§ Dr. Howard Stoate (Dartford)
I am delighted to have secured the debate on obesity in children, the importance of which we are only beginning to understand. Had we had this debate a few years ago, we might have categorised childhood obesity as a cosmetic problem and talked about image, self-esteem, peer pressure and bullying. However, as I hope to show, the problem of obesity is far more serious than that. If not tackled effectively, it could become as serious a public health issue as smoking. Obese youngsters have already brought lawsuits against McDonald's in the US.
The impetus for this debate comes from my research assistant, Brian Jones; he and I wrote a report on public health in children that was published by the Fabian Society under the title "All's Well that Starts Well". The facts are stark. According to Andrew Prentice, professor of international hygiene at the London School of Hygiene and Tropical Medicine, seriously obese children are losing up to nine years on average to diseases that were not as common in their parents. The number of obese children in the UK has doubled in the past 10 years: about 10 per cent. of children are now officially obese and are therefore at serious risk of developing any number of potentially life-threatening conditions such as diabetes, heart disease and cancer.
The Harvard growth study assessed mortality and morbidity in 508 lean or overweight adolescents after 55 years of follow-up. The relative risk of death almost doubled for obese adolescent boys. Obese teenagers are now being diagnosed with type 2 diabetes, a condition that is closely linked to obesity and usually found only in those over 40. Those who develop type 2 diabetes in their teens run a high risk of visual impairment, leg amputations, renal failure requiring dialysis or transplantation, or premature death from heart disease. Obese people are 27 times more likely to develop diabetes than people of normal weight. It is estimated that at least 5 per cent. of all cancers can be attributed to obesity. There is also a class dimension to obesity: the UK 1958 birth cohort shows that only 18 per cent. of obese seven-year-old boys from non-manual backgrounds remained obese at 23, compared with 31 per cent. of boys from manual backgrounds.
Exercise is vital. Compared with 20 years ago, our diet now contains much more fat and high-energy foods, whereas we burn about 700 calories a day less. According to the British Heart Foundation, one in three children between the ages of two and seven do not do even the minimum recommended amount of exercise a week, and by the age of 15, two thirds of girls fall into the physically inactive category. In the past five years, the time spent by primary school children in physical education has more or less halved. Only about a third of secondary school children receive two or more hours of physical education a week, compared to half in the mid-90s. That is particularly alarming given that, as the report by Fairclough and Stratton shows, school sport provides the only form of regular exercise for 30 per cent. of secondary school pupils. The National Playing Fields Association also points to a huge drop in the number of school playing fields in the past few decades.
Fear, too, has become a factor. According to the Children's Society, 15 per cent. of parents refuse to let their children play outdoors because they are worried 126WH that their children might be approached by strangers. Less than 5 per cent. of children now walk or cycle to school, compared with more than 80 per cent. 20 years ago. Nurseries rarely let their young children play outdoors for fear of accidents and due to lack of supervision. Children become accustomed to staying indoors and become unused to exercise. Faced with such disincentives, children are simply abandoning exercise in favour of other pursuits. Who needs a playground when you have a PlayStation? Studies in the USA suggested that television viewing may be one of the most important determinants of childhood and adolescent obesity. One study showed a 2 per cent. increase in the prevalence of obesity for each additional weekly hour of television viewing.
There is considerable epidemiological and metabolic evidence that dietary fat plays an important role in the aetiology of obesity. The proportion of fat in the UK diet has increased dramatically since the second world war, from about 20 per cent. to nearly 40 per cent. of total energy consumed. There is evidence that obese people tend to have diets that are far higher in fat than the average. National surveys show that the typical diet in the UK contains 11 per cent. of its energy as protein, 37 per cent. as fat and 48 per cent. as carbohydrate. The report of the Committee on Medical Aspects of Food and Nutrition Policy—COMA—indicates that we should keep our dietary proportion of calories from fat to less than 30 per cent.
High sugar intake is also an issue. Twenty-one per cent. of seven to 10-year-olds in the UK drink almost 10 cans of fizzy drink per week. The US Department of Agriculture, however, recommends consuming no more than 40 g of refined sugar per day—the equivalent of one can of fizzy drink, which can contain up to 11 teaspoons of sugar. Only 12 per cent. of UK children choose to drink water. In addition, a Government study of the diets of more than 2,000 children aged four to 18 over a week in 1997 suggested that, on average, British young people were eating fewer than half the recommended five portions of fruit and vegetables per day, and one in five children ate no fruit that week. Seventy per cent. of parents with young children who were interviewed in a recent survey admitted that they do not know enough about food and nutrition to feed their children healthily. Many parents use sweets, biscuits and fizzy drinks to buy good behaviour from their children.
