Obesity and Fatty Liver Disease

Wayne David Excerpts

Thursday 8th June 2023 Westminster Hall

[Wayne David (Caerphilly) (Lab)]

I beg to move,

That this House has considered the matter of preventing obesity and fatty liver disease.

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I am truly grateful to the 19 right hon. and hon. Members from across the House and from all parties who supported the application for this debate. I am the chair of the all-party parliamentary group on liver disease and liver cancer, and I thank all my colleagues in the group for their steadfast support. I am also grateful to the Backbench Business Committee for granting time for this debate.

The debate’s aim is simple and straightforward: to sound an alarm. This country faces a crisis—a fatty liver disease crisis. One in five people in the United Kingdom suffer from fatty liver disease. That is a quite incredible figure, and it is driven by obesity. Two thirds of the adult population of the United Kingdom are overweight or obese. It is worth noting that liver disease is often associated with alcohol misuse, but liver disease is increasingly being driven by obesity. I am also pleased that today is the global awareness-raising day for non-alcohol related steatohepatitis, or NASH. Some 150 million people across the world suffer from NASH, which is the most severe form of fatty liver disease.

As I said, two thirds of people in Britain are obese or overweight; that is the third highest obesity rate in the whole of Europe. The rise in obesity is having a hugely detrimental impact on the nation’s health. Fatty liver disease is a problem in itself, but it is also closely related to cardiovascular disease, type 2 diabetes and a multiplicity of cancers. It is also worth noting that liver disease has a huge impact on economic development, and that obesity is directly related to that. Obesity costs the UK economy £58 million a year and is a huge drain on the national health service, which is already under huge pressure.

If obesity is a huge problem, how do we tackle it? There are a number of ways. First, we can promote healthy living, and more active lifestyles in particular. To cite my own example, at one time, I prided myself on not having set foot in a gym, but now we have a tread- mill at home and I use it regularly. That is becoming more regular all the time.

Secondly, there is the issue of junk food. Fat, sugar and salt are present in all junk foods. The UK is the largest consumer of ultra-processed food in Europe. I was startled to see a television report earlier this week focusing on the prevalence of emulsifiers in food. I was not aware of what an emulsifier was; for a moment, I thought it was a kind of paint. Emulsifiers are basically used to keep food together, and they are totally unnecessary from a nutritional point of view. Nevertheless, there are serious studies and concerns about the potential harm that the use of excessive emulsifiers in so many of our foods can have on our health. The food industry needs to address that in a significant way. However, it is no good simply to leave everything to those in the food industry. They exist to make profit and that will inevitably have an impact on their profitability. There is therefore a need for a level playing field, and Government regulation is vital. That must be a significant agenda for the immediate future.

The Government really have to deliver on existing policy commitments. We are still patiently waiting for them to implement the 9 pm watershed plans to protect children from junk food advertising on television and online. There also needs to be a ban on advertising multi- buy junk food deals according to that cut-off point. I was encouraged this morning by a visit to Parliament of children from Nant Y Parc Primary School in Senghennydd, near Caerphilly, in my constituency. The children were aware that this is a serious issue. Everyone, especially children, loves junk food, but a discipline needs to be imposed. There is nothing wrong with an occasional burger or KFC, but it must be now and again and not a regular part of their diet. It is important that, time and again, that is stressed to young people at all levels of education.

When we look at liver disease outcomes in care, the huge variation across the country is striking. Inequalities are hugely geographically focused. If we look at non-alcoholic fatty liver disease deaths in England, we see that the north-west of England has a far higher mortality rate than the west midlands. In general, liver disease mortality rates are four times higher in the most deprived areas.

We hear a lot about levelling up these days, but not so much about the need to level up healthcare and life expectancy. That is why I am calling on the Government to lay out a clear set of policies to level up liver disease treatment and make real their declared ambition to narrow the gap in healthy life expectancy. That is why I say that a prompt, thorough and comprehensive review of adult services in England is vital if we are to successfully tackle huge inequalities and geographical variations in liver disease treatment, outcomes and care.

