Health: Obesity — Debate

– in the House of Lords at 1:59 pm on 7th January 2010.

Alert me about debates like this

Moved By Lord Pendry

To call attention to the progress made in combating obesity among young people; and to move for papers.

Photo of Lord Pendry Lord Pendry Labour 2:01 pm, 7th January 2010

My Lords, I am pleased to have secured this debate today, as the level of child obesity is unacceptable and, if current trends continue, it is set to rise even further. However, too often this debate has a negative and hopeless tone to it. The problem is serious, but it is not hopeless. There is plenty of hope. A number of organisations are doing good work, there is record investment in our young people and we are seeing the worrying trends begin to reverse.

Let us be clear about the facts. Too many people in this country are obese and far too high a proportion of them are children. In fact, the National Health Service Information Centre report on obesity published earlier this year found that 30 per cent of girls aged between two and 15, and 31 per cent of boys, are classed as overweight. Of the girls, 16 per cent are obese, while for the boys the figure is 17 per cent. The figures are the result of a steady and worrying increase in recent years. In 1995, only 12 per cent of girls and 10 per cent of boys were obese, which means that there are now around 300,000 more obese girls and roughly 550,000 obese boys.

On top of that, a sad and difficult but none the less true fact to absorb is that these increasing trends tend to be concentrated in less affluent areas, which has led to significant health inequalities over the years. The direct cost to the National Health Service has reached £500 million a year, with a further cost of £2 billion to the wider economy. The Government's worst-case projection of recent trends suggests that 75 per cent of the population could be suffering the ill effects of excess weight within 15 years, with spiralling annual costs. Thankfully, these projections have been downgraded recently, but the threat remains.

Obviously there are significant health risks associated with obesity, which can begin at a young age. They include heart disease, some cancers, high blood pressure, high cholesterol and mental health problems-mental health disorders now affect 10 per cent of all 10 to 16 year-olds. Worryingly, we have also seen a big increase in the number of young people suffering from type 2 diabetes, despite its normal association with adults. In order to do something about rising obesity levels and to prevent the problems that I have described, we have to go back to basics and ask ourselves why so many children are obese today. There is no great mystery about it: too many children take too little exercise and eat too much junk food.

Let us take diet first. An average of only 21 per cent of boys and girls consume the recommended five portions of fruit and vegetables every day, despite the fact that 65 to 70 per cent know that five a day is what they should be aiming for. Similarly, with physical activity, nearly 30 per cent of boys and 40 per cent of girls are unlikely to take the recommended amount of exercise, despite the fact that they know, and their parents should know, that it is good for them.

It would be easy to despair at these figures and paint a picture of doom for the future, but it is not my intention to do that. I am perhaps more positive than many on this issue. It is very important to note that, although the figures for a good diet and plenty of physical activity remain too low, they are increasing all the time. For example, the 20 per cent of children now eating their five a day represents an increase of 10 per cent since 2001. That is good progress, because, as we all know, behaviour takes a long time to change.

Similarly, it would be easy to despair at the worrying lack of fitness among our young people. A report entitled Nature, Childhood, Health and Life Pathways was published in December 2009 by the University of Essex. The team found that aerobic fitness in English children is lower than the global average. However, that is not all; in fact, it is declining by 1 per cent a year, which is twice the global average. All the research behind the report suggests that in 1998 the average 10 year-old could beat in a fitness test 95 per cent of children of the same age in 2008. The report goes on to give specific examples as to why this is and why fitness and physical activity are not necessarily an integral part of our culture or mindset. In the east of England, for example, the study found very low levels of cycling among young people despite the fact that the region, as we know, is flat, relatively dry and has a mild climate. Only around 7 per cent of boys and 2 per cent of girls cycle to school. The report calculates that a small change in culture, so that children who are currently being driven to school cycled instead, would lead to a substantial increase in fitness and have the added bonus of a 70,000 tonne annual reduction in carbon emissions.

However, as with diet and nutrition, I am not going to paint a picture of despair. Some fantastic work is going on at all levels-by national and local government, in schools and through the national governing bodies of sport-that seeks to revolutionise the country's approach to physical activity. That is a source of great hope to me and, I hope, to other Members of the House and it will form the focus of the rest of my speech.

Members of the House will know that I have strong links with sport and recreation through various sports organisations and their umbrella body, the CCPR, and through my chairmanship of the All-Party Parliamentary Sports Group. I take great interest in these issues and I can say through my experience that more emphasis than ever before is being put on physical activity for young people by the Government, schools, PCTs and sports organisations. That is having a big impact on the ground and gives us hope for the future.

The benefits of physical activity are well documented and can be crucial in tackling crime and anti-social behaviour, improving education and fostering community cohesion. However, as we are talking about obesity, it is in health that the benefits of physical activity can really be seen in the young. That is underpinned by the fact that people involved in sport and physical activity are 20 to 30 per cent less likely to die prematurely and up to 50 per cent less likely to develop major chronic medical conditions. The World Health Organisation argues that positive and early exposure to physical activity can have a significant impact on healthy lifestyles for young people and therefore influence the choices that they make when they transfer to a less structured environment. Physical activity at a young age also provides key health interventions at an age when they can last. These interventions lead to lasting improvements in bones, muscles, joints, the heart, lungs, co-ordination and movement control and obviously to maintaining a healthy body weight.

As the European Non-Governmental Sports Organisation states, physical activity is,

"especially important as sedentary lifestyles amongst children are rising".

This is not a policy position or an opinion; it is merely part of the argument over the benefits of physical activity. That argument has been won and recognised by the Government. In adopting the Department of Health's Be Healthy, Be Active physical activity action plan, the Secretary of State celebrated the difference that physical activity makes to people's lives. He set a target for the UK to rise from 21st to fourth in the international physical activity table and pledged to hold regular ministerial summits on the issue in recognition of the cross-departmental benefits of physical activity. Of course, there is also the target of ensuring that young people are able to do at least five hours of organised physical activity per week-known as the 5 Hour Offer-which is as bold as it is necessary.

Staying with government initiatives, I believe that the Change4Life scheme is starting to make a big impact. If it is afforded the right support and time to become truly established, this impact will widen. Launched last January, the scheme's aim is to tackle the unhelpful habits that our way of life has caused many of us to fall into, by encouraging small changes in the way in which we eat and move, with the ultimate aim of allowing us to live better and longer lives. The scheme, which was launched through a series of targeted TV adverts, provides easy guides for parents wondering what to feed their children and how to get them moving; it even allows parents to plan active rather than sedentary family holidays. It also lets parents know what physical activity events are taking place in their areas, with Bike4Life, Swim4Life and Walk4Life events planned all over the country.

The Change4Life initiatives have inspired other, more specifically local schemes, such as one in Manchester, which as noble Lords may know is close to my heart. A sub-brand of Change4Life has been developed and will be launched this month as Points4Life. Developed by Manchester City Council and surrounding district councils, this is a loyalty scheme like a Tesco or Sainsbury's club card. It is designed to ensure that participants can have free access to leisure centres or purchase sports equipment. With the right support, this scheme can provide an enormous incentive for people to make small but necessary changes in their lifestyles.

The emphasis placed on physical activity by the Government is crucial in driving the agenda forward. However, despite the potential impact of things like Change4Life and the 5 Hour Offer, they are not delivered at the snap of a finger. It takes drive, determination and partnership on the ground, where the difference is really made. It is worth mentioning organisations that have done this best. The Youth Sport Trust is a central part of the offer. As schools present a unique opportunity in terms of time, facilities and supervision of young people and physical activity, the trust has worked individually and collectively with more than 500 schools across the country to improve physical activity provision for pupils. Together they are doing a great job and are reversing trends that have been embedded over a number of years.

It is right that we recognise that 93 per cent of young people took part in at least two hours of PE in 2007-08, up from 82 per cent in 2005-06. They have been helped by a number of institutions, which have attained sports college status. Those have been shown by government surveys between 2005 and 2008 to have had a very positive impact on the frequency of physical activity and on the health of pupils. The Organisation for Economic Co-operation and Development has acknowledged that the combined efforts of government, schools and the Youth Sport Trust have led to young people in this country doing more physical activity in schools than young people in many other countries do. This represents major progress.

The governing bodies of sports have also done great work in increasing the level of physical activity among young people. New initiatives have taken root in communities all over the country and are making a big impact. For example, the free swimming initiative is a £140 million programme driven by the Amateur Swimming Association and supported by central and local government. The British Cycling Skyride days are popping up all over the country, with 65,000 people taking part in the London ride in September. Cricket's Chance to Shine initiative, a £50 million programme to get cricket back into schools, led to nearly 250,000 young people playing cricket in 2,082 schools, with 56,000 coaching hours provided. England Netball is placing great emphasis on getting young people to play the sport again. This is great for girls, for whom this is one of the most popular activities, but it also ensures that many boys are playing netball. The Rugby Football Union's Go Play Rugby scheme focuses on player recruitment and retention. It provides local rugby events, training days and links to local clubs. There is also a reward system, which provides incentives for new players to get their friends involved.

