Obesity

Diane Abbott Excerpts

Wednesday 9th November 2011 Westminster Hall

[Dr Wollaston]

I thank the Minister for that helpful response and look forward to hearing the outcome of that.

Children at primary school and in the early years before they have reached school are among the really high-risk groups. Some 85% of obese children go on to become obese adults, whereas only 12% of normal weight children become obese adults, so it makes sense to focus on that group of children, but that can happen only if we have better early identification. We should introduce annual measurements of weight and height, so that we can see when children are starting to slip towards obesity. We should target our resources much better on that group.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Years ago, parents with chubby children would be told, “It’s puppy fat and they will grow out of it.” There is still that idea around among otherwise bright and responsible parents. We need to press the point that chubby children grow into chubby adults.

[Dr Wollaston]

I absolutely agree with the hon. Lady. We need to be much clearer with parents that their children are at risk and that being overweight is not something that they will grow out of.

We should be much more creative about how we target help to high-risk children. Why not allow all those children to have free healthy school lunches? As poverty and deprivation have such strong links with obesity, considering that high-risk group is particularly appropriate if we are to address the Marmot agenda. Unfortunately, families on tight budgets are much more likely to be pushed towards unhealthy and cheaper choices. If we want to nudge them in the right direction, we must recognise the role that price plays in the choices that they make. We should look at the role of loss leaders. We urgently need a change in what supermarkets offer so that loss leaders are redirected towards healthy rather than unhealthy products.

Why not incentivise exercise in those high-risk families with vouchers for success and free access to good-quality sports facilities? We should incentivise a whole-family approach to cooking skills because cooking is a fun activity. An effective way forward would be to make such a service free and readily available to whole families.

On liquid calories, a survey conducted by the British Dental Association and Ipsos-MORI showed that 47% of children’s fluid intake is in the form of sugary and carbonated drinks. That means that one in five children is consuming 500 calories or more a day just in the form of sugary drinks and 73%—nearly three-quarters of children—are consuming more than 200 calories a day. It is a staggering number of calories that children are consuming.

If we look at adults, we will see that there is a particular issue with alcohol. The chief medical officer has already highlighted that around 10% of an adult’s calorie intake can be through alcohol. What we should understand from that is the role that discounting plays. I have mentioned that before. It really does not matter how disciplined the rational part of our brain tries to be—the irrational and impulsive side will continue to be irrational and impulsive. It is not helpful to see heavily discounted products in super-sized multi-buy packs piled high at the check-outs in supermarkets. If we want to move “nudge” towards “shove”, we should regulate how supermarkets market their products. I do not suggest that the whole answer to obesity lies in regulating supermarkets. I realise that there is a complex interplay between over-supply, pricing, culture, marketing, poor consumer choices and human nature. There is also the interplay between genetic predisposition and a lack of exercise. However, it is unlikely that our current strategy will go far enough in this regard. If we are going to do something about the £5 billion a year that this problem is costing us—the figure is predicted to rise to £10 billion a year by 2050—I suggest and hope that the Minister takes a strong line and abandons the idea of giving the problem a little nudge, in favour of giving it an almighty shove.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing this important debate, to which we have all been glad to contribute. He reminds us of how many issues we have in common in these British Isles.

I want to focus on the important subject of child obesity, and to talk about the responses so far to the Government’s obesity strategy entitled “Healthy lives, healthy people: a call to action on obesity in England”, which was presented to both Houses on 13 October. First, however, I want to say that some people might feel that Members of Parliament have a certain temerity talking about healthy lifestyles when their own lifestyle is relatively unhealthy, and I speak as someone who has been in this House for 20 years. Perhaps we should give credit to the few colleagues we sometimes see going through the Division Lobby dressed in their running gear after a bracing run. I am sure that Members will unite with me in congratulating those rare Members on that.

