Diets: Fat

Question for Short Debate

14:00:00

Asked by

To ask His Majesty’s Government what assessment they have made of the benefits of diets with adequate fat content for reducing appetite, as an alternative to the use of drugs such as Ozempic.

My Lords, the Question in this debate lists two different treatments for the same problem: the obesity epidemic. The first treatment is as old as the hills—simply to eat the right amount of the right kind of fat. The other treatment is to use new drugs such as semaglutide, marketed as Ozempic, which have been found to act in the same way as fat. I suggest that the former—the healthy diet—should be where we concentrate our efforts to combat the epidemic. When we consume healthy fats, gut hormones such as CCK and GLP-1 are secreted in the duodenum, delaying the emptying of the stomach and creating a natural sense of fullness that curbs overeating. When the fat has been absorbed and moves on, normal service is resumed by the stomach. This simple process helps to tackle the root cause of obesity. By contrast, the new weight-loss drugs have serious side effects, including pancreatitis and other problems, along with long-term effects that are as yet unknown. The new weight-loss drugs require regular injections. They act in a similar way to fat but with a stark difference. Natural fats are safe, inexpensive and readily available in whole milk, nuts, butter and so on. Studies such as those showing lower obesity rates in Canadian children who were raised on whole milk underscore these benefits. Will the Minister ensure that her department considers this evidence instead of the biased propaganda of the food lobby? It was, after all, the food lobby that caused the obesity epidemic in the first place. It put profit over health by encouraging the overconsumption of the wrong types of food. Since the 1960s the food industry has promoted a low-fat diet, allegedly to address concerns about atheroma, which tends to block arteries. As noble Lords will know from their Greek studies, atheroma is the ancient Greek word for porridge—well, it may be Greek porridge but it is no Scottish porridge, that is for sure. The food industry has excessively promoted low-fat products packed with a lot of sugar; a low-fat diet is pretty tasteless because fat is what gives food its taste. So they had to pour in vast quantities of sugar, which fuels the cravings and excessive calorie intake contributing to today’s obesity epidemic. Despite evidence supporting the benefits of certain fats, the Department of Health still publishes on the web outdated low-fat guidelines, in part because misleading information such as the Eatwell Guide and the traffic light labelling on food packaging demonises fats without considering their positive role. After years of vilifying fats, we now turn to drugs that mimic fats’ natural benefits—a perfect case of the food industry being hoist by its own petard. Ultra-processed foods have frequently been blamed for the obesity epidemic, but there is no scientific confirmation of this. It is clear that excessive consumption of UPF can cause obesity, of course. Unfortunately, many so-called scientific publications blur these lines, incorrectly blaming the obesity crisis on ultra-processed foods. Meanwhile, we overlook the impending disaster of nearly 40 million citizens facing premature death from obesity-related diseases. The argument that obesity is unavoidable because we live in an obesogenic society, with factors such as genetics and thyroid dysfunction, is misleading. These claims suggest that obesity cannot be controlled, which diminishes the role of personal responsibility. The reality is that obesity results from consuming too much food or too much alcohol, regardless of genetics. It does not matter what your genetics are: there is only one way of getting obese, and that is putting too many calories into your mouth. There is no disease that causes obesity per se. A failing thyroid gland is often blamed, but it is the resulting slowing of the metabolism for such a patient that requires fewer calories. If people continue eating the same number of calories, obesity will result. Beyond the physiological aspects, we need a transparent, evidence-based public health campaign. A well-executed campaign has been successful in the past, although this has been denied in some quarters. Let us look back in history, as most of the answers are in history. The AIDS awareness campaign launched in the UK by the then Secretary of State for Health, Norman Fowler—the noble Lord, Lord Fowler—was highly successful, as was a similar campaign in Uganda. A similar approach to obesity could save the UK economy £98 billion every year. The Department of Health should encourage practical dietary changes, such as reducing daily intake and incorporating healthy fats, and support these choices through better regulations and labelling to clarify the benefits of healthy fats and reduce confusion about what constitutes a balanced diet. Rather than complex BMI measurements, we need only a simple assessment. For instance, if your waist measurement is more than half your height, you are eating too much of the gross national product. It is important that this message gets through. The APPG on Obesity criticises the “nanny state” approach, yet if we seek a hands-off solution, more individual responsibility and awareness will be essential. Imagine the impact if each of the 40 million obese people in this country were to reduce their intake slightly, perhaps by skipping a meal a day or choosing foods with fats that encourage fullness. This approach could improve individual health, reduce NHS expenditure and, ultimately, save many from premature death.

