Obesity and Fatty Liver Disease

Jim Shannon Excerpts

Thursday 8th June 2023 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Mr Hollobone; it is always a pleasure to serve under your chairmanship. It happens very often that you and I are here in Westminster Hall, but perhaps for different reasons and to participate in different ways.

I thank the hon. Member for Caerphilly (Wayne David) for leading the debate. It is always a pleasure to hear his calm voice, and today he put the case forward admirably. It is also a pleasure to follow the hon. Member for Erewash (Maggie Throup), who brings a vast stock of knowledge from her former role and her deep interest in these subjects. Whenever she speaks in Westminster Hall or the main Chamber, it is always with facts, evidence and a determination to get the answers.

As the vice-chair of the APPG on liver disease and liver cancer, I am pleased to be here to draw attention to the liver disease crisis, but I am not pleased that there is a crisis of liver cancer in Northern Ireland. One of the great things about the Minister—I do not say this to give him a big head or anything—is that whenever we ask him questions, his first intention is clearly to respond in a positive fashion. That being the case, I have a couple of asks for him.

I am also pleased to work alongside the two shadow Ministers, the hon. Members for Linlithgow and East Falkirk (Martyn Day) and for Bristol South (Karin Smyth). I was saying beforehand to the Labour shadow Minister that very often—most Thursdays—she, the Minister and I, and sometimes others, have this shift in Westminster Hall. We are always pleased to come and to participate. As we look forward, I hope that we can work together and emerge with a good practice for obesity prevention and the early diagnosis of fatty liver disease, which I hope can be replicated across the whole of this great United Kingdom of Great Britain and Northern Ireland.

I was delighted to sponsor the British Liver Trust’s “Check your liver health” event in Portcullis House in January. The hon. Member for Caerphilly referred to that event. The turnout was great; he was absolutely right. I thank all MPs who took the time to attend. I personally got the all-clear. That does not mean that someone can sit back and say that everything is all right; they have to continue to do the right things, so that they do not fall back.

I would like to give some background on the situation in Northern Ireland. I always like to give a Northern Ireland perspective, because I believe that that enriches the debate, even though it probably replicates what everybody else is saying as well. When the SNP shadow Minister speaks, he will give Scotland’s perspective, and I very much look forward to hearing that also. In Northern Ireland, nine out of 10 liver disease cases are preventable. That is the point that we start from and it is what the hon. Member for Caerphilly said in his introduction: we can prevent liver disease if we eat right—if we have the correct diet—and we exercise, so it is really important that we do that. There is also the question of alcohol. I am not against anybody drinking alcohol, but if people do that, they should do it in moderation.

Liver disease deaths have doubled in the last two decades, which contrasts with the trends in other chronic diseases, which have decreased or stabilised. While liver disease and liver cancer have increased, other diseases have fallen. We cannot ignore that. There is an onus on Government. Government cannot do everything for everybody, but they can raise awareness and perhaps give some of the direction that is needed. It is important to recognise the trend.

Liver disease deaths in Northern Ireland increased by 39% during the period encompassing the pandemic—between 2018 and 2021. That was primarily driven by obesity and alcohol misuse. The pandemic was part of the reason for that, but there is also an onus on all of us individually, including me. We need to exercise and do the right things. Northern Ireland does have a non-alcohol-related fatty liver disease and haemochromatosis pathway in development, so there is a policy by the HPSS—health and personal social services—in Northern Ireland, but progress is slow.

I am, as always, keen to ensure that the Minister here uses his good offices to encourage the devolved Administrations to be active, and I am sure that that will be the case. The Minister himself is proactive. I know that he has had regular contact in all his ministerial roles—in Education and now in Health—and I hope that discussions with those in Northern Ireland continue. Has he had an opportunity to have discussions with the Department of Health back home in Northern Ireland? If not, may I request that he do that?

