UK House of Commons Health Committee publishes its long-awaited Report on obesity

The UK Health Committee urges comprehensive raft of measures to combat the devastating threat to the nation’s health posed by obesity.

The House of Commons Health Committee publishes its long-awaited Report on obesity on Thursday 27 May..

Obesity has grown by almost 400% in the last 25 years such that three-quarters of the adult population are now overweight or obese (around 22% are now obese). England has witnessed the fastest growth in obesity in Europe and childhood obesity has tripled in twenty years.

The Report paints a bleak picture of the likely threat that obesity poses, saying: “Should the gloomier scenarios relating to obesity turn out to be true, the sight of amputees will become much more familiar in the streets of Britain. There will be many more blind people. There will be huge demand for kidney dialysis. The positive trends of recent decades in combating heart disease, partly the consequence of the decline in smoking, will be reversed. Indeed, this will be the first generation where children die before their parents as a consequence of childhood obesity.”

Obesity is linked with a wide range of diseases, such as heart disease, diabetes, renal failure, osteoarthritis and psychological damage. Only recently has the strong association between obesity and various cancers emerged and obesity is now regarded as the greatest avoidable cause of cancer after tobacco. The Report calculates the cost of overweight and obesity to the nation at up to £7.4 billion per year, a figure which will rapidly rise.

Chairman David Hinchliffe said:

“The devastating consequences of the epidemic of obesity are likely to have a profound impact over the next century. Obesity will soon supersede tobacco as the greatest cause of premature death in this country. It is staggering to realize that on present trends half of all children in England in 2020 could be obese. Already a third of children in America (which is ahead of us only by a few years in obesity trends) are likely to become diabetic.

Our inquiry is a wake-up call for Government to show that the causes of ill health need to be tackled by many Departments not just Health. It is simply unacceptable that sports and education ministers should have endorsed initiatives to supply schools with sporting equipment or books but which required children to buy Cadbury’s chocolate or Walker’s crisps. We found a total lack of joined-up solutions at present. Wholesale cultural and societal changes will be needed if any headway is to be made. The urban infrastructure will need to be completely redesigned to encourage an active lifestyle. Food companies and supermarkets will need to take real responsibility for their products and marketing, not simply pay lip service to it while undermining genuine efforts to reform the nation’s diet. Labelling needs to be radically simplified. And schools will have to encourage activity and actively monitor the health of their children.”

Causes of obesity

Obesity develops when there is a sustained imbalance between the amount of energy consumed by a person and the amount used up in everyday life. The combination of factors affecting both nutrition and physical activity, and the vicious cycle arising from these changes, is explained by Professor Andrew Prentice:

What has happened in our environment in terms of the history of human evolution is remarkable in the last two generations. We have never seen anything like this, where we have the coming together of the technological, electronic, television revolution and the highly available, high energy-dense and very cheap foods … where physical activity comes in is that you rapidly get into a vicious cycle of inactivity, sloth and weight gain: as soon as you start to gain a load of weight, it is all the more difficult to go up those stairs; as soon as you start to become a little less fit, you resist doing those things which in the first place will help you not to become overweight, and so it rapidly becomes a vicious cycle.

The Report notes that the average person now walks 189 miles per year compared to 255 miles 20 years ago. Levels of cycling have fallen by over 80% in the last 50 years. Fewer than 1% of school journeys are now made by bicycle and half the nation’s children fail to achieve the Government’s modest target of 2 hours activity per week. At the same time, energy-dense foods, which are highly calorific without being correspondingly filling, are becoming increasingly available. The Report explains that humans have evolved to be very good at recognising hunger, but very bad at recognising satiety. While in times of uncertain food availability this asymmetry could help people survive famines, in today’s environment, it is very conducive to weight gain.

Solutions

As a preface to the solutions it offers, the Report cautions against the simplistic approach to the problem of obesity originally adopted by the Public Health Minister, and instead supports the view of leading academics and clinicians that solutions will necessarily be complex and multifaceted. It notes a worrying lack of government co-ordination on this issue, and recommends the establishment of a Cabinet-level public health committee to oversee the development of targets across all relevant government departments.

