I thank Mr. Speaker for granting me this Adjournment debate, in which I wish to explore some aspects of the relationship between sugar and obesity.
I am happy to see the Under-Secretary of State for Health in his place, because this is the first time that he has replied to one of my debates. We have been colleagues for a long time, and I have great respect for him and praise him for the way in which he does his job. If I say anything too controversial, I hope that he will forgive me, because I mean only to highlight some contradictions, not to criticise the Government. I hope that he will take my comments in that spirit and perhaps take a couple of them away to think about, given that I have, without being sycophantic, supported my Government on every occasion.
Sugar is a crucial ingredient in many foods that are enjoyed by millions of people in the UK every day, but consuming large amounts of it can lead to obesity. It is only recently that we have recognised the scale of the obesity problem, and I congratulate the Government on having responded energetically and quickly. The evidence clearly shows that obesity has become a real problem. The number of obese people increases by more than 1,000 a month on average, and the Eurostat yearbook published earlier this year revealed that UK adult obesity levels were the worst in Europe.
A summary provided by the British Medical Association highlights the severity of the problem, stating:
“In the UK there are around 1 million obese children under 16 years of age…estimates indicate that, if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020.”
Every year, the health service spends at least £2 billion on treating ill health caused by poor diet. Soaring rates of obesity have led to an increase in childhood type 2 diabetes and will lead to more cases of heart disease, osteoarthritis and some cancers. The rise in type 2 diabetes among children parallels the steadily rising rate of obesity. Type 2 diabetes was once seen only among adults—the average age for developing it is 52—so the increase among children is worrying. In the five years between 1996 and 2001, the proportion of children aged between 6 and 15 who are obese rose by 3.5 per cent.
Obesity is responsible for 9,000 premature deaths a year in England and reduces life expectancy by an average of nine years. The National Audit Office estimates that 18,000 sick days a year are linked to obesity, costing the economy at least £2.5 billion a year, which includes the cost to the NHS and the cost of sickness absence to industry. According to the Department of Health, the rise in obesity, particularly among children, “threatens disastrous consequences.” If it continues, it could cost the economy £3.5 billion a year by 2010. The threat is therefore considerable, and the momentum behind increasing obesity means that it will be hard to stop, let alone to reverse. There is no doubt that the Government are responding to this great challenge, and I praise the Secretary of State and all the Ministers involved. However, the Under-Secretary will agree when I say that all available levers will have to be used effectively if success is to be achieved.
I want to draw attention to the school drinks regime, which needs to be looked at. Strictly speaking, it is a matter for the Department for Education and Skills, but that Department is taking advice on it from the Department of Health. Two of the most important factors to consider when deciding what drinks should be readily available in schools are calorie content and hydration. The effects of dehydration on learning have been shown in many studies, but they are not widely recognised or acted on. The UK expert group on hydration reported on a study conducted at Leeds university that showed that children’s ability to do arithmetic was impaired even if they were only between 1 and 2 per cent. dehydrated. The group advises that 40 per cent. of 11 to 18-year-olds do not drink the minimum amount of 1.2 litres a day recommended by the Food Standards Agency. It concluded that children should have access to a wide variety of beverages to encourage them to drink frequently.
The Government have recently addressed the issue of the range of drinks available in schools by setting out lists of foods and drinks that are prohibited in schools. Smoothies and fruit juices, which are high in nutrition, are still sold in schools, and rightly so, but they are expensive, fairly high in calories and not particularly good for hydration. However, low-calorie soft drinks, which are good for hydration and which tend to cost less, are prohibited. In effect, the school drinks regime bans all low-calorie cold drinks apart from water. Put simply, that means that one of the only options available to children who are thirsty but who are reluctant to drink water is expensive calorific drinks that will not hydrate them sufficiently. An alternative is for youngsters to bring high-sugar drinks from home or to buy them from off-school premises.
It is not too late to make adjustments to the school drinks regime. It would be absurd to be concerned about overweight and obese children, but to introduce a drinks regime that became part of the problem rather than part of the solution. The genesis of the new school food programme took place before our awareness of obesity increased, so the drinks regime might not take obesity into account to the extent that we surely now require. A recent undated “Dear Stakeholder” letter from the School Food Trust details several difficulties. It says that translating the school meals review panel recommendation on “pure” drinks is difficult given that European legislation sets safety standards for ingredients, and adds that changes might be required to the EU legislative framework. Does that mean that UK regulations covering drinks in schools cannot yet be tabled?
If the review panel had asked parents whether they wanted pure drinks, I am sure that it would have got a lot of positive responses. However, I am equally sure that if it went to parents now and asked whether they wanted to ban all low-calorie cold drinks apart from water from schools, bearing in mind the perils of dehydration and weight gain, the answer would be no. Such confusion is in clear contrast to the formula adopted by Ofcom in restricting television advertising to children of foods that are high in fat, sugar or salt. The definition of such products has not led to arguments with industry or conflicts with the EU legislative framework, and I commend it to the Department of Health and the Department for Education and Skills as a way ahead, in contrast to their more complex attempt to set menus. Of course, such an approach would lead to a different list of cold drinks that were allowed in schools. That is not to say that juices and smoothies, or other higher-calorie but nutritious drinks, should not be allowed. However, they should be available along with low-calorie options so that they are not used to prevent dehydration.
