Childhood Obesity Strategy

Sarah Wollaston Excerpts

Thursday 21st January 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House calls on the Government to bring forward a bold and effective strategy to tackle childhood obesity.

I want to thank the Backbench Business Committee for granting time for this debate. I also want to thank all my colleagues from across the House who are members of the Health Select Committee—and the staff of the Committee, particularly Laura Daniels—for their work on the report on childhood obesity that was published recently. Outside this House, there are also many organisations and individuals who have campaigned tirelessly to improve children’s health.

Perhaps we can start by looking at the example of Team GB and their success in the Olympics. On the morning of their track cycling victory, the architect of the team’s success, Sir David Brailsford, put their success down to the principle of marginal gains and their relentless pursuit of identifying every efficiency in the rider, the bike, the environment around them and their training regime. All those marginal gains were added together to win gold for Team GB in the Olympics. I think we need to adopt the same principle when it comes to tackling childhood obesity.

Too often, I hear people saying that it is all about education, or about getting children to move more in PE at school, but I would say that there is no single measure. We all know that this is an extremely complex problem that requires action at every level. I therefore call on the Minister to look at every single aspect of tackling childhood obesity. If we were running a cycling team hoping to win the Olympics, we would realise that we could not achieve success if we left any of the factors out, so let us apply that principle here.

Let me set the scene by telling the House why this subject matters so much. We know from the child measurement programme in our schools that around one in five of our children who enter reception class are either obese or overweight. However, by the time they leave in year 6, a third of our children are either obese or overweight. Perhaps even more worrying are the stark data on the health inequality of obesity. A quarter of the children from the most disadvantaged groups in our society are leaving school not just overweight but obese, which is now more than twice the rate among children from the most advantaged families. My first question for the Minister is this: will the childhood obesity strategy not only tackle the overall levels of obesity but seek to narrow that yawning and growing gap in our society between the least and most advantaged children? Any strategy that fails to narrow that gap will have failed our children.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Does the hon. Lady agree that some of the overall problem can be explained by the fact that people do not know how much sugar is in their food? She will know that women are supposed to have no more than six spoonfuls a day, and men no more than nine. Only today, when I was in Portcullis House, I bought three items: a Snickers bar, which has five spoonfuls of sugar; a yoghurt with seven spoonfuls; and a Coke with nine. She will be glad to hear that I did not eat any of them; perhaps I was just removing them from other people. Does she agree that an awareness of how much sugar we are eating is very important if we are to manage our diets?

[Dr Wollaston]

Indeed. I completely agree with the hon. Gentleman, and I shall come on to that subject later. I am relieved to hear that he is not on a sugar high for the debate.

I want to set out not only the scale of the problem but its consequences. It has consequences for the whole lifetime of our children, in relation to their physical and emotional health. They also suffer the impact of bullying at school, as they are too often stigmatised in the classroom because of their weight. There is increasing evidence that obesity is a factor in causing many preventable cancers, and it also has an impact on conditions such as diabetes and heart disease. This has a cost not only to individuals but to wider society and to the NHS.

The Minister will know how essential it is that, as part of the “Five Year Forward View”, we tackle the issue of prevention. We cannot do that without tackling obesity, particularly among children, given the lifetime impact and consequences of the condition. She will know that 9p in every £1 we spend in the NHS is spent on diabetes. We estimate from the evidence that the Health Committee took during our hearings that the overall cost of obesity to the NHS is now £5.1 billion a year, and the wider costs to society have been estimated to be as high as £27 billion, although the estimates vary. We simply cannot afford to take no action.

Physical activity is of course extraordinarily important and I am confident that it will feature strongly in the Government’s strategy, but it is no good focusing solely on that. Physical activity is good for children, whatever their weight. Indeed, it is good for all of us, whatever our age. However, any strategy that assumes that we can tackle childhood obesity solely through physical activity will simply be ignoring the overwhelming evidence that most of the gain will be in reducing calories. That is not just about sugar, however. It is easy to be accused of demonising sugar. The fact is that children have more than three times the recommended amount of sugar in their diet, but that is perhaps the easiest aspect of the problem to tackle. The Minister will recognise the fact that we are talking about overall calories, which also include fats.

