Obesity: Covid-19 — [Philip Davies in the Chair]

– in Westminster Hall at 9:30 am on 10th November 2020.

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Photo of Philip Davies Philip Davies Conservative, Shipley 9:30 am, 10th November 2020

I remind Members of the changes to normal practice to support the new call list system and ensure that social distancing can be respected. Before they use them, Members should sanitise their microphones using the cleaning materials provided, and they should respect the one-way system around the room.

Members may speak only from the horseshoe and if they are on the call list. Even if debates are under-subscribed, Members cannot join the debate if they are not on the call list. They are not expected to remain for the winding-up speeches, but I would not discourage anyone from doing so.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 9:31 am, 10th November 2020

I beg to move,

That this House
has considered obesity and the covid-19 outbreak.

This issue has come to my attention so many times over the past few months—I am highly aware of it. I applied for this debate in March, but because of the covid-19 restrictions I was able only to introduce a petition. I am glad to have reached this pinnacle of opportunity to speak on the matter.

I thank colleagues who supported my application for the debate and the Backbench Business Committee, which kindly found time for us to discuss this important issue. I also thank Members for attending the debate and for emailing me to register their interest in speaking in it. I look forward to hearing from the shadow spokespersons of the SNP and Labour party, and especially from our Minister, who is always courteous to everyone, with the answers we hope to hear from her on this topic of great importance.

For the first time in many a month this nation can smile, following the news this morning that it is hoped a vaccine will be available. I do not want to pre-empt the final trials, but for once the nation smiles with hope that better days lie ahead, which must good news for us all.

Obesity is one of the country’s greatest health challenges. The UK has, unfortunately, the highest obesity rates in western Europe, and they are rising faster than those of any other developed nation. We cannot ignore that, which is why we are debating it today and why the Minister is here to respond. We are a majority-overweight nation, with more than six in 10 UK adults being overweight or living with obesity. That has a significant effect on the nation’s health, on the NHS and on the quality of life of each and every one of us living with the condition.

Obesity increases the risk of developing conditions such as type 2 diabetes, and I declare an interest as a type 2 diabetic. I was once a 17 stone, overweight person.

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

I was having Chinese takeaway five nights a week with two bottles of Coke. It was not the way to live life, but I had a very sweet tooth.

Until about a year before I realised I was a diabetic I did not know the symptoms. My vision was a wee bit blurred and I was drinking lots of liquids—two signs that should tell you right away that something is not right. I took a drastic decision to reduce weight and lost some 4 stone, which I have managed to keep off.

We need to look at our diet and our lifestyle. We all live under stress, and we all need a bit of stress because it keeps us sharp, but there is a point where we draw the line. I recall the day I went to the doctor and he told me, “We are going to put you on a wee blood pressure tablet.” I said: “If that is what you think, doctor, I will do what you say.” He added: “When you start it, you have to keep at it. You cannot take a blood pressure tablet today and then not take it next week, because your system will go askew.”

Obesity leads to high blood pressure and some types of cancer and is strongly associated with mental health and wellbeing, which is so important in the current crisis. There are strong links between the prevalence of obesity and social and economic deprivation. People living with obesity face extraordinary levels of stigma and abuse. We need to be careful and to be cognisant of other people’s circumstances, because they might have a genetic imbalance, which I will speak about later.

The outbreak of covid-19 makes the obesity epidemic more urgent. It is deeply concerning that obesity is a risk factor for hospitalisation, admission to intensive care and death from covid-19. The facts are real. People with a body mass index of 35 to 40 are 40% more likely to die from covid-19 than those of a healthy weight. In people with a BMI of 40-plus, it rises to 90%. That places the UK population in a very vulnerable position.

In the latest report from the Intensive Care National Audit and Research Centre, which audits intensive care units in England, Wales and Northern Ireland, almost half—47%—of patients in critical care with covid-19 since 1 September had a BMI of 30 or more. In other words, they were classified as obese. Those figures show that almost half the people in critical care had a lifestyle that they needed to address. That figure compares with the 29% of the adult population in England who have a BMI of 30 or more. People with obesity are much more likely to be admitted to critical care with coronavirus.

We also know that covid-19 has a greater impact among black, Asian and minority ethnic communities. Currently, 74% of black adults are either overweight or living with obesity. That is the highest percentage of all ethnic groups. That is a fact—an observation—not a statement against any group, but we have to look to where the problems are and see how we can reach out to help, because we need to reach those groups.

It is encouraging to see the Government setting out the steps that they will take to support people to live healthier lives and reduce obesity. Those steps will make a positive contribution to the environment we live in and will encourage people to make healthier choices, helping to prevent obesity. I will also speak about other groups, because it is sometimes those in a certain financial group who do not have the ability to buy the correct foods and are driven by the moneys that they have available.

The Government now have to implement their proposals and fund them adequately. Then they need to measure their success and to review what more can be done. Three childhood obesity strategies have been published since 2016, and the proposals have not yet been fully implemented. One reason we are here today is to see how those proposals can be implemented, and we need a timescale. I know we are on the cusp of finding a vaccine, but we also need to address the issue of obesity in the nation as a whole. Perhaps covid-19 is an opportunity to address it. We cannot afford a delay. It has to be an urgent priority for the Government and the Minister if we are to protect people from severe illness from covid-19.

Furthermore, we need to address the structural drivers of obesity. Inequality is a key element, as I mentioned a little earlier. Obesity prevalence in children is strongly linked to socioeconomic deprivation. Families with lower incomes are more likely to buy cheaper and unhealthier food because what drives them—let us be honest—is what is on offer this week and what budget is available to buy the food that is on the shelf. We do not always check the labels. Is it high in calories, sugar and salt? Those are things that we probably should check, but we do not, because the driver is money.

A report by the Food Foundation in 2018 found that the poorest 10% of households need to spend 74% of their income on food to meet its Eatwell guide costs. That is impossible for people on low incomes. When the Minister sums up, perhaps she will give us her thoughts on how we can address that issue directly.

I welcome the Prime Minister’s commitment to the support for schoolchildren and school meals. It is good news; it is good to know that the four nations in this great United Kingdom of Great Britain and Northern Ireland are united in taking action on that issue. Scotland is doing it, Northern Ireland is doing it, Wales is doing it and now England is doing it. That is good news, because by reaching out and offering those school meals we will help to address some of the issues of deprivation and how the mums and dads spend the money for food in the shop. This is a way of doing that. We all know that school meals have a balance as well, so it is really important over the coming school breaks and other times that children have the opportunity to have them. In Northern Ireland, the Education Minister set aside £1.3 million to help to provide school meals over the coming period.

The Government need to work more closely with the food and drink industry as well, to make the healthy option the easiest option. However, while we need to support healthier choices and behaviours, there is no point in seeking to make individuals’ behaviours healthier if the environment in which they live is not suited to healthy behaviour. It is okay to say these things, but how do we make them happen? We need to look further at the social factors that lead to obesity, and we need to address them to make them more conducive to healthy living. To give just two examples, eating more fruit and vegetables and walking, which gives the opportunity to be out and about, are among the things that we need to look at.

There is a long-term process, which involves planning, housing, the workplace, the food supply, communities and even the culture of life in the places that we live in. It is about the groups of people we live with and the people we have everyday contact with. Earlier, I mentioned genetics, which is also an important factor in causing obesity. Again, it is a fact of life that there are people who may carry extra weight because of their genetics. Indeed, it is suggested that between 40% and 70% of variance in body weight is due to genetic factors, with many different genes contributing to obesity. Again, I am sure the Government have done some research on that issue, working with the bodies that would have an interest and even an involvement in it. It might be helpful to hear how those people who have a genetic imbalance, for want of a better description, can address it.