Recently we have become more aware of sugar in our diet, but I was surprised by the Government’s response when last year in the other place, Earl Howe raised the question of the link between sugar and body weight. Lord Warner replied:
“The available evidence on the relationship between sugar and body weight is not clear. More evidence of whether sugar is associated with body weight and obesity is required before definitive conclusions can be drawn.”—[Official Report, House of Lords, 4 May 2006; Vol. 681, c. WA96.]
That alarmed me a little. It is obvious to everyone that high consumption of high-calorie foods such as sugar has an effect on weight gain. We can surely all agree on that.
In the past two decades UK sugar consumption has increased by 31 per cent., to 1.25 lb per person per week. A comparison of the 1978 and 2002 editions of the industry handbook on the nutritional value of foods, McCance and Widdowson’s “The Composition of Foods” shows that many foods that were previously thought to be healthy and largely sugar-free are anything but. For instance, in 1978 Kellogg’s Special K had 9.6 g of sugar per 100 g; it has since risen to 17 g per 100 g. In crude terms, that means that that breakfast cereal now contains almost as much sugar as vanilla ice cream.
The Food Standards Agency wants food companies to reduce the amount of sugar in their products, and is so worried about the trend that it is considering imposing legal limits. Sainsbury’s says that it is looking at the products that it sells to see whether it can reduce sugar and salt levels, but earlier this month it announced a reformulation of its own brand of regular soft drinks, replacing all low-calorie sweeteners with sugar. The timing is particularly surprising, given that both the European Union and our own FSA are considering how to encourage reformulation to limit sugar content. If progress is to be made in that respect, the Government must have a constructive relationship with food manufacturers. I believe that we can do slightly better.
I shall now focus on the role of low-calorie sweeteners. In previous statements about tackling obesity, the Department of Health and the Food Standards Agency advised against fizzy drinks, but that blanket condemnation failed to recognise that sales of diet colas containing virtually no calories outstrip sales of full sugar versions in the UK. To lump all fizzy drinks together when talking about obesity is misleading. Late last year, at a meeting with the FSA, industry representatives were told that future FSA advice would be against sugary drinks, not fizzy drinks. There seems to be a contradiction between that advice and the school drinks regime. If the FSA is advising against sugary drinks, how is it that smoothies and juices are still on the menu? That question highlights the need to focus on the properties of the drinks that are prohibited, rather than the broad categories that they fall into, as currently happens.
One of the arguments that are used against low-calorie sweeteners is that they encourage a sweet tooth. I have not seen any studies or scientific evidence to demonstrate that. I am happy to apologise to the Under-Secretary if he can produce such evidence. Any studies that have been done have rejected such a conclusion. Following through on those studies, the School Food Trust amended its advice on its website, and even the National Institute for Health and Clinical Excellence was asked to clarify its advice to the public. I assume that if industry were to come up with a salt substitute that passed all the safety tests, the Government would give it a warm welcome. Yet at the moment there are safe sugar substitutes and the Government are hesitant about endorsing or encouraging them.
I have received a briefing from Ajinomoto, the largest food manufacturing company in Japan, which manufactures the low-calorie sweetener aspartame. Aspartame is the most widely studied food additive, with more than 200 published papers about it. Any paper that has raised a serious health concern has failed at basic peer review level. Most recently, in May 2006, the European Food Safety Authority reconfirmed its safety. It is unsurprising that aspartame should be safe, given that it is a simple combination of two amino acids that occur naturally in our bodies.
Professor Jack Winkler, director of the nutrition policy unit at London Metropolitan university has said:
“The choice between sugared and sugarfree drinks represents one of the fundamental choices you face in nutrition policy. Do you try to encourage people to adopt the ideal diet for the human animal (the principled approach) or do you start from where people are at and lead them slowly in the right direction (the pragmatic approach)? Translating that into terms of sugar, do you try to deny people the sweet foods they love but do not need, or do you accept their preference for sweet foods, but try to restrict the adverse consequences for weight and teeth by substituting some of the sugar with sweeteners? I am an unapologetic pragmatist.”
Experience has taught us politicians that we must usually take the pragmatic approach, but there is a good argument for saying that officials have been inclined to take what Professor Winkler describes as the principled approach. Perhaps that has led to some of the lack of agreement with industry on the school drinks regime.
Again, the clarity of Ofcom’s definition,
“high in fat, sugar and salt”
commends itself. The benefits of sugar substitution in the fight against obesity are widely recognised by clinicians, academics, slimming organisations and of course the general public. The Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), has acknowledged that sugar substitution with low-calorie sweeteners has a role to play in reducing energy intake. I therefore urge the Under-Secretary to reconsider which drinks are allowed in schools.
I praise the Government for being proactive in tackling obesity, which is a huge public health concern in the UK today. I know that this is not in the Under-Secretary’s remit, but in that of the Minister of State, Department of Health, my hon. Friend the Member for Don Valley. However, if he thinks that there is room for further discussion and that we can make progress, I shall be happy to seek a meeting with him and bring with me some of the people who have made me aware of the issue, to explore it further. If, on the other hand, he thinks that it would be a waste of time, I shall be happy for him to tell me, “You go your way and I will go mine on this issue.”
My hon. Friend has always been very helpful, and I want to make it clear to him that my comments are meant to be helpful to the Government. This issue has been raised with me by youngsters in my constituency, and I raise it today to ask the Government to focus a little more sharply on policy and to eliminate contradictions. However, I know that there are different considerations to balance. In conclusion, I reiterate that I am trying to be helpful and to make progress. I will be happy if my hon. Friend goes away and thinks about my comments, because it is not often that I get up and say that the Government have got things slightly wrong. I generally praise them from the rooftops.
