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Volume 792: debated on Wednesday 18 July 2018

Question for Short Debate

Asked by

My Lords, I say at the outset how much I am looking forward to the maiden speech of the noble Baroness, Lady Boycott, with all her expertise. We hope to hear a lot of her expertise in the years to come.

I start by recounting the story of Labour’s deputy leader Tom Watson, which he recently broadcast in the media. He explained that he was 51, very overweight and had tried many diets. When he started looking into the problem, he realised that all the advice given by the authorities was completely wrong. His research showed that he needed to cut down radically on sugar and starchy carbohydrates, and find ways of getting fat into his diet. Fat stops one feeling so hungry during the day. He also overcame his craving for sugar. This regime resulted in him losing seven stone, or 39 kilograms.

What Mr Watson rediscovered was what had been well known during the war. In 1939, one-third of the British people were either underfed or fed on the wrong food. Food rationing cured that rapidly. For the first time, people had the right quantity and right kind of food. There was no obesity then because they ate food that satisfied them: food they had to chew, including wholemeal bread with plenty of dripping on it—there is nothing wrong with fat, except saturated fats. Also, of course, there was very little sugar and less starchy food. I should explain that when we eat fat it leaves the stomach and goes into the duodenum, releasing a hormone which specifically delays the emptying of the stomach and makes one feel full. Hence, it limits the amount we eat. After the end of rationing in the 1950s, the food industry wished to increase its sales and profits. Realising that it was not selling a great deal of food and that fat was actually a brake on how much people ate, it decided to demonise fat and encourage carbo- hydrates. A low-fat, high-carbohydrate diet is pretty tasteless because it is fat that gives it the taste. The industry had to add large quantities of sugar so that people would eat it, and so began the obesity epidemic.

Another story I would like to tell is of a Member of your Lordships’ House who was paralysed and in a wheelchair. Being overweight, he decided to take three stone of weight off. He could not exercise and so decided on a really revolutionary way of losing weight. He lost three stone simply by eating less. Politicians and that organisation, NICE, have repeatedly stated that all the calories we eat are expended on exercise. This simply is not true. Only a fraction of the calories we eat are used up on exercise. Anyone who disputes this can go to the gym and exercise on one of the machines for half an hour. If they slave away and look at the dial to see how many calories have been used up, it will be about 300 calories in half an hour. That is what one gets from a small bar of chocolate.

The press and the media have been very helpful in the last year or two in drawing attention to the real cause of obesity, which is putting too many calories into one’s mouth. Many people find it difficult to eat less, so it is probably worthwhile looking at preventable problems that make obesity more likely. A lady of 42 with an eating disorder gathered together about 45 other ladies with a similar condition to see whether they could help one another with their problem. When they went round telling their stories, they had all been sexually abused as children. That is of course an anecdote—anecdote being Greek for “unpublished”, which is arguably what most anecdotes should remain—so let us look at science.

An excellent paper published by Danese and Tan in 2014 demonstrated without doubt that the maltreatment of children is associated with a substantial elevated risk of developing obesity. There is so much domestic violence and sexual abuse of children that a greater drive on reducing these risks might also help to solve the obesity epidemic. There has also been a suggestion that as mothers increasingly work outside the home, that may lead to families increasingly relying upon ready-made junk food, which never satisfies hunger and therefore leads to people eating far too much of it and hence obesity. This may be an important contributing factor.

Some elements of the food industry have made an effort to stem the obesity epidemic. The late Professor Terence Wilkin produced some very good scientific work, which clearly showed that obesity leads to inactivity but that inactivity does not lead to obesity—so do not call children couch potatoes. When one examines the genetics of all this, it is not a question of simple inheritance. It has been shown that the children of obese parents are six to 10 times more likely to be obese but, even then, it is not inevitable that they will become so. They will become obese only if they put too many calories in their mouth. There are some medical conditions which affect appetite but none that directly lead to obesity. The tendency towards obesity looks as though it is established early on in life, long before children go to school. As Professor Wilkin stated, this questions the rhetoric around school meals, computer screens, playing fields and of course physical activity, which is fairly unstructured in early childhood.

It is important to restate that physical activity is important for mental health, the heart and the body’s general well-being and functioning. But I hope the Minister will finally put to rest the repeated statements from the Department of Health and Social Care and elsewhere, saying that obesity can be solved by increasing activity and diet. They link those two but only a fraction of the calories we eat are used up in exercise. In their advice, exercise and diet should not be coupled together. They should be separated, not put in the same sentence.

The obesity epidemic is probably costing £30 billion a year. Saving on that would be a great help to the NHS. This whole subject has been bedevilled by, first, the food industry demonising fat and promoting sugar and carbohydrates—by the way, among five to eight year-olds tooth decay is far and away the leading cause of hospital admissions, which are mainly caused by excessive sugar consumption. Secondly, there is the false statement that all the calories we eat are expended in exercise, when only a small fraction are, as I said before. Thirdly, there is blaming and insulting other people, such as calling children couch potatoes when in fact inactivity does not lead to obesity.

Fourthly, there is the nonsense of skimming milk. Skimmed milk is so tasteless that sugar has to be added to get children to drink it. There is no need to skim milk. Eight thousand children in Canada were given whole milk from birth until the age of eight; their calcium metabolism was good and they were not fat but very healthy. Whole milk can actually reduce the incidence of stroke, as in the work published quite recently by Professor Otto in Texas. Human breast milk contains 3.5% fat, as does cows’ milk. I do not think they have started skimming human breast milk yet but you never know.

A fifth part of the department’s advice was to have only two eggs a week. There is no scientific basis for this at all. You can have an egg every day if you want. The sixth thing was that GPs were told not to call patients obese because it was judgmental. There is a difference between being judgmental and making accurate diagnoses. Seventhly, psychological reasons may have a role in obesity but we do not quite understand how.

What is the answer to all this? It is an all-out campaign involving every man, woman and child, every institution, school, university and government department to try and reduce the obesity epidemic.

I believe that the Department of Health and Social Care is moving in the right direction. The idea is not to tell people what to do but to tell them the truth—not in a patronising way, as in the old days, when at 7.50 every morning, at breakfast time, you turned on the radio and the radio doctor would say, “I’m the radio doctor and I’m going to talk about your bowels”. The answer to that was to switch the thing off, saying, “We’re not having bowels for breakfast”.

There have been some very good programmes such as “The Archers”, “Horizon” and many others, which have been very professional in promoting preventive medicine. In a recent campaign against AIDS—

May I remind the noble Lord that he needs to wind up, because this is a timed debate? I am so sorry.

I was just going to say that there was a successful campaign against the AIDS epidemic, run by the present Lord Speaker when he was Secretary of State for Health. Why was it so successful? Because he was honest and straightforward, and did not beat about the bush. He said, “Don’t die of AIDS. AIDS is lethal”. That is how we need to fight the obesity epidemic, which is killing millions and costing billions. The cure is free. Eat less. Put fewer calories into your mouth. We must do this: we owe it to our children.

My Lords, to assist the House, before the next speaker starts may I remind all speakers that when the clock strikes five minutes, time is up?