What can we do to prevent that? First, it is vital to instil the habit of exercising in children when they are young if they are to carry on taking exercise when they are adults. Traffic, fear of crime and intimidation, dirty and poorly maintained facilities, and a lack of time have, as we have seen, led to a decline in children using public parks and playgrounds. To make those amenities more appealing to parents and children, we must invest in equipment and facilities to ensure they are safe to use, and as attractive and child-friendly as possible. We must make it easier for children and parents to walk or cycle from home to community facilities. That means creating safer road crossings, dedicated cycle lanes and, where necessary, better lighting. Wherever possible, road planners should give priority to pedestrians and cyclists, especially in heavily built-up areas. We need more home zones and quiet lanes.
We must deal with the fear of crime. The public want to see a greater uniformed presence—be—it police officers, park wardens or street wardens—on our streets 127WH and in public places. Visible patrols may not add much to the crime-fighting capability of the police and other law enforcement agencies, but they have the effect of reassuring anxious parents.
We must ensure that young people are consulted when new play spaces and amenities are being designed. There is no point in investing money in facilities that will not be used. Better use must be made of the 100,000 voluntary sport and leisure clubs across the country. By creating links with local clubs and municipal leisure centres, and by encouraging them to provide coaching sessions for schoolchildren, schools could make extra-curricular sport much more accessible. That would also ensure that children are introduced to a much wider range of sports and leisure activities than the schools themselves can provide. If they are to let children use their facilities without charge, most clubs will require extra funds from somewhere to meet their additional running costs. The Government would have to consider making grants available to any club that participates in such a scheme.
The Government White Paper "Schools achieving success" gave a commitment that all children will be entitled to two hours of physical exercise and sport every week, within and outside the curriculum. However, much work must be done before that pledge can be realised. The new opportunities fund, the Department for Culture, Media and Sport, and the Department for Education and Skills are making substantial funds available to enhance and refurbish existing physical education and sports facilities, especially in deprived areas, but that is only the start.
We need better teaching. Primary teacher training puts little emphasis on sport and PE, and the Qualifications and Curriculum Authority does not offer primary teachers who teach PE much guidance. Much PE teaching is stereotyped, with most children being exposed to the major sports only. Schools need to broaden the range of sports that they offer. Given the choice, many teenagers would prefer to use a treadmill or weights than play hockey or football. If young people would prefer disco-dancing or roller-blading, why not let them do that? If every secondary school could buy fitness machines or at least come to an arrangement with a local fitness centre, it could significantly boost physical activity rates among teenagers. We must also improve access to school facilities. The key to sustaining children's interest in sport is to ensure that they have access to school facilities and equipment after school, at weekends and during school holidays. Schools should keep their sports halls and fields open all year round, although pupils would have to be properly supervised. We need to look into how that could be funded.
The responsibility for school and community sport should be transferred from DCMS to the Department of Health. To give that Department the responsibility for promoting sport would highlight—in the most public way possible—the link between sport and exercise, and good health. It would show that we consider sport to be more than simply entertainment.
How can we set about modifying young people's diets? We must broaden their food horizons. If they get into the habit of eating fruit and vegetables from an early enough age, they will continue to do so throughout 128WH life. An obvious place to start to teach good nutritional habits is at school, but an outright ban in schools on sweets, chocolate, burgers, crisps and the like is not the answer; children will simply react against any such coercion. It is perfectly reasonable to serve burgers in school canteens once or twice a week, as long as plenty of healthy alternatives are on offer. The challenge is to ensure that healthy alternatives are appetising and affordable. We need high-quality produce and imaginative catering staff. We must also ensure that schools have the required resources at their disposal. Earmarked funds may be necessary to ensure an annual healthy meals grant that would go directly to the head teacher.
We need to make fresh water freely available to all children; for example, there should be a water cooler in classrooms. Children are often forced to drink fizzy drinks simply because there is no alternative. In 50 per cent. of schools, drinking water fountains in the toilets are the only source of fresh water, and in 10 per cent. of schools, there are no facilities at all. Children should not be prevented from buying fizzy drinks, but they should be encouraged towards better alternatives, providing fresh water is available.
We should make nutrition and food education a compulsory part of the primary and secondary curricula. Food education has become increasingly marginalised in recent years because of pressure from core curriculum subjects, a lack of specialist equipment and kitchen space in schools, and a shortage of properly qualified staff. There is a statutory obligation on primary but not secondary schools to offer food technology lessons. The Government strongly recommend that schools offer students the opportunity to study food technology, but 10 per cent. of schools offer nothing at all, and many others offer only a limited introduction to the subject. Unless children are given a grounding in cooking and have some understanding of what they are eating and the effect that it will have on them, they will not learn the skills that they will need to eat properly when they leave school. We need a food education syllabus that is focused specifically on cooking and nutrition. At present, there is not enough emphasis on food in food technology lessons. Pupils are more likely to spend time designing biscuit packaging than baking biscuits. Schools would have to be given extra capital grants to invest in facilities, but I believe that it would be money well spent.