Without going into the motivations and challenges faced by people living with obesity, and particularly those living with severe obesity, it is clear that it is not always easy for them to lose weight. Let us be honest: it is not easy to lose weight. Some people say, “Well, what do you do? Do you stop eating? Do you cut back on your eating?” But if someone enjoys their food—I enjoy my food, although in smaller quantities, I have to say—and overeats, we have to address that issue as well.

We want to encourage people to improve their wellbeing and mental health and to have the willpower. There are a lot of factors that need to be part of that process. I was therefore pleased that the Government strategy sets out plans to work with the NHS to expand weight management services. Again, perhaps the Minister will give us some idea of what those services will be.

Support for people to manage their weight can range from diet and exercise advice to specialist multidisciplinary support, including on psychological and mental health aspects, and bariatric surgery. We have the National Institute for Health and Care Excellence guidance on these treatment options, which sets out who should be eligible for them, yet they are not universally commissioned, which means that many patients cannot access support even if they want to. Given the urgent need for people to reduce weight to protect themselves against covid-19, we need to make these services more accessible by increasing their availability and the information provided about them to patients and the public.

Over the years, I have had occasion to help constituents who probably had a genetic imbalance and were severely overweight. The only way forward for those people—men and women—was to have bariatric surgery. On every occasion that I am aware of involving one of my constituents, bariatric surgery was successful. It helped them to achieve the weight loss that they needed and it reduced their appetite. That made sure that their future was going to be a healthy one.

We have strict acceptance criteria in the NHS for obesity treatment that are not found with other conditions. If a person has a BMI of 50, they must follow diet and exercise advice and receive a multidisciplinary specialist report. These services are otherwise known as tier 2 and tier 3 services. We are almost sick of hearing of tiers 1, 2 and 3, but they are a fact of life for obese people before they are even eligible for surgery.

If a patient does not complete those courses, they must start again, which can make some people lose motivation. The lower levels of support are absolutely necessary and effective for the appropriate patients, but it would be better to remove the loopholes and duplications. That would allow more people to achieve the appropriate support, even before additional resource is provided.

Currently, the United Kingdom performs 5,000 bariatric surgeries every year, which represents just 0.2% of eligible patients. If more people had the opportunity to have that bariatric surgery, they would probably take it. Can the Minister indicate what intention there is to increase the opportunities for surgery? We lag behind our European counterparts when it comes to surgery for obesity, despite it showing benefits in terms of cost, safety and the ability to reverse type 2 diabetes.

Many reports in the papers in the last few months have indicated how people can reverse their type 2 diabetes and the implications of that. Talking as a type 2 diabetic, I am ever mindful that if people do those things and reduce their weight, it helps, but it may not always be the method whereby type 2 diabetes can be reversed. When I lost that weight, I found that my sugar level was starting to rise again after four years, and I moved on to tablets and medication, which controls it now. Ultimately, the control will be insulin, if the level continues to go the wrong way.

The British Obesity and Metabolic Surgery Society has recommended that the number of surgeries should increase incrementally to 20,000 a year—a massive increase from 5,000, but we believe it will heal some of the physical issues for the nation. This is a small proportion of the total number of people with obesity, but they would also benefit the most. This debate is not about highlighting the issues, but about solutions. I always believe that we should look at solutions and try to be the “glass half-full” person rather than the “glass half-empty” person, because we have to be positive in our approach.

For people who require nutritional, exercise or psychological advice, face-to-face services were closed during the first wave of the pandemic. I understand the reasons for that. While digital and remote services can provide help to vulnerable people during lockdown, these new ways of working cannot reach everyone. How do we reach out to all the people who need help? That is vital as the country moves through future stages of the pandemic. We hope we have turned the corner, but time will tell in relation to the trialling for the new vaccine. Obesity continues to be a priority, and services should remain available.

Lastly, in future, obesity services should not be cut as part of difficult funding decisions. I understand very well the conditions in the country and the responsibility that falls on the shoulders of the Health Ministers not just here in Westminster, but in Scotland, Wales and Northern Ireland. It is vital that the inequity in access to these services is corrected to ensure that people can access support, no matter where they are in the country. What discussions has the Minister had with the regional Administrations—with the Northern Ireland Assembly and particularly with the Minister, Robin Swann, and with our colleagues in Scotland and Wales? If we have a joint strategy, it will be an advantage for everyone. I would like to see the person in Belfast having the same opportunities as the person in Cardiff, Edinburgh, London and across the whole of this great nation.

I have three asks of the Minister, along with all the other questions I have asked throughout my speech—I apologise for that. Can she reassure us of the continued political prioritisation of the prevention and treatment of obesity? I call on the Government to implement, evaluate and build on strategies to reduce obesity. Can the Minister tell us how have discussions on that been undertaken with the regional Administrations across the UK? I also call on the Government to work with local NHS organisations and local authorities to ensure that services are available to our constituents who wish to manage their weight.

In summary, given the range of secondary conditions caused by obesity—this also applies to covid-19—would it not be more prudent to address their underlying cause before they occur? I always think that prevention, early diagnosis and early steps to engage are without doubt the best way forward, and it would be helpful for the nation as a whole if those things were in place. I believe that would help to reduce the impact of conditions such as type 2 diabetes, heart disease, kidney disease, high blood pressure, stroke, sleep apnoea, many types of cancer and more. The problem with covid-19 is that although our focus should rightly be on covid-19, we must not forget about all the other, normal—if that is the right word—health problems that people have, because dealing with those is very important for our nation to move forward.

The NHS currently faces huge demands, but reducing obesity now would significantly reduce demand on wider NHS services. It is a question of spending now to save later, if we are looking at the financial end of it. It is not always fair to look at the financial end, but we cannot ignore it, because there is not an infinite budget available to do the things we want to do; we have to work within what our pocket indicates. And we have to do that while also protecting people who are vulnerable to coronavirus.

I commend the Minister and our Government for their focus on obesity. I very much wish their new obesity strategy success. How it will work across the four nations is important, but we need to do more, in both the short and long term, to prevent and treat obesity, and we must do so with adequate funding, which is crucial to enable the operations, strategies, early detection and early diagnosis to be in place.

I hope that our future strategies to reduce obesity will continue to focus on how people can also be supported to live healthily. When it comes to these things, we have to be aware that it is not just one person who is living with the obesity; the family also live with it. Sometimes we forget about the impact on children, partners, wives, husbands and so on. Whenever someone sits down for a meal, is their meal the same as what the rest of the family are having? It would be better if they were all eating the same food, in terms of diet and content. I believe that if we can achieve that, we will find a way forward.

May I thank in advance all right hon. and hon. Members for taking the time to come to this Chamber and participate in the debate? Like me, they are deeply concerned about how covid-19 is affecting those with obesity issues. Today is an opportunity to address this issue, and I very much look forward to hearing other contributions; I am leaving plenty of time for everybody to speak.

Photo of Philip Davies Philip Davies Conservative, Shipley

It might be helpful if I say that I intend to get to the Front Benchers no later than 10.30 am. There are currently five Members on the Back Benches who want to speak, so if people could take seven minutes or so each, that would be helpful to give everyone a fair crack of the whip.

Photo of James Davies James Davies Conservative, Vale of Clwyd 9:52 am, 10th November 2020

It is a pleasure to follow Jim Shannon. I congratulate him on initiating today’s important debate and on his thoughtful introductory comments. It is great to see the cross-party representation here today on this matter.

