What should Conservatives do about obesity?

Yesterday in the Commons, Andrew Lansley set out the Conservative approach to Britain's "obesity crisis" - a crisis that is projected to soon account for more premature deaths than smoking.  Last weekend's Observer presented a nightmare scenario of £45bn in social costs by 2050: "Soaring rates of diabetes, strokes and heart disease caused by more Britons becoming fatter will cost the NHS alone £6.5bn".  These sorts of projections should always be treated with a pinch of lo-salt but, putting aside the hyperbole, most agree that there is a real problem.

Mr Lansley, Shadow Secretary of State for Health, said that Britain needs "a supply chain initiative that will reduce fats, sugar and salt progressively and substantially."  "We must also promote good diet, he continued, "targeting certain junk foods".

Mr Lansley also called for:

• "A combined traffic light and Guideline Daily Amounts labelling scheme?"
• "A national research centre on obesity"
• "A nationwide programme to identify cardiovascular risk"
• "Ring-fenced public health budgets so that we cannot carry on seeing such budgets being raided to meet national health service deficits".

Mr Lansley attacked the Government for halving the number of public health professionals and for halving lottery funding for community sport "when half the population do no sport and take no active recreation".

It is not just UK Conservatives who are taking obesity seriously.  One of the Republican candidates for the US Presidency has also been an interventionist on public health.  This is what Mike Huckabee, Governor of Arkansas, said at the beginning of last year:

"I don't want to be the sugar sheriff.  I don't want to be the grease police. That's not my job. But when I look at our state budget, and I see that every year our Medicaid budget is increasing by 9 to 10 percent, and I look at state employees' health plans and I see that those costs are escalating at double digits and twice the rate of inflation — as a fiscal manager, I have not only the right but frankly also the responsibility to see what can we do to improve this bottom-line cost."

It's easy for libertarian Tories to say that it is no business of the state to try and influence what people eat but what is their solution to the obesity challenge?  Obesity, family breakdown and drug addiction are some of the bigger drivers of the growth in the size of the state.  Do we act against these drivers now or do we wait and pay later?

Comments

[Chad Noble]

Answer: Social insurance.

Annual medicals will lead to adjusted premiums so people pay for projected usage.

Simple. If they want to be porkie, or smoke etc then fine, as long as they for their future care.

[old school tory]

Perhaps Eric Pickles could bring something (other than loads of pies) to the table?

[Lindsay Jenkins]

'Free health care' encourages disregard for fundamentals like obesity. If patients had to pay for their health care much of the problem would melt away.

[Jennifer Wells]

Given that we are not going to get a system of social insurance that would force people to be responsible I fear it has to be the forms of interventionism advocated by Andrew Lansley.

[George Hinton]

The key thing to remember is.....Do not get involved in this story.

What is developing is a clear indication, for all to see, of the increasingly authoritarian and dictatorial nature of NuLab and the agencies that it has spawned.
Obesity is an individuals choice, it is not up to government to interfere and macro manage everybody's lives. Advice and health warnings can be given, but on no account should we penalise such people by with-holding health care.
To mange this problem we should ensure that all children are properly educated that the perils of obesity are explained. But more importantly, that children are given every opportunity for exercise and sport and learn at an early age the benefits of a healthy diet.
Clearly it would also help if parents were made aware of what a healthy diet constitutes, that at least one parent was available at home to ensure that proper meals are prepared and cooked. But, education not compunction is the way forward. Afterall we do live in a democracy, don't we?
A quite damning story this week is the news that Hillingdon/Uxbridge will build an Olympic sized pool, the first in London for 40 years!!. Now that's a story and an indictment on the lack of spending in the capital.

[simon]

It's debates like this that make you wonder WTF?!? The answers are obvious- MORE non-compeditive sport in schools (get rid of all the crap in school canteens); if adults are working more than 39 hours a week is it any wonder their spare time is spent RELAXING rather than exercising ( and having less time to cook, and therefore buy 'ready slop' from local supermarket). Unless the long working hours culture in this country is adressed then you might as well pack-up-shop and stop going on about obesity. Or we could introduce a 'fat-tax': 'where you pay more if you weigh more'! Either that or give a free copy of 'let's get physical' to every person in the country! Oh ok- i'm not taking this too seriously...

[Chad Noble]

"Given that we are not going to get a system of social insurance"

Actually we already have National Insurance, and we already have mixed public/private health provision within the NHS, so there is no need for any scary changes, the existing Labour-approved framework is enough.

Just pledge to continue providing a mixed service as now, but to use NI to incentivise people to be healthier, rather than pegging it to income.

If that doesn't perfectly fit within Cameron's 'tax the bad' approach, I don't know what does!

[Moral minority]

Eric Pickles had slimmed down when I last saw him. He seems much slimmer than Nicholas Soames who reportedly feasts regularly at Wiltons and clubs in St James's.

