Obesity Strategy 2020

Nigel Evans Excerpts

Thursday 27th May 2021 Commons Chamber

[Jo Churchill]

I am going to push on, I am afraid.

The Queen’s Speech on 11 May confirmed our intention to take that measure forward through the health and care Bill, and the Government aim to publish the consultation response as soon as is practicable. Many people objected to the sugar drinks industry levy, saying that it would mean a decline in sales. Five years on, we have seen a decline of around 44% in sugar in soft drinks. Revenue raised has often been diverted into sports activities in schools and so on, and sales have risen to over 105% of what they were in the beginning.

Information helps the consumer; it also helps manufacturers and retailers to look at diversifying their products, and much of the customer research, including the McKinsey report—I think it was put out by the Food and Drink Federation, but it might have been the British Retail Consortium—shows that this is the direction in which customers want retailers and manufacturers to go.

We want to take this measure into alcohol labelling, as well. As we know, each year around 3.4 million adults consume an additional day’s worth of calories each week from alcohol, which is the equivalent of an additional two months’ worth of food a year. Despite that, the UK drinks industry is not required to provide any information on how many calories each drink contains, and up to 80% of adults have no knowledge at all.

Action to ensure that people can make an informed, educated choice is what we want, and we will be publishing a consultation shortly on the introduction of mandatory calorie labelling on pre-packed alcohol and on alcohol sold in the on-trade sector. Once again, it is interesting to note that this labelling happens to a large degree with most low-alcohol content drinks and in many own brands, so the measure is merely about ensuring that customers can feel fully informed.

Turning to weight management services, on 4 March, we announced £100 million of extra funding for healthy weight programmes to support children, adults and families to achieve and maintain a healthier weight. More than £70 million of that will be invested into weight management services made available through the NHS and local authorities, enabling some 700,000 adults to access the support that can help them lose weight. It includes digital apps, weight management groups, individual coaches and specialist clinical support.

There has been a fantastic response from local authorities to the planned roll-out of these services. It shows the widespread need and support for helping people achieve a healthier weight and is an example of the importance of partnership in action. The remaining £30 million will go to: funding initiatives to help people maintain that weight, because we know that weight lost can often be quickly regained; giving access to the free NHS 12-week weight loss plan app; continuing the Better Health marketing campaign to motivate people to make healthier choices; improving services and tools to support healthy growth in early years and childhood; and helping up to 6,000 families and their children to grow, develop and have a healthier lifestyle and weight. In addition, we will invest in helping people access the weight management services and support they need through a range of referral routes across the health system.

We are also looking at incentives and incentivising healthier behaviours. We have committed £6 million to developing a new approach to health incentives. The aim is to support people towards adopting healthier behaviours. That work will be supported by Sir Keith Mills, who pioneered reward programmes such as air miles and Nectar points. It will look at the best innovation to motivate people drawn from not only the public sector, but the private sector.

Since it is critical that a child has the best start in life, we are also working to improve infant food and the information around it. We will consult shortly on proposals to address the marketing and labelling of commercial food and drink products for infants and young children—to reiterate what Dame Sally Davies has said, there is the halo effect, where we think what we are purchasing for our children is healthy, but potentially it is not—so that parents and carers can have clear and honest information that aligns with advice on the products that they feed their children and babies, giving every child the best start in life.

We are not alone in working to address the challenges of obesity; it is pretty much a global problem. The effect of collaboration internationally is critical for us all to learn. The UK has established effective working partnerships with, for example, Mexico, Chile and Canada, as well as international organisations such as the World Health Organisation. I have had discussions with some of my counterparts across the world, including those leading on measures such as health incentives. Through partnerships we share best practice and ensure our interventions are based on experience and the evidence.

Tackling obesity and helping people to maintain a healthy weight is, as I have said, an extremely complex issue, and that is reflected by the wide range of action we are taking. Of course, we would like to move more quickly and have a magic solution, and there is more that we want to do, but I recognise the scale of the policy we are bringing forward. It is a far-reaching and radical plan to reduce obesity in our society; I do not want us to carry on being second in a league table in which we should not be proud of being second.