We come to the Front-Bench speakers, who have a limit of 23 minutes each.
Thank you, Mr. Chope, but I suspect that I shall not take up all of that generous offer.
I congratulate the hon. Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this debate on an important issue, even though other hon. Members have not seen it as such. I do not intend to blame all of the problem on the Government or to be partisan about it, because there are genuine and serious issues involved that need proper, rational discussion. I was interested to hear the hon. Gentleman’s comments on sugar substitutes, and I learned a lot from listening to him.
I start with the problem of obesity. The hon. Gentleman gave some frightening statistics, especially about the youngest children. Of children aged between two and 10, some 9.9 per cent. were obese in 1995, and 13.4 per cent. were obese in 2004. That is an alarming rise. I shall go on to discuss the public service agreements that three Departments entered into in 2004 to halt that trend by 2010, but the trend is very much in the other direction at the moment and is extremely alarming.
Thirty-one per cent. of English 15-year-olds are overweight. As the parent of two teenage sons, I know that parents see this problem all around them among their children’s friends. There is a balance to be struck between diet and exercise, which are equally important, but I shall return to that point. Too many youngsters are overweight, and one increasingly has the sense that parents do not notice what is happening to their children, which I find alarming. An extraordinary 17 per cent. of 15-year-olds are obese. Not only this country is affected. I understand that British children are among the fattest in the world, but the trends are similar across the developed world—the number of obese children across the whole of the developed world almost doubled between the 1980s and the 1990s.
What are the effects of those alarming trends? The life expectancy of anyone who becomes obese is reduced by an average of nine years, which contradicts all the trends in the other direction as countries develop. As the hon. Gentleman said, there is also an impact on health in the form of type 2 diabetes, cardiovascular disease and certain cancers, as well as the mental health problems that are associated with obesity, which should not be forgotten. Another effect is the cost both to the individuals concerned and to society as a whole. It is estimated that up to 7 per cent. of health care costs across the EU is committed to dealing with obesity-related illnesses. That is extraordinary.
Let us consider the role of sugar. I was alarmed by the quote from Lord Warner, which I had not heard before, that no clear link had been established between sugar and body weight. The Government ought to be working on the precautionary principle, and such an apparently complacent attitude on the part of a Minister rather contradicts the whole approach of the Food Standards Agency, which is pushing for action to reduce levels of sugar in food. I would be grateful if the Minister would specifically address Lord Warner’s comments. Does he accept them, or does he think that even if the evidence is not all there yet, we have to work on the basis that there is a link and that we must take action to reduce sugar levels?
Sugar consumption has implications not just for obesity but for tooth decay. I had the pleasure of visiting my dentist yesterday, and he commented on the extent of work that had been done in my mouth. He told me that things had improved an awful lot for children’s dental care in the years since I was born, but there is a danger that things will slip in the other direction because of the significant increase in sugar in our diets.
In an article in the British Medical Journal, an academic likened sugar to a hard drug and said that it was addictive and harmful—potentially as damaging as tobacco. There is a danger of us all becoming food fascists, and my general approach to such issues is that we should take everything in moderation and that sugar can play a proper part in a balanced diet.
I would not for one moment accuse the hon. Gentleman of being a food fascist, but if he were to remove sugar from people’s diets, what would he replace it with, given the relative calorific value of the alternatives?
I was about to discuss the changes in the sugar content of certain familiar products in the past few years. Perhaps I can deal with that first. There is an excessive amount of sugar in our diets. I am no expert—the hon. Member for Westbury (Dr. Murrison) is much more of an expert than me, and I shall welcome his contribution—but there has been a lot of analysis of the sugar content of foods in the past 30 years. The hon. Member for Middlesbrough, South and East Cleveland also raised this issue.
It seems that the sugar content of many foods has doubled. There is a particular problem with foods such as cereals, because there is a widespread assumption that they are a good, healthy food. The hon. Gentleman told us that the sugar content of Special K, which I think everyone assumes is broadly a healthy food, has doubled since 1978. Most consumers would also think of wholemeal bread as a healthy product, but Hovis wholemeal has 3.7 g of sugar per 100 g—three teaspoons of sugar per three slices of bread. That is amazing; I had no idea that its sugar content was so high.
Which? has discussed the sugar content in many ready meals. We live in an ever more frenetic society in which, often, both parents work and so increasingly rely on ready meals. However, the sugar content of ready meals is much higher than that of the food that families would previously have cooked themselves. Many ready meals have a sugar content as high as 23 g per 100 g. I would never have realised when I sat eating my Waitrose tomato soup that it contained 6.4 g of sugar per 100g. So, the trend of the past 30 years has been that many food manufacturers have dramatically increased the sugar content of their foods.
What should we do about it? In a sense, there is a conflict between concerns about the nanny state and the Government seeking to control or heavily influence behaviour, and the imperative to tackle a serious public health issue. The trends are so serious that we must do something, and Government, industry, other public sector bodies, such as local government, and individuals all have a role to play.
The Public Accounts Committee examined the Government’s situation, referring, in December, to the public service agreement of 2004. That was signed up to by the Department of Health, the Department for Education and Skills and the Department for Culture, Media and Sport. The particular commitment was to halt
“the year-on-year rise in obesity among children under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole.”