Advocates of the nanny and bullying state should remember that the cost of treating obese people and smokers is offset by lower pension costs when they die early. Smokers and drinkers also contribute far more in duty than the extra costs of the healthcare. Cheers!

[Tony Makara]

I think obesity is definately linked to the microwave. At one time having a burger took a bit of effort as it had to be fried or grilled. Twenty minutes work. Over the last thirty years the microwave has made it possible to cook a burger in sixty seconds.

Supermarket sales tactics have also contibuted with families tempted to buy multipacks of chocolate and crisps, often with thirty or so bars/packets in a multipack. These are left in the fridge or cupboard and the temptation to eat more is there.

Personal responsibility is of course the main cause and cure. People are overweight because they choose to be. They have the option to eat or not. I don't think its the role of goverment to tell adults what food to eat but I think where children are concerned, where a child cannot exercize judgement it is wise for the government of the day to offer guidence through the school and through the parents to have the child eating sensibly.

[Editor]

I think that's enough about the great Eric Pickles everyone!

[matthew]

enough about Eric Pickles, what about fatty Soames? There really is no excuse for being fat, it's antisocial and dangerous.

Tax the fatties.

Annual weigh-in, anyone with BMI over 30 and body fat percentage over 30% for men or 40% women, will be charged £1,000 lard tax.

[Steevo]

You do have socialized healthcare so there will always be justification to intrude into others' lives for the sake of 'fairness'. No one should have to be unduly burdened with increased taxes to pay for another's bad behavior, right?

Besides, Health Secretary Alan Johnson warned obesity could be as big a crisis as climate change unless the nation starts to lose weight soon. There should be no problems to simply, obey. The UK could have the next Nobel Peace Prize.

[John Ionides]

I was very disturbed to see that the report appeared to say that it was not the fault of the poeple involved, but that they just existed in an "obesogenic" environment. I think that trying to take away indivudal responsibility for this is extremely worrying.

What should be do? Well, people are eating more calories than they can use (and are doing this consistently). The bottom line should be education - people have to realise that being overwieght has many significant health problems associted with it. As the state is in change of education, it could try to put in place a testing regime that placed less empahsis on educational achievemnet and more on other skills (be it sport, or the arts) to get people in the habit of doing more than just working as well as making the dangers of obesity known.

Personally, I would encourage schools to look at cookery too, although I appreciate the problems here (high infrastructure costs, crowded curriculum, lack of cookery teachers, not wanting governement to micromanage schools) as there is of course a dietary component to obesity too.

Other than that - why worry? If people want to eat themselves to oblivion it should be their choice. Sure it will cost the NHS more to treat them in the short term, but then again they will die younger (on average, quite a lot younger) so the state will gain by not having to stump up for pensions.

[Winchester whisperer]

Remember the Roman obesity preventative: stick a feather down the throat and on to the next course

[Tanuki]

I don't think "the government" should do anything about obesity, just as they shouldn't be trying to ban the "size 0" models from fashion catwalks.

Consideration could maybe be given to introducing NHS surcharges when 'self-inflicted' conditions are being treated - that would recoup the costs, just as drivers with poor accident-records pay higher insurance premiums.

The biggest lever though - just remember to tell everyone that fatties aren't sexy! Get this into peoples' heads and the problem will largely solve itself.

[Chad Noble]

A certain famous private health insurance company is already offering reduced costs linked to number of gym visits.

Cameron could easily praise this initiative then detail his aspiration to achieve the same savings for those within the national health system by linking at least part of the NI cost to health.

There could then be no accusations of elitism, as this would clearly be seeking to offer those within the national health system the same kind of savings linked to health already available to those with private health cover.

[Treacle]

Why are we even talking about this?

More jobsworth quango's reporting to jobsworth ministers who then want to have more targets and expensive meddling.

It is imperative that we don't 'have a policy' about it.

Link healthcare direct to individuals by health credits and leave it alone for the market to sort out, the alternative has been a disaster anyway.

You cold abolish all government subsidy to the bloody quango's though....

Oi! who's nicked my pork pie?

