Obesity and childhood obesity is one of the most serious health challenges we face. Now, right now in the UK, almost a quarter of children are overweight or obese by the time they start primary school, and more than a third are by the time they leave, putting them at greater risk of obesity-related conditions like diabetes and cancer, heart disease and asthma.
A report by the Association of Public Health Observatories suggests that Britain is now the most obese nation in Europe, and the fifth most overweight of the world's 33 most developed nations.
Looking ahead, the number of overweight and obese people is likely to increase. The Foresight report has predicted that by 2025, nearly half of men and over a third of women will be obese.
There is no doubt that this is a serious problem. It is one that is affecting every community across this country. But just like with so many other challenges we face, the most disadvantaged communities are being hit even harder by this issue.
The increase in the number of children who are obese is a particular cause for concern. Obesity is not something that children tend to grow out of. Fifty-five per cent of 6-9 year olds and 79 per cent of 10-14 year olds who are obese will remains so into adulthood.
There is a very real danger that significant numbers of today’s children will live shorter lives than their parents and spend more of their years in poor health.
It is important to be clear that this issue is not about how our kids look. It is not about that. It is about how our children feel, and the possibilities that are open to them. It is about their health and the health of our nation and the health of our economy.
What we see when we look at the figures is that high income countries, like Britain, have higher rates of obesity and drinking, and lower levels of exercise.
When Nye Bevan introduced the NHS, less than one in ten households had a television and less than a third owned a car – now one, if not two or three television sets are found in 98 per cent of all households and 19.5 million households own a car – 8.4 million have two or more.
The burden placed on the NHS today by our obesity crisis is huge. Direct costs caused by obesity are estimated to be £4.2 billion per year and forecast to more than double by 2050 if we carry on as we are.
Labour nursed the NHS back to health when we were in Government, reflected clearly by slashed hospital waiting times and much improved primary care. However, we should have done much more to tackle a range of specific health problems, such as obesity and alcohol abuse, with a greater focus on the underlying causes.
Under this government, signs of strain brought about by their approach to the health service have already been noted – rising waiting times, operations cancelled, beds mothballed, frontline posts frozen or cut, services cutback.
Already under this government, there is an increasing number of people are being admitted to hospital for treatments linked to obesity. Already, the number of hospital admissions for obesity has risen more than 30% while the number of gastric band procedures has soared by 70%, with London seeing some of the highest numbers, figures have shown.
So we need to take this issue seriously, as seriously as improving under-achieving schools, as seriously as eliminating youth violence or stopping the spread of HIV/AIDS or any of the other issues that we know are devastating our communities.
But in order to address this challenge, we also need to be honest with ourselves about how we got here, because we know that it wasn't always like this for British children and for our communities.
The way we live today is very different from even when I was growing up.
In school, we had regular exercise, like it or not. And then when we got home in the afternoon, after school or in the summer, there was no way we would be allowed to lie around the house watching TV.
Our parents made us get up and play outside. And we would spend hours riding bikes, playing football and running around. This is unheard of to many of the children I meet in my constituency.
Eating was a totally different experience back then. In my house, we rarely ate out. Even when both parents worked outside of the home, most families in my area sat down at the table together as a family for a meal. And in my house, we ate what we were served. We either ate what was there or we didn't eat. It was as simple as that.
Fast forward to today and so many children cannot attend local schools or do not, so instead of walking to school, they ride in a car or they're in a bus. And in too many schools, school sports has been axed because of budget cuts pushed by this government.
Indeed, fears about safety mean that those afternoons outside have been replaced by afternoons inside with TV, video games, the Internet.
The children I meet in my constituency are keen to grab fast food or something from the corner store -- places that have few, if any, healthy options.
We've seen how kids in our communities regularly stop by these shops on their way to school -- buying themselves fizzy drinks and crisps for breakfast. And we've seen how they come right back to those same shops after school.
CHANGING THE DEBATE
Obesity develops gradually from poor diet, lifestyle choices and, to some extent, from your genes.
But there are also significant external, environmental and social factors such as changes in food production, the way we travel and the way we work.