We may be most concerned about obesity in children, but the trend also very much afflicts the rest of the population.
The Public Accounts Committee drew attention to the fact that there were no ring-fenced budgets or specific programmes, and that the approach was to try to influence existing Government programmes and the food industry to change the formulation of products. I fully appreciate that the PAC was commenting on a previous period, that things have moved on since and that some things have improved. However, its conclusion was that “little concrete action” had been taken.
Since then, we have seen the traffic lights initiative on food labelling and the Ofcom rules on advertising in respect of children’s programmes. Both measures have been controversial and there has been pressure on Government and regulators from both sides to push in one or other direction.
Some products show guideline daily amounts—the alternative, industry solution—as opposed to the traffic lights system promoted by the Food Standards Agency. I am conscious that the food industry is spending a fortune on fighting its corner, because it recognises the potential financial impact in relation to some of these products. I understand its concerns that as products are reformulated, they need to maintain their attractiveness so that they can sell them. It is legitimate for the industry not to want massively to damage its business. There must be an objective assessment of the evidence during this, in a sense, trial period involving the two competing approaches. The industry says that it wants eventually to implement whatever is most effective, so there is an onus on it to demonstrate that its scheme is effective. It is important that it works closely with Government and the FSA to ensure that whatever emerges is based on objective evidence and a rational decision about what works best.
Judging by what I have seen so far, we need something that is simple, that consumers understand and that guides behaviour. That pushes me, perhaps rather reluctantly, in the direction of a traffic lights system. There appears to be some evidence that consumers are changing their purchasing habits and identifying the information on the packaging.
There is a duty on the food industry to behave responsibly. Large companies all sign up to the concept of corporate social responsibility. In this regard, their corporate social responsibility is to take a lead, rather than just be pushed, to ensure that their products are as healthy as possible and to reformulate as much as they can in order to address the dangerous trends that we are witnessing.
As for the Ofcom measures, there is a lot of pressure to go further than Ofcom has gone and to adopt the 9 pm watershed prohibition. As policymakers, the Government, the FSA and Ofcom ought to make a rational, objective assessment of how the regime is working before deciding whether more draconian measures are necessary.
In February, one of the Minister’s ministerial colleagues said:
“We now look to the Committee on Advertising Practice to put in place similar rules for…cinema, magazines and the internet.”
I would be most grateful if the Minister could update us on exactly what has happened in that regard. Are those rules in place or likely to be in place soon? That commitment was made back in February, so it would be valuable to know whether action had been taken.
I said that other public bodies had a role to play. In preparing for this debate, I noted that Liverpool city council, a good Liberal Democrat council, is taking the sensible step of removing drinks machines that sell very sugary products from its main sports facilities. The Norfolk and Norwich university hospital has Coca Cola machines throughout its buildings, and in this day and age, that is rather bizarre. My concern is that the hospital is driven by the money that the machines provide rather than what is in patients’ interests.
Some valuable trends are occurring in schools, and the Government have played a part in those. However, I know of schools in my constituency that have rejected the dismal food that comes from the county council’s provider and have opted for their own, in-house cooked meals, which are of a high standard. I enjoyed a meal at Stalham middle school, where the quality of the food was tremendous. This is happening all over the place, and it is a good thing.
I want to end by again making a point about exercise. This debate is about one part of the equation, the importance of exercise being the other. Disturbing trends can also be seen in that regard, because there are lots of pressures on families, particularly given the development of the internet. There is a trend for children to remain sedentary and not go out and get enough exercise. Some children and teenagers have an embarrassment factor that puts them off some of the traditional sports, so we must be open-minded about the whole range of sports and exercises in which they can engage. It is crucial to get the message across, through schools, sports clubs and so on, that exercise is important.
I am practising what I preach, because I am training for the great London run on 1 July. Incidentally, I am accepting sponsorship for Cruse Bereavement Care, which is an excellent charity. Last night, I ran 9 km around the course—I am still here to tell the tale, although my body has somewhat seized up. Exercise is incredibly important for children and adults, and the Government must keep repeating that message.
I shall try not to expand my contribution to fit the time available. I congratulate the hon. Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on raising this important subject and on his having consistently done so over several years by way of parliamentary questions and early-day motions.
It is important to avoid junk science and drawing easy conclusions. We know several things about the subject, without fear of peradventure. We know that obesity is dramatically on the rise, and we have a particular problem in this country according to the Eurostat data that has recently become available. We are on safe ground in asserting that obesity can lead to conditions such as type 2 diabetes, coronary heart disease, cerebral vascular disease, various forms of arthritis, cancer and probably some forms of mental ill health, but in 2002, the National Academy of Sciences concluded:
“There is no clear and consistent association between increased intake of added sugar and BMI”—
that is, body mass index. The hon. Gentleman alluded to that, and it is central to any debate about obesity and sugar.
Although the hon. Member for North Norfolk (Norman Lamb) was kind enough to say that I am an expert, I am not. It is important not to draw easy conclusions. As the hon. Gentleman said, relativity comes into it, but most of us as lay people probably feel that sugar does lead to obesity. Indeed, a core sugar has a calorific value, but so do many other substances. My intervention was aimed at establishing that we should not necessarily assume that sugar will lead automatically to obesity. If sugar is removed from the diet, what is it replaced with?