As a vice-chair of the all-party parliamentary group on obesity and a practising GP, I am only too aware of the significant health and financial implications of obesity. In the course of this year, a realisation of the link between obesity, its comorbidities and poor covid-19 outcomes has sparked renewed interest in tackling Britain’s obesity crisis. It is the case that 19.8% of critically ill covid patients are morbidly obese; that is almost three times the national average, which stands at 2.9%. And for those who are overweight or obese, the likelihood of dying from this virus is 37% higher than average.

There are of course numerous international league tables that rank covid’s impact on countries, and many people have suggested that the UK’s unenviable position in those tables is due at least in part to the fact that the number of overweight or obese individuals in the UK stands as high as 67%. Of course, obesity is frequently an outcome of poor life chances, but it can also perpetuate them. The economic impact of obesity cripples some of our communities, and tackling it is therefore a matter of social justice. Obesity rates among the most deprived 10% of the population are more than twice that for the least deprived 10%, and the gap in prevalence of obesity between rich and poor is, tragically, still growing.

My constituency in many ways epitomises the national picture. I can travel from one area, a coastal pocket of deprivation and the poorest ward in Wales, where obesity and poor health go hand in hand with economic inactivity and high premature death rates, to another area, just several miles away, where the average body mass index is markedly lower and life expectancy and income levels are significantly higher. To me, that inequality within a single constituency is unacceptable. Not only is reducing obesity levels vital as we seek to minimise the impact of the pandemic; as an issue that I fear will become even more important in the aftermath, it should also be considered a critical element of the Prime Minister’s levelling up agenda.

The harsh truth is that obesity is strongly associated with a number of serious health conditions, including many leading causes of death. It is also associated with poorer mental health outcomes and reduced quality of life. Being overweight can exact a tough emotional toll, from bullying at school to the pain of lifelong judgmental attitudes and stigma.

The overall societal cost of obesity is estimated to be £27 billion a year, saddling the NHS with an annual bill of several billion. As a GP, any day’s work reinforces to me that we live in a society where the freedom to make the right choices is severely constrained for some. Supermarkets are packed with temptingly priced, high-fat, sugar and salt—HFSS—products. There are takeaways on every street corner, bountiful coffee shops serving syrup-laden flavoured drinks, and pubs and bars offering large, 200-plus calorie glasses of wine. We have a culture that normalises these things on a day-to-day basis. It is far too easy for all of us to consume more calories than our sedentary lifestyles can withstand.

While some may navigate this environment unscathed, making healthy choices has become increasingly difficult, even more so in poorer communities. Whether under enormous stresses and strains from other aspects of life or fighting to feed a family on a tight budget in limited time, the long-term health outcomes of what we eat and drink may not always be our top concern. The measures we need to implement are not about taking away choice, but about the Government helping to rebalance the playing field in favour of healthier options, for the benefit of all.

In July, the Government published a new strategy, “Tackling obesity: empowering adults and children to live healthier lives”. This committed the Government to introducing a new campaign to encourage all those who are overweight to take action with evidence-based tools and apps. We should not forget the huge impact of exercise and dietary advice; in my experience we often have a very poor understanding of what is healthy.

The strategy also committed the Government to expand weight management services via the NHS; to consult over improving the traffic light system on food labelling; to legislate to require large, and potentially smaller, restaurants, cafés, and takeaways to add calorie labelling to the food they sell; to consult over calorie labelling on alcohol; to legislate to end the promotion of HFSS foods through product placement, online and at the end of supermarket aisles; to get rid of “buy one get one free” offers relating to unhealthy foods; and finally to ban the advertising of these same products online and before 9 pm on television.

These proposed measures follow on from apparent success through reformulation and the soft drinks industry levy, which has reduced the levels of sugar consumed from soft drinks. I have been pleased to join many others in pushing for such measures in my time on the Health and Social Care Committee, particularly as part of the childhood obesity strategy. Obesity in children at reception age currently stands at 9.9%, reaching 21% in year 6. We know that children with obesity are more likely to develop complications and disability later in life at a younger age, and there is a continuously worsening picture year on year.

With this in mind, we need to consider going beyond the measures in the Government strategy. If we look at the world through the eyes of children, I feel we need to attempt to tackle issues such as the location and quantity of fast food outlets on a cross-governmental basis. I would be pleased to hear the Minister’s perspective on this and also when a timeline might emerge for implementing the remainder of the Government’s obesity strategy. Further, how will the Government ensure that support is available across the country and includes those with severe and complex obesity, for whom diet and exercise alone are not sufficient? How and when will weight management services and bariatric surgery become more accessible?

In the immediate future, how do the Government intend to ensure that those living with obesity will be among the first to receive the covid-19 vaccines that we have heard so much about in the last day or so? Looking to the longer term, how do they intend to ensure that tackling health inequalities through the levelling up agenda will proceed despite the huge financial impact of the pandemic?

To conclude, the Prime Minister’s obesity strategy announcement in June created welcome attention and dialogue, which have been continued through an all-party parliamentary group inquiry, today’s debate and, it is now likely, Government action. However, it is vital that we keep up the momentum, especially given that the covid-19 pandemic is still, sadly, very much with us.

Photo of Andrew Selous Andrew Selous The Second Church Estates Commissioner 10:00 am, 10th November 2020

I congratulate Jim Shannon on bringing this important debate before the House.

When the Prime Minister announced the improvements to the child obesity strategy a few weeks ago, he made the point that the UK is unfortunately an outlier, in that we are the most overweight nation in the whole of Europe, after Malta. Sometimes I think we do not quite realise how serious our national situation is or the implications it has for people’s lives. To me, this has always been a social justice issue, because it significantly adversely affects the poorest people up and down our country.

I was struck by some information in the House of Lords Select Committee on Food, Poverty, Health and the Environment report, “Hungry for change: fixing the failures in food”, which is a very good read, for any Members who want to take the issue further. It points out the reason we are the most overweight nation in Europe, after Malta. It is not difficult to see. On page 19 the report states:

“In the UK, more than half (50.7%) all total dietary energy from purchases came from highly processed foods”.

That compares with Italy, where the figure is only 13.4%, and Portugal, where it is only 10.2%. In other words, our diet is five times worse than that of the Portuguese. All the figures are going in the wrong direction. Despite all the strategies, it continues to get worse. The debate today needs to be a national wake-up call on this issue. Well done to all the Members who are here. I know the Minister gets it, and I know the Secretary of State gets it, but this is a combined national effort. It is not just up to the Government. It is up to food retailers, local authorities and schools—and, yes, it is up to us as families, parents and individuals to do the right thing. Everyone needs to pitch in and do the right thing.

Further into the report, on page 20, I found it completely shocking that 47% of primary schoolchildren’s dietary energy comes from products that are high in fat, sugar and salt. That is nearly half, and it just is not good enough. It does not have to be like that. There is healthy, nutritious food that will help our children to grow and develop as we all want them to. The figures show that a fifth—one in five—of children born today are on a trajectory to have type 2 diabetes by the time they are 65, with all the limiting implications that has for their lives and what they will be able to do, as the hon. Member for Strangford said.

At the really gruesome end of the statistics is the average number of diabetes-related amputations over the last three years, or from 2015-16 to 2017-18. The NHS undertook 9,155 amputations because of type 2 diabetes, with taxpayers’ money. Of those, 27%—more than a quarter—were major amputations, or above the ankle. People are losing their feet because of a lifetime of bad diet. It is a bit grim to spell it out this early on a Tuesday morning, but we cannot tiptoe around the issue. It really is that serious, and we need to do something about it. Yet a number of things are still going in the wrong direction.