Football is also playing its part through the auspices of the Football Foundation, of which I am president. For example, Brighton and Hove Albion last year received more than £113,000 for a healthy living project. Notts County received more than £222,000 over three years for a similar project. The Premier League and the Professional Footballers' Association's community fund has granted Middlesbrough FC £300,000 to help youngsters with healthy activities and Sunderland £270,000 to tackle obesity.

These are only a handful of examples, but there are many more across the whole range of sports and activities. It is laudable work and it adds great value to what is going on in schools. The work by schools and governing bodies has been consolidated further by the excellent work of a number of outside organisations, which we should also celebrate. The StreetGames organisation, for example, provides physical activity opportunities in deprived communities that lack facilities and in which childhood obesity is heavily concentrated. It brings the chance to be active to the doorstep and at the same time fosters a sense of togetherness and community pride. According to the legal firm KKP, which undertook an assessment of StreetGames programmes, there is growing evidence of their,

"positive impact on the social capacity and community infrastructure of run down and neglected housing estates, making sport accessible to everyone regardless of income and social circumstances".

Because of the time, I will not go on to talk about some of the other developments that are taking place. Although childhood obesity remains too high, I hope that I have painted an optimistic picture for the future. There is more investment and more emphasis on physical activity than ever before; people are working with drive and expertise to provide new and constantly improving physical activity opportunities for the young people of this country. If we support this work properly and allow it to flourish, the worrying rise in childhood obesity can be reversed and this country will be much better off for it.

Photo of Baroness Farrington of Ribbleton Baroness Farrington of Ribbleton Government Whip

My Lords, I congratulate my noble friend on managing to make his speech in spite of his obvious difficulty because of his heavy cold. Other noble Lords will not get such laxity.

Photo of Baroness Walmsley Baroness Walmsley Spokesperson for Children, Schools and Families 2:21 pm, 7th January 2010

My Lords, there is only one cause of obesity and that is taking in more calories than you use up. For a normal active child on a healthy diet there is really no problem about obesity-the difficulty arises when they either eat too many calories or use up too few, or perhaps both. My noble friend Lord Addington will talk about the issue of sport and exercise and their role in using up calories and strengthening the heart. So, apart from recommending dancing as a very enjoyable and fashionable way of taking exercise in these days of the popularity of "Strictly", I am going to concentrate on one of my favourite topics: food.

I love food. Indeed, I would die without it. I like to grow it, pick it, cook it, eat it and socialise with it. I certainly like to know as much as possible about what is in the food that I do not grow myself and how it was produced. I have a great aversion to factory-farmed meat with all its animal health issues and to battery hens and eggs. I have also found that children are fascinated by growing and picking food and then, of course, eating it. However, one of the main causes of child obesity these days is that their parents do not cook, so they eat a lot of fast food or processed food. Then you really do not know what is in it; there is often too much salt, too much sugar, too many additives or preservatives and too many calories. But when you cook your own food you know exactly what is in it. You can have a wonderful school meals service, and I will say more about that later, but if the parents cannot or will not cook at home, school meals are only taking care of a minor, though important, portion of the child's diet, although the advent of breakfast clubs has increased that proportion.

Having been brought up in a household where my mother cooked and then taught me, I find it sad that there are many young parents who did not have that advantage and did not learn to cook at school, since for many years it was not taught. Indeed, many schools simply did not have the facilities, and then we had a subject on the curriculum called Food Design and Technology which had more to do with processing, packaging and labelling than with real food. However, these days cooking has become part of the entertainment industry so, even if you did not learn at school, you can hardly fail to see cooking done on TV. How many cookery programmes are there, and what proportion of books and magazines are devoted to it? Cookery books have become bedtime reading, but I sometimes doubt how much of their contents land up on the plate. But I wonder what other leisure activity saves you money, improves your health and extends your life.

Famous chefs may not thank me for saying this but I think cooking is not difficult. Certainly, following the many recipes you find in women's magazines and even newspapers is not too difficult. I cooked a soup from the weekend Guardian on Monday. I think the Sainsbury's Magazine in particular has done a fine job in showing that cooking can be easy, fun and accessible, and I would point out that you do not have to shop at Sainsbury's to read it. These magazines, if the recipes for family meals were followed, would certainly save a great deal more than their cover price for the family budget. In these times of recession, many magazines have concentrated on economical cuts of meat and other cheaper but nourishing ingredients. I think that it is more a matter of confidence than ability when people say they cannot cook. So how do we get over that?

We must certainly teach children to cook in school. How are the Government getting on with their pledge that every child will learn to cook? I heard an excellent programme on Radio 4 last week about school food. It talked about one particular school where the 11 and 12 year-olds were actually helping in the school kitchen to cook school lunches and food for the breakfast club. The health and safety issues had been overcome and the idea was being rolled out across the county. The cook was running after-school cookery clubs for parents, showing them how to make some of the dishes that were most popular with the children. There is now, I am pleased to say, a lot of this sort of innovation in schools. School dinner ladies and gentlemen have vastly improved their skills, and facilities have improved enormously under the Building Schools for the Future programme.

It is five years since Jamie Oliver, inspired by a particular dinner lady who has now taken a national role, called attention to the state of our children's school food, and enormous strides have been made since then. I pay tribute to him and the school caterers, the School Food Trust and the many schools that have put their minds to improving their food and attracting more children to choose it over packed meals. Mind you, there is nothing at all wrong in principle with a packed meal as long as it is healthy and balanced, though I would much rather have a hot one in this weather.

The advantages of children taking school meals are many. Apart from the new criteria on quality, balance and nutritional content, which are difficult to achieve in a packed lunch, they learn to socialise when eating, which is what they will do for the rest of their lives. They learn table manners and about green issues, such as food miles and GM, and about the food culture of other cultures, and, in the best schools, they are encouraged to be adventurous and try a little of something they do not get at home. There are lots of good reasons for making school food attractive to children so that they will choose it.

Some schools encourage children to bring in recipes that their parents cook at home. Some that have the space have started a school garden where the children grow fruit and vegetables and then cook and eat them. I heard about one school that displayed its very first lettuce from the school garden with such pride on the counter at lunchtime that I am not sure if anyone ate it. I understand that pride. My husband often laughs when I come in from the garden proudly laden with my own produce-he laughs and then he eats it. Unfortunately, many schools do not have the open space to enable them to grow food. Does the Minister know of any scheme whereby other land such as a free allotment might be made available for a school that wanted it?

Of course, many of us these days are so busy that we rush our food. There is a great danger of that in schools as well, since there is a limited time for lunch and hundreds of children to get through the system. It presents a great logistical problem. However, I am very concerned about one particular solution to this: the biometric solution whereby children are fingerprinted and pass through the till by putting their finger on a screen that then deducts the cost from the balance their parents have put into their account. Some schools have done this without asking or even telling the parents, and I feel that it is an infringement of the child's privacy. I have every sympathy with the need for a quick cashless system but I feel that a personal bar code would be more acceptable. Of course a cashless system also has the advantage of lacking stigma for those children on free school meals, but there are other ways of doing that.

There are also lunchtime clubs to which children want to rush off so they hate queuing in the dining room, which is an enormous challenge for the caterers. This is one of the most frequent reasons given by secondary-age pupils for not having school meals. The trouble is that their solution is often not a packed lunch but whatever they happen to buy at the nearest supermarket or fast food outlet.

That is why education for the pupils themselves about the importance of a healthy diet is vital for preventing obesity. In the end it is the child who will choose his food, but I strongly support those head teachers who make it a school policy that children do not leave the premises at lunchtime, particularly because of the social problems that it often causes in the neighbourhood when hordes of teenagers descend on the local chip shop. I realise that I will not make myself popular with the managers of chip shops by saying this.

As long as the school meals offer is attractive, good value and of high quality, and there is an option of a packed lunch, I see no reason why such a policy should not be enforced. Therefore, it is important that as many children as possible take school meals, now that they are usually of good quality. Price, of course, is an issue for hard pressed families. I am sure that you can put together a filling packed lunch more cheaply than a school lunch, but it may not be as nourishing. Only this week, the School Food Trust has suggested that schools should offer discounts or special offers on lunches for a limited period to encourage children to try school meals, just like a January sale. The trust says that such a move would dramatically increase take-up of healthy school meals as demand for school food is more sensitive to price changes than other foods. Research by London Economics has estimated that a 10 per cent increase in the price of school meals can lead to a fall in take-up of between 7 and 10 per cent. The trust adds that areas where discounts have been offered have successfully boosted demand. A three-week period of discounts in 2009 in York and Waltham Forest increased take-up by 22 per cent and 10 per cent respectively according to an analysis of the relationship between school meal take-up and prices.