I hesitate to mention the Sugar Association because it clearly has an interest in a debate about sugar. Nevertheless, it points out legitimately that fats deliver more than twice the number of calories per gram than the carbohydrate sugar. Furthermore, and probably more importantly, fat is laid down while energy from other sources is quickly burned off. It would be beneficial to think a little more laterally about the contribution that sugar and other forms of energy-providing substances make to obesity.
When trying to work out what is fact and what is fiction, it is probably worth while reflecting on energy in and energy out. There has been a recent series of interesting results from academic institutions that have looked at the energy-out side of the equation. We cannot consider energy in—sugar—without considering energy out. The Minister will be aware of Plymouth’s prospective EarlyBird study and the recent cross-sectional study at Bristol university. On first examination, they appear to be contradictory, but when taken together they show that there is a difficulty in the assumption that providing exercise for schoolchildren will alter behaviour in the long term.
I was disappointed to read the results of the prospective study from Plymouth because I would like to believe, as I am sure would the Minister, that providing sports facilities and exercise in schools will lead to a long-term change in people’s behaviour so that they enhance the energy-out side of the equation. Unfortunately, that research suggests that the pattern is more complex. I would like to know where we are with the “Choosing Activity, a physical activity plan” of March 2004, which was relaunched in August last year, particularly in the context of focusing on energy out and taking into account those two important studies, the results of which we had earlier this year.
The hon. Member for Middlesbrough, South and East Cleveland mentioned fruit juices and smoothies. Most of us assume that smoothies are a good thing. Certainly the packaging suggests that they are full of good stuff and sometimes that they contain as much as five pieces of fruit compressed into a little bottle. Therefore, they seem to be a good thing and an easy way of satisfying the Government’s insistence that we should consume five pieces of fruit or veg a day. They are, of course, high in good things such as antioxidants, but they may also be high in substances such as sugar, so how do we play one off against the other?
The hon. Gentleman also mentioned dehydration. I have had correspondence from various authorities on the subject, but I am having difficulty in working out what part dehydration plays, particularly as we live in a temperate climate. I am not aware that the Food Standards Agency has looked at the issue, and I would be interested to know what it makes of it and particularly what it thinks about reports that dehydration degrades people’s ability to do maths in schools.
The school fruit and vegetable scheme was launched three years ago at a cost of £77 million, and I understand that the Department of Health is reviewing that. Will the Minister comment on where we have got to with that review and with emerging reports that it has not significantly changed behaviour? I would be interested to know whether the Minister, on the basis of the evidence available to him now, intends to change the school fruit and vegetable scheme and, if so, in what way. While he is about it, perhaps he would comment on other initiatives that have been launched since the White Paper “Choosing Health”—for example, the teen life check and the obesity toolkit.
Initiatives introduced by the Government and their agencies often have unintended consequences, and I am thinking particularly of the FSA’s attack on salt, which I fully support. However, it seems that there is a conflict between salt and sugar. As I said about the competing benefits of various substances in smoothies and fruit drinks, we must compare and contrast, and work out what is for the best. Kellogg’s has been up front and said that it is adding sugar to some of its cereals because salt is being reduced, presumably because of pressure from the Government and their agencies.
We have heard about Special K, which I do not recall having had for a long time, but my parents and grandparents used to have it and it seems that it was a lot less sugary back in 1978 when the data started to be gathered for the Widdowson textbook, which is the trade text. The sugar content has risen dramatically since then.
Various other foodstuffs were discussed by the hon. Members for North Norfolk and for Middlesbrough, South and East Cleveland, and I shall not repeat what they said, but I am a little alarmed to find that fruit and even vegetables are now being bred to enhance their sugar content. The carrots that I ate in 1978 contained 5.4 g of sugar per 100 g, but that increased alarmingly to 7.4 g of sugar per 100 g in 2002 to match consumers’ palates.
Waitrose soup has been mentioned but, unlike the hon. Member for North Norfolk, I do not eat it as I do not have a Waitrose near my house. I have an Asda, and its sticky chilli chicken contains 19.2 g of sugar per 100 g. Tesco’s crispy beef and sweet chilli sauce contains 23.1 g per 100 g, which is a remarkable amount of added sugar. Neither of those products appeals to me, but clearly they cater for consumers’ tastes. If other palatable ingredients, such as salt, are driven down, inevitably they must be replaced with something if the company is to continue to sell its products. I am slightly concerned that in forcing down one ingredient, we are driving up others without having first assessed which ingredient is more damaging.
It seems that the link between sugar and obesity has not been established, so the FSA might reasonably take the view that salt, which is proven to be harmful, must be its prime focus, rather than sugar.
My impression is that the FSA has moved on to sugar. Is the hon. Gentleman saying that it is not wise to do so, and that it ought to stick with salt? The FSA gives the impression that it must tackle sugar.
I am not sure that the FSA has moved on, and I hope that it does not move on as the hon. Gentleman suggests, because that would be the wrong way to consider the problem. We cannot leap from one substance to another; we must consider the issues holistically. That is the guts of what I was trying to put across.
There is, however, clear and largely uncontroversial evidence to link high salt content with various forms of ill health, hypertension and the sequelae of that. We hear from various authorities that the link between sugar intake and increased BMI is not so well established, and it would be a pity if in chasing down sugar, we drove up salt, which is uncontrovertibly linked to ill health. That would be a dangerous thing indeed.
