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Health: Obesity

My Lords, I begin by congratulating my noble friend Lord Pendry on initiating this debate. I commend him for all the excellent work that he does to support sport and physical well-being in this country. The subject of this debate is much more interesting, consequential, and intellectually and practically challenging than might appear at first sight. Obesity among young people and adults is not just a problem for the UK but is a genuinely global issue. The WHO’s international obesity task force estimates that in 2007 some 1.4 billion people in the world were obese or overweight using standard measures. This number includes a rapidly accelerating proportion of children and young people under 21. The scale is truly extraordinary. In Europe there are few countries reporting obesity rates below 10 per cent and in several European countries these rates are above 20 per cent, including the UK and countries as diverse as Germany and Finland. In fact, the most rapid increase of all is in this country, where rates rose threefold between 1980 and 2001. In the United States, famously, obesity affects one in three adults and reaches rates of 50 per cent among some groups. This touches on what the right reverend Prelate said because these groups especially include poor black American women. In Latin America, obesity rates are rising in many countries; they are more than 20 per cent in Paraguay, for example, and have reached 36 per cent of women in that country. Similar figures pertain to Asia, where Japan is an interesting case. Japan was easily the longest-lived society in the world, largely as a result of the Japanese diet, but rates of obesity are climbing very steeply and have now reached more than 20 per cent among adults. They are climbing especially strongly among young people and the rates among those aged 15 to 21 are the same as for the adult population—20 per cent. It is a quite extraordinary secular change. Some people say that with a phenomenon such as obesity we can apply the post-modern argument that you cannot judge; that there are many different kinds of people’s bodies and we should not sit in judgment over what size they might be. That argument is demonstrably wrong for reasons which have been alluded to by my noble friend Lord Pendry. There are deep connections between obesity—and, indeed, being overweight by the standard measure—and dramatic health consequences, the most important one of which is type 2 diabetes. In the United States it has been noted that 45 per cent of children with newly-diagnosed diabetes have type 2 diabetes and almost all of them are radically overweight or obese at the time of diagnosis. Looking at the United States healthcare system, some people argue that it could be overwhelmed by the prevalence of type 2 diabetes some 15 or so years down the line simply because of the implications of this. As my noble friend said, these problems converge with a range of other harmful effects. A phenomenon this profound and on this scale is not going to be dealt with by homilies such as we should take more exercise, eat less or eat more healthily; it will not be dealt with by public health programmes. I support what the Government are doing, what my noble friend said and the importance of education and health programmes, especially those aimed at young children, but a phenomenon which is this deep-rooted and global will not respond significantly to such endeavours and we will have to look elsewhere if we are seriously going to confront it. I hope your Lordships will forgive a slight digression. A few years ago I wrote a book on anorexia, the rise of which in modern societies correlates more or less directly with the expansion of supermarket culture. Once you have supermarkets there are no longer local diets; you cannot follow a local diet. Everyone has to decide what to eat in relation to how to look and how to be. At this point there is a tremendous acceleration in compulsive or addictive eating patterns, not only here but across the world. It occurs mostly in the affluent parts of the poorer world as well as in the developed world. Anorexia is obviously the opposite of obesity but the two often go in tandem. For example, you will sometimes find young girls who will starve almost to the point of death and six months later they are really fat; you get an alternation between the two. The scale of this phenomenon and its expansion shows that we are dealing with addiction or compulsiveness. When you have strong addictive or compulsive elements it is difficult to alter them. We will have to be much more radical and structural if we are to get to terms with the impact on our society to which obesity and being radically overweight, and eating disorders in general, should be closely linked. There is an interesting overlap between the issue of obesity and being overweight and the more general debate around the issue of well-being. The two matters are closely connected and have common policy implications. I disagree with the right reverend Prelate because, to me, obesity across the world is by and large a phenomenon of affluence. It is certainly heavily class biased—it tends to be concentrated among poorer groups—but it is mainly in those countries which are becoming richer where obesity takes off in a radical way. We