A local solution to obesity

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Obesity should be tackled at a local level, with health boards empowered to find the right solutions for their areas

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• Norman Lamb
• guardian.co.uk, Tuesday November 11 2008 15.00 GMT
• Article history

Although action is long overdue, the government is right to be looking for fresh thinking on how we can tackle what is undoubtedly our greatest public health challenge. Last year the parliamentary public accounts committee accused the government of "dithering and confusion", so I welcome this new focus. My frustration and fear is that dictating strategy so much from the centre, handing money down from Whitehall to the select few, will not deliver the sort of change required.

First, why is action necessary? If current trends continue, 40% of Britons will be obese by 2025. Even today, over a third of children who leave primary school are overweight.

This problem is starting early and a recent study by the Department of Health showed that nine out of 10 parents were unaware that their children were overweight.

A Foresight report last year estimated that by 2050 obesity would cost the NHS £50bn a year.

Whichever way you look at it, obesity has the potential to crush the life out of the NHS. But far more importantly, the health consequences for individuals are disastrous. Just look at the increasing incidence of diabetes. The potential also for increasing rates of heart disease, arthritis and some cancers is frightening.

As our society has got richer it has also got fatter. But the troubling paradox is that the most deprived communities also have the highest levels of obesity. The Foresight report warned of a "polarisation of the population, into the junk food eating, less-educated poor and functional food eating, better-informed higher classes". In the poorest areas of the country, access to healthy foods and exercise facilities is more difficult.

So what needs to happen? I certainly accept the case for the government piloting fresh ideas. Redesigning our towns and cities to encourage walking and cycling is the right thing to do. And I am very much in favour of exploring whether incentives can work to empower people to make informed choices.

Those who condemn this as yet another example of the nanny state have got it wrong. The state should be acting as enabler. There is a common interest here for both the state and citizens: reducing inequalities, controlling health costs and encouraging people to stay healthy. But for this to work, we have to move away from the dependency culture which exists in this country where, for any initiative to happen, it requires a hand-out from central government.

The Liberal Democrats' vision is of a radical shift of power away from Whitehall to local communities – locally elected health boards working with local government, integrating health and social care, addressing the health needs of their area. Along with democratic accountability to the communities they serve, health boards would also have the power to raise funds locally, with a commensurate reduction in national taxation.

We raise more of our taxes centrally than any other country in Europe apart from Malta. With that power, local health boards and local authorities could be free to innovate, to determine what is right for their area – and to find ways of reducing healthcare costs in the longer term.

A scheme they may choose to follow is one that has been introduced in Nova Scotia with strong public support. There, families get a tax-back payment if their children enrol in sports or activity clubs. A similar incentive payment could be made to those on benefits. In other countries, where healthcare is funded through insurance, providers have found that offering incentives – in the form of reduced premiums – to participate in screening, health risk assessments and physical activity reduces claims. In other words, this approach keeps people healthier and cuts cost. Surely there are positive lessons to learn here for a tax funded system.

I give the government credit for, at last, initiating some action. But please don't believe that what we have heard so far will make a dramatic difference.

Healthy Weight, Healthy Lives A Cross Government Strategy for England

The government’s new ambition on excess weight, announced in the Comprehensive Spending Review 2007 is to be the first major country: to reverse the rising tide of obesity and overweight in the population, by ensuring that all individuals are able to maintain a healthy weight.

Our ambition is to be the first major nation to reverse the rising tide of obesity and overweight in the population by ensuring that everyone is able to achieve and maintain a healthy weight. Our initial focus will be on children: by 2020, we aim to reduce the proportion of overweight and obese children to 2000 levels.

Britain is in the grip of an epidemic. Almost two-thirds of adults and a third of children are either overweight or obese,1 and work by the Government Office for Science’s Foresight2 programme suggests that, without clear action, these figures will rise to almost nine in ten adults and two-thirds of children by 2050. This matters because of the severe impact being overweight or obese can have on an individual’s health – both are associated with an increasing risk of diabetes, cancer, and heart and liver disease among others – and the risks get worse the more overweight people become. They matter because of the pressure such illnesses put on families, the NHS and society more broadly, with overall costs to society forecast to reach £50 billion per year by 2050 on current trends.

At the core of the problem is an imbalance between ‘energy in’ – what is consumed through eating – and ‘energy out’ – what is used by the body, including energy used through physical activity.

