Health and Social Care Committee
Oral evidence: Food and Weight Management, HC 223
Wednesday 3 June 2026
Ordered by the House of Commons to be published on 3 June 2026.
Watch the meeting
Members present: Layla Moran (Chair); Danny Beales; Dr Beccy Cooper; Jen Craft; Josh Fenton-Glynn; Andrew George; Paulette Hamilton; Alex McIntyre; Gregory Stafford.
Questions 848 - 965
Witnesses
I: Sharon Hodgson MP, Parliamentary Under-Secretary of State for Public Health and Prevention, Department of Health and Social Care; Dr Clare Hambling, National Clinical Director for Diabetes and Obesity, NHS England; Professor Aidan Fowler, National Director of Patient Safety and Deputy National Medical Director, NHS England; and Natasha Burgon, Director of Health Improvement, Department of Health and Social Care.
Witnesses: Sharon Hodgson MP, Dr Clare Hambling, Professor Aidan Fowler and Natasha Burgon.
Q848 Chair: Welcome to this session of the Health and Social Care Committee. This is the eighth and final session in what has become a very wide-ranging inquiry into food and weight management. Before introducing our witnesses, we want to start with a video of testimonies from people with lived experience who came to our weight management roundtable in January. In the video, they share their experiences of accessing treatment and living with obesity, which we always want to bear in mind in our work. As ever, we are extremely grateful to anyone who shares testimony with us, but particularly our lived-experience witnesses, who will share their stories so publicly today.
[The Committee was shown a video.]
I again thank those lived-experience witnesses. Minister, can I start by asking for a very brief response to their stories?
Mrs Hodgson: That was really powerful, and I thank them for sharing that with us. I am probably like a lot of the population in having had my own, still ongoing, battle with being overweight and obese at times. Three stones seems to be my constant up and down—I go up and then get it down. I am on the way down again now, and I am determined to try to get a bit further down and not to have this constant yo-yoing. I absolutely know where everyone is coming from on this. There is a lot there to take on board and unpack, and obviously that is what we will do.
Chair, I also say a huge thank you to you and the Committee for choosing this as one of your deep-dive investigations. As you said, this is the eighth session. I have looked back on the other sessions, and they have been amazing. You have done a lot of work on this, and the list of witnesses has been really impressive—no pressure on us in having to follow the experts you have had before you! We are very much looking forward to the report that you will produce. I am sure it will have a lot of very good recommendations that we will want to take on board.
Q849 Chair: Thank you very much. I see you have brought officials with you so, very briefly, could we have introductions—your names and what you do?
Natasha Burgon: Thank you for having me. I am Natasha Burgon, the director for health improvement in the Department of Health and Social Care. That basically means that my focus is on population-level policies to make it easier for people to live longer, healthier lives and make healthy choices. My remit covers diet and obesity, which is the main reason I am here, but, for completeness, it also covers tobacco and vapes, alcohol, gambling and substance misuse.
Professor Fowler: I am Aidan Fowler, the national director of patient safety in NHSE, and also deputy medical director representing NHSE today.
Dr Hambling: I am Clare Hambling, the national clinical director for diabetes and obesity. I am by background a general practitioner, with an interest in all things cardiometabolic health and population health. For the interest of the Committee, I continue to hold a clinical role alongside my national role.
Chair: Thank you. We will direct most questions to you, Minister, but if you want to pass to your officials at any point, that is fine.
Q850 Danny Beales: Good morning, Minister, and welcome. We saw some powerful testimonies in the video, and they represent some of the people who have tried and accessed weight management services to different degrees. We have also had evidence that, despite the scale of the obesity challenge in the UK to the public and the NHS, only 1% of eligible patients are accessing tier 3 weight management services. Is that a failure?
Mrs Hodgson: It does not sound very good when you say 1% of eligible patients. That means we have to go further, faster, to use a phrase that politicians like to use. But we genuinely do, and we will.
Q851 Danny Beales: There are targets in place to go further, which is helpful. It is 1% now, but where will we be on access to tier 3 weight management services at the end of the Parliament or in 10 years?
Mrs Hodgson: We have committed to the roll-out of GLP-1s. As you will be aware, the guidance changed in June last year. People with diabetes were already accessing GLP-1s under that pathway, but the new pathway took it to a BMI of 40 or more in four out of five chronic health conditions. That is being rolled out over the next 12 years. I know everyone will roll their eyes at the glacial pace, but we will be monitoring and will have a big check-in after three years. Clare, have we set any year-on-year targets? I know we have the three-year check-in.
Dr Hambling: We have an ambition with regards to weight management therapies that, by June 2028, 220,000 people will have been assessed and offered the opportunity to take that up as an intervention. I think it is really important, however, to understand that within the pathway of care that we now have for weight management. I empathise enormously with those who gave evidence in the video, and I thank them very much for sharing their stories. We are at an interesting point in time. There are many advantages to the development of new therapies for obesity, but one area that is particularly important is that it really has helped us to open conversations about overweight and obesity.
