Childhood Obesity and Diabetes

Keith Vaz Excerpts

Wednesday 24th April 2013 Westminster Hall

[Philip Davies (in the Chair)]

Before I call Mr Keith Vaz, Members should be aware that although things are quiet at the moment, we have been advised that there is a possibility of lots of noise outside, due to the work being carried out to try and get the visitors’ entrance up and running. If the noise reaches an unacceptable level and people are struggling to hear, we can ask them to stop. Things are all quiet at the moment, but if that happens, please let me know and we can do something about it.

[Keith Vaz (Leicester East) (Lab)]

It is a huge pleasure for me both to serve under your chairmanship during this important debate, Mr Davies, and to raise the issue of childhood obesity and type 2 diabetes. In 2007, after a chance testing by my local GP, Professor Azhar Farooqi, who is now the clinical commissioning group lead in Leicester, I was diagnosed with type 2 diabetes. Before I discovered that I had diabetes, it was not really a subject that I was aware of. Since then, it has become my passion inside and outside Parliament.

I begin by paying tribute to the Minister, who has truly revitalised the debate on obesity and diabetes since becoming a Minister. I agree with what she said, in her interview with Total Politics this week, about the public health Minister’s job. I have deleted one or two words, but she said that

“this is not a soft…girly option, it is a…serious job”,

and she is absolutely right. That is why I am delighted to see, on the Opposition Front Bench, the shadow Minister for public health, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), who entered the House with me in 1987.

I am also delighted to see so many other Members of Parliament who have either raised the issue of diabetes or have been involved in campaigns. There is the hon. Member for Strangford (Jim Shannon), who, like me, is a type 2 diabetes sufferer; the hon. Member for Mid Derbyshire (Pauline Latham), who has raised the matter many times in the House; and my hon. Friend the Member for Inverclyde (Mr McKenzie), who was in the Chamber, but has popped out. There is also the hon. Member for Southport (John Pugh), the hon. Member for Morecambe and Lunesdale (David Morris), who is my next-door neighbour in Norman Shaw North, and last but not least, the hon. Member for Torbay (Mr Sanders), who is the chairman of the all-party parliamentary group on diabetes and who, for many years, has raised the issue with such passion.

Childhood obesity has become an important political issue. The NHS report, “Statistics on Obesity, Physical Activity and Diet”, of February 2012, stated that in 2010, about 30% of boys and girls were classified as either overweight or obese. The study found that 17% of boys and 15% of girls were obese, which is an increase from 11% and 12% respectively in only 15 years. The factors that cause childhood obesity are a major part of the debate. A recent study by University college London found that 30% of the difference between the bodyweight of one child and another can be explained by their genes. However, genes alone cannot explain the rapidly increasing incidence of childhood obesity.

The ever-increasing numbers of overweight children must be addressed, or we will have a generation of obese children growing into obese adults. It will be a generation at risk from the associated dangers of being overweight, including having type 2 diabetes. Unless we do something about that trend now, the twin epidemics of obesity and diabetes will overwhelm the NHS.

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

Does my right hon. Friend agree that whereas a generation ago, if a child was overweight, adults used to say, “They will grow out of it”, we cannot afford that type of complacency now?

[Keith Vaz]

My hon. Friend is absolutely right. I hope that by securing the debate and by hearing the contributions of hon. Members, we can get a pathway to try and show that complacency will actually help people to get diabetes. That is why I hope that hon. Members will join me today in a war on sugar, a fight against fat, and a battle against the bulge.

We must address three key areas. The first is the role of Government in facing the obesity epidemic head on. That is closely linked to the second key area, which is the role of food and drink manufacturers. The responsibility deal was a flagship of the previous Secretary of State for Health, who is currently Leader of the House. It was launched in March 2011, but I am sorry to say, it appears to have failed. Voluntary agreements with industry have made little impact. The headline pledge to cut 5 billion calories a day is simply incalculable, arbitrary and misleading.

The Department of Health, in response to a parliamentary question of mine, said:

“It is not possible to measure the exact contribution of business’ actions to changes in consumers’ calorie consumption.”—[Official Report, 6 February 2013; Vol. 558, c. 339W.]

By February 2013, 122 companies had signed up to one or more of the responsibility deal’s six pledges, but it is what happens afterwards that really matters. Those pledges, sadly, in my view—I am ready to be convinced otherwise when the Minister replies—have, at best, paid lip service to the Government’s aim of getting the nation to eat more healthily, drink less, be more active, and have healthier working lifestyles.