14:09:00

My Lords, I am most grateful to the noble Lord, Lord McColl of Dulwich, for this debate. I pay tribute to his long and consistent work in this area. He is experienced in a whole range of different aspects of this, having been a surgeon, and probably knows more about the gut than I ever will. My contribution is one of gratitude for having a peg on which I can hang a coat and pick up several other topics related to obesity. Obesity, like drink or drugs, comes from filling the empty hole inside us. It can lead to greed, excess and, as we see in many areas, premature death, or certainly an unhealthy later life. It represents a great cost to the NHS and we have to continue working on it. I declare an interest as a member of the Food, Diet and Obesity Committee, which has just produced the report Recipe for Health. We did not focus excessively on fat, but I am sure that colleagues who are better qualified than I may make contributions on that topic. We did not focus on the new drugs either. I am worried about what lies ahead with the changes in prospect from those drugs. I shall say a little more about that. In the committee, to the extent that I was able to attend, I focused primarily on the fundamental problem of excess sugar being consumed, particularly by children, who I worry about, and the consequences of that. The major reason why children go to hospitals and A&E is dental problems, which in the main arise from sugar. Like our committee, I should have liked to see taxes introduced to reduce the amount of sugar that we find in soft drinks and elsewhere, but we did not get that yesterday in the Budget. Instead, we got a reduction in the price of alcohol—what a surprise. Our report did not look at the point the noble Lord, Lord McColl, raised about the effect of alcohol on obesity. I welcome my noble friend the Minister, who is listening to me again on this topic. I have been campaigning for years that we should show calories not just on menus but on all drinks. The one area of drinks that is excepted, of course, is alcohol. The previous Government were looking at that and undertaking consultation. I do not know whether they ever concluded it, so could my noble friend say whether they did? She may not have the answer to hand, but could she write to us? If it was concluded, what is the outturn of that exercise and when will we see a Labour Government prepared to introduce calories to labelling on alcohol? Some of her forebears spoke in favour of it when I was campaigning for this over a decade ago. It is sugar that worries me. The new drugs will be used and needed, but we have to avoid some of the difficulties of lack of regulation and oversight that we have had in the past when new drugs have been introduced. I have done work over many years on addiction related to drink and drugs. I did work on heroin in the early part of this century, when methadone was introduced in lieu of heroin to try to reduce harm. We were spending next to nothing in 2005 on methadone. I cannot now get from the Government a precise or even a round figure on what we are spending currently on methadone, but the rumour is that it is about £1 billion a year, when you take into account not just producing it but the way it has to be administered and the secondary trading that takes place. This is the danger that I bring to the Committee’s attention, which we must be aware of. Unless we keep strict controls on the new drug, we could see it mushroom and spread very quickly indeed—and we could even see secondary markets start to develop. I hope that the Minister is aware of that. Can we look for incentives to get the food and drinks industry to change its approach? I know that some of them are willing to have conversations about trying to have better formulas in foods, and I hope the Government will be prepared to move on that front.

