdown the different approaches in meeting their clinicians—telephone calls rather than meeting in person, and reviewing their charts and sugar graphs over time, which is regularly done at these reviews. I agree completely that it is really important that we now try to address this backlog as much as possible. I know that the Secretary of State is committed to making sure that, with the uplift, we try to tackle as much of the backlog as possible, including for patients with type 2 and type 1 diabetes.

[Baroness Jenkin of Kennington (Con)]

My Lords, I associate myself with the remarks of the noble Lord, Lord Brooke. I think everybody in the Chamber will appreciate the challenges that my noble friend has faced today with all these questions. My noble friend will probably know that 10% of NHS spending is currently on type 2 diabetes. That is £25,000 a minute, £1.5 million an hour, and rising. He will be aware that diabetes is reversible by diet. I am not sure whether he is also aware that, under the leadership of Jonathan Valabhji, the NHS has now endorsed a 12-week programme which has put many patients into remission rather than having to go on to medication.

[Lord Kamall (Con)]

I thank my noble friend. I have done my homework and I have read a little about what has been happening up to now, especially about the NHS diabetes prevention programme, which identifies those most at high risk of developing diabetes and refers them on to behavioural change programmes and personalised education to reduce their risk of developing diabetes, including things such as bespoke exercise programmes and learning about healthy eating and lifestyle. The programme achieved full national rollout in 2018 and 2019, with services available to patients in every system in England.

As we know, tackling diabetes is multifactorial. Nevertheless, the NHS long-term plan sets out plans for increased action on diabetes and related issues. I shall mention just a few, including the healthy weight strategy launched in July 2020 to help adults and children maintain a healthy weight, and the restrictions on the promotion and advertising of foods high in fat, sugar and salt, as was mentioned earlier. It is really important with programmes such as this that we look at these studies on a longitudinal basis and look at the evidence. Some of these programmes will work, and some will not. That is just the way the world is. We have to make sure that we tackle unintended consequences first of all, and that any future policy is very heavily based on evidence rather than a wish. That will be the most effective way of tackling diabetes.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Baroness Jenkin of Kennington Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Jenkin of Kennington (Con)]

My Lords, I speak today in support of the amendment tabled by the noble Lord, Lord Brooke, and, while I have the utmost sympathy for those with eating disorders, to oppose that of the noble Baroness, Lady Bull.

When I came to this House over 10 years ago, my office-mate, my noble friend Lord McColl, was a lone voice asking questions about obesity and its consequences. We talked about it endlessly at our desks. In my case I was motivated as, after 55 years of being overweight, I had finally lost 28 pounds—and I have more or less kept it off. For years I struggled with my weight, so I know how hard it is, but I also know how important it is not only for my own long-term health but for the future—indeed, potentially the survival—of the NHS. Anything that we and the Government can do to help and support others in a similar position, with information that makes it easier to make informed choices, must be tried.

The rise in obesity and its related problems, including diabetes, heart disease and cancers, is a growing problem internationally as well as in this country. The relationship between our environment and health is becoming increasingly clear, and I very much welcome the part 2 of the national food strategy, which joins up the dots so clearly.

In 2017 I chaired a report on childhood obesity for the Centre for Social Justice. If previously I had not been aware of the severity of the crisis, I certainly was by the time that we had done the work and launched the report. Dr Chris van Tulleken’s current work on ultraprocessed foods—seemingly more chemicals than food—which now make up over 60% of the average Briton’s diet, is particularly alarming. He experimented on himself by eating a diet of 80% of these highly addictive foods for a month. What it did to his body was shocking: not only did he put on more than 14 pounds in weight, he suffered many other side-effects such as heartburn, sleep problems, loss of libido and piles. The food even altered his brain. The effect on our children’s health and their growing brains is horrible.

As the Minister said, nearly one-quarter of children in England are overweight or obese when they start primary school aged five, and this rises to one-third by the time they leave aged 11. Childhood obesity rates in the UK are among the highest in western Europe. Obese children are more likely to become obese adults; currently, around two-thirds of adults are overweight or obese, with one in four living with obesity. We know that regular overconsumption of a relatively small number of calories leads to individuals becoming overweight or obese.