I have spoken before on the importance both of raising awareness of the risks of obesity and of early diagnosis. People with excess weight and fatty liver disease are at higher risk of cardiovascular disease and a wide range of cancers. People who are obese are two times more likely to develop liver cancer, three times more likely to develop colon cancer, two and a half times more likely to develop high blood pressure and five times more likely to develop type 2 diabetes. I declare an interest as a type 2 diabetic. I will give an idea of what that involves. When I was diagnosed as a type 2 diabetic some 15 years ago, I weighed 17.5 stone. I was a big fat puddin’—I am talking about myself, so I can use this terminology. I lost some four stone and have kept that weight off. But people have to work at it; that is what the hon. Member for Caerphilly was saying. Diet control helped for a while, but my diabetes—this debate is not about diabetes—is now medication-controlled. It is important that people are aware of that issue. That included me, who came through that particular episode some years ago.

British Liver Trust research reveals huge geographic variation in access to patient care pathways for the early diagnosis and management of liver disease in primary care. Furthermore, removing stigma surrounding the impacts of liver disease is crucial. That is why it is important that we all recognise that we have to encourage people. It is so alarming that 49% of liver patients surveyed by the British Liver Trust in October 2022 reported experiences of stigma from healthcare professionals. When someone comes to our office, our job as MPs is not ever to be judgmental; it is to help the person with whatever the issue may be. I think that there is a case for healthcare professionals to have the same attitude when people come to them. This should be not about judgmental attitudes, but about saying, “What can we do to help?” People should look at it that way.

I congratulate the Royal Victoria Hospital liver support group in Northern Ireland on its recent 25th anniversary. Its chairman, Jim Kilpatrick, is a constituent in a neighbouring constituency, and he is a passionate campaigner who has been instrumental in improving support for patients in my constituency of Strangford—indeed, in all areas. I commend him for that and for the support of carers across Northern Ireland. There was a debate in the Chamber earlier about carers. I think we all have experience of that—I know my family have. Jim Kilpatrick presents an understanding and supportive stance on behalf of the support group, persuading, assisting and making life better, as well as focusing attention on and driving the strategy. The Royal Victoria Hospital liver support group is a network of volunteer liver patients and their carers who provide confidential, compassionate, emotional and psychological support for all adults, teenagers and children coping with a liver condition. Their vital work is a lifeline to my constituents and patients across Northern Ireland.

Liver disease is a silent killer, largely asymptomatic in its early stages. Three quarters of patients are diagnosed with cirrhosis in hospital, when it is too late for effective treatment. The hon. Member for Caerphilly emphasised the need for early diagnosis, and he is right. Risks can be drastically reduced through early detection and through diet, exercise and drinking in moderation. Let us be honest—there should be moderation in everything. It is so important that we raise awareness.

I give sincere thanks to the British Liver Trust, which has been in constant contact with my office and has been so insightful in the information it has provided. I want to put on the record how grateful I am to the trust for providing me and my staff with the information to prepare for this debate. I look forward to working with it in future as we collaborate to address this important issue and improve the health of constituents. I am convinced that the trust would be keen to work alongside the Minister and his Department. Has he had an opportunity to discuss these matters, to work in partnership and to help each other.?

I am also keen to receive an assurance that any co-ordinated plan or strategy here on the mainland can be delivered by the regional Administrations, including the Northern Ireland Assembly. I am confident and convinced that the assurances I seek will be given. I say this not as a political comment, but when it comes to many things, particularly health, one of the great things is that we can work collaboratively and better as the United Kingdom of Great Britain and Northern Ireland. It is always better to share our details, our practices and our experiences. By doing so, we can move forward together and make sure that across this great nation we can all improve our health.

--- Later in debate ---

[Will Quince]

My hon. Friend is absolutely right; we are constantly learning more. At the moment, I do not think there is a definition of an “ultra-processed food”. There has been a lot of work. We are learning more and more about the issue and it has recently exploded into the public domain. We need to ensure that more people are aware of and being educated about what is actually in their food, and that they are looking at labels. If we go back 20 years, we were all very much alive to E numbers —does everyone remember E numbers?—which no one looked at before. Now, we often look over the back of the packaging to see the number of E numbers in our products. The more that the public are educated and informed so that they can look out for these things, the better. My hon. Friend the Member for Harborough will be happy to discuss this further with my hon. Friend the Member for Erewash. I know that ultra-processed foods are an issue about which the public are concerned, and we certainly have more to do on food labelling.