Q852 Danny Beales: Do you know how many? I appreciate that there are lots of developments, and we will go on to some of them in this session, but in terms of the number of patients who are eligible for treatment—that is, who should be accessing support and treatment—do you have any sense whether, at the end of this Parliament or at the end of the decade, the 1% will be 2% or 10%? If it is 220,000, that is still quite a low percentage of the eligible population, bearing in mind the scale of the obesity crisis for public health and the NHS. Will it be 1%, 2%, 3%?
Dr Hambling: I do not have a specific number. However, I think it is important to recognise that obesity is a very—
Q853 Chair: Does it not exist? Sorry, just to clarify.
Danny Beales: Is there any target apart from that 220,000?
Chair: You may write to us if it is somewhere else and you do not have it in your head, but does it just not exist?
Professor Fowler: I think not as a percentage, Chair. We look at the numbers of people we treat; we do not look at it as a percentage.
Chair: Okay. Sorry, I just wanted that clarification.
Q854 Danny Beales: Just to finish this, because we have other questions to get through, do you think there should be clearer metrics and targets, locally and nationally, for offer and uptake of such interventions?
Dr Hambling: One of the challenges is that we have a programme that covers a whole range of different interventions, so along with our public health, food and food environment policies, we have a suite of options in clinical practice. Everything from behavioural change—
Q855 Danny Beales: Sorry to interrupt. There is a suite of options but, in reality, that suite of options does not exist for patients. They are not given a suite of options, are they? There is a range of interventions, nationally and locally, but with huge variability in what is available and what is offered, and we have seen very low uptake as a result. Is it not important that there are clearer metrics and targets to drive the system to provide that range of options to people?
Dr Hambling: Because we have a multifaceted approach to this, we hope to be doing much more in terms of prevention as well as offering management. It can be quite difficult to determine the right target to set in that context. We are working very hard to ensure that we are making more options available for people living with overweight and obesity, and I hope to share some of the detail of that with you during this meeting.
Mrs Hodgson: Obviously, we take the challenge. That 1% is not good enough at all, especially when we cannot give you an answer with regards to targets and when we are going to increase that number. A number of you spoke in the Health Bill debate on Monday, was it? I’ve been swotting for this, so I’ve lost track of the days. We are going to have the single patient record, which will hopefully be a tool that GPs can use to identify eligible patients. Some of the patients whose testimonies we saw would probably have been eligible. They might still be eligible.
Q856 Danny Beales: Just to clarify, we have heard that patients are knocking at the door of the system. It is not that they are not being identified; they are banging on the door asking for support. We found that there are huge uptake and variability issues. Fifteen ICBs are restricting access. Some do not provide any services at all, it seems. Is local commissioning appropriate for the scale of the challenge of the obesity crisis? Is the local commissioning of these services and responsibilities up to them to decide? There is no statutory obligation. Is that appropriate?
Professor Fowler: You highlight a very complex problem and a lack of capacity in the system in some areas. A lot of this stuff has arisen fairly organically over time, and it is a very rapidly changing field—GLP-1s, for example, are a new thing. I absolutely accept the challenge that, whereas we have done better in other public health areas—air quality, smoking and so on—this is an area we really need to focus on and do better. A more strategic, cohesive approach would be helpful to us as we develop all these new treatments and put them in place.
Q857 Danny Beales: What does that strategic coherence look like? Is it a national framework, minimum services or standards?
Professor Fowler: Whatever you call it—
Danny Beales: What would you call it?
Professor Fowler: A national framework would be a perfectly good term for it. We had a different system in the past, a tiered system. We have changed from that, for good reason. Some of what you heard in the video was about people having to go through multiple steps before they got to the right point.
Q858 Danny Beales: What does that process look like? Where are we in developing that?
Professor Fowler: We must not lose focus on prevention, and we must not come to the view that we must treat our way out of this problem. There is a lot of complexity in prevention and food. We can talk about that. We must not lose sight of that.
Danny Beales: We are going to come back to that.
Professor Fowler: There are a number of different treatment options, and patient choice is important. The importance of ICB commissioning is that they know their local populations really well and can tailor it.
Q859 Danny Beales: Would you say that those ICBs that are not commissioning weight management services do not do so because they know their local population and they do not have an obesity crisis?
Professor Fowler: No, I do not think that is right.
Q860 Danny Beales: I think this Committee would agree. You have indicated that there needs to be more coherence at a national level. Maybe that could be a framework. We have agreed that there is a problem. There seems to be agreement that there needs to be more coherence at national level. What should that look like? What will that look like? How will we get clearer national guidance, a framework or standards? Is there any view of what that should look like at the moment?
Mrs Hodgson: In the Department, we are looking at modern service frameworks across a number of areas. One of the things in all the sessions preparing for this hearing was whether one of the Committee’s recommendations would be to have a modern service framework.
Q861 Danny Beales: Would you welcome that?
Mrs Hodgson: Absolutely. Without pre-empting what you might recommend, I think that would be welcomed by the Department.