I accept that it can be very difficult for caterers to keep quality up and prices down. However, there have been interesting experiments whereby local councils have made school meals available free to all pupils, not just to those who qualify for them. This increased uptake terrifically and, I believe, improved school discipline and learning, but it is hard for a council to offer such a programme in these constrained days. However, the results showed that the outcomes were very beneficial to both behaviour and learning. Do the Government have any plans to do their own experiments along these lines in order to inform national policy?

I end by giving your Lordships an example of what can be done given the will to do it. I found this case study, and many more interesting ones, on the School Food Trust website. In 2004, six Liverpool primary schools identified the need to improve the quality and choice of their food, so they set up a not-for-profit consortium called Food for Thought, an apt name given that children's ability to learn has often been reliably shown to be affected by what they have for breakfast or lunch. They brought in lots of partners including the local authority and the local Sure Start programme and invested their delegated budgets in it. Within a year they were delivering meals in all six schools, replacing processed food with homemade dishes from fresh locally reared and sourced ingredients. Meal prices remained fixed and were cheaper than the meals at other schools provided by the city council. Menus run on a six-week cycle, subject to pupil preference and the seasonal availability of produce.

Staff rotate across the schools and share best practice. Children are encouraged to experiment and get a more varied diet than before. They have open days when parents can come in and try the food with the children, and they are pleasantly surprised. Local NHS staff deliver training and taster sessions for parents, teaching them about diet and nutrition. They also have small groups of children helping in the kitchen to prepare the food. The result was a 67 per cent increase in uptake in one school and big improvements in the others. Children enjoy their food and look forward to it. Their director, Mike Carden, says:

"The solution to healthy food is to develop a service that actually cooks its own meals. It is only by adding value to fresh vegetables, meat and fish in the kitchen that real costs and real quality can be managed effectively".

I quite agree with him, especially in these days when, for so many families, cost is a real issue. We are what we eat. It is only by cooking from basic ingredients that you can feed a family on a tight budget, so we owe it to our children to teach them how to do it and to make sure that our schools have the facilities to do that.

Photo of The Bishop of Bradford The Bishop of Bradford Bishop 2:34 pm, 7th January 2010

My Lords, I thank the noble Lord, Lord Pendry, for calling for this debate on childhood obesity. Your Lordships may think that I speak simply as an act of confession. My robes hide the fact that I suffer from central adiposity; in other words, I put on weight around my middle and therefore carry an increased risk of type 2 diabetes and cardiovascular disease, and when I look round the Chamber, I see that I am not the only one. Therefore, the topic for debate is close to home.

Obesity in this country has reached epidemic proportions and the trends in childhood obesity are so serious that we now expect life expectancy to be shortened by its knock-on effects. The cost to the economy is predicted to be £45 billion a year by 2050. The second reason why this debate comes close to home for me is that Bradford has a higher rate of obesity among children than the national average, and standards of healthy eating and physical exercise are among the lowest in the country. I suggest that in the battle against obesity we are focusing, so far at least in this debate, far too narrowly and that we are starting too late in a child's development. The message-I know that we want a message which is easy to understand-seems to be to children, and, yes, through their parents, to take more exercise, give up junk food and eat their five fruit and veg. It is an important message but it only goes so far. I asked my daughter, who is a paediatrician, what one thing she would like me to say in the debate. She said, "Educate the parents. Don't put blame on children for things they can't control. Get parents to think about what they want their children to be like as grown-ups".

The obesity epidemic has come about through a change of lifestyle: the availability of energy-dense foods; the plethora of fast-food outlets; use of microwaves; pre-prepared meals; decline in cooking skills; the fact that families do not eat together but graze on their own; and the decline in physical activity. These have been mentioned by previous speakers. Is it not ironic that there is so much sport and so many cookery programmes on television but we are so busy watching them that we do not exercise or eat properly? But these are lifestyle choices and they are adult choices, not children's choices. They are choices that adults make for their children.

Chronic stress leads to obesity as well. First, our bodies respond to stress by depositing fat around the middle rather than on the hips and thighs. Secondly, we turn more and more to comfort foods. Three years ago the Sun newspaper had a feature on child obesity. One child gained 15 stone in five years after his parents divorced. The stress is caused by the parents. In poor countries obesity is a disease of the rich but in the developed world it is a disease of the poor, as the noble Lord, Lord Pendry, noted. Wilkinson and Pickett, in their book, The Spirit Level, argue that this is more about relative wealth and poverty than actual wealth and poverty. They compare the Netherlands, a comparatively equal society where 7.6 per cent of children aged 13 to 15 are overweight, with the United States, the most unequal of rich countries, which has 25.1 per cent overweight. They also note that when the Berlin Wall came down and inequality increased dramatically in what had formerly been East Germany, there is evidence that the social disruption led to an increase in the body mass index of children as well as adults, although this could, of course, have been due to stress as well as to the greater disparity between wealth and poverty.

Poverty itself restricts choice. Some poor people do not simply have access to the nutritional foods recommended in the Sainsbury's recipes in the same way that most of us do. I could take you to a large council estate in Bradford where there is no greengrocer. There is nowhere for the people to buy their five fruit and veg which we would not be without. The local vicar saw the problem so he went to the wholesale market every week early in the morning, bought the fruit and veg and sold it in the church hall to everybody who came to the various clubs and so on. This enterprise has grown to such an extent that the wholesaler now delivers to the church. The point I am trying to make is that overcoming obesity is not purely a matter of individual exercise and diet. It is about the way we shape our society institutionally and corporately. I would add that educational programmes are too narrow and suggest that they start too late in a child's development.

My third and main local reason for choosing to speak in this debate is to commend to this House a wonderful piece of epidemiological research known as Born in Bradford. Fourteen thousand mothers are being recruited during antenatal care and 80 per cent are responding. Fifty per cent of these are of south Asian origin. Their family history is recorded and their child's growth and development monitored. As your Lordships will know, obesity leading to type 2 diabetes and CVD is particularly prevalent among south Asians in Britain. The aim of the programme-or at least the part of it relevant to our debate-as laid out in a grant application made in 2007 is as follows: to strengthen public health systems for monitoring excess weight gain in infants; to deliver new protocols and supporting tools to enable the identification of children who are at risk of obesity; to improve our understanding of the aetiology of childhood obesity in multi-ethnic populations; and to test new family-based solutions to prevent obesity in these populations. Twenty per cent of the 14,000 children in the project are monitored in detail.

A few months ago I had a preview of some of the early results of the project. Unfortunately for us they have not yet been published but they prompted me to wish to speak in this debate. Professor John Wright, the co-ordinator of the project, has allowed me to say that they have identified levels of obesity starting off in the first year of life common to white British and Asian babies. Yet the advice given by NICE on obesity in 2006 does not look at the evidence base for children under the age of two and, as far as I know, there is no advice available to health visitors in relation to obesity management for under-twos, in particular those in south Asian families where in-laws are an especially important influence on babies' diets. There is also the need to explore further what has for some time been known as the Varca hypothesis that those who are underweight at birth are more prone to cardiovascular disease later in life.

The noble Baroness, Lady Thornton, kindly gave me samples of booklets from the Change4Lifeproject. I am grateful to her. They are a valuable and attractive contribution to the battle against obesity. I suggest that materials such as CDs be prepared for those who are not comfortable with the written word and in some other languages besides English and I particularly urge that there be greater focus on the impact on childhood obesity of infants' experience in the womb and in the first year of life.

Photo of Lord Giddens Lord Giddens Labour 2:44 pm, 7th January 2010

My Lords, I begin by congratulating my noble friend Lord Pendry on initiating this debate. I commend him for all the excellent work that he does to support sport and physical well-being in this country.

The subject of this debate is much more interesting, consequential, and intellectually and practically challenging than might appear at first sight. Obesity among young people and adults is not just a problem for the UK but is a genuinely global issue. The WHO's international obesity task force estimates that in 2007 some 1.4 billion people in the world were obese or overweight using standard measures. This number includes a rapidly accelerating proportion of children and young people under 21. The scale is truly extraordinary. In Europe there are few countries reporting obesity rates below 10 per cent and in several European countries these rates are above 20 per cent, including the UK and countries as diverse as Germany and Finland. In fact, the most rapid increase of all is in this country, where rates rose threefold between 1980 and 2001. In the United States, famously, obesity affects one in three adults and reaches rates of 50 per cent among some groups. This touches on what the right reverend Prelate said because these groups especially include poor black American women. In Latin America, obesity rates are rising in many countries; they are more than 20 per cent in Paraguay, for example, and have reached 36 per cent of women in that country.

Similar figures pertain to Asia, where Japan is an interesting case. Japan was easily the longest-lived society in the world, largely as a result of the Japanese diet, but rates of obesity are climbing very steeply and have now reached more than 20 per cent among adults. They are climbing especially strongly among young people and the rates among those aged 15 to 21 are the same as for the adult population-20 per cent. It is a quite extraordinary secular change.

