Childhood Obesity Strategy

Geraint Davies Excerpts

Thursday 21st January 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House calls on the Government to bring forward a bold and effective strategy to tackle childhood obesity.

I want to thank the Backbench Business Committee for granting time for this debate. I also want to thank all my colleagues from across the House who are members of the Health Select Committee—and the staff of the Committee, particularly Laura Daniels—for their work on the report on childhood obesity that was published recently. Outside this House, there are also many organisations and individuals who have campaigned tirelessly to improve children’s health.

Perhaps we can start by looking at the example of Team GB and their success in the Olympics. On the morning of their track cycling victory, the architect of the team’s success, Sir David Brailsford, put their success down to the principle of marginal gains and their relentless pursuit of identifying every efficiency in the rider, the bike, the environment around them and their training regime. All those marginal gains were added together to win gold for Team GB in the Olympics. I think we need to adopt the same principle when it comes to tackling childhood obesity.

Too often, I hear people saying that it is all about education, or about getting children to move more in PE at school, but I would say that there is no single measure. We all know that this is an extremely complex problem that requires action at every level. I therefore call on the Minister to look at every single aspect of tackling childhood obesity. If we were running a cycling team hoping to win the Olympics, we would realise that we could not achieve success if we left any of the factors out, so let us apply that principle here.

Let me set the scene by telling the House why this subject matters so much. We know from the child measurement programme in our schools that around one in five of our children who enter reception class are either obese or overweight. However, by the time they leave in year 6, a third of our children are either obese or overweight. Perhaps even more worrying are the stark data on the health inequality of obesity. A quarter of the children from the most disadvantaged groups in our society are leaving school not just overweight but obese, which is now more than twice the rate among children from the most advantaged families. My first question for the Minister is this: will the childhood obesity strategy not only tackle the overall levels of obesity but seek to narrow that yawning and growing gap in our society between the least and most advantaged children? Any strategy that fails to narrow that gap will have failed our children.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Does the hon. Lady agree that some of the overall problem can be explained by the fact that people do not know how much sugar is in their food? She will know that women are supposed to have no more than six spoonfuls a day, and men no more than nine. Only today, when I was in Portcullis House, I bought three items: a Snickers bar, which has five spoonfuls of sugar; a yoghurt with seven spoonfuls; and a Coke with nine. She will be glad to hear that I did not eat any of them; perhaps I was just removing them from other people. Does she agree that an awareness of how much sugar we are eating is very important if we are to manage our diets?

[Dr Wollaston]

Indeed. I completely agree with the hon. Gentleman, and I shall come on to that subject later. I am relieved to hear that he is not on a sugar high for the debate.

I want to set out not only the scale of the problem but its consequences. It has consequences for the whole lifetime of our children, in relation to their physical and emotional health. They also suffer the impact of bullying at school, as they are too often stigmatised in the classroom because of their weight. There is increasing evidence that obesity is a factor in causing many preventable cancers, and it also has an impact on conditions such as diabetes and heart disease. This has a cost not only to individuals but to wider society and to the NHS.

The Minister will know how essential it is that, as part of the “Five Year Forward View”, we tackle the issue of prevention. We cannot do that without tackling obesity, particularly among children, given the lifetime impact and consequences of the condition. She will know that 9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence that the Health Committee took during our hearings that the overall cost of obesity to the NHS is now £5.1 billion a year, and the wider costs to society have been estimated to be as high as £27 billion, although the estimates vary. We simply cannot afford to take no action.

Physical activity is of course extraordinarily important and I am confident that it will feature strongly in the Government’s strategy, but it is no good focusing solely on that. Physical activity is good for children, whatever their weight. Indeed, it is good for all of us, whatever our age. However, any strategy that assumes that we can tackle childhood obesity solely through physical activity will simply be ignoring the overwhelming evidence that most of the gain will be in reducing calories. That is not just about sugar, however. It is easy to be accused of demonising sugar. The fact is that children have more than three times the recommended amount of sugar in their diet, but that is perhaps the easiest aspect of the problem to tackle. The Minister will recognise the fact that we are talking about overall calories, which also include fats.

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[Dr Wollaston]

I thank my hon. Friend and fellow member of the Health Committee for her intervention. At a time of shrinking public health budgets, there is a huge additional benefit from having this kind of levy, in that many of the other measures that the Minister will want to see in the strategy—on exercise in schools, teaching in cookery lessons and health education—could be funded in part through a sugary drinks tax. I hope she will look carefully at this idea and consider introducing it.

[Geraint Davies]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is meant to be a 15-minute opening speech. Mr Davies will want to speak and he will not want me to take any minutes off him, so I am sure this will be a very quick intervention.

[Geraint Davies]

The debate is often between reformulation and tax. I agree with the tax on fizzy drinks, but if we had a tax on overall sugar input—for the sake of argument, let us suppose that sugar makes up half a Hobnob and the tax is at 10%—that would give an incentive to the manufacturers to reformulate without the price going up and we could get the sugar content down.