Q862 Danny Beales: That is very helpful. Thank you, Minister. Until we get to a modern service framework, or even then, where ICBs are clearly not commissioning services, getting eligible patients at scale or commissioning to NICE-based recommendations—there is lots of evidence of that—what does oversight and accountability look like at the moment for ICBs?
Professor Fowler: I think we are about to get better at this, on the basis of having more data—there are new data streams coming online—and incentivisation through QOF to ensure we are getting data on levels of obesity and treatment. Clare can probably add to that. There are things happening that will improve the variability you are talking about. We have not always had data that tells us exactly what is going on at the local area level. We will have more of that, as well as incentives for people to proactively manage obesity in their area.
Dr Hambling: Data extraction, particularly from primary care, has been one of our big challenges. At the moment, we have a number of different data sources that we can use in looking for recorded prevalence of overweight and obesity, but we do not have data extraction specifically for that that comes from primary care records for the whole population. That is a challenge.
We have a national obesity audit that takes data from tier 2 services and specialist weight management services, including bariatric procedures, but it does not currently have a feed from primary care, so there is no doubt that that is a limitation. An aspiration would be for that to develop over time.
I also have a leadership role within the national diabetes audit, so I can compare between the two in terms of what we have been able to do. We have a richness of data in the national diabetes audit that has really helped us to understand the service we provide, where we have gaps and where we need to do more for people. There is no question that having a really robust and rich dataset is really empowering in terms of driving improvements in treatment and care. I would welcome anything the Committee could do to enable that.
Danny Beales: It sounds very sensible to have much clearer national data. That was my last question, but just to clarify: 220,000 people make up 1.4% of those living with obesity. Shifting from 1% to, maybe, almost 2% of people does not seem like the shift from treatment to prevention that the 10-year plan envisages. Hopefully, whether it is a modern service framework, clearer national standards, data that is in some way better or a clearer national system, we might be able to increase uptake beyond that.
Q863 Paulette Hamilton: My questions are around the roll-out of the Mounjaro jab and similar drugs. Given that about 3.4 million people are eligible for the Mounjaro jab but only 220,000 will be treated in the first three years, Minister, do you accept that the roll-out is currently progressing too slowly?
Mrs Hodgson: Yes, I do. It would be hard not to accept that when you hear those numbers. None the less, it is rolling out and hopefully it will increase. If you were looking at a curve on a graph—not that I am Chris Whitty—it would start quite slow but hopefully progressively increase. That would be my hope so that it could reach far more people. You are right to challenge us on the 220,000 in the first three years, especially when people who would have been eligible up to now have not been able to get it and have had to access it privately or struggle on their own.
Q864 Paulette Hamilton: I hear you, but I will stop you there. Do you not think that the way you have rolled it out is developing a two-tier system?
Mrs Hodgson: We already have a two-tier system, and we are trying to reverse that. I take the challenge that we need to reverse it at speed, because you are right that we currently have a system where the people who can afford to access these weight-loss drugs are doing so in pharmacies and—
Q865 Paulette Hamilton: Sorry to stop you again, Minister, but people who can afford it are able to access it quite easily, while those who need it on the national health service cannot access it at all, because of the drip method of bringing it out. Does the Department need to do more to level up a lot quicker than is being talked about?
Mrs Hodgson: Again, I agree that we must do more, and that we must do it at pace, but we also need the wraparound care. It was terrible to hear about how the bariatric patients were just left, but we must also consider the ones who were on GLP-1. I absolutely do not disregard what you are saying about the slow pace, but one of the things we are doing is providing the wraparound care, to make sure that every person who is prescribed GLP-1s via the NHS will get monitored and will get help with changing habits and doing things like more weight-bearing exercise, because we don’t know everything about the side effects yet. We know that there may be some muscle loss and decrease in bone density.
Q866 Paulette Hamilton: I am going back to the offer, Minister. I hear you and absolutely agree with you that wraparound care is necessary, but my questions are really about the offer. Evidence suggests that local systems are rationing access even beyond the criteria that you have set nationally, so I will ask you again: how can patients have confidence that it is a fair national offer?
Mrs Hodgson: I will bring the team in, but some of the other pressures are about GPs being sufficiently trained, knowledgeable and able to support and prescribe these drugs, because it is all so new. There are cost pressures as well. That is one of the things. But to respond on some of the detail, Clare and Aidan might—
Dr Hambling: Perhaps it would be useful if I gave a little background. It is important to recognise that we are, through the NHS in England, among the first nations in the world to make this available to patients at scale, nationally, in a publicly funded healthcare system. While I understand some of the frustrations, I think it is also important that we recognise that this is a good news story and should be seen very much as a success.
In terms of commissioning and the advent of these drugs, for the very first time, NICE determined that delivery of the medication could be through primary care services, which gives us a great opportunity. We have not traditionally had care pathways in primary care for the management and support of people living with obesity, so what this has enabled us to do is introduce new pathways of care. Obviously, as we do that, quite a lot of background work needs to be done. We need to ensure that we implement those pathways safely and effectively and that we build towards improving capacity and building for the future.