[Sally Roberts]

John Ionides I agree with what you say that education is key - but it is not the whole answer to what is a very complicated problem.
This is an area where I speak from a great deal of personal experience.
As my closest friends and family will know, I have struggled with the "demon" of disordered eating and its consequences for much of my life. I was slim as a young child but at the age of seven became ill with Hepatitis A which I had contracted from a dirty swimming pool on a family holiday in Spain. At that time (during the 1960s) there was a school of thought that the fatigue associated with this illness could be helped by putting the patient on a high-carbohydrate diet and, as a result of this (and no doubt as a result of my mother over-feeding me through her loving concern for my wellbeing) I began to put on weight, with the inevitable result that as I grew older I was bullied at school and found it hard to be accepted by my peers.
As a result, at the age of about 19 or 20 I discovered the "joys" of anorexia - the winter of 1978-79 was one I well remember as I was existing on a cube of cheese, an apple and a plain yoghurt each day topped up by gallons of black coffee and, not surprisingly I was freezing cold all the time despite wearing several layers of clothing!! I became very thin but of course could not keep this up and began the "binge and purge" cycle which continued off and on for many years with the result that my weight yo yo'ed constantly.
I realise that my problems were caused by emotional turmoil and my inability to handle my own strong feelings and all the "ups and downs" of my life.
The story ends happily however. In July 2006 I joined "Lighter Life" - a programme which combines group therapy with its weight loss and weight management programme. The actual diet consists of "foodpacks" which are very like Slim Fast products, plus 4 litres of water a day. Once all the weight is lost you reintroduce food gradually and to cut a very long story short here I am, slim, happy and with a completely different attitude to food (which I no longer view as "the enemy") and to my own body image (positive!)
The point I make is that those who dismiss the problem of obesity as something either vaguely amusing or something which can easily be dealt with by "simply eating less and exercising more" are missing the point that many many people are confusing food with love! Lighter Life is very expensive - that is its main drawback - but if such schemes could be subsidised and more people encouraged to take them up then we might have a real answer to the problem.

[Jonathan Sheppard]

I think there are two issues with obesity. The food you take in and the exercise you do. There is alot of research that suggests the amount of calories people eat hasn't really risen over the years - what has happened is that the amount of calories people burn has dramatically dropped.

This is particularly the case for children. Gone are the days where kids play football in the street. They now have the TV the playstation and the internet. So that is one issue.Government does has a role here. Competitive sport is schools - and how about stop selling those playing fields. Planning policy also is important. New estates need to make adequate provision for parks/ play areas.

On food the traffic light system isn't necessarily an answer. Having been invovled in debates about this while working in the retail sector I found it interesting that say for example pre packed pineapple chunks (which would be one of the five a day you are meant to have) get a red light for having too much natural sugar. I think I am fairly educated - but when I go shopping I dont really take the time to read all the ingredients on the food I buy.

I believe there is no such thing as a bad food - but moreover too much of anything (milk cheese wine whatever) can have health consequences. It is no good giving health message that say for example full fat milk is bad - which has had the effect that some parents stopped their kids drinking the stuff - which led to calcium deficiency. Any messages about food have to be carefully crafted.

Now, having rambled on, one of the biggest reasons for the rise in obesity is time. What do I mean. Well as pointed out in the comments above - people are becoming more and more time poor. You get home from work. You can't be bothered to cook - you order a take away or a pre packed meal.

You work all day sat down - by the time you get home - you can't be bothered to go to the gym. Now some would say it's Government's job to force people out of their arm chairs. I'm not so sure that's what we want the state to do - but if we don't the implications are clear. The obesity time bomb is ticking. Forget how much the NHS spends on smoking related diseases - this is the one that will suck up the resources of the NHS at an ever increasing rate.

However, as with smoking - we really need to talk about personal responsibility. It is down to the individual to tackle this - though we should be looking at policies that make that individual choice easier to make.

[LiberalHammer]

Having a policy is a better idea than not. Reason being is that obesity will cost lots in terms of medical treatment, insurance bills, days lost at work, etc. Yes it is up to the individual but it is libertarian dogmatism not to accept that the health of the nation is important.

[tired and emotional]

If people want to get fat let 'em. The reason for the growth in the state is that we are all addicted to state intervention in everything. The reason for the growth in waistlines is prosperity and laziness. Labour are destroying the former and encouraging the latter. We need not join them.

Reading some of the snippets from the obesity 'report' that just came out was instructive. It fell over itself to say that it was not the fault of fat people that were fat. Rather the state should expand in some doomed attempt to make food less fattening so that the tubbies may gorge themselves even further as they sit in front of Celebrity Fat Club each night.

Given that we claim to be worried about the rising cost of healthcare etc etc then, rather than some sort of idiotic knee-jerk attempt to further regulate what people eat and how food is produced in order to hit some bizarre NuLabour-style pork target, shouldn’t we simply introduce top-up payments for the obese in the NHS?

I seem to remember that smokers were and are being denied treatment by some trusts on cost grounds. Given that the principle of the universal health system we are all required to genuflect in front of has only ever existed as a fevered fantasy in Bevan’s brain, why don’t we simply charge fatties for the strain they put on the system?

Oh yes I forgot. Being fat is a sign of what we laughingly refer to as poverty these days and we can’t expect those too poor to stop overeating and go for a walk occasionally to take responsibility for the crap choices they make can we?

How about requiring schools to make children participate in competitive sports? If we are going to beg the state to reach further into our lives to fix the problems we lack the will or intelligence to solve for ourselves let’s at least focus on creating positive habits in the young rather than bansturbation on a whim.

