Obesity

Sarah Wollaston Excerpts

Wednesday 9th November 2011 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the hon. Member for East Londonderry (Mr Campbell) for securing this important debate. I do not want to repeat his message about the economic cost of the problem, but I would say, having been a general practitioner for 18 years, that once someone becomes obese, it is extraordinarily difficult to regain their normal weight in the long term.

I would like the Minister to consider the following points. We need to focus on better identification of those who are most at risk, particularly children, and to target action on those high-risk children. A nudge will just not go far enough, and it is time for more of a bit of a shove. We need particularly to look at the role of liquid calories in obesity among children. I ask the National Institute for Health and Clinical Excellence to update its guidance and review the evidence.

Nearly two thirds of adults are overweight or obese, but they do not start out that way. Around one in five four to five-year-olds are overweight or obese, but by the time they reach 11, that figure will have risen to one in three.

[The Minister of State, Department of Health (Mr Simon Burns)]

On the point about NICE, may I give my hon. Friend a reassurance that might be helpful at this stage in her contribution? As she may know, NICE has recently consulted on whether now is the right time to review its original guidance. As a result of that consultation, it will be making a decision later this month.

[Dr Wollaston]

I thank the Minister for that helpful response and look forward to hearing the outcome of that.

Children at primary school and in the early years before they have reached school are among the really high-risk groups. Some 85% of obese children go on to become obese adults, whereas only 12% of normal weight children become obese adults, so it makes sense to focus on that group of children, but that can happen only if we have better early identification. We should introduce annual measurements of weight and height, so that we can see when children are starting to slip towards obesity. We should target our resources much better on that group.

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

Years ago, parents with chubby children would be told, “It’s puppy fat and they will grow out of it.” There is still that idea around among otherwise bright and responsible parents. We need to press the point that chubby children grow into chubby adults.

[Dr Wollaston]

I absolutely agree with the hon. Lady. We need to be much clearer with parents that their children are at risk and that being overweight is not something that they will grow out of.

We should be much more creative about how we target help to high-risk children. Why not allow all those children to have free healthy school lunches? As poverty and deprivation have such strong links with obesity, considering that high-risk group is particularly appropriate if we are to address the Marmot agenda. Unfortunately, families on tight budgets are much more likely to be pushed towards unhealthy and cheaper choices. If we want to nudge them in the right direction, we must recognise the role that price plays in the choices that they make. We should look at the role of loss leaders. We urgently need a change in what supermarkets offer so that loss leaders are redirected towards healthy rather than unhealthy products.

Why not incentivise exercise in those high-risk families with vouchers for success and free access to good-quality sports facilities? We should incentivise a whole-family approach to cooking skills because cooking is a fun activity. An effective way forward would be to make such a service free and readily available to whole families.

On liquid calories, a survey conducted by the British Dental Association and Ipsos-MORI showed that 47% of children’s fluid intake is in the form of sugary and carbonated drinks. That means that one in five children is consuming 500 calories or more a day just in the form of sugary drinks and 73%—nearly three-quarters of children—are consuming more than 200 calories a day. It is a staggering number of calories that children are consuming.

If we look at adults, we will see that there is a particular issue with alcohol. The chief medical officer has already highlighted that around 10% of an adult’s calorie intake can be through alcohol. What we should understand from that is the role that discounting plays. I have mentioned that before. It really does not matter how disciplined the rational part of our brain tries to be—the irrational and impulsive side will continue to be irrational and impulsive. It is not helpful to see heavily discounted products in super-sized multi-buy packs piled high at the check-outs in supermarkets. If we want to move “nudge” towards “shove”, we should regulate how supermarkets market their products. I do not suggest that the whole answer to obesity lies in regulating supermarkets. I realise that there is a complex interplay between over-supply, pricing, culture, marketing, poor consumer choices and human nature. There is also the interplay between genetic predisposition and a lack of exercise. However, it is unlikely that our current strategy will go far enough in this regard. If we are going to do something about the £5 billion a year that this problem is costing us—the figure is predicted to rise to £10 billion a year by 2050—I suggest and hope that the Minister takes a strong line and abandons the idea of giving the problem a little nudge, in favour of giving it an almighty shove.

--- Later in debate ---

[Dr Poulter]

Yes, certainly. There is an issue about how physicians prescribe effectively. Statins are an effective way of controlling cholesterol, and there is good evidence that they benefit people with heart disease and high cholesterol and that they increase life expectancy. There has been a lot of research, and I believe that it has been shown that statins may have beneficial effects in reducing the risk of breast cancer, although the Minister will correct me if I am wrong.

The right hon. Gentleman touches on the wider point that the emphasis in this debate needs to be on effective community-led interventions that tackle obesity and health care, and my hon. Friend the Member for North Swindon (Justin Tomlinson) discussed that very effectively. However, we need to ask how we will make those community health care measures effective.