[Pauline Latham (Mid Derbyshire) (Con)]

Does the right hon. Gentleman agree not only that parents have a huge responsibility to feed their children appropriately and ensure that they get adequate exercise, but that schools have a huge responsibility to give children nutritious, non-fattening and not sweet foods—healthy foods—and through sports, encourage them to take the exercise that will make them healthy and set in train for their whole lives the habits of exercising and eating healthily? It is not only about parents, because schools should help too, as well as the industry that he is talking about.

--- Later in debate ---

[Keith Vaz]

I thank the hon. Lady for her intervention. I fear that she may have seen a copy of my speech, because she has mentioned the very issues that I intend to raise. All three areas are extremely important. It is not one area alone that can deal with the issue; it is a combination of all three factors.

The first factor is the manufacturers. Coca-Cola pledged to reformulate its best-selling drinks to reduce calorie content by at least 30%, but it has chosen not to reformulate its classic, full-fat Coca-Cola, the world’s most popular drink. A can of full-fat Coca-Cola has eight teaspoons of sugar. If the responsibility deal is to be truly believed, it has to be more robust. The pace of change among food and drink companies must be dramatically increased. The only alternative to the responsibility deal, in my view, is legislation.

Last year, I introduced a private Member’s Bill, the Diabetes Prevention (Soft Drinks) Bill, to reduce sugar content in soft drinks by 4% and to establish a programme of research by requiring manufacturers of soft drinks to reinvest part of their profits in diabetes research. In 2010, 14.5 billion litres of soft drinks were consumed in the United Kingdom. According to research by Professor Naveed Sattar of the university of Glasgow, the average person in the UK consumes between a fifth and a quarter of their daily calorie allowance through non-alcoholic drinks. Those are somewhat hidden calories. Professor Sattar said:

“This analysis confirms that many people are perhaps not aware of the high calorie levels in many commonly consumed drinks.”

The consumption of sweetened soft drinks clearly has a part to play in the increasing waistline of the nation.

Attempts to legislate on the issue have been rather unsuccessful. In September 2012, New York’s mayor, Michael Bloomberg, introduced a ban on super-size fizzy drinks to tackle the city’s obesity problem. The ban was overturned in the New York supreme court by a coalition of drinks companies and industry groups.

Legislation has not been limited to sugary drinks. In October 2011, the Danish Parliament passed a so-called fat tax on foods containing more than 2.3% saturated fat. The tax was scrapped after concerns were raised about its adverse effect on the economy as increasing numbers of Danes crossed the border to purchase food in Germany. Clearly, that would be less easy if we did such a thing in England, because of the ability to go to Scotland and Wales.

The hon. Member for Mid Derbyshire mentioned schools. She is absolutely right. The third key area is the role of schools in childhood obesity. Healthy eating in schools has been given a real boost by initiatives such as Jamie Oliver’s “Feed Me Better” campaign, which successfully attempted to transform lunch-time menus. However, many schools still have vending machines offering fizzy drinks and sugary snacks. We should issue an ultimatum: schools should remove all vending machines by 31 December this year. That would go some way towards addressing the problem of bad nutrition in schools.

[Ms Abbott]

Does my right hon. Friend agree that it is regrettable that the new academies are not subject to the same regulations in relation to food and not having vending machines? Surely the strictures that apply to state schools should apply to the new academies.

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[Keith Vaz]

I thank my hon. Friend for her intervention. I did not know that that was the case, but if it is, it should be put right. All teaching establishments should be treated on the same basis and should all get the same message from Government.

Let us consider the issue of where schools are situated and the ability of fast-food chains to mushroom around schools. Many children purchase fast food on their way home from school. For many, fast food is readily available. For example, in my constituency, there are 61 fast-food outlets within a 1-mile radius of Rushey Mead primary school. Positive action has been taken by some local authorities. Waltham Forest council, for example, banned fast-food outlets near schools in 2008. However, more must be done to address the issue. Since 1 April 2013 and the creation of health and wellbeing boards, the onus has surely been on local councils to consider sensible planning restrictions to tackle childhood obesity.

Schools need to do more to educate pupils about the benefits of eating a healthy diet. I commend the excellent report by Ella’s Kitchen, “Averting A Recipe For Disaster”, which urges the Department for Education to address poor nutrition for children by making cooking in schools compulsory and by giving free breakfasts to every child. We currently have an epidemic of childhood obesity, which in 20 years’ time will turn into an epidemic of type 2 diabetes.

The incidence of diabetes is truly alarming. Sometimes we repeat these statistics so often that they lose their impact, but I have to repeat them again today. There are an estimated 3 million people in the UK with the condition, and a further 850,000 are thought to have the condition but are not aware of it. The complications from poorly managed and poorly treated diabetes are shocking. It is the leading cause of blindness, kidney failure and lower-limb amputations. Each week, there are 100 diabetes-related amputations; and each year, 24,000 people die earlier than expected due to complications from the condition. Not only are the health risks extreme, but the cost to the NHS is enormous. It is astonishing. The NHS spends roughly £9.8 billion a year and 10% of its budget treating the condition and its associated complications.

