Obesity and Fatty Liver Disease — [Mr Philip Hollobone in the Chair]

Backbench Business – in Westminster Hall at 1:30 pm on 8 June 2023.

Alert me about debates like this

Photo of Wayne David Wayne David Labour, Caerphilly 1:30, 8 June 2023

I beg to move,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Several hon. Members:


Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

Order. The debate can last until 3 o’clock, and I am obliged to call the Front Benchers no later than 2.28 pm. The guideline limits are 10 minutes for the SNP, 10 minutes for His Majesty’s Opposition, 10 minutes for the Minister and two minutes at the end for Mr David to sum up the debate. There are three highly distinguished Back-Bench Members seeking to speak in this debate. I hope you will allow each other enough time to get your contributions in. The first exemplar of that will be Maggie Throup.

Photo of Maggie Throup Maggie Throup Conservative, Erewash 1:42, 8 June 2023

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to participate in this extremely important debate. I congratulate Wayne David on securing the debate, which is timely because it coincides with International NASH Day. International NASH Day aims to raise awareness of fatty liver disease and non-alcoholic steatohepatitis, which affects more than 115 million people globally. Up to one in five people in the UK have non-alcoholic fatty liver disease, and almost 12% of the population have NASH. I am sure it comes as no great surprise to anyone, as the clue is in the name, that one of the key causes of non-alcoholic fatty liver disease is obesity.

The need to tackle obesity as a priority was first identified by the Government in the early 1990s in the “Health of the Nation” White Paper. In the three decades since then, there have been policies such as the soft drinks industry levy, the pilot of the “Better Health: Rewards” scheme in Wolverhampton, restrictions on product placement and calories on menus, which have been introduced effectively with the aim of reducing obesity. I am particularly proud that many of those measures were introduced or reinforced during my time as public health Minister. However, despite those policies being implemented successfully, the obesity rate continues to increase, so more needs to be done.

A recent report by the Obesity Health Alliance argued that obesity is the new smoking. That comparison was reinforced yesterday by the announcement of £40 million to pilot ways to make the newest and most effective obesity drugs accessible to eligible patients. That is an acceptance that obesity is a disease and should be treated with drugs, in the same way that lung disease is treated with drugs. Following that argument through, immense effort has gone into stopping smoking measures and reducing exposure to cigarettes, so immense effort should now be put into reducing everyone’s exposure to foods that are more likely to cause obesity—that is, ultra-processed foods. The delayed 9 pm watershed and action on two-for-one offers will do just that.

Research by the Obesity Health Alliance shows that 72% of people believe a 9 pm watershed on junk food adverts should be brought in during popular family TV shows. The measure has public support, so why hold back? When will the Minister’s Department introduce those important measures? Provisions are on the statute book, so let us just get on with it.

Statistics provided by the House of Commons Library highlight how obesity is steadily getting out of control in England. Since 1993, the proportion of adults in England who are overweight or obese has risen from 52.9% to 64.3%, and the proportion who are obese has risen from 14.9% to 28%. It is no surprise that the UK has the third highest obesity rate in Europe. Furthermore, the alarming rate of child obesity is of real concern. Data from the national child measurement programme outlines that in England, 10.1% of reception-aged children —aged four to five—were obese in 2021-22 and a further 12.1% were overweight. At ages 10 to 11—in year 6—23.4% were obese and 14.1% were overweight. Obesity prevalence is highest among the most deprived groups in society: children in deprived parts of the country are twice as likely to be obese than their peers in more affluent areas.

The health and economic impacts of obesity are devastating. Obesity is a force multiplier on fatty liver disease, cardiovascular disease, stroke, type 2 diabetes and cancer, and that, of course, puts ever-increasing pressure on the NHS. The combined cost of obesity to the Treasury—that is, to the NHS, the Department for Work and Pensions, and the economy as a whole—is projected to be £58 billion a year. I feel, however, that that could be a conservative projection, as there are many factors that have not been taken into consideration.

Those who are obese cost the NHS twice as much as those who are not. It has been estimated that those who are obese take four extra sick days a year, which equates to 37 million sick days across the UK working population. Those stats are clearly very concerning, and there needs to be a collective effort to tackle this widespread problem. If action is not taken now, we will embed ill health and low productivity into generations to come.

