Obesity and Fatty Liver Disease

Debate between Maggie Throup and Philip Hollobone

Thursday 8th June 2023 Westminster Hall

[Maggie Throup (Erewash) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to participate in this extremely important debate. I congratulate the hon. Member for Caerphilly (Wayne David) on securing the debate, which is timely because it coincides with International NASH Day. International NASH Day aims to raise awareness of fatty liver disease and non-alcoholic steatohepatitis, which affects more than 115 million people globally. Up to one in five people in the UK have non-alcoholic fatty liver disease, and almost 12% of the population have NASH. I am sure it comes as no great surprise to anyone, as the clue is in the name, that one of the key causes of non-alcoholic fatty liver disease is obesity.

The need to tackle obesity as a priority was first identified by the Government in the early 1990s in the “Health of the Nation” White Paper. In the three decades since then, there have been policies such as the soft drinks industry levy, the pilot of the “Better Health: Rewards” scheme in Wolverhampton, restrictions on product placement and calories on menus, which have been introduced effectively with the aim of reducing obesity. I am particularly proud that many of those measures were introduced or reinforced during my time as public health Minister. However, despite those policies being implemented successfully, the obesity rate continues to increase, so more needs to be done.

A recent report by the Obesity Health Alliance argued that obesity is the new smoking. That comparison was reinforced yesterday by the announcement of £40 million to pilot ways to make the newest and most effective obesity drugs accessible to eligible patients. That is an acceptance that obesity is a disease and should be treated with drugs, in the same way that lung disease is treated with drugs. Following that argument through, immense effort has gone into stopping smoking measures and reducing exposure to cigarettes, so immense effort should now be put into reducing everyone’s exposure to foods that are more likely to cause obesity—that is, ultra-processed foods. The delayed 9 pm watershed and action on two-for-one offers will do just that.

Research by the Obesity Health Alliance shows that 72% of people believe a 9 pm watershed on junk food adverts should be brought in during popular family TV shows. The measure has public support, so why hold back? When will the Minister’s Department introduce those important measures? Provisions are on the statute book, so let us just get on with it.

Statistics provided by the House of Commons Library highlight how obesity is steadily getting out of control in England. Since 1993, the proportion of adults in England who are overweight or obese has risen from 52.9% to 64.3%, and the proportion who are obese has risen from 14.9% to 28%. It is no surprise that the UK has the third highest obesity rate in Europe. Furthermore, the alarming rate of child obesity is of real concern. Data from the national child measurement programme outlines that in England, 10.1% of reception-aged children —aged four to five—were obese in 2021-22 and a further 12.1% were overweight. At ages 10 to 11—in year 6—23.4% were obese and 14.1% were overweight. Obesity prevalence is highest among the most deprived groups in society: children in deprived parts of the country are twice as likely to be obese than their peers in more affluent areas.

The health and economic impacts of obesity are devastating. Obesity is a force multiplier on fatty liver disease, cardiovascular disease, stroke, type 2 diabetes and cancer, and that, of course, puts ever-increasing pressure on the NHS. The combined cost of obesity to the Treasury—that is, to the NHS, the Department for Work and Pensions, and the economy as a whole—is projected to be £58 billion a year. I feel, however, that that could be a conservative projection, as there are many factors that have not been taken into consideration.

Those who are obese cost the NHS twice as much as those who are not. It has been estimated that those who are obese take four extra sick days a year, which equates to 37 million sick days across the UK working population. Those stats are clearly very concerning, and there needs to be a collective effort to tackle this widespread problem. If action is not taken now, we will embed ill health and low productivity into generations to come.

Non-alcoholic fatty liver disease is triggered by a build-up of fat in the liver, and as its name suggests, it is usually caused by obesity. Early-stage non-alcoholic fatty liver disease does not usually cause any harm. However, if left untreated, it can lead to serious liver damage, including cirrhosis. Some 90% of liver diseases are preventable, and in the UK, the most common causes of cirrhosis are excessive alcohol consumption, hepatitis and NAFLD.

What can we do to avert this public health crisis? As individuals, we can all take measures to help us to avert the risk of NAFLD—simple measures including eating a balanced and healthy diet, and in particular, not eating ultra-processed foods. Additionally, we can all increase our activity levels, as the hon. Member for Caerphilly indicated. It has been estimated that if those who are overweight or obese lost just 2.5 kg—5½ lb for people of my generation—that could save the NHS £105 million over the next 15 years. I am sure that most people would want to lose more than just 5½ lb, and doing so would save the NHS even more money—5½ lb, or 2.5 kg for the younger ones in the room, is not a lot.

We need to do more to promote early diagnosis and raise awareness of the different causes of liver disease. It would be remiss of me, as chair of the all-party parliamentary group for diagnostics, not to mention the possible impact of community diagnostic centres. Community diagnostic centres provide a quick and easy way to access checks, tests and scans, providing routes to early diagnosis. The recent announcement by the Department of Health and Social Care that fibroscan services will be made available in 100 community diagnostic centres is welcome. It could result in thousands of people being made aware of the poor condition of their liver, which could still be reversible.

Despite that positive news, I would like to see an expansion of liver testing in areas where obesity levels are higher and the risk of fatty liver disease is more extreme. Lives are saved when diseases are caught early. I am interested to hear the Minister’s comments regarding the expansion of fibroscan services to all CDCs. My own local integrated care system in Derbyshire is currently categorised as green, indicating that an effective pathway is in place for the early detection and management of liver disease. Will the Minister therefore look at emerging good practice throughout the country and emerging good practice pathways at the ICS level, with a view to establishing a national pathology pathway to accelerate early diagnosis? Government policy towards obesity over the last 30 years has mainly been focused on individual responsibility, rather than mandatory policy, but we can all see that that is not working.

Monday night’s BBC “Panorama” highlighted just how harmful ultra-processed foods are, and how they contribute massively to diet-related ill health. However, they are among the most profitable foods that companies can make. I know that this may sound unlikely, but there is a willingness among food manufacturers to reformulate; however, as the hon. Member for Caerphilly said, they want a level playing field. Sadly, no company is willing to step out of line and lead the way, yet if the consumption of ultra-processed foods continues at the current rate and the obesity rate continues to rise, our nation will be economically poorer and very unhealthy. To be bold, I believe this country is addicted to ultra-processed foods, similar to the way it was addicted to smoking in past decades. We tackled smoking addiction by intervention; it is now time to tackle ultra-processed food addiction by intervention too.

To conclude my remarks, this debate has undoubtedly helped to raise awareness of the problem of obesity and the detrimental impact it has on people’s health, including liver disease, as well as the economy and the NHS. Clearly, more needs to be done to tackle the health inequalities of obesity and improve early diagnosis of fatty liver disease. The Government need to be bold and brave for the sake of the individual, the NHS and the economy.

[Mr Philip Hollobone (in the Chair)]

I call Jim Shannon.