The question is about balancing one with the other, and I am not sure that even the FSA—sage organisation that it is—would have either the answers or the ability, given our knowledge about the subject, to strike a reasonable balance between the two. I accept that it is important for the FSA to consider sugar, and that it tries to improve our evidence base, but I am pretty clear that its chief target recently has been and continues to be salt. If that is true, that approach is entirely rational.
I suspect that there is a link between sugar content and cost, and I should be interested to know the Minister’s view on that. The hon. Member for Middlesbrough, South and East Cleveland referred to Professor Jack Winkler of London Metropolitan university, who blames European trade reforms for making sugar cheaper and for contributing to obesity. He has made the link between sugar and obesity; others may be more cautious about doing so. However, I need no encouragement to attack the evils of the European Union and its doings, and I should be interested to hear whether the Minister shares Jack Winkler’s concerns about its impact on the price of sugar, and therefore, according to Professor Winkler, on obesity in this country.
The hon. Member for Middlesbrough, South and East Cleveland mentioned sweeteners, and like me he has received a briefing from Ajinomoto about aspartame. Does the Minister believe that low calorie sweeteners of the sort referred to by the hon. Gentleman and approved by the European Food Safety Authority in May 2006 are to be encouraged? If so, how does the Minister think they might be used as a replacement for sugar, sucrose and dextrose in the UK diet?
Advertising is important in the debate. The Minister called on the Committee of Advertising Practice in February to put in place rules governing the advertising of food high in fat, sugar and salt in non-TV media, and the hon. Member for North Norfolk referred to that. I believe that rules concerning magazines and cinema will come into force in a few days’ time, but I am less clear about rules relating to the internet, computer games and mobile phones. I should be interested to hear whether the Minister’s call on the committee a little while ago has resulted in the drafting of any rules for the advertising of products high in fat, sugar and salt to children through those novel media.
In the large amount of time remaining to me, I shall mention briefly the impact of labelling. It is important for people to understand as fully as possible what they are buying and consuming. The Food and Drink Federation wrote to me, essentially supporting the guideline daily amounts method of front-pack labelling. I suspect that it wrote to other hon. Members, too. It provided many obliging statistics, and pointed out that
“50 per cent. of UK retail food and drink packs now carry this”—
The other major means of providing such information is through the traffic light scheme that the FSA has been—up to this point—very keen on, has been trialling, and, we understand, will be reviewing to determine whether it needs to alter its tack or remain on its set course. Whichever scheme ultimately emerges as the victor, it must be the one that is most user-friendly, most likely to alter people’s purchasing preferences, and thereby the products that are available on predominantly supermarket shelves.
However, I sound a cautionary note about nutrient profiling, for all the predictable reasons. We have heard about the red-lighting of dairy products such as milk and cheese, and of other products such as Marmite and tomato ketchup, which is based on the nutrients that they contain in 100 g of product. I do not know about you, Mr. Hood, but the last time I consumed 100 g of ketchup or Marmite at one sitting was a very long time ago. Such information does not seem to be terribly relevant to what people actually consume and how they actually behave. That is one of my chief problems with nutrient profiling.
In 2005, “Commissioning Obesity Services: PCTs’ Services and Strategies” was published. Its methods for tackling obesity do not appear to have been rolled out terribly well, and I should be interested to hear how the Minister feels about the prescription of various forms of weight reduction, such as those that Weight Watchers and Slimming World provide, which appear to be cost-effective when compared with the cost of medication for dealing with obesity.
How is the quality and outcomes framework being used to tackle obesity? GPs get very few points for addressing obesity through the QOF, and given the scale of the problem, which we heard about from the hon. Members for Middlesbrough, South and East Cleveland and for North Norfolk, it seems strange that a mechanism that was set up to improve health should fail so signally to address one of the biggest public health problems that we face today—obesity.
I congratulate my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this Adjournment debate and on campaigning on the issue for a long period. As well as being my hon. Friend, he is a very good friend, and he says quite rightly that, usually, he praises fully the Government’s achievements. Today, however, he has raised some extremely important issues that are worthy of serious consideration.
The Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), who leads on public health issues, would welcome the opportunity to meet my hon. Friend, and anybody else whom he felt useful, to discuss the issues that he has raised. It is always good to offer meetings on behalf of colleagues; whether they thank me for it is an entirely different matter. However, it would be useful if such a face-to-face meeting were to take place.
All hon. Members who have contributed to this debate have defined the scale of the problem. It is serious for the individual affected and a major challenge for families in this country. It also presents new questions for our society and raises significant issues for our economic well-being going forward. Tackling such issues must, however, be a shared responsibility. There is no one partner in society who alone can tackle and resolve these fundamental and profound issues. The Government must of course fulfil their responsibility, but so must parents, in the case of young people. In the case of older people and adults, there is a responsibility on citizens. There is also the question of the role of the regulatory authorities and the behaviour, in respect of both self-regulation and corporate responsibility, of industry and the private sector in those regulatory regimes. Every partner needs to play their full part if we are to have a chance of tackling the issue on a long-term and sustained basis.
To turn to some of the progress made, this country’s strategy is acknowledged internationally as being progressive and positive. Progress has been slow, but it has been significant. There has undoubtedly been a positive change in people’s awareness of the importance of healthy living, and there are signs that children and adults are beginning deliberately to adopt healthier eating and physical activity habits. The fact that we as a society debate the issue, as well as the fact that people reflect on their behaviour and the impact that it has on their health, the quality of their lives and, in the most extreme cases, their life chances, is an important advance. A few years ago, such issues were not at the forefront of people’s minds or anywhere near the public policy agenda, so we have made significant progress.