[Pauline Latham]

The right hon. Gentleman talks about amputations. My father had his leg amputated because of diabetic complications, but his problem was that he never stuck to his diet. People must be given more help to understand the complications that they can and probably will incur if they do not take the prognosis seriously and control their diet, because if they do not do so, they will have those long-term problems.

[Keith Vaz]

The hon. Lady is absolutely right. I do not want to steal lines from the Minister’s speech, but when she recently addressed a forum on diabetes, that was exactly what she said: diet is extremely important. We are all busy people and when we walk into the Tea Room for our cup of tea, we are faced with Club biscuits, Jaffa Cakes, Victoria sponges—plural—and all kinds of other things that entice us, so even if I go in saying that I must have a banana or an apple, I end up, as the hon. Member for Strangford has seen, picking up a Club biscuit. The hon. Member for Mid Derbyshire is absolutely right: diet is crucial. That is why I wish the newly appointed diabetes tsar, Dr Jonathan Valabhji, the best of luck in dealing with those figures.

How do we cope with this situation? There are practical steps that health care providers, local authorities and the general public can take, but the key is prevention. The new NHS health checks will offer those aged between 40 and 74 a check to assess their risk of heart disease, stroke, kidney disease and diabetes. If only I had had that check when I was 40, I would have discovered six years earlier that I had diabetes. However, new research revealed by the university of Leicester on Friday suggests that the checks could detect at least 158,000 new cases of diabetes or kidney disease, but they are not being taken up. I pay tribute to the work of Professor Kamlesh Khunti of Leicester university, who was behind the research that revealed the number of cases that could be discovered. The health check has enormous potential to find those in the early stages of diabetes or even with symptoms of pre-diabetes.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I apologise, Mr Davies, for what may become something of a love-in. I will probably pinch some of the right hon. Gentleman’s speech, and I pay tribute to the great work that he has done. Does he agree that great work has been done in Leicester with the health checks that are being rolled out there? The approach is forward-thinking. Anyone who registers with a doctor and is in the right age group automatically gets a health check. The work is also being driven by the excellent charity with which the right hon. Gentleman is associated. Does he agree that real, positive work is being done in Leicester from which the rest of the country can learn?

[Keith Vaz]

Absolutely. I thank the Minister for her kind words. I know that she has to pass Leicester in order to get to London and I know that she has made a number of visits to the city; she was there recently. I thank her for the compliment that she has paid to Leicester and to Silver Star. The Government must not miss this opportunity to set targets for GPs, because it is only through setting targets that we can secure real change.

Another avenue that could be explored is the role of pharmacies in testing for diabetes. According to the Royal Pharmaceutical Society, there are more than 10,000 community pharmacies in the UK. I believe that those pharmacies are under-utilised. My mother, before she died, had absolute faith in her local pharmacist. Of course she listened to her doctor and she got her prescription. On occasion, she would listen to her son and her daughters. However, the person she really respected was the pharmacist, and because pharmacies are on the high street, they are available to local people, so they can get their tests. The benefits of testing for diabetes in pharmacies are twofold. Bringing testing into the community because the pharmacies are there means that hundreds of thousands of people who have not been diagnosed with the condition can discover whether or not they have it and, more importantly, it would reduce the pressure on already over-burdened GPs.

Finally, I want to talk about the new landscape of health care and its role in tackling diabetes. The Health and Social Care Act 2012 offers an unparalleled opportunity to revolutionise diabetes care and prevention. I warmly welcome the introduction of health and wellbeing boards, which will put local councils firmly in the driving seat to address public health. I have always believed that local authorities have a role in providing those services. Importantly, the boards will be able to work with charities, such as Diabetes UK, which have done outstanding work over many years and provided so much help to so many people. The first thing I did when I discovered I had diabetes was become a member of Diabetes UK. I receive constant updates about what I should do and a little loyalty card, which I have not used yet, but it has the telephone number.

It would be remiss of me not to bring up Silver Star, which the Minister mentioned and with which I am privileged to be associated. It targets at-risk communities. Indeed, having been established in Leicester, sent buses to Mumbai and Goa, and supported charitable work in Yemen, the charity opened its first London diabetes centre in Edgware only two weeks ago with the help of Mr Speaker, in the place he was born—not quite the hospital, because Edgware general is down the road. He was born in Edgware however, and it was great to have him back to open the new unit.