Non-alcoholic fatty liver disease is triggered by a build-up of fat in the liver, and as its name suggests, it is usually caused by obesity. Early-stage non-alcoholic fatty liver disease does not usually cause any harm. However, if left untreated, it can lead to serious liver damage, including cirrhosis. Some 90% of liver diseases are preventable, and in the UK, the most common causes of cirrhosis are excessive alcohol consumption, hepatitis and NAFLD.

What can we do to avert this public health crisis? As individuals, we can all take measures to help us to avert the risk of NAFLD—simple measures including eating a balanced and healthy diet, and in particular, not eating ultra-processed foods. Additionally, we can all increase our activity levels, as the hon. Member for Caerphilly indicated. It has been estimated that if those who are overweight or obese lost just 2.5 kg—5½ lb for people of my generation—that could save the NHS £105 million over the next 15 years. I am sure that most people would want to lose more than just 5½ lb, and doing so would save the NHS even more money—5½ lb, or 2.5 kg for the younger ones in the room, is not a lot.

We need to do more to promote early diagnosis and raise awareness of the different causes of liver disease. It would be remiss of me, as chair of the all-party parliamentary group for diagnostics, not to mention the possible impact of community diagnostic centres. Community diagnostic centres provide a quick and easy way to access checks, tests and scans, providing routes to early diagnosis. The recent announcement by the Department of Health and Social Care that fibroscan services will be made available in 100 community diagnostic centres is welcome. It could result in thousands of people being made aware of the poor condition of their liver, which could still be reversible.

Despite that positive news, I would like to see an expansion of liver testing in areas where obesity levels are higher and the risk of fatty liver disease is more extreme. Lives are saved when diseases are caught early. I am interested to hear the Minister’s comments regarding the expansion of fibroscan services to all CDCs. My own local integrated care system in Derbyshire is currently categorised as green, indicating that an effective pathway is in place for the early detection and management of liver disease. Will the Minister therefore look at emerging good practice throughout the country and emerging good practice pathways at the ICS level, with a view to establishing a national pathology pathway to accelerate early diagnosis? Government policy towards obesity over the last 30 years has mainly been focused on individual responsibility, rather than mandatory policy, but we can all see that that is not working.

Monday night’s BBC “Panorama” highlighted just how harmful ultra-processed foods are, and how they contribute massively to diet-related ill health. However, they are among the most profitable foods that companies can make. I know that this may sound unlikely, but there is a willingness among food manufacturers to reformulate; however, as the hon. Member for Caerphilly said, they want a level playing field. Sadly, no company is willing to step out of line and lead the way, yet if the consumption of ultra-processed foods continues at the current rate and the obesity rate continues to rise, our nation will be economically poorer and very unhealthy. To be bold, I believe this country is addicted to ultra-processed foods, similar to the way it was addicted to smoking in past decades. We tackled smoking addiction by intervention; it is now time to tackle ultra-processed food addiction by intervention too.

To conclude my remarks, this debate has undoubtedly helped to raise awareness of the problem of obesity and the detrimental impact it has on people’s health, including liver disease, as well as the economy and the NHS. Clearly, more needs to be done to tackle the health inequalities of obesity and improve early diagnosis of fatty liver disease. The Government need to be bold and brave for the sake of the individual, the NHS and the economy.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 1:52, 8 June 2023

Thank you for calling me, Mr Hollobone; it is always a pleasure to serve under your chairmanship. It happens very often that you and I are here in Westminster Hall, but perhaps for different reasons and to participate in different ways.

I thank Wayne David for leading the debate. It is always a pleasure to hear his calm voice, and today he put the case forward admirably. It is also a pleasure to follow Maggie Throup, who brings a vast stock of knowledge from her former role and her deep interest in these subjects. Whenever she speaks in Westminster Hall or the main Chamber, it is always with facts, evidence and a determination to get the answers.

As the vice-chair of the APPG on liver disease and liver cancer, I am pleased to be here to draw attention to the liver disease crisis, but I am not pleased that there is a crisis of liver cancer in Northern Ireland. One of the great things about the Minister—I do not say this to give him a big head or anything—is that whenever we ask him questions, his first intention is clearly to respond in a positive fashion. That being the case, I have a couple of asks for him.