I am a massive fan of the Food Foundation, which is run by our wonderful former colleague Laura Sandys CBE. Its “Broken Plate 2020” food report shows that 14% of local authorities in the last 18 months saw a more than 5% increase in the number of fast food takeaways. What were the directors of public health doing in those 14% of local authorities, where things were clearly going in the wrong direction? Indeed, fast food takeaways in the local authority areas with the highest number make up some 40% of all food outlets in those areas. We really can do better than that.

We need to hold the food industry to account, as the Obesity Health Alliance has said, to meet its targets to reduce sugar and overall calories from everyday food. Yes, there has been some progress in children’s breakfast cereals—so thank you for that; well done—but not nearly enough progress on a huge range of food.

I often quote the Dutch supermarket Marqt, which is a private business looking to make a profit, but its whole raison d’être is to sell healthy, nutritious food; it is not part of its philosophy to sell food that will be bad for its customers. If Marqt can do it, as a commercial business in the Netherlands, come on Sainsbury’s; come on Tesco; come on Asda; come on Morrisons: step up and show that you can do that too. Colour coding on front-of-pack labelling will be mandatory from next year. We can do more of that, which would make it easier for people to pick up the right, healthy things.

I find it surprising that the quality and outcomes framework for our GPs does not include a specific incentive for them to do anything about children being overweight or obese. That has to change. We pay our GPs to do lots of very good things. If this is a national priority—and I think everyone here thinks it should be—then for goodness’ sake let us align the financial incentives for GPs with what we are all trying to achieve and deal with this issue early on, in the right way.

Overall, if we want a strapline for what we are trying to do, we want healthy food to be the easiest option for people, and it also needs to be affordable. Amazingly, in Europe, healthier food is often cheaper than the less healthy food—this is according to the 2019 Food Foundation report. It does not have to be the case that unhealthy food is cheapest; in other parts of Europe, it is not the case. We could align the financial incentives to make it easy on people’s pockets, when money is tight, to put healthier things in their shopping baskets. We also need to stop the stigma in this area. Some of our press do not report this issue well, and that is not helpful. Further, we need to ensure enough bariatric surgery to help people who have become severely overweight or obese.

I have a few questions for the Minister. Can she give us an update on menu labelling? The Government say that they will use the powers in the Food Safety Act 1990 to lay the legislation before Parliament in 2020. There is not much of 2020 left, so can the Minister tell us when that will happen?

The consultation on the labelling of alcoholic drinks has not been published yet. When can we expect that? The consultation on promotions of products that are high in fat, sugar or salt has not been published yet. When can we expect that? The long awaited 9 pm watershed has not been published yet. When can we expect that? The “What Next?” proposals include eight additional policy proposals with limited information about who is responsible, so it would be good to have some more detail on that. I would like to see schools gripping this issue. They do a good job now in providing healthy and nutritious food, but they should have more of an emphasis on teaching children about the importance of healthy nutrition throughout their lives and about how to cook well, which is also extremely important.

All our healthcare professionals have a role. Every contact is supposed to matter, and this issue is supposed to be mentioned in every contact between a healthcare clinician and a patient. Dr Susan Jebb from Oxford has done lots of good work on how to do that well. We can copy the great work that has been done in Amsterdam to bring down child obesity in particular.

There are even little things that we can do. Dr Jebb said that when we fill up at the petrol station, we should sometimes pay at the pump because there is an array of temptation when we pay in the shop. It seems a trivial thing. Lots of us pay at the pump because of covid, so perhaps that will help a bit. There are lots of things that we can do. This strategy is very urgent, and I look forward to hearing from the Minister how we are going to take it forward.

Photo of Wera Hobhouse Wera Hobhouse Liberal Democrat Spokesperson (Justice), Liberal Democrat Shadow Leader of the House of Commons, Liberal Democrat Spokesperson (Women and Equalities) 10:10 am, 10th November 2020

It is a pleasure to take part in this debate with you in the Chair, Mr Davies, and I congratulate Jim Shannon on introducing this important issue. It is also a pleasure to follow the hon. Members for Vale of Clwyd (Dr Davies) and for South West Bedfordshire (Andrew Selous). The hon. Member for Vale of Clwyd is a GP and the vice-chair of the all-party parliamentary group on obesity, so he speaks with great authority on this subject.

I believe that we have to focus on the social inequalities that are at the very bottom of this issue. Let us tackle it from that perspective. Obesity is, of course, a major problem and can greatly increase a person’s risk of other health conditions. It is absolutely right that supporting people towards a healthier weight is a Government priority, and I fully support it. Any strategy aimed at tackling obesity must recognise that it is a complex condition with many underlying causes, including factors tied to socioeconomic issues. Managing weight is often not simply a matter of just eating less and exercising more. Unless that is recognised, this strategy will not be effective in the long term.

I want to say something about my experience as a councillor. Before I became a Member of Parliament, I was a councillor in one of our most deprived councils, and 10 years ago we tried to ensure that children learned how to eat healthily. If people cook their own food at least they know what is in it, so we tried to ensure that people knew how to cook. We then recognised, going even deeper into that, that a lot of families did not even have the means to cook. Some of the children had never seen water boil.

Those are the issues we face if we are talking about how to teach children early how to eat healthily, cook their own meals and know what is in their own food. Some families are at that level of deprivation: children have not learned to cook and have not seen their parents cook. That is how deeply we need to get into the issue. We need to understand that, without stigmatising families who live like that and without using language that shames people who are overweight. We must understand that, additionally, there are mental health problems and other deeper underlying problems that go with this issue. I urge the Minister to go deeply into that subject and recognise the social inequalities that lie at the bottom of it.

I want to talk about one particular aspect of the strategy that concerns me—calorie labelling in restaurants. There is limited evidence to suggest that that measure has a meaningful impact on tackling obesity. Worse still, it could be harmful for those at risk of living with or recovering from an eating disorder; that is, of course, at the other end of this problem. There is an epidemic of people suffering from eating disorders such as anorexia and bulimia and being underweight. Approximately 1.25 million people suffer from an eating disorder in the UK. It is also true that many people living with an eating disorder also live with obesity. Treatment, therefore, is not as simple as consuming fewer calories. The eating disorder charity Beat is one of many voices sharing concerns about that aspect of the obesity strategy, and I ask the Minister to look carefully into that concern. Calorie counting is well recognised as an unhealthy behaviour: one sufferer described it as an “all-consuming obsession” that “took over my life”. Learning to disregard calorie counts is a large part of recovery from an eating disorder. Having the freedom to go to a restaurant with friends or family—something that many of us take for granted—can be a very big step.

I highlight a quote from one of Beat’s volunteers:

“One of the greatest joys of recovery is being able to go to a restaurant for a meal with friends, and I enjoy going out now with my friends and family, but I really struggle to eat in public once I have noticed the calories. Once I have seen the number, I can’t stop my brain telling me I can only have the food with the lowest amount of calories.”

Research shows that individuals with anorexia or bulimia are more likely to order significantly fewer calories when that information is provided.

Eating disorders and obesity can in many ways be part of our somewhat strange relationship with food. People can go from obesity into bulimia—these things are connected—and it is important that we recognise that. I was extremely grateful to the mental health Minister for meeting me and representatives from Beat a few weeks ago. I appreciate the time she spent listening to our concerns about this element of the strategy, and I know she is committed to supporting those with an eating disorder. As chair of the all-party parliamentary group on eating disorders, I would welcome the opportunity to have another meeting with her and representatives of Beat to talk about that particular, very concerning aspect of the obesity strategy.