The problem is clear: it is likely that eating out frequently, including eating takeaway meals, contributes to this gradual overconsumption of calories. Research suggests that eating out accounts for 20% to 25% of adult energy, and that when someone eats out or eats a takeaway meal they consume, on average, 200 more calories per day than if they eat food prepared at home. This all adds up. Data also tells us that portions of food or drink that people eat out or eat as takeaway meals contain, on average, twice as many calories as equivalent retailer own-brand or manufacturer-branded products. Some 96% of people eat out, and 43% do so at least once or twice a week—a huge increase on even a decade or so ago.

There is strong public demand for calorie labelling in the out-of-home sector. People want information so as to make better choices. Nearly 80% of respondents to a survey by Public Health England said they think that menus should include the number of calories in food and drinks. This thirst for information also applies to alcohol. An experiment conducted by the RSPH in 2017 showed that, on an evening out in the pub, those drinking with calorie labelling on the menu drank 400 calories fewer than those who were not aware of what they were drinking. The problem is huge, and every tool in the toolkit has to be used to tackle it. There is no time to waste.

Women’s Health Outcomes

Baroness Jenkin of Kennington Excerpts

Thursday 8th July 2021 Lords Chamber

Moved by

[Baroness Jenkin of Kennington]

That this House takes note of the steps taken to improve women’s health outcomes.

[Baroness Jenkin of Kennington (Con)]

My Lords, it is an honour to be introducing this debate on a topic so close to the hearts and other more intimate body parts of 51% of the population—and some men too, of course.

In my International Women’s Day speech this year, I departed from my usual topics of either women in Parliament or the reality of women’s and girls’ lives in the developing world to talk about women’s health. This change was a result of the Government’s very welcome launch of the first ever consultation and call for evidence to improve the health and well-being of women in England, designed to use women’s voices and experiences to write a new women’s health strategy. For the first time in years, I pondered a woman’s life cycle in terms of health, and I am grateful for the chance to expand on those thoughts today. What I found then, and again now, brought home to me all too graphically the experience of millions of women at different stages of their lives.

Let us start with puberty. It is a confusing time for any child but it is especially so for girls, who are entering puberty about a year earlier than they did back in the 1970s according to global data of 30 studies on breast development. Studies also show that early menstrual bleeding, the last clinical sign of puberty for girls, is associated with a higher risk of obesity, type 2 diabetes, heart disease and allergies. During this period—excuse the pun—I thank journalist Emma Barnett for her book, Period: It’s About Bloody Time, which asks why we are so uncomfortable talking about, and clam up about, menstruation—girls have their first introduction to expensive sanitary products, starting for many period poverty, which affects their school attendance. Estimates vary, but around one in five women of childbearing age suffers from painful, irregular or heavy periods, many to a truly debilitating extent.

Endometriosis manifests itself around this time as well. It is a long-term condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. The main symptoms are back and stomach pain, increased period pain, pain during or after sex, pain when peeing or during a bowel movement, feeling sick, constipation, diarrhoea, blood in pee and difficulty getting pregnant. There is a seven-year wait to get diagnosed, with 40% of women needing 10 or more GP appointments before being referred to a specialist.

At this age, social media pressure and social contagion start to have an impact on teenagers’ body image, including anorexia and self-harming. Since 2016, there has been a 45% increase in labiaplasty operations, a female genital cosmetic procedure flippantly referred to as “designer vaginas”. This coincides with a time when vulnerable girls are groomed on the internet and the effects of porn not only are felt on their mental health but lead to this irreversible surgical procedure.

I turn to STIs and birth control. Syphilis and gonorrhoea have almost doubled in the past five years in school-age girls. While chlamydia is decreasing thanks to the screening programme, it remains a problem because of the irreparable damage to girls’ fertility and chronic pelvic inflammatory disease. Avoiding pregnancy is still largely seen as a girl’s responsibility. Boys should be taught that using a sheath not only prevents unwanted pregnancies but also reduces STDs for girls.

