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Health: Obesity

My Lords, the purpose of this debate is to draw attention to the most serious epidemic to affect many parts of the world. The obesity epidemic will soon involve half the population of this country. It is killing millions of people, costing billions of pounds and the cure is free: eat less and live. The results of obesity cause great distress and suffering and include cancer, arthritis—which often needs joint replacements—and type 2 diabetes, which leads to blindness, loss of limbs, heart attacks, strokes and very much more disability. The best measure of obesity is the body mass index, BMI, which is the weight in kilograms divided by the square of the height in metres. In terms of body mass index, 20 to 25 is healthy, 25 to 30 is overweight, above 30 is obese and over 40 is morbidly obese. How is it that intelligent, well meaning leaders of this country have allowed themselves to be hoodwinked into believing the false information about obesity that it is all to do with a balance between the calories that we eat and the exercise that we take? Of course, they have been aided and abetted by NICE—or, under its more recent name, the National Institute for Health and Clinical Excellence. In its document on obesity of January 2010, NICE stated: "““A person needs to be in ‘energy balance’ to maintain a healthy weight – that is, their energy intake (from food) should not exceed the energy expended through … exercise””." There is its crucial mistake, because the real balance is between calorie intake and the total expenditure of energy in the body. The simple fact is that only 20 per cent of the calories we eat or drink are used up in exercise, which means that diet is five times more important than exercise in controlling weight. Put another way, if we were successful in doing something which has never been achieved before—namely, getting the population to double the amount of exercise that they do in a day—it would increase energy expenditure only by 20 per cent. If, on the other hand, every plate of food was reduced by half, this would reduce the calorie intake by half. We have to run 17 miles in order to reduce our weight by one pound of fat. Bearing in mind that as little as 20 per cent of the calories we eat or drink is used up in exercise, where does the remaining 80 per cent of the energy go? It is consumed by numerous activities over which we have no control: the heart beats 2.5 billion times in a lifetime, the kidneys filter 4.5 metric tonnes of blood and there are a myriad of activities in other organs of the body such as the liver, the pancreas, the bones and the alimentary tract. As regards those who believe that the energy from food is all used up in exercise, where do they imagine the energy comes from to run the heart, liver, pancreas, brain and so on? Perhaps they imagine that they run on air—perhaps hot air. The sad thing is that there are politicians in all parties and people in many well meaning organisations who have also been misled. Most of their publications have adopted the mantra that exercise and diet are the solution to obesity but few, if any, emphasise that diet is five times more important than exercise. Politicians persist in believing that the issue is about having a balance between diet and exercise because that is what the quango NICE says in its publications. When one examines what NICE published in January 2010, one sees that it recommends exercise and diet on seven pages and on three other pages it puts it the other way round, as diet and exercise. Nowhere does it state that reducing calorie intake is much more important and effective in reducing weight. On page 21, it recommends that obese adults should take more exercise even if it does not lead to weight loss. If treatment is not working, why not try another treatment such as eating less, which is five times more effective? But perhaps the most impractical advice in this paper was that people who have lost weight may need to do an hour and a half of exercise a day to avoid regaining weight. I must say that I would have been very disappointed if any of my medical students had produced a document such as this. But there is good news. I went to see the director of NICE, who has now admitted that the institute got it wrong. I look forward to politicians accepting this new advice that diet is five times more important than exercise. Why are people willing to turn a blind eye to this problem while millions of people suffer as a result? By saying that taking exercise is the answer, we avoid upsetting the millions of obese people whose excessive weight often prevents them exercising and we give them a good excuse to stay as they are. We deceive them by avoiding the heart of the matter which is that we need to eat less. Of course, those in the food industry are delighted to hear that lack of exercise and sports facilities are to blame for the obesity epidemic as that lets them off the hook. I have been asked not to be negative about exercise because all the political parties have been campaigning to increase activity and they do not want this momentum to be torpedoed. I understand that. I would never be negative about exercise because it is of great importance for the integrity of the heart and the control of the wrong sort of cholesterol. Exercise also gives a sense of well-being and high morale, but that does not alter the fact that what we eat is five times more important than exercise when we are dealing with weight control. The subject of obesity is beset with a number of red herrings. Many people believe that obesity is due to genetics, hormones, brown fat, psychological factors, sexual abuse and so on. These factors may help to explain why people eat too much but they are certainly not the cause of obesity. Those factors were around during the war when food was rationed but there was no obesity then, apart from those miscreants who were indulging on the black market. Over the years, I have had many obese patients who have assured me that they eat very little and sometimes they were speaking the truth. Their obesity was due to their alcohol intake. Noble Lords will perhaps know that three cocktails such as mai tai will contain 1,000 calories. That is another hazard for the unwary. There is a good deal of confusion about childhood obesity, which is now a very serious problem and getting worse. The organisation Change4Life has estimated that there are 1 million obese children under 16 in the UK, and around the world there are 2 million children under five who are overweight. We are beginning to see earlier and earlier the complications of obesity in these children, such as type 2 diabetes, heart disease, high blood pressure and cancer. Again we are bedevilled by the obsession that exercise is the solution, but reliable long-term scientific research clearly shows that overeating is responsible and that it starts in the first five years of life. There was a misleading article in the Daily Telegraph on 8 November 2010 headed, ““Exercise, not diet, key to obesity””. This was based on a Norwegian study which was fundamentally flawed. However, the same article mentioned the reliable work of Professor John Speakman of the University of Aberdeen, who presented unique data using state of the art technology. He found that rising obesity levels were due to increasingly excessive food intake. The overall physical activity levels have been constant over the past 25 years while weight levels have soared due to the greatly increased calorie intake. Professor TJ Wilkin of the Peninsula medical school has carried out a unique study, published in Archives of Disease in Childhood in 2009, that included annual measurements of physical activity and body composition over 12 years. This shows that obesity leads to inactivity, but inactivity does not lead to obesity. Furthermore it concluded that the pathway to obesity seems to be, "““set early in life, long before school age””." This questions the rhetoric around school meals, computer screens, PE time, playing fields and physical activity, which, of course, is unstructured in early childhood. A recent meta-analysis incorporating 15 reports on over 13,000 children concluded that a nine year-old child subjected to intense pressure for 18 months would lose on average just three ounces, or 80 grams. The obesity epidemic is killing millions, costing billions and the cure is free. Will Her Majesty’s Government embrace the essential fact that reducing food intake is five times more effective than exercise?