My Lords, I am grateful to the noble Lord, Lord McColl, for securing the debate and for the wise words he always gives us on this topic, from an authoritative position. Like him I look forward greatly to the maiden speech of the noble Baroness, Lady Boycott. I am sure that she will add greatly to our deliberations not only today but in the future.

I shall focus on child obesity. I am sorry that our time is limited, because this is a very big subject. I do not understand why, because we have no further business today—

We have some more business, do we? Then I withdraw that comment.

I shall focus on the child obesity plan. Contrary to some of the criticisms I have made in the past—although I shall make a few today—I share the view of the noble Lord, Lord McColl, that we are at last moving in the right direction. I believe that the publication of chapter 2 of the plan, which came out not too long ago, included some bold adventurous measures. My first question to the Minister is therefore to ask him whether the current consultations are within a specific timeframe. If so, when they conclude, will there be additions to chapter 2, or will the Government produce a chapter 3 to follow it?

I ask that question because I have previously raised a number of points about two or three fundamentals that had been missed from both the first plan and chapter 2. In particular I, like the noble Lord, Lord McColl, believe that there is a case for a wide-ranging and focused national campaign involving everyone but focusing especially on children. I argued that there was no mention of the broadcasters in chapter 2 or the earlier plan, other than in the context of the watershed and advertising, which is an entirely separate issue. I believe that there is a role for broadcasters working with government to try to ensure that this major problem that we face is addressed properly and over the widest possible front.

I have had some conversations with the BBC, and asked it to point me to a major programme that it had produced focusing solely on child obesity and communicating primarily with children. It is doing a lot of programmes, but it struggled to identify such a programme. I am pleased that Public Health England has now taken up the baton, is in conversation with the BBC and will have further talks early in September. That is good progress in the right direction, but I would welcome some advice from the Minister about how that will fit in with the present plan.

To make my second point I return to what the noble Lord, Lord McColl, said. To recover from any problem we need a diagnosis in the first instance. The real problem we have now with obesity is that people do not think that they are overweight: there is great dispute about that. We do not know what the weights of children from 11 to 16 or 18 are. We have a lot of evidence about children aged four and 11, but once they get to 11 we move to a different system of measurement, and only a couple of thousand people aged from nought to 16 are analysed. Of those, surprisingly, 50% required a visit by a nurse, which suggests there is a problem there that has not been fully examined.

I notice that I am running out of time, so I shall conclude quickly. I have been writing about the need for weighing people so that they are aware of what they weigh. Public Health England does not as yet agree with that, and neither do the Government, but I believe we need to get back to the hard facts to take the programme further forward. I hope that the Minister will be prepared to have a look at this topic with others who, like me, believe we need the facts in the first instance to make the progress required.

My Lords, the noble Lord, Lord McColl, is going down a fairly well-trodden path when he speaks on this subject. My steps will not be exactly new to anybody who has been listening to debates on this subject either. This is an interesting debate, and I look forward to hearing the newer voices: the noble Baroness, Lady Boycott, will, I hope, prevent ourselves repeating ourselves for ever.

There is one very odd aspect of the current obesity problem, which has never occurred in history before: it seems to be concentrated among those who are less well-off. For the first time in history food is very cheap. It may be the wrong type of food, and consumed in the wrong way, but it is very cheap. It is also odd that the poor are those in society who take the least exercise and are the most obese. It is difficult for people who live in poorer communities to organise themselves to do the right amount of activity or sport, or to be in the right environment to take casual exercise. If people live in nice areas with wonderful walks, they may walk either with or without a dog; they will take that amount of exercise. But if people live somewhere where it is difficult, unpleasant or even dangerous to walk around, they will not. Nobody does something that is unpleasant unless they have to.

Sitting at home with a full-fat, or fully leaded, cola—or fizzy drink; let us not be brand-specific—and a packet of crisps is a nice thing that everybody will do every now and again. The difference is whether someone thinks that they are having a guilty pleasure every now and then, or whether that is the norm. People also have to adapt what they think they should be getting out of this. Simon Stevens, CEO of the NHS in England, described exercise as a miracle cure or wonder drug. It works. People burn up calories and put on muscle mass, and as they put on muscle mass they burn up more calories, and make themselves much healthier.

Throughout our lives, especially towards the end of life, those with the least muscle mass and those who cannot move very well are much more likely to be ill in later life. That is a fact. As for the ideas about weight, I have news for you, my Lords: every single prop forward should be dead, according to the height/weight index, as should anybody who does any form of exercise like sprinting or canoeing—you name it. Weight is not the best guide; it is carrying the wrong type of weight that matters. A sprinter, or someone whose sport requires sprinting, will be taking a different type of exercise and acquiring muscle mass. All these things come together.

What are the Government going to do to allow people to get the best out of all this? Education and information about the right types of food is an important factor, and that is being provided. There are also tax incentives. The action taken on smoking has shown us what can and cannot be done, and told us about the long timescale and lead-in. Things can be done. There is also a NICE policy about bringing together sport and exercise, and involving local government and the Department for Education. The department of health is probably the only department that has sufficient power and gravitas within government to make sure this happens. Local government is under tremendous stress at the moment, and the DCMS just does not have the bite when it comes to budget and power. It has to be led by the department of health. When the Minister replies, will he say how the department is leading this exercise and bringing its colleagues in? We cannot do it unless we bring them all tighter—unless we make sure that everybody has the same hymn sheet.

My Lords, I thank my noble friend Lord McColl for initiating this debate, and I declare my interests in the register. I very much look forward to hearing the maiden speech of the noble Baroness, Lady Boycott, who I remember so well for her achievements in journalism and for her unique food web. My noble friend Lord McColl is always a mine of fascinating doctors’ stories, and I wholeheartedly agree that we need an honest campaign to tackle obesity. It is a problem of plenty, which makes one feel uncomfortable when one thinks of those in parts of Africa, North Korea and even Venezuela where people still suffer from malnutrition.

Obesity poses a serious health risk in the UK. It causes real harm and costs the NHS a fortune in treating diabetes, high blood pressure, heart disease, liver disease, kidney disease and other conditions. It is brought about by the actions of the individuals concerned. In brief, it will occur if, over a prolonged period, intake of calories significantly exceeds calories consumed, so both diet and exercise are relevant. It is not exogenous, like many cancers. Accordingly, an important need is to help those concerned demonstrate greater self-control by reducing consumption, increasing exertion or both. I prefer this approach to indirect actions such as sugar taxes or advertising bans, which are costly in resource terms, limit choice for those not at risk, and are at best scatter-gun.

Our greatest priority must be to tackle the habits of our children. We must teach them self-restraint and the habit of exercise. I believe one of the cheapest and best things we could do is to require all children to run the Daily Mile, and perhaps half a mile for the little ones. There are reports springing up everywhere of its success in terms of weight and health. I heard only yesterday of the impact in my grandchildren’s school as year 4 run a mile round the playground, and we should thank the Daily Mail, INEOS and ITV for giving this initiative real legs. It is also good for children to walk to school, so maybe children should be asked at register whether they have walked as a bit of behavioural psychology to encourage parents and carers from every walk of life.