I am also pleased to work alongside the two shadow Ministers, the hon. Members for Linlithgow and East Falkirk (Martyn Day) and for Bristol South (Karin Smyth). I was saying beforehand to the Labour shadow Minister that very often—most Thursdays—she, the Minister and I, and sometimes others, have this shift in Westminster Hall. We are always pleased to come and to participate. As we look forward, I hope that we can work together and emerge with a good practice for obesity prevention and the early diagnosis of fatty liver disease, which I hope can be replicated across the whole of this great United Kingdom of Great Britain and Northern Ireland.

I was delighted to sponsor the British Liver Trust’s “Check your liver health” event in Portcullis House in January. The hon. Member for Caerphilly referred to that event. The turnout was great; he was absolutely right. I thank all MPs who took the time to attend. I personally got the all-clear. That does not mean that someone can sit back and say that everything is all right; they have to continue to do the right things, so that they do not fall back.

I would like to give some background on the situation in Northern Ireland. I always like to give a Northern Ireland perspective, because I believe that that enriches the debate, even though it probably replicates what everybody else is saying as well. When the SNP shadow Minister speaks, he will give Scotland’s perspective, and I very much look forward to hearing that also. In Northern Ireland, nine out of 10 liver disease cases are preventable. That is the point that we start from and it is what the hon. Member for Caerphilly said in his introduction: we can prevent liver disease if we eat right—if we have the correct diet—and we exercise, so it is really important that we do that. There is also the question of alcohol. I am not against anybody drinking alcohol, but if people do that, they should do it in moderation.

Liver disease deaths have doubled in the last two decades, which contrasts with the trends in other chronic diseases, which have decreased or stabilised. While liver disease and liver cancer have increased, other diseases have fallen. We cannot ignore that. There is an onus on Government. Government cannot do everything for everybody, but they can raise awareness and perhaps give some of the direction that is needed. It is important to recognise the trend.

Liver disease deaths in Northern Ireland increased by 39% during the period encompassing the pandemic—between 2018 and 2021. That was primarily driven by obesity and alcohol misuse. The pandemic was part of the reason for that, but there is also an onus on all of us individually, including me. We need to exercise and do the right things. Northern Ireland does have a non-alcohol-related fatty liver disease and haemochromatosis pathway in development, so there is a policy by the HPSS—health and personal social services—in Northern Ireland, but progress is slow.

I am, as always, keen to ensure that the Minister here uses his good offices to encourage the devolved Administrations to be active, and I am sure that that will be the case. The Minister himself is proactive. I know that he has had regular contact in all his ministerial roles—in Education and now in Health—and I hope that discussions with those in Northern Ireland continue. Has he had an opportunity to have discussions with the Department of Health back home in Northern Ireland? If not, may I request that he do that?

I have spoken before on the importance both of raising awareness of the risks of obesity and of early diagnosis. People with excess weight and fatty liver disease are at higher risk of cardiovascular disease and a wide range of cancers. People who are obese are two times more likely to develop liver cancer, three times more likely to develop colon cancer, two and a half times more likely to develop high blood pressure and five times more likely to develop type 2 diabetes. I declare an interest as a type 2 diabetic. I will give an idea of what that involves. When I was diagnosed as a type 2 diabetic some 15 years ago, I weighed 17.5 stone. I was a big fat puddin’—I am talking about myself, so I can use this terminology. I lost some four stone and have kept that weight off. But people have to work at it; that is what the hon. Member for Caerphilly was saying. Diet control helped for a while, but my diabetes—this debate is not about diabetes—is now medication-controlled. It is important that people are aware of that issue. That included me, who came through that particular episode some years ago.

British Liver Trust research reveals huge geographic variation in access to patient care pathways for the early diagnosis and management of liver disease in primary care. Furthermore, removing stigma surrounding the impacts of liver disease is crucial. That is why it is important that we all recognise that we have to encourage people. It is so alarming that 49% of liver patients surveyed by the British Liver Trust in October 2022 reported experiences of stigma from healthcare professionals. When someone comes to our office, our job as MPs is not ever to be judgmental; it is to help the person with whatever the issue may be. I think that there is a case for healthcare professionals to have the same attitude when people come to them. This should be not about judgmental attitudes, but about saying, “What can we do to help?” People should look at it that way.