Let us be honest: liver disease is a silent killer. It is often diagnosed very late, by which time the damage is irreversible and treatment is not really an option. Sadly, three quarters of people currently diagnosed in hospital following emergency admission cannot be given effective treatment or intervention because it is too late for them.

Since the launch of the British Liver Trust’s campaign last year on early diagnosis, we have seen improvements in pathways for early diagnosis across the four nations. I pay tribute to Pam Healy, the chief executive of the British Liver Trust, and her extremely active team for their work in raising the issue across the country and, in particular, in Parliament. I was extremely pleased that more than 90 Members of Parliament from the Commons and the Lords attended a liver health test we organised in January. I have to say, some MPs were judged to need intervention.

I am also pleased that the Government have made some progress on this issue, and that only yesterday the National Institute for Health and Care Excellence announced its decision to recommend the use of fibroscans as an option to assess liver damage in primary care. I welcome that positive step forward. I urge the Minister to put real emphasis on early diagnosis by adopting a new pathology pathway and ensuring that every community diagnostic centre has a facility to make an assessment of fibrosis—no ifs or buts, it should be available in every community diagnostic centre.

I urge the Minister to recognise that this is not an England-only issue; it affects the whole United Kingdom, and we need to look carefully at good practice in the devolved nations. I am a Welsh Member of Parliament who represents a constituency in the south, and I am very pleased that my own health board, the Aneurin Bevan University Health Board, pioneered a pilot project that laid the foundations for the Welsh Government to introduce the all-Wales abnormal liver blood test pathway, and they have recently published a quality statement on tackling liver disease. This was the first part of the United Kingdom to do so, and I hope that the other nations in the UK will follow that good example quickly. That work and other good practice is worth examining carefully and emulating throughout the whole United Kingdom.

Fatty liver disease is a clear barometer of the nation’s health. The obesity crisis in our country is clearly exacerbating health inequalities and causing real harm to people. It is resulting in a significant cost to the NHS and having a hugely detrimental economic impact. I therefore urge the Government to take immediate action to tackle this issue coherently and systematically. I very much look forward to the Minister’s positive reply.

[Several hon. Members rose—]

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[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to the hon. Member for Caerphilly (Wayne David) for securing a debate on this hugely important issue, and of course to the all-party parliamentary group that he chairs for its important work on tackling liver disease and liver cancer. I am responding on behalf of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), who is the responsible Minister in this area. Nevertheless, I will try to give as full a response as I can.

The Government welcome the opportunity to discuss the prevention of obesity and fatty liver disease, and I thank all hon. Members who have contributed today—particularly the hon. Member for Caerphilly, my hon. Friend the Member for Erewash (Maggie Throup) and the hon. Member for Ealing, Southall (Mr Sharma), who did not have to be here but who came to raise their points.

I particularly thank my hon. Friend the Member for Erewash for all her work as a Minister at the Department of Health and Social Care. She is a passionate advocate for tackling obesity and the conditions that result from it. She and I know that we do not agree on everything—we have had many a debate on this issue—but we both believe passionately in tackling it, because we know how important it is.

As has been said, liver disease is one of the most significant killers of working-age people in England, and I suspect that that is the same across our United Kingdom. In the last two decades, around 90% of liver deaths in England have been related to lifestyle and unhealthy environment, and the vast majority are alcohol related. These diseases are responsible for a four-times increase in liver mortality over the past few decades. The populations most at risk from non-alcoholic fatty liver disease are those living with obesity or type 2 diabetes.

Alongside its role in non-alcoholic fatty liver disease— I appreciate that the focus of today’s debate is obesity—obesity is also the leading cause of other serious non-communicable diseases, such as type 2 diabetes, heart disease and some cancers, and it is associated with poor mental health. As the hon. Member for Caerphilly pointed out, this represents a huge cost to the health and wellbeing of individuals, and also to the NHS, wider society and our economy. It is estimated—this must be correct, because the hon. Gentleman and I have exactly the same figure—that obesity costs the NHS £58 billion. That is a loss to the economy and, importantly, a reduction in the quality of life of people up and down the country.

