Obesity Strategy 2020

– in the House of Commons at 2:54 pm on 27th May 2021.

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[Relevant document: Sixth Report of the Women and Equalities Committee, Session 2019-2021, Changing the perfect picture: an inquiry into body image, HC 274.]

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care 2:56 pm, 27th May 2021

I beg to move,

That this House
has considered implementing the 2020 Obesity Strategy.

I congratulate my hon. Friend Andrew Selous on securing this important debate on something I know he is passionate about and about which I have met him on many occasions.

Currently 64% of all adults and 30% of children are classified as overweight or living with obesity. This masks the fact that in some areas the figure is as high as three in four adults. It is a complex issue that has a huge cost not to only the health and wellbeing of the individual but to the NHS and the wider economy. It makes individuals susceptible to a plethora of illnesses. Indeed, my hon. Friend the Minister for Care, who was at the Dispatch Box for the previous debate, commented to me that if we could get the general weight of the population down we would help people with more exercise and a better diet, as well as the health trajectory of those who live with dementia.

Covid has shone a light on why it is more important than ever that we need to get the nation healthy. Obesity is the only modifiable risk factor for covid-19 and a major modifiable risk factor for other diseases such as diabetes, cardiovascular, and some cancers—in point of fact, many. We are therefore at a teachable moment in which we can change attitudes, educate and influence drivers around less than healthy dietary and physical activity, and motivate behaviours so that they change. Helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health, and we all have a role to play in meeting the challenge. It is complex. There is no silver bullet. There is no single source of responsibility. It will take action from all of us to work together to achieve our ambition—from the producer, to the processor, to the retailer, to the customer, with quite a dollop of influencing the environment through actions we in Government and in Parliament take and are taking.

Our strategy to meet the challenge, published last July, is far-reaching in its ambition. It reflects the significant work undertaken over the past four years to halve childhood obesity. Currently two out of every five children who enter primary school are overweight or obese. That number rises in the six years they are at primary school to three out of every five children.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

On the Government’s ambition, the Minister said very clearly, and it says in the strategy, that we want to halve childhood obesity by 2030. The strategy also says,

“reduce the number of adults living with obesity”,

although I looked and could not find a specific target. Is she able to set out what the Government think that trajectory should look like? What I am concerned about—she will see this when I make my remarks later—is that there are lots of practical measures in the strategy, but I am struggling to see how the Government will actually deliver the result, which is fewer people being overweight or obese. Having some milestones on that journey, rather than just waiting until 2030, would be helpful so we can judge whether it is working and make some course corrections.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

I understand why my right hon. Friend is calling for milestones but, although the problem is a national one, there are different numbers for the proportion of the population that is overweight or living with obesity in each area. We can set milestones, but a national mile- stone may mask whether we are achieving what we need to achieve in the areas—often the more deprived areas in our communities—where we need to help, encourage, support and educate people to get them further on this journey. I will listen attentively to his contribution, as I always do, and then I may come back to him in my closing speech.

Three out of five children are overweight or obese by the time they leave primary school. We know that there is a direct correlation between the dietary habits picked up early in life and behaviour later on. We are working to create the right health environment to support people, and I will set out briefly some of the actions we are taking, starting with out-of-home calorie labelling. Restrictions laid in the House on 13 May will require large businesses in England with 250 or more employees, including restaurants, cafés and takeaways, to display calorie information for non-pre-packed food and soft drink items that they sell. Many have already gone some way in doing that. These regulations will support customers to make informed, healthier choices when eating out or purchasing a takeaway.

As I said, many businesses have articulated to me that they understand fully the importance of providing information and being proactive in leading the way. They recognise the demand from their customers for more information so that they can pursue a healthier lifestyle. Smaller businesses currently do not fall within the scope of the regulations.

We have also listened carefully throughout the consultation period to individuals and stakeholders who have the challenge of living with eating disorders. We feel we have been careful and sensitive and have put in reasonable adjustments to help that group. We have also exempted schools from the requirement to display calorie information, given the concern about children in school settings. We have included a provision in the regulations allowing business to provide a menu without calorie information on request.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Justice), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Women and Equalities)

The Minister knows that I have had a number of conversations about calorie counting. What really concerns me is the evidence base for whether this will really reduce the number of people suffering from obesity. As she knows, I am very concerned about the effects on people suffering from an eating disorder, and so far there is no evidence that it will make a significant difference to those who suffer from obesity. Can she provide me with some numbers or assure me that there will be a constant watch on how this is actually affecting those with obesity?

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

If the hon. Lady allows, I will go through the rest of my contribution. I hope she will take away that this is about building blocks. As I said, it is a complex situation, and there is no silver bullet. We must look at the antecedents of both conditions, including the link to mental health for those who suffer from anorexia and certain other eating disorders, and at some of the broader challenges when we are looking at those who are overweight or living with obesity. They need to be taken in the round, but one cannot be cancelled out against the other.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

I am going to push on just a bit, and then I will of course come back to my right hon. Friend.

We are also taking action to stop the promotion of less healthy products by volume and prominent locations online and in store. We want to support shoppers to purchase healthier options and shift the balance of promotions that way by maximising the availability of healthier products. We still need to eat, and we are not banning anything, but we are trying to educate, encourage and make people aware, so that they have the option of a healthier choice by default.

Last December, we confirmed that we will legislate on the promotion of foods high in fat, salt and sugar in stores and online. This will apply to medium-sized and large businesses—those with more than 50 employees—in England, and it will come into force next year. I would like to congratulate and thank those large retailers that are already taking these steps, because the argument is often put forward that it is unaffordable for a business to do this, yet many of the large retailers are doing it.

Photo of Richard Fuller Richard Fuller Conservative, North East Bedfordshire

I am grateful to my hon. Friend for outlining some of the measures she is asking businesses to undertake. She will appreciate that the last year has been very difficult for all businesses. As a Health Minister, she perhaps has not been able to have as much engagement with business, so would she take up the opportunity, ahead of the implementation in June, to come and visit Jordans & Ryvita, a cereal manufacturer in my constituency—she may have some familiarity with it—so that she can listen to its points of concern about the proposals she is making?

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

My hon. Friend and I have spoken about Jordans. Indeed, my first job was selling Jordans Crunchy bars at county shows when I was—oh—several decades younger. I will of course be happy to talk to him after this, but I would also gently point out that I have British Sugar, which is also in this food group, in my constituency. I not only meet its representatives on a regular basis, but I also met as lately as yesterday representatives from the British Retail Consortium and the Food and Drink Federation.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

The intervention I was going to make when the Minister was dealing with Wera Hobhouse was on the impact assessment for the regulations she mentioned. I have looked very carefully at the evidence, and it seems to me that the best case for these regulations is that we will reduce the number of calories consumed by 80, which is an apple, and the worst case will reduce it by about eight, which is a 10th of an apple. It seems to me that the cost of these regulations simply is not justified by the outcomes.

Because the Minister did not take my intervention at that time, she went on to talk about the legislation for promotions online, and I have looked at this. The Government’s goal for this legislation is that it reduces the calorie consumption by 8 billion calories. That sounds like a lot, but if we look at the number of children in the period that is spread over, it is equivalent to each child eating one fewer Smartie a day. Given that the children who have the most serious obesity problem are consuming up to 500 calories a day, reducing their calorie consumption by three calories a day simply does not do it.

The Government’s ambition is correct, but I just have a real worry that these particular measures simply will not have the effect that the Government and all of us wish to happen.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

I am very glad that my right hon. Friend is joining me in the ambition of wanting to get the weight of the nation down. I would gently push back, and say that I do not recognise those calorie figures. I am sure we can have a longer discussion over where that evidence base is drawn from, and about the fact that there is actually a much greater impact. As I have pointed out on two or three occasions, this is about the building blocks of all these different measures coming together, and they will be monitored and assessed as we go through.