[Sir Paul Beresford (Mole Valley) (Con)]

I need to declare an interest here; it is a fairly well-known one. My union has been pressing me to remind my hon. Friend that sugar intake has a disastrous effect on the teeth and causes tooth decay. Is she aware that the most common cause of hospital admissions among five to nine-year-olds is tooth decay? Every week, almost 900 children in this country require hospital treatment for tooth decay, and the biggest single factor is sugar.

[Dr Wollaston]

I thank my hon. Friend for mentioning that. I was going to come on to that point and he has saved me from doing so. I completely agree that we must not forget the impact of sugar on children’s teeth. He will recognise that there are great health inequalities relating to that issue as well.

So how should we tackle this? I have spoken many times about a sugary drinks tax, but I recognise that that is not where the greatest gain lies when it comes to tackling childhood obesity. As the Minister will recognise from the evidence presented by Public Health England, price promotions will need to form an extraordinarily important part of the childhood obesity strategy if it is to be effective. It is a staggering fact that around 40% of what we spend on our consumption of food and drink at home is spent on price promotions. Unfortunately, however, they do not save us as much money as we assume. They encourage us to consume more. In British supermarkets, a huge number of those promotions relate to sugary and other unhealthy products. I call on the Government to tackle that as part of their strategy. We need a level playing field as we seek to rebalance price promotions, but that has to be done in a way that does not simply drive us towards promoting other products such as alcohol. We need to take a careful, evidence-based look at all this.

[Norman Lamb (North Norfolk) (LD)]

I am delighted that the hon. Lady is pursuing this issue. Has she looked at whether there could be a tax on the ingredient “sugar” in products, so that we create an incentive to reformulate, in order to reduce sugar content not just in fizzy drinks but across foods and drinks generally? Could that be a way to get the industry to start to think about the content of its food?

[Dr Wollaston]

I thank the right hon. Gentleman for his point, which prompts me to address the issue of a sugary drinks tax. We looked at examples of where taxation can be applied across sugar more broadly, perhaps to incentivise reductions within reformulation, as some countries have done. However, we wanted to address the single biggest component of sugar in children’s diets, which is sugary drinks. The Committee recommended a sugary drinks tax rather than a wider sugar tax, and there are several reasons for doing that. First, we know that it works. Secondly, it addresses that point about health inequality.

Mexico introduced a 1 peso per litre tax on sugary drinks and by the end of the year the greatest reduction in use—17% by the end of the year—was among the highest consumers of sugary drinks. The tax drove a change in behaviour. The whole point of this sugary drinks tax is that nobody should have to pay it at all. To those who say it is regressive, I say no it is not; the regressive situation is the current one, where the greatest harms fall on the least advantaged in society. As we have seen with the plastic bag tax, the tax aims to nudge a change in behaviour among parents, with a simple price differential between a product that is full of sugar, and causes all the harms that we have heard about, including to children’s teeth, and an identical but sugar-free product—or, better still, water.

[Keith Vaz (Leicester East) (Lab)]

I congratulate the hon. Lady on securing this debate and on her work in this area. We do not really have to wait for a tax; we can take what the Mayor of London has done in City Hall as an example. He has made sugary drinks more expensive, and therefore people have that choice immediately. In the presence of the Chairman of the Administration Committee, the House’s greatest living dentist, who is participating in this debate, may I say that it is possible for this House to put up the price of sugary drinks so that those who go to the Tea Room will then have that choice?

[Dr Wollaston]

I thank the right hon. Gentleman for that and welcome what he describes. That movement is not just happening in City Hall, because it is being recommended within the NHS by Simon Stevens. I also congratulate Jamie Oliver and the many other outlets that are introducing such an approach. The other point to make is about public acceptability, because all the money raised goes towards good causes. As we have seen with the plastic bag tax, the fact that the levy is going to good causes increases its public support. That levy has been extraordinarily effective, as plastic bag usage has dropped by 78%. That is partly because we all knew we needed to change but we just needed that final nudge. That is what this is about: that final nudge to change people to a different pattern of buying. It has a halo effect, because it adds a health education message and that is part of its effectiveness.