Although obesity rates have been relatively stable over the past few years—in fact, over the past decade—they are still stubbornly high. About one in four adults, and one in four children aged 10 to 11, live with obesity, so the prevalence remains far too high. I am particularly concerned about childhood obesity, not just because I am a Minister at the Department for Health and Social Care, but because I am a former Children’s Minister and Minister with responsibility for school sport.

Two weeks ago, I represented the United Kingdom at the World Health Assembly. I spoke to representatives of about 25 other countries, and it was interesting how many times obesity came up as a challenge that they are facing too, so we need to work together. As the hon. Member for Strangford (Jim Shannon) said, it is not just about our United Kingdom; we need to work together and share best practice globally to make sure we are tackling this issue together. I raise the point about children because, from my work as Children’s Minister, especially on early years, and as a father of two children, I know too well that habits are formed really young, so we have to tackle this issue at the earliest possible point.

Data shows that people in lower income groups are more likely to be living with obesity than the rest of the population. Nevertheless, the issue is prevalent across all groups, as the hon. Member for Ealing, Southall said. The hon. Member for Bristol South (Karin Smyth) raised health inequalities and the major conditions strategy, which sits with the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately). I know she would be happy to meet hon. Members to discuss the major conditions strategy ahead of the interim report, which I understand is due to come out this summer. I am happy to commit my ministerial colleagues to meet hon. Members, as I do regularly.

Obesity is a complex problem that is caused by many factors, and there is no single solution. My hon. Friend the Member for Erewash and I have had many debates on this issue, and there are many ways that we can tackle it. It is multifaceted and complex, and therefore the solution will inevitably be somewhat complicated.

I am not particularly fond of talking about my own health. I often hear people say that they prefer the expression “living with obesity” to “obese people”. When we come back to Parliament and are sworn in again, they take our photo. I was 19.5 stone at the time of the 2019 general election, and they still, to this day, use that photo. I turn up at events and people say, “You don’t look anything like your photo.” The point I am trying to make is that I know how difficult these things are; it is a daily battle to lose weight and keep it off. It is a mixture of diet and exercise. I passionately believe that we need to empower people to make better, healthier life choices. There are interventions that we are making and further interventions that we should make to tackle this issue. I assure the House that, although this is not my direct ministerial responsibility, I am a passionate but realistic advocate of the measures that we can and should take to tackle obesity.

I genuinely believe that a mix of actions at a local and national level are required to help with the prevention of excess weight gain and to promote healthy behaviours. We know that obesity does not develop overnight; it builds up over time. It is frequently about excessive calorie consumption. It does not have to mean overeating hundreds of calories a day, although we all do that sometimes, and we then have to overcompensate in another way. It often means small amounts of excess calories, consumed regularly, which add up for adults and children, so there is a big education piece that we need to do. We are doing that, but we need to do more.

As my hon. Friend the Member for Erewash said, yesterday, as part of action to treat those already living with obesity, the Government announced plans for a two-year pilot, backed by £40 million, to look at ways of expanding access to new weight loss drugs outside of a hospital setting through primary care that more eligible patients will be able to benefit from, therefore reducing their risk of obesity-associated illness.

One area that is certainly within my ministerial responsibility is our work on research with the National Institute for Health and Care Research. Obesity is one of our national healthcare missions; we are determined to look at some of the innovative solutions out there to help people to take control, and empower them to make healthier life choices and control their weight.

[Wayne David]

I note that the Minister said there is Government support—in a limited way, at the moment—for weight loss drugs. I welcome that, but I am cautious; there is a real danger of placing too much emphasis on drugs as a way to lose weight. They can be in addition to other measures, but those other measures are critical. I welcome the Minister’s views on that, but there is a danger of putting too much emphasis on those drugs.