We are also very conscious, as we start delivering those pathways, that we are not considering one therapy only. We know that the development of weight management therapies is a fast-evolving area, and we hope that very soon there will be a number of choices for patients. We are very much thinking through a more drug-agnostic approach, if you like, and ensuring that we are embedding the development of pathways. With that, it is necessary for primary care clinicians to be able to acquire the necessary knowledge and skills to grow their confidence in managing the use of the drugs and supporting patients.
Q867 Paulette Hamilton: Let me stop you there, because we have a lot to cover in a short space of time, and I am talking about capacity. I am going to go back. You have talked about building clinical capacity and competence, so what evidence is there that the capacity is actually being built? I ask because that is not what patients who need this drug are saying. They are saying they can’t get it. GPs are sending them away. Unless you can pay for it, you can’t get it. So how can you evidence to the Committee that you are building that capacity?
Dr Hambling: We have been working very closely with ICBs for some time now, and we have put together and issued national commissioning guidance in order to support ICBs in implementing that. We now have assurance from all ICBs that they have primary care pathways available. Along with that, and recognising that some ICBs were developing at different paces, we have this year for the first time moved the delivery of weight management therapies and access to our behavioural change and lifestyle support programmes into the primary care quality and outcomes framework. That is a really important move, because it gives visibility to all people who would be eligible for access to therapy on the GP clinical system throughout the NHS in England. I hope that will start to make a difference in terms of helping evolve those primary care pathways.
Q868 Paulette Hamilton: My last question before handing back to the Chair is how you are ensuring that the Department is measuring this, Sharon—I mean Minister.
Mrs Hodgson: You can call me Sharon. I will ensure it because I will be asking the questions. As you know, I am just into my third month in the job, and I have done a deep dive into it and prepped for this Committee. One of my areas of passion when coming into the role was healthy food, obesity prevention, the obesogenic environment and what we can do about it, so I will not just turn my focus to something else once this is over. This will be something that I will be holding the team to account for.
Q869 Paulette Hamilton: Can I also put the question to Dr Hambling? As Minister Hodgson said, she just stepped into the Department a few months ago. What was put in place beforehand to ensure that the Department is measuring this?
Dr Hambling: Because this is a new pathway of care, we did not explicitly have a data feed available previously to support the development of this pathway, so we have had to build data reporting as we go. As I mentioned before, one of the challenges is that we do not currently have robust primary care data extraction for the national obesity audit. We have other audit programmes, from which we will be able to learn a lot about the implementation of the programme. For example, because cardiovascular disease and type 2 diabetes are two of the clinical indications for access to the therapy in our early-phase cohort, we may have data through the CVDPREVENT audit or the national diabetes audit, which may help to inform treatment and care.
Q870 Paulette Hamilton: Thank you. I am going to talk a bit about alternative models of care for Mounjaro. My first question in this area, Sharon, is about private providers that already deliver GLP-1 at scale and use models of care that are less resource-intensive and that meet the patient’s need. How is the NHS working with them, and what is it learning from their expertise?
Mrs Hodgson: That is a really good question. Some good private providers and pharmacies do support people along their journey using GLP-1s. You are right that we can probably learn a lot from what has been working in the private sector, but we all know that there are some horror stories in the private sector as well, with people not getting any support at all. One message I want to go out is that I discourage anyone from accessing them on the black market or from some dodgy bloke—
Chair: We are going to come to that specifically in detail later—fear not.
Mrs Hodgson: All right—I should have guessed that you would. Obviously, the NHS has to be the gold standard in providing this treatment. I hear what you are saying, that there might be less expensive ways to provide wraparound care, but we are always going to want to make sure that we give the support that people need. Taking the challenge from Paulette, could we do this in a more cost-effective way that would enable the roll-out to be speedier?
Dr Hambling: Just to address one of the other issues, the NHS has a phased implementation programme, so we have made a clinically led decision to support those with the highest clinical complexity and greatest clinical need as a priority. The cohort for whom we are currently initiating therapies in the NHS have already lived with multiple long-term conditions. They are a cohort of people who are much more clinically complex, so a greater degree of clinical oversight is a necessity. It is absolutely right that that is embedded in our NHS services, in primary care, where GPs know these individuals, know how best to support them and can cater for adjustments that will be required with the management of their long-term conditions. That is absolutely essential from a patient safety point of view. Along with that, we have our behavioural support wraparound care, which patients will be able to access.
It is important to understand that many of the patients who seek treatment and care through private providers are perhaps of a lower clinical complexity. A number of initiatives will explore alternative pathways of care, particularly around whether there would be any evidence base for, for example, community pharmacies to be able to access treatment.
Q871 Paulette Hamilton: Can I stop you at that point to ask specifically about pharmacies? What consideration has been given to nationally commissioned community pharmacy-led services to support the roll-out?
Mrs Hodgson: I think this is being looked at. We can use pharmacies more in that way, upskilling pharmacists to be part of that roll-out. Am I correct?
Dr Hambling: There is an initiative for an obesity pathway innovation programme, which is led by the OLS. That will explore whether access could be enabled through other types of pathway delivery, such as community pharmacies or obesity management hubs, and will explore digital options.
