05/11/14 – Health Select Committee’s call for evidence on diet, exercise and health

Speaker: Dr Sarah Wollaston MP, Chair, Health Select Committee

All Party Parliamentary Group on a Fit and Healthy Childhood

Wednesday 5 November, 2014

Chair: Baroness Benjamin

Baroness Benjamin welcomed the attendees and introduced Dr Sarah Wollaston MP

Dr Sarah Wollaston MP

The Health Select Committee is launching a call for evidence on diet, exercise and health and seeks contributions from the APPG on a Fit and Healthy Childhood.

The child statistics from the Child Measurement Programme illustrate stark health inequalities relating to obesity at year 6 and make a strong case for a targeted approach to the problem.

Of children from the least deprived group, 6.2% present as obese in reception. By the time they leave in Year Six, the figure is 12.8%.

12.5% of children acknowledged to be most deprived, present in reception as obese. By Year Six nearly a quarter are obese, and heading for serious life-long problems. This is why taking action is imperative.  The focus should be on prevention.  By Year Six a third of all children are overweight.  Obese or overweight children are likely to become overweight or obese adults. Further evidence comes from the incidence of tooth decay; now the primary cause of child hospital admission.

The Health Select Committee has published its Inquiry into Children and Adolescent Mental Health Services, and there are manifest links between obesity and mental health.  Being overweight or obese is particularly detrimental to young women; affecting self-esteem and future life chances.

Dietary choice is the main issue to be addressed – in particular calorie intake and, as with alcohol consumption, the crucial determinants are price, availability and marketing.

Reducing the consumption of carbonated sweetened drinks for children by influencing parental attitudes would be a good start.   There should be a national campaign such as “Don’t Drink Your Calories”.

It is important to engage with industry.  A small price differential between a sweetened sugary drink and a zero calorie sugary drink would drive behaviour in a positive manner. Similarly,   much can be done via product marketing methods.

It would be good to work with supermarkets by means of loss leaders on healthier foods; thereby assisting us as a nation to reduce overall calorie intake.

Portion sizes and school meals are equally important. Some schools are piloting projects with obese children.  The Child Measurement Programme could be rolled out in areas  of highest deprivation. Children moving towards obesity would therefore be monitored, alongside targeted intervention for their families.

If one parent is obese there is a 50% chance that the child will be obese. If both parents are obese there is an 80% likelihood that a child will present as obese. Support should be offered to the whole family.

Cheap and free schools meals could be offered to children at risk of obesity, combined with targeted family support. Remedial action need not be expensive – and will certainly be cheaper than dealing with the burden of obesity on the NHS in later life.

Dr Sarah Wollaston MP welcomed discussion from the meeting, requesting a formal written submission from the All-Party Group and a representative from the Group to present evidence at the Enquiry.

Recommendations and discussion

There is a need for more definitive information about the science on obesity. For example, does fructose mess with the metabolism? Consumers need clarity with informative and definitive information.

Look at the very young child and the messages around the first two years of life. Consider portion sizes at these stages, there are no official portion sizes for the very young.

Early intervention, encourage families with healthy eating at an early stage. In discussions the messaging must emphasise “healthy weight”, the term “obesity” is not a useful one.

What is in place to help families if a child is obese or underweight?

Dr Sarah Wollaston MP: There is no consistency across the country, the way parents are informed needs to be delivered in a non-judgemental manner. There also needs to be carrot and stick to help make changes. What would be an effective pilot to propose to NHS England that they should run and compare the standard approach of getting a letter, a variety of different interventions and see which works best?

Contributor:  there is variation on what is done, a lot of times it is just a letter. Local authorities and public health and wellbeing boards have a new opportunity in this area. This is a good chance to look at obesogenic environments. There needs to be a holistic approach. There are good examples of positive engagement in schools, but there is no network to share that learning. 2020 Health are talking to the Institute of Education and are due to run a pilot on this area in 2015. Increasingly “malnutrition” is being talked about because those who are obese and underweight can be mal- nourished. Children arrive at school unable to take part because they don’t have the nourishment to function.

Contributor: Regarding early intervention, work from The Millennium Cohort study shows that between the ages of 5 and 11 the gaps widen. Children from poorest families are twice as likely to be obese at age five compared to those from the richest. By age 11 they are three times as likely to be obese.

The data also shows some driving factors, such as the early introduction of solids, this is thought to be a causal link; there is a growing body of evidence to suggest that this could also result in increased levels of hospital admissions in infancy. There are other elements of the diet, including fruit consumption that are also important. Sleep is also significant. Children arrive at school and fall asleep because they are badly nourished and have not had adequate restorative rest. Not having sufficient sleep also predicts obesity and overweight through childhood. These are elements the enquiry should take on board.

Baroness Benjamin: A previous speaker, Professor Robert Lustig, raised the issue of sugar consumption at an early age and its effects. This should be looked at. Pepsi feel that they should have a stronger voice in the debate, perhaps the Inquiry should invite them to take part alongside companies such as McDonalds.

 Play and movement

The conversations on calories-in and based on nutrition, is all driven by adult language, with terms such as “exercise” used. This is not a child-centred term; children play. Schools find nutrition easier to police and monitor. It was pointed out that children from less well-off backgrounds are not likely to run around in the playground. The fact that child obesity is higher in urban areas was raised, as well as the possibility of “active travel” being considered at an earlier age. Some contributors saw play in school as a problem, as well as the fact that some primary schools did not have trained PE teachers. Even then, PE teachers tended to only deal with children who were “sporty”. It was suggested that what was needed was teaching people how to move well.

Another aspect of “play” raised by the group was the way government chooses areas on which to intervene. The last government had a 12 year plan for playable space in and around each home. The current government has given the decisions about child play to local authorities; who can choose to prioritise this or not. Children did not have representation at all Local Authorities.

Baroness Benjamin reiterated the need for a Cabinet level position for a Minister for Children, to work across all government departments with strategies for children, as recommended in the APG’s last report. Hopefully the Select Committee report will say something similar.

In response to an earlier point about giving consumers some clarity on the scientific aspects of the nutrition debate one contributor suggested that the science debate was too difficult and complex to distil in this way.

It is too difficult to get consistent scientific information, not just about obesity, also fat, sugar etc. The science of obesity has not been resolved. The alternative is to set out a programme of a few practical things that politicians can do to deal with childhood obesity. This might have more impact.

Dr Sarah Wollaston MP : Agreed, the method used by British Cycling: incremental gains, creating policy which dealt with the low-hanging fruit first for the greatest gains, whilst acknowledging that everything matters and will be dealt with. A “what works” approach, backed up by evidence. In the meantime the next government could commit to this as a policy route to give the greatest gains. This avoids being distracted by the controversies and debates.

Further recommendations for consideration by the select committee were:

  • A case for banning marketing of energy drinks to children?
  • Promoting emotional literacy. Considering who is responsible for delivering activity advice: the parents or government? Everyone thinks that someone else is dealing with this issue (government thinks it is parents, parents think it is government) there is no umbrella organisation dealing with this.
  • The building blocks of a meal, an explanation of what the macronutrients should be on a plate for each meal.
  • Gathering insights into why people make the choices that they do and the behaviours and motivations.

Dr Sarah Wollaston MP thanked the group and reminded it to send in the submission and give evidence to the select committee. The committee would focus on a “what works” approach and avoid getting ground down in the controversies.

Baroness Benjamin closed the meeting.