Some people say that with a phenomenon such as obesity we can apply the post-modern argument that you cannot judge; that there are many different kinds of people's bodies and we should not sit in judgment over what size they might be. That argument is demonstrably wrong for reasons which have been alluded to by my noble friend Lord Pendry. There are deep connections between obesity-and, indeed, being overweight by the standard measure-and dramatic health consequences, the most important one of which is type 2 diabetes. In the United States it has been noted that 45 per cent of children with newly-diagnosed diabetes have type 2 diabetes and almost all of them are radically overweight or obese at the time of diagnosis. Looking at the United States healthcare system, some people argue that it could be overwhelmed by the prevalence of type 2 diabetes some 15 or so years down the line simply because of the implications of this. As my noble friend said, these problems converge with a range of other harmful effects.

A phenomenon this profound and on this scale is not going to be dealt with by homilies such as we should take more exercise, eat less or eat more healthily; it will not be dealt with by public health programmes. I support what the Government are doing, what my noble friend said and the importance of education and health programmes, especially those aimed at young children, but a phenomenon which is this deep-rooted and global will not respond significantly to such endeavours and we will have to look elsewhere if we are seriously going to confront it.

I hope your Lordships will forgive a slight digression. A few years ago I wrote a book on anorexia, the rise of which in modern societies correlates more or less directly with the expansion of supermarket culture. Once you have supermarkets there are no longer local diets; you cannot follow a local diet. Everyone has to decide what to eat in relation to how to look and how to be. At this point there is a tremendous acceleration in compulsive or addictive eating patterns, not only here but across the world. It occurs mostly in the affluent parts of the poorer world as well as in the developed world. Anorexia is obviously the opposite of obesity but the two often go in tandem. For example, you will sometimes find young girls who will starve almost to the point of death and six months later they are really fat; you get an alternation between the two.

The scale of this phenomenon and its expansion shows that we are dealing with addiction or compulsiveness. When you have strong addictive or compulsive elements it is difficult to alter them. We will have to be much more radical and structural if we are to get to terms with the impact on our society to which obesity and being radically overweight, and eating disorders in general, should be closely linked.

There is an interesting overlap between the issue of obesity and being overweight and the more general debate around the issue of well-being. The two matters are closely connected and have common policy implications. I disagree with the right reverend Prelate because, to me, obesity across the world is by and large a phenomenon of affluence. It is certainly heavily class biased-it tends to be concentrated among poorer groups-but it is mainly in those countries which are becoming richer where obesity takes off in a radical way. We are, by and large, dealing with the phenomenon of affluence, even though it is heavily related to inequality for well known reasons.

If your Lordships take the point that obesity often has a strong component of addictiveness or compulsiveness about it, let me offer three observations on a more radical and structural approach to the issue. First, certainly in the UK and in many other countries too, alcohol consumption is significantly related to obesity. It is also strongly addictive, not only physiologically but socially and morally. When we consider the issue of obesity, we should take on board what the Chief Medical Officer is saying about alcohol because the two are intimately related. Quite apart from whatever you eat, if you consume enough alcohol it makes you fairly robust; it follows the similar fast food addictive pattern of behaviour. The Chief Medical Officer says- and I agree, although it was very controversial when it was announced recently-that we should radically curb children's access to alcohol, eliminate the availability of cheap alcohol and regulate the siting of alcohol in shops and supermarkets.

Those are the kinds of interventions that I feel we need, not just because of the direct overlap with obesity, but because of the obvious relationship between commercial sales, obesity and being overweight. In a supermarket, where do they put the sweets-they put them where you leave the shop, knowing that is where you make impulse buys. That is also the case in other kinds of shop. I am not going to mention the name of the shop, because I am speaking in the House of Lords, but you go out of the House of Lords, you get into the Tube station and there is a well known paper shop there. You buy a paper and they offer you an enormous chunk of chocolate, reduced in price by 60 per cent. That is ridiculous. You need some kind of structural regulation of the sale of certain kinds of food goods, and you need to break the pattern that is initiated by an organised consumer culture. That is essential both for alcohol and for food related to obesity and being overweight.

Secondly, by all means do what my noble friend Lord Pendry is suggesting, which I strongly support, and encourage young children and young adults to take more exercise. We hope that the coming of the Olympics to this country will have some positive impact on that. Indeed, my noble friend mentioned the progress that has been made. But again, we are talking about massive social changes here, which underlie the phenomenon of obesity. This is essentially the transformation from an industrial, agrarian society, which happens with affluence, to a service-based society, a post-industrial society. A life of physical labour sustained the health of a large number of working people-although it sometimes also broke their health in coalmines. Now only 10 per cent of the population are involved in physical labour, and mostly it is not of the old kind.

A post-industrial society is a car-based society. It has been mentioned that not many children cycle to school. Well, hardly any parents walk their children to school anymore; they drive them. So you are talking about a whole form of social organisation that underlines these patterns. A significant interventionist aspect of coping with obesity is actually intervention in urban design. That is the only way we are going to resolve these issues in a satisfactory way.

I shall refer to one or two of the countries that were alluded to by previous speakers. Denmark has low rates of obesity, not just because of eating patterns, but because in Denmark you have a lot of cycle paths and quite rationally organised cities in which there is encouragement to use public transport and to walk to work. These sorts of things are structurally implicated in the phenomenon of obesity and therefore we have to intervene on this kind of level and have a convergence of policy.

Thirdly, we should consider a more stringent and targeted use of the fiscal system, where it seems to me-strange though it might appear-that there is a kind of analogy with the politics of climate change. In fiscal systems, for obesity or being overweight, we should apply the "polluter pays" principle. For example, in New York State, a 15 per cent tax is being proposed for all sugar-based soft drinks. We should consider such tax-based interventions here, unpopular though they are with the food industry. We should recognise that producing structural change will meet resistance from vested interests in that industry, but it is in the interest of the Government to try to secure as much co-operation from it as possible.

At the moment, the situation is very like climate change, because you have an industry that is deeply implicated in promoting a certain kind of diet, linked to a certain kind of sedentary lifestyle, where that industry does not pick up the social consequences of what it is producing. This is directly analogous to organisations that are producing greenhouse gases. They are not picking up the cost to the environment of those gases. We should apply the "polluter pays" principle to them.

My concluding thought is that we had an interesting report from the Government yesterday on food security. We do have to plan ahead for food and I hope that the programme on food security will be extended to include the issue that has been the subject of this debate.

Photo of Lord Rosser Lord Rosser Labour 2:59 pm, 7th January 2010

My Lords, I, too, thank my noble friend Lord Pendry for enabling us to have this debate. As my noble friend said, one of the ways of addressing obesity among young people is through the development and expansion of sporting activity. I recently participated in Parliamentary Sports Fellowship Scheme, which provided me with an opportunity to spend some time with Sport England and see the kind of projects and schemes in different parts of the country that it supports financially, and develops with other organisations and bodies in order to increase involvement and participation in sport.

Among the many benefits which the evidence shows that increased participation in sport and physical activity delivers is a reduction in the specific risk factors that contribute to poor health, one of which is obesity. Sport England is investing nearly £880 million in sport in the run-up to the Olympics to create a top-class community sport system, to benefit people of all ages by getting 1 million to take part in more sport. To achieve that will involve reducing the numbers of children and young people who drop out of sport when they leave school, as well as developing those with talent to fulfil their potential. We need a sporting structure that enables more people to stay and enjoy being involved in sport-whether as players, coaches or volunteers-throughout their life. In terms of the Olympics and Paralympics, it means ensuring that as many of the venues as possible are designed and developed for community use once the Games have finished.

According to the Active People Survey results, 635,000 more people of all ages are doing more sport since the Olympic bid was won. As only one example of how this is being achieved, I mention that over 100,000 young people have completed Paddlepower Start, a Canoe England initiative aimed at getting more young people into canoeing.

In autumn 2008, Sport England also launched a £36 million Sport Unlimited programme to give 900,000 young people aged 11 to 19 access to 10-week high-quality courses in an array of sports out of school. The young people concerned are asked what sports they want to do, and the 10-week taster sessions are then laid on in the sports that people are interested in doing. Results to date show that 177,000 young people have completed courses since the launch of the scheme, and the three-year programme aims to get 300,000 of the participants to go on to play regular sport in a club.

One of the big challenges for Sport England is tackling the drop-off in sports participation when people leave school. Links have to be further developed between clubs and schools, as young people who join a sports club are far more likely to continue playing sport when they leave school. In 2008-09 School Club Links enabled 1.5 million to take part in sport at accredited clubs, which was an increase of 130,000 on the previous year. On average, schools had links with seven different clubs in 2007-08 compared to five in 2003-04, and 32 per cent of pupils participated in club sport in 2007-08 compared to 19 per cent in 2003-04. Nine sports have signed up to reduce the number of children dropping out of sport when they reach 16: badminton, basketball, football, gymnastics, hockey, netball, rugby league, rugby union and tennis.

Sport England also invests in StreetGames, to which my noble friend Lord Pendry referred, a national charity with a proven track record in overcoming barriers to participation in disadvantaged areas by delivering what is called doorstep sport, which uses tailored, neighbourhood-based sporting initiatives delivered at a time, location and in a style that meets the needs of local people. Figures show that StreetGames should have met its target to achieve its 1 millionth attendance by the end of 2009, having only officially launched in 2007.