Yes, we absolutely need to recognise that obesity is a massive public health issue. We need to tackle it, and I welcome the fact that the Government have made it a priority. But it is important that we make sure that the strategy does not hit people with an eating disorder, such as anorexia or bulimia, in an adverse way.

Photo of Jo Gideon Jo Gideon Conservative, Stoke-on-Trent Central 10:17 am, 10th November 2020

It is a pleasure to serve under your chairmanship, Mr Davies, and I am grateful to Jim Shannon for having secured this incredibly important and timely debate. The contributions we have heard so far show how broad a subject this is, and how vital it is that we discuss it in full. As a member of the all-party parliamentary group on obesity and chair of the all-party parliamentary group on the national food strategy, I am very much aware that this issue should be top of our agenda as we come out of covid and look at public health. I join my hon. Friend Andrew Selous in congratulating the Food Foundation on the excellent work it has been doing on this issue.

The global pandemic has made us all aware of our vulnerability. It has forced us to question how our underlying health might impact our personal level of risk from the virus. Although current evidence does not show that excess weight increases a person’s chances of contracting covid-19, it does indicate that obese people are far more likely to become seriously ill and to need intensive care. Over the past 12 months, we have seen a dramatic shift in public attitudes towards measures for tackling obesity, as a result of many people seeing only too clearly the health consequences and risk factors of being overweight. Reducing the risk of serious illnesses and the raised risk of suffering badly with covid-19 is reason enough to prioritise tackling obesity; other reasons include the estimated cost of £6.1 billion to the NHS every year, and three times that cost to the economy through absences for sickness, as well as the increased risks associated with heart disease, type 2 diabetes and certain types of cancer.

Tackling obesity is central to our commitment to levelling up. Statistics tell us that excess weight is more likely among those living in deprived areas, those with disabilities, and those without qualifications. That means that areas such as Stoke-on-Trent Central, my own constituency, have higher than average levels of obesity. Levelling up is not just about the left-behind areas catching up with other parts of the country: it is about tackling the entrenched economic and social inequalities of our society—the social inequalities that hold people and communities back right across the country.

In my own constituency of Stoke-on-Trent Central, a number of socioeconomic inequalities are known to have direct links to higher rates of obesity and poor nutrition, which in turn can lead to malnutrition. A recent analysis conducted by the Health Foundation charity found that people living in post-industrial towns and cities across the midlands, the north-east and parts of Wales have unequal exposure to the potential causes of obesity. That means that, on average, residents living in areas such as Stoke-on-Trent live much closer to fast food and junk food outlets compared with the rest of the UK—on average, they have 114 fast food outlets per 100,000 people, compared with 77 per 100,000 in the south-east. That matters, because evidence shows that an individual’s ability to be active or eat healthily is strongly influenced by the circumstances in which they live.

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

The hon. Lady is focusing on the number of takeaways in those communities. They are there because people cannot cook for themselves. It is important that the Government look at how many families have the ability to cook for themselves. I recognise the temptation to order a takeaway, but it is the result of the problem of people not being able to cook.

Photo of Jo Gideon Jo Gideon Conservative, Stoke-on-Trent Central

I thank the hon. Lady and absolutely agree. There are other factors as well, including income, housing, access to green space and exposure to junk food advertising.

On the extra factors, I discussed the issues around exercise with Stephanie Moran, the executive principal of the Esprit Multi Academy Trust, and visited the Grove Academy in Hanley to see first hand the challenges of organising outdoor exercise in a covid-safe way. This Victorian-built junior school, which was built for 100 people in a busy, dense residential area, has no green space and an inadequate playground area for what are now up to 480 pupils to exercise daily. We must include the right to exercise as a vital element of tackling obesity as well as looking at nutrition, and ensure that schools such as Grove Academy have access to green space.

Recently, I spoke to consultants at the Royal Stoke University Hospital, who shared their concerns about the increasing number of children with type 2 diabetes whom they had to refer as a consequence of poor diets and unhealthy lifestyles.

The Government started to address the challenge of poor diet in 2018 with the soft drinks industry levy, which has led to a significant reduction in the sugar content of drinks. This July, I wholeheartedly welcomed the Government’s Better Health campaign, which looked to address some of the issues through measures such as a ban on the TV and online advertising of fatty foods before 9 pm, and an end to all “buy one get one free” deals on unhealthy foods.

However, successive Governments have adopted different approaches to tackling obesity and, until now, they have neglected to address the structural inequalities that are so strongly linked to levels of obesity. The national food strategy and the Government’s obesity strategy are intended to be long-term approaches with comprehensive and holistic solutions.

I was delighted with the announcement from the Department for Work and Pensions earlier this week. It confirmed that, as of April next year, the Government will increase the amount of financial support made available to pregnant women or those with children under the age of four, to help them buy fruit and vegetables. The recommendation is to increase the rate of the Healthy Start payments from £3.10 to £4.25—just one of the core recommendations in part 1 of the national food strategy. It is a decisive step in the right direction, and I look forward to working with the Government, through my chairmanship of the all-party parliamentary group on the national food strategy, to see future recommendations implemented as part of their strategy for tackling obesity and malnutrition in the UK.

I say this to the Minister: although obesity is perceived as a health issue, for the reasons we have discussed today, it very much also goes to the heart of levelling up, so I believe that the solution can only be found in a cross-departmental way.

As we slowly but surely emerge from this pandemic, it is important we do everything in our power to capitalise on the momentum and shifting public perception within our attitudes towards tackling adult and childhood obesity. By addressing the structural, economic and social inequalities that exist in parts of the UK and by implementing the long-term and holistic solutions that will emerge from a national food strategy, we will be in the unique position to turn the tide on obesity once and for all, and ensure that everyone has access to healthy food and opportunities to exercise in every community across our country.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee 10:25 am, 10th November 2020

It is a pleasure to serve under your chairmanship, Mr Davies, and I add my congratulations to Jim Shannon.

We have had an important and interesting debate. I would like to follow what my hon. Friend Jo Gideon said by stating that we need to look at the issue holistically. This is not just a health problem; it is also an education problem and a Department for Work and Pensions problem.

I was particularly struck by the comments of the hon. Member for Strangford: we cannot use fat shaming and stigma to force people to lose weight. Over the summer, we learned from the Prime Minister’s brave words about his own battle with covid, his own unwellness and how that had been exacerbated by his weight. It might be easy from Downing Street to recruit the services of a personal trainer, but that is not open to everybody; we have to find routes to enable individuals to empower themselves to take control of their own wellbeing—whether that be through exercise and diet, or through receiving the emotional and mental support they need.

We all know that weight is not just a physical issue—there is an inextricable link between food and the way people feel about themselves. It is critically important that the support services are there to dig into that and to find the best routes, because we all know it will be an individual journey for each and every person.

I have to admit that the Prime Minister inspired me throughout lockdown; I made sure my “covid stone” was in the right direction, but for many that was not the case. It has been demonstrated that people have put on weight, and as we go into another lockdown there is real anxiety about the impact on people’s wellbeing.

I keep banging on about wellbeing—people think that I have gone all airy-fairy and am about to break out the crystals and the twinkly music—but the reality is that mental, physical and emotional wellbeing are all linked. Just yesterday, I was at Focus Fitness in Southampton talking to the personal trainers, who are all operating over Zoom in a covid-secure way. They made the point that there has to be a wellbeing approach that reaches across all generations and socioeconomic groups, and that we must find routes to help the poorest in our society embrace these initiatives as well.