We are facing a crisis in childhood obesity. As I said earlier, gone are the days when we could look at a chubby child and say that they would grow out of it: chubby children grow into obese adults. I have to say, more in sorrow than in anger, that a wide range of people both inside and outside this House have expressed doubt about the effectiveness of the Government’s obesity strategy. Before moving on to what I think the Government should be doing, let me focus on the picture in London.

London has higher levels of childhood obesity than any other British region. The capital’s childhood obesity rate is 22%, compared with an average for England as a whole of just 19%. Across the capital, one in five youngsters are obese, with rates varying widely from 12% in leafy Richmond to 28% in Westminster. Childhood obesity costs the capital £7.1 million a year to treat, and the annual bill could reach £111 million if today’s young people remain obese into adulthood.

Research commissioned by the Greater London assembly found that adult obesity costs London £883.6 million a year, and in my own constituency—Members will forgive me for mentioning it—a quarter of all year 6 pupils are obese. That is one of the highest rates in the country as recorded by the national child measurement programme. In 2010 in City and Hackney, 13% of children in reception year were overweight and 14% were obese. The number of overweight children was similar to the national average, but the proportion of obese children was slightly higher. Greater efforts are needed to prevent overweight and obesity at the pre-school stage, because a high proportion of children are already obese and overweight by the time they start school. The escalation of the trend through to year 6 suggests that we also need to implement robust interventions in primary schools.

A number of Members have talked about parental responsibilities. I put it to colleagues that some of the parents who are doing what we might understand as the wrong thing are, in their own minds, trying to be good and vigilant parents. One of the problems that young children in Hackney and the rest of London have is their sedentary lifestyle, and part of what motivates parents to keep their children indoors is this idea of stranger danger. We all know that attacks on children have not gone up in 20 years, but childhood obesity has spiralled. Many parents—not bad or careless ones—think that they are doing their children a service by keeping them indoors, safely watching television or playing on the PlayStation, rather than playing outside.

I was not the most sporty of children, unlike some of the Government Members who have contributed to the debate, but in the summer holidays my mother thought nothing of us having breakfast and then going out to play all day. We might have come in for lunch, or have gone to a friend’s and come back for tea. Nowadays, no London parent would allow their child to play out all day without knowing where they were, and it is that sort of vigilance and possibly unwarranted fear of stranger danger that leads to many thoughtful parents deciding, perhaps because they have not had the education or do not have the understanding, that they will feel better if their children are indoors rather than outside playing.

Let us also remember that in a big city such as London a greater proportion than ever of our children live in flats, maisonettes and other accommodation without a back garden. As a child, if I was not out, I spent most of the day in the back garden, on the swing, climbing trees and shouting at my brother, but many children in my constituency are trapped in flats and it is not obvious to their parents where they can be allowed to play safely.

[Andrew Bingham]

That is a good point. We talked briefly about video games. Does the hon. Lady think that the advent of Wii Fit-type games is beneficial? I have seen young people playing them, and they involve a lot of jumping around and so on, which I suppose is a form of exercise, at least.

[Ms Abbott]

Far be it from me to advertise any particular product in this Chamber, but Wii Fit games are perhaps better than PlayStation games.

[Mr Simon Burns]

I have been listening carefully to the hon. Lady, who is making some valid points. The danger has to do with not simply the age of computer games but the age of television before that. For some parents—this is a generalisation—the easy option is to let their children spend hours watching television or playing games, because it involves less effort on the parents’ part. One must try to educate people that that is not only an easy option but an unfair one.

[Ms Abbott]

I am loth to agree with the Minister, but I think that he is right on that point. A particular interest of mine is the education of urban children and the challenges of getting them to achieve their educational potential. As part of working with parents, especially in urban communities, we must teach them that just putting their children in front of a television set is not necessarily the best thing for their health or their education.

I agree entirely with what has been said about exercise and sport, but we also need a particular focus on girls and exercise. Statistics show that girls give up exercise younger; after they leave school, they do not continue to exercise, as boys do. I was interested to hear about, was it ice hockey—

[Justin Tomlinson]

It was an ice-skating disco on Friday nights.