[Will Quince]

The hon. Gentleman raises a good point; I totally agree. As further details are published, he will see the current criteria for accessing those drugs. The reality is that more and more are coming on stream, and they will be part of our arsenal and one of our tools to help people tackle obesity and make healthier life choices.

What do we also know about the drugs? Well, we know that they are effective. However, they are effective only for as long as someone takes them, unless they change their lifestyle and behaviour. Anything we do in relation to drugs must be alongside an education piece, and supporting and empowering people to make healthier life choices. Ultimately, and ideally, we do not want people to be on drugs for the rest of their lives where it is not necessary. We want the drugs to be a tool and enabler to help and support them to get to a place where they can manage their own weight. That might be difficult for some people and they may struggle to do so, and for others it may not. It is just a helping hand; the hon. Gentleman is right.

As hon. Members made their contributions, I scribbled down the actions—just in my own mind—that the Government have taken over the past few years, such as calorie labels on food in supermarkets. I know that that made such a difference, because when I am looking, I make active choices. I look at the traffic light system, I look at the calories, and I look at the amount of salt and sugar in these products; and doing so enables me to make healthier choices. That is important. There is the calorie labelling on food sold in large businesses, including restaurants, cafés and takeaways, which came into force back in April—not uncontroversially.

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[Will Quince]

I thank the hon. Member for that intervention. He is absolutely right; not everyone has the luxury to make choices, and they will often have to go for the cheapest products or products that are available in their area when others might not be. That is why it is so important that we continue the work with industry on reformulation.

Personally, I have been more of a convert to Government action in this area. The soft drinks industry levy has been hugely successful. The industry was already doing a lot of that work. Nevertheless, the levy has nudged and pushed it further in the right direction—but there is more work to do.

I would push back ever so slightly on a couple of the comments that have been made today about industry not wanting to do this. It is not moving at the pace that we want, expect and need it to, but it is doing it. The sugar content of cereal is down by about 15%, and it is down by about 14% in yoghurts and fromage frais. We need industry members to go further, but they are doing it because they are responding directly to what their customers and consumers are telling them they want, and to people actively choosing healthier products. However, we have more to do on reformulation and working with industry.

We will also introduce restrictions on the advertising of less healthy products before 9 pm. I will answer the question on that from my hon. Friend the Member for Erewash in just a moment. The major conditions strategy call for evidence is open, and, as I said, my hon. Friend the Member for Faversham and Mid Kent will gladly meet colleagues to discuss that.

There is also the piece of work around supporting people with weight management, such as the NHS digital weight management programme, the weight loss drug programme and pilot that we announced yesterday, which I just spoke about, and the better health campaigns—including the NHS weight loss app Couch to 5k, which, if anyone has not tried it, is a great way of getting into running, and Active 10. There is also the NHS health check, which includes checking on BMI, encouraging people and giving them the tools to take control of their health.

Then there is the research piece. As I say, this is one of our healthcare missions. Obesity is right there at the top; we want to see the newest and most innovative products and medicines coming forward and being used first in this country.

The hon. Member for Bristol South is absolutely right that this cannot just be an issue for the Department of Health and Social Care; it must be a cross-Government issue. I remember when I was the Children’s Minister and had responsibility for school sport: looking at school sport investment and premiums, at the upskilling of primary school PE teachers in particular, and at the holiday activities and food programme, which was specifically targeted at children in receipt of free school meals.

I remember visiting some eye-opening educational programmes. In one example—I would love to get a number of parliamentary colleagues to try this experiment—there was range of soft drinks, from a Monster energy drink through to flavoured water, and a big box of sugar cubes. The children were asked to put against each product the number of sugar cubes they thought it contained. You would be amazed, Mr Hollobone, how many children put six cubes against the water and very few against the Monster or the full-fat Coke, despite the can of Coke containing something like six cubes of sugar. In schools, we are also promoting the daily mile, the healthy schools programme and healthy school meals. That is all important work, but do we need to do more? Of course we do.