Don’t suppose this will make it in. Tim doesn’t allow my comments anymore.

[christina]

Do leave it alone, please. If people get fat life won't be such fun or as long.

My unscientific observation is that the poorer the family the more obese. Just wandering around on a nice day like today and obesity didn't seem to be more than a minority problem. The only point of the whole PR "spinning" is to provide the media with something to write about already pre-digested for them by the spinners at no expense to the media.

The Beeb devoted a third of its bulletin last night to this non-story. I suppose it makes a change from blaming the public for the sun warming the earth. Last week we drink too much at home whereas the week before that red wine stopped heart attacks

We're being brainwashed. And it's all a distraction from the catalogue of government disasters[ C.,difficile, F&M, bluetongue, filthy hospitals, failing schools, unemployed doctors and nurses - - etc ad infinitum]

[Patsy Sergeant]

Obesity is a problem, not least because it is beginning to impinge on everyone. Some planes - so it is reported - are introducing extra large seats, I believe that in some hospitals there are extra large beds, maybe I have picked up this news that at the moment only applies to the USA, but if the problem continues unchecked here, the same adjustments will have to be made and that is expensive for everyone.

I do think that people should be encouraged to take personal responsibility for their lives and what they choose to do, too many people are encouraged to think that what happens to them is not their fault, so therefore they feel that someone else should somehow take responsibility for whatever is wrong with them! And this persuades them that THEY don't have to make the effort (that is so often needed), to make any changes to their habits or life-style.

[Jim Carr]

The Conservatives should not participate in the "debate", other than to point out that it is purely a diversionary tactic to shift the focus from hundreds being killed NOW in NuLabour's "well-funded NHS".
I must declare an interest here - I drink more than 3 bottles of wine per week, so would obviously be a target for the government inspector coming round to check my weight and wine consumption, as "Red Dawn" Primarola is no doubt planning.
The Conservatives, though, should oppose this encroachment into civil liberties.

[Man in a Shed]

We should be tough on John Prescott and tough on the causes of John Prescott.

[realcon]

The infantilised BBC1 10 oclock news is not a good advert for the compulsory licence fee.

[dizzy]

"It's easy for libertarian Tories to say that it is no business of the state to try and influence what people eat but what is their solution to the obesity challenge?"

Easy, there is no challenge so it doesn't require a solution. Let people get fat.

[Editor]

Dizzy: You decreeing that there is no challenge does not mean that there isn't one.

[Jonathan Sheppard]

I really do think this will be the biggest health issue in years to come and one the NHS will struggle to face. My view is that those who say do nothing at all - as its not the job for the state to interfere at all may well prefer something is done now - when the state forces interference in years ahead by raising taxes to pay for more and more spending on health - no on prevention - but on treating this issue.

One small plan of attack could be to use the nationwide network of pharmacies to provide healthy eating and nutritional information.

[dizzy]

Likewise you decreeing that there is doesn't mean there is. Fact is people should be free to get fat.

[tired and emotional]

The challenge is there editor but it is not the one you have identified.

The challenge is not to correct and re-educate people who are acting entirely lawfully so that their behaviour is more in tune with the 'needs' of the systems we have.

The challenge is to change the systems that 'serve' us so that they can accomodate the lawful behaviour of those that use them, no?

Otherwise we are saying, the system can't work like this, we must change the people that use it, whether they like it or not.

Welcome to social democracy.

[Henry Rogers]

I found Dim Prim's lectures on TV News thoroughly offensive, and I doubt whether anyone pays the slightest heed to that sort of thing, least of all the people she is trying to reach. The only purpose served will have been to take the heat off Brown for a short while.

[Editor]

Dizzy: There's plenty of evidence of a rise in obesity and related health problems.

Yeah, people should be free to get fat - noone is recommending prohibition but with socialised medicine (which ain't going to be dismantled anytime soon) we all pick up the bills related to obesity.

There is, therefore, a public interest in encouraging people not to get fat.

I don't have solutions. Andrew Lansley thinks he has. The danger is that you just have your head in the sand (or is that a meat pie?).

[Jonathan Sheppard]

If we are looking at initiatives they could include:-

1) Planning to ensure green spaces for social and leisure activities (the estate I just sold my house on had a green piece of grass with one of those things to sit on, on a spring - you could hardly call it a park)

2) Schools need to ensure more activity - this includes more competitive sport and stopping all sales of school playing fields.

3) Provision of healthy eating information - at places where people are happy to take it

4) Health MOTs offered by pharmacies on an annual basis if you want one. Prevention is better than cure.

I think there is lots that could be done - but Ive never been convinced of any coordinated attempt to do it.

[Chad Noble]

The 'challenge' is really about money not health, in that it is to stop the health system collapsing under the weight of these porkers.

