Childhood Obesity and Diabetes

Adrian Sanders Excerpts

Wednesday 24th April 2013 Westminster Hall

[Mr Adrian Sanders (Torbay) (LD)]

It is a pleasure to serve under your chairmanship, Mr Davies, for the first time. I congratulate the right hon. Member for Leicester East (Keith Vaz) on securing this important debate.

I would like to highlight the clear distinction between type 1 and type 2 diabetes. The vast majority of children with diabetes have type 1, which is not preventable and needs daily treatment with insulin. That is not to say that diet is not important; some believe that one can put off presenting with type 1 by adopting a very sensible diet and exercise regime, but that is not proven. The fact is that there is not a lot that most people can do to stop it happening, myself—a type 1 diabetic—included. It is going to happen; it is a question of when.

The vast majority of people with diabetes have type 2, which is explicitly linked to lifestyle. Other risk factors include ethnicity and family history. Type 2 usually manifests later in life, but lifestyle in a person’s early years has a considerable bearing on later risk. Just to confuse the situation, rather worryingly, we now see cases of children developing type 2 diabetes, with about 500 cases diagnosed in the UK to date. It is therefore extremely worrying to hear that a quarter of children entering reception classes are overweight or obese—the proportion rising to one third at age 11.

How significant a public health disaster obesity is likely to become cannot be overstated. On current trends, it is estimated that direct costs to the NHS will be £10 billion a year by 2050 and the wider social costs will be many times that once issues such as early incapacity, lack of productivity and so on are factored in. An obese man is five times more likely to develop diabetes than a healthy man. Obese women are 13 times more likely to develop it than their healthy counterparts. Diabetes is one of the more costly long-term conditions for the NHS to deal with, so higher levels of obesity will clearly lead to greater problems for the NHS, and I am not sure anyone has yet figured out how to address the human and financial costs.

I am happy to welcome the work that the Government have undertaken so far on diabetes and wider public health issues. We have made significant progress in identifying where the problems are and what is causing them, and the national diabetes audits have been a great help in that regard. For all its controversies, the Health and Social Care Act 2012 should allow health care professionals to integrate what they do with local authorities, public health services, schools and so on—whether it happens in practice has yet to be seen.

The overarching problems are clear: a more sedentary lifestyle, and, in childhood, the attraction of TV and video games; the lack of structured sport and exercise—especially in schools—and an increased perception among parents of the heightened dangers of playing outside. Coupled with those is an increasingly unhealthy diet, exacerbated by excessively sugary, salty and fatty foods. A difficulty arises when we consider how to tackle what is at root a cultural problem. France, for example, experiences the same commercial challenges, with the availability of unhealthy food and the growth of electronic entertainment, but has only half the UK’s rate of childhood obesity. A lot of voices call for quick, and sometimes superficial, Government interventions, such as banning or regulating sugary cereals, a tax on particularly unhealthy products and so on. Such policies might have some value as part of a wider strategy, but on their own they will not effect the cultural shift we need.

We need to improve the ability of consumers, especially parents, to make informed decisions about what food to buy and prepare. To me, that implies a two-pronged approach, with better food labelling at the point of sale—whether at a supermarket, restaurant or even fast-food outlet—and better education, particularly in schools, both playing a role. We need to look at promoting alternatives to sugar, especially in soft drinks, which contribute a great deal to childhood obesity.

I spoke at a diabetes conference yesterday. A concern that came up, which has been coming up for years, is that previous strategies to improve outcomes have often failed due to silo working or a lack of integration between services. In Torbay at least, the health care system has recognised the serious problems that causes and has integrated primary and social care services, which gives it a head start when tackling public health issues. We now need that principle extended to the policies and services that impact on child health, specifically obesity. In Whitehall, there has always been a chasm between the Department of Health and the Department for Education, and it needs bridging at national and local levels. We would do well to recognise that prevention works best the earlier it starts.

Statistics show that children are already in trouble before they get to school, so there is a role for early- years services as well. Whether we like it or not, public services are driven by financial imperatives and we will need to address the problems at the funding level, by giving schools, GPs and all the other interested parties a shared duty to tackle public health issues and rewarding those that show innovation in their curriculums. Change4Life is a good start. It rightly highlights that strategies and solutions are best designed and delivered at a local level.

