Childhood Obesity and Diabetes

John Pugh Excerpts

Wednesday 24th April 2013 Westminster Hall

[John Pugh (Southport) (LD)]

I pay tribute to the right hon. Member for Leicester East (Keith Vaz), who introduced the debate, for his characteristic generosity in congratulating all the other Members present; that is very much a feature of his style.

Let me start with the assumption that an obese child is an abnormality in some sense or other. It is not normal in nature for children to be obese; what is rather more normal is for people, as they get older, to find it difficult to stop being obese. If we think of portraits of obesity in literature, we think of Billy Bunter in the ’40s. Then, obesity was seen, in a very naive way, as a consequence of childhood greed, because it was a rare and not well-understood phenomenon. An earlier example is the plump lad in Dickens—I think he was called the fat boy—who was actually a thyroid victim. However, such children were unusual enough in those days to be pointed out; they were not at all a standard thing. Now, as all of us have recorded, the phenomenon of obese children is no longer a rarity in an advanced society.

Last week, the Minister and I attended an event organised by the all-party group on obesity, although I do not think she was aware I was there. A very earnest man told us we need to be careful about every extra Mars bar we eat every day; otherwise, we would increase our weight exponentially and eventually end up with serious problems. He was particularly horrid about egg custards and the like. Although what he said was probably broadly correct, I could not help thinking that it was not really sensible for any of us constantly to calculate exactly how much we had eaten, whether we had eaten too much or too little and by how much. I was slightly reassured by some research that came out after that event, which said, as the hon. Member for Inverclyde (Mr McKenzie) has just done, that there is more to this issue than meets the eye. If people become plump, it is not just a question of over-supply; it is sometimes to do with their glands and their endocrinology—whether they are burners or storers.

I recognise that this is a complex problem, but the fact of the matter is that the nations that have an obesity problem, as many advanced nations do, always have three principal characteristics: a relatively unlimited supply of food, easy access to that food—in other words, it does not have to be cooked or prepared in a long, elaborate way and can simply be grabbed—and a sedentary lifestyle. I do not see any of those changing any time soon. All three are probably necessary before nations have an obesity problem, and all three are, in many respects, here to stay.

I am therefore a little sceptical about claims that there is an easy solution to this problem. While other Members were speaking, I wrote down some of the solutions that were advocated, and every one can be faulted in some way. School dinners were mentioned. I used to be a teacher, and I used to see children walk past pictures of big, rosy apples, lettuces and things like that, before going straight for the pizza and chips. I was sometimes aware of how futile and ineffectual healthy eating programmes can be. The reality is that school dinners—many of us have experienced them—have never been notably healthy or low in calories, because it is assumed that children need lots of energy to get through the day. Working hard on school dinners and children’s choices is not, therefore, necessarily an easy solution.

A tax on fattening food was mentioned, and I am sure you would not warm to one at all, Mr Davies. The reality is that most food, if we eat enough of it, is fattening, with the possible exception of lettuce and something else, which requires more calories to eat it than we get from it—[Hon. Members: “Celery.”]

On education, the British public are not particularly lacking in knowledge about the things that make them fat and the things that are likely to have a less adverse effect. They are probably not quite as acutely aware as they should be about the calories in individual things. One of the easier ways of addressing some of the problems we have with alcohol is reminding people what the calorie intake from a glass of wine or a pint of beer actually is. However, that is not an automatic or a simple solution either.

Changes in family lifestyle were mentioned. Parental responsibility is important, but, at the same time, people’s lifestyles will be under increasing pressure in many ways—there is no evidence they will be under less pressure.

[Ms Abbott]

I am listening with interest to what the hon. Gentleman is saying, and I will respond to some of it in my remarks. He does not think the general public are ignorant of what food contains or the calorific value of food. However, people are often shocked to find that there is sugar in things such as baked beans and tomato ketchup; they often do not know how much sugar and fat there is in processed food. People who want to do right by their child will feed them these so-called breakfast cereal bars, but they do not understand how much sugar and fat there is in them.

[John Pugh]

There are benefits to the approach I outlined, although the people who are most acutely aware of the calorific content and the quality of their food are those who are already halfway to solving the problem. However, many people do not get even to that first base, and that is where public health messages have an impact.

[Mr Sanders]

Does my hon. Friend not think there would be an enormous benefit in having a simple traffic-light system so that parents buying children food understand that red means danger? Similarly, people queuing up at a fast-food restaurant will know which items on the menu contain the most sugar.

[John Pugh]

I hope hon. Members do not misunderstand me. I am not saying that the bits of the jigsaw cannot be put together and cannot ultimately constitute a perfectly satisfactory solution. I am saying that every one of the solutions so far advocated must come with a caveat, because it is not likely to be the magic bullet that will transform things. There is no magic bullet, and I will return to that theme when I conclude.