Ignoring it won't stop this future cost occurring.

There are only two solutions, imho; stop people getting fat or stop them getting free health care.

Like Dizzy, I say let people get fat if they want to, but that means them shouldering the cost of their choices.

[Joe James Broughton]

They are a real blight. It makes you want to kick them out of the way.

[christina]

If the party gets mixed up in this "spin" and rubbish it won't deserve to be taken seriously.

[tired and emotional]

Lansley has no solutions, there is no solution available to government. There may be a public interest in people not getting fat but there is none in spending huge sums on encouraging them not to get fat. This is because state encouragement doesn’t work in matters of personal choice.

Of course, while failing to stop people getting fat, we will succeed in encouraging the state to nanny us ever more, further attenuate our moral characters by demanding that the state find ‘solutions’ that allow the evasion of personal responsibility and are ‘blame free’ and simultaneously add to the costs of business with futile regulation while all the while avoiding the fact that socialized health care cannot and never could cope.

Being fat could be good for your health if it means you have to go private to get healthcare. How delicious.

[dizzy]

"There's plenty of evidence of a rise in obesity and related health problems."

You mean there is rise in measuring it. Additonally we are talking about BMI measures of obesity anyway. The Californian Governator is obese by those measures. Reagrding the "challenge" in the rise. That would be the rise that has been predicted on the basis of linear extrapolation.

"with socialised medicine we all pick up the bills related to obesity."

Indeed we do. But you are basing your argument on an extrapolated prediction anyway.

"There is, therefore, a public interest in encouraging people not to get fat."

Only if you assume that a linear extrapolated figure plotted on a graph over time is an accurate reflection of reality.

"The danger is that you just have your head in the sand (or is that a meat pie?)."

Better than having sheer faith in pseudo-scientific statistical analysis I;d say.

[Iain Murray]

Tim,

I haven't looked at the David King study but his record in anything that's an excuse for the Fatal Conceit is not good. I imagine there is little or no new evidence therein.

When I last looked at the science, it was clear that there is no evidence that being overweight necessarily shortened lifespans. Indeed, the latest CDC study suggested that overweight people might live longer than people of "normal" weight.

Moreover, there is no evidence to suggest that overweight children's lifespans are determined or even affected by their childhood weight.

Rob Lyons has a good look at the current UK health stats at Spiked: http://www.spiked-online.com/index.php?/site/article/3975/

The bottom line is that, at present, I see no evidence of there being a genuine (not merely aesthetic) problem in need of solution. And that if one does arise, we should instantly be wary of solutions that involve central planning and "radical restructuring of the way we live." Even smaller "solutions" may impose bigger trade-offs than the problem supposedly being solved. Those who are unaware of the trade-offs involved might be the ones with their heads in the sand.

[Jim Mcleod]

Isn't it a good job then, that both David Cameron and his nicotine problem and the slim Nicholas Soames all go private.
That should save a few quid down the line!

[Editor]

Dizzy: "You are basing your argument on an extrapolated prediction anyway."

Only to some extent. I did say the extrapolation needed to be treated with a pinch of salt. The consensus is that obesity is most certainly on the rise and - this is where I disagree with you Iain - is associated with poor health.

I don't recommend draconian solutions but I don't think a laissez-faire approach is prudent either. The post asked a genuine question in my mind. I don't know precisely what we should do but I think Lansley may be closer to the right approach than the do-nothings.

[Jack]

I'm sympathetic towards most of the 'libertarian tory' solutions, e.g eat less, move about more, but surely this problem is to do with this nations attitude to food.

As a society perhaps we should be more like the Italians, and fussy about what we eat, avoid microwave dinners, and enjoy more 'slow food'.

But I fail to see why the state should or how it can respond.

[Jonathan Sheppard]

I think it would be hard to dispute that obesity will end up costing the NHS and therefore us the taxpayer more and more every year. No there can be debates about the NHS and how it is funded - however if that in itself does not change surely addressing the issue is something a responsible goverment should be looking at.

Being overweight is something different to being clinically obese.

[Patsy Sergeant]

I have just returned from a follow-up appointment in the Fracture clinic in OPD at our local hospital. It was a VERY full clinic today, and well over threequarters of the patients were obese, and a fair percentage of those were grossly obese, and some of you are saying, in effect, that all the talk is unfair, and that obese people are as healthy as less fat people. No that was not a one off, as I have had to attend the local hospital more times than I would have liked, just recently and had plenty of time to study the prevailing inhabitants, plenty of time, just because there WERE so many patients of the type that I described queueing to be seen. Each time I waited hours also to be seen, and this is one of the hospitals that the ever so useful Health Trust wants to cut a chunk out of, i.e. close down.