14:14:00

My Lords, I declare my interests as recorded in the register, in particular my work with the World Cancer Research Fund and the fact that I am a scientific adviser to Marks & Spencer. Like the noble Lord, Lord Brooke of Alverthorpe, I was a member of the Select Committee which reported last week on diet and obesity. I congratulate the noble Lord, Lord McColl of Dulwich, on securing this debate and his introduction to it. The idea that eating a diet with plenty of fat suppresses appetite is not new. About 50 years ago, Dr Richard Mackarness published a book entitled Eat Fat and Grow Slim. However, like so many other dietary fashions, this one ran into the sands of evidence. I will mention just one study: a double-blind randomised control trial published in the journal Nutrients in 2018. The participants—older, healthy males—were offered one of three calorie-controlled drink supplements containing different amounts of fat, protein and carbohydrate, or a control drink containing virtually no calories. The results showed that adding fat to the supplements raised levels of the gut hormone cholecystokinin, to which the noble Lord, Lord McColl, referred, but did not suppress energy intake from a subsequent buffet meal with ad libitum food. The evidence does not support the idea that eating more fat suppresses appetite. The National Diet and Nutrition Survey shows that the population-average intake of fat is close to the recommended guideline of 35% of daily energy intake. However, the intake of saturated fat is above the guideline of 11% of daily energy intake. Saturated fat, in particular animal fat rather than fat from dairy produce, is associated with an increased risk of cardiovascular disease and stroke. Therefore, dietary advice is, correctly, to consume less saturated fat, but not because of its contribution to obesity. Turning to obesity, I will make three points. First, the best way to tackle the obesity crisis is to prevent people putting on excess weight in the first place. This is most effectively achieved, as the noble Lord, Lord McColl, said, by reducing calorie intake rather than by trying to burn it off with exercise—if you try to burn off the calories from one energy drink, you will find out how tough it is. Secondly, the dramatic rise in obesity during the past 30 years has been driven largely by the increased availability of cheap, highly palatable, calorie-dense food, known colloquially as “junk food”. The report of the Food, Diet and Obesity Committee published last week recommends a raft of policies to deal with this challenge. The overarching theme is that there should be a switch from the 700 or so failed policies based on individual choice to policies based on regulation of the junk food industry and the junk food environment. Does the Minister agree with that general proposition? Thirdly, it might be tempting to see effective weight-loss drugs such as Wegovy and Ozempic as a “get out of jail free” card. They will have an important role, but they are not the answer to treating the millions of obese people in this country and a much larger number around the world. At the moment they are very expensive, although it is possible, with many drugs in development, that the price will come down. More importantly, they require a lifelong commitment: it is not just about taking the drug for a few weeks; it is about taking it for ever. Recent data from the United States, where one in eight people has tried a weight-loss drug, show that two out of every three obese people give up taking the drug within a year and then regain the weight they have lost. The Government have said they want to shift from treatment to prevention as one of the three pillars of reforming the NHS. Can the Minister explain to us in broad terms how she envisages this shift from treatment to prevention being applied to diet and obesity, the second-biggest avoidable risk of ill health? In this context, I want to cite one example and ask the Minister to comment on it. My local sports centre, owned by Oxford City Council and which I visit regularly, has an entrance packed with junk food—sugary drinks, ice creams, doughnuts, the lot. Does the Minister think that that is an appropriate way for a local council to run a fitness centre?