Many people have mentioned cooking. During half-term, I was at the community pantry based at Romsey Community School, where we were talking about the Connect4Summer courses that were run over the summer and the half-term courses. They bring families together and give them ingredients, recipes and those basic cooking skills, which are so important. What really struck me was that the pantry gives away fruit and veg—there is a free bag of fruit and veg that people can take. I asked, “Why are people not taking it unless it is free?” I was told that it was because people did not know how to cook with it.

The point is absolutely crucial. I was blessed, in that my mother taught me how to cook reasonably well, but I know that I am lazy and do not have the time to cook properly from scratch. Lockdown enabled me to hone some of my cooking skills, but we have to make sure that those who are time-pressured—who in some cases are working two or three jobs—also have the ability to pick up that bag of vegetables and know they can cook something nutritious, quick and, mostly importantly, tasty.

I turn to the comments from Wera Hobhouse. I have a lot of sympathy with what she said about calorie counting. Some of the major chains such as Costa Coffee and McDonald’s have been advertising calorific values for years, yet the trajectory has been in the wrong direction: we are still getting fatter. In many instances, the battle has already been lost the minute a person walks through the door. Regardless of what the indication of calories on a menu is, people are in the wrong place to be making healthy choices.

It is important that we make labelling really straightforward. There is less than two seconds between someone picking up something in a supermarket and putting it in their trolley. That is no time to be inspecting the calorific fat and salt levels, so traffic lights or whatever mechanism makes things quick and easy have to be the way forward. People also have to have the skills to cook the healthier choices.

We have seen a rush over the last few days: the national media have been talking about how to lose a stone before Christmas and how to drop a dress size. Yet again, this is appearance-based, with little understanding that the issue is about people’s long-term wellbeing. I recognise that in some instances diets do not work and people will engage in yo-yo dieting, but in other instances they do. We have to find a way to empower people to make the lifestyle choices to bring about sustainable long-term differences to their way of life.

I think I have covered everything that I wanted to in a very limited time, but I look forward to the Minister’s coming up with some practical solutions as to how we can make a real difference to the people in our constituencies who need the most help, the most encouragement and the most support.

Photo of Patricia Gibson Patricia Gibson Shadow SNP Spokesperson (Consumer Affairs) 10:29 am, 10th November 2020

I want to begin by thanking Jim Shannon for his comprehensive exposition of the issue, setting out the scale of the challenges in tackling obesity and how the Governments across the United Kingdom must do all they can to tackle obesity across the UK in a holistic way. I am glad to be able to participate in this debate on obesity and covid-19 because it is very important, as many have said. There is huge consensus across this Chamber today: we have a real public health challenge and we need to tackle it with all the influence and tools that we have.

The pervasiveness of obesity in our society coupled with the health and economic consequences and the additional associated risk between obesity and covid-19 shows that supporting adults and children to be a healthy weight is, must be and must continue to be a public health priority. The recent report from Public Health England provided evidence-based insights into the relationship between excess weight and covid-19. We have heard today that the higher a person’s body mass index, the more likely they are to test positive for covid-19, they are more likely they are to be admitted to intensive care and, potentially, more likely to die a covid-related death. We heard from Dr Davies that if someone is obese, they are 37% higher than average more likely to die of covid-19. Those facts persist when studies are adjusted for confounding factors such as age, gender, socioeconomic status, ethnicity and comorbidities.

Over the years, since 2015 when I was first elected, I have spoken in a number of debates on issues such as healthy eating, junk foods, healthy lifestyles and so on. One thing I always think is important, and it has been noted today, is that we must always try hard not to sound as if we are telling people off for the food they eat and stigmatising them for the food they give to their children. If we sound as if that is what we are doing, we will not get our message across, as Wera Hobhouse said. The message we want to get across is that we understand that obesity is one of the most complex and biggest public health challenges of our time. As Andrew Selous reminded us, the UK is the most obese country in Europe, with the exception of Malta.

I believe this is a matter that has to be treated with a bit of sensitivity. We know that it is easy to eat healthily the better off you are financially. By way of illustration, it costs £3 in Tesco for 250g of blueberries. Blueberries are very healthy; they are a superfood. However, in Iceland supermarket, we can buy 10 chicken burgers for £2, which are not so healthy. If someone is on a budget, as a parent, their priority is to feed their children and keep them safe from hunger if at all possible. No one has the right to tell those parents that their choices are bad. The fact is they are doing the best they can with the income they have. Using another example, in Tesco, four oranges cost £1.50, but a multipack of 10 packets of crisps cost 99p. Although we know the blueberries and oranges are the healthy choice and the burgers and the crisps are not, if someone is on a very limited income, healthy choices are not always on the menu, as others have pointed out.

It is clear that the key to tackling obesity is tackling poverty and inequality. We also know that the poorer people are, the poorer their health and lifestyle outcomes. I know that because I grew up in poverty. My parents both died in their early 50s: the same age that I am now. Their poverty and early deaths are not coincidental—not at all. It is the same story up and down our constituencies wherever poverty thrives and preys on our constituents.

Obesity does not just make people more prone to covid and its serious consequences, although it certainly does that. Obesity prevents people from living fulfilled and active lives. It is the second-biggest preventable cause of cancer and is linked to around 2,200 cases of cancer every year in Scotland. Living with extra weight or obesity is the most significant risk factor for developing type 2 diabetes and can result in increased risk of other conditions, including cardiovascular disease and hypertension.

The annual cost in Scotland of treating conditions associated with being overweight and obese is estimated to range from £363 million to £600 million. The total annual cost to the economy in Scotland of people being overweight and obese, including labour market costs such as lost productivity, is between £1 billion and £4.6 billion, and Jo Gideon set out the overall UK costs. Studies last year showed that 66% of adults in Scotland over the age of 16 were overweight, with 29% being obese. Men are more likely to be affected, but obesity rates are consistently higher in our most deprived communities. The hon. Member for Vale of Clwyd reminded us that tackling obesity must ultimately be about tackling social injustice—a sentiment that everyone in this Chamber can accept.

What covid has exposed with crystal clarity, if it were needed, and what it has exacerbated are the shocking health inequalities in our nation. I want to see a Scotland—a United Kingdom—in which people eat well, have a healthy weight and are physically active: who would not want that? The Scottish Government have committed to supporting a targeted approach to improving healthier eating for those on low incomes, expanding and improving access to weight management services for those with or at risk of type 2 diabetes, and extending access to weight management services to everyone living with obesity. They seek to build on and consolidate the positive physical activity behaviour changes that we have seen during covid-19, such as walking, cycling and a range of measures that I do not have time to go into.

I am keen to see the Minister today set out similar actions across the UK and how Scotland and the rest of the UK can learn from each other and share good practice in doing more to tackle obesity. Fundamentally and ultimately, however, the scourge of poverty is at the heart of tackling all inequalities. As in other ways, the covid crisis has thrown inequalities in our society into stark relief, and this debate has been worth while in underlining that.

When the covid crisis is behind us, as one day it will be—the sooner the better—I hope that across the UK we all, citizens and Governments alike, do not forget the lessons it has taught us about our society and the terrible and ongoing impact of poverty on our communities.

Photo of Alex Norris Alex Norris Shadow Minister (Health and Social Care) 10:37 am, 10th November 2020

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate Jim Shannon on introducing the debate and on the tone he set in doing so. The disparities between our nation and similar nations show that something different is going on in the UK, and that should, we hope, act as a call to action for all of us in seeking to do something about it.

The hon. Gentleman’s references to income and ethnicity equalities were important and well made. He was a little bashful in talking about the financial impact, but it is worth recalling that obesity is terrible for the individual and for the collective in its impact on our health service and economy. We have not only a moral but a vested interest in this.