StreetGames has committed to working with at least six national governing bodies of sport, and will be increasing that to 14 bodies, which will involve connecting doorstep sport to mainstream clubs, leagues and talent development structures, as well as help in recruiting and deploying volunteers within disadvantaged areas. Since its launch in 2007, StreetGames has recruited and trained over 5,500 coaches, community sports leaders and volunteers and has successfully engaged groups of young people who are often hard to reach; 87 per cent of participants are from disadvantaged communities and 31 per cent are from black or ethnic-minority backgrounds.

Sport England also runs leadership and volunteering programmes for young people to promote and organise sport, particularly among their age-group peers, and then works with local clubs, schools and the community to create the broader opportunities that allow such young people to create a formal and valued contribution to sport.

Of course, addressing obesity is not just a question of seeking to increase participation in sport and physical activity. It also involves issues of diet, lifestyle and the activities and objectives of the major food and drink manufacturers and retailers. However, investment in sport can have an impact on obesity as well as having many other benefits. I have never ceased to be impressed by the energy, enthusiasm and commitment of the thousands of volunteers who give up so much of their free time and play such a significant role in helping to provide and develop sporting opportunities and facilities for people of all ages, including young people. I also see this through my involvement as an honorary vice-president of the Ryman Isthmian football league, where so many of the 66 constituent clubs also run teams for young people from the age of eight, thanks to the involvement of committed volunteers.

There is now an increasing clamour for swingeing cuts in public expenditure. The resources and support that a body such as Sport England provides enables all those thousands of volunteers, as well as the paid professionals, to provide the opportunities for young people to participate in increasing numbers in more sports and physical activity. That provides a benefit in a variety of ways, including addressing obesity, not only to the young people themselves but to the community as a whole through the financial and social advantages of having a healthier and happier population.

I hope that in the months and years ahead, common sense and sound financial sense will prevail and we will continue to see the necessary resources provided to enable the good work that has already been done on increasing and developing sporting and physical activity, particularly among young people, to continue and thrive.

Photo of Lord Moynihan Lord Moynihan Conservative 3:07 pm, 7th January 2010

My Lords, I am grateful for this opportunity to contribute to this debate by speaking in the gap. I participated in a debate earlier in the week, but it was somewhat curtailed by the weather and I was unable to pay tribute to the noble Lord, Lord Pendry. His contribution to young people and, above all, to sport and recreation, through a long and distinguished political career is, without doubt, outstanding, as was his contribution to the debate this afternoon. His assessment of the subject of obesity characteristically focused with equal weight on diet and medical treatment on the one hand, and on activity levels through sport and recreation on the other. As he knows, I firmly believe that an Olympics sports legacy from London 2012 must reach far wider than the confines of the Olympic park and the satellite venues. I declare an interest as chairman of the British Olympic Association, a director of the organising committee for the Games and a member of the International Olympic Committee's international relations committee.

I shall confine my brief comments to London. To tackle obesity in London, we must transform the landscape for Londoners by improving access to improved sport and recreational faculties at an affordable cost. As a starting point, what is required is for government to introduce a much needed statutory requirement to ensure adequate provision of facilities for sport and recreation in England and Wales. In Scotland, where such legislation exists, the per capita funding for sport is £46; in England, where local authorities are under no such obligation and are struggling to meet their statutory requirements, it is no surprise that the per capita spend is £19. Working with Kate Hoey and her London Community Sports Board, of which I declare membership, we are seeking to make a small difference by delivering a genuine grass-roots legacy for sport in London. The facts provided by the Government's Active People Survey make disturbing reading for Londoners. Only one-fifth of Londoners regularly take part in sport and while the most recent results, published last month, show a slight increase on the previous year, participation in sport still remains significantly lower than it was on the day that London was awarded the 2012 Games. We have, I believe, only one 50-metre swimming pool in operation. Almost half of London's adult population does no activity at all. Participation rates for disabled people are less than 10 per cent. One in six Londoners is obese. On current trends and without a major increase in facilities, 50 per cent of Londoners are predicted to be obese by 2050.

More seriously, in many respects, one of five London children is obese, and one in three is in the category of obese or overweight, which is significantly higher than in England as a whole. In short, we need action. We need to build a London-wide programme to deliver on the four goals identified by the mayor in his 2008 plan for increasing participation. They are: get more people active; transform the sporting infrastructure; build capacity and skills; and maximise the benefits of sport to our society by recognising its immense value as a tool for tackling crime and promoting community cohesion, as well as improving health and contributing towards tackling obesity. These are key objectives in the challenge to deliver a true Olympic sports legacy for the country.

Photo of Lord Addington Lord Addington Spokesperson for Defence, Spokesperson for Culture, Media and Sport , Deputy Chief Whip 3:11 pm, 7th January 2010

My Lords, this is one of those debates when we have a lot of old friends and a lot of themes that occur again which we have to look at. The noble Lord, Lord Pendry, displays that great political quality of persistence on this. We have to keep coming back to the subject and monitoring what the Government do, how we look at it and how we develop our approach to problems such as obesity and the relative factors of sporting activity and diet.

I was cursing the right reverend Prelate the Bishop of Bradford at one point during his speech because he got to the joke that I wanted to make about the fact that we seem to have produced a nation that sits on a sofa watching TV, predominantly sport and cookery programmes. We are told consistently by various chefs, whether they are selling books or trying to do a public service, or some combination of the two, that we should understand what we eat and that, if you are going to eat meat, it is probably better that it is healthy meat, both for the taste and for the sake of the animal before it becomes a lump of protein on your plate, and so on. They go on about this, but you are watching it sitting at home with a bag of crisps in front of you, the crust of a take-away pizza with far too much cheap cheese on it and several cans of lager that were sold at a discount in a supermarket.

It is not a very good image, but then again, as somebody pointed out to me, historically did we ever have that great a diet? No, we did not. The British were renowned for the fact that, if we did not boil it, we fried it; to us, vegetables were exotic things that had to be boiled into submission before they could be eaten, just in case they misbehaved in some way.

As the noble Lord, Lord Giddens, pointed out, we used to break a sweat when we went out to work; we actually worked and used our bodies much more. Even in getting to work and back we would invariably use muscle power. The whole process is out of whack. We are an animal that has developed a body based on muscle designed to move and do certain types of functions. If you do too much of it you will break the body down eventually, but it is designed to move and be active. We have got to a point where many people in our society are not doing this.

Many people have enjoyed and do enjoy types of physical activity. Sport is a natural expression of this, as are recreational activities. There is a bizarre dividing line between exercise and sport; it does not really exist, but we try to put it in. I would say that going jogging is not sport, because you are not competing with somebody, yet on many government statistics it is. It does not matter. We are talking about certain types of recreational physical activity.

I was one of the few people to be told that they had lost a few pounds over Christmas, because I now have a much fitter dog and I live out in the countryside with hills. That leads to my other point. If you happen to live in a part of the countryside where you can walk, you will take exercise because it is a pleasant activity. If you live somewhere that does not have well marked footpaths or you do not have the opportunity or a pleasant environment to do this, you will not. Of course, many people in extreme green politics would tell us to go back to a world where we live in unheated houses. Being cold and trying to keep yourself warm burns off calories; possibly we will all be a pound or two lighter at the end of the current spell of weather. Unless we can make a society where this type of taking exercise is encouraged as a pleasant leisure activity, it is not going to happen. The temptation to sit on the sofa and watch a professional athlete or a professional chef doing something is always there. We have all done it. If you have not, you are very unusual.

We should also remember that eating can be seen as a leisure activity, which we have all delved into. There has to be some reason to encourage us to go out. Saying that it is good for you may make you join a gym or buy a diet plan, but it does not make you use the gym or the plan. That is the fact of the matter. Many people in the fitness industry used to make a great deal of money out of people who joined a gym and did not use it. Of course, they now realise that there was a huge greater potential in putting people on prescription activity, but I welcome their self-interest, which is possibly the nation's self-interest here. Perhaps the Government would like to comment on how much they intend to encourage the use of gyms, predominantly in down periods, for treatment. I would be very interested.

How are we going to encourage people to exercise? The noble Lords, Lord Rosser and Lord Pendry, touched on this. We have done a lot of work for the self-interest of sports to keep people coming through, trying to make sports more enjoyable, especially in the initial phases. I have bored the house silly about Rugby Union's transition from a 15-a-side game, played at the age of 13 when the wingers froze to death and there were three people round the ball hugging on to it all the time and everybody else pretended to tackle and got out of the way, to a game that encourages minis and juniors. I thought that that was the case until I discovered my nephew at a state school announcing that he would rather be a soccer player and being told that he should play for the honour of his school-it was an honour to be there, not something for him. Despite the fact that I think that soccer is probably a second-best option, which should be considered only in a dire emergency-it helps to have your prejudice on the table occasionally-I still felt on that occasion that the school was very wrong, because it should be encouraging people to take part in a sport that they enjoy.