There are also many statistics that reinforce that belief. For example, there has been a 7.7 per cent. increase in expenditure on fruit and vegetables, which is the biggest increase for more than 20 years, alongside a 6.1 per cent. decrease in expenditure on confectionery. In 2006, 72 per cent. of people were aware that they should eat at least five portions of fruit and vegetables a day, which was an increase from 51 per cent. in 2002. In 2005-06, 80 per cent. of schoolchildren did at least two hours of school sport a week, which is up from an estimated 25 per cent. in 2002. The figure is also higher than our target for that period, which was only 75 per cent. There is also no doubt that children’s fruit and vegetable consumption is increasing, with 17 per cent. consuming at least five portions a day in 2005, which is up from 10 per cent. in 2001. There is therefore evidence that significant progress is being made.
What would the Minister say to the National Foundation for Education Research and the university of Leeds, which seem to think that the schools fruit and vegetable scheme has not succeeded in its stated intentions?
The hon. Gentleman raised that issue earlier, which I shall deal with head-on in a few moments. It is as though he would be pleased if what he has described was the case, which I find alarming for an hon. Member trying to make a mature contribution to the debate. However, I shall deal with the point directly in due course.
A lot of changes have been made. For instance, the Ofcom changes have restricted TV advertising of food and drink high in fat, salt and sugar to children, while new rules from the Committee of Advertising Practice will come into effect on 1 July. Tougher nutritional standards for school food have been announced and front-of-pack labelling now makes it much easier for consumers to understand the nutritional value of processed foods. NICE published guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children in December last year. There has also been partnership working with the National Heart Forum on revising its toolkit, “Lightening the load: Tackling overweight and obesity”, which aims to support local areas in developing local strategies to tackle overweight and obesity in children and adults.
There has also been the new “Healthy Start” scheme, as well as new care pathways for NHS primary care professionals and self-help guides for patients. The Government launched the national step-o-meter programme, which has trained 4,000 primary care health professionals across 220 PCTs in motivational interviewing and the use of pedometers as a motivational tool. Nearly 20,000 schools have volunteered to be “Healthy Schools” or are working towards becoming one, which is more than 85 per cent. of schools in this country. That is incredibly important, if we think about the potential for long-term and sustained change that it gives us. There is now also a coalition of 150 organisations in the public and private sectors, working together and using social marketing techniques to develop a deep understanding of the drivers of families’ food and physical activity habits. Significant progress has been made, but it is important to acknowledge, as hon. Members have done, that we still have a long way to go in tackling the challenge.
I should like to turn to some of the points that my hon. Friend and other hon. Members made about sugar, drinks and obesity. There is limited scientific evidence regarding intakes of sugar-sweetened drinks and weight gain, and it is unclear whether an association exists. It is hard for me as the Minister to relate to that, but that is what the scientific evidence suggests and we cannot afford to ignore that scientific and expert evidence.
Has my hon. Friend the Minister commissioned studies through his Department or is he relying on external research work? If he is saying that he cannot see the evidence, surely the sensible thing, given the size of the Department’s budget, is to commission its own research work. That would keep the researchers occupied for a long while.
I should like to refer to other research that has been conducted on the issue. For example, the World Health Organisation report on chronic diseases, which was published in 2003, did not directly link sugar with weight gain, but suggested that a high intake of free sugars in soft drinks possibly promotes weight gain, which is an important nuance. The Food Standards Agency considers there to be insufficient evidence to make a judgment on sugar-sweetened drinks and obesity, but continues to monitor the evidence as it emerges, which is important.
The Minister mentioned the Food Standards Agency, but as The Sunday Times reported in May:
“The Food Standards Agency…which launched a crackdown on salt two years ago, wants companies to reduce the amount of added sugar in food products and is even considering imposing legal limits.”
Does he fully support the FSA in pursuing the level of sugar in some products or is he saying that there is insufficient evidence for us to adopt a precautionary approach and seek to reduce levels?
I agree entirely with the hon. Gentleman, who made the point about the precautionary principle in his earlier contribution. That is why we as a Department are working with the FSA and the industry to reduce sugar in a range of foods. The Department for Education and Skills and the School Foods Trust are also working to take the issue forward. I agree with the hon. Gentleman’s point that we should proceed on the precautionary principle. I support what the FSA has said recently; its point is that we need to assess evidence as it emerges and adjust our strategy accordingly. We need to proceed by using the precautionary principle as the basis for moving forward.
The World Health Organisation report did not directly link sugar with weight gain, but did suggest that a high intake of free sugars in soft drinks possibly promotes weight gain; I made that point earlier. The physiological effect of energy intake on satiation and satiety from sugar in fluids was found to be different from that from sugar in solids. Sugar in fluids was found to be less well detected by the body, leading to incomplete compensation of energy at subsequent meals.
A systematic review of sugar-sweetened drinks, weight gain and obesity, published by Malik et al. in 2006, has also been helpful. It assessed 30 studies and concluded that, in general, greater consumption of sugar-sweetened drinks is associated with weight gain and obesity. However, several of the epidemiological studies reviewed had inherent problems, including small sample size and short follow-up, and were confounded by other dietary factors.