I congratulate the Royal Victoria Hospital liver support group in Northern Ireland on its recent 25th anniversary. Its chairman, Jim Kilpatrick, is a constituent in a neighbouring constituency, and he is a passionate campaigner who has been instrumental in improving support for patients in my constituency of Strangford—indeed, in all areas. I commend him for that and for the support of carers across Northern Ireland. There was a debate in the Chamber earlier about carers. I think we all have experience of that—I know my family have. Jim Kilpatrick presents an understanding and supportive stance on behalf of the support group, persuading, assisting and making life better, as well as focusing attention on and driving the strategy. The Royal Victoria Hospital liver support group is a network of volunteer liver patients and their carers who provide confidential, compassionate, emotional and psychological support for all adults, teenagers and children coping with a liver condition. Their vital work is a lifeline to my constituents and patients across Northern Ireland.

Liver disease is a silent killer, largely asymptomatic in its early stages. Three quarters of patients are diagnosed with cirrhosis in hospital, when it is too late for effective treatment. The hon. Member for Caerphilly emphasised the need for early diagnosis, and he is right. Risks can be drastically reduced through early detection and through diet, exercise and drinking in moderation. Let us be honest—there should be moderation in everything. It is so important that we raise awareness.

I give sincere thanks to the British Liver Trust, which has been in constant contact with my office and has been so insightful in the information it has provided. I want to put on the record how grateful I am to the trust for providing me and my staff with the information to prepare for this debate. I look forward to working with it in future as we collaborate to address this important issue and improve the health of constituents. I am convinced that the trust would be keen to work alongside the Minister and his Department. Has he had an opportunity to discuss these matters, to work in partnership and to help each other.?

I am also keen to receive an assurance that any co-ordinated plan or strategy here on the mainland can be delivered by the regional Administrations, including the Northern Ireland Assembly. I am confident and convinced that the assurances I seek will be given. I say this not as a political comment, but when it comes to many things, particularly health, one of the great things is that we can work collaboratively and better as the United Kingdom of Great Britain and Northern Ireland. It is always better to share our details, our practices and our experiences. By doing so, we can move forward together and make sure that across this great nation we can all improve our health.

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall 2:03, 8 June 2023

Thank you, Mr Hollobone, for giving me the opportunity to speak for the second time in two days.

I congratulate my hon. Friend Wayne David, the chair of the all-party parliamentary group on liver disease and liver cancer, on securing this debate. As vice-chair of the APPG, I am concerned that the UK Government lack a coherent strategy for tackling the worsening liver disease public health crisis, which disproportionately affects our most disadvantaged and marginalised communities. Ealing’s mortality rate for men under 75 is among the worst in the country.

Despite being a leading cause of premature death in the UK, liver disease has not been appropriately prioritised by the Government and was overlooked in the major conditions strategy. Fatty liver disease is a public health emergency. Liver disease mortality rates are outpacing those for other major conditions, such as diabetes or respiratory conditions, which have stabilised or improved over the past 40 years. I am not complaining that those conditions have improved, but it is a fact that liver disease has not been taken seriously. Liver disease deaths are four times higher in the most deprived areas, where risk factors such as obesity, alcohol misuse and viral hepatitis are more prevalent. Poverty and deprivation are key drivers of both obesity and fatty liver disease in the UK.

Ethnic minorities have higher obesity rates than the national average, and south Asian populations are particularly vulnerable to developing fatty liver diseases due to a combination of genetic and societal risk factors, but limited action is being taken to accelerate earlier diagnoses of liver disease within primary care and community settings to reach the communities most at risk. Will the Minister commit to an urgently needed review of adult liver services to tackle the huge inequalities in liver disease outcomes and care across the country? Early detection and diagnosis is key, as all previous contributors have indicated clearly and eloquently. Four in five people with NASH, the most severe form of fatty liver disease, are undiagnosed. The prognosis of NASH is often poor with patients at high risk of liver failure and liver cancer, which has a five-year survival rate of just 13%.

My local integrated care system—North West London ICS—is currently categorised as green, which indicates there is now a fully effective pathway in place for the early detection and management of liver disease. Sadly, due to societal, ethnic and deprivation reasons, my constituency and Ealing lag behind other areas. I urge the Minister to look at the positive examples of ICSs, such as North West London ICS, and see how the great work they are doing can be replicated more widely across the country. I also ask the Minister to expand the work needed to ensure equitable access for all to those improved pathways.