That leads to my other point, which is where clubs are better. Clubs will make sure that you do not drop the activity at the first available opportunity. We have to work on this. How are the Government going to encourage it? What is their ongoing process? The Government have done a lot. The noble Lord, Lord Pendry, mentioned some of the projects, but the fact is that they still are not working well enough. A great deal of effort has gone in. In the debate on Tuesday, to which the noble Lord, Lord Moynihan, referred, I asked which of the schemes for initiating people into a sport and encouraging them to keep active works best. I was promised an answer. The Minister who gave me that promise is sitting beside the noble Baroness, Lady Thornton. Has the Department of Health made an assessment of the best return in its terms about this? What do we have to do to deliver? Is the best option to go through the junior clubs to get the mass participation levels up? Is it things such as infrastructure? Is it making sure that parks are available and that buses take you to somewhere to go for a walk, with or without a dog? What is being done? How are we encouraging people?

As my noble friend said, growing your own vegetables in allotments is popular. You are taking exercise if you do some gardening. How are the Government taking on and structuring the task of making activity pleasant? They have to do it that way. Unless we forget about 150 years of technology, most of our lives are not going to be ones of heavy manual labour. For many, there will not be even the labour of walking somewhere or riding a horse. We must to try to find a way to show that taking the right amount of exercise to keep us healthy is a pleasant experience. The challenge for this Government and anyone who supports this aim is how to integrate it into society. The structures that are needed to take in the changes and the sticks and carrots that will have to be used on society are complex. There will be more than one answer. There will not be a right answer; there will be better answers. We know that nothing is absolutely for free.

I have raised sports medicine on numerous occasions in this House. Are we investing enough in sports medicine, physiotherapy and educating doctors about when to use sports medicine? I have a permanently misshapen left arm, because only a couple of years ago a consultant did not know that anything could be done about it. Apparently I am lucky that I still have function in the arm, as that might not have been the case. What are we doing about making sure that the medical profession knows about maintaining people in activity and making sure that they are not frightened, for instance, of being curtailed in work activity because of sporting activity? How is all this being integrated?

We have the advantage in this House that when we ask the Government questions we do not ask individual departments. I suggest that when the noble Baroness replies she tells us how to bring these matters together. The noble Lord, Lord Davies, has told us that the Treasury takes overarching control of sport, despite the fact that it has no way of delivering. It has to go through the departments responsible for health and education and through the DCMS, which does not have much of a chance of delivering. How does that come together? Unless we take sport and recreational activity more seriously and give them more thrust, the Government are bound to waste effort. Will the Government give at least some of the answers to this great, multifaceted question?

Photo of Earl Howe Earl Howe - Shadow Minister, Health 3:22 pm, 7th January 2010

My Lords, the noble Lord, Lord Pendry, deserves our thanks for giving us the opportunity to debate this extremely important public health issue, which we have not done for a considerable time. I thank him in particular for his very powerful opening speech.

Indeed, I am sure that the Minister will agree that we have had some excellent contributions this afternoon from around the House, pointing to a good measure of cross-party consensus on this subject. Although I do not intend to fracture that consensus too much, because there are many things which the Government are now doing right, I think it is worth beginning by putting today's situation into context. We are living at a time when nearly a quarter of all adults in this country, and nearly a fifth of children, are obese under the standard definition. Those percentages have practically doubled since 1993.

The real wake-up call, if any were needed, came with the Foresight report of two years ago, which predicted that, without corrective action, Britain could be a "mainly obese society" by 2050. Pro rata, the UK now has more obese people than any other OECD country except Mexico, the USA and, perhaps surprisingly, New Zealand. The penalty to be paid for this in the long term will be measured, certainly, in premature mortality; but its effects will chiefly be felt in terms of increased morbidity, which will carry with it a high knock-on cost to the general economy. The noble Lord, Lord Giddens, rightly mentioned diabetes.

The seriousness of the threat posed by obesity is nothing new. However, that is why it is all the more reprehensible that, until recently, Ministers have failed to place due emphasis on it. The Minister may not like to be reminded that the last Conservative Government put considerable emphasis on this area of policy. As early as 1992, we set a target of reducing obesity to 6 per cent of men and 8 per cent of women. In 1999, the Government scrapped that target and did not replace it. It took two scathing reports-from the Chief Medical Officer in May 2003 and the Health Committee in May 2004-to prod the Government into setting a new target in July 2004. That target was to halt the year-on-year rise in obesity among children under 11 by 2010. What happened to that? It was abandoned in the 2008 Comprehensive Spending Review, when it became obvious that it was not going to be met. Instead, Ministers published a new target to reduce the proportion of overweight and obese children to 2000 levels by 2020. That is an incredibly ambitious target, bearing in mind that thus far the Government have not even managed to stall, let alone start reversing, obesity levels.

For too long, the Government took their foot off the pedal when it came to the effort and resources devoted to the issue. The story is all of a piece with their general record on public health. In many major problem areas, such as deaths from alcohol and the incidence of sexually transmitted infections and teenage pregnancy, the trends have been and still are in the wrong direction. By their own admission, the Government are even on course to miss their target for infant mortality and life expectancy at birth. The difference between the life expectancy of the richest and poorest in our country is now greater than at any time since Queen Victoria. That is not the sort of legacy that any Government, let alone a Labour Government, would wish to leave behind.

Only in the last two years has the government effort to combat rising obesity levels begun to take shape. Change4Life, with its various offshoots such as Start4Life, is a well conceived and worthwhile programme. It explicitly acknowledges that success in tackling obesity depends not only on the state, but also on industry and, crucially, families and individuals taking action. In this respect, the problem of obesity is different from the public health challenges that we faced in the past. The issue cannot be solved by passing laws, as we did with water sanitation in the 19th century and air pollution in the 1950s, because obesity originates in private space and does not impinge directly on the freedom or well-being of others. Any sustainable solution to the problem must start from that realisation. Only by changing people's attitudes and motivation will we be able to make a difference over the long term.

What does it take to do that? Of course there is a role for government: regulation is important. The Government's job is to provide leadership and an environment in which consumer tastes can be influenced and healthy eating choices made. The obvious examples of creating such an environment are food and alcohol labelling, making sure that there are consistent and clear public messages on nutrition, and making physical activity more accessible to greater numbers of people. However, if the key to the problem is changing people's motivation and attitudes, the trick is to encourage them to take responsibility for their own lifestyles and health. You do not encourage a sense of responsibility by nannying people and lecturing them on the negative consequences of being overweight. Instead, you provide them with positive messages about the benefits and enjoyment to be had from healthy living. You provide them with information with which to make choices, and examples and role models to follow. This applies to children as much as adults. Young people most of all have to feel empowered rather than put upon. We have to tap into their self-esteem.

One mistake made by the Government was their failure to recognise that when they introduced healthier school menus. Healthy meals can deliver benefits, but they will not do so if there is no motivation on the part of the children and their families. The introduction of those menus led to an increase in the uptake of packed lunches stuffed with crisps and chocolates. What was the Government's response? To impose another regulation to inspect school lunchboxes. We ended up with mothers feeding their children burgers through school railings. Thankfully, the Healthy Schools programme has come some way since then, including, I am glad to say, the introduction of cookery classes. I quite agree with what the noble Baroness, Lady Walmsley, said about that.

In fact, many of the decisions that people take about what they eat and drink are not really decisions at all; they are actions driven by force of habit-even compulsiveness, as the noble Lord, Lord Giddens, said. A lot of people damage their health without understanding what they are doing or how to put things right. In that context, the Minister may be aware of some research published recently by Volterra, which accounted for the rising obesity over recent years by reference to the phenomenon of peer acceptance. Peer acceptance is about people continuing to follow modes of behaviour because other people within their social group are behaving in the same way. People feel less pressure to change their actions and habits if their friends are not also doing so. It becomes socially acceptable to be fat. Volterra does not claim that that is the only factor that accounts for the rise in obesity-far from it-but it is certainly one that ought not to be ignored in any study of the subject. That takes us into an interesting realm: the psychology of human behaviour and the way in which societal norms are created and maintained. Those are difficult subjects for policy-makers, but ones that must be grappled with.

I said that I am supportive of Change4Life, but if there is a difference between the Government's approach and that of my party, it relies in the split of responsibilities between the different stakeholders. My view is that regulation in areas such as food advertising has reached its limit of usefulness, apart from trying to put in place a consistent approach in all media channels such as the internet. On the other hand, the Government have taken too long to give a clear commitment on food labelling. The traffic light system may have the merit of simplicity, but its main flaw is that it characterises food as good or bad when what matters is whether a diet is good or bad. The EU Commission has said that we need to adopt a uniform system based on guideline daily amounts, combined with a colour indication system, and I agree. On interventionist measures, I also agree with what the noble Lord, Lord Giddens, said about urban design and the use of fiscal levers, particularly in relation to high-strength alcoholic drinks.