Q872 Paulette Hamilton: What timescale are we looking at for things like that?
Dr Hambling: Unfortunately, I cannot give you any detail on the timeframe for that.
Q873 Chair: Could you write to us?
Dr Hambling: I think we can do that.
Q874 Alex McIntyre: Aren’t lots of these pharmacies already doing it? Almost every pharmacy is offering it privately, not free on the NHS. If we are saying there is a timeline, presumably that could be done quite quickly. If they are already offering it privately, why can’t we offer it on the NHS? You are talking about upskilling; they have the skills. They are doing it privately, but just not doing it for NHS patients.
Professor Fowler: We have to be cautious of assuming that the right treatment for everybody is a GLP-1, because there are other pathways. We need to be careful. These are relatively new drugs. They do have safety issues. There are very few—they are pretty safe drugs, we have used them for longer in diabetes. There are, as we know, potential short-term side effects, but we do not really understand completely the long-term effects, although we are beginning to. For example, we need to think carefully about the risk of muscle loss and bone loss in the long term. We do not want to have people on treatment long term, but we know that when they come off these drugs, there is a tendency to relapse and put on weight. If people are going to be on drugs long term, we need to be cautious that we are not putting a generation of people into elder care in a more frail state than they might be—
Q875 Chair: Are you purposefully restricting it?
Professor Fowler: No, we are not purposefully restricting it. We are watching very carefully as we introduce it—that is the point I am making. We are not restricting it; we just need to be very cautious that we do not end up with a model where GLP-1s are given to everybody when that might not be appropriate for them.
Q876 Paulette Hamilton: The Department has indicated that new models of care are being tested at the moment, which you started to talk about. With the NICE review expected in three years, is that soon enough given the pace and scale of change needed?
Mrs Hodgson: We have to take that challenge on board. The date is 2028, which is only two years from now. When you talk about the numbers, with 1% going to just 1.4% of eligible patients, we have to do our best to up the pace. Clare, do you want to come in on new models?
Dr Hambling: The other thing to bear in mind is that the timeline for that review was co-determined by NHS England and NICE. We need to be able to gather the data to undertake that review. I would expect that, at that point in time, NICE will do a more comprehensive review. We are anticipating that there are likely to be new therapies before that time. All these things will contribute to any decisions about the scale of roll-out thereafter—
Q877 Paulette Hamilton: Can I stop you there? They are talking about oral GLP-1s. Is the associated wraparound support there for them? There seem to be a lot of things coming on to the market at the moment, with no real co-ordination or structure. It is just there. If you are able to pay for it, you can get it. If you cannot pay for it, there does not seem to be a system in place to allow you to get it. What assurances can we be given that, given the high demand, whether it be for GLP-1s and the associated work you talked about earlier to build confidence, or the oral medication that is coming, we will meet that demand and that the NHS can afford it?
Dr Hambling: That is one of the reasons we have started working to develop these pathways of care in primary care, with the intention being to build capacity over time. The other important aspect for the Committee to understand is that although NICE has determined that these therapies are cost-effective on an individual patient basis, unfortunately the number of people who are eligible is such that it creates affordability challenges for the NHS.
Paulette Hamilton: I will leave it there, as I think that is a good place to stop. Thank you.
Q878 Alex McIntyre: I have listened with interest to the answers you have given so far. A couple of weeks ago, the Prime Minister said that there will be an end to incremental change and that it will not cut it any more, but from what you have said so far, it seems that our response to that in the obesity world is, “Well, at some point, once we get a framework, do a review and get somewhere, we might actually start to take some wider action.” Although that 220,000 number is welcome for GLP-1s—I will come on in a moment to other models that might be available—28% of people in this country are living with obesity and another 34% live with overweight. Do you genuinely think that we are throwing the full might of the British state and the NHS at this problem, given the impact it will have not just on people living with overweight and obesity but on people developing type 2 diabetes, heart disease and cancers? Do you genuinely think we are on target and acting at the pace needed to achieve the moonshot?
Mrs Hodgson: The moonshot is an ambition, and it is the right ambition to have. The statistics are showing that.
Q879 Alex McIntyre: It is a great ambition—we all agree on the ambition—but do you think that, currently, the Department is acting at the pace needed to deliver it?
Mrs Hodgson: You mentioned the PM talking about an end to incremental change. He has now set up delivery units in every Department. We have a delivery unit and people who will help to drive this forward, on behalf of the Prime Minister, to fulfil that ambition. I would imagine that this will be one of the targets that we will have to up our game on.
Q880 Alex McIntyre: Having worked in NHS structures for a long time in my previous career, I understand the complexities around this. However, when we put our mind to it, we can see how quickly the structures can move—if we look at covid, for example, that was a real time of national emergency. We talk about this at the same scale as the emergencies coming down the line—obesity and the impact it will have on our public health—yet the scale of the response seems to be “business as usual.” Going back to constituents like mine, why could we not go out and text every single person whom GPs have on record as being overweight and obese to offer them some intervention in the next six months? Is it a resource problem, or a lack of capability? If we are really serious about this and it is an urgent crisis, as all the rhetoric and our ambitions say, why is that not the scale of the response?