The Government are setting up health and wellbeing boards, which are a very useful part of their health care reforms, because they will, for the first time, bring together different organisations in a meaningful way. Local councils in certain towns may run good community initiatives that connect GPs with leisure centres, exercise and sport, and some schools may encourage sport and physical activity in an effective way or have good links with local sports clubs. However, that does not often happen in a co-ordinated way across whole counties or, indeed, across the country. Health and wellbeing boards will help to bring together different organisations to address key public health problems, and obesity is a key public health challenge in all our constituencies.

As part of the health care reforms, the health and wellbeing boards will be able to address issues such as obesity. For example, if we know that there is an issue with teenage pregnancy or obesity in certain schools or among certain schoolchildren in my constituency, targeted interventions can be put in place in a much more community-focused way by getting the local authority together with health care representatives at a much more strategic level. That must be a good thing, because it allows much more targeted interventions.

The second thing I want briefly to discuss—I do not want to speak for much longer—is nudge theory. My hon. Friend the Member for Totnes has a slightly different view of it. I have more faith in nudge theory than she does, and I say that because we have had debates about agriculture—some of the Opposition Members here today were present—in which we discussed the need for corporate firms and supermarkets to show greater corporate responsibility on issues such as food labelling. We have now seen active movement from some supermarkets on honest food labelling. For example, we talk about food in a store being labelled British only if it is actually farmed in Britain, and not if it is merely processed or sliced here. We are beginning to see such initiatives come through, with supermarkets supporting British farmers. Morrisons is a good example of a supermarket where the British food stamp actually means something, and that allows consumers to make an informed choice. Supermarkets are therefore able to show corporate responsibility when they are asked to do so, although things are not entirely perfect, as we all know.

In a similar vein, the Government have introduced a public health responsibility deal, and it is a good initiative. Almost 200 different companies have signed up to the deal, including supermarkets such as Asda, the Co-op, Morrisons, Marks and Spencer, Sainsbury’s, Tesco, Waitrose and many others. Fast-food outlets such as McDonald’s, Pizza Hut and KFC have pledged to remove trans fats and introduce calorie labelling as a result of this initiative. Those are all pleasing and beneficial steps in the right direction.

[Dr Wollaston]

Does my hon. Friend share my concern, however, that organisations such as Asda, which have signed up to the new responsibility deal, are in some ways undermining it by offering hugely discounted alcohol products?

[Dr Poulter]

There are areas of obvious concern, where supermarkets can go further. As I said earlier, when we were talking about the agricultural sector, even though several supermarkets are backing honest food labelling, and showing responsibility in food labelling and calorie counting to tackle obesity, it is right to highlight the areas in which they need to show greater corporate responsibility. Cut-price alcohol is one of those, and we will continue to monitor it carefully in our work on the Select Committee on Health, and as physicians. My hon. Friend makes a good point.

In preparing for the debate, although I do not normally take an active interest in children’s TV, I found out about an Icelandic TV show called “LazyTown”—the Minister may want to expand on the subject a little later. The show is watched by children all over the world, and we have it in Great Britain as well. There is a healthy sports superhero character, called Sportacus, who motivates children to eat healthily and be active. In Iceland several “LazyTown” initiatives have been run in partnership with the Government and the private sector. For example, children between four and seven years old were sent an energy contract, which they and their parents signed, in which they were rewarded for eating healthily, going to bed early and being active. In one supermarket chain, all the fruit and vegetables were branded “sports candy”, which is the “LazyTown” name for fruit and vegetables. That led to a 22% increase in sales at that supermarket, and improved health and reduced obesity levels in Iceland.

The fact that Iceland’s child obesity levels have started to fall as a result of initiatives of that kind is good evidence in support of such corporate responsibility. Those initiatives are designed to support supermarkets coming together with Government, to make effective use of the nudge theory of improving behaviour, and they can work—and have worked. For that reason, we must support what the Government are doing, because there is evidence that it can work. It is a good thing and the evidence from Iceland is that we need to do what works, with children and communities.

I understand, and I am sure that the Minister will confirm, that the Department of Health has set up a partnership with “LazyTown” and is interested in expanding that initiative in the United Kingdom. We need more such approaches. The reason supermarkets sign up to such deals and initiatives is that it is good not just for the children, who become healthier and less obese, but for the supermarket and its brand image. Supermarkets see that working with corporate responsibility—we see it in our constituencies with Tesco schools vouchers—can enhance their image and custom, and do real good, for example, by reducing obesity levels.

I have greater faith in the nudge theory than my hon. Friend the Member for Totnes, and we need to allow similar initiatives to take root in the future. What has been done in the past has not worked very well; obesity levels have been going up. We have good evidence, from examples of corporate responsibility, that things can be tackled, so let us give nudge theory a chance. Let us also look to those health and wellbeing boards to provide community-based interventions that will work. If we do not do something, things will get worse, and the boards are a good way to address the problem.