Looking at the wider agenda, the food industry is capable of taking on greater responsibility for promoting healthy living-not just in reformulating products, which it is already doing very successfully, but in initiating and sponsoring exercise and wellness programmes. Many large food manufacturers are doing great work along those lines in schools, in the workplace and in the community under the Business4Life banner. I have no doubt that we should encourage more businesses, including SMEs, to buy in to that sense of shared responsibility. We owe a debt to the Advertising Association and, not least, to its former chief executive, my noble friend Lady Buscombe, for having secured a commitment worth about £200 million from industry to resource those initiatives.

Recent reports have suggested that childhood obesity is levelling out. We need to treat those reports with caution, because some of them look only at averages. A team at University College, London, reported last month that obesity in children from wealthier backgrounds may indeed be improving, but that the problem is still getting worse-indeed, considerably worse-in children from lower socio-economic groups. Those are the people who should give us the greatest concern, and we should bear in mind, too, that hospital admissions of patients being treated for obesity have shot up over the last five years. Within normal value-for-money constraints, I believe we owe it to the Government to support them in any properly researched programme designed to combat obesity in the young. With an expanding buy-in from industry as well, it may at last be that we are on the right road to achieve results.

Photo of Baroness Thornton Baroness Thornton Government Whip, Baroness in Waiting (HM Household) (Whip) 3:35 pm, 7th January 2010

My Lords, I thank my noble friend for raising this important issue and congratulate him and other noble Lords on their usual informed and important contributions. It is of enormous regret that, due to the weather, the noble Baroness, Lady Finlay of Llandaff, has not been able to make what I know would have been an outstanding contribution to the debate. I understand that she will seek another opportunity in future and I very much look forward to that.

I welcome the opportunity to update noble Lords on the progress we have made in tackling obesity. First, however, like most other noble Lords, I shall refer to the scale of the problem we face. In 2007, as the noble Earl, Lord Howe, mentioned, the Foresight team published its report entitled Tackling Obesities: Future Choices. It predicted that if action was not taken, the levels of obesity would rise by 2050 to 60 per cent in men, 50 per cent in women and 25 per cent in children. It also forecast that the direct cost of obesity and overweight to the NHS would double by 2050 from the already massive current figure of £4.2 billion. My noble friend Lord Pendry quite rightly mentioned the obvious health effects, such as the increase in childhood diabetes.

Obesity is a complex and long-term phenomenon, and no sensible analyst would pretend that there is only one answer or there is an easy one. A number of factors drive people towards overweight and obesity. Foresight has described the "obesogenic environment": the physical and social environment in which we are often encouraged to expend the least amount of physical effort while consuming a large number of calories. Noble Lords have given various descriptions of that in this debate. Of course it is essential that we eat healthily and exercise appropriately, but, as noble Lords have also said, simple exhortations telling people to engage in more activity or to exercise greater self-control are not enough. Indeed, that can be counterproductive when talking to the young and children. My noble friend Lord Giddens is quite correct that the homilies are not working.

In January 2008 we published our obesity strategy Healthy Weight, Healthy Lives, which set out how we will help people to reach and maintain a healthy weight. Further commitments were made in April 2009 when we published our One Year On plans. Our aim is to be the first major nation to reverse the rising tide of obesity, with the initial focus on reducing the percentage of obese children to 2000 levels by 2020. Our strategy has four essential strands for action which commit us to helping people to make healthier choices, creating an environment that promotes healthy weight, ensuring effective services are available for those at risk and strengthening the delivery system of their services. Our strategy is based on expert input from Foresight and is internationally recognised.

I am pleased that we have made some progress in the past year on a number of fronts in addressing obesity among children and young people. However, my noble friends Lord Pendry and Lord Giddens rightly say that this is about changing culture and changing habits. Noble Lords may be aware that child obesity rates are beginning to level out, so I would say to the noble Earl, Lord Howe, that this reflects some progress. New data published in December from the Health Survey for England for 2008 show that child obesity levels are the lowest since 2001. Among two to 10 year-olds, the reported figure for 2008 is 13.9 per cent compared with 15.5 per cent in 2007 and 2006. These figures are supported by data from the National Child Measurement Programme 2008-09. However, obesity levels are still too high, especially for teenagers and adults, and we certainly cannot be complacent. What we can say is that we have taken a tiny step towards progress.

We have been helping children and their families to make healthier choices, and many noble Lords have referred to the importance of recognising that parents remain the biggest influence on their children. There is a significant correlation between obesity in parents and their children. In families where both parents are overweight or obese, a child is six times more likely to be overweight or obese than a child in a family where the parents are both of a healthy weight. Nurture, not nature, is the main reason for this. What children eat and drink and how much physical activity they get is largely determined by the choices that their parents make for them. Therefore, last year we launched Change4Life, a highly innovative campaign which aims to help families to,

"eat well, move more and live longer'.

The campaign, aimed primarily at families with children aged five to 11, seeks to motivate individuals and families to make behaviour changes around diet and activity. More than 412,000 families have registered with the campaign and receive information and advice tailored to their needs on healthy eating and physical activity. At the national level, we already have the support of over 170 companies and organisations that are Change4Life partners and who promote Change4Life to the people who use their services. Noble Lords mentioned the importance of working with industry at all sorts of levels, and indeed that is exactly what we have aimed to do with the Change4Life campaign.

I hope that the right reverend Prelate the Bishop of Bradford will be pleased to learn that on 1 January we launched Start4Life, a sister campaign to Change4Life. Start4Life is aimed at parents-to-be and parents of babies and children up to the age of two to encourage them to get their babies off to the best start in life through breastfeeding, effective weaning and active play. If we are to head off the obesity epidemic of the future, we need to begin with the parents and children of today. My native city of Bradford is clearly a target for this campaign. I was keen to learn what the right reverend Prelate had to say and I join him in expressing my concern for our city.

My noble friend rightly mentioned the work of the Sports Trust and other organisations with these campaigns and initiatives. I join with other noble Lords in paying tribute to all organisations, particularly in the third sector, which are active in this area. I mention in particular the sports and leisure trusts across the country which have fully embraced Change4Life in its various manifestations such as Swim4Life.

We have been trying to create an environment that promotes healthy weight. The Healthy Child Programme covers the first five years of life. This universal health visitor-led programme has a clear focus on promoting healthy weight, with more targeted support for those who need it most. In September, we issued comprehensive new guidance for the review that takes place when a child reaches the age of two. At the same time, we launched the new Healthy Child Programme for children and young people aged five to 19. Led by nurses working with families, schools and young people themselves, and in partnership with other providers, this means that we have for the first time a comprehensive programme to promote the health of all children and young people. The noble Baroness, Lady Walmsley, made a superb case for good food and cooking, and we would all agree with her that cooking is in fact easy. Indeed, I join her in paying tribute to Jamie Oliver as one of our celebrity cooks who makes the case that cooking is easy and something that everybody can do.

For children at school we have extended the statutory nutritional standards for the types of food that can be served in schools, and we have restricted choice to healthy options in maintained secondary schools and special schools so that all state schools are now covered. The regulations also ban high salt, fat and sugar foods from vending machines in schools. We are supporting schools with funding for new and refurbished kitchens and to train cooks to prepare healthier menus. We provided £220 million-worth of funding over three years from 2005-06 to help schools and local authorities manage the transition to the new standards, and a further £240 million over the following three years to 2010-11 to subsidise ingredients and other costs directly related to the cost of providing a school lunch. In all we have invested £650 million between 2005-06 and 2010-11 to support school food. We believe that this investment is paying off. The noble Earl may be right that this had a slightly unsteady start, but we know that the proportion of children eating school lunches is rising again. The latest figures show that nearly 44 per cent of primary pupils and 36 per cent of secondary pupils are now eating healthier school meals.

The noble Baroness, Lady Walmsley, mentioned new initiatives and the importance of the School Food Trust which, of course, is financially supported by the Government. Cookery classes are compulsory in primary schools and have been reintroduced into the curriculum at key stage 3, so that pupils aged 11 to 14 can learn the basics of cooking simple, healthy meals.

My noble friend Lord Pendry is known for his work promoting sport and physical education in schools, and he will be aware that nine out of 10 pupils aged 5 to 16 now take part in two hours of high quality PE and sport in the curriculum each week, but we need to go further. Our PE and sport strategy for young people sets out our ambition that this age group should be able to take part in five hours of sport per week. The noble Lord, Lord Moynihan, knows that we want to use the enthusiasm and interest that will be generated in the run-up to the Olympics in 2012. We are putting more professional coaches in schools, upgrading school sports facilities and providing more attractive sporting opportunities for the community, but I welcome the noble Lord's remarks and hope that he will agree that we are making some progress. I congratulate him on the work of the London School Board.

For 16 to 18 year-olds in education, schools and colleges will be expected to work in partnership with clubs and community groups to ensure that at least three hours of appropriate activity are available. For young people not in education, training or employment, community providers and local authorities should work together to provide access to affordable opportunities to take part in sport. In the eight years to 2012, we will have invested £2.4 billion in PE and sport for children and young people.