The charity has sought—this takes us back to the point made by the hon. Member for Mid Derbyshire—to deal with issues relating to children and sport; the importance of diet; and the role of parents and professionals. On Friday, the charity and I will unveil the winners of a painting competition held by Silver Star in association with Leicester City football club. All the school children of Leicester were asked to paint a picture showing the importance of a healthy lifestyle. I thank the football club’s chairman, Mr Raksriaksorn, and his son Top for naming the charity as one of their charities of the year and for working with it to ensure that children realise the importance of sport. I hope that on Friday not only will the winner of the competition be announced, but Leicester City football club will at last get into the play-offs where we belong, as it is one of the last games of the season.

The health clock on diabetes has reached 11.59 pm. We need either to toughen the responsibility deal or to pass legislation. Schools need to take immediate action to remove vending machines that sell sugary drinks. We need local councils to give fewer planning permissions for fast-food outlets near schools, or, better still, no planning permissions. We need a radically different approach to ensure that everyone at risk is tested for diabetes. If we do not do so, the NHS will be overwhelmed and it will not only affect our generation, but our children’s generation. That is why we must act now.

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[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.

[Keith Vaz]

We must have a timetable. If we go for just a voluntary deal, everyone will sign up, but if there are no benchmarks and no timetable, this will just drift on for ever. The idea was a very good one, but it lacked teeth.

[Ms Abbott]

That is my exact point. Of course we want co-operation with industry, but there must be teeth—sanctions or at least the possibility of legislation—and, above all, there must be a timetable.

When it comes to childhood obesity, the most important thing is early intervention. Medical evidence shows that overweight children have, in proportional terms, gained most of that weight before they start school, so what we do in the very early years is absolutely key. Will the Minister tell us whether the Government plan to take action on training health professionals in weight management in accordance with the National Institute for Health and Care Excellence guidelines as well as emphasising the importance of parenting style and parents’ lifestyle when children’s weight is considered? Interesting research shows us that 70% of boys who have overweight fathers are overweight themselves, and 90% of girls who have overweight mothers are also overweight, which is why we stress the importance of early intervention and working with the family in an holistic way. We are talking about not any one measure but holistic working. Will the Minister tell us whether she is working with her colleagues in the Department for Education on these matters? In particular, is she following the example of Finland, where there is a high uptake of healthy free school meals, which means that children are getting accustomed to what is a proper balanced meal?

Furthermore, will the Minister tell us what she will do about the situation in academies and free schools, because they are exempt from the nutritional standards that apply to other schools? They can have machines selling fizzy drinks. Is the Minister looking at planning legislation and making public health a criteria in planning, which would make it much simpler to ban fast food shops around schools?

We appreciate the energy and enthusiasm of this Minister, but, partly because of the reliance on responsibility deals, not everyone is swept away with what the Government are doing around health, nutrition and obesity. A few months ago, Jamie Oliver said:

“This whole strategy is just worthless, regurgitated, patronising rubbish.”

Does the Minister agree that firmer and more comprehensive proposals are needed to encourage active travel and make the built environment more accessible for young pedestrians and cyclists, and that we need to take action on junk food advertising and promotions of such foods in stores?

Finally, the Public Accounts Committee report into the management of diabetes services in the NHS recently highlighted the need for action from central Government on reducing the rising numbers developing type 2 diabetes. It said:

“The Department of Health and Public Health England should set out the steps they will take to minimise the growth in numbers through well-resourced public health campaigns and action on the risk factors for diabetes”.

I understand that campaigners such as Diabetes UK have expressed their disappointment that the Government have rejected that proposal. Will the Minister tell us today why the Government chose to reject such sound recommendations made by a highly respected Committee of this House? Does she not agree that the rejection of the Committee’s recommendation might lead some observers to think that the Government will listen only to the food industry on obesity?

It is clear to me, and to all those who have campaigned for years on these issues, that self-regulation and voluntary targets alone will not work. Diabetes UK, the royal colleges and others are all coming together to call for a more robust approach to the regulation of the food and drink industry. However the Government appear a little reluctant about such a move.

Once again, I congratulate my right hon. Friend the Member for Leicester East on securing this important debate. I do not believe that there is any one measure that can impact on the matter of childhood obesity and diabetes. I have touched on some of the practical issues, but there are many others, such as culture and ideas of parenting. There is a generation of young women whose notions of parenting are limited. They hear advertisers say, “Give your child this healthy bar and that makes you a good mother,” and they do not have the information to think beyond that. Diabetes is the No. 1 public health issue facing us now, and childhood obesity gives a premonition of even worse public health problems to come. I wait with interest to hear what the Minister has to say about the points that I and some of my colleagues have raised in this interesting debate.