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Health: Obesity

My Lords, the noble Lord, Lord Pendry, deserves our thanks for giving us the opportunity to debate this extremely important public health issue, which we have not done for a considerable time. I thank him in particular for his very powerful opening speech. Indeed, I am sure that the Minister will agree that we have had some excellent contributions this afternoon from around the House, pointing to a good measure of cross-party consensus on this subject. Although I do not intend to fracture that consensus too much, because there are many things which the Government are now doing right, I think it is worth beginning by putting today's situation into context. We are living at a time when nearly a quarter of all adults in this country, and nearly a fifth of children, are obese under the standard definition. Those percentages have practically doubled since 1993. The real wake-up call, if any were needed, came with the Foresight report of two years ago, which predicted that, without corrective action, Britain could be a "mainly obese society" by 2050. Pro rata, the UK now has more obese people than any other OECD country except Mexico, the USA and, perhaps surprisingly, New Zealand. The penalty to be paid for this in the long term will be measured, certainly, in premature mortality; but its effects will chiefly be felt in terms of increased morbidity, which will carry with it a high knock-on cost to the general economy. The noble Lord, Lord Giddens, rightly mentioned diabetes. The seriousness of the threat posed by obesity is nothing new. However, that is why it is all the more reprehensible that, until recently, Ministers have failed to place due emphasis on it. The Minister may not like to be reminded that the last Conservative Government put considerable emphasis on this area of policy. As early as 1992, we set a target of reducing obesity to 6 per cent of men and 8 per cent of women. In 1999, the Government scrapped that target and did not replace it. It took two scathing reports—from the Chief Medical Officer in May 2003 and the Health Committee in May 2004—to prod the Government into setting a new target in July 2004. That target was to halt the year-on-year rise in obesity among children under 11 by 2010. What happened to that? It was abandoned in the 2008 Comprehensive Spending Review, when it became obvious that it was not going to be met. Instead, Ministers published a new target to reduce the proportion of overweight and obese children to 2000 levels by 2020. That is an incredibly ambitious target, bearing in mind that thus far the Government have not even managed to stall, let alone start reversing, obesity levels. For too long, the Government took their foot off the pedal when it came to the effort and resources devoted to the issue. The story is all of a piece with their general record on public health. In many major problem areas, such as deaths from alcohol and the incidence of sexually transmitted infections and teenage pregnancy, the trends have been and still are in the wrong direction. By their own admission, the Government are even on course to miss their target for infant mortality and life expectancy at birth. The difference between the life expectancy of the richest and poorest in our country is now greater than at any time since Queen Victoria. That is not the sort of legacy that any Government, let alone a Labour Government, would wish to leave behind. Only in the last two years has the government effort to combat rising obesity levels begun to take shape. Change4Life, with its various offshoots such as Start4Life, is a well conceived and worthwhile programme. It explicitly acknowledges that success in tackling obesity depends not only on the state, but also on industry and, crucially, families and individuals taking action. In this respect, the problem of obesity is different from the public health challenges that we faced in the past. The issue cannot be solved by passing laws, as we did with water sanitation in the 19th century and air pollution in the 1950s, because obesity originates in private space and does not impinge directly on the freedom or well-being of others. Any sustainable solution to the problem must start from that realisation. Only by changing people's attitudes and motivation will we be able to make a difference over the long term. What does it take to do that? Of course there is a role for government: regulation is important. The Government’s job is to provide leadership and an environment in which consumer tastes can be influenced and healthy eating choices made. The obvious examples of creating such an environment are food and alcohol labelling, making sure that there are consistent and clear public messages on nutrition, and making physical activity more accessible to greater numbers of people. However, if the key to the problem is changing people's motivation and attitudes, the trick is to encourage them to take responsibility for their own lifestyles and health. You do not encourage a sense of responsibility by nannying people and lecturing them on the negative consequences of being overweight. Instead, you provide them with positive messages about the benefits and enjoyment to be had from healthy living. You provide them with information with which to make choices, and examples and role models to follow. This applies to children as much as adults. Young people most of all have to feel empowered rather than put upon. We have to tap into their self-esteem. One mistake made by the Government was their failure to recognise that when they introduced healthier school menus. Healthy meals can deliver benefits, but they will not do so if there is no motivation on the part of the children and their families. The introduction of those menus led to an increase in the uptake of packed lunches stuffed with crisps and chocolates. What was the Government's response? To impose another regulation to inspect school lunchboxes. We ended up with mothers feeding their children burgers through school railings. Thankfully, the Healthy Schools programme has come some way since then, including, I am glad to say, the introduction of cookery classes. I quite agree with what the noble Baroness, Lady Walmsley, said about that. In fact, many of the decisions that people take about what they eat and drink are not really decisions at all; they are actions driven by force of habit—even compulsiveness, as the noble Lord, Lord Giddens, said. A lot of people damage their health without understanding what they are doing or how to put things right. In that context, the Minister may be aware of some research published recently by Volterra, which accounted for the rising obesity over recent years by reference to the phenomenon of peer acceptance. Peer acceptance is about people continuing to follow modes of behaviour because other people within their social group are behaving in the same way. People feel less pressure to change their actions and habits if their friends are not also doing so. It becomes socially acceptable to be fat. Volterra does not claim that that is the only factor that accounts for the rise in obesity—far from it—but it is certainly one that ought not to be ignored in any study of the subject. That takes us into an interesting realm: the psychology of human behaviour and the way in which societal norms are created and maintained. Those are difficult subjects for policy-makers, but ones that must be grappled with. I said that I am supportive of Change4Life, but if there is a difference between the Government's approach and that of my party, it relies in the split of responsibilities between the different stakeholders. My view is that regulation in areas such as food advertising has reached its limit of usefulness, apart from trying to put in place a consistent approach in all media channels such as the internet. On the other hand, the Government have taken too long to give a clear commitment on food labelling. The traffic light system may have the merit of simplicity, but its main flaw is that it characterises food as good or bad when what matters is whether a diet is good or bad. The EU Commission has said that we need to adopt a uniform system based on guideline daily amounts, combined with a colour indication system, and I agree. On interventionist measures, I also agree with what the noble Lord, Lord Giddens, said about urban design and the use of fiscal levers, particularly in relation to high-strength alcoholic drinks. Looking at the wider agenda, the food industry is capable of taking on greater responsibility for promoting healthy living—not just in reformulating products, which it is already doing very successfully, but in initiating and sponsoring exercise and wellness programmes. Many large food manufacturers are doing great work along those lines in schools, in the workplace and in the community under the Business4Life banner. I have no doubt that we should encourage more businesses, including SMEs, to buy in to that sense of shared responsibility. We owe a debt to the Advertising Association and, not least, to its former chief executive, my noble friend Lady Buscombe, for having secured a commitment worth about £200 million from industry to resource those initiatives. Recent reports have suggested that childhood obesity is levelling out. We need to treat those reports with caution, because some of them look only at averages. A team at University College, London, reported last month that obesity in children from wealthier backgrounds may indeed be improving, but that the problem is still getting worse—indeed, considerably worse—in children from lower socio-economic groups. Those are the people who should give us the greatest concern, and we should bear in mind, too, that hospital admissions of patients being treated for obesity have shot up over the last five years. Within normal value-for-money constraints, I believe we owe it to the Government to support them in any properly researched programme designed to combat obesity in the young. With an expanding buy-in from industry as well, it may at last be that we are on the right road to achieve results.