I now move to the stage of planned pregnancies and hoped-for motherhood. One in four pregnancies ends in miscarriage, and these women feel let down. There is insensitivity and a lack of empathy in healthcare and arrogance among healthcare professionals, mainly male doctors, who will not and do not listen to patients. My friend had six miscarriages and finally visited a male Harley Street IVF doctor, who put her on a standard protocol for getting pregnant despite her arguing vociferously that getting pregnant clearly was not her problem. She got pregnant again and endured another avoidable miscarriage because she was not listened to. She then went to a female consultant and had a live birth on the first round of tailored treatment.

Antenatal care is inconsistent. Every woman should have the option of the same midwife throughout, up to their delivery. I wish my noble friend on the Front Bench today—she is probably very uncomfortable in her last two weeks—luck and an easy, quick birth, although I am afraid that there is no such thing as a pain-free birth. I also wish her access to the pain control that she wants and, ideally, no episiotomy. I am afraid that nothing can prepare her or other new mothers for the post-birth challenges of getting her body back to a reasonable condition, breastfeeding, disrupted sleep and so called “baby blues”, possibly followed by postnatal depression, which affects between 10% and 20% of women.

I come to motherhood next. In the vast majority of cases, women are the lead parent, combining most child- care with work, usually at a greater career cost than the father. This in turn leads to tension at home and often a relationship breakdown, leaving the mother as the major childcare provider, which in turn leads to increased mental health issues—I think other colleagues will talk about this—or the use of drugs or alcohol as crutches, which I think the noble Lord, Lord Brooke, may raise.

I turn to the eventual emptying of the nest, which is another time of stress in a relationship and often comes at the same time as caring for elderly parents. This is close to my heart because last year we lost my mother, whom we lived with, aged 96.

I now move on to the menopause, which is a “big one”. Some 34 years ago, I ran the Amarant Trust, a menopause charity funding ground-breaking research into HRT with the team at King’s College Hospital, which also ran our self-referring clinic. Women attended in droves, largely because of hostile, and in some cases misogynistic, GPs. I was pregnant at that time so my own hormones were in turmoil, although not lacking in oestrogen and the myriad of miserable symptoms that so many women experience at that time. I can still remember the distress that so many patients suffered in silence and how debilitated they were by the onslaught of flushes, sweats, sleeplessness, vaginal dryness, discomfort during sex and problems with memory and concentration.

A couple of years ago, I attended a round table with the then Women’s Health Minister and campaigners. I was astonished to find that the situation for menopausal women is no better than it was all those years ago when I was actively involved. Indeed, 23% of women who visit their GPs with symptoms are prescribed antidepressants instead of HRT. I was one of the lucky ones—I sailed through—but those suffering symptoms should of course be given the informed option of taking HRT, a transformational drug that makes life worth living again for so many women. I give a big shout-out to James Timpson, who wrote in last weekend’s Times of the need to

“stop the menopause hijacking careers”.

One newish MP told me that, before she was prescribed HRT, she thought that she would have to give up her job as an MP because it was impossible for her to do it properly. I am delighted to be a founder member of the new APPG for the menopause and look forward to its forthcoming inquiry.

In between all this, we have a miserable list of prolapses, cystitis and thrush. Although I have been comparatively lucky in my own health journey, the latter two caused hours of itching and discomfort, including of course painful sex. This is not always easy to discuss with a partner.

Then we have the female cancers. Cancer Research’s most recent figures, from 2015 to 2017, report about 75,000 new cases of breast, cervical, uterine and ovarian cancers. The Government’s sustained good work with the introduction of HPV vaccination is very welcome. Since then, infections of HPV in 16 to 18 year-old women have reduced by 86% in England. Considering that around 80% of all cervical cancers are caused by HPV, we hope for big reductions in that cancer in the years to come, but let us keep the pressure on for improving the treatment and life expectancy of women suffering these diseases.

I turn to the final countdown, once we have passed the period of caring for aging parents and the move towards osteoporosis, leading to life-changing fractures caused by brittle bones, and then finally dementia.