My hon. Friend the Member for Erewash asked about the delay to policies, specifically to the restrictions on advertising and promotions. I understand her frustration but the delay to advertising restrictions allows the Government and regulators to carry out certain processes necessary for the robust implementation of the restrictions. Those processes include carrying out consultations, appointing a frontline regulator, the laying of regulations and the drafting of guidance. She asked specifically when that is coming in; it will be in October 2025. She also asked about the volume price promotions ban, which was delayed due to the unprecedented global economic situation. I do not know the answer and I do not want to mislead her. The legislation states October this year, but I do not know latest position, so I will ask my hon. Friend the Member for Harborough to write to her.

[Wayne David]

I think there was an intake of breath in the Chamber when the Minister mentioned October 2025 for the introduction of the limit on advertising. Is there any way that he would support measures to circumvent the excessively long delay? I think the will is there; it is a question of just dotting the i’s and crossing the t’s to ensure that everybody is on board. That can be done relatively quickly, if there is the political will.

[Will Quince]

As much as the hon. Gentleman tempts me to make Government policy on the hoof, as it is not my policy area I will refrain from doing so. I will ask my hon. Friend the Member for Harborough to speak directly with the hon. Gentleman to see if there is any way that process could be accelerated.

I will turn to early diagnosis and community diagnostic centres—a subject raised by the hon. Members for Caerphilly and for Bristol South, and by my hon. Friend the Member for Erewash. I am a massive fan of community diagnostic centres. In fact, I was in one in Roehampton this morning.

NHS England is playing a key role in helping to reduce preventable deaths from liver disease, and, as my hon. Friend the Member for Erewash alluded to, it has begun the process of fibroscans through community diagnostic centres. There is a £2.3 billion programme to increase the number of CDCs across the country to 160. The commitment so far is that 100 of them will be diagnosing liver disease by March 2025. If we can accelerate that, we will. We are accelerating the CDC programme. That is within my gift, and I will look at that closely to see what is within the art of the possible. Of course, I am keen to see what we can do to boost diagnostic capacity to diagnose liver disease and improve earlier diagnosis, which leads to improved health outcomes.

The hon. Member for Strangford asked about work in Northern Ireland. We do so much work across the United Kingdom on public health, research and medicines, as well as in the health space. I do not know the specific answer, because it does not sit within my portfolio, but I have no doubt that my hon. Friend the Member for Harborough will be working on that on an all-nation basis. The spirit of collaboration is important when it comes to these issues.

A lot of poor health is preventable; that point has been made a number of times during the debate. People instinctively want to be and to stay healthy. Sadly, however, most people who are diagnosed with liver disease at a late stage, when it is less treatable, are often diagnosed during an emergency hospital admission. That has to change, and the Government are determined to take action to make the needed changes. As the hon. Member for Caerphilly said, today is International NASH Day—a day to raise awareness of non-alcohol-related fatty liver disease and its more advanced form. I hope that by debating the topic, we have raised awareness of that hugely important issue, and of the disease.

[Wayne David]

We have had an excellent debate. The Chamber has heard contributions from six Members, and although they have been from different political parties there has been a unanimity among them about the importance of the issue and some of the measures that need to be put in place urgently to tackle the fatty liver disease crisis.

The Minister has made some positive remarks, it has to be said, but I hope that he will report back to his colleagues to ensure that the issue is given greater priority within the Department of Health and Social Care. He has made certain commitments to provide information and make representations on the basis of what has been said. I hope he will do that—I think he will.

It is essential that we move forward, as far as possible on a consensual basis. We all recognise that this is a huge issue that has to be addressed as a matter of urgency. To do that we need the will of the Government to work with others, to come forward with a policy, as they now have, and to develop that policy to address the situation in the not-too-distant future.

Question put and agreed to.

Resolved,

That this House has considered the matter of preventing obesity and fatty liver disease.