Another element of the environment is advertising. Currently, we are failing to protect children from over-exposure to high-fat, salt and sugar products via advertisements on both television and online platforms. I would gently say that if adverts did not influence people, they would not be used. Therefore, to help tackle the current situation, let us just see more advertising of healthy food. It always strikes me as quite interesting when watching a diet programme on the television that each ad break is often interspersed with adverts for high-fat, salt and sugar products. This does not affect the advertising industry’s revenue, because there is still a need to advertise and people still need to eat, but the foods advertised often do not reflect the balance that we need to enjoy a healthy life.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

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.

Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means)

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

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care) 3:16 pm, 27th May 2021

It is a pleasure to open this important debate on behalf of the Opposition.

Obesity is a significant public health challenge in this country. It is a growing problem that compounds down the years in missed potential and accelerated poor health. I am glad the obesity strategy recognises that, as well as being a matter for individuals in their personal choices, there is a significant impact from our environment. As such, we have a responsibility in this place to do what we can to help people to maintain a healthy weight.

Almost two thirds of adults are overweight or living with obesity—I am one of them—and we have heard that a staggering number of our children leave primary school overweight. This is an unequally distributed problem, with hospital admissions due to obesity nearly three times greater in poorer communities than they are in the best-off communities. At a population level, it is clear that excess weight brings with it increased risk of diseases such as diabetes, cancer, heart disease, liver disease and, of course, associated mental health conditions. In 2019-20—this is such as staggering figure—there were over 1 million hospital admissions for which obesity was either the primary or secondary cause. That was up 17% on the year before, and represents a 600% increase on the previous decade. That is an extraordinary changing picture and one that should kick us all into action. We have also seen in the last year that living with excess weight makes us more vulnerable when fighting the effects of covid. As the Minister says, it is one of the risk factors we can actually make a direct and swift impact on. It is clear that we need to act.

I have said before when we have debated this topic that where the Government bring forward sensible proposals, we shall work with them to implement them in the national interest. Happily, the 2020 strategy contains many such proposals that we are very keen indeed to see implemented. The 9 pm watershed on unhealthy food adverts is prudent. Efforts to curb the promotions and prominent placements of things that we know are bad for us is a good idea, too. Sometimes, even when we are trying to make healthy choices it feels like we cannot escape reminders of those other options. An expansion of NHS weight management services is well overdue, and I hope we will empower such services to use all effective treatments and resource them to be able to do so, too. Traffic lighting is a valued and effective tool in understanding what our food comprises of. We will support proposals that strengthen and develop that system, and I hope we hear a little bit more about that later. A national-level publicity campaign is valuable and we will support its introduction. There is so much to agree with and I have consistently said so to the Minister. Indeed, the only addition I will contribute here is that we need to get on with it and that we do not have time to waste. There are elements, however, that I want to probe and seek reassurance on from the Minister.

On the total online advertising ban, I do not think it is a secret that the Government do not do online policy very well. I think the ever-running saga of the online harms Bill shows that. Online advertising is complex and sophisticated and is changing all the time. I am conscious of concerted efforts by those in the advertising industry to seek to offer the Government a way of delivering on this goal that reflects their expertise in this area. I hope to get an assurance from the Minister that officials are at least talking to them about that and taking it seriously.

On the restrictions on retailers, I hope that we will get a proper chance to understand and debate the qualifiers on square footage and staffing levels. I do not think we would want to be in a situation where this ends up affecting relatively few organisations, creating an unlevel playing field or promoting perverse outcomes, such as having fewer staff. I would be interested to hear from the Minister in that regard.

Crucially, we heard from Wera Hobhouse about calories on menus. I know that that has public support, and support from many campaigners, but if we effect that, it really must be done correctly and properly. I strongly do not believe that before they sought to publicise that and press on the Government have given enough consideration to those with eating disorders who will be negatively impacted.

Photo of Richard Fuller Richard Fuller Conservative, North East Bedfordshire

I am grateful to the hon. Gentleman for cantering through his support for the Government. I just want to take him up on his first principles and the rationale, from his philosophical point of view, for why he believes the Government have a right and a responsibility to manage what people eat and how they look. Does he put obesity on the same level as the tobacco industry of the past? Obviously, health measures were taken because of the harmful effect that tobacco could have on people. If he does not put it on that level, what level does he put it on? Does he put it on the same level as alcohol, which causes a lot of poor health? If not, does he believe that we ought to be doing more on alcohol?

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care)

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 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.

Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means)

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.

Photo of Andrew Selous Andrew Selous The Second Church Estates Commissioner 3:26 pm, 27th May 2021

Thank you very much, Mr Deputy Speaker.

Although we should always talk about obesity with sensitivity and avoid stigma at all costs, we lack courage and fail in our duty if we do not address it. Fundamentally, it is about life chances and social justice, and we want life, and life to the full, for all our constituents.

We are regularly asked to do more for the NHS, and rightly so. One crucial way we can help the NHS is to focus on the prevention of obesity. The 2019 paper by S. C. Davies produced by the Department of Health and Social Care calculated the medical cost and lost productivity cost of obesity at around 3% of gross domestic product, or £60 billion. As a country, we have the worst rates of obesity in Europe. There is absolutely no doubt that this matter is urgent and needs action now.

I salute the young people of Bite Back 2030, with their #AdEnough campaign, for their stand against the 15 billion junk food adverts they are bombarded with online every year. One young man told us he had more of those than he had contact from his grandmother. It is excellent that the Government are taking action on that. We should also curtail junk food advertising on radio, outdoors and in cinemas, restrict junk food sponsorship of sports events and teams, and remove child-friendly characters from junk food packaging.

There is, I am afraid, quite a lot more work to do on reformulation. The 20% reduction target is far from being achieved by this autumn, with only 3% achieved so far. I congratulate Tesco, Asda, Weetabix, Co-op and Aldi on big reductions either overall or in some categories. By contrast, Mondelēz International and Mars Wrigley saw the sales weighted average of sugar per 100g in their sweet confectionery increase. They need to get with the programme. We need to start flooding our supermarkets, schools and the out-of-home sector with healthy, nutritious, delicious and hopefully often home-grown food, and we need to make sure that healthy food is affordable; as the Food Foundation has pointed out, this is often the case in Europe but, bizarrely, not always the case in the United Kingdom. That is something we should concentrate on and we can change, and we need to take it very seriously indeed.

It has always mystified me that the quality and outcomes framework in primary care does not reward GPs for collecting data on children’s body mass index and ensuring there is a first-class diet, exercise and cooking skills offer online and in person locally. Primary care must be at the front of this campaign to make sure we are a nation of people with healthy weights.

Bite Back 2030 says that 60% of schools are not upholding school food standards even though it is the law to uphold them. We must strengthen the enforcement mechanism to make that happen, as school food is a great child health opportunity that we are not making the most of and that we need to act on urgently.

Photo of Alison Thewliss Alison Thewliss Shadow SNP Spokesperson (Treasury) 3:30 pm, 27th May 2021

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.

Photo of Greg Smith Greg Smith Conservative, Buckingham 3:40 pm, 27th May 2021

Obesity is clearly a huge challenge facing our country, and one that absolutely should not be ignored, but I do fear that the state is significantly overreaching in some of the proposals that have come forward as part of the obesity strategy. The approach to foods high in fat, sugar and salt encompasses a perversely broad range of products, including butter, granola, porridge oats, muesli and protein bars, none of which have any particular appeal to or indeed are marketed to children, yet all of which are treated as junk food.

Breakfast cereals were previously heralded for high fibre but are now demonised. No distinction is made for naturally occurring sugars and fats from the dried fruits and nuts that are so often present in those products. If the state is really saying that breakfast cereals are bad, where does that naturally push people? A bacon sandwich? A full English? A pain au chocolat? All are things that I am particularly partial to but that I do not think the public health establishment will be keen to endorse. Perhaps people could have toast? But then we see that butter is on the HFSS naughty list.