[Jim Shannon]

The Minister always brings good responses. The SNP spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day), made a comment that I endorse totally, because it is something that I hear from my constituents every week. With respect, many people can look at the labels and see what they mean, but what do they look at first? They look at the price, because they are trying to make a meal for their family. What drives them will be, “What can I afford to do?” I am conscious that the Minister has been very constructive in his responses, but there must be a wee bit of reality as well.

[Will Quince]

I thank the hon. Member for that intervention. He is absolutely right; not everyone has the luxury to make choices, and they will often have to go for the cheapest products or products that are available in their area when others might not be. That is why it is so important that we continue the work with industry on reformulation.

Personally, I have been more of a convert to Government action in this area. The soft drinks industry levy has been hugely successful. The industry was already doing a lot of that work. Nevertheless, the levy has nudged and pushed it further in the right direction—but there is more work to do.

I would push back ever so slightly on a couple of the comments that have been made today about industry not wanting to do this. It is not moving at the pace that we want, expect and need it to, but it is doing it. The sugar content of cereal is down by about 15%, and it is down by about 14% in yoghurts and fromage frais. We need industry members to go further, but they are doing it because they are responding directly to what their customers and consumers are telling them they want, and to people actively choosing healthier products. However, we have more to do on reformulation and working with industry.

We will also introduce restrictions on the advertising of less healthy products before 9 pm. I will answer the question on that from my hon. Friend the Member for Erewash in just a moment. The major conditions strategy call for evidence is open, and, as I said, my hon. Friend the Member for Faversham and Mid Kent will gladly meet colleagues to discuss that.

There is also the piece of work around supporting people with weight management, such as the NHS digital weight management programme, the weight loss drug programme and pilot that we announced yesterday, which I just spoke about, and the better health campaigns—including the NHS weight loss app Couch to 5k, which, if anyone has not tried it, is a great way of getting into running, and Active 10. There is also the NHS health check, which includes checking on BMI, encouraging people and giving them the tools to take control of their health.

Then there is the research piece. As I say, this is one of our healthcare missions. Obesity is right there at the top; we want to see the newest and most innovative products and medicines coming forward and being used first in this country.

The hon. Member for Bristol South is absolutely right that this cannot just be an issue for the Department of Health and Social Care; it must be a cross-Government issue. I remember when I was the Children’s Minister and had responsibility for school sport: looking at school sport investment and premiums, at the upskilling of primary school PE teachers in particular, and at the holiday activities and food programme, which was specifically targeted at children in receipt of free school meals.

I remember visiting some eye-opening educational programmes. In one example—I would love to get a number of parliamentary colleagues to try this experiment—there was range of soft drinks, from a Monster energy drink through to flavoured water, and a big box of sugar cubes. The children were asked to put against each product the number of sugar cubes they thought it contained. You would be amazed, Mr Hollobone, how many children put six cubes against the water and very few against the Monster or the full-fat Coke, despite the can of Coke containing something like six cubes of sugar. In schools, we are also promoting the daily mile, the healthy schools programme and healthy school meals. That is all important work, but do we need to do more? Of course we do.

My hon. Friend the Member for Erewash asked about the delay to policies, specifically to the restrictions on advertising and promotions. I understand her frustration but the delay to advertising restrictions allows the Government and regulators to carry out certain processes necessary for the robust implementation of the restrictions. Those processes include carrying out consultations, appointing a frontline regulator, the laying of regulations and the drafting of guidance. She asked specifically when that is coming in; it will be in October 2025. She also asked about the volume price promotions ban, which was delayed due to the unprecedented global economic situation. I do not know the answer and I do not want to mislead her. The legislation states October this year, but I do not know latest position, so I will ask my hon. Friend the Member for Harborough to write to her.