The Report calls for a sustained health education campaign to target obesity by raising individual awareness of its consequences, but, crucially, it emphasises the need for solutions to address environmental as well as individual factors, making healthy choices easier to make within the increasingly obesogenic environment:

The obesogenic environment needs to be tackled at the highest levels. It is not adequate to focus on the individual, especially the child, and expect them to exercise self-control against a stream of socially endorsed stimuli designed to encourage the consumption of excess food calories.

The Report emphasises that as it is clear that people are now overeating in relation to their energy needs, solutions need to address both sides of the energy equation, nutrition and physical activity.

Nutrition

The Report notes the food industry’s relentless targeting of children through intense advertising and promotion campaigns, some of which explicitly aim to circumvent parental control by exploiting ‘pester power’. This was demonstrated by the Media Strategy Brief for Walker’s Wotsits, which stated that the “desired consumer response” for the campaign was “Wotsits are for me—I’m going to buy them when I get a chance and pester Mum for them when she next goes shopping.”

To counter this, the Report recommends an industry-led, voluntary withdrawal of television advertising of unhealthy food to children, together with a wide-ranging review of all forms of food promotion. This should be backed up by action to reduce the promotion and availability of unhealthy foods in schools, through engagement with parents and governors. In addition to this, industry should take active steps to reformulate foods to reduce their energy density, and to introduce healthy pricing strategies to make healthy choices affordable for all.

In recommending that these measures are initially introduced on a voluntary rather than a statutory basis, the Committee say that they have chosen to take the food industry at their word in seeking to be part of the solution, not just the problem. However the Report is clear that if insufficient action has been taken in three years the Government will need to introduce more direct regulation.

The Report refutes the argument frequently cited by the food industry and also supported by the Secretary of State for Culture, Media and Sport that there are no such things as healthy or unhealthy foods, only healthy and unhealthy diets, and calls on the Government to accept the clear fact that some foods, which are extremely energy-dense, should only be eaten in moderation by most people. It goes on to recommend the introduction of legislation to effect a ‘traffic light’ system for labelling foods, either ‘red—high’, ‘amber—medium’ or ‘green—low’ according to criteria devised by the Food Standards Agency, which should be  based on energy density. The Report argues that not only will such a system make it far easier for consumers to make easy choices, but it will also act as an incentive for the food industry to re-examine the content of their foods, to see if, for example, they could reduce fat or sugar to move their product from the ‘high’ category into the ‘medium’ category.

Activity

The Report praises the recent measures and funding directed towards schools but describes as “lamentable” the fact that most of the nation’s youth fail to achieve the target of 2 hours of physical activity per week. It recommends that this should be raised to 3 hours, that activity should be broadened to embrace non-traditional activities such as dance or aerobics and that a school’s performance in terms of physical activity should form part of the Ofsted inspection.

The Committee remark that the key to improving activity levels across society is to boost activity in everyday life in areas such as transport. They describe as “scandalous” the failure of the Department for Transport to produce a National Walking Strategy which was promised 10 years ago, and seems to have been delayed by political timidity (with one witness suggesting that the Monty Python Silly Walks sketch was to blame).

The Committee call on the Government to:

• Co-ordinate departments to achieve widespread use of pedometers to measure activity in the community

• Take serious measures to boost cycling such as creating properly segregated cycle lanes

• Make all major planning proposals subject to a ‘health impact’ assessment

• Encourage industry to make workplaces more active perhaps via fiscal incentives from the Treasury

• Have a co-ordinating council for public health along the lines of those in Scandinavian countries

NHS

The Report argues that while the NHS has an important role to play, both in the prevention and treatment of obesity, evidence received by the Committee suggests that this has not been as high a priority for PCTs as it should have been. The Committee’s evidence covered cases of  GPs being asked to limit the prescription of NICE-approved obesity drugs, of specialist obesity services with closed waiting lists, and of pioneering local projects threatened with closure due to lack of funding. To address this, the Report recommends the establishment of a strategic framework for preventing and treating obesity within the NHS, underpinned by stringent public health targets. The strategy must include the expansion of services to treat obese patients within both primary and secondary care. A full range of treatment options should be open to obese patients, including behavioural or lifestyles approaches, counselling, drug therapy, and, as a last resort, surgery. In particular, children must have access to appropriate services, and should be screened for overweight and obesity annually within a school setting.