14:20:00

My Lords, I declare my interests. I am a member of the committee to which noble Lords have already referred and I have a problem in keeping my weight down, so it is a subject that has been of great interest to me and I am very grateful to my noble friend Lord McColl for introducing this debate. One of the difficulties, perhaps the greatest difficulty, when we are discussing food and diet is the tendency now to use hyperbole and oversimplification in dealing with a very difficult, complex subject. Of course, the press loves hyperbole and simplification, because it increases sales, but it does not actually solve the problem of obesity. From our report I take out two important factors. One is that obesity has overtaken tobacco as a risk factor for disability in England. The second is that the total cost of obesity is now calculated at £100 billion a year, equivalent to a tax rate of £400 per head. So, there is a lot to be gained by getting obesity under control. When we talk about simplification, the word “fat” is an oversimplification. There are good fats and bad fats, as my noble friend Lord McColl said. Some fats are extremely important to us. They are a source of energy; they help vitamin absorption; and they provide fatty acids, particularly omega 3 and omega 6, which are essential for keeping our nervous and brain systems healthy. Indeed, fat can be used to help reduce the urgency for food. Sarah Berry, associate professor at the Department of Nutritional Sciences at King’s College, says: “Fat makes us feel full for longer. It delays the rate at which our stomach empties food, which again helps us create that feeling of fullness. So, it also controls our blood sugar levels as well, so that we tend to consume less calories, potentially later in the day”. The idea that one can solve this problem of obesity with weight-loss jabs and get people back to work, which the Prime Minister seems to think is a good idea, is very flawed. Trials of the drugs have shown that people need help as well as just taking the drug. Eligible people who will require support cannot access the support to achieve behavioural change. These drugs will not work for everyone; all the trials have shown that. I repeat that obesity is a complex issue and trying to solve it with an injection is a poor cure when prevention would be far better. There is of course the question of obesity stigma in the workplace, which is a huge barrier to satisfactory employment and leads to poor well-being and burnout. On the barriers, it is not obesity alone that causes a person to be unemployed; there are many other problems. When we talk about oversimplification, we must remember that diets and our bodies are very complex. New research is demonstrating the importance and relevance of our gut microbiome. It demonstrates that we need to eat over 30 different plants of different colours weekly, 30 grams of fibre a day and around 100 grams of protein a day. We need to stop eating foods that are high in fat, sugar and salt, especially those that are ultra processed. There are other issues. We need to eat within a certain timeframe. All our daily consumption should be within a 12-hour period. To pick up the point made by the noble Lord, Lord Krebs, exercise is not the panacea. I was very sorry to hear Chris Whitty say that this was going to be the new solution to obesity; it is much more complex. Exercise can help on the fringes, but it is not the main solution. The main solution is eating a healthy, balanced, varied diet, but that is not what the Eatwell Guide tells us to do. I hope the Minister will look at our report where we analyse this very carefully, because we come up with some sensible solutions, including raising tax on people that produce the wrong food for us.

14:25:00

My Lords, I thank the noble Lord, Lord McColl, for securing this short debate. It is certainly of the moment, but I come at this issue from a slightly different viewpoint. I am not in the habit of discussing my weight in public, but this is the moment of truth; I am going to out myself. For the past two years, I have been injecting myself every week with either Ozempic or Mounjaro. As a result, I have lost over 12% of my body weight and I am keeping it off. Yes, it is expensive and, yes, I will probably have to continue my injections for the rest of my life, but to me it is worth every penny. I was not fat, but I was in danger of getting on the wrong side of chubby. I knew the risks. I never eat desserts nor sweets nor any junk food, but still the dial went in one direction. The key to weight loss can be summarised in two words—eat less—but that is easier said than done. I suppose the corresponding two words are: exercise more. Fewer carbs, more carbs, protein only, no fruit, skip breakfast, do not eat after 6 pm, fast for 18 hours a day and of course the 5:2 diet—I tried them all. The trouble is, you work hard at it, perhaps you reach your target weight and then it creeps back again. You are always miserable. As for exercise, those who know me can attest that I can bore for Britain on the subject. Three intense workouts every week, and my phone tells me that I average 7,200 steps per day over a year and often over 10,000 paces—all this is to no avail. Then along came Ozempic. A weekly self-administered injection is all that it took. It suppresses the appetite and reduces the craving for food—you just lose interest. To me, the difference between dieting and Ozempic is that when you diet all you ever think about is food. When you inject, all you ever think about is the next morning’s rendezvous with a weighing machine. However, there is more to Ozempic than just weight loss. First, there are all the other health benefits. This week, the Economist, not known for hyperbole, called it the most important drug ever. A drug that started out being used to regulate diabetes can now reduce weight. There is strong evidence that it can control the incidence of kidney and liver disease, cardiovascular issues and sleep apnoea, and reduce drug addiction and opioid inflammation. They say that it can contain ageing and even Alzheimer’s. That is a lot of things. This medication is up there with statins, Prozac, aspirin and even the contraceptive pill in changing our health and behaviour. Then there are the economic benefits. Some 25% of the population are obese. Many are prone to illness. Their potential productivity is often diminished. At present, the annual cost of obesity to the NHS is around £6.5 billion, and it is expected to increase by 50% by 2050. It is the second-biggest preventable cause of cancer. Add to that the cost of treating all the other illnesses that I have mentioned which GLP-1 might be able to arrest, and you can see that the NHS could make some major savings from the wholesale employment of GLP-1. If these drugs are as game-changing as I suggest they are, they will have a profound and positive effect on our health and on our economy. They are to be encouraged.