[Dr Wollaston]

I thank the hon. Gentleman for that, which brings me on to reformulation. It should also form a core part of the strategy. Our view was that we should have a centrally led programme of reformulation across foods and drinks, and that what manufacturers want is a level playing field. The trouble with reformulation is that it takes time; there has been an effective programme on salt, but that has happened very gradually, over a 10-year period. There is no reason why these things should be mutually exclusive; I come back to that point about marginal gains and say let us do all of the above. I know that the Minister is looking closely at reformulation and understands how powerful it will be. The evidence we heard was that it could take 6% of the sugar out of children’s diets. Reformulation, alongside other programmes, will play a part, but it will not work on its own and, unfortunately, it will take longer.

We also need to examine the pervasive effect of marketing and promotion. Do I want to have a kilogram of chocolate for almost nothing when I buy my newspaper? Of course I do, but please do not offer it to me. Please do not make me walk past the chicanes of sugar at the checkout or when I am queuing to pay for petrol. We know that 37% of all the confectionary we buy is bought on impulse. It does not matter how much we are intending not to buy it, if it is presented to us on impulse, we buy it, as impulse is an extraordinarily powerful driver. I therefore hope that any strategy will tackle that part of consumption, along with portion sizing. The supersizing of our society is in part down to the supersizing of portions and offers. All of this needs to be included in our approach, as does dealing with advertising. This advertising is pervasive and it is hitting our children everywhere they go, on television, online and through the influence of “advergames”. We know that this is very powerful in driving choices for children, so I hope the Minister will look carefully at that. She will have seen our recommendation of a watershed of 9 pm.

Time is running short, so I shall close my remarks, as I know other Members will want to cover many other aspects, such as exercise, the effect of what local authorities do, how much more powerful they could be in their roles if we gave them greater planning powers, and so on. Early intervention, research, education, teaspoon labelling—please do it all. We need a bold, brave and effective strategy, and we need to learn from British cycling and the law of marginal gains.

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[Will Quince]

My hon. Friend makes a very good point, and I will come on to that in a bit more detail. The important element is that any approach we take must be evidence-based. I absolutely agree with her that we need to look at all the evidence.

I stated that the proportion of those aged two to 10 who were obese had gone from 17% in 2005 to 13% in 2013. The evidence suggests that childhood obesity rose quickly in the mid-2000s and has slightly fallen ever since. That is an important fact for two reasons. First, it suggests that our education programmes in our schools and the Government-backed campaigns on obesity within the last decade have had a positive impact in halting the increase in childhood obesity. Secondly, it undermines the scaremongering that suggests that childhood obesity is rocketing year on year. It simply is not; the reality is much more complex.

As my hon. Friend the Member for Totnes has already mentioned, there is a growing clamour for a sugar tax on soft drinks to combat childhood obesity. She has called in a recent article for a 20% tax on sugary drinks as part of that overall solution. Her calls have been echoed by the British Medical Association and other public health campaigners. I have huge respect for my hon. Friend, but I think that a sugar tax is completely the wrong answer. A sugar tax is illiberal and patronising —in my view, nanny statism at its worst.

Given how sugar tax campaigners argue, one might think that consumption of sugar in the UK is at a record high. It is not. Consumption of sugar per head in the UK is falling, from a high of more than 50 kg a year in the 1980s to less than 40 kg a year now. What is more, soft drink consumption in the UK is falling. The latest household food survey from the Department for Environment, Food and Rural Affairs shows that household soft drink consumption purchases have fallen by 5.2% since 2011 and by 19% for high-calorie soft drinks in the same period. Regular soft drink purchases are now at their lowest level since 1992.

[Geraint Davies]

Does not the hon. Gentleman agree, though, that a sugar tax would be eminently fiscally responsible? It would gather revenue, increase life chances, increase health and reduce health costs. From the point of view of the Exchequer, it would be very sensible. Can he not come up with other sensible ideas like that?

[Will Quince]

The hon. Gentleman makes an important point and, of course, that would make sense if the evidence suggested that a soft drink tax implemented anywhere else in the world had actually worked and had the effect that he suggests. He is right to suggest that there are a lot of other measures that we as a Government and that businesses and organisations can take to address this issue; I do not believe that the sugar tax is the right one.

Sugar tax advocates have pointed out the introduction of a sugar tax in Mexico and the corresponding 6% decline in soft drink sales since the tax was introduced. However, research in The BMJ does not show evidence of a link between the introduction of the tax and the small decline in soft drinks consumption. Further taxes on non-essential energy dense foods were also introduced at the same time as the sugar tax, and they accounted for a higher proportion of Mexicans’ daily calorific intake. As the authors of the research admitted,

“we cannot determine the independent role of each”

of the taxes. The research even acknowledges that there is a lack of information on nutritional data for packaged drinks in Mexico, which means that researchers cannot see what the fall in soft drink consumption meant for a decline in sugar intake.

As many Members may know, Mexico does not have safe drinking water. As a high-profile advocate of the sugar tax in Mexico, Alejandro Calvillo, stated:

“We know that there are people who drink a lot of sodas and they don’t have access to drinking water.”

