There are growing concerns about the burden of disease as a result of unhealthy diets and physical inactivity; not only the impact upon individuals but the consequences for the NHS and for wider society.
A significant proportion of our population takes too little exercise and many people’s diets are unbalanced with, for example, too much fat, sugar and alcohol. This in turn contributes to high and rising levels of obesity and an increase in avoidable illness and health inequality.
The Health Committee decided to hold an inquiry into the impact of diet and exercise on physical and mental health, in both children and adults. They will focus on a 'what works' approach to achieving healthy weight and increasing physical activity. Amongst the issues that it will examine are:
- Evidence of the impact of diet on health and the most effective way of conveying healthy eating and drinking to the public in order to achieve a more healthy weight.
- Evidence of the impact of physical activity on health, including its impact independent of weight.
- Recent trends in body mass index, physical activity levels, diet and conditions linked to obesity and physical inactivity, including the availability and quality of data in this area. What are the current and future costs to our wider economy and to the NHS of obesity and physical inactivity?
- The effectiveness of recent policy action to improve physical activity levels and diet, and the evidence base supporting different interventions, including: National public health initiatives; local public health initiatives, including the role of Local Authorities, Health and Wellbeing Boards, schools and the Child Measurement Programme; the impact of broader factors on physical activity and diet, including transport, sport and recreation, town planning, and food labelling, marketing, availability, pricing and formulation.
- The role of schools, parents, Local Authorities and government in encouraging active play, travel and sport for children and young people, including: how do we encourage and enable greater physical activity in older adults and the disabled?
- The role of NHS organisations and Public Health England in improving levels of physical activity and diet, including: what services are currently provided and commissioned to encourage healthy eating and physical activity, and do these services meet current needs both in terms of availability, access and quality and is there sufficient evidence for what works best at local level?
- National and local accountability for improving physical activity levels and diet. What policy changes, including national or local regulation, taxation or financial incentives have been shown to be effective in other countries? Are we losing the fight and simply encouraging a 'normalisation' of obesity and is this distracting from prevention and early intervention?
The Committee invited written evidence on the subject.
Royal College of Physicians of Edinburgh
UK Parliament Health Select Committee call for evidence on the impact of diet and physical activity on health
The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the call for evidence on the impact of diet and physical activity on health. The College represents Fellows and Members across the UK, with around 50% of our UK membership working in the NHS in England.
The College suggests further examination of the work being carried out by the EPODE International Network[i], which focuses on Community Based Programmes to reduce childhood obesity prevalence. EPODE studies[ii] from France taking a whole community approach to interventions across the life course including breastfeeding; active travel for children; schools; community events and cookery classes are showing promising results, and should be investigated to see if these are replicable in a UK context.
The costs of obesity and lack of physical activity to both the NHS and the wider economy are significant. Data from Public Health England has indicated that the indirect costs could be as much as £27 billion by 2015[iii], while Diabetes UK has stated that diabetes currently accounts for about 10 per cent of the NHS budget, with projections indicating this will rise to 17 per cent of the entire NHS budget within 20 years[iv].
A recent Scottish study of obstetric complications related to obesity[v] indicated the increased costs of maternity treatment and care, which Fellows of the College report is widespread throughout different specialities outside obstetrics. The College would suggest that both treatment and prevention should therefore be given higher priority and we would be keen to enter dialogue into how this could be achieved.
In terms of the retail environment, the Committee may wish to further examine the numerous academic studies into eye tracking, environment and product placement which indicate that purchasing decisions may not be under conscious control[vi]. Food labelling is complex and while standardised front-of-pack labelling has been introduced the College would suggest this is kept under review and the efficacy of this system be evaluated.
Local authorities have a significant role in the area of obesity and physical activity, for example by promoting active travel, but professionals and NHS staff also need to lead, and lead by example. Many people have more immediate challenges in their life than something which is long term and somewhat intangible such as the effects of obesity. Many people may lack the locus of control to change behaviour in the face of societal norms for eating, activity or alcohol consumption where these activities have significant social meaning, and therefore topic based rather than holistic behaviour interventions may have limitations.
The Committee may wish to further investigate the particular impacts on specific groups, eg those with physical or learning disabilities, or mental illness, who are most likely to be disproportionately affected by the impact of diet and physical activity on health.
All College responses are published on the College website www.rcpe.ac.uk.
Further copies of this response are available from Lesley Lockhart (tel: 0131 225 7324 ext 608 or email: l.lockhart@rcpe.ac.uk)
[v] Denison FC, Norwood P, Bhattacharya S, Duffy A, Mahmood T, Morris C, Raja EA, Norman JE, Lee AJ, Scotland G. Association between maternal body mass index during pregnancy, short-term morbidity, and increased health service costs: a population-based study. BJOG 2014;121:72–82. http://www.bjog.org/
[vi] International Journal of Obesity (2008) 32, S137–S142; doi:10.1038/ijo.2008.250 http://www.nature.com/ijo/journal/v32/n7s/full/ijo2008250a.html
Candy at the Cash Register — A Risk Factor for Obesity and Chronic Disease; Deborah A. Cohen, M.D., M.P.H., and Susan H. Babey, Ph.D. N Engl J Med 2012; 367:1381-1383