Health: Obesity

Lord Patel Excerpts

Monday 4th April 2011 Grand Committee

[Lord Patel]

My Lords, you cannot really find fault with the logic of the noble Lord, Lord McColl—do not eat and you will not put on weight. The problem is that for most of us, if you mention food we want to eat. I am going to focus on strategy, but I cannot find fault in his logic.

The noble Lord has already referred to the fact that obesity is recognised as a major public health problem and that it may well be getting worse. A policy review of several countries, including the United Kingdom, finds common themes. All express concern at the prevalence of obesity, thought to be the result of over-consumption of energy-dense foods and inadequate levels of physical activity. Few countries have specific strategies; instead, obesity is tackled through separate policies of nutrition and physical activity. Policies often in general terms identify sets of actions without any firm commitments—often interventions that focus on schools, workplace and active transport. What is noticeable is the absence, almost, of fiscal and legislative interventions from policies; neither are the policies funded. The interventions are poorly supported by research or evidence. The proposed measurement of the effectiveness of policies is weak and not clearly formulated. The strategy to tackle the so-called “tsunami of obesity”, which threatens several countries in the world, is largely concerned with options for ways to develop policies rather than a set of interventions to reduce obesity.

We have known about the associations of obesity and disease, and the noble Lord, Lord McColl, mentioned some of them. There are some 17 different diseases that we know of that have associations with obesity, costing the health service in England in the region of £4 billion—costs that will exceed health costs due to tobacco and alcohol use. The joint report in January 2011 of the Academy of Medical Sciences and the Royal Society of Edinburgh—and I declare an interest as a fellow of both—made some key recommendations on diabetes and obesity that have implications for policy research and management of patients with obesity and diabetes at individual and population level.

Obesity, as everybody understands, is a condition characterised by an individual having excess body fat caused by higher energy intake than expenditure. Excess energy is stored in the form of adipose tissue. Statistics have already been mentioned and are clear: 25 per cent of the adult population is obese and 65 per cent may well be overweight, while 23 per cent of children at reception in school are obese or overweight and 33 per cent of 10 to 11 year-olds are obese or overweight. Those are important findings from the child measurement studies. The pester power of children and the pushing of calorific foods to children by shops contributes to this. A well-known politician reportedly asked:

“As Britain faces an obesity crisis, why does WH Smith's promote half-price Chocolate Oranges at its checkouts instead of real oranges?”

When he said that, he was much applauded by the population and by the citizens. The politician was David Cameron.

I turn to the current Government’s strategy, or what it might be. We await the publication. The public health White Paper suggests that the Government will take a holistic approach with emphasis on personal responsibility and choice, but they will be reluctant to use regulation or legislation. The focus will be on voluntary agreements with industry through public health responsibility deals. Interventions are likely to be based on strong evidence, but there is not enough strong evidence, especially as NICE is asked to put the obesity interventions review on hold. There are suggestions that the Government will use the famous “ladder of interventions”, beginning with the least intrusive—information, education and so on—but regulation of industry or individuals will be used only if the initial steps of the ladder do not work. That is the well known nudge theory which involves no regulation, prompted choice and co-operation with the private sector, and it will be subject to strict post hoc evaluation.

I ask the Minister: what is the evidence that the nudge theory will work? What is the roadmap to evaluation? What measurements will be used and who will carry them out? A major plank of the policy is the responsibility deal. Who will lead that responsibility deal? Who will be responsible for it? Could the noble Earl comment on the reports that several charities and consumer organisations have withdrawn, seeing it as industry influencing consumers rather than reforming their business practices?

I hope that the Government will take on board in their strategy several issues that have some evidence as to their effectiveness. They are such simple things as a front-of-pack colour-coded labelling scheme for foodstuffs; a ban on advertising on television before 9 pm of food that is high in fat, sugar or salt; a continuation of the national child measurement programme; information on calorie content on all products; a commitment from local authorities to provide, to protect and to maintain the environment that will enhance physical activity; promotion of research into psychology and anthropology of behavioural change; cost effectiveness of interventions; and, lastly, a ban on trans-fats in all foods, as I have said before. Strategies that demonstrate reduction in childhood obesity are key indicators of success and, therefore, the childhood measurement programme should be continued.