We should also find some very simple and memorable ways of helping children to eat well. For me, there is simple magic in fresh fruit—five pieces a day if possible and not juice, which is high in calories—salad, freshly cooked vegetables and, indeed, vegetable oil, the fat we need, which can be transformational. Schools should teach cooking and projects should look at how to prevent and tackle obesity.

Our second-biggest priority is to help young adults under 40 not to gain weight, so delaying associated diseases. Essentials here are keeping up daily exercise with simple habits like walking from the bus stop or up the escalator. Employers have a duty to encourage healthy eating habits—for example, in canteens and in public procurement. I have said before that Tesco provided free fruit for children. Diet and health featured strongly on training courses, and I remember publishing a good book on the glycaemic index to help staff with weight problems. Such ideas need to be extended and to become an important part of a firm’s contribution to society and to worker welfare. Above all, the NHS needs to take a grip on its own staff’s issues with obesity. It is not fair on them or a good example to users of the NHS.

Our third priority is to stop the bulge in middle age and beyond in the majority of us who are not naturally willowy. In recent decades, I have found it essential to keep an eagle eye on the scales and to take action when the weight creeps up. I bought a Fitbit so that I walk 10,000 steps a day and get my beauty sleep. As the Minister knows, sleep is positively correlated with slimness and health and negatively correlated with weight gain and with dosing on Twitter, Facebook and Netflix.

Obesity has become rather a gloomy subject characterised by slow progress and huge public health costs. We need a new culture of self-restraint and a less tolerant attitude to obesity in society and in ourselves.

My Lords, first I am grateful to the noble Lord, Lord McColl, for this debate, which has enabled me to make my maiden speech so early, and to noble Lords for their kind words and welcome. I am incredibly honoured to stand here before you today. The first thing I would like to say is how very grateful I am to everyone from all parts of the House for their kindness towards me, to the noble Baronesses, Lady Kennedy and Lady Jenkin, who introduced me, and to my noble friend Lady Kidron who has been such a splendid mentor. I will always be very grateful to all the people who work in this amazing building for showing me where to go, providing a welcoming smile and always making me feel, literally from the moment I walked in, really welcome and at home.

After a long career, which has included founding a feminist magazine Spare Rib when I was 21 and editing three national newspapers, in 2008 I accepted the post of chair of the London Food Board, working first for Boris Johnson and then for Sadiq Khan. For the past decade, all aspects of food have been central to my life and my professional life: food policy; food poverty; urban food growing; the effects of the way we eat and grow food on climate change; children’s holiday hunger; animal welfare; and—you name it—very much so, obesity.

Life does not happen without food. Its construction is a miracle. We are all ultimately powered by plants, which in turn are powered by the sun. Food builds our bodies and provides our daily fuel, and what nature gives us is precisely calibrated to enable us to thrive. No one in this building or in this country would dream of filling the tank of their precious Ferrari with Coca-Cola, yet we are happy to fill the world’s most complex machine—the human body, the bodies of our little babies—with weird, highly processed junk which bears scant relationship to what I would call food. Yes, of course, it is tasty. It is tasty beyond belief. It is salty, sugary and spicy. I am far from immune, but this availability has triggered a health crisis which is, across the world, spinning out of control.

Food-related disease is now the world’s number one killer, but it is not so just as a result of heart disease and cancers. Bad diets lead to obesity which means living with ill health for much of your life, and it is sadly the poorest in our society who carry the biggest burden here. Diabetes, one of the possible outcomes of obesity, is not a pretty disease; it leads to lost limbs, loss of energy and kidney failure. Twenty limbs are amputated every day in this country as a result of diabetes. Did you know that last year in Vietnam they chopped off more limbs than they did at the height of the Vietnam War because of diabetes?

For me, obesity is not an individual problem. We are quick to blame the individual as a fat failure, but all the evidence points to the culprit being the ready availability of high-fat, high-sugar foods—foods that overwhelm the impulse control of children, young adults and adults, which are packaged and promoted to create the impression that they are fun, cool and life-enhancing. Many are placed in shops where children are bound to encounter them: at the tills and at grasping height. If noble Lords need further evidence, in this country 99.8% of advertisers’ budgets is spent on what I would call unhealthy food and only 1.2% on fruit and vegetables.

Changing diets can completely transform health outcomes in lots of ways. It is time for an integrated approach to food policy with it no longer being sectioned out to different departments. We must recognise that the huge burden that is being placed on the National Health Service, which other noble Lords have referred to, could be lifted if we all ate better. It is not just about obesity. One of the things that shocked me when I was chair of the London Food Board was to discover that, in this great city of ours, one of the prime reasons that the elderly go into hospital in London is malnutrition and dehydration. So a council saves—let us be generous here—£15 a day on a meals-on-wheels and a person ends up in a high dependency £600-a-night hospital bed. This is because of cuts. Councils cannot afford it. Why can we not rethink this system? One pot of money. We all deserve to eat well.

I am both humbled and very excited to be amid so many of you who care so much about a subject that I care so much about. I hope that by adding to your number, I can add to your strength. We can, through food policy, achieve a better world—one that is fairer, that calls a halt to the inequalities that we see now where the poorest in our society are not only condemned to poorer lives, but all too often to poorer health outcomes. I know that food lies at the heart of many of the problems we need to fix, but it is also the route to so many of the solutions where everyone, whatever their background, can enjoy a good life, made possible through good food. It is my privilege and my pleasure to join your Lordships to work to that positive outcome.

My Lords, it is an honour and a pleasure not only to have been one of the noble Baroness’s supporters last week, but to be following her now. Like many women in this country, I feel I have been following her for most of my life. The noble Baroness no doubt feels that her younger self—founding Spare Rib aged 21—would have been amazed to see herself here today. Well, I can assure her that my 16 year-old self, in awe of her many achievements, would have been far more astonished at the thought of being here with her today.

The noble Baroness, Lady Boycott, has had an extraordinary and wide-ranging career to date, from 1970s feminist, newspaper editor, writer, farmer to chair of the London Food Board and fearless campaigner on many other issues. As she starts yet another new career, all of these experiences will have given her skills and expertise which will significantly enhance our deliberations, not least in the fields of women’s rights, food and obesity, which we debate today, and I look forward to continuing working with her on many of these vital topics.

My noble friend Lord McColl and I share an office. Tackling obesity has become a shared passion, which we discuss regularly, and I am grateful to him for giving us the opportunity to open up our daily conversation to the Chamber today.

May I start by congratulating the Government on chapter 2 of the childhood obesity plan? As the introduction says,

“Childhood obesity is one of the biggest health problems this country faces”.

It also acknowledges that it is a social justice issue disproportionately affecting children in low-income households in the more deprived areas. The plan makes a good start, and I look forward to the consultation. But I am aware, from the challenges of chairing the Centre for Social Justice’s childhood obesity report Off the Scales last year, that keeping food campaigners and the food industry in the same room is not easy.