How can we possibly compare the results in a developing country that has unclean, unsafe drinking water with how a tax might operate here in the United Kingdom? Instead, let us compare like with like. When sugar taxes have been tried in developed nations such as France, they have had a negligible effect on reducing consumption. Denmark scrapped its sugar tax on soft drinks in 2014 and labelled it an expensive failure. The Danish Ministry of Taxation labelled food and drink taxes as

“misguided at best and may be counter-productive at worst”.

They even described it as an expensive liability for business, and, as we all know, a sugar tax would be a very bitter pill for British businesses to swallow.

Study after study on soft drinks taxes in the USA also shows that they have a negligible impact on sugary drink intake and calorie consumption. What is more, the small decline in sugary drinks is almost entirely offset by consumption of other sugary products.

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[Geraint Davies (Swansea West) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Mid Worcestershire (Nigel Huddleston). I agreed with everything he said, including his disagreement with the hon. Member for Colchester (Will Quince). I also agree with the points made by the hon. Member for St Austell and Newquay (Steve Double). We are both members of the SAS—Surfers Against Sewage, that is, before people get the wrong idea.

I congratulate the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), on introducing this debate. As she will know, I have been active in this area, not least in the Sugar in Food and Drinks (Targets, Labelling and Advertising) Bill, which has its Second Reading tomorrow. The Bill basically asks for sugar labelling because people do not realise how much sugar they are eating. As I said earlier, this morning I bought three products from Portcullis House: a can of Coke, which has nine spoonfuls of sugar, the daily limit for a man; a container of yogurt, which has seven spoonfuls, more than a woman is allowed; and a Snickers bar, which has five spoonfuls.

The reason for a focus on fizzy drinks, other than the reasons set by the Chair of the Health Committee, is that they represent a very large proportion of the overall sugar intake of children, and so they represent an easy big hit, early on. There was a trading of statistics about the efficacy of sugar taxes, but we need only look at the elasticity of demand for fizzy drinks. Part of my background is in marketing products in multinational companies—not these products. I was the marketing manager for Colgate, for example. People have talked about the impact on teeth. When I was at Colgate, we thought that with the advent of fluoride we were going to see the end of tooth decay. However, there has been such a big increase in the consumption of fizzy drinks through focused marketing, that we have turned the corner and gone into reverse, and people’s teeth are dropping out. The point about marketing aimed at children highlights some of the demographic differences in the impact of sugar, because high consumers of television tend to be less well-off people who pick up brand awareness from watching it and then follow those brands.

I am in favour of labels noting the number of spoonfuls of sugar. I know that the Minister will say that there are issues with packaging in Europe, but my understanding is that, while there is a European competence, we have a national opportunity to do our own thing, and that is what we should do. Jamie Oliver and the Health Committee are following up on that. Retailers could put pressure on manufacturers to take voluntary action, but, sadly, even though retailers claim they are doing so, they are not taking proper responsibility, certainly not on cola drinks, which is a massive problem.

At one point in my distant past, I promoted the School Meals and Nutrition Bill. Its suggestions that Ofsted should be required to audit nutrition in schools and to get rid of unhealthy vending were agreed. I also still stand by its suggestion to gate children in schools so that they could not run to McDonald’s or elsewhere at lunchtime.

Obesity is costing the economy about £47 billion a year. This is not just about diabetes and the cost to the NHS, which is terribly important; the overall economy is suffering. Members have mentioned bullying in school, but obesity also has an effect on people’s quality of life. It is uncomfortable and those who are obese live shorter lives. If people know that one jar of pasta sauce has six teaspoonfuls of sugar and another has three, they will be able to make a rational choice; otherwise they will pick the one that is sweeter. The mechanisms available are simple. Members have also mentioned the need to encourage exercise, which is clearly very important.

On the main thrust of the debate, I agree with a fizzy drinks tax, but I want us to move towards an ingredient tax, which would mesh into the reformulation. Professor Graham MacGregor, who is now working with Action on Sugar, has been instrumental in getting the salt content down through reformulation. As I have said, if a 10% tax is put on a Hobnob, for example, the producer could reduce the amount of sugar and the price would not go up.

There are concerns about regressive taxation. The sad fact is that poorer people find it more difficult to afford fresh foods. People pooh-pooh that argument, but if various products are mashed up with sugar, salt and fat and then frozen, they will stay on the shelf for months on end. However, if produce has to be sold within a week because it is going to decay, it will be more expensive, which causes problems. There is a case to be made for taking the revenues from the tax and hypothecating it to provide easier access to fresh foods for people with less money. As well as putting up the prices of sugar-rich products, we need to provide information. We have a battery of opportunity to confront this difficult task.

It has been suggested that multinationals have been helping. Such companies are rational, focused and see the lie of the land. They know that people have cottoned on to the fact that sugar consumption is costing the country an arm and a leg, sometimes literally. Productivity is down and costs are up, and they know that the Government will ultimately take action, so they are following a rational trajectory. We need to encourage them to do so.

We have heard stories about elasticity of demand before. As every economist knows, when the price is put up, demand goes down. That is not a point of argument. Certain manufacturers used to say that there was nothing wrong with smoking. We know there is a problem with sugar. The emerging science suggests that if, for example, I and the hon. Member for Colchester both consumed 2,000 calories a day but I took in more sugar than him, over time I would develop a predisposition that meant that more of the calories I consumed would settle as fat. I would then feel hungry and listless and become obese. There are, therefore, other issues associated with sugar consumption.