Many breakfast cereal producers pay farmers, including in my constituency, a premium for buying their oats, thereby paying for the environmental and wildlife schemes that I am sure we all value. Let us be in no doubt that any policy that reduces cereal-makers’ ability to sell wholegrain cereals will adversely impact on great British farmers.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I was intrigued to listen to my hon. Friend’s list of products. Is not the issue that there is a focus on individual products when, actually, the important thing in getting to a healthy weight is not individual products but a person’s diet as a whole and the balance between individual products across their diet? To demonise individual products is not the way to go.

Photo of Greg Smith Greg Smith Conservative, Buckingham

I absolutely endorse and agree with everything that my right hon. Friend says. It must be about the promotion of a balanced, healthy diet. Some of the things that we all know are not particularly good for us can be part of that balanced, healthy diet, so I absolutely agree.

The restrictions also undermine some alternatives to high-sugar sacks. For example, protein bars are used by many adults who lead highly active lifestyles. Surely the restriction contradicts the ultimate goal of the Government’s strategy: healthier living.

Let me move on briefly to the question of TV advertising. Broadcasters and creative industries throughout the United Kingdom are estimated to be in line to lose some £200 million because of the proposals. With children spending far more time watching online content than traditional TV channels, it is essential, not least for our public service broadcasters, that there is an absolutely clear level playing field between TV broadcast and online. Anything less would be to let down our broadcasters, particularly, as I say, our public service broadcasters.

I would also argue that the 9 pm watershed is equally destined to fail, as research shows that it will lower the calorie intake among children by just 1.7 calories a day, which is simply inconsequential. We need a more proportionate, less interventionist solution that ensures fairness for all. Obesity is a complex problem, but the solution cannot be nannying, ineffective policies.

I certainly did not get into politics to tell people what they should and should not eat, because when people are free to make an informed choice about the way they live, without coercion or state interference, they are much more likely to keep those changes long term, to the benefit of the health of the nation. I urge the Government to rethink the proposals and strip out the nonsensical inclusion of products such as cereals and protein bars. Let us look once more to freedom, choice and personal responsibility.

Photo of Paul Blomfield Paul Blomfield Labour, Sheffield Central 3:45 pm, 27th May 2021

The Government are clearly right to say that this is one of the greatest long-term health challenges that we face, and it starts with our children. One in four enter primary school overweight or obese and, as the Minister pointed out, one in three leave in that position six years later. We have a shocking problem that gets worse during children’s primary years.

Like any disease, there are two ways of tackling it: prevention and treatment. I broadly welcome the measures being proposed by the Government on prevention, although we should look carefully at the evidence and concerns around calorie labelling for those with eating disorders, but prevention is not enough in itself. We need proper treatment services for children, and currently we do not have them.

Imagine for a moment that we were talking about another disease—say, cancer. Would we say, “We’ll invest in prevention, but I’m afraid we’ll not offer any treatment for children with the disease.” Of course we would not, but that is what we are saying for obesity currently. The Health and Social Care Committee highlighted the problem in its 2018 report, noting evidence from Public Health England that only 56% of local authorities

“have a tier 2 weight management service for children” and that those services

“are not intended to support individuals with complex needs. When looking at tier 3 and 4 services, service provision is bare.”

It went on to recommend:

“The Government must ensure there are robust systems in place not only to identify children who are overweight or obese, but to ensure that these children are offered effective help through a multidisciplinary, family-centric approach.”

However, the Government’s obesity strategy does not acknowledge the issue. I have become aware of it through the work that I have done with Shine Health Academy in my constituency—a great local project providing the sort of tier 3 services that the Committee wanted. They take children on referral from GPs, teachers and social workers, and they have great outcomes, but they are funded mainly by charities, because neither clinical commissioning groups nor local authorities have responsibility for commissioning services.

I know that the Minister recognises the problem because, together with the inspirational leader of Shine Health Academy Kath Sharman, I met her to discuss the issue about 18 months ago. There have been some positive initiatives by NHS England, and I welcome the work to establish complications related to excess weight clinics—CREW clinics—to support children and young people with severe obesity, but it is limited. As I understand it, the aim of such services is to manage the comorbidities associated with obesity rather than tackling the disease itself. There are just seven centres in the plan, each for 100 children. It is useful, but it is a very small step assessed against need, because the Obesity Health Alliance calculates that there are 450,000 children in the UK who, if they were adults, would be eligible for bariatric surgery. That is shocking, but it is the scale of the challenge.

There are also worries about the CREW approach. Such clinics seem to place too much emphasis on the role of hospitals, and risk being about medical management rather than weight management. They definitely have a role to play and are fundamental to the treatment of comorbidities, but they should not be the only model of care. Above all, there is no certainty of future funding. In her summing up, I ask the Minister, who I know cares about this issue, to say whether it will finally be the Government’s intention to establish clear responsibility for commissioning tier 3 services for children as the Health and Social Care Committee recommended, because frankly nothing less will do.

Photo of Alun Cairns Alun Cairns Conservative, Vale of Glamorgan 3:49 pm, 27th May 2021

Thank you for inviting me to contribute to this extremely important debate, Mr Deputy Speaker. I pay tribute to my hon. Friend Andrew Selous for securing the debate, and to the way in which the Minister and the Opposition spokesman have contributed so far. Obesity rates are too high, without question, and the long-term consequences include a range of diseases: covid, which has already been mentioned, dementia, cancer, diabetes, heart disease, liver disease and so many more. The need to tackle obesity therefore goes without saying.

The challenge of obesity and its consequences among young children naturally has a very long tail. Introducing policies to meet the childhood obesity challenge naturally requires an understanding of the complexity of the causes if we are to have a real impact on the effect. Diet is obviously central to what we need influence, but it is not the full story. Contributing to the make-up of the diet there will be a series of complexities, and there needs to be clarity around the content of food products. I pay tribute to the work that the Government are doing and what they have committed to do in the Queen’s Speech, and to the work that has been done on labelling and on the sugar tax, which has contributed to a reduction in sugar in fizzy drinks and other products.

Knowledge and skills are important, including, for example, on the availability of fresh vegetables. Fruit and vegetables are obviously important, as is knowing how to cook. Standards and approaches in schools are also difficult. We need education in schools and among parents, who are also central to tackling childhood obesity. Lifestyle is an issue. The slower lifestyle through the lockdown period has enabled many people to address their own weight, but others have not done so. All of these issues naturally have complexities associated with them. Exercise is clearly also an issue, as well as eating disorders, which have been highlighted. I am trying to highlight the complexity of all that we need to face.

With these points in mind, I ask the Minister to consider the cause and effect directly, as well as the focus that has been given to the advertising industry and the marketing of food products, to establish whether it will have the desired impact. Whatever action we take, we must be sure that it will make a difference. There have been calls for many years for a television advertising ban. I can remember it being discussed in Cabinet and being resisted because the evidence was unconvincing. We need to consider that, although there is a call for a television advertising ban, habits have changed. Very few children these days watch television in the way that we might have done when we were younger, and that demonstrates the further complexity of the debate. Displacement is another issue. Advertising is more likely to move online, and I think all Governments recognise the challenge of tackling advertising online. Finding a solution is much more complicated when dealing with things online, as we have seen from the example of Governments struggling to tackle adult content online being accessed by children.

In the very limited time I have, I want to ask the Minister to look at the consequences, both positive and negative, and to question whether one will outweigh the other. I ask her to engage with the industry to see whether a solution can be found in which the industry itself, including broadcasters and online advertisers, can support the Government’s aims.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Justice), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Women and Equalities) 3:54 pm, 27th May 2021

I speak today as the chair of the all-party parliamentary group on eating disorders and I want to highlight the anxiety felt by many of those with an eating disorder about one specific aspect of the obesity strategy: calorie labelling on menus. Obesity causes serious health problems and there is no doubt that far too many people in this country do not have a healthy weight. I add my unequivocal support to the Government’s aim of addressing obesity, but obesity has to be considered as one side of our complex relationship with food. It is a form of disordered eating and therefore cannot be separated from other forms of disordered eating and cannot be dealt with in isolation. Calorie labelling on menus will not only be ineffective in tackling obesity, but will actively damage those with an eating disorder.