Last month, I stumbled across a BBC programme “The Big Crash Diet Experiment”, which took four obese people with serious weight-related health issues—fatty liver disease, heart problems and type 2 diabetes—and, under medical supervision, put them on a nine-week 800-calorie-a-day regime. The presenter, a doctor, was sceptical at the start, like many of us viewers. The programme included interviews with a number of medical experts, including former government obesity adviser Professor Susan Jebb. The results were immediate and dramatic. All four volunteers lost a considerable amount of weight—to the extent that they changed shape before our eyes. Overall, there was 20% less of Father Paul, and his diabetes went into remission; Rebecca lost nearly three stone; Yolande’s liver fat was reduced by a third. I know that ITV has also recently shown a similar programme with similar results.

Curious to know more, I got in touch with Professor Roy Taylor, from Newcastle University, who also featured in the show. He told me that the current position is exciting. It is now accepted by all UK diabetes specialists that type 2 diabetes is a potentially reversible condition. My noble friend the Minister may be aware that the national clinical director for diabetes and Simon Stevens are actively discussing how to roll this out in the NHS. Last month, the American Diabetes Association changed its official position and recognised for the first time that remission of type 2 diabetes was possible.

Changing long-established beliefs about any medical matter takes time, quite rightly. It is 10 years since the publication of the hypothesis of type 2 diabetes being a simple and reversible state, and it is seven years since publication of the proof that real people could actually achieve this. Early next month, Professor Taylor’s paper describing the mechanisms in liver and pancreas as people achieve remission of diabetes will be published in the internationally leading journal Cell Metabolism.

Noble Lords will not be surprised, however, to hear what his research participants report as the greatest barrier to success. They describe very clearly the personal and social difficulties in maintaining reasonable long-term control of food intake in the current obesogenic environment. Although around one-third report no trouble in avoiding weight regain, the majority—like most of us—have to struggle against our food-centred culture: unthinking acceptance of the notion that eating between meals is okay; unregulated fast food production with high added-sugar content and hence lack of feeling full despite significant calorie intake; and the lack of simple, clear labelling of calorie content. He also said that the argument that voluntary regulation by the food industry might help is flawed. The need for action is eloquently illustrated by the simple fact that the average man and average woman are now over 10 kilograms heavier than in 1980. At a current estimated cost to the NHS of £30 billion a year, this cannot continue. I urge my noble friend to act.

My Lords, I thank the noble Lord, Lord McColl, for introducing this debate with his usual clarity and passion. I also congratulate the noble Baroness, Lady Boycott, on her invigorating maiden speech. I loved Spare Rib.

We know a lot about obesity. We know its side effects, which include illnesses such as cancer and diabetes. However, there is a warning. Our experience of public health shows that just giving people of any age the facts about the health detriments caused by smoking, alcohol and poor diet is not enough to change their behaviour. We also need to examine the more complex aspects of these issues.

Like many other countries, we have an obesity crisis. I am currently writing a report on adolescent health for the Council of Europe, where I chair the sub-committee on children. Our report will focus on three aspects of adolescence: mental health, sexual health and obesity. Those topics might seem diverse and unconnected but I think that they have some points in common, chief among which is the development of self-esteem in young people. As we know, young people who have high self-esteem are more likely to have better social skills, better decision-making skills and better resilience, enabling them to resist pressure and seek help when needed.

The same things tend to influence young people’s mental health as influence their sexual health and possible obesity, namely their parents and family, social and other media, advertising, gender, laws and policies, friends, school, and so on. Surely we need to focus on what those influences are doing to children rather than on one simple issue, even if it is a health issue. For example, we know that children from lower-income backgrounds tend to be more obese, so poverty is the driver, and we need to look at poverty. Surely we also need to look at how the media is influencing children and works to their detriment.

One in five children in this country is already overweight or obese before starting school. That is not a child’s problem; it is a parental and societal responsibility. In particular, it is the responsibility of the food industry to make its labelling of sugars more accurate. Interestingly, and the noble Lord, Lord McColl, mentioned this, I have not seen much reference to the importance of breastfeeding in relation to its impact on future obesity. I know that I have read evidence of this but it was many years ago. I wonder if the Minister has any advice on breastfeeding and its impact on obesity.

I know there is more demand generally for healthy food and that this has had an impact on sugar content in food, and that many schools have taken very seriously their attack on sugary drinks and healthier school meals. I know some schools are encouraging children to walk to school and do more exercise. Exercise, as the noble Lord, Lord McColl, was saying, is good for us, and perhaps the feeling of well-being from doing exercise can help to raise self-esteem and the wish to look good. Yes, exercise eats up some calories but, as the noble Lord says, the crucial thing is undoubtedly diet.

What can the Government do? This would be my list, for a start: stop making people poorer so that they do not have to rely on food banks for family food; educate parents about obesity; start now with a firm strategy on school meals; insist immediately on child-friendly watersheds on advertising food that is high in fat, sugar and salt; involve local communities in decisions about reducing obesity; help schools to develop personal, social and health education programmes that increase self-esteem and decision-making skills and to provide consistently healthy food; and set clear goals and targets for reducing obesity, with measures which can be evaluated and learned from. Does the Minister agree?

As I said at the beginning, we know what and where the problems are. Now is the time for swift and breath-taking action to combat obesity. The NHS cannot afford such a problem. Apart from financial concerns, society, and especially children, cannot be allowed to suffer the side effects of obesity. There is much to do, and I shall be most interested in the Minister’s response to this important debate.

My Lords, I congratulate my noble friend on introducing this very important subject. I also congratulate the noble Baroness, Lady Boycott, on her outstanding maiden speech; she delivered it with passion and knowledge, and we look forward to hearing further contributions from her.

To my mind, there are three elements to obesity: first, the type of food that we eat; secondly and most importantly, the quantity that we eat; and, thirdly, the exercise that we take or fail to take. I feel that the debate in this country has focused far too heavily on the first aspect. We have demonised some foods and not paid enough attention to maintaining a balanced died and burning off the calories that we consume. There are no bad foods, only bad diets. Any food eaten in excess and to the exclusion of others is bad for a person.

For years the Department of Health had a vendetta against dairy products—milk and cheese—based on old, discredited research that fat products were bad for one. I can safely say that when I was Food Minister many years ago, every bit of advice that I was told by our health experts to issue to the public was countermanded at least twice over the next few years. Can any noble Lord tell me authoritatively how many glasses of red wine you should take each day? It seems to change every year whether or not one is pregnant. No wonder there is public cynicism about government diktats on food.

Nothing was sillier than taking action against sugary drinks but not against the giant cakes and buns now prevalent in all Starbucks, Caffè Neros and other similar places. A few years ago, a croissant was a little thing about five inches long. Now they are gigantic things about 10 inches long and stuffed with chocolate. Many mornings, I witness people popping into a Starbucks near here and ordering their decaf soy skinny lattes—and then a chocolate chip muffin. We used to have something called fairy cakes or angel cakes when I was a boy, but now there are gigantic muffins at 650 calories apiece, which is one-third of a woman’s recommended daily intake.