Photo of Martyn Day Martyn Day Shadow SNP Spokesperson (Health and Social Care) 3:07, 8 June 2023

I am grateful to Wayne David for securing today’s important debate, and for the comprehensive manner in which he introduced the issue and highlighted the scale of the problem. We have had a very informed debate. Obesity is a problem on an escalating global scale, with Scotland’s obesity levels among the highest of OECD countries. Indeed, I was until recently classed as obese myself, and despite reducing a bit I am still in the overweight category. I am going the right way, but I have a long way to go to catch up with Jim Shannon, who has made much greater headway than I have.

Obesity vastly increases the chances of a person developing a range of lifetime diseases, including heart disease, type 2 diabetes and several other forms of cancer, as well as non-alcoholic fatty liver disease, which is what we are focusing on. Obesity reduces quality of life and ultimately contributes to premature death. As we have heard, the UK is very much the sick man of Europe in terms of obesity, and sadly rates of obesity are even higher in Scotland than in England, Wales and Northern Ireland. Two thirds of adults aged 16 and over in Scotland are overweight, and nearly one in three people are obese, placing them at higher risk of premature death, chronic disease and a multitude of cancers. Obesity doubles the risk of developing liver cancer.

The causes of obesity are complicated and vary from person to person. They include the genetic make-up of a person and biological and social factors. It is also heavily influenced by health inequalities. A report by Public Health Scotland found that for children from the most deprived backgrounds, the risk of obesity was almost three times higher than for those from the least deprived—21% versus 8%. There can be no denying that poverty is a significant factor, as are housing, education, access to open spaces, exposure to advertising and the availability and sale of unhealthy foods, all of which affect whether we can be active or eat healthily and consequently have an impact on the risks of developing obesity. The predominant driver in all those factors is what we eat, which is in turn shaped by our environment. For example, for many living in poverty, eating healthy food is a secondary consideration to just eating at all —or even heating their homes. Access to healthy food should be a right, not a privilege.

I am therefore delighted that the Scottish Government have committed to restricting less healthy food promotions and to improving the availability of healthier options when people are eating out in their Out of Home action plan. Their support has also meant investment of more than £400,000 in the last five years to help smaller businesses reformulate common products to make them healthier. That plays an important role in improving dietary health by removing hundreds of millions of calories from Scottish food and drink products. We could, and need to, do a lot more on that if we are going to improve people’s diet, and local companies that are rising to the reformulation challenge should be commended for their efforts.

More needs to be done, however. Minister Jenni Minto announced in Holyrood last month that the Scottish Government will undertake a consultation on regulations to restrict promotions of food high in fat, sugar and salt. That is a vital next step in fixing the broken food system, which is driving the obesity and fatty liver disease crisis in Scotland. So I echo other hon. Members’ points and ask the Minister to commit to delivering prior policy commitments that are still to be implemented. Those include implementing the 9 pm watershed to protect children from junk food advertising on TV and online, and banning multi-buy junk food deals. Those measures enjoy huge public popularity, and I believe they would be effective tools.

The Scottish Government are at the forefront of efforts to strengthen obesity prevention and improve earlier detection of liver disease, including through pioneering use of intelligent liver function tests in primary care, which are now being piloted in sites across England as well. The British Liver Trust categorised my local health board, NHS Lothian, as green in autumn 2022, as it now has a fully effective patient care pathway for the early detection of liver disease. That is important because the mortality rate for chronic liver disease in my local health board is lower than the national average in Scotland, at 15.3 versus 17.9 per 100,000, reflecting the growing momentum for action to help improve liver disease outcomes and save lives.

Scotland is also at the forefront of harnessing new diagnostic tools to improve earlier detection of liver disease. The hon. Member for Strangford and others have spoken about how detection is important. We must prevent people from becoming ill in the first place if we really are to tackle the problem. However, by the time people are diagnosed, we often find they are too far down the pathway to make significant improvement.

The intelligent liver function testing pathway developed by the University of Dundee uses an automated algorithm-based system to further investigate abnormal liver function test results on initial blood samples from primary care. Intelligent liver function tests represent a nearly threefold increase in the diagnosis of liver disease and are estimated to be saving the NHS more than £3,000 per patient with an abnormal liver blood test. Indeed, iLFTs are now being piloted in Birmingham, Wolverhampton, Coventry, Liverpool and north London, and the roll-out of such technology is welcome. I urge Ministers to look at other examples of good practice from the devolved nations to help improve patients’ pathways for early detection and management of liver disease. Will he commit to delivering a new nationally endorsed pathology pathway for early diagnosis of liver disease that incorporates intelligent liver function testing in primary care?