The proliferation and accessibility of fast-food outlets has certainly been an issue. However, research about the causes of obesity in richer countries has shown that more deprived areas tend to have fewer outlets offering healthy foods. Indeed, a basket of healthy food would cost more in a poor part of east London, for example, than it would in somewhere like Fulham. So we need to understand more about the food choices that poor people can make.
Another issue a lack of regular, dependable access to food – food insecurity. A cycle of insecurity-based overconsumption can promote obesity.
However, I want to change the terms of the debate. We need to understand broader cultural issues and the way society has changed in recent years.
Whilst we need to avoid dangerous caricatures around ‘broken Britain,’ what we have seen in recent years is a maelstrom within British society and culture, alongside the rise of consumerism and a rapidly changing economy.
An inability to delay gratification - whether with food, alcohol, money or sex - risks becoming the hallmark of our age, reinforced by advertising and media (by the age of ten, the average British child recognises nearly 400 brand names).
Further, low-skilled manual jobs have shrunk in the factories, the farms, the docks and the shipyards. They are now more likely to be found in call centres and in the retail and services industry.
Should individuals be helping themselves?
Clearly individuals are very much responsible for their health and for their lifestyle choices.
A combination of a healthy, balanced diet, and regular exercise is the right medicine. Experts recommend vigorous exercise such as brisk walking, swimming or cycling five times a week for 20-30 minutes.
However, obesity is a societal problem – one that reaches much further than the individuals it claims.
It is not the Government’s role to impose lifestyle choices on the British public. But we do need a national movement to tackle the growing problem of obesity.
Two years ago, the Tory Health Secretary declared that there is ‘no excuse’ for people to be too fat. He insisted that people claiming biological or environmental causes for their obesity are simply making excuses.
Studies about the predictors of obesity in the UK have shown that the poorest are most likely to be obese. For example, one recent University of Glasgow study found that residents of an impoverished Glasgow neighbourhood were more than twice as likely to be obese compared with residents of an affluent neighbourhood only mile away.
Rather than allowing this condition to create division within society, government, business, media outlets and the public, we need to unite to address the complexity and seriousness of the epidemic at hand.
Is there a role for government?
The Government needs to develop and implement a sustained response to a problem that will have profound and long-term consequences for health and well-being, as well as major costs to the health budget and the wider economy. Prevention, in the first place, is the key.
But this is not a licence to hector and lecture people on how they should spend their lives – not least because that approach simply will not work.
I have spoken to so many experts about this issue, and not a single one of them said that the solution is to have government tell people what to do. It's not going to work. Instead, families must responsibility and making manageable changes that fit with their budgets and their needs and their tastes.
It's about making those little changes that can really add up -- simple things like taking the stairs instead of the elevator, walking instead of riding in a car or bus.
Yet when it comes to David Cameron’s vision of a smaller state, it becomes very easy for politicians to stand on the sidelines accusing some of the most vulnerable people in our society of only having themselves to blame. But we need to consider the complexity and the sensitivity of the issues involved.
Just as the government has a moral duty to tackle poverty and exclusion, it also has duty to address obesity.
A bit less nannying and a bit more nudging?
I think there is a risk of oversimplifying the role of Government in tackling obesity. On the one hand, lecturing people on lifestyle choices and imposing health regimes will not help. On the other, a Government that wipes its hands of the problem, often ends up wagging its finger at the most vulnerable families in the vague hope that they will do as they are told.
Richard Thaler’s Nudge showed how positive influence can work. Thaler’s iron rule is “no bans, no mandates [government compulsion]”.
However, when Thaler, himself, is pressed, he has said that he would have opposed a smoking ban and would have opposed the Clean Air Act – probably the piece of 20th century legislation that has saved more lives in Britain than any other.
Does education have a role – say the teaching of domestic science at school?
Education has a key role to play.
9 out of 10 of our kids today could grow up with dangerous amounts of fat in their bodies. This can cause life-threatening diseases like cancer, type 2 diabetes and heart disease.
Schools should be on the front line in the battle against obesity, and early intervention is really important.
Healthy school dinners and the teaching of domestic science are crucial tools in improving the nation’s health.