That brings me to the second problem: the amount that we consume. The official recommendations for calorie intake are 2,500 for men and 2,000 for women, but those were set way back in 1990 in the US. In fact the Library tells me that the first ones were suggested by a splendid American called Wilbur Olin Atwater in 1888. They are generations out of date and were set at a time when we were a much more active population, when children played outside rather than sitting in their bedrooms texting, when we walked to school rather than being carted, and when more adults were doing manual work. It is nonsensical to retain these grossly excessive calorie levels now. What is worse is that they are being exceeded. Apparently many of those who know about the levels and want to follow them do not realise that they are exceeding them on a daily basis, while the other half of the population either do not know or do not care. We seem to be waiting for a magic pill so that that we can continue our gluttony and our lazy lifestyles in the hope that the NHS will fix it for us without having to change our behaviour one iota. Apparently Public Health England now suggests a guideline of 1,800 calories but does not want to change the advice of 2,500 and 2,000. What stupidity is that?

When I was in the 51st (Highland) Division I would eat a huge fry-up for breakfast, an enormous lunch and an even bigger dinner—about 5,000 calories a day—and I lost weight and was fit. Now I do not do much exercise. In fact I do not do any at all; I sit on my backside all the time. If I consume more than 1,000 calories a day then I put on weight. What a major scientific breakthrough that is: if we scoff more calories than we burn off then we get fat and obese.

Obesity is not an illness; it is a lifestyle choice. We are creating a nation of fat, idle people who will bankrupt the NHS, and we should have the courage to say so in blunt terms. Our strategy must be threefold. First, it must tax excessively sugary foods—all of them, not just some—and penalise excessively large food items. Secondly, calorie intake guidance must be revised downwards to recognise our indolent, lazy lifestyle. We need constant campaigns on that. Planning guidance should force councils not to have high streets full of takeaway food shops; research suggests that locations with supermarkets provide better diets than streets without such shops. Thirdly, we must have a huge campaign to get the whole nation exercising. Exercise alone does not compensate for overeating but it has a part to play. I too commend the Daily Mile initiative, which gets children exercising for a mere 15 minutes per day. It should be compulsory in all schools. My wife has tried to force me to do it as well.

There is no easy answer, but at the moment I do not think we are even asking the right questions.

My Lords, I thank the noble Lord, Lord McColl, for his ongoing interest in this subject, although I suspect that I may have some slightly different views. I also take this opportunity to welcome my noble friend Lady Boycott. When the list of new Peers came out, my roommate, the noble Baroness, Lady Kidron, was delighted to see her on the list, and she is so sorry that she is unable to be here tonight. I draw your Lordships’ attention to my declaration of interests: I am chairman of ukactive, which works in the area of physical activity.

I am particularly interested in childhood obesity. We now have a generation of children in primary school who are more likely to die earlier than their parents because of obesity, so I am a huge supporter of the Daily Mile and structured play. Measuring children is incredibly important because we must know what we are dealing with. We do not allow our children to do trigonometry without doing basic maths but we try to teach them sport without teaching them basic physical literacy. So there is a long list of things that we could do in schools to improve physical activity and tackle obesity.

Sadly, we are not going to be able to turn back the clock to a time before fast food and coffee-shop pastries on every street corner, but moderation is part of the answer. Of course it is about what you eat, but it is also about the energy that you expend. I believe obesity and physical activity and exercise should be inextricably linked. It is a complex issue but we have to look at the whole self, the whole individual, to ensure that they are mentally and physically well. It is not just about the size of our waistlines; it is about the health of our hearts. A lack of physical activity causes up to 37,000 premature deaths in England alone. Physical inactivity is the fourth-greatest cause of disease and disability in the UK. Globally, it is linked to more than 5 million deaths per year—similar to the number of lives lost to smoking, and higher than the number caused by obesity. The key priority should be to tackle the obesity and inactivity crises together, in a way that recognises the complexity of the issue and takes a holistic approach to improving the nation’s mental, physical and nutritional health.

I was delighted with the second childhood obesity strategy, which was recently published. However, what are the Government doing to adopt a comprehensive approach that promotes the nutritional and physical activity sectors working together to tackle obesity in the UK? Physical activity has a significant benefit for everyone. Not only does it have a major positive impact on weight management; it can also improve the health of those from the youngest to the oldest in society.

We need to look much more closely at what happens in the workplace. PricewaterhouseCoopers estimates that workplace absenteeism costs the UK around £29 billion per year. That, too, is linked to inactivity. I am pleased to see that progress is being made in this area. Earlier this year, the Government and ukactive published guidance for workplaces, encouraging them to prioritise the health of their employees and to take part in physical activity. But we need to do more. I know from personal experience that although I can walk a couple of miles around this building every day, we have to find different ways of integrating physical activity into our lives. It might mean going to the gym or getting off the bus a couple of stops earlier. It must be something that is filtered through the day, not something that is done just a couple of times a week. This is about educating people to think about how they can be more physically active and about what they consume.

The guidance is promising but, alone, it will not improve health or activity levels or reduce the prevalence of obesity among the people of the UK. We need a campaign to build on this guidance. There are proposals to expand the cycle-to-work scheme to include a much broader array of health-related purchases. This is important and could generate savings of around £240 million per year.

Let us think about the danger that we are putting young people in with obesity. I have a 16 year-old daughter. My aspiration for her has never been that, due to obesity or physical inactivity, her life will be shorter than mine. I urge the Government to look at this problem in a joined-up manner so that we can tackle it and help future generations of our young people.

My Lords, I thank first my noble friend Lord McColl for initiating this debate and, secondly, the noble Baroness, Lady Boycott, for her excellent maiden speech—clearly we have another person joining those interested in this subject. I declare my interests as the president of the British Dietetic Association, a TUC-registered trade union that looks after dieticians working in the health service. I can perhaps give my noble friend Lord Blencathra the answer to his question: how much red wine should we drink per day? I am informed by a doctor friend of mine that the figure is two units more than the doctor himself consumes and that, whichever doctor you ask, you will get the same answer.

I want to cover two issues in my brief allotted time. The first is the veracity of the numbers in the obesity debate. There is a great tendency today to exaggerate numbers, seemingly on the principle that the bigger the better. If noble Lords look at the House of Commons briefing on obesity, which has been circulated, 61.4% of all adults are obese or overweight. This may be true but it becomes a meaningless figure—many will say, “That’s all of us then, isn’t it? We don’t need to do anything about it”. I have some evidence that a BMI of around 26 or 27, which is technically overweight, has been shown as the best BMI for a longer life; we need to look at the figures. As the noble Lord, Lord McColl, would agree, BMI is an inaccurate measure anyway; the waist circumference to height factor is much better. We need to concentrate our resources on where the problem actually exists. Clearly the biggest problem concerns people with a class 3 BMI of over 40—those are the people who have real difficulty with weight problems. The second group are those with a class 2 BMI of 35 to 40. We tend to pepper-gun the problem, rather than dealing with it discretely.

I would like the Minister to go back to the department and look at the overall figures. Looking at the briefing—and this is confirmed in other briefings—we are asked to believe that obesity among children aged 10 to 11 is roughly 20%. On the exact same page of the briefing from the Library, we find that at 16 it is 11%. I do not believe the figure has dropped by 50% during those five years at school. It does not make sense. In Australia, the obesity level of 16 year-olds is 7%. The Minister needs to look at how these figures are put together.