14:29:00

My Lords, I, too, thank my noble friend Lord McColl for initiating and introducing today’s debate. He and I have shared a tiny cupboard—sorry, room—for the past 10 or so years and have spent many happy hours discussing obesity, its impact on the population and the cost to the country. It is great to be expanding those private conversations into a more public arena today. For many years, this topic was rather a niche interest; my noble friend I were almost the only people to raise it in the Chamber. However, I am delighted that more people are now aware of the urgency of the situation, as the financial and personal costs have rocketed. I am delighted to be the fourth member of the Food, Diet and Obesity Committee, which reported last week, to speak today. I hope my noble friend and the Minister will forgive me for straying a little outside the subject of today’s debate to make some broader comments about a healthy diet, including learnings from our report. As we have heard, the report, Recipe for Health: A Plan to Fix Our Broken Food System, has been widely welcomed by food campaigners and others active in the sector. I urge noble Lords who were not on the committee, especially the Minister, to read at least the report’s conclusions and recommendations. What became clear over the course of hours of evidence is that our food system is broken and needs to be fixed for people to have better diets and healthier lives. The statistics speak for themselves and are terrifying. Two-thirds of adults are overweight or obese, while the situation with children is as bad—and growing. The costs are enormous: at least 1% to 2% of UK GDP, with billions in healthcare costs and lost productivity. This public health emergency is driven primarily by the overconsumption of unhealthy foods. As we have discussed, today’s debate is not about ultra-processed foods, which now make up nearly 70% of the average young person’s diet; there will be plenty of opportunity to debate those and the responsibility of the food industry in greater detail when—in the not too distant future, I hope—our report is discussed. Rather, it is about having a healthy and balanced diet, and how we can achieve that for both children and adults. All of us in this Room—at least, those of us speaking —grew up eating real food: meats and two veg, liver, stews and roasts, all freshly cooked. There was little choice, and there was no constant marketing or encouragement to snack between meals. There were no takeaways or out-of-home delivery services, which add significantly to excess calories. Today’s children are more likely to be drinking puréed fruit from pouches than biting into an apple. They are more comfortable opening packets or takeaway trays and are hardly able even to recognise real food. Our parents would find today’s dietary patterns absolutely unrecognisable. Only last month, the Prime Minister said that the NHS was in a critical condition and that there would be no extra money without reform. The review of the noble Lord, Lord Darzi, and the Secretary of State’s response to it confirmed the analysis of Henry Dimbleby’s food strategy and highlighted the importance of prevention, as the noble Lord, Lord Krebs, and others mentioned. It was disappointing, therefore, to see seemingly nothing in the Budget to address this matter. We have a major health problem on which, if it were a communicable epidemic, the Government would be forced to act. People want to do the right thing but need help and support. The recommendations in our report are clear; I urge the Government to act on them.

