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House of Lords Hansard
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Obesity: Low-fat Diet
09 June 2016
Volume 773

Question for Short Debate

Asked by

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To ask Her Majesty’s Government what assessment they have made of recent new dietary advice that contradicts recommendations to eat a low-fat diet to tackle obesity.

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My Lords, I would like to thank the noble Lords who are speaking in this debate; it is especially appreciated as the timing is not what we originally expected. Before I get to the heart of today’s debate about dietary advice, let me start with the basics and the seriousness of the current situation. Obesity and its related illnesses are costing the country a fortune and it is not sustainable. Only this week Simon Stevens, chief executive of NHS England, told the Health Select Committee that we now spend more on obesity-related conditions than on our police or fire services. Figures from the US released yesterday show that 40% of women in the States are now obese—and we are not far behind. On current trends, three in four adults will be overweight or obese in twenty years’ time.

If we do not wake up to the extent of this crisis, the NHS could end up bankrupt. Enormous amounts of money are already spent on treating diseases that are entirely preventable. After my Question on this topic a couple of weeks ago, a severely disabled friend told me how frustrated he felt that, because of the costs of obesity, there is much less money available for the needs of people like him who have no control over their condition. The problem is that we in the western world live in an obesogenic society—one that tends to cause obesity. For almost all of us food is readily available, most of us never feel hunger and our lives are increasingly sedentary compared to the generations before us. It is all too easy to put on weight and maintaining a healthy weight is also a challenge. If we see someone slim today, we assume them to be a person of real self-discipline.

I declare an interest: six years ago, I was 28 pounds heavier. I was fat. I disliked it, but seemed unable to do anything about it. Like millions of others, I tried every diet going, back to grapefruit and hard-boiled eggs, which I think was a 1970s fad. I remember one diet based on ration coupons—it was not a bad idea given that as a country we have never been as healthy as we were during rationing. You name it, I tried it. I finally gripped it thanks to Louise Parker, and I recommend her common-sense approach as set out in her recently published book, Lean for Life. If you put two or three strangers together—women, anyway—the topic is an immediate ice-breaker: how to lose it, how to keep it off, what tips do you have, what works for you? It is a source of endless fascination.

One pound of fat equates to 3,500 calories. If you consume an extra 100 calories a day—just one small glass of wine, for example—you will put on 10 pounds a year, 20 pounds in two years; it is all too easy. But it can work the other way round: cut out that daily glass of wine and, all things being equal, you will lose 10 pounds a year. While on the topic of alcohol, how is it possible that there is still no calorie labelling on alcoholic drinks?

I read recently of an experiment where two groups of people spent an evening out at the pub. One group had calories included on their drinks menu and consumed an average 380 calories each. The other did not and drank the equivalent of 764 calories—double the amount. One piña colada, for example, is 245 calories, approximately the same as a Mars bar. How many people know that, or that a pint of beer and a packet of crisps contain a similar number of calories? It is not uncommon for people to drink two or three cocktails or large glasses of wine or to have three pints on a night out, but would they necessarily eat two or three chocolate bars or packets of crisps? People want this information and it should be made transparently available.

We currently spend £1 million every hour on type 2 diabetes. If the number of people affected increases at the present rate—400 new diagnoses every day—by 2025 there will be 5 million people with diabetes in this country. Half these people have diabetic complications: heart disease, eye disease and kidney disease, and there are more than 100 amputations a week as a result of vascular disease in people with diabetes. This is unsustainable.

The good news is that it does not have to be this way. Earlier this week we heard of mounting evidence to show that losing weight is the best way to fight cancer. A daily brisk walk of just 25 minutes was shown to almost halve mortality rates for breast cancer sufferers, while a waistline larger than 35 inches increased death rates by a third. This may be an added incentive for some, assuming that doctors are aware and pass on the information. Should the messages be clearer and tougher? A friend of mine lost five stone when his doctor made it clear that he was unlikely to see his daughters grow to adulthood. Some may disagree with this approach but it worked for him.

In the interests of research for this debate, I watched a few programmes over the weekend. “Junk Food Kids: Who’s to Blame?” was absolutely tragic. Those poor children have multiple teeth extractions, simply because they are drinking fizzy drinks and fruit juices instead of milk or water. They have dreadful diets and take no activity. I also watched a couple of episodes of “Lose Weight for Love”, which is currently on the television, where obese couples locked into cycles of overeating which threaten their relationships as well as their health are separated from their co-dependent partners for 10 weeks to learn better habits on their own, at the same time supported by a team of experts. The issue for them is more than food, it is their psychological relationship with food.