The World Health Organisation has said that the sugar calorie intake should be 5%. Those of us here know that that means six spoonfuls for women and nine spoonfuls for men, but people out there do not realise how much sugar they are supposed to have, and even if they did they are not able to calculate it. Public Health England has produced an app that enables people to scan products with their phone to find out how many cubes of sugar they are consuming. It is difficult to calculate how much sugar is in one chunk of chocolate and in the bar as a whole. It would be better if it was all clearly labelled, without having to go through that process. The app is helpful and I welcome it, but it is not a serious solution.

[Dr Tania Mathias (Twickenham) (Con)]

I concur with the hon. Gentleman on labelling. Does he agree that, whether we label a chocolate bar or fruit, we need information on sucrose, glucose and fructose? We need to know how many of those chemicals are in everything we consume, including fruit.

[Geraint Davies]

I agree that people should be aware of that. My big beef, as it were, is that people do not know how much added sugar they are consuming. For instance, they do not know if there is twice as much sugar in one jar of pasta sauce than another. People need to know how much sugar they are taking in. To a certain extent, people prefer naturally occurring sugar in bananas and similar products, but I agree with the hon. Lady that people should know what they are eating.

The manufacturers argue that they have done everything they can. The back of a packet of Frosties has all the information, so long as people have a PhD and a lens through which to read the data. Products are packaged in such a way as to give the impression that they are healthy. The Bill that I am promoting tomorrow argues that products should not be allowed to be promoted as low fat when they are in fact high in sugar, because people infer from that that they are healthy. It also proposes an overall, aggregate sugar target—similar to a carbon target—so that the Government can see how much sugar we are consuming overall and gradually manage strategies to get it down.

[Dr Tania Mathias (Twickenham) (Con)]

May I join other Members in applauding my hon. Friend the Member for Totnes (Dr Wollaston) for securing this important debate? I did not come across paediatric type 2 diabetes when I was a medical student. Perhaps her experience was similar to mine. Like many people, I was shocked to find at the turn of the century that there were instances in this country of childhood type 2 diabetes. There are now more than 100 cases a year in this country of that incredibly serious condition. Just a few months ago, a three-year-old in America was diagnosed with type 2 diabetes. The treatment involved decreasing the weight of the child, who was obese.

I believe that the Minister’s strategy should be cultural. The papers show that more evidence is emerging and it is prescient. It involves not just genetics, but nurture. Studies of children who have been adopted by obese parents show that there is a risk that they will have childhood obesity.

On culture, I, like others, have seen many households with a TV room but no dining room. Families do not eat at a dining table in the same way as previous generations did. Members have talked in depth about the cultural change relating to exercise. I applaud the head of St Ninians in Stirling, who introduced a 1-mile-a-day idea for the primary schoolchildren. Interestingly, obesity levels on entry to the school are not as high as those in other schools; the figure a few years ago was one in 10. There is now an association—we are not talking about causation—between the 1 mile a day and pupils leaving St Ninians without being obese. That lady has rightly been given Pride of Britain awards. I want that culture change to continue and for the House to applaud it.

At the moment, I am not in favour of new taxation. In our culture, we can access such information. I absolutely agree with what everybody has said about better labelling, and we need more of it. However, as I said to the hon. Member for Swansea West (Geraint Davies), we need information about all the foods we eat—about fruit and vegetables, as well as about fast food. There is a debate about using sucrose as opposed to fructose, but we need to be aware of all such chemicals. In our culture today, we can give people that information. I would like to have such information myself.

As we get more evidence, the treatment and management of, as well as education about, childhood obesity will rise to the levels available for adult obesity. For many people, the concern is not about the obesity itself, but about its medical consequences. An obese adult who goes to their GP can look at the algorithm or the chart, and discuss the five or 10-year risk of their developing cardiovascular problems. If we give parents such information about their child, they will, in time, change their family habits. They do not want their child to have an increased five or 10-year risk of cardiovascular complications.

[Geraint Davies]

On that basis, does the hon. Lady advocate removing the tax on cigarettes?

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[Mrs Drummond]

That is exactly what I was going to come on to, so I thank the hon. Lady very much indeed.

Last week, I met Home Start, a national family charity with a strong presence in Portsmouth. It has an army of volunteers who offer unconditional help and support to all families who need help in getting it right, and show them how to cook healthily. There is, however, a major role for our schools in tackling obesity. The school where I am a governor, Milton Park primary, is taking the lead locally in educating children about healthier choices. The cooks at the school have won awards and I can recommend their so-called “chocolate muffins,” which in fact are made of beetroot.

I would like to see cooking classes become mandatory in schools. I know it would be difficult to re-establish kitchens, but the rewards would be worth it. I see that as the only way to prevent future generations from continuing poor eating habits. The only way to do that is by teaching them how to cook healthily and how to budget. Like some of my colleagues, I was against a sugar tax to start with. If we can use the sugar tax to fund cooking classes in schools, however, then I am all for it.