are, by and large, dealing with the phenomenon of affluence, even though it is heavily related to inequality for well known reasons. If your Lordships take the point that obesity often has a strong component of addictiveness or compulsiveness about it, let me offer three observations on a more radical and structural approach to the issue. First, certainly in the UK and in many other countries too, alcohol consumption is significantly related to obesity. It is also strongly addictive, not only physiologically but socially and morally. When we consider the issue of obesity, we should take on board what the Chief Medical Officer is saying about alcohol because the two are intimately related. Quite apart from whatever you eat, if you consume enough alcohol it makes you fairly robust; it follows the similar fast food addictive pattern of behaviour. The Chief Medical Officer says— and I agree, although it was very controversial when it was announced recently—that we should radically curb children’s access to alcohol, eliminate the availability of cheap alcohol and regulate the siting of alcohol in shops and supermarkets. Those are the kinds of interventions that I feel we need, not just because of the direct overlap with obesity, but because of the obvious relationship between commercial sales, obesity and being overweight. In a supermarket, where do they put the sweets—they put them where you leave the shop, knowing that is where you make impulse buys. That is also the case in other kinds of shop. I am not going to mention the name of the shop, because I am speaking in the House of Lords, but you go out of the House of Lords, you get into the Tube station and there is a well known paper shop there. You buy a paper and they offer you an enormous chunk of chocolate, reduced in price by 60 per cent. That is ridiculous. You need some kind of structural regulation of the sale of certain kinds of food goods, and you need to break the pattern that is initiated by an organised consumer culture. That is essential both for alcohol and for food related to obesity and being overweight. Secondly, by all means do what my noble friend Lord Pendry is suggesting, which I strongly support, and encourage young children and young adults to take more exercise. We hope that the coming of the Olympics to this country will have some positive impact on that. Indeed, my noble friend mentioned the progress that has been made. But again, we are talking about massive social changes here, which underlie the phenomenon of obesity. This is essentially the transformation from an industrial, agrarian society, which happens with affluence, to a service-based society, a post-industrial society. A life of physical labour sustained the health of a large number of working people—although it sometimes also broke their health in coalmines. Now only 10 per cent of the population are involved in physical labour, and mostly it is not of the old kind. A post-industrial society is a car-based society. It has been mentioned that not many children cycle to school. Well, hardly any parents walk their children to school anymore; they drive them. So you are talking about a whole form of social organisation that underlines these patterns. A significant interventionist aspect of coping with obesity is actually intervention in urban design. That is the only way we are going to resolve these issues in a satisfactory way. I shall refer to one or two of the countries that were alluded to by previous speakers. Denmark has low rates of obesity, not just because of eating patterns, but because in Denmark you have a lot of cycle paths and quite rationally organised cities in which there is encouragement to use public transport and to walk to work. These sorts of things are structurally implicated in the phenomenon of obesity and therefore we have to intervene on this kind of level and have a convergence of policy. Thirdly, we should consider a more stringent and targeted use of the fiscal system, where it seems to me—strange though it might appear—that there is a kind of analogy with the politics of climate change. In fiscal systems, for obesity or being overweight, we should apply the "polluter pays" principle. For example, in New York State, a 15 per cent tax is being proposed for all sugar-based soft drinks. We should consider such tax-based interventions here, unpopular though they are with the food industry. We should recognise that producing structural change will meet resistance from vested interests in that industry, but it is in the interest of the Government to try to secure as much co-operation from it as possible. At the moment, the situation is very like climate change, because you have an industry that is deeply implicated in promoting a certain kind of diet, linked to a certain kind of sedentary lifestyle, where that industry does not pick up the social consequences of what it is producing. This is directly analogous to organisations that are producing greenhouse gases. They are not picking up the cost to the environment of those gases. We should apply the "polluter pays" principle to them. My concluding thought is that we had an interesting report from the Government yesterday on food security. We do have to plan ahead for food and I hope that the programme on food security will be extended to include the issue that has been the subject of this debate.