The series has taken a holistic approach to diet change and weight management by offering psychological therapy alongside behavioural, diet and exercise interventions. This joined-up thinking does not happen in healthcare as money is siloed into different specialisms. For long-term change to occur, we need to understand why food is so often used to self-medicate. All the couples have lost substantial amounts of weight and appear to be motivated to keep it off. A year later, one couple have lost six stone each.

I think every single one of the participants admitted that before the programme they drank litres of fizzy, sugary drinks every day, which provided no nutritional value at all—empty liquid calories. I commend the Government for taxing them. But at the same time as introducing the tax they really need a publicity campaign about what sugar does to your body. It seems to me, as a lay man, quite right that sugar has become dietary enemy number one, along with processed snacks. I was fascinated by the Guardian’s long read “The Sugar Conspiracy”, published on 7 April, and I recommend the Sugar Smart app as an easy way of checking the amount of sugar in any product.

Yet although losing weight is simple, it is not easy. Giving up sugar is horribly difficult. I could happily go home this evening and eat a tub of ice cream and a packet of chocolate biscuits, but I will not. Once upon a time I might have but I am now motivated by concerns about my long-term health. While I appreciate that the accepted golden rules for a healthy, cancer-free life are not fool-proof, I try to live by them: no smoking, limited alcohol, healthy weight and regular exercise. Should the Government be looking at carrots—I do not mean the vegetables—for those who achieve these goals and thereby potentially save a lot for our overstretched health service?

The current dietary advice is confusing. For example, the Eatwell Guide recommends basing meals on potatoes, bread, rice, pasta or other starchy carbohydrates. Are we so sure that this is good advice? After all, we feed starchy crops to animals to fatten them, so why would they not have the same effect on us? For years we were told not to eat more than two eggs a week, but then research showed that cholesterol in eggs had almost no effect on blood cholesterol. The consequences of that advice were that egg producers went out of business and the population missed out on affordable, natural, nutrient-filled food as it swapped it for sugar-laden, industrially processed cereals. Recent reports have added to the confusion and muddled messages help nobody. So for the sake of our NHS, our nation and especially our poor chubby children, I urge the Government to focus on accuracy and clarity when they finally publish their obesity strategy.

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My Lords, first, I must congratulate the noble Baroness, Lady Jenkin of Kennington, on securing this debate. Far more than that, I must pay tribute to her absolutely tireless efforts to raise the matters of diet, eating well and food waste. She has raised almost everything from what goes into our mouths to what does not and becomes food waste, and how to eat well and cheaply. She lives by the example—she has told us how much weight she lost—but in this House she has constantly emphasised the need for cooking skills. Nobody has done more in the last few years to raise the issue here than she has. I thoroughly agree with her. I cannot blame the public for their weariness with government food advice. There have been contradictions in that advice. There has been unclear and quite hard-to-follow advice. That is a recipe for confusion and people have just stopped listening.

The noble Baroness, Lady Jenkin, mentioned the Eatwell plate. I underline that to ask the Minister: did as much effort go into ensuring that the advice in the new Eatwell Guide is as sound as she would like? An awful lot of effort went into the redesign of the Eatwell plate. The knife and fork were taken away, apparently because her department thought that they did not resonate with the public. There are a lot of questions about the advice. When we talk about fats, for example, the new Eatwell Guide differentiates unsaturated oils, such as vegetable and olive oil and lower-fat spreads, from other foods that are high in fat, salt and sugar. That is because some fat is essential in a healthy balanced diet, but other foods high in fat, salt and sugar are really not healthy. They should be eaten much less often and in very small amounts. The size of the purple section on the Eatwell plate reflects the fact that oils and spreads are high in fat and contain lots of calories. That seems sound advice but, for all the reasons underlined by the noble Baroness, Lady Jenkin, it is still confusing.