On sport, it is unquestionably the case that one reason why children acquire the extra pounds is that they move around far less than they ever did. When I was at school, the dinners were intensely fattening, but children moved far more, so the obesity problem was not that marked. One issue, however, is that if the problem starts early, as my hon. Friend the Member for Torbay (Mr Sanders) suggested, and the child is already overweight, he or she will be more reluctant to engage in sport and likely to look for excuses to avoid sport, so offering them a wider menu of sporting opportunities, by itself, will not help.

Pressure on producers and the responsibility deal were mentioned, and a lot can be achieved through such measures. The Minister will confirm that we have, almost without noticing, reduced the amount of salt in our food by agreement with the producers, and nobody has really minded. Clearly, similar results can be achieved by agreement with sugar producers, and there is no reason why that should not happen. Again, however, people tend to deceive themselves. We are all familiar with the phenomenon of people who sit there with a beefburger and chips, but who have a diet coke by their side. The assumption is that if they drink the diet coke, the effect of the chips and the beefburger will somehow be negligible.

The right hon. Member for Leicester East mentioned the issue of access. Access to fast food is one of the principal reasons why society has the difficulties it does. When we go to railway stations or other places where we are in a hurry to buy things to take on our journey, it is noticeable that we are presented with larger snacks than we would want, such as grab bags and extra-large chocolate bars. There is no explanation for that, other than that the producers are being blatantly irresponsible and trying to shift more of their product.

I must make a confession that may shock many Members present. As a student, I once worked as an ice cream salesman, driving an ice cream van. Our strategy was always to turn up at schools around lunch time, although my ice cream was of such low grade that the children would walk past my van. Instead, they would go to the Mr Whippy van, even if it got there later, so our strategy did not entirely work. However, Members can see that having food near lots of ravenous children is attractive to commercial interests, even if it is irresponsible of them to pursue such a strategy.

All those solutions have merit, but most of them have limitations. It is tempting simply to say there are a lot of issues—I have said as much myself—and that we have to press all the buttons to get the effect we want. I am quite happy to go along with that, I would like us to concentrate on what works and on what there is clear evidence to support; that is what I think needs to happen. One serious problem that concerns me, and which has been mentioned, is tokenism. I have seen tokenism in action; I have seen schools go through the motions of telling the children a bit about food and sticking up the appropriate pictures, but nothing really changes, so the phenomenon persists because it has not been properly addressed. There is irrevocably an element of personal and family responsibility. We cannot take that out of the equation. However, the most successful methods of making it easier for people to make the right choices must be evidenced, supported, endorsed and spread. We should not put into practice a mechanism that might or might not work.

A concern that results indirectly from concentration on the problem in question is the increasing incidence among children of not diabetes but eating disorders. However we pursue the agenda, we must do so in a way that makes it less likely that increasing numbers of children will, because of a legitimate concentration on their health and weight, become obsessed with their body shape and develop problems with eating behaviour that they would not have if they grew up naturally and in a satisfactory way.

--- Later in debate ---

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

I congratulate my right hon. Friend the Member for Leicester East (Keith Vaz) on securing this important debate on childhood obesity and diabetes. We know the parameters of the problem: on current trends in childhood obesity, more than half of British children will be obese or overweight by 2020. A particular concern of mine, as the representative of an inner-city constituency, is that children in the poorest decile are more than twice as likely to be obese compared with those in a more affluent or middle-class decile. It is curious that, generations ago, obesity was a challenge faced by the well-off. We now live in a society, both here and in north America, where obesity is often a disease of poverty. I will return to that point.

We also know that diabetes is the No. 1 health threat in the UK, where 3.7 million people live with the disease, and as the Royal College of Paediatrics and Child Health has told us, care processes and outcomes for children with diabetes in England and Wales remain significantly worse than those for adults, which is what makes this debate so important. Thinking on the issue has changed. When I was a child, people said of a child who was a bit chubby, “Oh, they’ll grow out of it.” It was not seen as anything to worry about. We now know that overweight children become overweight adults, with all the associated health problems.

As always, the hon. Member for Southport (John Pugh) made an interesting speech, but he said a few things that perhaps need amplification. He seemed to say that it was inevitable that there would be a problem of obesity in advanced societies. I was in Finland last week, and Scandinavian countries—Finland, Sweden, Denmark—do not have our problems with obesity. That is for all sorts of reasons, one of which is that Governments have taken the issue seriously and made what were sometimes hard decisions to try to change public health outcomes.