The high prevalence of obesity in adults and children has been decades in the making. It is going to take time to see results from our interventions, and we may want to go back and change some of them. There is no single fix and no single point of responsibility. We all have a part to play and it is vital for us all—Government, Parliament, industry, employers, the health service, the wider public sector and all of us as individuals—to work together. I am really looking forward to what I anticipate will be a very varied set of contributions this afternoon.

[Mr Deputy Speaker (Mr Nigel Evans)]

There will be a three-minute limit on all Back-Bench contributions from the very beginning.

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[Alex Norris]

I thank the hon. Gentleman for that contribution. Philosophically, I believe that the state has a responsibility to act when we acknowledge evidence that we have an environment that promotes poor health in this way, so that it goes beyond our personal choices and the way in which we want to lead our lives to things that swamp us. I reject his characterisation of a hierarchy. I would consider the impact that it has on the public and, indeed, the pressures it creates. As for alcohol, I would absolutely support stronger alcohol strategy proposals from the Government, as I would an updated and refreshed version of the tobacco control plan, which we have been waiting on for many months. Again, I would not establish a hierarchy, but I think we can act in those areas and that we ought to.

The hon. Gentleman recognised the support that I had given so far, but I am afraid that that is now about to change—it is not just because of him, I promise. On calories on menus, we have seen the instrument. The impact assessment is comprehensive—it has five different options, 235 paragraphs, four annexes—yet eating disorders are afforded one mention covering three paragraphs before being discarded in a fourth. I do not think that that is sufficient or that due regard has been paid, and I hope that the Minister will revisit it. Alongside my hon. Friend the Member for Tooting (Dr Allin-Khan), I am seeking to bring together stakeholders who reflect a full range of views on this topic to forge a solution that realises important health benefits for one group but is not injurious to another section of society. I hope that the Minister is still in listening mode on the matter and might seek to do something similar.

That leads me to what I am saddest about with this strategy; the Minister knows about it, because I have raised it with her many times. Rather than having just an obesity strategy, we ought to have a healthy weight strategy. Eating disorders are increasingly common and can blight people for their whole lives, and their lives and voices are missing from the strategy. I have thought about this for a long time—since last July—and I think we can guess why that is: talking about eating disorders inevitably challenges us to talk about mental health services in this country, and of course, the Government are not keen to do that, as it would offer a reckoning of their leadership in this area over the previous decade. Access to high-quality mental health services of all kinds is too rare. People wait too long and the oft-repeated promises about a parity of esteem approach have not led to meaningful action. That gets worse when we talk about child and adolescent mental health services. The evidence is irrefutable that the root of challenging behaviours around food is at that time in life, but, as every right hon. and hon. Member knows, trying to get a young constituent into CAMHS treatment is simply too hard. We are failing a big and growing part of our population by not addressing that, too, so in that sense the strategy has missed a really important opportunity.

I turn to public health. As I say, I am glad that these proposals have been brought forward. It has to be said, though, that they follow a decade of the Government’s cutting services that improve the public’s health. I know that it is a core strategy of the current Administration to act as a new Government and run as far away as possible from their record over the last 11 years—I would want to do that if I were them—but they cannot do so.

The public health grant, even with the recent uplift relating to covid, is nearly a quarter lower in real terms than it was five years ago. I had responsibility for the public health grant in Nottingham for three years prior to entering this place. My experience was that, with the growing pressures for demand-driven services such as drug and alcohol services and sexual health services, added to the consistent cuts to local authorities, there just was not anything left for longer-term services such as those that deal with healthy weight. That has meant a withering of nutrition guidance, shared cooking programmes and specialist support. That has absolutely weakened our approach to taking healthy weight issues head-on in this country. These proposals should have included a commitment to reversing those cuts and, frankly, some humility for having imposed them in the first place. That point needs addressing.

Of course—I will make this my final point—this is an issue about poverty in this country, too. If we eradicated much of the poverty, we would take a lot of the obesity with it. As I said, there is compelling evidence that obesity is much worse in poorer communities. Again, that makes it all the more mystifying that those massive and ongoing cuts to local authorities have been targeted at the poorest communities, especially in the big cities. That is an extraordinary public policy disconnect and, again, it is something that we ought to address in the strategy if we really want an all-services approach, at all levels of government, to taking on this national issue.