Even with the generous 12 minutes that I have today, I can only touch the surface of women’s health issues. I pay credit to Health Ministers for taking our problems seriously and, in particular, to Nadine Dorries for driving this agenda, and whose own personal challenge with having an IUD fitted 36 years ago—which in the end she failed because of the intensity of the pain—was laid bare in the Daily Mail earlier this week. Many women are unable even to have a cervical smear because of the agony, but they now feel emboldened to speak out because of other women talking publicly, including the campaigner Caroline Criado Perez.

I am not alone among women in wondering whether, if these debilitating conditions afflicted men, better treatments would have been found by now. Less than 2.5% of publicly funded research is dedicated solely to reproductive health, despite the fact that one in three women in the UK will suffer from a reproductive or gynaecological health problem. There is five times more research into erectile dysfunction, affecting 19% of men, than into premenstrual syndrome, which apparently affects 90% of women.

Women are underrepresented in clinical trials even though biological differences between males and females can affect how medication works. The general assumption is that women do not differ from men except where their reproductive organs are concerned, and data obtained from clinical research involving men is simply extrapolated to women. This has important implications for health and healthcare. I understand that over 100,000 women have responded to the Government’s consultation and that they are currently unpacking the data. On behalf of women everywhere, I thank the Government for the initiative and for the forthcoming sexual and reproductive health strategy.

Noble Lords may not be aware that instances of domestic abuse increase by 26% when England play football and by 38% if they lose. So those who may not be looking forward to Sunday’s game will be especially welcoming the actions that the Government are taking on violence against women and girls.

I look forward to hearing from my noble friend the Minister about how these initiatives will improve life for millions of women who are suffering in at least some of the ways that I have described today.

--- Later in debate ---

[Baroness Jenkin of Kennington (Con)]

My Lords, I thank all noble Lords who have participated in this debate and used such a wide variety of their experience to educate us and to plead their different causes—particularly the seven male noble Lords who have supported us. I rather like the idea of it being the seven ages of woman; I will stick with that one. I particularly thank my noble friend the Minister, not only for his comprehensive reply to us today but for his deeply moving description of his and his mother’s experiences. I challenge anyone not to have a lump in their throat hearing this very moving story. He has always been a great supporter of women and of the causes I have supported, and I am extremely grateful to him for that.

I will touch on a couple of the topics we have discussed; they have all been run through by other noble Lords. Like the noble Baroness, Lady Ritchie, I have participated in a clinical trial; it happened to be about endometriosis. I have no idea whether the drug we were testing is currently on the market, but it was a very long time ago so the answer is probably not yet. One of the lessons Covid has perhaps taught us is that clinical trials can be sped through and happen more quickly than we originally thought. I am very glad that other noble Lords raised this as an issue.

A number of noble Lords talked about mental health. The fact that so many people talked about it made us aware of what a big issue it is. Although the noble Baroness, Lady Cumberlege, is not with us today, I suspect that a large number of people—probably more people than are listening to this debate—heard her on the radio this morning. I was very struck by the dignity of the victims: the mother of one victim spoke particularly eloquently and with such dignity about her experience.

A number of noble Lords talked about Sir Michael Marmot and his work on inequality. It is a massive wake-up call for all of us, and the theme of inequality is so clear in the work that he does. It is tempting to think that this debate has been a rather miserable litany of bad experiences, but I think it was my noble friend Lady Bottomley who said—as the Minister has just said—that there have been massive improvements in so many areas. We must not forget that.

I return to the point I mentioned at the beginning. I changed my usual topic of International Women’s Day, but the noble Baroness, Lady Nicholson, raised the hideous plight of so many women across the world. We must remember to count our blessings that we live in such a wonderful country, where we have access to healthcare that is so much better than in so many places across the world.

I will end by again wishing my noble friend Lady Penn good luck. With her typical efficiency, she is actually due on the day we rise, two weeks today—and with her typical efficiency, she will probably have the baby on that day or the day after.

I know the Government are serious about this agenda, and they know that we will be watching them.

Motion agreed.