On the point about getting more girls involved, that is why I proposed merging youth and leisure services to identify opportunities. Girls, in particular, follow what is on television. If street dance, cheerleading or football is popular, let us provide those services and facilities, and they will come flocking.

[Ms Abbott]

I agree. That is the point that I was going to make. We need to be more innovative in the sorts of game that we encourage and make available to children. Girls do not want to play ping-pong, because they are quite self-conscious physically, but they will do things such as breakdancing and ice skating.

As other Members have said, we have a generation of parents, especially in inner cities, who do not know about food, have only the dimmest idea of where some foodstuffs come from and do not know how to cook. Because they are bombarded by advertising for processed food, when they whip out a ready meal from Marks and Spencer, it is not just idleness; they think that they are being good parents: “Look, I’m getting you something from Marks and Spencer which is advertised on the television.” We should work with communities and parents to educate them.

In my view, the Government obesity policy’s reliance on responsibility deals is a little problematic. Common sense suggests that companies that make billions of pounds every year peddling fizzy drinks and foods larded with trans fats will not seriously undermine their profits by genuinely trying to change the public’s eating habits. Although we must applaud the Government for whatever progress they think they have made with responsibility deals, we must go beyond them as they are currently fashioned if we are to stop the epidemic of obesity among our young people.

To return to the Government’s obesity strategy, the message from health professionals, key health groups and experts is clear. We need tough action now and a proper long-term strategy to stem the rising tide of lifestyle-related diseases. Jamie Oliver, probably the single most famous person in public health, has said in the past few weeks that this Government’s obesity strategy is

“worthless, regurgitated, patronising rubbish”.

As usual, he was not pulling his punches. Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said that the Government’s plan

“has no clear measures on how the food and drink industry will be made to be more ‘responsible’ in their aggressive marketing of unhealthy food…Suggesting that children in particular can be ‘nudged’ into making healthy choices, especially when faced with a food landscape which is persuading them to do the precise opposite, suggests this would be best described as a call to inaction.”

Which? executive director Richard Lloyd said that the Government’s approach to tackling obesity was

“woefully inadequate…The Government calls on people to cut down the calories they eat, but isn’t giving them the tools to do so.”

Charlie Powell, campaigns director of the Children’s Food Campaign, said:

“This is a deeply disappointing and utterly inadequate response which represents a squandered opportunity to address the UK’s obesity crisis.”

There is broad agreement in the House about the issues that we must address. It is a mix of issues; there is no silver bullet. Better labelling of food, including in restaurants and cafés, is part of the answer. Fashioning a sport offer for young boys and girls is crucial, as is better education and working with parents and communities.

I would like to say a word about gastric bands. We read an enormous amount about them, particularly in relation to celebrities. As a Conservative Member said, there are cases, if people have tried everything else, where a gastric band might be the answer, but I deprecate the promotion of gastric bands without some of the measures that we have discussed if that suggests to people that they can eat whatever rubbish they like because, at the end of the day, the NHS will pick up the tab for a gastric band. That is not the way forward, either for costs in the NHS or for people’s quality of life. I have read about people who, having got gastric bands, proceeded to liquidise fish and chips so they could continue to enjoy their favourite junk food. That suggests that a gastric band, in itself, is not the answer to the underlying issues.

I hope that, in his winding-up speech, the Minister will address the serious concerns raised about the Government’s obesity strategy by a wide range of stakeholders and specialists. I look forward to hearing what the Government plan to do further to address the growing epidemic of obesity among our young people.

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to serve under your chairmanship, Mrs Riordan, during this extremely interesting and thoughtful debate, to which there have been a number of erudite and imaginative contributions across the range.

I congratulate the hon. Member for East Londonderry (Mr Campbell) on securing the debate and giving us the opportunity to discuss one of the major public health issues of modern times. He has spoken repeatedly on the subject in the House and should be congratulated on doing so. He knows, of course, the scale of the problem. Most adults in England, 61%, are overweight. Sadly, one third of those are clinically obese, giving us one of the highest obesity rates in the world. As for children, almost a quarter of four to five-year-olds are overweight or obese, rising to one third in 10 to 11-year-olds. I am sure that we all agree that those figures are genuinely shocking. The hon. Gentleman will be aware that the scale of the problem in Northern Ireland, to which he alluded during the course of his remarks, is similarly daunting, with 59% of adults and 22% of children overweight or obese.