[Ay Up]

Sorry to get personal Ed but can we have a post for suggesting names like we had for Black/Yellow Saturday but for the 'free 2B me' element in the party? Their howls are amusing- "people aren't getting fatter", "well being fat isn't bad for your health anyway" etc.
So say single middle-aged men who spend all their time on computers no doubt.
Its all well and good wanting the state to butt out of this but itd have to butt out of provision of healthcare completely before it loses the right to take an interest in our health.
My suggestion would be Ostrich Tories? Or continuing the animal theme how about State leeches?!

[tired and emotional]

How about democrats, libertarians, freedom-lovers, small government types, or conservatives?

[John Leonard]

As some have inferred here already this is not really a medical problem. This is a societal problem so why is it being dealt with by the Health Minister?

The proposals here seem to me to be no more than a sticking plaster on an infected wound. It may allow the wound to heal (I doubt it will properly) but it will not cure the infection (our Broken Society).

How many times have Labour attempted such solution types and failed?

Certainly the solutions outlined have a value but on their own without strategic societal changes the value is small.

More often than not all that is achieved is that the issue is suppressed for a period before reappearing in a more virulent form.

The fact is such solutions do not deal with the underlying issues only the symptoms.

I believe it is time that Public Health issues such as obesity were not looked at not as 'coal-face' medical issues relating to the individual but as strategic issues relating to a faulty societal construct.

The Social Justice and Quality of Life reports identify many of what I believe are the underlying issues which explain obesity, alcohol abuse and all the other problems which face our society. Therefore it is through these vehicles and not the Health service that potentially we will find real solutions to these issues.

Consequently, it is about time that much of the Public Health prevention was taken out of the NHS remit and the NHS focussed on its core service of healing people and medical prevention of infections and diseases.

Medical professionals are right to highlight the issues and say that prevention is better than cure.

However, they cannot effect that prevention of issues such as obesity by adopting an oppressive, repetitious blame culture approach against the individual especially when the underlying causes are partialy beyond both parties control.

They have been trying it for far too long without much success at a very high comparative financial cost. Furthermore, it is a distraction from their primary objectives.

Also it is a bit rich to tell the public how to behave when so many of our hospitals should have a health warning outside the front door.

So take the implementation of the necessary prevention measures away from the NHS. Perhaps a new department (Social Justice, Social Development?) is needed.

Having done this perhaps Andrew Lansley and his team can get about looking at what the medical health remit for the government should be in the 21st Century. I think this is particularly important because I think the NHS has been drifting for many years.

I suggest these should be the inital questions they should be asking -

What does contemporary society need in terms of medical health provision?

What should be the role of Government in medical health and what will the role of the NHS in supporting those needs?

How should the NHS be structured to meet those needs?

What skills do they need to provide the NHS service?

How will individuals pay for their NHS provision?

These may seem rather simplistic questions but I suggest what is currently in place does not reflect the answers that would be provided in many cases (i.e local A&E services).

I read the Stephen Dorrell report and I don't recall it telling me any of these things. All I recall is acronyms, committees and bureaucracy.

As such it didn't really tell me anything worthwhile at all.....

[Patriot]

If the following very scary story is true we should all be very, very careful to stay healthy.....

From today's Guardian...

""Only dogma and corporate capture can explain this. It beggars belief that US health privateers straight out of Michael Moore's Sicko are being lined up to run core NHS services.""

http://www.guardian.co.uk/commentisfree/story/0,,2193518,00.html

[Erasmus]

Iain Murray: "The bottom line is that, at present, I see no evidence of there being a genuine (not merely aesthetic) problem in need of solution."

As any true conservative should instinctively grasp an aesthetic problem is a genuine problem.

[Rachel Joyce]

As a public health doctor, I could talk at length about the evidence (or lack of evidence) about various interventions,
but I won't. However - there are a number of important points:
1. obesity is worst in the most deprived groups. I believe this is linked to the state taking away personal and social resonsibility from communities and people - health inequalities or variations have got worse under labour. Under one analysis I am aware of, upper middle class children are getting a bit slimmer whilst the poorest heavier. If you give people back personal responsibilty for other areas of their lives, it translates into responsibility for health as well. This is not necessarily therefore about targeting the obesity, but targeting the dependency culture.
2. People cannot make choices without proper information. Until recently the vast majority had no idea about transfats or the advisable level of salt in diet. The Labour government abolished the Health Education Authority which gave out consistent information for people to access in regard to health issues. The Foods Standards Agency have been very weak on labelling and awareness raising. Even the libertarians must agree that information is necessary for freedom.
3. We do not have sufficient information on the evidence-base of many public health interventions. National priorities for R&D do not deliver what we want. There should be more funding freed up for local areas to allow more research on the issues that we are facing every day. Most new Labour NHS work undergoes poor quality evaluation rather than proper trials, so we go round in circles over and over again.