There is an underlying message, which is quite clear, about eating within your need for calories. It is usually about eating less. I would have to declare an interest here in that I probably should eat a bit less. I have to declare a second interest as a co-chair of the All-Party Food and Health Group and a third interest as a vineyard owner. I took greatly to heart the comments the noble Baroness, Lady Jenkin, made about glasses of wine. She is quite right that they contain calories, but on the other hand the Mediterranean diet, often held up before us as a very good example, contains some red wine. My husband had red wine recommended to him by his cardiologist as an alternative way of thinning his blood following a stent operation. It is back to what my mother said, which is that a little of what you fancy does you good—underlining “little”.

I turn for a moment to a point touched on by the National Obesity Forum in its very controversial report. The way the report came out was unfortunate, because the headlines that resulted were controversial, but that does not mean that everything in the report should be dismissed. The report accuses major public health bodies of colluding with the food industry. I do not know whether that is true but the NOF and the Public Health Collaboration have called for a “major overhaul” of current dietary guidelines. That advice is very sound.

I do not know where the line is drawn between collusion and allowing the food processing and retail industries to reformulate, including by using things that could not even be defined as food. This practice is clearly exposed in Joanna Blythman’s book, published last year, Swallow This: Serving Up the Food Industry’s Darkest Secrets, which shows just how important it is to debate this issue and the causes of obesity. She uncovers just how much of the seemingly more natural—but still processed—foods are clever products of the chemical industry. She has said:

“The pace of food engineering innovation means that newer, more complex manufactured food creations with ever more opaque modes of production are streaming onto the market every day”.

She explains how just about everything from your seemingly healthy option of granary farmhouse loaf or sliced egg salad sandwich has a slew of processes and ingredients for which our digestive systems just were not designed.

Just as the public learned to avoid E numbers and artificial ingredients, so the food industry has now learned to use innocuous-sounding ingredients that really belong in a chemistry lab, not a kitchen. Why does this matter? Have they been passed as safe? Given some of the research coming out now, it matters because we are paying the price with our health. For millennia, our digestive systems evolved to efficiently process vegetables, nuts, fruit, pulses, eggs and the occasional meat and dairy product. Suddenly, in the second half of the 20th century they came under assault.

The effect was explained earlier this year by Jenni Russell, writing in the Times, where she set out the work of the genetic epidemiologist Professor Spector of King’s College London. His work has been to do with the growing amount of evidence that the destruction of our gut bacteria by processed foods is the real enemy and could be behind the obesity crisis. In essence, précising his work, she said that something very curious happened in Britain in the mid-1980s. Obesity rates had scarcely shifted in the 20 years since records have been kept. They were more or less steady, but then rocketed overnight—not just here but around the world. Obesity almost trebled, and every age group was affected. Whether they were 16 or 60, people suddenly started getting fat.

Your Lordships could say that that was because people were sitting in front of the television much more and eating more and worse foods. I know that things such as corn syrup, which goes into so much food, are also implicated. The fact that our food is not the food that our digestive systems have learned to recognise over hundreds of years must have some bearing on this. Other work from around the world is just becoming evident. For example, Professor Chang in Berkeley, California, is exploring the connection between copper and fat metabolism. There are all sorts of things that we are just at the beginning of understanding. Although it is about eating less and taking more exercise, it is also about the fact that our current food system is fatally flawed, especially when it comes to our health, and obesity is the symptom of this. As Professor Tim Lang, who has been working on these issues for decades, says, there is a,

“need for a complete change of mind set to tackle these”,

issues,

“away from a productionist approach with its successes and subsequent problems”.

He outlines a new direction for food policy, building it around sustainable development, low-impact farming systems, diets and low energy use.

The debate about fat and obesity is incredibly important, but we must hold it in the right context. At the moment, it is a bit like seeing someone suffering from a bad cut and having a debate as to whether to put on a plaster or bandage or to sew it up. As a very short-term measure, we need to think about the plaster, but in the long term we need to be able to buy and prepare food that contributes to our health rather than undermines it. That means seasonal, local and less processed food, with more pulses—the noble Baroness will agree with that—more vegetables and more cooking skills taught in schools. What are the Government doing to ensure that all schools receive nutritional guidelines and that academies and free schools are no longer excluded—and that A-level cooking will be part of the curriculum, because I understand that it is being dropped?

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My Lords, I am grateful to my noble friend Lady Jenkin of Kennington for initiating this debate, which draws attention to the false and misleading advice that a low-fat diet is the way to tackle the obesity epidemic—an epidemic which is killing millions, costing billions and to which the cure is free. You just have to eat fewer calories.