Professor Fowler: Obesity is increasing and we need it to be decreasing, so there is a big problem to deal with—I accept that. Clare started to talk about cost; if you look at everyone who might be eligible for a GLP-1, the cost of the drugs is estimated to be £4 billion, with the wraparound services taking that to around £15 billion. The capacity in general practice that would be needed to support that—and it is important to support that—would be about 20% of the whole capacity. The scale means that we cannot do it overnight, and it has to be balanced.
Q881 Alex McIntyre: That is fair enough. I probably speak quite vociferously about other models, having gone through a different pathway on the type 2 pathway to remission programme myself. We have had evidence that the result of that is really impressive and that people keep the weight off; it is significantly cheaper than the GLP-1s, has a massive broader impact on people’s health and, as it is provided by private providers, there is wraparound care and an app. It is already there and ready to go. Why could we not roll that out to 2 million obese people over the next year? It is just for diabetes; why could we not roll it out for broader obesity?
Mrs Hodgson: How many are currently accessing the pathway to remission?
Dr Hambling: Again, perhaps it is useful to capture this in our more upstream early intervention programmes. We have a suite of those, one of which is the path to remission programme. This year, we have embedded that within the quality and outcomes framework. The intention is to increase visibility of those pathways of care that are available to people living with overweight and obesity, and the qualifying criteria; but within that domain of the quality and outcomes framework it also includes referrals to locally commissioned weight management programmes. That is starting to adopt a more upstream approach and to support and enable access to all those programmes that can make a difference to people.
In terms of the nationally commissioned lifestyle support programmes, over time more than 2.8 million people have referred into them, so we know that a lot of people are able to access them. It is really important, as Professor Fowler said, that we consider this as a whole pathway of care and are not focused on one area alone. This needs a multifaceted approach, if we are to make a difference and support everyone.
Q882 Alex McIntyre: I hear what you are saying, but what I am saying is that urgency is needed. Prevention is obviously really important, and lots of colleagues will come on to that, but we currently have 28% of the population living with obesity. That is going to cost, and we talked about the cost of GLP-1s. What is the current cost to the NHS of not acting?
Mrs Hodgson: It is about £9 billion.
Q883 Alex McIntyre: What are the projections? Presumably it will go up and up.
Mrs Hodgson: I think the cost to society of obesity is more than £100 billion—£107 billion.
Q884 Alex McIntyre: What this Committee finds very frustrating is that we talk about the cost of individual measures, but not about the wider cost of obesity. I appreciate that you probably have these same discussions with the Treasury, but we need the Department to bang down the Treasury’s door and say that it is not acceptable to pit these things against each other because of the massive cost that is coming down the line if we do not tackle it.
On the wraparound support, we have had evidence from the leisure sector, particularly from people like ukactive, saying that they want to get more involved but that there are barriers. The muscle loss point is a really important one. All the evidence shows that exercise will not take the weight off, but it helps with that body composition piece and with ensuring that you keep the weight off in the long term. What more can we do to engage with the leisure sector? For example, should we be using more social prescribing of PTs or more active spaces as part of that wraparound care?
Mrs Hodgson: I think some GPs were socially prescribing to gyms, probably as part of earlier pathways, but I see what you are saying. Is that currently part of the GLP-1 wraparound care that we offer?
Dr Hambling: It would not necessarily specifically be, but there will be areas where that model of care already exists. For example, where I work, we have a model of care where that is accessible.
One of the developments that we would hope to see through the emergence of our neighbourhood health models is that much more holistic approach to care for people living with the greatest complexity. Often, that will involve liaison and partnership working across the whole system, including providers of physical activity and other locally commissioned services.
Q885 Alex McIntyre: As we heard in the video, lack of mental health support has an impact. What plans does the Department have to roll out mental health support and ensure that there are accessible pathways for people to get that support, particularly after they have lost a great amount of weight?
Dr Hambling: We have developed the wraparound behavioural support for obesity prescribing programme and it is fully comprehensive, looking at behavioural change to support people more holistically. Within the commissioning guidance that we developed to support implementation across ICBs, we make a number of recommendations. For example, where a GP has identified that an individual has a specific need—perhaps a more complex disordered eating concern or other mental health concerns—they should, in addition to the behavioural support, make use of other local services that are available. It is really important that that is undertaken. It comes back to the fact that it is really useful that these pathways are being developed in primary care with GPs who know these individuals very well and can support them in a more holistic way.
Q886 Alex McIntyre: Clare will know this from my previous work, but I have a particular passion for young people living with diabetes. I am a type 2 diabetic myself, having been diagnosed at 32. We have a massively growing problem in this country with young people living with diabetes. Not all of that is obesity-related, and we should be really clear about that. There is a lot of stigma attached to diabetes. For only about 50% of people with type 2 diabetes is it related to their weight. However, that is still half of a very large population. What are we doing to focus on young people in particular? We know that young people diagnosed with type 2 diabetes and obesity-related illnesses have their life expectancy dramatically cut. In my own example, having been diagnosed with type 2 diabetes in my 30s, my life expectancy is now 16 years less than the average. That is a huge problem going forward. What is the Department doing to focus on young people?