[Maggie Throup (Erewash) (Con)]

I am a fellow member of the Health Committee, in which we also discussed ring-fencing the sugary drinks tax so that money could be put back into health education about obesity, particularly in schools, to prevent child obesity in the future. Could my hon. Friend speak a little more about that?

[Dr Wollaston]

I thank my hon. Friend and fellow member of the Health Committee for her intervention. At a time of shrinking public health budgets, there is a huge additional benefit from having this kind of levy, in that many of the other measures that the Minister will want to see in the strategy—on exercise in schools, teaching in cookery lessons and health education—could be funded in part through a sugary drinks tax. I hope she will look carefully at this idea and consider introducing it.

[Geraint Davies]

rose—

[Geraint Davies]

The debate is often between reformulation and tax. I agree with the tax on fizzy drinks, but if we had a tax on overall sugar input—for the sake of argument, let us suppose that sugar makes up half a Hobnob and the tax is at 10%—that would give an incentive to the manufacturers to reformulate without the price going up and we could get the sugar content down.

[Dr Wollaston]

I thank the hon. Gentleman for that, which brings me on to reformulation. It should also form a core part of the strategy. Our view was that we should have a centrally led programme of reformulation across foods and drinks, and that what manufacturers want is a level playing field. The trouble with reformulation is that it takes time; there has been an effective programme on salt, but that has happened very gradually, over a 10-year period. There is no reason why these things should be mutually exclusive; I come back to that point about marginal gains and say let us do all of the above. I know that the Minister is looking closely at reformulation and understands how powerful it will be. The evidence we heard was that it could take 6% of the sugar out of children’s diets. Reformulation, alongside other programmes, will play a part, but it will not work on its own and, unfortunately, it will take longer.

We also need to examine the pervasive effect of marketing and promotion. Do I want to have a kilogram of chocolate for almost nothing when I buy my newspaper? Of course I do, but please do not offer it to me. Please do not make me walk past the chicanes of sugar at the checkout or when I am queuing to pay for petrol. We know that 37% of all the confectionary we buy is bought on impulse. It does not matter how much we are intending not to buy it, if it is presented to us on impulse, we buy it, as impulse is an extraordinarily powerful driver. I therefore hope that any strategy will tackle that part of consumption, along with portion sizing. The supersizing of our society is in part down to the supersizing of portions and offers. All of this needs to be included in our approach, as does dealing with advertising. This advertising is pervasive and it is hitting our children everywhere they go, on television, online and through the influence of “advergames”. We know that this is very powerful in driving choices for children, so I hope the Minister will look carefully at that. She will have seen our recommendation of a watershed of 9 pm.

Time is running short, so I shall close my remarks, as I know other Members will want to cover many other aspects, such as exercise, the effect of what local authorities do, how much more powerful they could be in their roles if we gave them greater planning powers, and so on. Early intervention, research, education, teaspoon labelling—please do it all. We need a bold, brave and effective strategy, and we need to learn from British cycling and the law of marginal gains.

[Several hon. Members rose—]

--- Later in debate ---

[Will Quince (Colchester) (Con)]

It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson). I thank my hon. Friend the Member for Totnes (Dr Wollaston) for calling this important debate. I am sure that Members can all see that I am a man who likes his food, and that I am not particularly in a position to lecture others on obesity. At the same time, I cannot ignore the fact that too many children in this country are obese, that poor children are more likely to be obese than rich children—boys and girls in the lowest quintile are three times more likely to be obese as those in the highest quintile—and that those living in towns are more likely to be obese than those living in rural areas. Those are unpalatable facts. It is right and proper that we investigate, and, where we have clear evidence, take the appropriate action.

However, the evidence does not suggest that childhood obesity is a problem that is getting significantly worse. The proportion of obese children in year 6 is higher than it was in 2006-07, but for reception children the proportion has fallen over the same period. Moreover, there has been a significant decrease in the proportion of British children, aged two to 10, who are obese.