Colleagues made excellent contributions. Dr Davies picked on the disparities in the impact of covid and outcomes for obese people, and in raising them the Prime Minister did a public service. The hon. Member for Strangford also mentioned social justice issues—a theme that Andrew Selous developed with characteristic force. We will all take away the statistic on processed food as it brought into sharp relief the difference between the UK and other countries. That should act as a wake-up call, and I hope this will be a kick-off for parliamentary debates on it.

I was glad that Wera Hobhouse referenced eating disorders. When we discuss obesity I prefer to refer to a range of healthy weight interventions. The obesity strategy might be better as a healthy weight strategy because it is only part of the picture. The hon. Lady made important points about how the different disorders are linked.

The phrase that I underlined from the speech of Jo Gideon was that the public mood has changed in recent months. It has, and we must take this opportunity, but a delicate balance must be struck. You, Mr Davies, have spoken publicly about the need not to moralise, and you and I have had that conversation in the context of gambling. People switch off if we wag our finger and say that they should be as virtuous as we are. We do not, however, do our people a service if we are blind to the challenges that our environments and our lifestyles are creating for us. We must find the balance between not wagging our fingers and being assertive enough to say when things are not working and are not right. The time when the public mood is changing is a good moment to do so.

I liked the emphasis that Caroline Nokes gave to wellbeing. I do not think that is too new age for us to latch on to. It would be a really good outcome of the covid settlement, as people have made this extraordinary national sacrifice, to have public services, an economy and a general environment that points towards wellbeing for all of us. We should all be interested in that.

In my community, in 1920, poverty manifested itself in malnutrition. We have all seen the pictures of rake-thin children. In 2020, it is the opposite. A third of our children leave school overweight or living with obesity. In the adult population, two thirds of us are above a healthy weight and half of those are living with obesity. That is a challenge of exceptional scale. It is a population-level public health challenge. That behoves us to act. We know that obesity is a risk factor for heart disease, type 2 diabetes, some cancers and covid-19, as hon. Members have said. This is a good moment to tackle a national crisis.

My party has had interest in this matter for some time. Members may recall that our former deputy leader, Tom Watson, who is no longer of this parish, took on this issue personally during the last Parliament. His journey was incredible and I know people have taken great interest in it. He is a great ambassador.

We are glad to see the obesity strategy. I am happy to say publicly, as I have said in the media, that we support the Government in their efforts. We want to see the strategy actually implemented, so we do not get bogged down in consultations for ever and things do not actually happen. Rather than pushing the Minister on the substance of the strategy, I will push her on making it happen. There are arguments to broaden it out to a healthy-weight strategy and bring in greater emphasis on mental health, but at the moment I will take what we have.

Yesterday, the Minister replied to my written parliamentary question on this issue. It is clear that there is no new money for this and it is within the public envelope. I will talk about public health cuts shortly. The reality is that there have been diminished resources for this over the past few years. The impact of covid-19 on public finances means that resources are likely to diminish further. We should question whether we are geared up to meet such a significant challenge.

One reason why it is expensive and hard to tackle obesity centres on the complexity of the issue. It is about not just food, but childhood experiences, education, income and mental health, as well as poverty, in which I have a direct interest as the representative of one of the poorest communities in the country. We know that in communities such as mine, children are twice as likely to be obese as children who live in better-off places. Those children are no different. It is not because our burgers are any bigger or our sugary drinks any more sugary in Nottingham. There is nothing in the waters. Those environmental factors in our community push children and young people towards obesity. It is fine and right to talk about personal choice, but we have to understand that there are structural, social and economic inequalities in our country that close down choices, limit opportunities and push very difficult life outcomes on to our young people.

This is a challenge for the Government. This Administration and previous Governments in the past decade have not taken a long view on this—an investment view, rather than a finances view. Short-term decision making will cause greater problems. Public health cuts are a shining example of that. The migration of public health to local authorities is a good thing and one of the few aspects of the Health and Social Care Act 2012 that is likely to remain much longer. However, cuts to local authorities have meant a diminution or repurposing of those services.

I know from three years of leading in Nottingham on our public health grant that once we have paid for drug and alcohol services and sexual health services, which are demand-led services, there is not a lot left for smoking cessation, which really works, or for early life-course interventions, which are spectacularly effective. Unhealthy weight barely gets a look in. Across the country, we have seen the complete loss of any supported cooking programmes or those sorts of things that pull down the myth that cooking and eating healthily is hard or time-consuming.

That is thing that frustrates me. If I could get one message across to my neighbours, it would be that with a little bit of planning, it could be cheaper for them to eat healthily and it could be better for them, too. We have lost that, because we have lost the support through the public health grant. Covid makes everything harder because all of our local authorities—I am talking about England specifically; I apologise to Scottish colleagues—are looking at their finances. The “don’t worry, we’ll meet all your covid expenses” promise will not be honoured—that is clear by now—so there will be in-year cuts, and they will come from the places that they came from in the past, because they cannot come from children’s or adult’s social care, but from things that are seen as discretionary That is bad for individuals and our communities, and it is dreadful for all of us collectively because it will create much greater expense further down the line.

I will reference briefly free school meals. When I wrote this speech at the weekend, events had not moved on. Again, that was a prime example of understanding the cost but not the value of something really significant. Research by the Nuffield Foundation found that the provision of free school meals leads to a fall in obesity rates. I have gone public on this: I have no more interest than you, Mr Davies, in moving to a point where the Government feed children routinely. However, we need to understand that it is partly a good thing. When we have children at school, it is good because we educate them, but we can do many other good things around health and exercise, and we should not miss those opportunities.

Before I finish I want to make a quick point about Public Health England. I still think it is a very odd thing—one of the oddest things that has happened in an exceptionally odd year—that during this pandemic the Secretary of State for Health and Social Care would want to abolish Public Health England. It is an important ring-holder body for our obesity efforts as a country. I understand the disease and infection control points, but the Secretary of State wants his organisation, so he will have it. To an extent, I will not contest that space but, for the remaining functions of Public Health England, which are vital whether it is around obesity, smoking or drugs and alcohol, I really hope the Minister will give us a sense of what the plan is. I have asked parliamentary questions, so I know the consultation is coming soon, but we do not have long if it is to be up and running by April. I hope we have a soft landing. I will commit publicly to making no political capital out of it. We will all be relieved and will move on and never mention it again. That would be in all of our interests.

The hon. Member for South West Bedfordshire said the real theme to take away from this is a combined national effort. I really like that. We can find a high level of political consensus on this really easily. As the hon. Member for Stoke-on-Trent Central said, there is a public interest. Industry is falling over itself at the moment to tell us about the good things that it is doing. That is great. We should welcome that and encourage it. If we come together, resource it properly and see the long-term benefits of it, we can make a significant difference. It will make the country much healthier, more robust in many ways, and we will all be better for it.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care 10:47 am, 10th November 2020

What a pleasure it is to serve under your chairmanship, Mr Davies. My first very pleasant duty is to thank Jim Shannon for securing this debate. It has been an hour and a half of people coming together. We know that we have a problem and we have tried to come up with solutions. As has come out from across the Chamber, we know it has taken us some time to get here, and we know that it will take more than one individual silver bullet to get to the place that we want to be. Although one is often pleased to be at the top of a list, being at the top of the list or second to Malta on the obesity statistics is nothing to be proud about. As many hon. Members have outlined, the concomitant of that results in links to poor outcomes from covid-19, whether it is the links to heart disease, diabetes, cancer or any one in a plethora of things. It is really about an individual’s ability to have a good quality of life for as long as possible, because we know that obesity affects it quite dramatically.