Studies show that there is only a small body of low-quality evidence supporting the suggestion that calorie counts on menus lead to a reduction in calories purchased. While there is limited evidence that calorie labelling will support the public in losing weight, there is convincing evidence that it would harm people with an eating disorder. About 1.25 million people in the UK have an eating disorder, and the 2019 health survey found that 16% of all adults aged 16 or over screened positive for a possible eating disorder. Over the pandemic, the charity Beat has reported a 173% increase in demand for eating disorder support, and research shows that individuals with anorexia and bulimia are more likely to order food with significantly fewer calories when presented with a menu including calorie counts. Those with binge eating disorder are more likely to order food with significantly more calories.

Many people with eating disorders also live with obesity. Up to 30% of people seeking weight management services would meet the diagnostic criteria for binge eating disorder. Clearly, a reductionist approach to nutrition means that the obesity strategy risks harming some of the very people it is designed to support.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I am sympathetic to the point the hon. Lady is making, and she will know from my intervention that I think the evidence with respect to calories and out-of-home labelling is quite weak. Is labelling on products purchased in supermarkets also a problem for those with eating disorders? I ask that genuinely; I do not know the answer. Can she furnish that information?

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Justice), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Women and Equalities)

I am particularly concerned about calorie labelling in restaurants. People who suffer from eating disorders are isolated and fearful of contact with others because they are thinking continuously about what they are going to eat or drink. Going out to a restaurant gets them through that step, and it is often a significant step towards recovery. As I say, my particular concern is labelling on restaurant menus.

In response to the survey on calorie labelling conducted by Beat, one respondent said:

“My eating disorder thrives off calorie counting and knowing all the calories in everything. I would feel compelled to look at calorie labels” in restaurants and

“I would feel embarrassed asking for a different menu. Please don’t do it. Please.”

The Mental Health Minister has been extremely generous with her time, listening to the all-party parliamentary group’s concerns about the plan to mandate calorie labelling on menus. The APPG is grateful for her interest in improving early access to eating disorder treatment. However, I must repeat my plea to the Government to look again at this element of the obesity strategy.

Addressing obesity and tackling eating disorders should not be in competition. We must tackle them together. I look forward to working with the Minister to develop an obesity strategy that successfully addresses the obesity epidemic, but does not harm people with other forms of eating disorder.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean 3:58 pm, 27th May 2021

As I said in my interventions on the Minister, I very much support the Government’s objective. A situation in which 36% of adults in England are overweight and 28% are obese is not good, and there are many health consequences of it, but my view is that, fundamentally, we need, first, to enable people to understand whether they are overweight or obese. That might sound like a foolish thing to say, but there is some evidence that people do not recognise whether they or those around them are overweight or obese, and are not very good at working that out.

Secondly, we need to make people understand the health consequences of being overweight or obese. The Minister talked about incentives. The real incentive that people should have is that they want to be healthier. Unless individuals themselves want to be healthier and move towards a healthy weight, it seems to me that we will not get very far.

Frankly, getting to a healthy weight means having a healthy diet. It does not mean going on a diet and then going back to unhealthy eating; it means changing diet permanently. In many cases, it means making not dramatic changes but small changes that people stick to, such as reducing portion sizes. It is about reducing treats and things we like, not getting rid of them. When I eat, I like all the bad things, but I have become better as I have got older—I have needed to—and now I am a bit more controlled about how many times I have them. I watch the size of my portions, because as I have got older, I have had to watch what I eat.

It seems to me that it is about diet, not about individual foods. As my hon. Friend Greg Smith said, demonising individual foods is not a very successful strategy. There are plenty of things that I like that would individually be very unhealthy, but I just do not eat them very often. That is where we need to get to: people need to understand what a healthy weight is, understand the health consequences and want to get there themselves.

I have a couple of questions for the Minister. She spoke about the evidence for out-of-home labelling. The impact assessment is a rather weighty document of 76 pages, but one of the things that I learned as a Minister is that it is worth plodding through such documents. There is lots of useful information in it, but I did not find any compelling evidence that introducing out-of-home calorie labelling would have any significant impact on the quantity of calories that people consume. Given the concerns that Wera Hobhouse and the charity Beat have rightly set out about those with eating disorders, the case for its successful impact is not very compelling. There is quite a lot of concern that it will not be helpful, so I think the Government ought to think again about their approach.

I also have a question about the soft drinks industry levy. The levy has been successful in reducing the amount of sugar consumed; in my constituency, Suntory Beverage & Food Great Britain and Ireland, which produces Lucozade, Ribena and Orangina, has led the industry in taking more than 50% of sugar out of its products. It has also invested £13 million in new machinery at its Forest of Dean plant to produce those products—I was very proud to launch the new production line. However, although we have reduced the amount of sugar consumed, I have seen no evidence that we have therefore reduced the quantity of calories consumed or made any impact as a result.

Photo of Alun Cairns Alun Cairns Conservative, Vale of Glamorgan

My right hon. Friend is making a very effective, cogent argument. Does he agree that because there is a will to come up with a solution that will have an impact, there is a danger that unless we take account of all the evidence, including his points about the impact of the sugar tax, we might well feel better for doing something, but not quite achieve what we set out to achieve?

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

That is right. I am very keen that we look at the evidence. I can see that through reformulation we have led the industry—the company that makes Lucozade and Ribena has been successful in doing that—but the real question is whether that has reduced the number of calories consumed, both by adults and by children, and had any impact on the number of people who are overweight or obese. It has clearly been successful in reducing the quantity of sugar consumed, but as my hon. Friend the Member for Buckingham said, sugar in itself is not a bad thing; people need to consume a certain amount of sugar to have a healthy diet. My worry is that we have reduced the amount of sugar in these products, but that will not actually make any difference to whether people have a healthy diet.

All these measures need to be tested. The point that I was making to the Minister earlier is that I do not want us to introduce them, wait nine years until 2030, and then say, “Goodness, it hasn’t worked.” I absolutely accept the Minister’s point that national targets may not make sense, but we need to look, at a local level, at whether the measures are successful. If they are not working, we need to change them and look at what the evidence suggests would be more successful in getting people to a healthy weight so that we all lead a healthier lifestyle.

Photo of Dan Carden Dan Carden Labour, Liverpool, Walton 4:03 pm, 27th May 2021

It is a pleasure to speak in this debate, which is covering a wide range of issues. At its heart, it is about trying to support a healthier British public, which I think the whole House genuinely cares about.

My reason for speaking in the debate relates to alcohol labelling; I am sure that the Minister remembers our recent Adjournment debate. We are in the incredible situation where a product such as non-alcoholic beer or wine may provide its calorie content, nutritional information and a lot more, but an alcoholic product need contain only three pieces of information by law: the allergens, the percentage of alcohol by volume and the amount of liquid in the container. That is quite a bizarre situation for us to be in, so I am pleased to hear that the Minister is pushing ahead with the consultation on alcohol labelling. There has been some confusion in recent weeks and months. Just a few weeks ago, we heard that the Government had ditched plans to force pubs to list calories as part of a drive to tackle obesity. That came from Downing Street. I hope that, given what the Minister said, the consultation will be kicking off some time soon.

I want to push the Minister once more on the need for a national alcohol strategy. We had the highest rate of deaths from alcohol on record this year. Alcohol-specific deaths are at an all-time high at a moment when drug and alcohol services are underfunded and mental health services are overstretched.

If this is all about supporting a healthier nation—we have the obesity strategy, Dame Carol Black’s review of drugs, a consultation on alcohol labelling, a review of the Gambling Act 2005, and a promised addiction strategy from 2019—I suggest to the Minister that that work needs to be pulled together. The issues that we have touched on in this debate, including mental health and poverty, which are drivers of addiction, really need to be focused on in the months and years ahead.