In Portsmouth, there are a number of charitable organisations actively engaging with the community to help to tackle obesity through a more active lifestyle. Affiliated with Portsmouth football club, Pompey in the Community provides education and opportunities for children in the city.

[Geraint Davies]

The hon. Lady makes some interesting points about the relationship between nutrition and poverty. Does she agree that it is a good idea to provide free school breakfasts in school? They help poorer children in particular to achieve and to know what good food tastes like.

[Mrs Drummond]

I totally agree. I also back the attempt by the right hon. Member for Birkenhead (Frank Field) to get free school meals for everybody receiving the pupil premium. That is a very good point; I am thinking particularly of a healthy breakfast with porridge, not necessarily sugar-laden cereals.

Not only does Pompey in the Community provide a lot of the physical education curriculum in local schools, but it runs a number of out-of-school and holiday clubs. There are plenty of sports clubs in Portsmouth. I would like to see a lot more outreach from sports clubs to children from low-income families. The Portsmouth Sail Training Trust does this with sailing, focusing solely on children from low-income backgrounds. More sports clubs need to get out and do this, too. Perhaps we could use the sugar tax to help to fund some of those sports activities. I would also like to see more sport in the curriculum, with the possibility of at least one hour of activity every day. We heard about a school doing one mile a day. Every school should be doing that. I would like the Department for Education and the Department of Health to lead on more sport in school, perhaps with extended days to fit it in.

Often the simplest changes are the most effective. By encouraging our children to walk to school, and by continuing to develop nutritional education, I am sure we will see more positive results. Members on both sides of the House talk a lot about tackling deprivation in our communities. It is crystal clear that the House must now turn its energy towards fighting the terrible problem of obesity, through education and providing more opportunities for an active lifestyle.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Member for Totnes (Dr Wollaston) for securing this extremely important debate. It is not listed in my entry in the Register of Members’ Financial Interests, but I must declare a terrible sweet tooth, which gives me great experience from which to speak in this debate.

Over preceding decades, there have been profound changes in the UK in the relationship we have with food. Historically, the public health challenges we faced tended to relate to under-nutrition and unsafe food and water. However, in modern society, those issues have largely been replaced by the risks of poor diet. Food is now more readily available and there have been significant changes in how we eat, the type of foods we consume, and how they are produced and marketed. Busy lifestyles and easy access to convenience and processed foods have helped them to become a staple part of many families’ diets.

In general, we over-consume foods high in fat, sugar and salt, and we do not eat enough fruit, vegetables, fibre and oily fish. Our type of diet underlies many of the chronic diseases that cause considerable suffering, ill health and premature death. It is also a major factor in the issue of childhood obesity, heart disease and type 2 diabetes. The recently published findings from the Health Committee’s investigation into childhood obesity highlighted that one in five children is overweight or obese when they begin school. That figure was found to rise to one in three by the end of primary school. There was also evidence of inequality between different sectors of society, with those from deprived backgrounds found to fare significantly worse and to be twice as likely as their more affluent counterparts to be overweight or obese.

These figures are extremely concerning. Obesity is a serious problem that has significant implications, both on the long-term wellbeing of the individual child and on society as a whole. Many of the most serious and potentially life-shortening physical health risks that accompany obesity are well publicised and have been raised already in the Chamber today. I will not, therefore, go into them again.

Instead, I will highlight the detrimental social effects that can impact on individuals’ overall wellbeing and life chances. Research indicates that childhood obesity is associated with mental health issues in both children and adults, such as depression, low self-esteem, social isolation, self-harm and behavioural problems. It is also associated with stigma and bullying. In addition to obesity, a poor diet that includes too much sugar and acidic food substances can lead to oral health issues, which can impact on an individual’s ability to eat and socialise, and this again can adversely affect their mental health and contribute to their social isolation.

Addressing these issues will require a concerted effort to alter health choices, to address cultural and lifestyle issues and to improve our relationship with exercise and sport. It will require a multifaceted response; no single measure will do the trick. We need a response from private enterprise to improve choices and healthy options that are appealing and, importantly, cheap, as was highlighted by my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson). We need to address the effect that marketing can have on children and parents and make sure it is done responsibly, as was mentioned by my hon. Friend the Member for Glasgow Central (Alison Thewliss). We need to enhance skills gained at school and home in cooking healthy meals, and this must be role-modelled at school, with fruit bars, water and other healthy choices that are low in fat, salt and sugar, as was discussed in detail by the hon. Member for Washington and Sunderland West (Mrs Hodgson).

Childhood obesity must also be addressed by local commissioning in areas where fast-food outlets are placed near to schools. In one of my local areas, refuse staff are in place at school lunch times to clear up fast-food packages left by school children in shopping squares. This must be addressed and must not be encouraged. Wider Government initiatives are also required to improve food labelling. We need labelling that is understandable to families and ordinary people and which does not look like gobbledegook.

As debated today, taxation should be considered as part of an evidence-based approach. We also require an increased focus on sports, exercise and healthy pursuits as being integral to our lifestyle; increased funding; and an emphasis on engaging children and young adults in these activities and making them affordable to people from all walks of life. We know from psychological research that education, in itself, does little to change behaviour. We therefore require a Government strategy to reinforce healthy choices. This would be cost-effective in the long term for our health service and quality of life.