Mrs Hodgson: That brings us to the prevention discussion, which I am also keen to have a deep dive into.
Q887 Alex McIntyre: We will come to that. In terms of treatment, how can we focus on younger people who perhaps do not access services in the same way or visit their GP for other things? There might be a stigma attached. If you are young and part of the Instagram generation, getting beach-ready for the summer, there is all that stigma attached to accessing weight management services. How will we focus on that generation of people, who desperately need the support now?
Mrs Hodgson: It is worrying that the age of people diagnosed with type 2 is coming down. I am trying not to touch on all the prevention stuff and the manifesto commitment to the healthiest ever generation of young people, which I am absolutely obsessive about.
Q888 Alex McIntyre: And on the treatment side?
Mrs Hodgson: On treatment, I will bring in Clare or Aidan. Are you talking about young people over the age of 18?
Alex McIntyre: Yes. Young adults are being diagnosed with type 2 diabetes at a worrying rate, and they are generally more obese than the previous generation.
Mrs Hodgson: So you are asking whether we have a different pathway and treatment programme for those young people.
Alex McIntyre: Yes.
Dr Hambling: To touch on your point about young people with early-onset type 2 diabetes—again, this sheds light on the importance of data—we were able to identify that through the national diabetes audit. We understand that young people living with early onset type 2 diabetes often need a greater level of support. As a consequence, we were able to implement the T2Day programme, which has a specific focus on young people living with early onset type 2 diabetes. The programme was funded and supported primary care practitioners to give a higher-level, more detailed and much more comprehensive review of young people. It asked them specifically to consider things like the psychological aspects that they may be living with and social concerns that they may have. That more comprehensive review ensured that all their physical healthcare was better catered for and the treatment pathways they were able to access were explored.
Q889 Alex McIntyre: For weight management services more broadly, are there any similar pathways for young people?
Dr Hambling: We do not, as yet, have pathways specifically for young people.
Q890 Gregory Stafford: To touch briefly on one of the points that Mr McIntyre raised a second ago, do you think it inequitable that VAT is not charged on council-run leisure centres but is generally levied at 20% on independent leisure centres? Will you raise that with the Treasury to see whether there can be a more level playing field on the business side? Obviously, council-run leisure centres cannot look after every single member of the population—there are not enough of them—and we should encourage people to go to independent providers, but that 20%, which they will pay for in their membership, could put them off.
Mrs Hodgson: I have to be honest that I was not aware they are charged differently—I do not know if anybody else on the panel was aware of that differential. I will write to the Treasury and make that point.
Q891 Gregory Stafford: Brilliant. Thank you very much.
Moving back slightly to GLP-1s, we have heard evidence that barriers to accessing NHS weight-loss treatments are driving some patients to unregulated and potentially unsafe sources. Do you believe that the NHS access constraints we have talked about are leading to a patient safety risk?
Mrs Hodgson: I recognise that it will be a driver for people seeking those drugs elsewhere. Obviously, the strong advice would be that they use registered pharmacies, be they community pharmacies or online. The wider point that you are making is not lost on us. Again, it comes down to cost pressures.
Professor Fowler: We have already discussed the fact that there is not sufficient access for the potential demand out there for reasons of cost, capacity and so on, and we know that people are seeking GLP-1s. As Clare said, that is often a different cohort from those we are currently treating in the NHS—the ones with the most significant issues, comorbidities and so on. Some of those people will seek private providers.
On the safety front, there are concerns about black market drugs. The MHRA has a specific—
Chair: We have had the MHRA before the Committee. We are very well aware of this.
Q892 Gregory Stafford: Following on from that, given that you recognise that there is a potential problem, do you believe that the regulatory bodies, including the MHRA, are adequately resourced to deal with this problem from a regulatory point of view, to keep patients safe?
Mrs Hodgson: Well, we are aware of the example in Northampton, where they smashed a massive illegal drugs ring that was being run out of a country estate. There were arrests. They seized 20 million doses of illegal medicines. I think 12,000 GLP-1 pens were seized. I am happy to have conversations with the MHRA to ask whether their unit is adequately resourced to smash other drug rings that might be out there, producing these drugs and selling them on the black market. That is a fair question, and I am happy to take it away.
Q893 Gregory Stafford: If they then turned round to you and said, “No, Minister, we do need more resources,” is that something you would be fighting for?
Mrs Hodgson: Within the Department, when we have our conversations with the Treasury, that would be another part of it.
Natasha Burgon: It isn’t something that they have raised with the Minister to date.
Q894 Gregory Stafford: Interesting—thank you. As Mr McIntyre alluded to with his “beach ready” comment, a lot of GLP-1s, especially those that are unregulated and potentially unsafe, are promoted via social media outlets. Do you think that the current regulatory framework is adequate to control all medicines being sold through social media and, in this context, specifically the GLP-1s?