14:33:00

My Lords, I am a type 2 diabetic. I overcome some embarrassment about my weight to say that I have lost more than 30 kilos over the past 30 years. More importantly, I have kept it off. Self-evidently, however, I need to lose more weight. My diabetic control has been very difficult and required major lifestyle changes, but they were not enough. So, in the past four months, I have been assisted in improving my diabetic control and reducing my weight by a further few kilograms with the help of Mounjaro, a drug from Eli Lilly. Since being diagnosed with diabetes in 1994, I have always had great support from St Thomas’ Hospital. It advised me a few years ago that a typical type 2 diabetic like me, in their 50s and 60s, can be expected to put on an average of between one and two kilos every year. Over a decade or two, that gain of between 20 and 40 kilograms is likely to have catastrophic health consequences requiring significant and costly medical intervention. For many people struggling with their weight and diabetic control, these new injections give great hope, but we should not see any of the different injections becoming available as a silver bullet to achieve weight loss. We should recognise first that they are helpful in improving diabetic control, which can be very difficult, as your pancreas becomes less and less effective at producing insulin and your sugar levels rise. The associated weight loss with these drugs is also helpful, but such treatment is far from appropriate as a first resort and some people struggle with unpleasant side-effects from them. However, we should never accept an approach towards obesity or diabetic control which says little more than, “Pull your socks up, make yourself eat much less, but eat more fat”. This approach will lead only to the obesity crisis in many of the more affluent countries becoming even greater. It will result in great damage to the health of their populations, their health systems and their economies. The Atkins diet is now widely discredited after the demise of the author of the books on it. The British Dietetic Association says that fat plays an important part in our diet and that people need a small amount of it. But it has warned against a high intake of saturated fats, which are often found in processed foods and associated with weight gain, making diabetic control harder, causing joint problems and some cancers. The questions for us to discuss should be about how to take strong steps to help prevent people becoming obese in the first place and how to help them achieve and maintain healthier lifestyles, manage their diets better, and adopt healthier lifestyles, including regular exercise. As the excellent report from the Select Committee on Food, Diet and Obesity, chaired by my noble friend Lady Walmsley, suggested last week, we need a broad range of measures to tackle the obesity crisis. I would begin with healthy, nutritious, and free school meals and stopping the proliferation of fried chicken and burger shops in close proximity to schools. We need, as the Select Committee says, to reduce the prevalence of marketing and advertising of unhealthy ultra-processed foods, especially to children. We need also to promote health education and physical activity in schools and after school. Poverty must also be recognised as a significant factor in many people having unhealthy diets and suffering from health inequalities. Poor parents struggle to provide healthy diets for their families. Healthier foods are more than twice as expensive per calorie as less healthy foods. One of the most important poverty-relieving measures would be to scrap the two-child limit for universal credit or tax credits. I am disappointed that this was not in yesterday’s Budget. In conclusion, we need to follow medical advice and look at evidence over time about the use of injections assisting diabetic control and weight loss. We cannot simply let people think that they can just resort to expensive weekly injections provided by the state. But nor can the state ignore the tremendous costs of obesity and diabetes.

14:38:00