In conclusion, we know that obesity doubles the risk of developing liver cancer, which is now the fastest rising cause of cancer death in the UK. Non-alcoholic fatty liver disease is now the fastest rising cause of hepatocellular carcinoma globally. In Scotland, liver cancer has seen the largest increase in mortality rates—38%—of all cancer types over the past decade, and liver cancer is now the fastest rising cause of cancer death in the UK. Unfortunately, Scotland has the highest incidence of liver cancer among our four nations.

The liver disease public health crisis disproportionately impacts our most disadvantaged and vulnerable communities. In 2021, chronic liver disease mortality rates in Scotland were 5.8 times higher in the most deprived areas than in the most affluent. Individuals in deprived areas are more likely to develop liver disease, be hospitalised with it and die from it than those in affluent areas. We must improve early diagnosis and prevention if we are to tackle this issue. That also means tackling poverty and health inequalities.

Photo of Karin Smyth Karin Smyth Labour, Bristol South 2:15, 8 June 2023

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to respond on behalf of the Opposition health and social care team. As Martyn Day said, it has been a very well-informed debate. I thank my hon. Friend Wayne David for the exceptional work that he and the other members of the APPG on liver disease and liver cancer are doing to raise awareness of this vital issue.

As has been demonstrated, rising obesity poses a profound threat to public health. We have heard today—from Strangford to Erewash, and from Southall to Linlithgow—that this is an issue across the United Kingdom. Before we hear from the Minister, I want to say how impressed I am with how everyone has tackled their own health and wellbeing through exercise, and I will certainly try to do better the next time I come to one of these debates.

As we have heard, obesity can impact on cardiovascular disease, as well as a variety of other conditions, not least non-alcoholic fatty liver disease. The British Liver Trust estimates that deaths as a result of liver disease have doubled in the last 20 years—that is a sobering statistic—with mortality rates are four times higher in the most deprived areas, as we have heard. Childhood obesity is also rising at the fastest rate on record, with 39% of obese children estimated to be suffering from non-alcoholic fatty liver disease. Not only is obesity rising and costing lives, but it is also causing people to live less prosperous and enjoyable lives and harming our economic productivity, as my hon. Friend the Member for Caerphilly said.

The case for action could not be clearer. If we want to lead happier, healthier lives, while also reducing pressure on our NHS and turbocharging our economy, we must get serious about addressing the obesity crisis. That can be done only by placing prevention at the heart of our work.

Despite our best efforts, individuals cannot tackle obesity alone. Too often, we have a narrative of personal responsibility, but it fails because it promotes harmful, outdated ideas about our bodies, and that is particularly true for women. We need a step change in how we tackle obesity as a society.

I am proud that Labour’s recently launched health mission set out a blueprint for shifting the focus of Government Departments, the NHS, and wider public services to prevention. Most relevantly to today’s debate, we want to give every child a healthy start in life, with a children’s health plan.

I pay tribute to Maggie Throup for her work as a public health Minister—she knows of what she speaks. We would want to implement that long-overdue 9 pm watershed for junk food advertising on television and to ban paid advertising of less healthy foods on online media. That would come alongside establishing fully funded breakfast clubs in every school and a balanced and broad national curriculum with a wide range of compulsory physical activities.

That is the start of our vision for Government. For far too long, public health problems such as obesity have been viewed as falling exclusively under the purview of the Department of Health and Social Care but, as we have heard, the causes of obesity are multifaceted. It is about what we eat, but also about our access to green spaces, our genetics, the money in our pocket, our access to community care, and so much more. If we want to tackle obesity and, by extension, this disease, every cog in the Government machine must recognise its responsibilities.

For that reason, Labour has committed to embedding health in all policies through the creation of a cross-departmental mission delivery board. That would bring together all Departments with an influence over the social determinants of health and act as an accountable body akin to the Climate Change Committee. That is the kind of bold, ambitious thinking that will define the next Labour Government.

