Obesity and Fatty Liver Disease

Martyn Day Excerpts

Thursday 8th June 2023 Westminster Hall

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the hon. Member for Caerphilly (Wayne David) for securing today’s important debate, and for the comprehensive manner in which he introduced the issue and highlighted the scale of the problem. We have had a very informed debate. Obesity is a problem on an escalating global scale, with Scotland’s obesity levels among the highest of OECD countries. Indeed, I was until recently classed as obese myself, and despite reducing a bit I am still in the overweight category. I am going the right way, but I have a long way to go to catch up with the hon. Member for Strangford (Jim Shannon), who has made much greater headway than I have.

Obesity vastly increases the chances of a person developing a range of lifetime diseases, including heart disease, type 2 diabetes and several other forms of cancer, as well as non-alcoholic fatty liver disease, which is what we are focusing on. Obesity reduces quality of life and ultimately contributes to premature death. As we have heard, the UK is very much the sick man of Europe in terms of obesity, and sadly rates of obesity are even higher in Scotland than in England, Wales and Northern Ireland. Two thirds of adults aged 16 and over in Scotland are overweight, and nearly one in three people are obese, placing them at higher risk of premature death, chronic disease and a multitude of cancers. Obesity doubles the risk of developing liver cancer.

The causes of obesity are complicated and vary from person to person. They include the genetic make-up of a person and biological and social factors. It is also heavily influenced by health inequalities. A report by Public Health Scotland found that for children from the most deprived backgrounds, the risk of obesity was almost three times higher than for those from the least deprived—21% versus 8%. There can be no denying that poverty is a significant factor, as are housing, education, access to open spaces, exposure to advertising and the availability and sale of unhealthy foods, all of which affect whether we can be active or eat healthily and consequently have an impact on the risks of developing obesity. The predominant driver in all those factors is what we eat, which is in turn shaped by our environment. For example, for many living in poverty, eating healthy food is a secondary consideration to just eating at all —or even heating their homes. Access to healthy food should be a right, not a privilege.

I am therefore delighted that the Scottish Government have committed to restricting less healthy food promotions and to improving the availability of healthier options when people are eating out in their Out of Home action plan. Their support has also meant investment of more than £400,000 in the last five years to help smaller businesses reformulate common products to make them healthier. That plays an important role in improving dietary health by removing hundreds of millions of calories from Scottish food and drink products. We could, and need to, do a lot more on that if we are going to improve people’s diet, and local companies that are rising to the reformulation challenge should be commended for their efforts.

More needs to be done, however. Minister Jenni Minto announced in Holyrood last month that the Scottish Government will undertake a consultation on regulations to restrict promotions of food high in fat, sugar and salt. That is a vital next step in fixing the broken food system, which is driving the obesity and fatty liver disease crisis in Scotland. So I echo other hon. Members’ points and ask the Minister to commit to delivering prior policy commitments that are still to be implemented. Those include implementing the 9 pm watershed to protect children from junk food advertising on TV and online, and banning multi-buy junk food deals. Those measures enjoy huge public popularity, and I believe they would be effective tools.

The Scottish Government are at the forefront of efforts to strengthen obesity prevention and improve earlier detection of liver disease, including through pioneering use of intelligent liver function tests in primary care, which are now being piloted in sites across England as well. The British Liver Trust categorised my local health board, NHS Lothian, as green in autumn 2022, as it now has a fully effective patient care pathway for the early detection of liver disease. That is important because the mortality rate for chronic liver disease in my local health board is lower than the national average in Scotland, at 15.3 versus 17.9 per 100,000, reflecting the growing momentum for action to help improve liver disease outcomes and save lives.

Scotland is also at the forefront of harnessing new diagnostic tools to improve earlier detection of liver disease. The hon. Member for Strangford and others have spoken about how detection is important. We must prevent people from becoming ill in the first place if we really are to tackle the problem. However, by the time people are diagnosed, we often find they are too far down the pathway to make significant improvement.

The intelligent liver function testing pathway developed by the University of Dundee uses an automated algorithm-based system to further investigate abnormal liver function test results on initial blood samples from primary care. Intelligent liver function tests represent a nearly threefold increase in the diagnosis of liver disease and are estimated to be saving the NHS more than £3,000 per patient with an abnormal liver blood test. Indeed, iLFTs are now being piloted in Birmingham, Wolverhampton, Coventry, Liverpool and north London, and the roll-out of such technology is welcome. I urge Ministers to look at other examples of good practice from the devolved nations to help improve patients’ pathways for early detection and management of liver disease. Will he commit to delivering a new nationally endorsed pathology pathway for early diagnosis of liver disease that incorporates intelligent liver function testing in primary care?

In conclusion, we know that obesity doubles the risk of developing liver cancer, which is now the fastest rising cause of cancer death in the UK. Non-alcoholic fatty liver disease is now the fastest rising cause of hepatocellular carcinoma globally. In Scotland, liver cancer has seen the largest increase in mortality rates—38%—of all cancer types over the past decade, and liver cancer is now the fastest rising cause of cancer death in the UK. Unfortunately, Scotland has the highest incidence of liver cancer among our four nations.

The liver disease public health crisis disproportionately impacts our most disadvantaged and vulnerable communities. In 2021, chronic liver disease mortality rates in Scotland were 5.8 times higher in the most deprived areas than in the most affluent. Individuals in deprived areas are more likely to develop liver disease, be hospitalised with it and die from it than those in affluent areas. We must improve early diagnosis and prevention if we are to tackle this issue. That also means tackling poverty and health inequalities.