Photo of Jonathan Lord Jonathan Lord Conservative, Woking 4:06 pm, 27th May 2021

While I welcome many aspects of the Government’s obesity strategy, today I want to argue against the Government’s outlined proposals to restrict TV and online advertising for high- fat, high-sugar and high-salt foods.

These proposals are blunt tools that will have little or no impact on obesity. The Government assess that both the TV watershed ban and the full online ban will lead to just a 4.5 daily calorie reduction among overweight children. That is completely inconsequential compared with initiatives such as The Daily Mile or Couch to 5K, which have the potential to increase calorific expenditure by about 100 calories a day, or targeted, community-based approaches, such as the Health, Exercise, Nutrition for the Really Young—HENRY—programme in Leeds or the Three Area Project in Wakefield. Those two programmes are based on a holistic approach. They address education, activity levels and food inequality, and have had measurable success.

Commentators might argue that the proposed bans do not matter, but they have large adverse impacts on broadcasters, online news media, advertising and production companies, food and drink companies, retailers and the hospitality sector. Advertisers have made it clear that this ad spend and investment will not be rerouted back through other channels but could leave the UK market altogether. The bans will reduce the advertising revenue that media reinvest in programming and content. They will prevent food and retail companies and the hospitality trade from communicating with their customers. They will impact jobs and remove most incentives food manufacturers have to invest in healthier alternatives in this market, because the alternatives themselves may still fall within scope.

The Quebec ban on advertising to children, introduced as long ago as 1980—incidentally, for reasons other than to tackle obesity—had no effect on childhood obesity rates in that province, compared with other provinces. Indeed, the prevalence of being overweight or obese among children in Quebec grew by 140% during the first 15 full years of the advertising ban—a faster increase than elsewhere in Canada, where those restrictions did not exist.

The UK’s advertising restrictions, currently in place across broadcast and non-broadcast advertising, including online advertising, are already among the strictest in the world. They restrict the exposure of HFSS advertising to children under 16. Although TV restrictions have been in place since 2008 and have reduced child exposure to HFSS on TV by around 70%, this has made no measurable impact on obesity rates. These current plans are disproportionate and not evidence-based; they are not targeted at the problem that the Government say needs to be addressed, which is to protect children. Indeed, they are sweeping and comprehensive, requiring new laws and a new regulatory structure.

I urge the Government to liaise much better with industry. The Committee on Advertising Practice, the advertising code body, has put to Ministers an alternative proposal to this online ad ban, which is targeted, workable, effective and enforceable. So, let us do that. Let us engage rather than have these damaging and over-the-top regulatory proposals.

Photo of Olivia Blake Olivia Blake Shadow Minister (Environment, Food and Rural Affairs) 4:11 pm, 27th May 2021

Like almost everyone speaking in the debate today, I support measures to ensure that people have a healthy relationship with the food that they eat. However, healthy eating habits cannot simply be measured on weighing scales or counted in calories. Today, we are facing a mental health crisis, one element of which is the rising epidemic of eating disorders, including obesity.

I fear that our strategy falls well short of the social and mental health support needed to help people manage a healthy relationship with food. I am talking about those who have any conditions relating to weight management, whether that is diabetes or heart disease, or an eating disorder. I hope that the new funding for services will see those approaches supported.

While I am fully supportive of interventions such as restrictions on advertising and work to improve the diet of the nation, I remain very concerned about certain aspects of the strategy. Before the pandemic, hospital admissions were increasing, especially among teenagers. In 2019-20, we saw a sharp 32% increase on the previous year to more than 21,000 cases, nearly 5,000 of which were children. In addition to hospital admissions between February 2020 and January 2021, the eating disorder charity Beat reported a massive 173% surge in demand for its services. During that time, we saw no corresponding rise in the levels of funding going to eating disorder services. I have sat with eating disorder specialists who have told me that the money that is available often fails to get to the frontline. One doctor I spoke to said that his service was originally designed for 60 children, but now serves 280, with inadequate funding for those places.

I know that NHS trusts are also struggling with non-specialist in-patient services for children. The rising demand means that they just do not have the expertise available to treat in-patients with eating disorders properly, with many waiting for urgent beds for children in crisis in any specialist unit anywhere in the country. We still see a situation in adult services where there are no waiting time targets for support for eating disorders.

I am highlighting this dire situation because one measure of the Government’s obesity strategy involves calorie labelling on menus. Among those who will be reading those menus will be people with eating disorders. There is a wealth of research that shows that calorie labelling can exacerbate unhealthy relationships with food and can be a predictor of the onset of eating disorders. In trying to fix one problem, there is a real danger that Ministers will make another far worse, the costs of which are not trivial. Eating disorders have the highest mortality rate of any mental health problem, and people who suffer from them are at increased risk of suicide and self-harm. While it is true that half of those with eating disorders recover, 20% remain in a chronic condition.

We should look at obesity in the round. Balanced nutritious meals, promoting healthy diets such as Mediterranean diets, and healthy levels of exercise are far more important ways of maintaining a healthy weight. I urge the Government to rethink and revisit that aspect of the plan, come up with a solution that balances the needs of all. If we really want to promote healthy eating habits, calories on menus are not necessarily the way to do it for the whole population and risk making a very bad situation even worse for those suffering from or at risk of developing eating disorders. I say this as someone with type 2 diabetes. I have lost weight in order to manage my diabetes. There is a real issue with anxiety around calories and weighing out food. More needs to be done to recognise these anxieties and mental health issues.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 4:15 pm, 27th May 2021

I am grateful to be able to speak on this matter. It has been an ongoing issue for the United Kingdom and I appreciate that it is one of our greatest health challenges that affects people of all ages. I want to put on record my thanks to the Minister. I have been involved in many debates where she has responded on the issue of diabetes, which I think she referred to in her introduction. I believe that she is totally committed to bringing together a strategy that we can all endorse and will hopefully bring about a healthier and leaner United Kingdom. I also welcome the commitment to the alcohol strategy.

I am a type 2 diabetic and I have had diabetes for approximately 14 years. I am proud to say that since being diagnosed I have lost almost four stone on what I weighed back in 2008 and 2009. I am not proud of the circumstances that got to me to where I was. I did not even know what diabetes was, to be truthful. I was not even sure what the symptoms were until I met a diabetic maybe the year before. The choices that led me to be diagnosed with type 2 diabetes were ill-judged. I never really gave thought to the health issues that can come along with the foods I was eating. Sweet-and-sour pork and two bottles of Coca-Cola six nights week are not a good thing for anyone, and they certainly were not good for me, as I found out for the worse.

I am now confident and well pleased with how I deal with the issue. It takes self-control. Mr Harper referred to self-control, which is very important. Not everybody can do it, but if they can, it is good that they can. Along with the tablets that I take for the diabetes, it seems to be bringing results. There is no place in society for judgment when it comes to the topic of obesity, as Andrew Selous said.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I cannot remember whether I said—as I should have done, when I was talking about people being disciplined—that I accept that it is a simple thing in one sense to reduce one’s calorie intake and take more exercise, but it is not easy for people to do. I did not want to indicate, if I had left that impression, that I thought it was easy. Equally, while there is no alternative, ultimately, to people taking responsibility themselves, I accept that many people require help and support to do so. I am glad that the hon. Gentleman has given me the opportunity to put that on the record

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

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.

Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means)

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.

Photo of Andy Carter Andy Carter Conservative, Warrington South 4:20 pm, 27th May 2021

It is a pleasure to follow Jim Shannon. I congratulate my hon. Friend Andrew Selous on securing the debate.

There is no doubt that tackling obesity is one of the greatest long-term health challenges this country faces. Weight loss is an incredibly difficult challenge for so many people. I spent the first few months of this year on an enforced walking programme and managed to lose a stone in weight. Coming back to Westminster, I am afraid I can already feel it piling back on, but that personal responsibility that my right hon. Friend Mr Harper talked about earlier is so critical.