I will now tackle the controversial area of food advertising. Sustain recently carried out a survey of television food advertising to children. It found that between 95 and 99 per cent. of the advertisements are for products that are high in sugar, salt or fat. Sustain points out that there are twice as many advertisements for such products during Saturday morning children's television than after the 9 o'clock watershed. That shows that food companies are deliberately targeting children. Food companies are also allowed to sponsor children's programmes. Although broadcasting rules prevent them from displaying their products on screen, they remain entitled to put their logo on the screen whenever there is an advertising break. For example, McDonald's sponsored GMT V's early morning show "Diggit".
Persuading children of the dangers of over-consumption of food that is high in sugar, salt or fat and of the need for a balanced diet is difficult when they are 129WH confronted every day by a barrage of food industry advertising that promotes processed foods. The adverts are designed to show that the regular consumption of sweets, crisps, chocolate and so on is perfectly natural and consistent with a healthy lifestyle. Backed up by celebrity endorsements, special offers and plenty of glitz and glamour, it is not surprising that young children, who are the most credulous and impressionable section of the viewing public, find the products attractive.
Obesity is a killer. Its consequences can be just as devastating as smoking or alcoholism, yet as a society we are prepared to allow the processed food industry to target its products at children. The Government should consider a comprehensive ban on food advertising to children. Doing so would not be without precedent in Europe. The Swedes, who have some of the best health outcomes in Europe, have had a blanket ban in place on all advertising to under-12s for some years. Not only has it stood up to legal scrutiny but it is highly popular with the Swedish public.
Far from restricting consumer freedoms, a total ban would enable young people when they reach adulthood to make a more informed choice as consumers about the food that they eat, having had the opportunity as children to learn about food in an environment free from undue external influences. The purpose of a ban would not be to prevent children from eating chocolate, crisps and so on but to help them be more discriminating as to when and in what quantities they eat such foods. A ban would help children to see such products more as the occasional luxuries that they once were than the staple foods that they threaten to become.
What about food labelling? According to the Food and Drink Federation, more than 80 per cent. of manufactured products in the UK carry nutrition labelling. However, there is considerable doubt as to whether consumers understand or even read the labels: for example, a recent survey carried out by Safeway revealed that only one in five people know what RDA stands for. Consumers have complained about the sheer number of different messages that appear on labels and have said that they find it difficult to gauge the value or relative importance of each of them. Messages such as low fat, percentage fat free, low in saturated fat, and others in the same vein leave consumers confused and no better informed.
§ Shona McIsaac (Cleethorpes)
On the point about fat content in food and so-called lower fat products, is it not the case that some of the advertising is completely false? Manufacturers bulk out the product with water and then sell it at a premium as lower fat food. In fact, the way in which they work out the figures is wrong and misleading and can lead to people eating higher quantities of so-called lower fat foods, which cause obesity.
§ Dr. Stoate
I thank my hon. Friend, who has considerable expertise in this field. I have discussed this issue with her on a number of occasions and I share her concern that food labelling is very misleading, often deliberately so. Consumers want manufacturers to employ simpler, standardised and above all spin-free language on their packaging. Instead of labels that say that a produce is low fat or that it is a certain percentage fat free, they want to be told how much fat is in the 130WH product that they are buying. The Food Standards Agency should draw up a universal nutritional code that incorporates a handful of readily recognisable symbols and a set vocabulary that is as transparent as possible. Nutritional labels should also follow a set form.
Not since the British standard diet in world war two have the public had access to a definitive, or supposedly definitive, guide to precisely what, when and how much they should eat each day. It should be possible for the Department of Health to produce a set of broad nutritional guidelines that incorporate advice on recommended daily allowances for the average man, woman and child, what foods contain and even some suggested daily menus. If the Government decided to send an officially sanctioned national nutritional guide to every home in Britain, it would transform the profile of public health in the United Kingdom and allow us to hammer home the importance of healthy eating.