My Lords, I thank my noble friend Lord McColl for securing this debate on a timely and important matter, but I also thank all noble Lords in this debate for their contributions. I warn the Minister that I tend to take a rather Socratic approach, so I will have lots of questions. The noble Baroness may not be able to answer all of them but I am happy for her to write to all of us. The noble Earl, Lord Caithness, and the noble Lord, Lord McColl, have shared some interesting statistics: an NHS survey estimated that 28% of the population are obese, and a further 38% are classified as overweight. As other noble Lords said, this is not only a health issue but an economic problem. The question is: how do we as a society encourage people to lose weight—to help them live healthier lives but also to reduce the cost to taxpayers of the NHS treating obesity, be that through medication or lifestyle changes? As someone who believes in personal freedom, I would not oppose anyone who decided to take Ozempic, as long as it was safe for them to do so and they were aware of the risks, as the noble Lords, Lord Mitchell and Lord Rennard, testified. However, there have been reports that the popularity of such drugs has led to a market for dangerous counterfeit drugs that mimic these effects. Can the Minister confirm whether the Government are aware of the proliferation of cheaper alternatives? Have the Government made any assessment of the safety of these alternatives and of whether some are in fact counterfeits? While medical advancements such as Ozempic can help to manage someone’s weight, surely it is important that we explore and promote alternative approaches, as the noble Lords, Lord Brooke and Lord Krebs, said. As my noble friend Lord McColl and the noble Earl, Lord Caithness, suggested, research shows that diets with enough healthy fat content, especially unsaturated fats, can be effective in making people feel that they have eaten enough and reducing their appetite. These diets can also stabilise blood sugar levels, which is critical for weight management and overall health. Education and prevention are just as important. Many people may not understand the impact of their dietary choices on their long-term health; they may not realise that better diets will not necessarily cost more; and they may not be aware that a small increase in physical activity can contribute to better physical health and mental well-being—although it is not a panacea, as the noble Lord, Lord Krebs, and the noble Earl, Lord Caithness, said. Can the Minister reveal whether the NHS is prioritising cost-effective lifestyle approaches, rather than focusing on weight-loss drugs as some sort of magic bullet? I urge the NHS and the Office for Health Improvement and Disparities, as well as the department, to ensure that accessible support is available to those from all backgrounds. Often, those from the most disadvantaged backgrounds face the greatest challenges in accessing healthy food and exercise facilities, leading to higher incidences of obesity within those communities. Noble Lords may have seen daytime television programmes—I know they work very hard, but in their rare moments of relaxation they might switch on the TV—where families are taught to cook healthier meals, which can often be cheaper than ready meals from the freezer section of a supermarket. When I was a Minister, I often wondered how you transfer these daytime TV lessons into people’s homes. I know that my noble friend Lady Jenkin has taken an interest in this issue for many years. One of my students recently wrote an assignment on Brite Box, a fantastic project in Kingston upon Thames that provides families with ingredients and an illustrated recipe guide so that they can cook a healthy meal on a budget together. What happens is that cooking together leads to meals being family occasions rather than one parent being stuck in the kitchen. Can the Minister tell us how the NHS, the Department of Health and OHID are working with similar local community projects across the country to encourage families in poorer communities to eat healthier diets? What steps are being taken to enhance dietary and health education in our schools, workplaces and community spaces? Finally, as weight-loss drugs such as Ozempic gain popularity and we start to see the results of the trial of tirzepatide in Manchester, we have to recognise the psychological aspect of obesity. Can the Minister tell us about how weight-management initiatives will consider the link between poor weight management and the mental health of individuals? What mental health support is available to overweight individuals with underlying mental health conditions, and how do we avoid the unintended consequences of those who suffer from eating disorders such as anorexia or bulimia? Once again, I thank my noble friend Lord McColl for securing this debate and all noble Lords for their contributions. I look forward to the Minister’s responses.