I conclude by praising the right hon. Member for Leicester East for securing the debate and for the work he does. I also thank the other hon. Members here today who are tireless campaigners in the field, and the Minister for her fresh approach to the subject. Any strategy we use must bring local stakeholders together. Whatever we do, it needs to be more ambitious than what we are doing.

--- Later in debate ---

[John Pugh]

There are benefits to the approach I outlined, although the people who are most acutely aware of the calorific content and the quality of their food are those who are already halfway to solving the problem. However, many people do not get even to that first base, and that is where public health messages have an impact.

[Mr Sanders]

Does my hon. Friend not think there would be an enormous benefit in having a simple traffic-light system so that parents buying children food understand that red means danger? Similarly, people queuing up at a fast-food restaurant will know which items on the menu contain the most sugar.

[John Pugh]

I hope hon. Members do not misunderstand me. I am not saying that the bits of the jigsaw cannot be put together and cannot ultimately constitute a perfectly satisfactory solution. I am saying that every one of the solutions so far advocated must come with a caveat, because it is not likely to be the magic bullet that will transform things. There is no magic bullet, and I will return to that theme when I conclude.

On sport, it is unquestionably the case that one reason why children acquire the extra pounds is that they move around far less than they ever did. When I was at school, the dinners were intensely fattening, but children moved far more, so the obesity problem was not that marked. One issue, however, is that if the problem starts early, as my hon. Friend the Member for Torbay (Mr Sanders) suggested, and the child is already overweight, he or she will be more reluctant to engage in sport and likely to look for excuses to avoid sport, so offering them a wider menu of sporting opportunities, by itself, will not help.

Pressure on producers and the responsibility deal were mentioned, and a lot can be achieved through such measures. The Minister will confirm that we have, almost without noticing, reduced the amount of salt in our food by agreement with the producers, and nobody has really minded. Clearly, similar results can be achieved by agreement with sugar producers, and there is no reason why that should not happen. Again, however, people tend to deceive themselves. We are all familiar with the phenomenon of people who sit there with a beefburger and chips, but who have a diet coke by their side. The assumption is that if they drink the diet coke, the effect of the chips and the beefburger will somehow be negligible.

The right hon. Member for Leicester East mentioned the issue of access. Access to fast food is one of the principal reasons why society has the difficulties it does. When we go to railway stations or other places where we are in a hurry to buy things to take on our journey, it is noticeable that we are presented with larger snacks than we would want, such as grab bags and extra-large chocolate bars. There is no explanation for that, other than that the producers are being blatantly irresponsible and trying to shift more of their product.

I must make a confession that may shock many Members present. As a student, I once worked as an ice cream salesman, driving an ice cream van. Our strategy was always to turn up at schools around lunch time, although my ice cream was of such low grade that the children would walk past my van. Instead, they would go to the Mr Whippy van, even if it got there later, so our strategy did not entirely work. However, Members can see that having food near lots of ravenous children is attractive to commercial interests, even if it is irresponsible of them to pursue such a strategy.

All those solutions have merit, but most of them have limitations. It is tempting simply to say there are a lot of issues—I have said as much myself—and that we have to press all the buttons to get the effect we want. I am quite happy to go along with that, I would like us to concentrate on what works and on what there is clear evidence to support; that is what I think needs to happen. One serious problem that concerns me, and which has been mentioned, is tokenism. I have seen tokenism in action; I have seen schools go through the motions of telling the children a bit about food and sticking up the appropriate pictures, but nothing really changes, so the phenomenon persists because it has not been properly addressed. There is irrevocably an element of personal and family responsibility. We cannot take that out of the equation. However, the most successful methods of making it easier for people to make the right choices must be evidenced, supported, endorsed and spread. We should not put into practice a mechanism that might or might not work.

A concern that results indirectly from concentration on the problem in question is the increasing incidence among children of not diabetes but eating disorders. However we pursue the agenda, we must do so in a way that makes it less likely that increasing numbers of children will, because of a legitimate concentration on their health and weight, become obsessed with their body shape and develop problems with eating behaviour that they would not have if they grew up naturally and in a satisfactory way.