My second point concerns the treatment of obesity. Clearly, current funding has been cut for local authorities. If we are to concentrate on the people who suffer from what I would call the top level of obesity, you need proper funding to do it. We have again—it is a bigger question—to look at how funding for health works. There is too much division between local authority, general practice and hospital practice; we need to look at joining them together.

I want also to talk about food and tax. The sugar tax is actually quite popular; I think any popular tax is a jolly good thing. I invite the Minister to initiate a few cross-party discussions on the extent to which sugar-laden goods and highly processed goods can be further taxed. If we can raise money for the NHS by taxing things—and being popular with it—I suggest that is a good thing.

Finally, I endorse what the noble Lord, Lord McColl, said about tooth decay. This is directly linked to sugar; it impacts particularly and very directly on five year-olds and is something we need to tackle. We cannot have a system in which the dental profession says 90% of decay is preventable, yet we do not have a strategy for it; I ask the Minister to look at a dental strategy.

Overall, the message I bring is that we need a good, well-targeted programme, particularly directed at gross obesity, rather than wringing our hands and saying, “Everybody’s too fat, but there’s nothing we can do about it”. We need a targeted programme. Please, Minister, look at these statistics.

My Lords, I congratulate the noble Baroness, Lady Boycott, on a smashing maiden speech. The Duchess of Windsor famously observed, “You can never be too rich or too thin” and I have often reflected on both parts of that proposition. If we accept the Dalai Lama’s analysis that the purpose of life is to be happy, the jury is definitely out on wealth—I have met a number of billionaires who are utterly miserable. On weight, though, I have no doubt whatever there is a definite correlation between increased girth and reduced enjoyment of life. As evidence of this, I cannot think of ever having met anyone who actually wanted to be obese.

Other vices, from smoking to drug-taking and sex addiction, have their enthusiastic defenders and of course there are many who shamelessly revel in the delights of eating and drinking. But who will speak positively of the consequences? Who lauds the up side of obesity? I know of no one. Most severely overweight people want and try to lose weight, so what is the issue? The NHS website, in a perhaps slightly oversimplified way, captures succinctly what we all know:

“Obesity is generally caused by eating too much and moving too little”.

If that is truly the case, surely the answer—we have heard it from lots of people today—is simply: eat less and move more. Obesity is clearly preventable and reversible.

I will concentrate on the “eating less” element—that is, eating less and eating better—and on how the Government can help. The importance, or otherwise, of exercise for health and well-being has been well covered by other noble Lords. Thankfully, the Government are on the case and have made an excellent start with their strategy and aim to halve childhood obesity by 2030, but plans and targets are not enough—not in a life-or-death situation, and not if the doctor is reluctant to treat you or the airline to fly you and people snigger when you give it your best shot at running for the bus.

Implementation of an effective plan is key, but the use of words such as “debate”, “consult”, “encourage” and “voluntary” are not very encouraging. They will take us nowhere and certainly do not reflect the urgency of the need to act right now to contain, curb and reverse this frightening, pernicious epidemic, which I believe is threatening our society. I prefer words such as “regulation”, “mandate”, “legislate” and “controls”. In that way we might just stop our food manufacturers and supermarkets selling food full of bad fats, sugar and salt, which are slowly killing us. This is a serious situation by any measure and it requires strong, determined and unambiguous action, not words. As the noble Lord, Lord Addington, said, this is a topic that we have talked to death in this Chamber.

We have already enjoyed past successes in changing anti-social and personally destructive habits. These include smoking and driving without a seatbelt or with a hand-held mobile phone. I believe that we just need to take more of the same action because it is proven. However, I suggest, without any wish to be humorous, that tackling obesity is the biggest challenge of them all, so let us institute, without undue delay, a powerful, emotive, heavyweight, long-term and high-profile advertising and marketing campaign, certainly online and on TV. It would be self-funding, with the aim of educating, influencing, encouraging and supporting, and it would help to counter the prolific advertising of junk food, which it is to be hoped the Government will tightly regulate soon. Such a campaign should of course be judiciously combined with an essential strong and clear regulatory framework, sanctions and fiscal measures designed to encourage or discourage as appropriate.

By succeeding in reducing obesity, the savings to the NHS alone, as has been mentioned many times, would be mega, but the real benefits, which are hard to overstate, would be accrued through fitter and healthier members of our society enjoying a more fulfilled, productive and happy life. Therefore, let us make this debating Chamber an action Chamber.

My Lords, I thank the noble Lord, Lord McColl, for bringing us back to this important subject, and I welcome the noble Baroness, Lady Boycott, to your Lordships’ House.

Travelling on the Tube yesterday in the middle of the afternoon, I sat opposite a gentleman who took up two seats. His stomach was protruding out of his shirt. He looked very uncomfortable, and he was eating a pasty. I thought, “Sir, this is not good for your health”. It took me back to an occasion soon after I entered your Lordships’ House when I sat down at the long table in the Home Room with a plate of salad. A former, very personable Member of the House sat next to me, looked at both our plates and started to laugh. She said, “Oh look! The slim lady is eating salad and the fat lady is eating sausage and chips”. I was too polite to say, “Well, yes, don’t you think there’s a connection?”. Of course, the noble Lord, Lord McColl, is right. What matters most is what we eat and drink.

Many clinicians now feel that it would help to regard obesity as a disease. We would then be less judgmental and recognise that many people suffering from it have been conditioned since childhood to respond to sugary or carbohydrate-rich foods, with those foods then becoming a need. The gentleman on the train is probably one of them. They need help and services, not judgment, and those must include mental health services. For some, one of the services needed is bariatric surgery, with a multidisciplinary team to help them return to a healthy body weight. I talked recently to an eminent paediatric bariatric surgeon. He told me that the service he provides is not widely available and yet it can save the lives of his patients and reduce the eventual costs to the NHS. Therefore, I ask the Minister what plans are in place to make this service available wherever it is needed. Of course, it is a last resort for very serious cases, and I want to emphasise that the surgeon I spoke to spends a great deal of time working with public health services to prevent people becoming obese in the first place. Prevention, I believe, is the key.

I was interested in two items on the news this morning which chimed exactly with what I wanted to say today. First, there was new guidance from Public Health England’s Scientific Advisory Committee on Nutrition about the number of calories that should be consumed by young babies. It was reported that many are consuming far too many calories and this is laying the foundation for obesity later in life. We were reminded that exclusive breast-feeding, at least for the first six months of life, lays the best foundation for health, not just because of the many antibodies and good micro-organisms passed on from mother to child but also because breast milk is perfectly balanced nutritionally and has just the right number of calories for healthy growth. Therefore, I call Public Health England in aid when I ask the Minister what is being done to encourage more mothers to breast-feed—we have a bad track record in this country—and to ensure that they can do so comfortably wherever they need to do it.

The second news item was about the Football Association saying that many days of play are prevented because of the state of the pitches. This is because of years of underfunding of local authorities, which cannot afford the necessary upkeep. As my noble friend Lord Addington told us, what we eat may be a major part of the obesity problem but keeping active is also vital. Incidentally, it is also important for mental health. A senior tutor at an Oxbridge college told me recently that, of all the students coming forward for counselling for mental health problems, not one took part in regular sport. She found that very significant and I am sure she is right.