[Steve Green]

Experts say individuals are not responsible for being fat (Obesity).
Well I say what a load of cobblers. You are what you eat and no one forces food into your mouth. This is not a nation of fools. We are all more than aware what food types are likely to make us fat if we eat too much of them. The only people who are not personally responsible for being fat are young children, in which case the blame is 100% on their parents.

I totally agree that this is a major problem. It is estimated that obesity will cost the country £46bn by 2047 if the country continues to get fat at the same rate we are seeing now.

But we need to put an end to all the myths about being fat. It is not so much to do with glands or genes, but it is to do with how much food you cram into your cake hole and how long you spend sat on your a*se.

Does this new Politically correct world have anything to do with this problem? I was a teenager in the 80's with plenty of access to junk food, but my school was not awash with fat kids. There could be one good reason for that and it's not very PC: fat kids got the p*ss taken out of them.

[Annabel Herriott]

To get part of the answer, take a walk down the cereal aisle of any supermarket. Pick any of 98% of the boxes off the shelf, and check the sugar content. Sugar,"malted" glucose syrup, honeyed, chocolate, frosted ------ and so on. Sugar as an element is extremely addictive. It gives a great insulin hike, which drops quickly, then you feel starving. Result - Weight gain. There must be some way of depriving the cereal manufacturers of their built in return sales ploy. I feel they are quite cynical about this. I have had arguments with them. The spokesman says "but if we did not add the"correct" amount of sweetness, people would only put sugar on them selves" !!!!!!!! This argument could be taken apart, and some legislation limiting this practice. It may be nanny statism, but inbuilt sugar takes away any choice in the matter. There are only one or two cereals on the market with no sugar in. Personally, I make my own muesli, so I know there is no sugar in it!
There are now thousands of sugar addicted fat children around, and the blame lies with the manufacturers.

[Patriot]

""The Labour government abolished the Health Education Authority""

Absolutely staggering.....I often find myself wondering these days if all these actions are deliberate rather than the result of obscene levels of incompetence.

[John Ionides]

I think that one other factor that is massively underestimated is the effect of central heating. Back in the bad old days when houses were not well heated, a good proportion of a person's calorie intake went on just staying warm. Indeed, I seem to recall that the average Irish farm labourer before the famine ate 20 lbs of tatties a day but that was pretty much his entire energy intake (i.e. there was very little heating).

This is more an underlying cause than anything we can do much about (inasmuch as I don't think it would be wise to have people living in cold, damp houses again), and of course it is tied into a sedentary lifestyle (try turning the heating off for a few days; it is extremely uncomfortable if you just sit around but is fine if you are constantly busy.)

[David Lindsay]

Many trends illustrate the decline of the working class, with its considerable intellectual and cultural (not to say political) achievements, into the pathologically non-working class, without any such. But none does so better than the loss of the ability to cook, and even of the desire to eat, food such as might sustain both the body and the brain.

Instead, foul concoctions, to which the word "food" does not properly apply, are consumed as some sort of badge of honour. Children are passed these things through school gates, or permitted to take them in place of school meals, on the grounds that that is what they prefer. What if they preferred vodka, or cigarettes, or heroin? Would we tolerate, and sometimes even encourage, that?

It will take a long time and a very great deal of effort to restore a society properly and worthily continuous with that of the miners' lodge libraries, the brass and silver bands, the pitmen poets and painters, and the late, lamented Labour Party. But that restoration, the basis of which is full employment with proper wages and civilised working conditions, must be done.

And we now see why in the starkest terms: the failure to do so is producing, where once that society flourished and where it must flourish again, a generation of children so ill-fed by parents so unconcerned by that fact, that those children will die before those parents.

[Korabl]

If a man takes no thought about what is distant, he will find sorrow near at hand.
that right

[Plopwell Orange]

Kick them into the hollybush so they go pop.

[sally Roberts]

Plopwell Orange?!!! Are you Gloy's cousin or has our friend metamorphosed into a fruit? If so, do we get Five a Day of him? I think we should be told!

[Derme]

To be able under all circumstances to practice five things constitutes perfect virtue; these five things are gravity, generosity of soul, sincerity, earnestness and kindness.

[Dr Rachel Joyce]

I would like to thank all of those that left comments. I would like to make it clear that I am in favour of low taxation, and am not necessarily convinced about a “Fat Tax”, but I see every day - first hand – the cost to the NHS of obesity, and it is absolutely huge.

We tax both smoking and alcohol for their effects on health (so-called “externality charges” to economists). I’m pleased that as a non-smoker I don’t have to pay extra for smokers - and smokers regularly tell me that they pay for their extra share of the NHS through tax on cigarettes. The same cannot be said for obesity. The price of different foods and other goods are artificially altered all the time by the CAP and trade restrictions, and it would be niave to believe we are paying the true market rate for food.