[Geraint Davies]

The hon. Lady is making a powerful and excellent speech. She might know that in Mexico the average consumption of Coca-Cola is 0.5 litres a day per person and that children are being fed Coke in baby bottles. Does she agree that the Government need to take action not just on pricing but on marketing? We cannot have this situation where people can buy two litres for 5% more, so that we have these huge stocks of Coke that people feel they have to get rid of before it loses its fizz, and everybody’s teeth fall out.

[Dr Cameron]

The hon. Gentleman makes a good point. I have pinpointed the need to address the effect of marketing on children and parents’ healthy choices.

A clear strategy would benefit our children, society as a whole and future generations. That is surely Parliament’s job. We should not shy away from a bold and effective obesity strategy.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I pay tribute to the Backbench Business Committee for allocating time for such an important debate and to the hon. Member for Totnes (Dr Wollaston) for her eloquent opening speech. I also extend my thanks to the entire Health Select Committee for producing such a comprehensive report on childhood obesity. She was dead right to entitle it, “Childhood obesity—brave and bold action”, because that is precisely what is needed. I would also like to thank for their contributions my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), my right hon. Friend the Member for Leicester East (Keith Vaz), my hon. Friend the Member for Swansea West (Geraint Davies) and the hon. Members for Colchester (Will Quince), for St Austell and Newquay (Steve Double), for Strangford (Jim Shannon), for Mid Worcestershire (Nigel Huddleston), for Twickenham (Dr Mathias), for North Ayrshire and Arran (Patricia Gibson), for Erewash (Maggie Throup), for Glasgow Central (Alison Thewliss), for Portsmouth South (Mrs Drummond) and for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I am sure I pronounced that kind of right.

Returning to the Select Committee report, the starting point has to be the scale and the consequences of the problem, and this requires looking at doing things differently. Failure to act will make the problem worse—not just for the individuals concerned, but for the public purse, which will, frankly, struggle to cope with the health inequalities that we are exacerbating.

The statistics are clear. Childhood obesity is strongly linked to deprivation, almost reversing the trend of the entire history of the human race whereby malnourishment, not obesity, was the key indicator of poverty. As we know from the statistics of Public Health England, the most deprived children are twice as likely to be obese at reception and at year 6 than the least deprived children—and that gap is widening, as the hon. Member for Totnes set out.

We often get into the habit of praising the fact that a debate is even taking place here, but in this instance, the timeliness of the debate really cannot be overstated. It is no understatement to say that the Government’s strategy has been a long time coming. Although we are debating obesity today, I hope that this is not a sign that the document is being slimmed down. Today’s debate has suffered from the slight disadvantage of addressing the contents of a document that does not yet exist. Perhaps the Minister will give some certainty—perhaps even a date—on when we can expect publication of the strategy. This also presents a rare opportunity, hopefully, to influence what will eventually be published in that strategy. It is important to remember that Government can do immense good when it comes to public health.

If we think about some of the great strides in public health that we have taken in recent years—from the banning of smoking in public places to reducing the rates of teenage pregnancy—we realise that these moves came about, in part, as a result of Members putting difficult issues on to the political agenda. With that in mind, I shall focus my remarks today around the key issue of obesity and diet.

I believe that we need action to tackle the problem at the supply side on the part of food and drink companies, and also action to tackle it on the demand side, with a need for far better education on how we could be looking after ourselves, as well as give people the means to eat healthier food. We believe a comprehensive and broad approach is necessary to help families, schools and children to make the right decisions. I commend the work of my hon. Friend the Member for Washington and Sunderland West, who has long been a champion of better standards of food in our schools.

In November, the Health and Social Care Information Centre released data showing that one in every five children leaving primary school are classified as obese, and one in every three children are either obese or overweight. Frankly, those figures should shame each and every one of us. Although there has been a shift in providing healthier, more nutritious meals at schools, so many of the problems start before school or at least outside of school hours.

Between April and September 2015, Trussell Trust food banks in Greater Manchester, which includes my constituency, gave 22,739 three-day emergency food supplies to people in crisis. Some 8,666 of those three-day emergency food supplies were given to children. When so many families are having to rely on food banks to feed their children, they may be limited in their ability to provide fresh and healthy meals. In these upsetting circumstances, feeding their child something is better than seeing them go hungry. Wider problems of poverty must be addressed to ensure that people have access to good diets. How does the Minister plan to help families who are having to rely on food banks to improve their diets?

Funding is a crucial side issue. Following the removal of protected status from all Department of Health budgets that are not controlled by NHS England, the pot of money that pays for public health will be subjected to huge cuts in the coming years. That will have a significant impact on Public Health England, and could put at risk our ability to tackle obesity to the necessary extent. It could also put at risk the future of public awareness campaigns, many of which have been a great success. The cuts in the public health grant to local authorities could drastically reduce the amount of support that is available locally to those who want to lose weight or have a healthier lifestyle. I should be interested to hear from the Minister how the public health cuts in the coming years are consistent with the emphasis on prevention in the “Five Year Forward View”, and, in particular, whether the crucial issue of funding will be addressed in the forthcoming strategy.