I remind your Lordships that when we swallow food it goes down through the gullet into the stomach, in the upper part of the abdomen. The advice to have a low-fat diet is wrong because, when fat enters the small intestine, it meets special receptors that detect differences in the composition of food. This information is transferred to the stomach and results in delay of emptying. Fat is especially important because, when it enters the small intestine, it greatly delays the emptying of the stomach by making the upper part of the stomach relax and the lower half less active. As the stomach emptying is delayed, it gives the feeling that one has had enough to eat. Later, when the fat has been absorbed lower down, the stomach then starts to empty again.

This is a beautifully balanced mechanism, which tends to prevent us eating too much and thereby prevents obesity. Not surprisingly, the food industry does not approve of this beautifully balanced mechanism, because it has resulted in less food being eaten and lower profits. So it joined up with some rather dubious scientists to produce research that erroneously claimed to show that fat was bad and carbohydrates were good. They ignored the fact that, when carbo- hydrates and sugar enter the stomach, there is very little delay, and the food quickly rushes on. There is no feeling of having had a full meal; the person soon feels hungry and starts to eat again—and they continue to eat too much throughout the day. This has led to obesity in a large proportion of the people in the UK and an even larger proportion of people in the United States.

Recently, there has been a lot of interest in the composition of food, especially in the fact that fat plays a valuable part in weight control. These statements are recent but not new; many of us clinicians have been teaching this for many years, because of the work of Professor Yudkin in the 1960s, and his book published in 1972. However, his message that the answer was fat, not carbohydrates, and that carbohydrates were the danger was not popular with some parts of the food industry, and his career was actually rubbished by unscrupulous scientists in cahoots with even more unscrupulous parts of the food industry. It was a disgrace. The campaign to extol the virtues of a high-carbohydrate, high-sugar diet was started largely in the United States, where it was decided by scientists and food manufacturers that the increasing amount of coronary artery disease was due to excessive fat in the diet. Fat was demonised; a high-carbohydrate, sugary diet was broadcast as the answer; and anyone who contradicted that was marginalised. It has been pointed out that a low-fat diet is not very tasty and it is thought that for this reason the food industry started putting a lot of sugar into food to compensate and make it more palatable, so boosting their sales. The food industry seems to regard money as more important than many parts of the health of the people.

In the United Kingdom, as many noble Lords know well, the Department of Health and NICE maintained for many years that the obesity epidemic was due to lack of exercise. It is a pity that some of the 500 people employed by NICE did not think to go to the gymnasium, get on a machine and exercise to see how few calories one actually burns off. One can pedal away on one of those machines for half an hour and only 200 or 300 calories will be burned up. One has to run miles to take a pound of fat off.

This whole subject has been bedevilled by all sorts of theories about the cause of the obesity epidemic: genetics, epigenetics, psychological disturbances and many other ideas. They are all very interesting, but none of them is the cause of the obesity epidemic. They may contribute to making it more difficult for some people to control their appetite, but one fact remains: it is impossible to be obese unless one is eating too many calories. Only a quarter of the calories we eat are actually expended on exercise. The remaining calories are burned up enabling the heart to beat 8 billion times in a lifetime, the kidneys to filter gallons of blood every day, and numerous chemical reactions in the liver, pancreas and so on.

We have been advised not to be judgmental and not to blame patients for being obese. We are not even allowed to call them fat nowadays, but it is not judgmental to be accurate in diagnosis. It is not for government to tell people how to run their lives, but it is the job of government to give a very clear picture of the truth. I hope that when the obesity strategy is eventually published it will have on the front cover: “Obesity is killing millions, costing billions and the cure is to eat less”.

In a recent review, Dr Aseem Malhotra, a cardiologist, concluded that the current global epidemic of atherosclerosis, heart disease, diabetes and obesity is being driven by a diet high in carbohydrates and sugar, as opposed to fat.

How can we help obese people to avoid an unnecessarily early death from the effects of obesity? It would help them to have a reasonable but not excessive amount of fat, which would satisfy their hunger early on in their meals, and to avoid a diet high in carbohydrate and sugar, which would continue to make them hungry. Roughage in many forms, such as wholemeal bread, wholemeal pasta—pasta integrale—and cereals without sugar also satisfy hunger quickly. It is essential to avoid high-carbohydrate and sugar diets which will continue to make them hungry. Many will need additional help from friends, dieticians and psychiatrists—all this to avoid so many unpleasant illnesses and to avoid them falling victim to this lethal obesity epidemic, which is the worst since the flu epidemic of 1919.