I am aware that those suffering, or at risk, from NAFLD want action from the Government now. With that in mind, I would like the Minister to address some questions. First, in relation to obesity and prevention more generally, the Government recently launched their consultation for the major conditions strategy, singling out six major groups of health conditions but, unfortunately, there is no mention of obesity in the consultation documents, although cases of several of the diseases mentioned are rising in part because of obesity. It would therefore be helpful if the Minister set out what role preventive obesity policy will play in those major disease conditions. Similarly, concerns have been raised that there was no mention of liver disease in the strategy. Will he therefore set out how he plans to address increases in liver disease, and specifically NAFLD?

I also want to press the Minister on health inequalities. The British Liver Trust describes liver disease as, effectively, a barometer for underlying health inequalities. It points out that the main risk factors—obesity, alcohol misuse and viral hepatitis—are most prevalent in marginalised communities, and we heard some shocking statistics from my hon. Friend Mr Sharma. That goes back to the point made earlier about the wider determinants of health. Unless the Government implement a coherent strategy for health inequalities, we will never be in a position to drive down liver disease.

The Minister will remember that in 2019 the Government pledged to extend healthy life expectancy by five years by 2035 and reduce the gap in healthy life expectancy by 2030. The clock is ticking. Not only is the target on track to be missed, but things are actually getting worse—inequalities in life expectancy are widening. Given that the Government binned their health disparities White Paper, will the Minister provide an update on how he plans to reverse the health inequalities that have widened on this Government’s watch?

We know that liver disease is largely asymptomatic in its early stages and that diagnosis is essential in providing effective treatment. As we have heard, one in four people diagnosed with alcohol-related liver disease in hospital die within 60 days, and there is evidence of huge geographical variation in the pathways for early diagnosis. Given that grim picture, what assessment has the Minister made of current diagnostic provision for liver disease, and how will he improve that picture so that, no matter where someone lives, they can receive a timely diagnosis?

In conclusion, our current trajectory must not be allowed to continue. Unless we address obesity and rising fatty liver disease, more lives will sadly be lost, and our health service will come under existential pressure. Labour stands ready and waiting to address this crisis, but we cannot afford to wait. The Government must get to work now. We look forward to hearing from the Minister.

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care) 2:22, 8 June 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo of Wayne David Wayne David Labour, Caerphilly

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

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care)

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

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

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

Photo of Maggie Throup Maggie Throup Conservative, Erewash

My hon. Friend is right that there is a lot more information there for people to make informed decisions on, but there are also hidden contents that people are not being informed about, such as the ultra-processed foods. Products may be labelled as low in fat, but they have other products in them to ensure that they will taste okay and still be low in fat. We need to not just look more at the overall messaging on packaging, but ensure that we reduce some other items in the products that are causing the obesity crisis.

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care)

My hon. Friend is absolutely right; we are constantly learning more. At the moment, I do not think there is a definition of an “ultra-processed food”. There has been a lot of work. We are learning more and more about the issue and it has recently exploded into the public domain. We need to ensure that more people are aware of and being educated about what is actually in their food, and that they are looking at labels. If we go back 20 years, we were all very much alive to E numbers —does everyone remember E numbers?—which no one looked at before. Now, we often look over the back of the packaging to see the number of E numbers in our products. The more that the public are educated and informed so that they can look out for these things, the better. My hon. Friend the Member for Harborough will be happy to discuss this further with my hon. Friend the Member for Erewash. I know that ultra-processed foods are an issue about which the public are concerned, and we certainly have more to do on food labelling.

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

The Minister always brings good responses. The SNP spokesperson, Martyn Day, made a comment that I endorse totally, because it is something that I hear from my constituents every week. With respect, many people can look at the labels and see what they mean, but what do they look at first? They look at the price, because they are trying to make a meal for their family. What drives them will be, “What can I afford to do?” I am conscious that the Minister has been very constructive in his responses, but there must be a wee bit of reality as well.

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care)

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

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

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

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

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

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

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

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

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

Photo of Wayne David Wayne David Labour, Caerphilly

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

Photo of Will Quince Will Quince Minister of State (Department of Health and Social Care)

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

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

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

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

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

Photo of Wayne David Wayne David Labour, Caerphilly 2:44, 8 June 2023

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

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

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

Question put and agreed to.


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

Sitting suspended.