My noble friend Lord Rosser outlined the achievements of and challenges faced by Sport England; he is quite right that we have a huge problem of young people dropping out of sport in their teens, particularly girls. We should not think of physical activity only in terms of PE and sport, as the noble Baroness, Lady Walmsley, said. We are encouraging children and young people to be physically active in their everyday lives through travel, play and leisure. The Chief Medical Officer recommends that children and young people should undertake a minimum of 60 minutes of moderately intensive physical activity each day. We are reviewing these guidelines and consulting on new recommendations for infants, toddlers and pre-school children, with the aim of producing guidelines to help them. We also think that travelling to school is very important, and have invested £140 million in travelling-to-school projects which encourage schools to have travel plans to get children walking, using public transport or cycling to school.

Children and young people have a life outside school. In the Children's Plan we announced a new agenda for supporting play, with the biggest ever investment in play by the Government. We have put in £225 million over three years, and an additional £10 million was pledged in April 2008, underlining the importance of play and why it should be taken seriously by every council in the country. We have consulted on our play strategy, which sets out a commitment to deliver 3,500 new or refurbished play spaces, and 30 new staffed adventure playgrounds, so that there is one in every neighbourhood in the country.

I have already mentioned the work that we are doing to improve the quality of food in schools. We agree with the noble Baroness, Lady Walmsley, about the need to increase the number of children taking school lunches. We are also promoting healthier food choices in a number of other ways.

The noble Earl referred to advertising. Working with Ofcom, we have placed restrictions on the broadcast advertising to children of foods high in fat, salt and sugar. Ofcom has reported a 34 per cent reduction between 2005 and 2007 in children's exposure to adverts on television for foods that are high in fat, sugar and salt. We will conduct a further review of the impact of these restrictions during 2010. We have committed to look at developing a set of voluntary principles to underpin all marketing communications about food to children, and we will be working with stakeholders on this over the coming months.

Front-of-package nutrition labelling is now widespread in the UK. The noble Earl asked how that would be taken forward. I agree with him that the FSA will need to resolve this issue; indeed, the intention is that that should happen in the course of this year.

Much of our focus is on preventing problems arising in the first place. We are also working to meet the needs of those at most risk of becoming obese, including those who are already overweight. We know that weight management services can play an important role in helping overweight or obese children to move towards and maintain a healthier weight. This is very important; nothing makes a young woman more miserable than being seen as and called "plump" during her teenage years. As well as the physical impact of these issues, we should not underestimate their impact on young people's mental health. In this financial year we are therefore providing PCTs with funding of £69 million within overall allocations that are about commissioning more weight management services.

I turn to specific issues raised by noble Lords. The noble Baroness, Lady Walmsley, raised the issue of cookery classes. As I said, they are already compulsory in primary schools and will be compulsory in secondary schools from 2011. The Cook4Life pilot programme aims to train Sure Start children's centre staff to run cookery activities for families with children, and the aim of the pilot is to develop skills, inspire and give confidence to parents with young children to cook healthy and nutritious food. That is an example of the kind of programmes that we are taking up.

The noble Baroness also raised the issue of the take-up of free school meals. We know that the take-up is increasing but we have commissioned the Child Poverty Action Group to report on the stigma of free school meals. It found that not all parents are aware of their entitlement and others do not know how the system at their school works, so we are also aiming to tackle it from the point of view of the amount of information that is available to parents as well as how the school handles those issues.

The noble Baroness raised the issue of biometric systems and barcodes for cashless food payment. I took her point about that, but she will know that these arrangements are made locally.

The right reverend Prelate raised several issues. I want to refer particularly to the Born in Bradford research that is going on, which I think is going to be very important and informative. I hope that he will take the opportunity of his presence in your Lordships' House to bring that information to us at a time when he is allowed to do so. He made an important point about the lack of money and the availability of healthy food in poorer communities.

The right reverend Prelate asked about NICE guidance for the under-twos. The evidence base for obesity in that age group is still quite small and not conclusive, but obesity in children may well begin in habits picked up from birth. We are therefore giving guidance to health visitors about what happens at the review at two years old. I suspect that the research from Bradford is going to assist us with this issue.

The Change4Life material is on DVD. Leaflets and information in languages for the black and ethnic minority community are expected to be available from February this year.

My habits from being a student at the LSE die very hard, and I nearly took up my pen and started making notes while my noble friend Lord Giddens was speaking. His analysis was spot on. I very much take the point about anorexia and obesity going hand in hand and about the issues of addiction and compulsion. We hope that some of the work that we are doing will address these problems. I think that he recognised that. I totally took his point about alcohol.

My noble friend Lord Rosser made a very important contribution about the work that he has been doing through the Parliamentary Sports Fellowship Scheme. It is one of those activities that I have always intended to do but never quite managed due to time constraints.

The noble Lord, Lord Addington, never bores the House silly on these issues. He is part of the expertise available in this House on these matters. Many of our programmes are working. I say to the noble Lord that it is not a choice of parks, clubs, change for life or allotments; we have to work across government. It is the responsibility of the whole of government, but also of all of us, to take these issues forward.

Photo of Lord Addington Lord Addington Spokesperson for Defence, Spokesperson for Culture, Media and Sport , Deputy Chief Whip

What I am really calling for is a government analysis of the best way forward in the various fields of physical activity because I am absolutely sure that a lot of such activity is wasted or is not as good as it could be.

Photo of Baroness Thornton Baroness Thornton Government Whip, Baroness in Waiting (HM Household) (Whip)

I take the noble Lord's point about the need to monitor and assess these activities to see which is the most effective. That is built into these programmes. We will be monitoring and assessing them. That is why they are often changed.

The noble Earl, Lord Howe, made an interesting comment about the targets for obesity being set by a Conservative Government. I wish to make two comments on that. It was a Conservative Government who put us in the terrible position in which we found ourselves as regards school meals. It was also a Conservative Government who allowed the sale of playing fields and did not even bother to record the number of playing fields that were sold, thereby reducing the availability of playing facilities. We have steadily reduced that. The first thing we did in 1998 was to start to count the number of playing fields that were being sold.

Photo of Lord Moynihan Lord Moynihan Conservative

I am grateful to the noble Baroness for giving way, but how would the Government know the number of school playing fields that had been sold given that she has just said that no statistics were kept to identify whether new playing fields were being added or sold?

Photo of Baroness Thornton Baroness Thornton Government Whip, Baroness in Waiting (HM Household) (Whip)

The point I am making is that if you are not even counting the number of playing fields that are being sold, that suggests there is no commitment to ensuring that children have access to those playing fields. The first thing you need to do to stop the sale of playing fields is to find out how many of them you are selling and where.

However, I think that the noble Earl and I agree on most of these issues, particularly as regards food and alcohol labelling and people taking responsibility for themselves as well as the Government providing leadership on these issues.

As regards the 2004 target for halting the rise in child obesity, we wanted a more ambitious target which included overweight as well as obese children. We do not regulate school lunch boxes. Schools decide their policy on packed lunches and have their own rules.

No one should be in any doubt that this Government have made tackling obesity a top priority. I thank my noble friend Lord Pendry and all other noble Lords who have taken part in this debate. I hope that noble Lords will be assured that we are working across government to help today's children to have a healthy and happy future as the young people and adults of tomorrow.

Photo of Lord Pendry Lord Pendry Labour 3:58 pm, 7th January 2010

My Lords, I, too, thank everybody for participating in this debate. I am glad that my throat virus did not prevent me being here. I do not intend to reply to all the points that have been made. However, I thank those who covered points other than the ones I made about sport and physical recreation. Food was the first one that came up. We also heard about the problems of alcohol with youngsters.

There have been some very thoughtful contributions. I always enjoy the speeches made by the noble Lord, Lord Giddens. He referred to the problems of obesity in a more global way than I did and I learnt a great deal from what he said. I also enjoyed contributions from the noble Lord, Lord Rosser, and from the noble Lord, Lord Addington, who is always here in debates relating to sport and physical recreation. I agree with the right reverend prelate the Bishop of Bradford and his daughter that the importance of this should not be put on children alone, or even parents alone, but on the environments in which they are brought up. The highest percentage of obesity is in those run-down estates.

I would like to thank my old sparring partner, the noble Lord, Lord Moynihan, for his kind words. When I was shadow Minister for Sport in another place, I had to shadow five Ministers for Sport but he was by far the best. I have said that publicly before but I say it here in this House. However, I must correct him on his intervention in the Minister's speech. We do know that 3,000 playing fields were sold off. When I debated this with the then Prime Minister, John Major, he agreed. We must place on the record that the Prime Minister of the day agreed that those had been sold off. Let us not have that from the noble Lord again because it is not the first time I have heard him say it.

I thank the Minister for her thoughtful response to the debate and the noble Earl, Lord Howe, for his contribution. I beg leave to withdraw the Motion.

Motion withdrawn.