One reason I wanted to speak in this debate is that children in the most deprived parts of the country are more than twice as likely to be obese as their peers who live in wealthier areas. That is sowing the seeds of adult disease and health inequalities in early childhood. We do need an urgent strategy so I welcome many of the measures the Minister talked about earlier.

I think we all agree on the need to address issues around obesity. How we tackle it is what we need to debate and what we are debating today. I heard the Minister say that there is no silver bullet and I think she is absolutely right on that. However, I am afraid there are some bullets that can have wide-ranging impacts, some of them unintended. As a number of hon. Friends have raised, one proposal is a TV and digital advertising ban. While some suggestions appear straightforward, I think this is a very complicated issue. The Minister herself said that if advertising did not work, the companies concerned wouldn’t do it. She is absolutely right on that, but there is significant evidence to suggest that introducing a ban will not deliver the necessary beneficial impacts she wants and could have significant outcomes on the public good. The Government’s own evidence, as we have heard, shows that the reductions in calorific intake will be negligible—about 1.7 calories a day. I think it was referred to earlier as a Smartie; I would refer to it as a Tic Tac. It really is not a significant amount of calories on a daily basis. My call to the Minister, therefore, is to encourage further investment in education in this area.

I want to mention in particular the impact that a reduction in advertising or an ad ban would have on public service broadcasters such as ITV and Channel 4. Some data I have seen suggests that about £200 million a year would be taken out of that sector, which is almost three times the amount the broadcaster spends on regional news each year. Regional news is something we all benefit from. It is incredibly important and the impact on public service broadcasting would be significant. My drive is to encourage broadcasters to put more emphasis on the campaigns they have been working on recently, such as the “Eat them to Defeat Them” campaign to increase the amount of vegetables in shopping baskets—around 500 million child-sized portions because of joined-up thinking between broadcasters and retailers, and something that children want to get involved with.

To conclude, one issue that has concerned me greatly relates to press reports suggesting that the ad ban will not be introduced across all platforms. It could be that it is just on TV platforms, rather than online platforms such as YouTube. That is a recipe for disaster, because the money currently spent on TV channels that generate wealth for this country will simply go overseas to the US.

Photo of Andrew Lewer Andrew Lewer Conservative, Northampton South 4:24 pm, 27th May 2021

With more than half the adults in this country classed as overweight, which has well-known associated health impacts on society and the NHS, I understand why the Government want to tackle this issue. Much of the strategy on public health education is not objectionable, unlike the proposals about the advertising of two-for-ones and where shops can display their wares, which I believe fall foul of the core Conservative principles, which are the reason I am in politics, of promoting freedom and the liberty of our citizens.

There is much evidence that suggests that such proposals will not work anyway and will be heavy-handed. That is why these ideas, thankfully, never came to fruition in two former Prime Ministers’ Administrations. The legislation will essentially nationalise the content of food advertising, which will be chosen by the Department of Health and Social Care in Whitehall. It is redolent of EU regulations about whether Jaffa Cakes are biscuits or cakes and Harold Wilson’s selective employment tax; instead we should trust citizens to make decisions for themselves and concentrate on education so that those choices are informed.

The proposed advertising ban on high-fat, salt and sugar products before 9 pm on TV and online in its entirety will not only catch those foods that we commonly think of as junk, but target foods such as ready-made sandwiches, butter and jam. Speciality businesses such as wedding cake shops or artisan producers of sausages will not be able to promote their products on the primary advertising mediums of the 21st century. We are a party that claims to stand behind business, but the financial impact across the food, advertising and broadcasting industries, in stifling entrepreneurship and competition, will be enormous. All these proposals, by the Government’s own admission, will reduce children’s calorie intake only by an unnoteworthy amount. Research from Mondelez International states that restricting promotions will lead to an average daily reduction of only 8 calories for adults.

An obesity strategy as a concept and one that empowers my constituents in Northampton South is fine, but proposals towards a nanny, banny state, which are contrary to years of the Prime Minister’s own writings and to core Conservative principles, are not at all fine. They exemplify the politician’s syllogism from the 1988 edition of “Yes Prime Minister”: “We have a problem. Something must be done. Well, here’s something, so let’s do that.”

Photo of Robbie Moore Robbie Moore Conservative, Keighley 4:27 pm, 27th May 2021

The challenge of obesity has of course been magnified by the last year’s events, and the evidence is clear, as ever, about the importance of having a healthy lifestyle and eating well. I welcome the national food strategy’s putting a better food system at the heart of the covid-19 recovery. It is worrying that one in three children who leave primary school is overweight and one in five is obese. It is crucial to rethink the food that young people are being given, and the right education is the key to the answer.

I recently met and had a great discussion with Ruth Hall, a constituent in Addingham and a former home economics teacher, about ensuring that people know how to prepare healthy food. She showed me her old lessons plans, which included guidance on making nutritious meals at an affordable price. The people she taught over her 36 years as a teacher were given the right skills to cook, and I am sure their children are better informed about healthier eating.

I worry that home economics as a subject for all at an early age in our schools is now lost, and I fear that a generation have now missed out on acquiring these skills, which I believe is a key reason for the worrying statistics I have mentioned. It is therefore vital for the Government to act to make sure that young people are equipped with the adequate training on and knowledge of nutrition and how to cook a decent meal—a decent, wholesome meal.

There is a much wider discussion to be had about where people’s food comes from. I regularly speak to farmers and those working in the food production sector, who are frustrated by the lack of knowledge about that nationally in the wider population. It needs to be at the heart of our good food strategy. The Government’s intentions to change how food is advertised, displayed and promoted in shops will undoubtedly create purchase behavioural change, but I am yet to be totally reassured of the absolute benefits that will have.

As my hon. Friend Andy Carter and the Minister have said, there is no silver bullet. However, of course, in this place we cannot ignore the fact that this issue disproportionately affects those in deprived communities. Currently, children in those communities are twice as likely to be obese than those in less deprived areas. That must be addressed. I am pleased that the Government have pledged to halve childhood obesity and close that gap by 2030, but our approach cannot just be Government-centred; communities must be key, active players, and parents must take more responsibility for what they feed their children and the consequences of that. Of course, that loops back to education.

I know that the NHS long-term plan has ring-fenced £4.5 billion to help local GPs, pharmacists and others deal with issues such as obesity, but I am sure that home economics, food nutrition, and teaching children and parents how to cook good, wholesome food will be a great start.

Photo of Jo Gideon Jo Gideon Conservative, Stoke-on-Trent Central 4:31 pm, 27th May 2021

As a member of the all-party parliamentary group on obesity and chair of the APPG on the national food strategy, I welcome the opportunity to contribute to this vital debate. We have heard many statistics this afternoon that underline the need for decisive and urgent action by the Government, so I will focus my comments on the complexity of the challenge and the need to tackle obesity with the same collective approach that we have seen work so well during the last year in response to covid-19.

I was pleased to see the importance of prevention acknowledged in the Queen’s Speech, in the words:

“Measures will be brought forward to support the health and wellbeing of the nation, including to tackle obesity”.—[Official Report, House of Lords, 11 May 2021; Vol. 812, c. 1.]

I particularly welcome the introduction of the office for health promotion, which acknowledges that our health is shaped by many factors and that the ability to make healthy choices is not simply a matter of individual behaviour change. Regional and community variations in obesity are strongly linked to the structural inequalities that we seek to address through our levelling-up agenda. Poor diet affects our ability to achieve our full potential, so tackling obesity is central to our commitment to level up.

However, to improve the nation’s health, we need to work together in the same way we did during the pandemic. From schools to local authorities, food producers, manufacturers and marketeers, health professionals and community groups, sports clubs, influencers, families and individuals, the battle to tackle obesity needs to be grasped by us all. That battle should not be framed as a war between the nanny state and personal freedom, as many more of our behaviours were during the pandemic, and I think that the majority of people acknowledge that.