This is a very important issue and it is right that the Government are seeking to act. We will support them to move at pace to implement evidence-based, effective interventions, but we will push them, too, to close the gaps in the strategy so that it becomes genuinely transformative. The stakes here are lofty, so our ambitions must be lofty too.

[Mr Deputy Speaker (Mr Nigel Evans)]

We will go, via video link, to Andrew Selous. Andrew, I have some great news for you; we have a bit more wiggle room, so you have four minutes.

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[Alison Thewliss (Glasgow Central) (SNP) [V]]

I want to start by echoing the sentiments of the Obesity Health Alliance; in this debate, weight stigma does not help people lose weight. The right support, evidence-based weight management, and fundamental changes to our obesogenic environment and food systems are all required to tackle this.

The health harms caused by obesity are well known, but I initially wish to mention one particular aspect that does not get the attention it deserves: liver disease. On average 40 people die of liver disease every day. The Foundation for Liver Research and the British Liver Trust have sent a helpful briefing, but in truth I had already committed to mentioning it in this debate. My husband, Joe, was diagnosed with stage 2 non-alcohol related fatty liver disease in 2019, after wandering around complaining of a wee pain under his ribs for five years. Since his diagnosis, he has made difficult but necessary changes to his lifestyle; he has lost 22 kg, taken up hillwalking, and has been carefully monitoring his weight, and I am very proud of him.

Some 90% of liver disease is preventable and, luckily for Joe, at stage 2 it can be reversed; however, as it can remain asymptomatic for up to 20 years, three quarters of people are diagnosed at a late stage when it is too late for lifestyle changes or interventions. Liver disease is the third leading cause of premature death in the UK, with deaths increasing by 400% over the past two generations; this is in stark contrast to other major diseases, such as heart disease and cancer, so I urge the UK Government, who have acknowledged liver disease in their obesity plan, to come up with actions, including doing all they can to spread information about this disease and the ways of preventing it.

The disproportionate harm caused by covid 19 to older people, minority ethnic groups, the people living in greatest deprivation, and those with obesity, diabetes and respiratory and cardiovascular disease has highlighted new vulnerabilities and underscored existing health inequalities. While much focus has been put on the direct health impacts of covid, the SNP recognises that we must also work to shift our focus towards reducing those inequalities and preventing ill health. We want everyone to eat well, be a healthy weight and have equal access to care.

The ambitious and wide-ranging actions to address this challenge are set out in the Scottish Government’s diet and healthy weight delivery plan. The plan, which has over 60 broad-ranging actions, has a strong focus on prevention, including population-level measures to make it easier for people to make healthier choices, as well as more targeted interventions. Alongside this, the SNP Scottish Government also published “A More Active Scotland: Scotland’s Physical Activity Delivery Plan”. This recognises the importance of physical activity in promoting and maintaining healthy weight. Progress towards the outcomes set out in this delivery plan is being monitored through a dedicated set of indicators linked to the active Scotland outcomes framework”. The SNP Scottish Government are continuing to provide £1.7 million in 2020-21 for improvements to weight management services for children and young people. Earlier this year, the SNP Scottish Government also published the refresh of their diabetes improvement plan, which strengthens the actions in the original plan to improve the prevention and treatment of diabetes and the care of all people in Scotland affected by it.

The SNP has consistently pressed the UK Government to ban junk food advertising on television and online before the 9 pm watershed, and we welcome that this is finally coming to fruition. Online adverts on social media are an area the UK Government must tackle strongly, as other Members have mentioned, because they are pervasive. In our recent manifesto, the SNP renewed its commitment to halve childhood obesity by 2030 and to significantly reduce diet-related health inequalities by pledging to provide free school breakfasts and lunches to every primary school pupil in Scotland, all year round, and to all children in state-funded special schools in Scotland; and to pilot the provision of free nutritious school breakfasts in secondary schools and explore the feasibility of universal breakfast provision in secondary schools.

We also want to make Active Schools programmes free for all children by the end of the Parliament, continue to improve nutritional standards of food and drink in schools, and bring forward legislation over the next Parliament to restrict the use of promotions on food and drink that is high in fat, sugar and salt. We will also aim to enshrine the fundamental right to food in law, as the cornerstone of being a good food nation. That will form part of the commitment to incorporate UN human rights charters into Scots law.