[Dr Wollaston]

Will my hon. Friend go back and look at those figures in more detail? What he will see is that, although those figures are falling for the wealthiest children, they are rising for the most disadvantaged children. We are seeing a widening of the gap, which masks the underlying problem.

--- Later in debate ---

[Will Quince]

The hon. Gentleman makes an important point and, of course, that would make sense if the evidence suggested that a soft drink tax implemented anywhere else in the world had actually worked and had the effect that he suggests. He is right to suggest that there are a lot of other measures that we as a Government and that businesses and organisations can take to address this issue; I do not believe that the sugar tax is the right one.

Sugar tax advocates have pointed out the introduction of a sugar tax in Mexico and the corresponding 6% decline in soft drink sales since the tax was introduced. However, research in The BMJ does not show evidence of a link between the introduction of the tax and the small decline in soft drinks consumption. Further taxes on non-essential energy dense foods were also introduced at the same time as the sugar tax, and they accounted for a higher proportion of Mexicans’ daily calorific intake. As the authors of the research admitted,

“we cannot determine the independent role of each”

of the taxes. The research even acknowledges that there is a lack of information on nutritional data for packaged drinks in Mexico, which means that researchers cannot see what the fall in soft drink consumption meant for a decline in sugar intake.

As many Members may know, Mexico does not have safe drinking water. As a high-profile advocate of the sugar tax in Mexico, Alejandro Calvillo, stated:

“We know that there are people who drink a lot of sodas and they don’t have access to drinking water.”

How can we possibly compare the results in a developing country that has unclean, unsafe drinking water with how a tax might operate here in the United Kingdom? Instead, let us compare like with like. When sugar taxes have been tried in developed nations such as France, they have had a negligible effect on reducing consumption. Denmark scrapped its sugar tax on soft drinks in 2014 and labelled it an expensive failure. The Danish Ministry of Taxation labelled food and drink taxes as

“misguided at best and may be counter-productive at worst”.

They even described it as an expensive liability for business, and, as we all know, a sugar tax would be a very bitter pill for British businesses to swallow.

Study after study on soft drinks taxes in the USA also shows that they have a negligible impact on sugary drink intake and calorie consumption. What is more, the small decline in sugary drinks is almost entirely offset by consumption of other sugary products.

[Dr Wollaston]

My hon. Friend is very generous to give way again. I wonder whether he has had an opportunity to look again in detail at the article in The BMJ to which he refers. He is citing the figure of 6%, but the article makes it clear that by the end of the year the decline was 12% overall, and—more importantly, if we are to address the issue of health inequality—17% among the heaviest users. He might wish to update himself. I am happy to share the paper with him.

[Will Quince]

I thank my hon. Friend and I would be delighted to take another look at that piece of research.

My hon. Friend has made a case for the sugar tax to protect the poorest, and I think that that was the point that she was just making. As I have mentioned, and this is a good point, the poorest children are the most likely to be obese. However, the statistics show that, in low-income households in Britain, soft drink purchases dropped by 14% between 2007 and 2013. Perhaps a 20% sugar tax on soft drinks is not very much to celebrity chefs such as Jamie Oliver and some of those who are pushing the idea of a sugar tax, but for those on the lowest incomes—who we know, proportionally, buy these products—about 12p a can or 37p per 2 litre bottle is a massive amount of money.

--- Later in debate ---

[Alison Thewliss]

I absolutely agree with what my good friend says. Bottle feeding tends to be at a set time—“Is it time for the baby’s feed yet?”—rather than when the baby actually needs to be fed, whereas breastfed babies are fed little and often on demand, which is a slightly better habit to get into.

There is also a beneficial effect on breastfeeding mothers. As well as reducing the risk of cancer and diabetes, breastfeeding burns calories and helps to get mothers back to their pre-maternity weight—for me the prospect of burning an extra 400 to 500 calories just by breastfeeding my baby was very attractive, and it certainly helped me to fit back into the clothes that I wore before I had my children, both of whom were breastfed for two years.