We must focus on public health. In our society, as in every other advanced market economy, we perceive health as something that inevitably worsens with age, but it can be restored quickly and efficiently through the intervention of trained professionals. Many seem to believe that the test of a good health service lies in its ability to manage disease, not prevent it. Perhaps that is because effective disease management is much easier to measure than effective disease prevention. Statistics relating to bed numbers, MRI scans, waiting times and successful operations can be easily compared, whereas successful disease prevention is less easily quantified. It is hardly surprising that the media and Parliament focus to such an extent on acute services, but that debate inhibits our ability to create a healthier society. After all, it is by influencing lifestyle choices, not by pouring billions into high-tech medicine, that we will make the biggest difference to the nation's health.
The Wanless report states that effective public health measures could save the national health service about £30 billion—20 per cent. of its budget—by 2022. By investing in prevention now, we could in the long term save the NHS billions in terms of expensive interventions of possibly limited effectiveness and treatment for long-term, chronic conditions. The human and financial costs of obesity are astronomical. In 1998, the cost to the NHS of treating obesity-related conditions was already close to £500 million, while the loss to the economy through 18 million sick days and 40 million days lost through premature death was nearly £2 billion. Obesity places an enormous financial burden on the individual through lost earnings and increased insurance premiums. According to figures given to me by Diabetes UK, the annual cost of treating diabetes is nearly £5.2 billion, or 9 per cent. of the NHS budget in 2000. By the time that this short debate is over, the NHS will have spent nearly £250,000 on treating diabetes. Given that there are at least 1 million undiagnosed diabetics in the UK, that figure will surely rise considerably.
There is no magic pill for obesity. Its effects—heart disease and diabetes—are almost irreversible. The wrong lifestyle choices during childhood and adolescence can prove devastating in later life. Until that is widely understood by parents and families, we will not be able to tackle obesity effectively. Refocusing the health debate on disease prevention is therefore 131WH essential. Unless we do that, we will not be able to persuade people of the importance of taking responsibility for their own health and living healthily.
The Government must take the lead. They must spell out the dangers of obesity to the public and make it clear that, although they can make it possible for families to live healthily by investing in schools and local amenities, the primary responsibility for preventing obesity in children lies with families.
§ The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)
I am grateful to my hon. Friend the Member for Dartford (Dr. Stoate) for raising the very important and serious issue of obesity in children. He is extremely active in the House on health issues.
UK researchers have predicted that the increase in obesity threatens to reverse gains in longevity made during the past 100 years and could in some cases result in parents outliving their children. A National Audit Office report highlighted the fact that obesity is responsible for more than 9,000 premature deaths each year in England, and that it reduces life expectancy on average by nine years. My hon. Friend will agree that we need to work hard to combat this disease. I was particularly alarmed when recently I visited an accident and emergency department in one of the most deprived communities in London, and a consultant told me that just a few months previously a four-year-old had died from obesity in the department.
Obesity is not simply a health matter. It requires cross-Government action, which is why the issue is at the heart of many of the Government's priorities. My hon. Friend is right to say that the percentage of obese adults in England has trebled since 1980. Figures from the latest health survey for England, which was published this week, show that 21 per cent. of all adult males and 23.5 per cent. of all adult females—more than a fifth of all adults—are now obese. Although the majority of obese and overweight adults were not obese children, we know that children's weight tends to track from childhood to adulthood. Obesity in childhood is an important risk factor for adult obesity.
The increase in the number of people who are overweight or obese is too rapid to be explained by genetic factors alone. It is most likely to have been caused by changes in lifestyle—diet and physical activity habits. The majority of children and adults in the UK do not meet recommendations on diet and physical activity. Increased snacking, increased consumption of carbonated drinks, and diets that are high in saturated fat may all contribute to increasing obesity rates. Few children eat the recommended five a day portions of fruit and vegetables. Four in 10 boys and six in 10 girls do not take the recommended hour of physical activity a day.
The World Health Organisation recently highlighted prevention as the key to lowering the global burden of heart disease and strokes. More than half of all deaths and disabilities caused by heart disease could be prevented by national and individual action to reduce major risk factors, which include obesity. The 132WH prevention and management of obesity are highlighted in the NHS plan and national service frameworks. Promoting health will be a key component of the children's national service framework, and the prevention of obesity in children will form an important element in that.
As my hon. Friend mentioned, obesity is linked to diseases such as diabetes. I am proud to have recently published the diabetes national service framework. The key elements of the delivery strategy include systematic plans to achieve NSF standards by 2013. They include plans for every primary care trust to provide eye-screening services, regular check-ups and appropriate medical treatment for every person who either has diabetes or is at risk of developing the disease. Further plans include setting up local diabetes networks and giving appropriate advice on diet, physical activity and smoking.