But I believe there could be real potential for the development of prevention programmes, aimed at reducing the risks of obesity, alcohol, tobacco, drug abuse, and violence by targeting the major social and psychological factors that promote the initiation of substance use and other risky behaviours.
It is important that we develop an environment where people can make healthy choices – and that we understand the significance of safe play areas for kids, physical activity and of advertising of junk food, sugary soft drinks and alcohol.
Research shows that only 17 per cent of parents with an obese child identified that child as having a serious weight problem, and the majority of parents overestimate the amount of exercise their child engages in and underestimate the amount of food they eat.
Many are discouraged or confused by over-medicalized terminology such as “BMI” and “the clinically obese,” and worry about the stigma that is attached to this subject. Messages about the importance of healthy living often don’t reach those most at risk.
We must also avoid stigmatising obese children. Self-esteem, confidence and education are crucial to tackling obesity.
Research tells us that people want practical support and information, not just from GP surgeries, but from the nurseries and schools their children attend. They want clear and consistent messages on what’s best to eat and how to stay healthy, delivered in a way that relates to the problems they face in their daily lives.
On the path to a Tory public health crisis
Under a Labour government, real progress was made in moving towards the right policy framework. Initiatives like Change4Like, and successes like the Breakfast Clubs programme have become crucial tools in the fight to improve the nation’s health.
Yet my concern is that under this government, we are on the path to a public health crisis.
What is becoming clearer and clearer is that when it comes to public health, the Tory-led Government’s first priority is to side with big business and protect private profit. Everyone can see that David Cameron and Andrew Lansley are in the pockets of big business.
Already, the Tory-led Government is showing signs of failing to implement ‘joined up thinking’ in tackling obesity.
It is nonsense for the Tory-led Government to talk about improving public health, when ideologically, it is firmly committed to so many things that are bad for the nation’s health. This is a government that is committed to big cuts pushing up unemployment which is known to produce poor public health outcomes. One of the first things that the Health Secretary did when he took office was to scrap the ‘traffic light’ system of food labelling, caving in to the demands of big business. He is also pushing the preposterous notion of scaling back Change4Life and pressing industry for funding, and working with firms like Mcdonalds on public health.
Significantly, the government’s approach to public health has been met with, at best, a lukewarm response by key stakeholders. The Royal College of Physicians have been ‘disappointed by the lack of detail, especially around how to deal with the threats posed by alcohol misuse, obesity and smoking;’ the BMA have demanded ‘tougher action;’ and health experts such as Tim Lang, professor of food policy at City University London have warned that the Tory-led Government’s approach is ‘over-reliant on corporate responsibility.’
Key health groups have walked out on flagship policies like ‘responsibility deals’ because this government had fast food outlets writing government policy for them.
Indeed, the Health Secretary himself is formerly a director of a marketing company with junk food clients. Meanwhile, Andrew Lansley's special adviser on policy development at the Department of Health is Bill Morgan, who used to work at Mandate Communications, a corporate PR agency whose clients have included health organisations and Kraft/Cadbury, Dominos Pizza, and drug companies.
The truth is that it cannot be left solely to the market or to the individual. You cannot conflate corporate responsibility with public health. Whilst we need to work very closely with business and industry, all the big changes in public health over the last two hundred years have been done in the face of huge corporate and commercial interests.
There is a role for legislation in the fight against obesity. Governments should be looking to provide the civic space that the country needs.
The gravity of the obesity challenge demands that we grasp the true nature and complexity of its causes, and enable people to adapt their lifestyles in order to avoid the damage that obesity can cause.
We need much more detail from the government on how parents and very young children will receive targeted advice, how government can work with schools and communities, how we would promote healthy food and how, by working with employers, we would make it easier for people to build exercise into their lives.
The Labour government commissioned the Foresight report because we wanted our best scientists to turn their minds to one of the most intractable problems of the developed world.
The calls for action have been echoed by health groups and academics across the country.
In the political battle between modern science and Tory ideology, I’m with the scientists.
To follow any other path wouldn’t just put our society at risk of obesity, it would put our health service at even further risk of decline.