I am reminded of a previous and ongoing health campaign, and the shift of public opinion, on the issue of smoking. I recall that it took many years and some Government legislation to alter the narrative significantly, even though the health risks associated with smoking have been widely known for decades. That is why I support, as part of a comprehensive approach to obesity prevention, the restriction of retail promotions on food and drinks high in fat, salt and sugar, the banning of junk food adverts on television before 9 pm, and a total ban online. Young people are particularly vulnerable to highly targeted online junk food advertising whenever they access social media.

If we are to see generational improvements in obesity levels, we must start with early years, so I welcome the recent increase in the Healthy Start payments made available to pregnant women and those with children under the age of four to help them buy fruit and vegetables, and the investment in school holiday clubs to ensure that many more children receive healthy food and exercise during the holidays.

Education has a vital part to play in behaviour change, with all schools offering healthy meals in their canteen and teaching about nutrition, underpinned by cooking skills for all. The latter must be measured as a key curriculum requirement, and the nutritional value of school meals needs to be included in Ofsted or local authority inspections to ensure that school food standards are met.

I also welcome the Government’s commitment to a health incentives and reward approach and the use of innovative tools to effect behaviour change, as well as the plan to build on existing digital solutions available via GPs to widen access to digital dietary support programmes to those who wish to improve their health, rather than to the clinically obese only. This Government are committed to winning the battle against the nation’s obesity crisis with a wide range of measures. It is a battle we cannot afford to lose.

Photo of Richard Fuller Richard Fuller Conservative, North East Bedfordshire 4:35 pm, 27th May 2021

I congratulate my hon. Friend Andrew Selous on securing this debate, and I welcome my hon. Friend the Minister to her place. It is clear with the breathless endorsements from the Opposition that the Government, if they wish, can fully get their way with these proposals, but I worry.

I worry that an opportunity for a determined and modern policy based on empowering individuals has instead been replaced with a rather tired, top-down, bureaucratic approach. I worry that the Department of Health and Social Care algorithm has resulted not in an intelligent group of products, but a confusing and ill-targeted group of products, as my hon. Friend Greg Smith said.

I worry that the policy is literally treating adults like children, particularly with its full-scale transfer of the nutrient profile model. Worse, I worry that the policy targets those who are poor, ethnic minorities and the elderly, who are most likely to be obese or overweight, and it connotes with it a rather condescending attitude that the Government know best for those particular groups of people.

I worry that the evidentiary base is flimsy. The Minister mentioned the sugar tax, and the sugar tax may have been successful, but that is not what is in this policy. In fact, the policy being proposed is very different from the sugar tax. I worry that success is not defined or measured. Essentially, the policy remains a matter of hope, as my right hon. Friend Mr Harper pointed out.

I worry about the haste of implementation, adding new efforts and responsibilities on businesses just as they are recovering from the impact of lockdowns. In particular, I worry about the impact on Jordans in my constituency and the farmers who are supporting that business. I worry that the Department has chosen to silence the power of businesses and the power of their brands, rather than enhance them in the efforts they wish to undertake.

I worry that the policy is blunt where it could be smart. For example, it prefers an outright ban to using technologies in advertising online that would help achieve the Government’s goals. I worry about the unintended consequences for people with eating disorders. I worry about timing. Many people are already anxious about their health post covid, and these measures will do nothing to avert those anxieties.

I worry about the social credit system of points that Sir Keith Mills may come up with in his review, with all of its potential ramifications. I worry where all this may lead—potentially we will have an NHS app. As we walk down the street and pass a restaurant or a bar, it will beep to tell us, “Please input what you have eaten.” Perhaps we will reach there one day. In fact, we are already there. Those apps are already under trial by the NHS.

Photo of Dr Caroline Johnson Dr Caroline Johnson Conservative, Sleaford and North Hykeham 4:38 pm, 27th May 2021

Helping people to achieve and maintain a healthy weight is one of the most important things we can do to improve our nation’s health. As a consultant paediatrician, I have seen at first hand a worrying rise in obesity among our children and the health complications that come with it. I remember in my practice seeing a nine-year-old heavier than I was at seven months pregnant. I saw a young teenager weighing more than 120 kg—that is more than 19 stone. I saw many children with significant obesity-related health problems.

As other Members have said, the trend is increasing. One in three children leaving primary school are already overweight and one in five are leaving with obesity. This trend is further exacerbated in the most deprived areas of this country, where children are twice as likely to be obese as their peers in the richest areas. This is tragically setting up far too many young people for a lifetime of health complications, from diabetes to mental health, as well as reinforcing health inequalities.

In my experience as a doctor, the patients I see want to maintain a healthy weight but find it challenging to do so—and it is challenging, perhaps not surprisingly given the food environment in which we live. In particular, eating out has gone from an occasional treat to a regular feature of our social lives, but we have very little information on how many calories are in the food offered. This is important because on average meals out contain more than twice as many calories as those prepared at home. Accordingly, I welcome the Government’s proposal to introduce calorie labelling on menus, because it will empower people and give them the chance to make the healthy choices that they want to make. Nutritional information is already available on the food and drinks that we buy in supermarkets; expanding the practice to larger restaurants and cafés will help customers to make more informed decisions when they eat out. The evidence shows that calorie labelling on menus can reduce the number of calories consumed by about 8% and, indeed, that it leads to the development of healthier menus.

Although I welcome the push for reformulation to reduce the sugar and calorie content of food, I am worried that in their efforts to reduce the calories on menus, food producers and establishments may make greater use of artificial sweeteners. Research has shown that the mismatch between the sweet taste and few calories provided by artificial sweeteners can confuse the body’s systems and lead to hunger cravings that result in the consumption of an even greater number of calories overall. We need to be careful to ensure that our efforts to reduce calories do not unintentionally create the opposite effect with artificial sweeteners.

Finally, I wish to discuss an area that needs greater emphasis in the Government’s strategy to tackle obesity: education. As other Members have mentioned, education is really important in tackling obesity. Today’s greater prevalence of eating out is partly because of an increase in disposable income and convenience. We also know that cooking skills at home are just not what they once were. Education has a significant part to play by instilling healthy habits in young people and showing them not just what is healthy but how to make it, so that by the time they leave school they have good kitchen-safety skills and can cook simple, healthy and nutritious meals. I hope that when she responds to the debate the Minister will have time to elaborate further on the Government’s intentions in regard to education in this policy area.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care) 4:42 pm, 27th May 2021

With the leave of the House, I shall respond to the debate. The funny thing about opening and closing this debate for the Opposition is that I have already posed 10-minutes’ worth of questions to the Minister and now I am back for another round. I do want to hear the answers to my questions and to the many good questions posed by Members from all parties, so I shall not speak for long. I am not sure whether that is a kindness to the Minister, but we are keen to hear the answers.

I want to reflect on some of the contributions, because it has been a really great debate. I hope that the people watching—there is a lot of interest in this subject—will have seen the quality of the discussions. There have of course been differences of view, but that is a good thing, and I hope people will have seen the House at its best this afternoon.

I have worked a lot with Andrew Selous on modern slavery, and he always works with such compassion. The tone that he set on having a non-stigmatising debate was a very good one. Jim Shannon picked up that theme too and I think we have managed to have such a debate. It is important that we continue that.

My hon. Friend Dan Carden made some points on alcohol labelling, following his recent debate on the subject. It would be helpful to hear clearly from the Minister that the briefing that such labelling was to be dropped is wrong. I think that is what we heard from her, but it would be helpful is she was very clear that that briefing is inaccurate. Will she pick up on the idea of having a national alcohol strategy and say how she feels about bringing together some of the existing strategies to attack many of the commonalities—for example, in relation to mental health services?