Some people who left comments seem to think that if you are obese you will die earlier and cost the country less. There is no evidence for this – but there is a significant amount of evidence that rising prevalence rates of obesity and the conditions associated with it – diabetes and its complications, heart disease, stroke and osteo-arthritis cost the NHS more and more every year.

Diabetes alone is costing the NHS £1 million EVERY HOUR -http://www.guardian.co.uk/society/2008/oct/08/nhs.diabetes.
There has been a 63% increase in the rate of diabetes alone due to obesity
- http://www.timesonline.co.uk/tol/news/uk/health/article5794849.ece.
Hip and knee replacements (which each cost the NHS £thousands and total cost £ millions ++) are becoming increasingly common for people in their 40s and 50s because of rising rates of obesity. The cost of obesity surgery is also on an exponential rise and is a significant cost to the NHS, not to mention the £ multi-million cost of obesity management services.

The Institute for Fiscal Studies looked at this a while back -
http://www.ifs.org.uk/publications/1797. They concluded that: “Obesity rates have risen substantially in the UK even over the past decade, and forecasts suggest that this trend is likely to continue. A ‘fat tax’ is one way in which the government might wish to intervene to reverse this trend..…There is certainly an economic justification for the government to intervene in an attempt to reduce obesity levels, since obesity imposes external costs on society as a whole and some estimates suggest that these costs can be high. A ‘fat tax’ is advantageous to the extent that it raises revenue, which the government could then use to finance other measures to combat obesity... However, there would be difficulties and costs in the design and implementation of any ‘fat tax’, and it may be that the level of taxation necessary to encourage people to change their eating habits would be high. Trials of any ‘fat tax’ scheme might be desirable….Given some of the problems highlighted in taxing fat or nutritional content, a more likely policy would perhaps be the taxation of certain foods that are considered unhealthy, such as snack foods or soft drinks. This would be akin to current legislation on alcohol and tobacco, which are also taxed with health concerns in mind. There are limited examples of such schemes in operation around the world at the moment, and some of these raise substantial revenues. It is not clear, however, how much success such a tax would have in reducing obesity levels in the UK.”

A New England Journal of Medicine article stated "As with any public health intervention, the precise effect of a tax cannot be known until it is implemented and studied, but research to date suggests that a tax on sugar-sweetened beverages would have strong positive effects on reducing consumption. In addition, the tax has the potential to generate substantial revenue to prevent obesity and address other external costs resulting from the consumption of sugar-sweetened beverages, as well as to fund other health-related programs. Much as taxes on tobacco products are routine at both state and federal levels because they generate revenue and they confer a public health benefit with respect to smoking rates, we believe that taxes on beverages that help drive the obesity epidemic should and will become routine."

On that basis, I think a TRIAL on snack foods or soft drinks might be worth a go - with proper evaluation - better, surely, than a tax on all foods as suggested by Reform? . For a graphic representation of the problem, have a look here to see how much larger the average portion size for junk food and sugary drinks are now compared to the past -
http://racheljoyce.blogspot.com/2010/06/how-portion-sizes-have-changed-1950s-to.html.

[Imli]

Rachel,

1) Can you give us proper efficacy rates of diets, not only lasting a few weeks, but across years say, 5 years with a weightloss of more than 10kg? (academinc references please, no handwaving)

2) What are the efficacy rates of the best treatments for a) alcoholic b) heroin addicts?
(no handwaving here either please)

I can tell you right now, that the answer to successful weightloss is 15 out of 10000 earnest dieters who'd lost more than 10kg (US FDA figures, also check out WeightWatchers figures, which are just as abysmal over the long term) and from what we can see, we have more alcoholics and junkies than ever despite millions spent on jails, policing and rehab, very few people ever get cured.

When you have treatment for the problems you worry about, then you can do something about them. But we as of yet have no treatment that works for longer than a very short time, the vast majority of people goes back to how they were within a few years -- almost no-one is cured. There are no successes you can show us, just theory of how you think it may work, maybe.

So, raising taxes is just snakeoil, you see it's not only sweets and sticky beverages but every curry house in the nation too, not to mention coffee shops with their popular calorie bombs and so on and so forth. And most people don't want to be fat, they are millions of folks who are damaging their bodies, wallets and souls in sheer desperation to match expectation like yours, and still, nothing works.

But, let's suppose you get your tax rise... how will you stop people from importing cheap sweets, or just making their own? Ration cards? How will you stop them being traded/stolen?

And, has it occurred to you that people will very easily get fat from foods that are not sugary? Bread is extremely fattening for example.

What you're dreaming of is socialist controlfreakery, you want to tell people how to live their lives. Real conervatives enable people to live freely however they want, by education and creating possibilities, they don't suppress human nature the way you are hoping to.

Btw, do you know how Mao got rid of the opium addicts? He killed them, that was his miracle cure.