As recently as the 1980s, obesity rates among adults were a third of what they are now. Although figures for the last few years show that levels of obesity may be stabilising, that is simply not good enough, because excess weight has serious consequences for individuals, the NHS and the wider community. Not only does it cause day-to-day suffering such as back pain, breathing problems and sleep disruption, but it is a major risk factor for diseases that can kill. An obese man is five times more likely to develop type 2 diabetes, three times more likely to develop colon cancer and two and a half times more likely to develop high blood pressure than a man with a healthy weight, and women face equally serious risks. That is not to mention liver disease, heart disease, some cancers and miscarriages, all of which are linked to excess weight.

Although the real and present danger of obesity in terms of immediate health risks is seen largely in adults, obesity also has significant effects on children and young people, as many hon. Members have mentioned. Obese children are likely to suffer stigmatisation, and there are growing reports of obese children developing type 2 diabetes. We also know that if a child is obese in their early teens, there is a high chance that they will become an obese adult, with related problems later in life.

As waistlines expand, so does the amount of money that we spend on the issue. As a number of Members have said, excess weight is a burden of approximately £5 billion each year, and costs billions more through days of work and incapacity. Neither can we ignore the link between obesity and health inequalities. Data from the national child measurement programme show a marked relationship between deprivation and obesity. The Marmot review in 2010 showed the impact that income, ethnicity and social deprivation have on someone’s chances of becoming obese. As things stand, the less well-off a person is, the more likely they are to be carrying excess weight, so we are talking about an issue of social justice, as well as a narrow health issue involving exercise and healthy living.

The hon. Members for East Londonderry and for Hackney North and Stoke Newington (Ms Abbott) both asked, in effect, whether the Department of Health should work with companies that produce and sell products that contribute to the nation’s obesity and alcohol problems. Up to a point, it is the responsibility of the individual how much they consume and what they consume. How do we make sure that people know what they are eating—the calorie, salt and fat content and so on? To my mind, that means clear, easily understandable labelling, and education about what is healthy and what is the best approach.

On the narrow point of the issue mentioned by both hon. Members, improving the health of the public is clearly a priority for the Government, but we need a whole-society approach to tackle the health problems caused by poor diet, alcohol misuse and lack of exercise. To change people’s behaviours, we need to make the healthier choices the easier choices for everyone.

Commercial organisations have an influence on and can reach consumers in certain ways that Governments cannot. They have a key role in creating an environment that supports people to make informed, balanced choices that will enable them to lead healthier lives. Through their position of influence, they can address some of the wider factors that affect people’s health, such as how healthy our food is and how easy it is to access opportunities to be more physically active. Through the work on the public health responsibility deal, despite what the hon. Member for Hackney North and Stoke Newington has said, we are tapping into that unrealised potential to help improve the public’s health.

[Ms Abbott]

rose—

[Mr Burns]

I will give way in a moment. It is also important to say that, if we can get an agreement with commercial companies to change the way they behave and some of their practices, it will be far quicker to achieve that and put it in place than to wait for the heavy hand of Government legislation, which can take a minimum of a year and sometimes years. Why wait for the heavy hand of legislation that might take a long time, if we can get a voluntary agreement that will work quicker and more effectively to start dealing with the problem?

[Mr Burns]

I will give way to the hon. Member for Hackney North and Stoke Newington first, because I promised her, then my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), and then I will make progress.

[Ms Abbott]

On changing commercial practices, when will the Government do something about the practice of so many supermarkets whereby they place rows of sweets next to the checkout? If a parent has fought off their children and not bought sweets on their way around the supermarket, the children then have 10 minutes to whine while the parent waits to pay for their shopping.