Scotland has one of the world’s best natural larders, but we know that so many people do not eat well and that obesity remains a significant problem. Evidence shows that in less well-off communities it is more difficult to obtain good-quality, fresh food at a price people can afford. Community larder projects, such as the Govanhill People’s Pantry in my constituency, have been springing up all over the place and working hard to try to redress the balance, in this case by working with FareShare to provide access to food in the community.

The overriding issue of poverty is, of course, key to tackling a lot of the issues; access to sufficient healthy food and the means to cook it is not there for everyone, not least because of policies such as the two-child limit, the upcoming removal of the £20 uplift to universal credit and tax credits, the UK Government’s neglect of people on legacy benefits, and the pretendy living wage. They all contribute to a situation where people cannot afford to eat healthily. If the UK Government want to tackle obesity, they cannot continue to ignore this reality.

Investment in regenerating neighbourhoods, increasing access to walking and cycling, and improving parks is also significant in getting people out and about and moving. Just last night, alongside local councillors, I met mums and grans from the Calton Community Association, who are desperate to access the newly announced Scottish Government fund for parks so that their kids can benefit from outdoor play. An obesogenic environment, coupled with a culture that allows the insidious influence of food giants and their ultra-processed foods to be advertised not just to us but to our children, has proven to be a recipe for disaster. I am looking forward to watching the latest programme by campaigner Dr Chris van Tulleken, “What Are We Feeding Our Kids?” and urge the UK Government to tune in tonight. The supermarket aisles are heaving with unnecessary infant snack foods, and the new report by the First Steps Nutrition Trust should be essential reading for the Minister.

One significant point of difference in the UK and Scottish strategies concerns our youngest citizens. Scotland’s healthy weight strategy specifically mentions the significance of breastfeeding, which can of course have a positive effect on maternal weight, as well as that of babies. The UK Government are committed to consulting

“on our proposals to help parents of young children to make healthier choices through more honest marketing and labelling of infant foods.”

Ministers could start by doing more to protect babies and pregnant mothers from the rapacious global formula industry, and, in this the 40th year of the World Health Organisation’s international code of marketing of breast milk substitutes, fully adopt the code. That used to be something the UK Government would blame the EU for their inability to do, but they have lost that excuse and must now act. The code sets out to protect all babies, however they are fed. As the chair of the all-party group on infant feeding and inequalities, I do not set this up as any kind of false pro-breastfeeding/anti-formula battle, because I know that for many formula is essential. Many mums want to breastfeed, but are failed by a UK Government who do not see breastfeeding as a priority and do not invest in support. Some years ago, Norway changed its approach and it now has one of the highest rates in the world. Norwegian mums do not have different breasts from us, but they do have a Government who made their needs a priority.

The Minister said that if adverts did not influence people, they would not be used, and she is correct. Formula companies spend astronomical figures on marketing, a cost that gets passed on to consumers at the tills and makes it challenging for many families to afford formula, and on the promotion of follow-on and specialist formulas, which are not necessary, but exist largely as a means of cross-promotion. I hope the UK Government will also act on that, as they claim they intend to look at honest marketing and labelling. As an example of that marketing, I share the concerns raised by the UK’s Baby Feeding Law Group that the National Trust has formed a partnership with HiPP Organic, a company with many documented violations of the code over the years. We should be under no illusions: these kinds of partnerships exist to benefit the company and boost their brand, and I urge the National Trust to reconsider.

I wish to touch briefly on the issue of calories on menus, on which I have received many emails, as I am sure other Members have. I can see what the UK Government intend, and I appreciate that for some people having calories listed on menus may be useful—I have certainly eaten fewer Danish pastries since coffee shops started to put calories on the display—but the policy is not about anecdotes and headlines and must be based on evidence. For those with a history of disordered eating, this is a deeply serious issue and such triggers can be very harmful indeed, so I urge Ministers to be cautious in what they are doing and to listen to and learn from the evidence from expert organisations such as Beat and from those affected.

I commend the Government for taking action on a range of issues to do with obesity but urge them to look more widely at the factors that cause obesity and to follow the Scottish Government’s approach with a healthy weight strategy.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call Greg Smith, with a four-minute limit.

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[Jim Shannon]

I am grateful to the right hon. Gentleman for clarifying the matter. I knew that is what he meant, but I thank him.