Why do these trends matter? Both being obese and being overweight increase the risk of a range of diseases that can have a significant health impact on individuals, although the risks rise with BMI* and so are greater for the obese:
• 10 per cent of all cancer deaths among nonsmokers
are related to obesity5
• the risk of Coronary Artery Disease increased
3.6 times for each unit increase in BMI5
• 85 per cent of hypertension is associated with a BMI greater than 255
• the risk of developing type 2 diabetes is about 20 times greater for people who are very obese (BMI over 35), compared to individuals with a BMI of between 18 and 256
• up to 90 per cent of people who are obese have fatty liver. Non-alcoholic fatty liver disease is projected to be the leading cause of cirrhosis in the next generation7
• health effects of excess weight are increasingly apparent even in children; the incidence of both type 2 diabetes and non-alcoholic fatty liver disease used to be rare in children, but is increasing8
• obesity in pregnancy is associated with increased risks of complications for both mother and baby
• social stigmatisation and bullying are common and can, in some cases, lead to depression and other mental health conditions

These diseases ultimately curtail life expectancy.
Severely obese individuals are likely to die on average 11 years earlier (13 years for a severely obese man between 20 and 30 years of age) than those with a healthy weight, comparable to, and in some cases worse than, the reduction in life expectancy from smoking.

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Healthy living strategy launched

Obesity levels could see a massive increase Johnson in Commons

A £372m strategy aimed at cutting levels of obesity in England has been launched by the government.

The strategy includes £75m for an "aggressive" campaign to promote healthy living to parents.

Several "healthy towns" will be created at a cost of £30m with comprehensive cycle routes and pedestrian areas.

Ministers said measures could potentially include offering obese people vouchers for gyms as an incentive to exercise.

Tackling obesity is the most significant public and personal health challenge facing our society Alan Johnson Health Secretary Beating the bulge (again) Q&A: Obesity strategy

Announcing the strategy, Health Secretary Alan Johnson said

food labelling was also key to helping people eat well,

and said regulation may be needed if industry could not agree on one system.

There are currently two, with the government backing the "traffic lights" as opposed to labelling showing the percentages of guideline daily amounts (GDAs) a product contains.

In the UK, nearly a quarter of adults and nearly a fifth of children are obese after sharp increases in the last decade.

Experts have warned the number could soar unless action is taken. It is predicted that 60% of men, 50% of women and 25% of children could be obese by 2050 if action is not taken.

Children top priority

Obesity is linked to an increased risk of cancer, heart and liver disease and diabetes.

MAIN MEASURES Identify at-risk families and offer early support and advice Make cooking lessons compulsory for children Increase children's activity levels £75m healthy living marketing campaign aimed at parents Work with industry to agree a universal food labelling system and to reduce portion sizes of fatty or salty foods A review of junk food ad rules Limit fast-food outlets near schools and parks Incentives to encourage weight-loss Personalised support via the NHS Choices website and more weight management services Do incentives work? Town designed to be healthy

Ministers said support and information - rather than "hectoring and lecturing" - were key to cutting rates.

Prime Minister Gordon Brown said: "We must do nothing less than transform the environment in which we all live.

"We must increase the opportunities we all have to make healthy choices around the exercise we take and the food we eat."

Ministers said tackling child obesity was the main aim. They pledged to reduce levels to those of the year 2000 by 2020.

The strategy focuses on measures to improve diet and lifestyle for pregnant women and children, promoting existing ideas such as encouraging new mothers to breastfeed.

It also includes the plans launched earlier this week for all children to receive cookery lessons in schools, and calls on all schools to have healthy lunchbox policies.

Planning powers

Councils will be urged to use their planning powers to prevent fast-food outlets setting up near schools.

But the strategy also sets out ways to improve adults' lifestyles, raising the possibility of financial incentives being paid to people to encourage them to live more healthily.

Existing measures to boost the number of people walking or cycling, rather than using the car are also included.

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Other measures outlined in the document include an early review of the junk food ad regulations recently introduced by broadcasting regulators Ofcom to protect children, and a plan to talk to the entertainment industry about tools to allow parents to manage how long children spend watching TV or playing computer games.

Employers will also be asked to play more of a role in helping workers be healthy - ministers suggesting holding weight loss competitions as a way of encouraging employees to lose weight.

Complex solution

Mr Johnson said:

"The core of the problem is simple - we eat too much and we do too little exercise. The solution is more complex.

"From the nature of the food we eat, to the built environment , through to the way our children lead their lives - it is harder to avoid obesity in the modern environment."

Professor Susan Jebb, chair of the expert group on obesity which advised the government on drawing up the strategy, said having an over-arching plan was more important than headline-grabbing initiatives, and welcomed the planned annual reviews of how measures were working.

But she added:

"A strategy alone doesn't miraculously help people live healthier lives. It has got to be transformed into concrete action."

Shadow Health Secretary Andrew Lansley said: "This announcement is typical of this government - it doesn't get to the root of the problem and provides a poor smokescreen for Labour's failure to make public health a real priority.

Norman Lamb, Lib Dem health spokesman, criticised the plan saying it amounted to "a series of vague aspirations and gimmicks, with few concrete commitments."

The Food and Drink Federation said UK manufacturers were "world leaders" in reformulating products, extending consumer choice and introducing improved nutrition labelling.

But Betty McBride, director of policy and communications at the British Heart Foundation, said: "The government is backing down from taking on industry in the fight against obesity.

"It is naive to expect voluntary compliance from an industry that is putting hundreds of millions of pounds into promoting these foods every year. Self-interest will always win out."