However, my main concern is with young children. We have had the statistics from the Royal College of Paediatrics and Child Health, and I join its demand that there should be a 9 pm watershed ban on advertising on TV foods that are high in sugar, salt and fat. I am pleased that chapter 2 of the childhood obesity plan promises a consultation on this. I am quite sure that the evidence will show that the majority of TV watched by children is not children’s programmes, which already have a ban, but family viewing between 6 pm and 9 pm. If your Lordships are looking for evidence that advertising these foods influences people’s choices, they have only to look at how much the food companies spend on it. The noble Baroness, Lady Boycott, reminded us of that. They would not do that if it did not work. People are influenced by messages that tell them how delicious these foods are and how happy they will be if they eat them, so I hope the Minister will assure me that when the Government get this evidence in the consultation, they will act decisively.

My Lords, the noble Lord, Lord McColl, is nothing if not persistent in his determination to challenge obesity. Essentially, his message to eat less is the one that he has expanded on on many occasions. I agree with him that we definitely need a national approach.

I welcome the noble Baroness, Lady Boycott, to your Lordships’ House and I congratulate her on her maiden speech. She brings great experience, not least of the media, and indeed she was a hero of mine when she edited Spare Rib. I understood slightly less well her editorship of the Daily Express, but I think that that experience will bring great weight to our debates.

There have been some excellent contributions, as ever, and pertinent questions to the Minister about the Government’s progress on their obesity strategies, particularly for childhood obesity. We have also received many excellent briefings. I particularly enjoyed the contributions of my noble friend Lord Brooke—I congratulate him on his work with the BBC—and my noble friend Lady Massey, who called for an action plan. It is fair to say that we have not cracked this one yet. I think that we are slow in having any impact in our attempts to halt the growth of obesity rates and the related, and very expensive, health and social problems that follow.

There is an even greater and more serious societal problem here which will not necessarily be resolved by the exhortation from the noble Lord, Lord McColl, to eat less, and which might be only partly resolved by the Government’s obesity strategy. We have both an obesity and an eating disorder crisis, and in my view they are different sides of the same coin. Obsessive eating and self-hate, compulsive eating and body dysmorphia are handcuffs that women, but not only women these days, place on themselves and assume they have to escape from. There are assumptions that people are weak-minded, greedy and undisciplined. When Susie Orbach wrote Fat is a Feminist Issue 40 years ago, she said that there were specific realities to the conditions of both fat and thin that we were all chasing and escaping through our eating. She was right then and she is right now. If the Minister and the noble Lord, Lord McColl, have not read FIFI, I recommend that they do so when it is reissued.

We are now 40 years on and the pressures to be thin and to have no hair on your body except on your head, or this year to have very thick eyebrows or next year none at all, are not exclusive to women. Huge damage is caused by the pressures put on our girls and boys and our men and women by social media, the media and advertising campaigns, from stereotyping of all types and the misogyny illustrated by the #MeToo campaign, and the production and advertising of high fat, salt or sugar foods. Parents are constantly fighting a battle to either afford or persuade their children into a healthy lifestyle, and sometimes both. Who would have anticipated the explosion in non-food foods that contain chemicals and sugars that do not get metabolised by the body? Who would have linked obesity to class? There is no doubt that obesity is linked to social class, being more common in the routine and semi-routine occupational groups than managerial and professional groups.

We have what you might call a perfect storm. No doubt big action is definitely required, but that has to be accompanied by a greater understanding of the nature of the problem and the challenge that we face. Can the Minister request that his right honourable friend the new Secretary of State convene a summit that seriously addresses the issue of body hatred and body image, and the factors that create it and have led to this explosion in obesity and eating disorders? I also ask that his right honourable friend address the solutions to these huge societal challenges, which cannot just be left to public health and educational policy agendas alone. It is time to look beyond the strategies that the Government are pursuing at the moment.

My Lords, first, I congratulate my noble friend Lord McColl on calling this debate and showing his usual enthusiasm and tenacity in doing so. I have a feeling that, given his injunction to us is to eat less, the timing of this debate, which means speaking between 6.49 pm and 8.02 pm, is perfect as we have all missed dinner. I also congratulate the noble Baroness, Lady Boycott, on a very passionate and persuasive speech; she will obviously bring many strengths to this House. I note that in 1984 she wrote a book called The Fastest Diet. I think she might have been one of the first people to promote the idea of fasting. I skipped breakfast this morning in her honour as I am on currently going through the fad of the 16:8 diet. I do not know whether it is helping; I generally just feel a bit tired, but that could be something else.

This is a topic we talk about a lot, but I think we are making progress and getting good ideas from it. I think we are making progress in government policy, too, and I will talk more about that. We know the level of the problem: a quarter of children aged five are overweight or obese, rising to a third by the age of 11, and six out of ten adults are overweight or obese. I am, however, mindful of my noble friend Lord Balfe’s point about accuracy. Strictly speaking, of the adults who are overweight or obese, a quarter are obese so most are overweight, and there are question marks about that. Nevertheless, that is a lot of people—a significant part of the population.

As many noble Lords pointed out, including my noble friend Lady Neville-Rolfe, there is not only a poverty dimension but an age dimension, so there are all sorts of social justice issues at work here. There are also huge economic costs: £6 billion a year to the NHS and about £27 billion to the economy at large, as the noble Baroness, Lady Massey, pointed out, endorsed by my noble friend Lady Neville-Rolfe. There are health costs linked to cancer, cardiovascular disease and diabetes—I thought the Vietnam example was terrifying. Though, as my noble friend Lady Jenkin pointed out, there is cause for hope about type 2 diabetes being a reversible condition, and I will return to that. There are other costs, too, including worklessness, oral health and the emotional and mental health costs, as the noble Baroness, Lady Walmsley, and my noble friend Lord Kirkham pointed out. I think it constitutes a crisis, and as the noble Baroness, Lady Walmsley, pointed out, it should be thought of as a disease, if not an epidemic, because it appears to be catching. It appears that if your peers are overweight, you are more likely to be overweight—that is a catching thing. Whether it is a meme rather than a disease, it is something that can be spread.

As has been said today, it is not simply as easy as saying you should eat less and exercise more, especially in what my noble friend Lady Jenkin evocatively called an obesogenic environment. It is a phrase I had not heard before, but I thought it was very evocative. Ultimately, we need to help people build up good habits of personal responsibility.

Lots of noble Lords talked about the role of schools, and I will return to that, but it is notable that Ofsted has said today that we cannot lump all this on to schools and every part of society needs to take responsibility. I could not agree more. As the noble Baroness, Lady Massey, pointed out, families and parents need to be equipped to give good advice and good parenting. As the noble Baroness, Lady Grey-Thompson, and my noble friend Lady Neville-Rolfe pointed out, corporates need to play a role in this, as of course do the Government. We all agree with that. We need to be guided by evidence and research, although, as my noble friend Lord Blencathra pointed out, sometimes the evidence and research, and all the advice that is based on it, can change.