The health survey for England refers to 1,000 people aged over 16, 277 of whom were obese and 31 were morbidly obese. In Northern Ireland, the figures are replicated; in fact, they are the same everywhere. Childhood obesity is a crucial issue on which much more needs to be done to make youths feel less self-conscious about the issue but at the same time able to do something about it. Obesity affects one in every five children in Northern Ireland. The figures there unfortunately show that there are outstanding problems to be addressed. Obesity exaggerates high blood pressure, diabetes and liver disease. Obesity is one of the three main causes of liver disease, in particular. Obesity also affects many other things, as the Minister said. It is very important to put that on record.

I have met constituents of mine over the years who had a medical condition that meant that they were not obese by choice but because of the circumstances of their own individual bodies. The people I am referring to had to go for bariatric surgery. I know some people who did that and I know it changed their lives. Perhaps the Minister could comment on how such procedures can be looked after within the NHS, because to do it privately costs over £10,000.

This is a serious health problem and it affects thousands of people. I want people to live their lives healthily and happily. I believe children should be taught that support is all around them and that their size is nothing to be ashamed of. There are ways to go about detecting obesity. However, I feel that one of the most important factors in tackling this issue is to reassure people that they will not be judged. Judgment often leads to resentment and failure, and there is no doubt that it is a sensitive issue for those who struggle with weight loss. I therefore urge the Minister to take that into consideration. I also urge others to be kind when it comes to such a topic. I believe that help and support is there for all those who are obese and seek help. I sincerely hope that in the coming years we can work together to bring forward a strategy that will encourage people and not do them down.

[Mr Deputy Speaker (Mr Nigel Evans)]

Wind ups begin at 4.44 pm. There are six speakers left. Hopefully, we will get you all in at four minutes. We will see.

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[Jo Churchill]

No, I am terribly sorry, I have only two minutes left, but I am more than happy to talk to my right hon. Friend at considerably more length. He asked me for a bit of evidence on the sugary drinks tax. There is the fact that that, over three years, it has reduced the calories consumed on every occasion that somebody drank a soft drink by 35.2%. The figures on out-of-home calorie labelling show that £5.6 billion will be saved for the economy over 25 years, and that is before we even get to the associated benefits to people’s health.

I am sorry that I am probably not going to answer every point, but we want to achieve the full potential of all people. It is about a joint effort. My hon. Friend the Member for South West Bedfordshire (Andrew Selous) has been a doughty campaigner. I have met members of Bite Back 2030 with him, and those are young people asking us to do something. I am working with colleagues in the Department for Education and the Department for Environment, Food and Rural Affairs to make sure that we are doing that. Indeed, the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Banbury (Victoria Prentis), who is on the Front Bench next to me, and I have the food strategy. Part 1 is already out and we are expecting part 2 in short order—that will very much go towards responding to what my hon. Friends the Members for Keighley (Robbie Moore) and for Stoke-on-Trent Central said. That Minister and I have worked together, with the Under-Secretary of State for Education, my hon. Friend the Member for Chelmsford (Vicky Ford), to look at how we can promote healthy eating for children and work across Government to drive these objectives.

I agree with my right hon. Friend the Member for Forest of Dean (Mr Harper), who said that this was about education, changing behaviour, changing the environment and not demonising individual foods. I want everyone to get to where he has, so I can see a future career as a healthy weight consultant, if nothing else. I congratulate Lucozade on what it has done. We will be continually monitoring the situation to make sure that we achieve our ambition on this. Partnership is key, and we are working with local authorities and working to build healthy weight management services. Promoting good health is central to this Government’s health agenda, and we will do that through the new Office for Health Promotion and proactively take the burden of preventable ill health and empower everyone to make the right choice. We would like to see immediate results, but the situation is complex, and we know it will take time. We all have a lot to gain by helping people achieve and maintain a healthy weight, and I look forward to the support of the whole House in doing that.

Question put and agreed to.

Resolved,

That this House has considered implementing the 2020 Obesity Strategy.

[Mr Deputy Speaker (Mr Nigel Evans)]

I ask Members to leave the Chamber in a covid-friendly way. The Minister for the Adjournment will not touch the Dispatch Box cover, because I am going to ask the Serjeant at Arms to sanitise it while we hear the opening speech.