We are working with a range of national, regional and local partners on programmes to tackle obesity, improve diet and increase levels of physical activity. Government action on obesity takes a life-course approach. The prevention of obesity starts at birth. Breast-fed babies are less likely to become obese later in life than formula-fed babies. Breast-feeding may also help mums to return to their pre-pregnancy weight. The infant feeding initiative, which was launched in 1999, aims to increase the incidence and duration of breast-feeding. We are moving ahead with the NHS plan commitment to reform the welfare food scheme. Our healthy start proposals will ensure that pregnant women, mothers and young children in low income groups have more access to a healthy diet, in addition to increased support for breast-feeding and parenting.
The fruit and vegetable intake of both children and adults remains low. We know that increased consumption of fruit and vegetables can reduce the risk of coronary heart disease and cancer, but increased consumption might help the maintenance of a healthy weight and the achievement of other dietary goals, such as a reduced fat intake. We are bringing fruit into nurseries and infant classes throughout the country through the national school fruit scheme, which is backed by £42 million from the new opportunities fund. The scheme will provide every four to six-year-old in school or nursery education with a piece of fruit a day. Much more needs to be done to ensure that both children and adults have all the information that they need to choose a healthy lifestyle. We have developed a simple "5 A DAY" brand to help people to recognise the five-a-day message and to give the message consistency in all settings. Children and young adults were involved in the development of the brand logo, and they decreed it to be trendy, cool and so on. The message is reinforced by the food in schools programme, which aims to improve children's health by encouraging a healthy diet at school and promoting clear and consistent messages on diet and nutrition within the school environment. Initiatives being set up as part of that scheme, such as the assessment of water provision in schools and the inclusion of healthier options in vending machines in schools, are part of the ongoing programme of promoting healthy diets in school. which includes nutritional school lunches.
133WH My hon. Friends the Members for Dartford and for Cleethorpes (Shona McIsaac) both raised the issue of labelling. We are keen to engage with the food industry to ensure that the levels of fat and sugar in their products contribute to a healthy diet. Clear and explicit food labelling is vital if people are to make healthy life choices. My hon. Friend the Member for Dartford, in his recent paper for the Fabian Society, drew attention to the fact that fat-free claims are often confusing. The Food Standards Agency is working to improve food labelling as well to provide clear, practical advice for consumers on what constitutes a healthy diet.
Is my hon. Friend aware that although we can purchase sandwiches from the Members' Tea Room that are advertised as being healthier, the percentage of calories that come from fat in those products is higher than in normal sandwiches? It is happening even in the House. It is essential that we tackle the problem of calories from fat, and food labelling should show the information clearly. A measure that gives the real content of fat in food should be used, instead of the figures constructed by the industry.
§ Mr. Lammy
My hon. Friend will recall that I was with her a few days ago when she made that point in the Tea Room. I do not wish to cast aspersions, but it is a serious issue and I would encourage my hon. Friend to talk further about the subject with the Refreshment Department.
Poor diet is only one side of the problem. A low level of physical activity among children also contributes to a rising level of obesity. We are putting in place a major programme of work to provide opportunities for children to be more physically active. My Department is working with the Departments for Transport and for Education and Skills to help children to develop travel plans and to put in place measures to make it safer and easier for children to walk and cycle rather than be driven to school. More than 1,000 schools have a travel plan in place, and a further 2,100 schools plan to have 134WH one during the next two years. Success stories include a school in Suffolk where 60 per cent. of pupils now go to school by bicycle. That is a result of a series of changes, including the introduction of traffic-free cycle routes that link nearby housing estates and neighbourhoods—[Interruption.]
§ Mr. John McWilliam (in the Chair)
Order. Will hon. Members wishing to take part in the next debate please not interrupt this one?
§ Mr. Lammy
Thank you, Mr. McWilliam. Those routes, which link nearby housing estates, enable pupils to cycle to school from up to five miles away without having to go along main roads.
The Departments for Education and Skills and for Culture, Media and Sport are developing schemes aimed at increasing the take-up of sporting opportunities among five to 16- year-olds. They aim to increase the percentage of children who spend at least two hours each week on high-quality PE and school sport. Significant investment is also being put into transforming physical education, school sport and club links over the next three years. For example, we are spending £224 million to expand the school sports co-ordinated programme; £60 million on club capital to help sports clubs to develop good-quality junior programmes and to make links with schools; and £10 million on supporting playgrounds. Those programmes are not only about sport in the traditional sense; they include other forms of physical activity such as dance, and walking and cycling to school.
The early identification of overweight and obese children is vital so that they can be given appropriate guidance and support. The Department supports the development of recently published guidance from professionals in primary care on the weight management of children. I hope that my hon. Friend the Member for Dartford will recognise that we are doing much in this area, and will be encouraged to work with us to take the agenda forward.