14:43:00

My Lords, I thank the noble Lord, Lord McColl, for bringing this important issue to the fore. He is a doughty campaigner and I know he has many strong views, to which I have listened not just on this occasion but on many occasions. I welcome the airing that we are having today. I thank other noble Lords, too, for their contributions. As ever, there is a fair amount of common ground and quite a bit of divergence in the opinions about how we tackle what is an obesity crisis. I particularly thank noble Lords, including my noble friend Lord Mitchell and the noble Lord, Lord Rennard, for sharing their very personal experiences; that always assists us. As many noble Lords have said, there is no doubt that obesity is significant in our country—and not just our country. As the noble Lord, Lord Kamall, observed, over 28% of adults are living with obesity, which puts them at risk of a whole range of health conditions. Obesity is also estimated to cost the NHS more than £11 billion per year, with total costs to the UK of £74 billion per year. The noble Baroness, Lady Jenkin, rightly referred to children’s obesity. It is shocking to realise that children with obesity are five times more likely to be living with obesity as adults. In other words, the seeds sown at the beginning are reaped in a none-too-positive way later on down the line. As mentioned by a number of noble Lords, obesity is particularly concentrated in the most deprived areas, with prevalence for children in the most deprived areas being more than double that in the least deprived areas. That gives some idea of what we are up against. As the noble Lord, Lord Krebs, and other noble Lords indicated, it is absolutely clear that we have to take action. I share the view expressed that the challenge before us is complex. It would be wrong to see it any other way. Indeed, I share the view that obesity is primarily caused by the consumption of excess calories. We have a food environment where unhealthy foods have become cheaper and more readily available. The noble Lord, Lord Krebs, made a point about a local fitness centre display in his own area. I certainly echo his sentiment that this is not an appropriate way to assist people’s fitness. If the noble Lord has not already, I encourage him to complain to his local authority, because we need a cultural shift as well as a number of practical shifts. In addition to the food environment that we are in, portion sizes have increased. The noble Lord, Lord McColl, rightly shines a light on this, and we are committed to addressing it. We have made a good start, and our mindset is very much about prevention over cure. On the question from the noble Lord, Lord Krebs, we have committed to implementing junk food advertising restrictions on TV and online and to limiting schoolchildren’s access to fast food. Our 10-year health plan will also reform the NHS by shifting the focus from sickness to prevention, as noble Lords have already observed. On the point raised by my noble friend Lord Brooke, as announced by the Chancellor yesterday we will take steps to ensure that the soft drinks industry levy remains effective and fit for purpose. That will be done by ensuring that the levy is uprated to reflect inflation since it came into force and in the future. Importantly for me, the Government will also review the soft drinks industry levy’s operation and structures, to aim to further drive down the sugar content in soft drinks. We will also review the sugar thresholds at which it applies and the exemption for milk-based drinks. I will be pleased to keep noble Lords informed on this development. I heard the observation by the noble Lord, Lord McColl, that he considers that there is—if I may use this term—a demonisation of fats. I assure him that the dietary recommendations are about promoting a balanced diet. The advice given tells people not to avoid fat per se but—the noble Lord, Lord Krebs, referred to this—to eat foods containing saturated fats less often and in smaller quantities, and to swap to unsaturated fats where possible. The reason for this focus is that there is robust evidence that switching saturated fat for unsaturated fat lowers blood cholesterol and reduces the risk of heart disease by almost a fifth. With more than 150,000 deaths from cardiovascular disease every single year, this is crucial. Indeed, the guidance and the policies, such as junk food advertising, cover both saturated fat and sugar—something of great interest to my noble friend Lord Brooke—so it is not one thing or another, as is often the case when we are speaking about this matter. Over 12 million people are living with obesity, so we need to provide support for them too—a number of noble Lords correctly outlined the importance of that support. The NHS and local government provide a wide range of services, including behavioural support programmes that provide advice to help people to adapt to a healthier diet. There are more specialised services for people living with severe obesity and for associated comorbidities. These can prescribe some of the newer obesity medicines as well as offering surgery. However, I emphasise that they should be considered further down the treatment pathway. Exactly what is appropriate for any individual is down to clinicians to advise, in discussion with that patient, and to consider clinical guidance. The noble Lord, Lord McColl, referred to Ozempic. As he will be aware, it is licensed to treat type 2 diabetes, and healthcare professionals have been reminded in guidance that it should not be prescribed solely for weight loss, although the obesity medicine Wegovy is approved for weight management on the NHS. However, obesity medicines are not a first-line treatment. Other things need to be tried first and other support needs to be in place. I agree that the primary focus should be on supporting behavioural change, including a healthier diet, and that is confirmed through NICE guidance, but we should acknowledge that obesity medicines can be very effective at helping some people to lose considerable amounts of weight, as my noble friend Lord Mitchell and the noble Lord, Lord Rennard, have described and demonstrated. The losses are considerable—in some cases, over 20% of body weight—and that is a benefit to health. However, as I said, these medicines should not be given alone, and support on diet and increasing physical activity, which the noble Earl, Lord Caithness, spoke about, are crucial. We need the food environment to be supportive for those managing their weight, ensuring that it is easier for people to eat more fibre, more vegetables and less sugar and salt, and to swap saturated fat for unsaturated. I turn to the reference to “jabs for jobs”. I am grateful that noble Lords have raised this issue today, because it is an opportunity to address the media coverage. The suggestion is that the Government will somehow target people who are unemployed with such medicines to help them to get back to work. I want to be clear: the NHS continues and will continue to treat people on clinical need. We are not targeting those who are unemployed. The coverage in the media refers to a study funded by the manufacturer of one of these obesity medicines. It will build evidence to increase our understanding about the potential wider value of such medicines, and it will look at the impact on health and healthcare use and collect data on things such as change in employment status. I turn to some of the other points raised. In answer to my noble friend Lord Brooke, we are indeed looking at incentives for reformulation and considering the balance of mandatory and voluntary measures. I thank the noble Earl, Lord Caithness, and the noble Baroness, Lady Jenkins, for raising the work of the House of Lords committee. I am glad to see that it has recently published its final report, and I look forward to looking at it and considering the recommendations. There are a number of specific questions that I have not been able to address, and I will be very pleased to pick up specifics in that regard. To conclude, obesity medicines are not to be seen as the first thing to turn to—the guidance is clear on that—but they have a place for some people when other options have not worked. We and the NHS are looking at how best to make the medicines that we are considering today available in a safe and effective way.

14:55:00

Sitting suspended.