[Geraint Davies]

Obviously funds are tight, but does my hon. Friend agree that if we introduce a sugar tax, it will ease the burden and enable us to focus our fire on reducing obesity in other ways?

[Andrew Gwynne]

That may well be the case, but we must of course ensure that any income raised by such a tax is reinvested in public health.

It is also important to increase levels of physical activity among adults and children throughout the United Kingdom. Inactivity is a key factor in ill health, and it is important that we encourage children to maintain active lifestyles from an early age. I believe that increasing the opportunities for young people to get involved in physical activity is just as important as improving diets. Treating obesity and its consequences alone currently costs the NHS £5.1 billion every year. Given that nearly 25% of adults, 10% of four to five-year-olds and 19% of 10 to 11-year-olds in England are classified as obese, the human and financial cost of inaction is significant. We must do much more to ingrain physical activity in our daily lives, whether that means walking instead of driving or taking the stairs instead of the lift. Every little helps.

A number of Members have touched on a point that is crucial to the debate. Many people have argued that the Government should introduce some form of tax on sugary products, particularly soft drinks, and the debate on that issue goes far beyond the Chamber. Public figures such as Jamie Oliver have come out in support of a sugar tax, and he has made a compelling case. However, the issue is complex, and I do not think that the answer is necessarily straightforward. Labour Members have always feared that a sugar tax, in itself, could be regressive, and that it would focus attention on consumers, many of whom are addicted to sugar, rather than manufacturers, who should be reducing the amount of sugar in their products. That said, however, I suggest to the Minister that it is right for us to look at the emerging evidence from other countries, which has shown that where similar taxes have been introduced they have had a positive effect, not least in changing behaviour.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am delighted to respond to the debate on behalf of the Government, and, following on from what the shadow Minister just said, I welcome the opportunity to take forward all the points made in the many excellent and well-informed—although occasionally a little confessional—contributions. It is a timely debate that will make a valuable contribution as we finalise our strategy.

The House is at a slight advantage as it has the chance to influence, but I am at a disadvantage as we have yet to publish the strategy and therefore I have to talk in slightly more general terms.

I welcome the Health Committee’s recent report, which we have debated once already, and its previous report, “Impact of physical activity and diet on health”. We will be formally responding to the Health Committee’s most recent report soon.

There is no denying that in England, and indeed globally, we have an obesity problem. Many shocking statistics have been given in this debate and I will not repeat them, but many Members on both sides of the House dwelled on the health inequalities issue—the gap that is emerging—and I will come back to that. My hon. Friend the Member for Colchester (Will Quince) drew our attention to what is, in effect, a stabilising of childhood obesity statistics, although it is at far too high a level. As he acknowledged, there is a pronounced gap between different income groups.

Once weight is gained, it can be difficult to lose and obese children are much more likely to become obese adults. In adulthood, obesity is a leading cause of serious diseases such as type 2 diabetes—as the right hon. Member for Leicester East (Keith Vaz) and others mentioned—heart disease and cancer. It is also a major risk factor for non-alcoholic fatty liver disease.

We also know that eating too much sugar is linked to tooth decay; it was good to hear my hon. Friend the Member for Mole Valley (Sir Paul Beresford) make that point. In 2013-14 over 62,000 children were admitted to hospital for the extraction of teeth. This is a serious procedure that frequently requires a general anaesthetic. Children should not have to go through this.

Many Members highlighted—I think there is consensus on this—that there is no silver bullet to tackle obesity. That means that in order to reduce rates we need a range of measures and all of us, and all the parts of our society mentioned in the debate, have a part to play, as our forthcoming strategy will make clear.

Sometimes in the national debate around obesity people question the role of the state and how it should intervene to drive change. In the face of such high obesity rates, with such significant implications for the life chances of a generation, it is right that tackling obesity, particularly in children, is one of this Government’s major priorities, and we showed the priority we place on the issue by making it a manifesto commitment.

As my hon. Friend the Member for Portsmouth South (Mrs Drummond) said, the human cost is enormous. Young children in particular have limited influence over their choices and Government have a history of intervening to protect them: we do not question the requirement that younger children use car seats on the grounds of safety, for example. Children deserve protecting from the effects of obesity, for their current and future health and wellbeing and to ensure they have the same life chances as other children, especially those in better-off parts of our society.

As I have said, I was struck by how many Members alluded to the health inequalities issue. There is strong evidence of a link between obesity and lower income groups. The obesity prevalence among reception year children living in the most deprived areas was 12% compared with 5.7%, and that gap rose to 25% as against 11.5% respectively by the time they leave primary school. That is not acceptable, and we must take action to tackle it.

Any Government with a state-funded health service also have a responsibility to take an interest in the nation’s health to ensure the sustainability of the NHS. The huge cost of treating lifestyle-related type 2 diabetes has been mentioned by a number of Members. Our election manifesto supported the programme for prevention set out in the NHS England’s “Five Year Forward View”, which states that

“the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

Tackling obesity is a key component of this work. I accept the challenge from the shadow Minister on budgets, but I can give him the assurance that over the spending review period we are still going to be spending £16 billion on public health. We can complement local action with national initiatives, and we will talk more about that when we publish our strategy.