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My Lords, I congratulate the noble Baroness, Lady Jenkin, on securing this debate on this important but highly confusing subject. The scale and enormity of the obesity crisis facing the UK and the rest of the world has been underlined, and it is clear that the Government’s long-awaited strategy, particularly in respect of providing clarity over dietary guidance, is desperately needed. I hope that the Minister will be able not only to give us some headline information on the content and direction of travel of the strategy, which we assume must now be in an advanced stage of development, but to be much more specific about the publication date for the strategy than just the timetable of “over the summer” that we have been given so far. I hope she fully realises the urgency and seriousness of the situation and the need for the Government to get to grips with the country’s obesity epidemic. The noble Baroness, Lady Jenkin, in particular graphically and thoroughly underlined the challenges we face.

The recent report from the National Obesity Forum and the Public Health Collaborative has led to even greater confusion about what we should and should not eat to help us lose weight or keep our weight in check. To quote one comment article on the report:

“If you’re not confused, you’ve not been paying attention”.

The same article, by Archie Bland in the Guardian, underlined the important need for clear messages on food, such as a simple five-a-day mantra, however much we place our own interpretation on it, and came to the same conclusion on the need for clear, straightforward guidance on tackling weight gain that has been supported here today—that is, eat less and move more. Regarding noble Lords’ comments on the Government’s advice on diet, the British Obesity Society’s 11 tips for 2016 seem pretty sound and cover the full range of issues we have been discussing today.

As we have heard, the report’s findings and conclusions have been fiercely challenged by key medical bodies, including the Royal College of Physicians, the Academy of Medical Royal Colleges, the Faculty of Public Health, the British Heart Foundation and of course government public health bodies. We also now have the bizarre spectacle of half the board of the National Obesity Forum resigning over a lack of consultation, involvement and input into the report. Regrettably, instead of contributing to the debate, the dramatic statements in the report, and particularly those surrounding its launch, have served only to polarise and confuse the debate still further in a very unhelpful way. They have also detracted from the effective debate and discussion of some of the report’s valuable findings and observations, as a number of contributors have pointed out. The dismissal of Public Health England’s Eatwell Guide as a “metabolic time bomb”, for example, and the description of the discouraging of eating low-fat foods as,

“perhaps the biggest mistake in modern medical history”,

were over-the-top statements not backed up by evidence in the report itself.

In his response to a Question about the report from the noble Baroness, Lady Jenkins, on 26 May, the noble Lord, Lord Prior, gave assurances to the House that the Government’s obesity strategy would clearly address the confusion and muddle over dietary advice. It is clarity and simple language that are needed, and that is what makes the need for the strategy ever more urgent.

There have been excellent points and questions from noble Lords to the Minister on low-fat and dietary issues, which I will not duplicate. I look forward to her response, particularly regarding this week’s Spanish research, which has found that the Mediterranean diet, with high-fat content from olive oil, does not cause people to put on weight. Confusion reigns. I hope she can reassure the House that the overall strategy will provide an accurate, evidence-based estimate of the current costs of obesity services to both the NHS and social care. Simon Stevens’ estimate is an alarming current cost of £9 billion a year to the NHS alone. We also want realistic forecasting on the future costs and scale of the epidemic, and on what funding is needed for the services to be able to cope.

Will the Minister acknowledge the importance of making sure that the strategy includes actions to ensure cross-departmental government planning and working, particularly for tackling childhood obesity? Recent figures show that over 28% of children aged two to 15 are obese, and thousands of children are being admitted to hospital because of their weight. We know how difficult it can be to achieve cross-government working, so can the Minister assure the House that the new strategy will address this issue? The Royal College of General Practitioners recently called for a COBRA-style workforce to be set up. Does she agree that this would be an important way of achieving the required joined-up approach that extends beyond the Department of Health?