I was interested in the findings of the Select Committee report, and I particularly note the points about marketing and sugar content in foods. I was a wee bit disappointed that it does not contain much discussion on baby foods and toddler milks, as there are significant issues in that area regarding the advertising and the content of the products. In evidence to the Committee, Dr Colin Michie of the Royal College of Paediatrics and Child Health stated:

“Follow-on formulas are not necessary for human beings, but it would not seem so if you watch television. The problem is we are all very convinced by the stories. There are other issues that have parallels for what was said earlier in that the milk companies sponsor education, training, events and an awful lot of professional activities, which again does exactly, to our minds, what we heard it does to infants’ minds: when we see brand names, we equate certain things with them. It is an insidious business that we know enough of to be very wary of.”

The artificial creation of a market for follow-on or toddler milks is of some concern, because those products are not subject to the same level of scrutiny as formulas for very young babies. Research gathered by the First Steps Nutrition Trust suggests that

“Growing-up milks and toddler milks contain almost twice as much sugar per 100 ml as cow’s milk, and some Aptamil and Cow & Gate growing-up milks and all SMA growing-up milks contain vanilla flavouring. It is unclear whether repeated exposure to sweet drinks in infancy and toddlerhood might contribute to the development of a preference for sweet drinks in later life.”

It is important to take cognisance of that and consider the issue as part of the obesity strategy.

[Dr Wollaston]

I thank the hon. Lady for her powerful contribution, and I completely agree with what she says. I also agree that the advertising of follow-on milks is a covert form of advertising infant formula. Does she feel that that should be completely banned?

[Alison Thewliss]

Absolutely, and a lot of the advertising is very—I supposed we could say cunning. Products are made to look the same on the shelves and to match the adverts for follow-on milks, rather than those for the younger infant formulas, and more needs to be done about that.

The sugars in follow-on milks are not always made clear on the packaging, and that should certainly be of concern to us in this House. Establishing a sugar habit at such an early age should be discouraged, and as was said earlier, that also has an impact on the teeth of a growing child. Baby Milk Action has campaigned tirelessly on the marketing of formula, and it has been involved in challenging those issues in the European Parliament. There are related issues concerning the marketing and composition of baby food, and about the jars and packets found in supermarkets, which are often marketed at babies under six months, contrary to World Health Organisation advice.

Pressure from groups such as Baby Milk Action, and actions by MEPs such as the Green MEP Keith Taylor, led yesterday to the European Parliament rejecting draft EU rules on baby food. If they had been approved, they would have allowed baby foods to contain high levels of sugar, and products to be labelled for use from four months of age, rather than from six months, which is the advice. As a result, the Commission has been forced back to the drawing board to bring the regulations in line with recommendations of the WHO and the World Health Assembly, and to fit better with the international code on such issues. I would like further debate on the composition of baby foods, how they are marketed, where they are placed in supermarkets, and what advice is given to parents. Again, the sugar content and the rationale behind waiting until six months before bringing babies on to solid foods is not always made clear to parents.

Advice on such matters has changed over the years and has sometimes been conflicting, and well-meaning advice from family members can cause doubt in the minds of new parents. People need to have the best advice on feeding. All agencies should be clear about the advice that they give out, and we must guard the most vulnerable babies in our society against the vested interests of wealthy baby food and formula companies that seek to exert influence on professionals and groups giving out that advice. I hope that these issues will be given due consideration in the debate on obesity, and that thought will be given to the contribution that breastfeeding can make to improving infant and maternal health.

--- Later in debate ---

[Dr Wollaston]

I thank all Members who have contributed to today’s debate, including the Minister, who rightly said that the action the Government take now will affect the life chances of a whole generation. I am grateful for her recognition of the importance of not only obesity in itself, but the pressing concern that everyone has about how health inequality affects this issue. I am also grateful that she is going to include that at the heart of the Government’s obesity strategy.

In conclusion, we are looking for bold, brave and, most importantly, effective action. I would like to finish as I started by saying that we should take a leaf out of the book of British Cycling, because there is no silver bullet and we need to follow the principle of marginal gains—let’s do everything.

Question put and agreed to.

Resolved,

That this House calls on the Government to bring forward a bold and effective strategy to tackle childhood obesity.