The hon. Gentleman seemed to imply that school dinners are not necessarily part of the solution. I believe that, certainly for primary school age children, being exposed to a range of healthy foods and having healthy school dinners makes a difference to outcomes for diet. I also believe that it is worth educating school children about diet. There has been a complete turnaround of public attitudes to smoking over the past 30 years. Many things contributed to that, including Government action, but it was also due to the role of education and public heath campaigns. I believe that, in the medium term, we can do that for healthy eating and diet issues.

We therefore know the parameters of the problem and that, as has been said, it cannot be fully accounted for by genetics; it is due to a mix of a more sedentary lifestyle and the consumption of far too many calories through the eating of more fatty, salty and sugary products. We should note, however, that one reason why people eat more fatty, salty, sugary and processed foods than they did when we were children is that they are marketed aggressively at families and children. I want to talk about pester power. If a child sees endless advertisements for Ronald McDonald, the parents, even if they know better, find themselves under great pressure when they are out to purchase foods that they know in their hearts are probably not the best for their children. An occasional treat is one thing, but the problem relates to when such foods are not just an occasional treat, but have become the mainstay of a child’s diet.

Government Members have talked about parental responsibility. I believe in that, but we must bear it in mind that childhood obesity and related conditions, such as diabetes, are issues not just for the child and their family, but for us as a wider society that is concerned about the health and well-being of all our people. To be blunt, there is also the cost of childhood obesity and of diabetes, hypertension and all the related conditions. I think that fully 20% of the NHS drugs budget currently goes on drugs for diabetes. It is all very well to talk about parental responsibility, and about the nanny state as opposed to the Pontius Pilate state, but I think that the state owes its people a philosophical responsibility, and we certainly owe the taxpayer a practical responsibility to do something about the financial consequences of the growing wave of childhood obesity and diabetes.

[John Pugh]

I want to take the shadow Minister back to her remarks about marketing. I genuinely accept much of what she said, but there is this phenomenon: firms such as Waitrose tell us that it spends a lot of time promoting healthy options, presumably to customers who can afford to shop there, but nevertheless records that people buy more convenience food from it. The fact that we go for convenience food is not just a direct result of marketing.

[Ms Abbott]

The hon. Gentleman has to understand that the problem is multifaceted and needs multifaceted solutions, one of which is more parental responsibility. The role of supermarkets, and what and how they market, is part of the problem. I live in east London, which is very varied demographically, and I can go half a mile to one supermarket that largely serves working class people—at the front and centre it has unhealthy foods—and half a mile in the other direction to Waitrose, which has fruit and wine. Supermarkets are part of the issue.

Hon. Members may remember the case last year of what The Sun newspaper described as the fattest girl in the UK. She became so obese that the back wall of her house had to be knocked down, and she had to be taken out of the house with a crane and taken to hospital. The point about her is that she had been obese all along, but had been sent to a health farm in America and had lost a considerable amount of weight. She and her mother were reported as saying that the day she came back after several months in the US on a healthy diet, her mother somehow did not have any healthy food in and sent out for fish and chips. With some obese children, it is almost an issue of co-dependency. If we are to work effectively with childhood obesity, we have to work with the family—whatever that family unit constitutes. Will the Minister tell us what action her Department is taking on marketing and promotions, and how it intends to encourage the reformulation of food products, because we need to reduce the high salt and sugar content of breakfast cereals and other items that are marketed at children online?

On the role of local authorities, we should—and I have said this more than once—move public health to local authorities. There are challenges to such a move, but also great opportunities. Potentially, it could mean an end to silo working, because in an ideal world, the education, environmental and leisure services departments work alongside public health professionals to achieve better public health outcomes. We must not forget that for every pound that is spent on things that affect our health, only 10%, I think, is spent by the NHS. The rest is spent by housing and leisure departments. Moving public health to local authorities represents a tremendous opportunity to deal with diabetes and obesity-related issues.

This has been a friendly debate, and people have fallen over themselves to be nice to each other, but let me perhaps insert a slightly cautious note. The great Professor Terence Stephenson, chair of the Academy of Medical Royal Colleges and of the Royal College of Paediatrics and Child Health, said this in relation to responsibility deals:

“The food industry cannot be relied upon to help lead the policy response to obesity. This is not a criticism of the food industry. It would be extraordinary if an industry with a duty to make profits for shareholders should act against its mission to push products and sell as much of them as possible. Asking the food industry to solve the problem is counter-intuitive; you would not put Dracula in charge of a blood bank.”

Of course it is fine to co-operate with industry, but industry must know that the Government are serious and that, in end they will legislate if it does not co-operate. Responsibility deals are fine in principle, but if industry thinks that it is all carrot and no stick, we will not get the results that we all want.