I spoke about mental health services earlier, as did others, including my hon. Friend Paul Blomfield, whose points about treatment services for children were very well made. After a decade of real famine in this police area and the continued failures in CAMHS, there is a commitment in the strategy on investment in healthy-weight services; I am keen to hear from the Minister some extra detail about what form that is going to take. If she does not have those details today, will she say when we are going to start to hear some and when we will have a chance to debate what form that is going to take? My hon. Friend Olivia Blake and Wera Hobhouse picked up on a point I raised in my opening remarks about eating disorders and they strongly displayed just how people feel, certainly those who are working and active in supporting people with eating orders. We are very lucky to have those people still making that case after such a challenging year for their support services. I hope the Minister has heard that, because I strongly believe that the impact assessment does not pay prominent enough regard to it. I hope she will confirm that she is still in listening mode and perhaps give us a date for when we can hear about and debate that secondary legislation, now that it has been published. I hope she will use this time to seek to meet some of those concerns.

Let me turn to contributions from Conservative Members. I was struck by the one from Alun Cairns on knowledge and skills, because the cruelty in all this is that scratch cooking is not only better for us, but cheaper. It is one of the few things where doing the right thing really rewards us. If my wife was watching this—let’s face it, she’s not—she would roll her eyes and say, “It tastes better if you do it right.” She has tasted my cooking and scrutinised my app-based ordering late at night, so she might say that I am in danger of a bit of hypocrisy there, but nevertheless it is true that scratch cooking is cheaper and healthier.

The hon. Members for Keighley (Robbie Moore) and for Sleaford and North Hykeham (Dr Johnson) picked up on the idea of education programmes. Whether or not we characterise them, as he did, as a recommitment to home economics, these sorts of programmes are effective. It is not making a particularly aggressively partisan point to say that a decade of cutting the public health grant has meant that, in essence, these services have disappeared across the country, but they did exist and can do so again. I hope that we will see a reinstatement of them, and I do not think it is nannying to do that. When this is done intergenerationally as well, it can have a great social benefit. The evidence behind it was good, and I would love to see a report on it.

The point made by Jo Gideon about public opinion was very important, as that issue has not been covered much. There has been a lot of talk about personal choice, to which I will turn shortly, but the public are ahead of us on this. On the vast majority of the interventions, even the ones I am most sceptical about, the public are more bullish than I am, so it is important that we do not lose that from the debate.

We heard contributions from the hon. Members for Woking (Mr Lord) and for Warrington South (Andy Carter) about the ad ban, which is not a silver bullet, as the Minister has said, although it is impactful. I might argue that the vigour with which those who oppose it say it is a bad idea shows why it might be a good one. Nevertheless, I hope the Minister will again demonstrate that she is in listening mode. When the industry comes together with proposals that meet the Government’s stated aims, I hope they will be given a fair hearing—that is entirely reasonable.

Mr Harper made very good points about reformulation, which is the big goal here; whatever we do with menus, what we have seen from the sugar tax is that once firms really put their shoulder to the wheel on this, we can do some incredible things. The progress made in the past decade or so, certainly in the soft drinks industry on reformulation, is a really good sign. I did not quite agree with the point he made on demonising products, as I do not think that that is the purpose. For me, the goal here should be informed choice, which all Members have talked about, and our knowing what is in those products. I do not think manufacturers would fear that, and they should not either. The point about informed choice was also raised by Greg Smith, who talked about “overreaching”. I would think the proposal we are talking about is quite modest; there are no bans in here, certainly not of products—it is just about ensuring clarity of what is in them, and we should do that.

I want to come to the point about free choice, as it was made by many Members, including the hon. Members for Northampton South (Andrew Lewer) and for North East Bedfordshire (Richard Fuller). If this is genuinely a matter of free choice—this is the thing I just cannot get past on this issue—why does obesity happen disproportionately on the same streets and estates, year after year, generation after generation, even though the people in those houses change? If this was purely a matter of free choice it would not happen that way and would be much more evenly distributed across the country, but all the evidence tells us that that is not the case, so I cannot quite accept that point, I am afraid.

I was not going to do this, but I thought the hon. Member for North East Bedfordshire was a bit unkind to me by suggesting I had offered “breathless” support to the Government. I might have been breathless but was trying to get a lot in and wanted colleagues to have a chance to contribute too, and I think there was balance in what I said. I know the hon. Gentleman now differentiates what is being proposed today from the sugar tax, but I remember even though I was not a Member at the time that he was very publicly and prominently against the sugar tax, saying it would not work. I do not think that has been borne out by the facts since then, and I gently say I think he is wrong again in the same way today.

I have now given a quick canter around all the contributions, which were very good, even the ones that perhaps I would not agree with and that were made by Members who might not have agreed with my contribution. We have got the strategy—we have had it since July—and what I want to hear from the Minister now is a real emphasis on delivery and implementation and on recognising the concerns raised by Members and those outside this place, and a real sense of how we will work together to implement it. As I have said, where that is done in an evidence-based way, we will be supportive, because this is a very big prize indeed.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care 4:50 pm, 27th May 2021

With the leave of the House, I would also like to thank everyone for the tone of the debate. It is important that we discuss these things and do so in the right way, which is essentially reflected in the comment of my hon. Friend Andrew Lewer that he did not come into politics to tell people what to do. Neither did I; I came here to help them, and the crux of this strategy is to inform, to educate and, as my hon. Friend Jo Gideon said, to slowly knit together policies such as the Office for Health Promotion and the healthy start vouchers so that we can start changing lives, and so that children do not end up in front of my hon. Friend Dr Johnson as a 12-year-old weighing 9 stone, with the concomitant effect that one in 10 adults over 40 have diabetes and 4.7 million people in this country have diabetes. I have met Jim Shannon discuss diabetes, Emma Hardy to discuss vascular disease—which is, again, completely compounded by carrying weight—and my hon. Friend the Member for Stoke-on-Trent Central to discuss the childhood challenges of poverty. We have often spoken about how particularly challenged Stoke-on-Trent is.

In no particular order, as I just happen to randomly have these figures to hand, I shall state that 8.6% of children in Northampton go into reception classed as obese, but that figure rises to 18.5% when they leave—about a 9.9% uplift. In the Forest of Dean the corresponding figures are 10.3%, with 19.3% of all children in year 6 coming out as obese. In Bedford the figures are 8.9% and 21% of all children, and more than six in 10 adults are overweight or obese.

Actually, I think the time has come to do something, and to help and to assist, because I do not think on our watch we can do nothing. This is about helping people have more quality, healthy life years, and surely that is why we are here. As my hon. Friend the Member for Sleaford and North Hykeham said, when we eat out we consume double the calories; surely it is better that we help inform, because if we were to prepare the food, we would have half the calories.

We are not banning advertising; indeed, we are offering probably the greatest marketing and advertising opportunity as we come out of the covid crisis. It cheered me this week that Kellogg’s has indicated that it will reformulate the amount of fat, salt and sugar in its products, taking out 10% of sugar and 20% of salt. The whole reason that the policy exists is to try to put children and, arguably, all of us on a better trajectory.

All the contributions were excellent, but I listened with some sorrow to my hon. Friend Greg Smith. I know his county and, indeed, I represent a rural county. I am not demonising breakfast cereals. Kellogg’s is going in the direction that its customers are demanding—I think, as Alex Norris said, that customers are ahead of us in this House on this—and reformulating, which is what we want it to do. A noble Friend in the other place once mentioned porridge and was derided for doing so, but I want to help families and children so that, no matter what they can access and purchase, they are, by default, able to access a healthier choice, so that they are not forced into making the choice of saying, “That, at least, is something to give my children”.

We are not banning butter, so my hon. Friend the Member for Buckingham can rest assured that he will still be able to have his butter on a bit of toast, if that is what he likes. I will not repeat A.A. Milne’s:

“I do like a little bit of butter to my bread!”

However, we are also not putting more than 16 product lines into this, because we have listened to industry, Wera Hobhouse and various others who have noted the challenges. I talk regularly to the Minister for Patient Safety, Suicide Prevention and Mental Health, my hon. Friend Ms Dorries, and we are incredibly cognisant of those who have eating disorders. The road that we travel has to be balanced so that people can make the right, informed choices.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care

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 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 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 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 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.

Photo of Nigel Evans Nigel Evans Deputy Speaker (Second Deputy Chairman of Ways and Means)

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.