In the time left, I want to raise two key issues on the strategy. First, looking at all the background information and briefing on obesity, the paucity of data about the extent of obesity among, and its impact on, ethnic-minority communities was particularly striking. NICE has underlined its concern that millions of people from ethnic-minority groups who may be at risk from weight-related diseases are not showing up under current tests. The body mass index test simply does not work for some groups, and NICE has called for BMI fatness thresholds to be lowered to ensure that up to 8 million people of African, Caribbean and Asian descent in the UK are covered in order to help identify those at risk of diabetes and heart disease. Do the Government support that view, and what action are they taking to address this problem? Different ethnic groups are associated with a range of body shapes and different physiological responses to fat storage. In terms of public health action, it is particularly important for south Asian populations in the UK, for example, to be aware of the health risks associated with an increased BMI and waist circumference.

According to Public Health England information, apart from the 2004 Health Survey for England data, there are few nationally representative data on obesity prevalence in adults from ethnic-minority groups in the UK, and data for many smaller ethnic groups are scarce or non-existent. Will the Government ensure that their strategy includes actions to investigate and gather information and data on key ethnic-minority groups so that their needs can be assessed as part of the strategy?

Secondly, do the Government acknowledge and recognise the importance of ensuring that the obesity strategy addresses the key issue of obesity among people with disabilities? Again, there are very limited data on this. People with disabilities are more likely to be obese and to have lower rates of physical activity than the general population, for obvious reasons. Children who have a limiting illness are more likely to be obese or overweight, particularly if they have a learning disability. Being both overweight and underweight are issues for people with learning disabilities. Obesity is associated with the four most prevailing disabling conditions in the UK: arthritis, back pain, mental health disorders and learning disabilities.

UK obesity rates have trebled over the last 30 years; the UK has the highest level of obesity in western Europe, ahead of France, Germany, Spain and Italy; and the alarming prediction is that, on current estimates, more than half our population could be obese by 2050. The scale of the problem makes the need for an ambitious health and social care strategy to address the challenges ever more urgent. I look forward to the noble Baroness’s response.

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I thank my noble friend Lady Jenkin for initiating this important debate, and I congratulate her on having certainly lost weight—and kept it off, which is indeed an achievement. My thanks also go to the noble Baronesses, Lady Miller and Lady Wheeler, and to my noble friend Lord McColl for their valuable contributions. I will pick up on the various points as I go through my speech.

Tackling obesity is indeed an important issue, as my noble friend implied. We know that obesity is a leading cause of serious diseases such as heart disease, type 2 diabetes and some cancers. Furthermore, obesity is a complex issue to which there is no single solution. Eating a healthy diet has a key role to play in helping people lose weight, maintain a healthy weight and thereby reduce the risk of type 2 diabetes and other problems related to obesity.

The noble Baronesses, Lady Miller and Lady Wheeler, suggested that messages are muddling. That is why Public Health England goes to great lengths to ensure that it advises the public clearly and consistently on what constitutes a healthy, balanced diet, basing that advice on broad, robust and objective evidence. It is also why it was so disappointing to see the opinion piece entitled Eat Fat, Cut the Carbs and Avoid Snacking to Reverse Obesity and Type 2 Diabetes. It claims that many of the Government’s dietary recommendations are wrong. However, it fails to provide good evidence. All it has done is confuse the public, and Public Health England has called it “irresponsible”.

To improve diet and reduce obesity levels, our advice remains that people should base meals on starchy carbohydrates, especially whole grains, eat at least five portions of a variety of fruit and vegetables each day, including pulses, as the noble Baroness, Lady Miller, mentioned, and cut back on food and drinks that are high in salt and sugar. That is our Eatwell Guide.

My noble friend Lord McColl and the noble Baroness, Lady Miller, mentioned that eating fat is a good thing. It is extremely important. Our recommendations are that 33% of energy should come from fat. As was also stated by my noble friend and the noble Baroness, the cure for obesity is to eat and drink fewer calories, and that must be remembered.

I underline that Public Health England bases its dietary guidelines on comprehensive reviews carried out by the independent experts who make up the Scientific Advisory Committee on Nutrition. The Eatwell Guide was put together by them and Public Health England, and they consult academia, health charities, public health professionals and representative professional bodies. They also monitor changes in the evidence base and, where sufficient new evidence emerges, will initiate a new review to ensure that the guidance remains current.