We are continuing to invest in the Change4Life campaign, which has been going on for many years. We have learned a lot from it, and we now have valuable evidence about what works and what provides motivation and support for families to make small but significant improvements. On 4 January, we launched the new Sugar Smart app to encourage parents to take control of how much sugar their children eat and drink. Members have described how people can scan the barcode on any of the thousands of everyday products that are catered for by the algorithm. This allows people to visualise the number of 4 gram sugar cubes the product contains. In the first 10 days of the campaign, about 800,000 people downloaded the sugar app. That is a great success, and an example of how we can empower families with information so that they can make decisions about their diet. A number of Members made that point, including my hon. Friend the Member for St Austell and Newquay (Steve Double), who talked about the role of families.

[Geraint Davies]

Will the Minister give way?

[Jane Ellison]

I do not think I have time. I think I know what the hon. Gentleman is about to say, and we have had the teaspoon discussion before. I recommend the sugar app to him; he acknowledged its introduction in his speech, for which I am grateful.

The Sugar Smart app builds on the Change4Life Sugar Swaps campaign, from which we learned a lot. More than 410,000 families registered with the campaign. However, we know that public health messaging and support are not enough. That is why our childhood obesity strategy will be wide ranging and involve Government action across a range of areas.

The food and drink industry also has a role to play, as many Members have said, and I am pleased that it has made progress in recent years. My hon. Friend the Member for Erewash (Maggie Throup) alluded to that fact earlier. Under the voluntary partnership arrangements and the responsibility deal, there has been a focus on calorie reduction, of which sugar has been a big part. We have made progress. Some retailers have also played their part by removing sweets from checkouts, which we welcome. We urge others to follow suit. Importantly, parents and customers have strongly welcomed that change and supported the measures being taken by the industry. But the challenge to the industry to make further substantial progress remains.

Providing clear information to consumers is vital if we are going to help them to make healthier choices. That has been a theme of the debate. The voluntary front-of-pack nutrition labelling scheme, introduced in 2013, plays a vital part in our work to encourage healthier eating and to reduce levels of obesity and other conditions. The scheme enables consumers to make healthier and more balanced choices by helping them to better understand the nutrient content of food and drinks. It is popular with consumers and provides information on the calories and nutrients in various foodstuffs. Businesses that have decided to adopt the scheme account for two thirds of the market for pre-packed foods and drinks.

As a Conservative and a former retailer I believe in customer choice, but if consumers are to make an informed choice they need information. Informed consumers can of course shape markets and drive change, as my hon. Friend the Member for Twickenham (Dr Mathias) pointed out in her thoughtful speech. That point came out strongly in the debate, and I shall reflect on it a great deal.

I want to say a little about physical activity, which is also a key theme. We are very clear that for those who are overweight and obese, eating and drinking less is key to weight loss, but we know that physical activity has a role to play in maintaining a healthy weight. It is also hugely beneficial in many other ways. For children it is a vital part of growing into a healthy, happy adult, so it has been great to hear about the work being done in schools up and down the country. We heard examples of that from my hon. Friends the Members for Mid Worcestershire (Nigel Huddleston) and for Erewash. That is why raising levels of participation in sport and exercise among children and young people is an area the Government are keen to make further progress on.

The Department worked closely with the Department for Culture, Media and Sport on the new sports strategy, published just before Christmas. We will be working with DCMS, Sport England and Public Health England in the coming months to implement the strategy. The Minister for sport and I have worked closely together on both the obesity agenda and her agenda on physical activity. We are also working to raise awareness of the UK chief medical officer’s physical activity guidelines. We have already developed an infographic for health professionals to use when they discuss physical activity with adults, but we want to go further and work on further infographics to raise awareness of the daily activity levels required for children and young people, including the under-fives. We hope that that will be a useful resource, not only for families, but for the leisure sector and for many more who have a key role in encouraging people to be more active.

A slightly different point was made by the hon. Member for Glasgow Central (Alison Thewliss), but it was an important one and she spoke knowledgeably about nutrition in the very early years and during pregnancy. I commend to her the recent chief medical officer’s report on women’s health, as it contained a number of chapters that I think she would find of huge interest if she has not already had the chance to look at them.

There has been a consensus on a number of facts, although a key one stood out: obesity is a complex issue, which the Government cannot tackle alone. Businesses, health professionals, schools, local authorities, families and individuals all have a role to play, as does Parliament. We were all struck by the contribution made by the hon. Member for Washington and Sunderland West (Mrs Hodgson), who spoke so passionately about the need to tackle health inequalities. She spoke about the influence of a good start in life and how that works all the way through one’s life. Parliament does have a role to play, so I welcome the engagement of so many Members from all parts of the House. I would be happy to provide more information if it is ever of help to Members about key public health indicators in their own local areas and how they can help to take this agenda forward. Local leadership will be important as we seek to make the critical leap forward on preventive health action described in the NHS “Five Year Forward View”.

This has been a great debate and I thank Members for their contributions. I look forward to discussing this issue further when we publish our comprehensive childhood obesity strategy.