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Health: Obesity

My Lords, I thank the noble Lord, Lord Pendry, for calling for this debate on childhood obesity. Your Lordships may think that I speak simply as an act of confession. My robes hide the fact that I suffer from central adiposity; in other words, I put on weight around my middle and therefore carry an increased risk of type 2 diabetes and cardiovascular disease, and when I look round the Chamber, I see that I am not the only one. Therefore, the topic for debate is close to home. Obesity in this country has reached epidemic proportions and the trends in childhood obesity are so serious that we now expect life expectancy to be shortened by its knock-on effects. The cost to the economy is predicted to be £45 billion a year by 2050. The second reason why this debate comes close to home for me is that Bradford has a higher rate of obesity among children than the national average, and standards of healthy eating and physical exercise are among the lowest in the country. I suggest that in the battle against obesity we are focusing, so far at least in this debate, far too narrowly and that we are starting too late in a child’s development. The message—I know that we want a message which is easy to understand—seems to be to children, and, yes, through their parents, to take more exercise, give up junk food and eat their five fruit and veg. It is an important message but it only goes so far. I asked my daughter, who is a paediatrician, what one thing she would like me to say in the debate. She said, "Educate the parents. Don’t put blame on children for things they can’t control. Get parents to think about what they want their children to be like as grown-ups". The obesity epidemic has come about through a change of lifestyle: the availability of energy-dense foods; the plethora of fast-food outlets; use of microwaves; pre-prepared meals; decline in cooking skills; the fact that families do not eat together but graze on their own; and the decline in physical activity. These have been mentioned by previous speakers. Is it not ironic that there is so much sport and so many cookery programmes on television but we are so busy watching them that we do not exercise or eat properly? But these are lifestyle choices and they are adult choices, not children’s choices. They are choices that adults make for their children. Chronic stress leads to obesity as well. First, our bodies respond to stress by depositing fat around the middle rather than on the hips and thighs. Secondly, we turn more and more to comfort foods. Three years ago the Sun newspaper had a feature on child obesity. One child gained 15 stone in five years after his parents divorced. The stress is caused by the parents. In poor countries obesity is a disease of the rich but in the developed world it is a disease of the poor, as the noble Lord, Lord Pendry, noted. Wilkinson and Pickett, in their book, The Spirit Level, argue that this is more about relative wealth and poverty than actual wealth and poverty. They compare the Netherlands, a comparatively equal society where 7.6 per cent of children aged 13 to 15 are overweight, with the United States, the most unequal of rich countries, which has 25.1 per cent overweight. They also note that when the Berlin Wall came down and inequality increased dramatically in what had formerly been East Germany, there is evidence that the social disruption led to an increase in the body mass index of children as well as adults, although this could, of course, have been due to stress as well as to the greater disparity between wealth and poverty. Poverty itself restricts choice. Some poor people do not simply have access to the nutritional foods recommended in the Sainsbury’s recipes in the same way that most of us do. I could take you to a large council estate in Bradford where there is no greengrocer. There is nowhere for the people to buy their five fruit and veg which we would not be without. The local vicar saw the problem so he went to the wholesale market every week early in the morning, bought the fruit and veg and sold it in the church hall to everybody who came to the various clubs and so on. This enterprise has grown to such an extent that the wholesaler now delivers to the church. The point I am trying to make is that overcoming obesity is not purely a matter of individual exercise and diet. It is about the way we shape our society institutionally and corporately. I would add that educational programmes are too narrow and suggest that they start too late in a child’s development. My third and main local reason for choosing to speak in this debate is to commend to this House a wonderful piece of epidemiological research known as Born in Bradford. Fourteen thousand mothers are being recruited during antenatal care and 80 per cent are responding. Fifty per cent of these are of south Asian origin. Their family history is recorded and their child’s growth and development monitored. As your Lordships will know, obesity leading to type 2 diabetes and CVD is particularly prevalent among south Asians in Britain. The aim of the programme—or at least the part of it relevant to our debate—as laid out in a grant application made in 2007 is as follows: to strengthen public health systems for monitoring excess weight gain in infants; to deliver new protocols and supporting tools to enable the identification of children who are at risk of obesity; to improve our understanding of the aetiology of childhood obesity in multi-ethnic populations; and to test new family-based solutions to prevent obesity in these populations. Twenty per cent of the 14,000 children in the project are monitored in detail. A few months ago I had a preview of some of the early results of the project. Unfortunately for us they have not yet been published but they prompted me to wish to speak in this debate. Professor John Wright, the co-ordinator of the project, has allowed me to say that they have identified levels of obesity starting off in the first year of life common to white British and Asian babies. Yet the advice given by NICE on obesity in 2006 does not look at the evidence base for children under the age of two and, as far as I know, there is no advice available to health visitors in relation to obesity management for under-twos, in particular those in south Asian families where in-laws are an especially important influence on babies’ diets. There is also the need to explore further what has for some time been known as the Varca hypothesis that those who are underweight at birth are more prone to cardiovascular disease later in life. The noble Baroness, Lady Thornton, kindly gave me samples of booklets from the Change4Life project. I am grateful to her. They are a valuable and attractive contribution to the battle against obesity. I suggest that materials such as CDs be prepared for those who are not comfortable with the written word and in some other languages besides English and I particularly urge that there be greater focus on the impact on childhood obesity of infants’ experience in the womb and in the first year of life.