Public Health England is taking forward a range of actions to help reshape the environment, to make the healthier choice the easiest choice for people, and to tackle inequalities relating to obesity. Public Health England has a broad plan and is committed to working collaboratively, at a national and local level, to pursue and advance a series of sustained actions to tackle and prevent obesity. Public Health England’s obesity plan is based on a framework that covers community engagement, monitoring progress, supporting delivery and changing the whole culture concerning obesity.

My noble friends Lord McColl and Lady Jenkin pointed out that exercise will not cause someone to lose weight. Exercise is important for lots of reasons, but there is no point going to a class or the gym and then going round the corner for a fizzy drink and a doughnut. It is this sort of culture that needs to change.

My noble friend Lady Jenkin also mentioned the problem of sugar in alcohol. The UK has secured provisions to allow voluntary calorie labelling on alcoholic drinks. This is already being used by Sainsbury’s, the Co-op and Waitrose. The possibility of mandating calorie labelling on alcohol is under discussion at EU level.

Public Health England recognises that weight-management services are an integral part of the public health and health service agenda for tackling obesity. Public Health England is clear that only by taking a whole-system, joined-up approach can we hope to make a difference.

As my noble friend Lady Jenkin stated, sugar is a huge problem. The sugar intake of all population groups in the UK is above current recommendations. We are encouraging a reduction in sugar intake through Change4Life, a social marketing campaign. It provides practical tips to help families reduce their sugar intake, and the sugar app is also a very good idea.

As part of its work, Public Health England is exploring how to support councils and the health service in providing evidence-based weight-management services that work better for people. In particular, Public Health England is collaborating with the Local Government Association and the Association of Directors of Public Health to support councils in developing local, joined-up approaches to tackling obesity. The noble Baroness, Lady Wheeler, mentioned the importance of this and of remembering that those with disabilities have complex nutritional needs. Also, ethnic minorities must not be left behind. This is why Public Health England is concentrating on exploring with the Local Government Association and the Association of Directors of Public Health how to take this down to a local level to decide what is needed in different areas to help those with disabilities and ethnic minorities.

Regarding type 2 diabetes specifically, Public Health England is working with NHS England and Diabetes UK on the development and delivery of Healthier You: the NHS Diabetes Prevention Programme. This year, Healthier You will refer at least 10,000 people to an evidence-based, behaviour-change intervention, funded by NHS England, shown to reduce the risk of type 2 diabetes in those with elevated risk. By 2020, the programme will be made available to up to 100,000 people at risk of type 2 diabetes each year across England. Those referred will receive tailored behavioural support to enable improvements in diet, increases in physical activity and weight loss. Furthermore, Healthier You will link into the NHS Health Check programme, which invites adults between the ages of 40 and 74 for risk awareness assessment and management of the key risk factors leading to premature death and disability in England.

As I mentioned a few minutes ago, obesity is a complex issue. Tackling obesity, particularly in children, is one of the Government’s major priorities and the Government will be launching a childhood obesity strategy next month. The strategy will look at everything that contributes to a child becoming overweight and obese. It will also set out what more can be done by all.

It is critical that we address with young people the obesity issues they face, as we know that it is much more difficult to lose weight later in life. That is why free school meals were introduced in all primary schools and why we have the School Fruit and Vegetable Scheme. I will have to write to the noble Baroness, Lady Miller, on her questions, as I am not up to date on what the Department for Education is doing in relation to cooking in schools and the curriculum.

The soft drinks industry levy announced by the Chancellor in the Budget was the first step in the process regarding sugar intake. The cross-government approach being led by the Department of Health is an exciting one. However, evidence suggests that many of those who have the potential to influence the diet and health of those with whom they come into contact, including childminders, fitness instructors, caterers and those working in care homes, currently receive little or no training in nutrition. Public Health England is working with the Association for Nutrition to devise a competence framework for use in training non-professionals in the catering, fitness and leisure industries in diet, nutrition and health. This is now being used to certify relevant courses. Moreover, the chief executive of NHS England is addressing the presence of unhealthy food and drinks on NHS properties. After all, if those looking after people are not eating healthily, it is not good for any of us. The initiative will encourage NHS staff to lead a much healthier lifestyle.

Eating a healthy, balanced diet plays a crucial role in all our work, but we have choices and we have to take responsibility for them. I thank everybody who has taken part today. If there is anything that I have left out and not mentioned, I will of course write to noble Lords.