With the possible exception of some fruit juices, sugar-sweetened drinks provide little nutritional benefit, and their consumption should be discouraged in favour of healthier options such as water and milk. We need to take greater note of the emerging evidence as the strategy and debate continue.
The Minister has just cited advice from experts about milk. What are we to make of the fact that, according to nutrient profiling, milk would get a red light under the traffic light system. What are we to do about that?
We have to consider the evidence that is emerging. As my hon. Friend the Member for Middlesbrough, South and East Cleveland said, there can be inconsistencies and unintended consequences. We need to try to align policy and strategy and ensure that they are based on evidence. All the time we are collecting more and more evidence that will influence, shape and refocus policy. That is the only answer that I can give the hon. Gentleman at this stage.
The hon. Member for North Norfolk (Norman Lamb) mentioned his concern about teenagers, and that is important. Obviously, we share a responsibility with parents, schools, role models and others for the influences on teenagers. The hon. Gentleman also rightly referred to the importance of exercise. We live in a society of the internet and iPods; many activities in which young people want to participate do not necessarily involve exercise. Young people’s behaviour, attitudes and how they choose to spend their leisure lives are changing. We need to consider the implications and impact of that and make sure that there are other influences.
The issue is often about making a direct link between what teenagers care about and aspire to and their behaviour. If we simply hector and lecture young people about why exercise and healthy eating are good, it is unlikely that we will get through to many of them. If we make the link between young people’s ambitions, aspirations and hopes for their lives and the potential damage that obesity and excess weight can cause them, we are more likely to make progress.
The hon. Gentleman also raised the issue of advertising in cinemas, magazines and the internet. The rules announced—in April, I think—will apply to all food and drink, except fruit and vegetables, and they will come into effect on 1 July; he wanted a specific answer on that. As a Department, we will monitor their impact with reference to Ofcom rules.
Will the Minister clarify whether that will apply to the whole range—cinema, internet, magazines and so on?
Yes, I can confirm that.
I move on to the comments made by the hon. Member for Westbury (Dr. Murrison), who seems to blame the European Union for obesity. It seems that the lunatics remain in charge of the asylum—the faces may be new and smiling, but the same ideological lunacy remains, with the belief that the European Union is somehow evil and responsible for the obesity problems of our society and our world.
I shall try to take the hon. Gentleman’s other points a little more seriously. He asked about “Choosing Activity”, and I shall update him on that. By January 2007, 57 of the 99 commitments set out in the plan had been achieved. For example, every school in England is now part of a school sports partnership, and 80 per cent. of pupils now take part in at least two hours of high-quality physical education and sport a week. As I said, that exceeds the 75 per cent. target that we originally set. The Government are clear that the root cause of obesity is calories in and calories out; the hon. Gentleman himself mentioned that in his speech. We have a comprehensive strategy on physical activity and diet. There is good evidence that “Choosing Activity” is beginning to make a real difference.
With all due respect, the Minister has made some silly and fatuous statements in this debate; this is his chance to redeem himself. He will, of course, be aware of the Plymouth EarlyBird programme and the Bristol university cross-sectional study on obesity—at least, I hope that he is. How does he reconcile those with the school sport strategy, which, I assume, will be updated or reviewed to incorporate that research? If my assumption is correct, will the Minister outline how that will be taken forward?
Of course we will take account of that research and consider its implications for the school sport strategy. Most people would say that we are making significant progress on changing the culture around school sports. There was a period in our history as a country when competitive sports, certainly in the state system, were downgraded and not encouraged. We had a problem with teachers’ ability and willingness to work outside the school day, but we are seeing a significant step change. Extended schools will make a tremendous difference to the range of opportunities for children and young people to participate in sporting activities and a whole range of extra-curricular activities that have been taken for granted in the private sector through the generations. Of course we will reflect on the implications of those studies, but we are firm on the benefits and progress of the school sport strategy.
The hon. Gentleman referred to dehydration. The FSA has not undertaken a specific research project on the issue, but other evidence supports the notion that hydration is important for good health and concentration. We do not have hard evidence on that, but the anecdotal evidence is there. The hon. Gentleman raised the school fruit and vegetable scheme. He said that it cost £77 million, but it actually cost about £38 million. The first evaluation showed that children on the scheme increased their consumption, but that that dropped off when they left the scheme. Further evaluation is to be published by the end of this month, and at this stage the Government have no plans to change the scheme.
The hon. Gentleman, as well as other hon. Members, raised the question of artificial sweeteners. The Government recognise that low-calorie sweeteners such as aspartame have the potential to help to reduce some people’s energy intake, particularly if the food or drink that contains them replaces products that contain sugar. That is a clear position. Did the hon. Gentleman want any further clarification?
We have evidence that we have a robust national strategy. We also have evidence that the issue is incredibly difficult to tackle effectively. It will require a long-term sustained commitment from all stakeholders. There needs to be an acceptance that, although the Government have major responsibilities, so do the private sector and families, as well as the community through the status that it gives the issue and the importance that it places on it. There is no doubt that obesity undermines individuals’ quality of life, length of life and life chances. There is no doubt that it places massive pressure on our public services. Equally, it undermines our economy in a global era when we need the full talents of all our citizens to be used to maximum potential if we are to compete with the Indias and Chinas of this world. Obesity should not be seen as a stand-alone or marginal issue. It is right at the heart of social and economic policy and of the health and well-being of individuals and our population. We have done a lot, but there is still a long way to go.