We are trying to do something about that. We have made a significant investment in a policy research unit to help make sure there is more consistent advice. I think there is generally a better understanding of the causes of obesity now.

My noble friend Lord McColl talked about the fat versus sugar debate. That still rages on and views still differ. Noble Lords also talked about calories versus exercise or inputs versus outputs, as I always think about it. The noble Lord, Lord McColl was firmly on one side of that debate, with the noble Lord, Lord Addington, firmly on the other, and other noble Lords, such as my noble friends Lord Blencathra, Lady Neville-Rolfe and Lord Kirkham and the noble Baroness, Lady Grey-Thompson, somewhere in between. I think of it in physics terms, as the law of conservation of energy: what comes in either goes out or stays. It is simply the case that in an isolated system, energy is conserved.

We need to look at this holistically, and that is what the Government have been trying to do. Noble Lords will know about what we call chapter one of the obesity strategy. The centrepiece of that is the sugar levy, which my noble friend Lord Balfe called a popular tax. There you go—they do exist. That has had a really big impact for everybody, children and adults, with 45 million kilograms of sugar being taken out of circulation as a consequence. As well as this, there have been big investments in school sports, breakfast clubs and food tech being in the national curriculum, which the noble Baroness, Lady Grey-Thompson, and my noble friend Lady Neville-Rolfe asked about.

We also know that chapter 1 did not have the full effect that we wanted, especially on reformulation, which is the point that my noble friend Lord Blencathra was making about the kinds of food everybody eats, not just one category or the other. This is what led to chapter 2, announced on 25 June. I was glad to see noble Lords welcoming that. There were really big moves forward, including a watershed for advertising unhealthy food, which the noble Baronesses, Lady Massey and Lady Walmsley, asked about. Also, there was a ban on price promotions of high-salt and high-sugar foods—trying to take the fun out of processed food, as the noble Baroness, Lady Boycott, said, which is a really good way to think about it. We ended the sale of energy drinks to children, which was one of the things that really worries me. If you look at the impact on school life, teachers will tell you that is a really big problem. It includes consistent calorie labelling outside the home, although, as my noble friend Lord Blencathra pointed out, it might not always help to know how many calories are in that Starbucks chocolate muffin. But it does help to provide a nudge. We are also introducing stronger government standards for food and catering services, something raised by my noble friend Lady Neville-Rolfe. And, of course, there is the Daily Mile, which has proved very popular—so popular that I wonder whether we, as an institution, should do it before Prayers. We might be able to show genuine leadership on that.

The point that the noble Lord, Lord Addington, and the noble Baroness, Lady Grey-Thompson, made is critical. I hope that noble Lords will see in chapter 2 that this is a cross-government effort. These are not just health things but encompass different departments, although I appreciate that we can always do more.

The noble Lord, Lord Brooke, asked about the consultations; I do not have a date by which they will be instigated, but they will be launched by the end of 2018. I absolutely salute the work he is doing to try to drive that campaign with national broadcasters, and I have brought that to the attention of my colleagues in the department.

The noble Baroness, Lady Walmsley, asked about prevention. It is interesting that our new Secretary of State has an interest in that whole agenda, and I think we will see more of that from him. Given the department he has run, he also understands the media and how you influence people’s behaviour when you do not have lots of money to spend—which the DCMS rarely has. We therefore also now have quite an interesting ally in the new Secretary of State.

We are trying to do other things. The noble Baroness, Lady Grey-Thompson, knows better than all of us in this Chamber about the importance of exercise. She has done it—she is a Paralympic champion herself. We are encouraging walking to school—there is a good joint project with Living Streets—more money is going into the Bikeability scheme, and there is the Sport England strategy and the CMO’s daily physical activity deadline. A lot is going on, but I agree that perhaps there is a need to wrap all this together, not just to talk about the food and health bits of it.

My noble friends Lord McColl, Lord Blencathra and Lord Kirkham emphasised different eating habits. There is a successful public health campaign called Change4Life, which has some quantifiable impacts on the way people eat food—the quantity as well as the quality—and there is more emphasis on preparing food from scratch rather than eating processed food. I encourage noble Lords to look at that, because it has been quite effective, and it uses public campaigns as well as other ways of promoting good eating habits.

My noble friend Lady Jenkin talked about the potential of fasting. The ancients understood this but we now have an evidence base, as she described, which means that we should probably put more emphasis on fasting as a technique, not just for losing weight but for better health as a whole. The department as a whole will need to take that forward.

On tackling other causes of obesity, my noble friend Lord McColl talked about stress and abuse, which was an incisive point. That goes hand in hand with what the noble Baroness, Lady Massey, said about building self-esteem, which in a way sometimes corrects the consequences of stress and abuse. She will know very well that some important steps forward have been taken in schools in this country to try to increase well-being and build character—I tried to do that in the schools I set up—which will have benefits for both mental and physical health.

Finally, on a few other issues which noble Lords raised, my noble friend Lord Balfe and the noble Lord, Lord Brooke, asked about weighing people. There is an issue about weighing teenagers forcibly, but clearly we need ways to sample age cohorts. I will investigate that further and see exactly how we do it. My noble friend Lady Neville-Rolfe talked about sleep, which we have touched on before. I am increasingly of the view that there may be a need for some government work on promoting good sleep—not that I am the Public Health Minister.

The noble Baronesses, Lady Walmsley and Lady Massey, asked about breast-feeding. We are absolutely promoting it and we recognise the advice of the Scientific Advisory Committee on Nutrition. It is also a part of the maternal health strategy. The noble Baroness, Lady Walmsley, mentioned bariatric surgery. There are NICE guidelines for that, so if people meet certain criteria it should be available to them.

Once again, we have had an interesting and wide-ranging debate, although obviously there are some areas of disagreement among us. I will end on the point the noble Baroness, Lady Thornton, made. I will certainly speak to the Secretary of State about it, and I think he is open-minded on this. You can look at the attitude he has taken to the role of social media, for example, which goes beyond what most pro-business Governments would be prepared to do. I think he will be sympathetic to this. In the end, this is about helping people to develop a healthy relationship with food. It brings to mind a book I read a few years ago, which is not about food at all, called The Case for Working with Your Hands, by Matthew Crawford. He talked about the alienation that comes from working in an office environment, such as in bureaucracies, because you are unable to feel what you have produced—you cannot touch it. He ends up, having done a philosophy degree, becoming a motorcycle mechanic—so it is a bit like Zen and the Art of Motorcycle Maintenance. It is about something physical. There is something about growing food or foraging for it—it is about going out to experience it, and knowing what it feels like. If we want to develop those good habits and a sense of personal responsibility, we have to get people involved—children, but adults as well—in the experience of growing food. That is not easy to do in cities, but we could discover that and do more of it.

Finally, these debates are incredibly helpful, because this is an iterative process. We have had chapter 1 and chapter 2, and I dearly hope that we will have chapter 3. I am sure that many of the ideas that noble Lords have suggested tonight will feature in it. Long may it continue, and I look forward to the next debate on obesity, which I am sure will take place before long. Once again I thank my noble friend Lord McColl for instigating this debate, and I congratulate the noble Baroness, Lady Boycott, on a superb speech.