I thank all hon. Members for their considered and thoughtful contributions in what has become very much a theme of the moment. Much of the work that has been done—the House of Lords report and the national food strategy—has led to this debate and highlights much of the work that needs to be done. The obesity strategy is the pathway of the marathon that is needed to help change those behaviours, and to help drive us in a direction where we see results and—as my right hon. Friend Caroline Nokes said—see them for a long time, because we want this work to produce results.

We have known for decades that living with obesity reduces life expectancy and increases the chances of disease, as I have said. The life of the hon. Member for Strangford, from being 17 stone and consuming Coke and Chinese food, has obviously now been totally turned around. However, as he said—indeed, it is the one thing that I want everyone to keep in mind—losing weight is not easy. It can be depicted in a Sunday magazine as something that can be achieved in four weeks, but actually it is incredibly hard. It is really, really hard to sustain weight loss. Given the way that we talk about this issue, I was really grateful that Wera Hobhouse and others spoke about the tone in which we talk about it, because it is really important.

Over the past few months, evidence has consistently shown that people who contract covid-19 who are overweight are—as my hon. Friend Dr Davies spoke about, both from the perspective of a doctor and as vice-chair of the all-party parliamentary group on obesity—will have poorer outcomes. We know that those outcomes get substantially poorer with age and with weight. We know that the one thing we cannot do in life is change our age, but we can modify our weight. Weight is the one modifiable factor that we have.

We have also heard from many hon. Members that the problem is more prevalent in black, Asian and minority ethnic populations and in those living in deprived areas, which was articulated by my hon. Friend Jo Gideon. People in those populations and in those areas are at greater risk of experiencing poorer health outcomes, not only from covid-19 but right across the health spectrum. And they have an elevated risk of being overweight or suffering from obesity.

Across all Departments, we are actively tackling obesity, because many different factors are involved and we need to make sure that we target them. Covid-19 has provided a laser focus on obesity, so it is crucial to support people in achieving a healthier weight, and to help families, because we know that there is also a common link between mothers and fathers who are overweight and their children’s weight; the likelihood is that their children will also be overweight, or obese.

So, in July we published the new strategy, “Tackling obesity: empowering adults and children to live healthier lives”, which sets out the overarching campaign to reduce obesity, including taking measures to get the nation fitter and healthier. I will look at some of those messages. This process is about building blocks and not about hectoring. As we all know, it is about helping people and having holistic policies. We know the statistics and we have heard them several times, so I will not repeat them. But it is right that our policy focuses on improving diet and reducing obesity.

Since we published the first chapter of the plan in 2016, we have seen important steps forward, and we have spoken to other nations. Just recently, I spoke to Joe FitzPatrick about calorie labelling on alcohol. I have also reached out to the other devolved nations, because, as has been said, it is important that we have such conversations.

We have also looked internationally. My hon. Friend Andrew Selous mentioned Amsterdam and the good work being done there, but I also had a very insightful conversation with Dr Jebb on Singapore, because it has done a great deal of work on how best to incentivise people on the journey to weight loss.

The soft drinks industry levy has been a huge success; the latest statistics show that the sugar content of soft drinks has dropped by 44%, which is a remarkable reduction. We know that sugar content in breakfast cereals, yoghurt and fromage frais has also dropped. However, we also know that calories have gone up in out-of-home desserts. So, we have a really mixed picture and that it is likely that further measures will be needed.

During the pandemic, we have seen people snacking more, with more snacks being purchased, as well as a reduction in levels of physical activity. The cessation of weight management and obesity services, as the NHS focused on covid-19, has not helped the situation, but we very much welcome local authorities’ efforts in adapting weight management, so that we have much greater results; there are many more remote and digital options available to us now.

I will now move on to consider the tangible things. First, the current advertising restrictions for products that are high in fat, salt or sugar are not protecting children. We are seeing significant levels of such advertising on TV and online, and we know that children are now viewing much more of their content online. The advertised diet in the UK does not reflect the healthy diet that so many hon. Members have spoken about. We have set out in the strategy that we want to ban those adverts on television before 9 pm, but we want to go further. This is a very auspicious day for the hon. Member for Strangford—it is almost as if he knew—as we launch the six-week consultation restricting advertising online. We have made it six weeks because we want it to be short and pithy and we want to get to a result, which is what so many hon. Members are keen for us to do.

We are taking decisive action on promotions. We spend more money on buy one, get one free promotions in this country than any other European country. We know they influence preferences and we want to shift the balance to help shoppers. As a further strand, we will legislate to stop the promotion of high fat, salt and sugar products by volume and prominent location— removing them from the gondola end. Those restrictions will apply online and in store and we will publish that result very shortly.

Food eaten out of the home—on-the-go food—which was mentioned by several Members, forms a growing part of people’s diet. That is part of the bigger narrative and bigger conversation about children’s learning to prepare food, eating as a family and all those other things that, if we had had more time, we would probably have discussed at more length. We are introducing legislation to require large out-of-home sector businesses with 250 or more employees to calorie label the food they sell. We will also encourage voluntary calorie labelling by smaller businesses, and we will look at the scope.

Many people mentioned weight management services, and the hon. Member for Strangford asked how we can evaluate them. We can see success through the child measurement programme, but we are very much aware that our bariatric referrals are much lower than across Europe, as is people’s ability to access weight loss programmes. There is some brilliant work going on in pockets and in some of the more deprived areas across the country, and there are great cook schemes. There is a brilliant weight loss project in Sheffield, and I met the people who run it. There is also a “dads and lads” project, helping dads and lads to cook, because it is not always a woman who needs to prepare the meal—says a mother of four, married to a man who does not cook very often. I will leave that there.

Our progress in work includes the NHS 12-week weight loss plan app, as we advertised in the summer, helping people with different levels of intervention to live better with obesity and hypertension and to get the support they need. We have accelerated the expansion of the NHS diabetes prevention programme and we hope to start to target some of the loss of limbs that my hon. Friend the Member for South West Bedfordshire spoke about. That programme has already helped half a million people. The better health campaign aims to reach millions of people who need to lose weight and encourage them in that behaviour change. The app also provides direction to weight loss programmes at discounted prices from Slimming World and WW, formerly known as Weight Watchers.

I am aware that I have not had time to canter through everything. To respond to the hon. Member for Bath, we are very aware that we ensure that messages are attenuated in the right way for those people who are struggling with eating disorders. They are a serious disease, and we work hard to ensure that the language and policy efforts do not have an adverse effect; we do impact assessments and put those on gov.uk. I also talk to my colleague the Minister for Patient Safety, Mental Health and Suicide Prevention, my hon. Friend Ms Dorries, who holds the portfolio for mental health, so we are very much attuned to ensuring that these policies are aligned. However, we know we have to do more. It is not our intention that anyone should be harmed in our raising awareness of obesity, but we do need to tackle this matter and we need to tackle it full-on.

My hon. Friends the Members for Stoke-on-Trent Central and for Vale of Clwyd spoke about levelling up. I am going to stop, although I have plenty more that I wish to say. It is a combined national effort—I could not have put it better—and I think we are all united in knowing that we must work hard to meet it.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 10:59 am, 10th November 2020

I thank all hon. Members for their contribution. I thank the shadow spokesperson and I thank the Minister in particular. I love the statement of a combined national effort; I think we have all captured that as the message we want to send out. I very much support what the Minister has said in relation to advertising and further reductions, the consultation programme that is going on, preparing and cooking meals and child weight loss programmes. All those things are important, so I thank the Minister and I thank hon. Members.

Motion lapsed (Standing Order No. 10(6)).

Sitting suspended.