Mrs Hodgson: The current regulatory framework—well, the MHRA are on top of it. I am sure that in the evidence they gave they went into detail about the work that they do. As Natasha said, they have never been in touch with us, asking about needing more resources, but I will ask them specifically, following your question. I don’t know whether Aidan has anything to add.
Q895 Gregory Stafford: Some of it is not just about the MHRA, though, is it, Minister? It is about the Advertising Standards Authority—other organisations are involved. So, it might be interesting to hear, from a patient safety point of view.
Professor Fowler: It is difficult for me to comment on advertising standards and that sort of thing, but you make a fair point. If people are still accessing this and social media is a part of that, there is an issue with it. That is not within our gift to resolve. I don’t know; I think it would be a cross-Government issue to resolve.
Q896 Gregory Stafford: My corollary question, Minister, is: have there been any discussions cross-departmentally about some of this, and if not, is that something you could find out about for us? I accept you haven’t been in the job long.
Mrs Hodgson: I will. Not so far in my tenure in this post, but I can definitely ask those questions.
Q897 Gregory Stafford: That would be helpful, thank you.
This will be the final question from me. We have heard other concerns about future GLP-1s coming in tablet form, leading to, potentially, an expansion in the counterfeit market. It is far easier to counterfeit a tablet than the sort of EpiPen injectables that we see at the moment. What conversations, if any, have you started having with the regulators about perhaps dealing with the element of the counterfeit market that might be coming down the line, given that there will be increased demand? I suspect—this is just my view—that once it turns into tablet form, the demand will increase, because plenty of people baulk at injecting themselves. Swallowing a tablet will be a lot easier.
Mrs Hodgson: That is something that we will have to be ready for. I don’t know how close the pharmaceutical industry is to producing GLP-1s in tablet form, but I take on board the point you make that they will be more popular, for the injectable fear reason, and easier to mass-produce. I don’t know whether those conversations have been started.
Professor Fowler: One of the issues is that the cost of those medications is not yet known and the driver for people to go to the black market would be about cost, so we don’t know how much of a risk that is. I have not heard the evidence that the MHRA gave, but I am sure they are alive to this possible future issue.
Q898 Gregory Stafford: From the Committee’s point of view, if I may speak for the Committee, we would welcome a little more detail on your interaction. Forgive me, I do not mean to put this rudely, but a lot of the answers you have given me have been “It’s not our problem, guv”—I am paraphrasing. It is a joint issue, which has to be thought about, especially in your role as director of patient safety, Professor Fowler. I know that you are not the regulator, but I would have thought that in the wider scheme of things this should be something that is very alive and on your desk.
Professor Fowler: To reassure you, we speak to the MHRA all the time about risks, the safety of medicines and so on. We have discussions about the black market and so on—this has come up with cosmetic surgery, for example. Those discussions go on, and we link closely with the safety leads in the MHRA.
Q899 Chair: To pick up on that point briefly, I have met families whose loved ones have passed away, tragically, because they accessed it on the black market, and then got sepsis and died. The coroner’s report is still ongoing, but the concern is that the injection itself and its administration caused the death. They do not feel that the MHRA is on top of that, and I am not sure that they will have heard today’s evidence and felt that you guys are either. I really hope, Minister, that when you go away and look at this, you bear in mind the fact that people have already died as a result of this, and there is a chance that it could get worse.
I want to move on to bariatric surgery. I have a set of questions, because I have spoken publicly about the fact that I had a sleeve gastrectomy. It was transformational: I lost half my body weight. I kept most of it off—not all, but I think that that is pretty much in line with how it works.
As a result of the fact that often people who have bariatric surgery keep it off, or keep significant amounts off, over their lifetime, the cost per increased year of good health—the measure that NICE uses, the QALY—is significantly lower than with GLP-1s. Yet what has become patently clear is that the number of people who could benefit from bariatric surgery much earlier in their battle with living with obesity and overweight is minute compared with what is currently offered.
I want to start by simply pointing to the deserts of bariatric surgery. Some ICBs do not offer it at all. I have heard from others who are frustrated that people move to an area to try to get it, because it is not cheap to get privately. Minister, what do you say to those people who live in ICB deserts where they simply cannot access bariatric surgery at all, when frankly that might well be the best pathway for them?
Mrs Hodgson: You will have heard that we are moving away from the tier system, because of the hoops that had to be jumped through before anyone would even be considered or referred for bariatric surgery. Prior to GLP-1s, that was the thing that absolutely would help transform people’s lives. Your testimony and honesty around that is fantastic, and the fact that you are talking about it will be so reassuring to people out there. The stigma of obesity and of all this treatment is something that those of us who have battled with weight know. We know all too well how real that stigma is. I definitely feel that I am treated differently when I am a bit slimmer than when I am a bit fatter. We all know those feelings.
To come back to your point, this whole jumping through hoops is the reason why we are moving away from the tier system, because you had to be on tier 3 or 4 before you were even on it. You had to do all that and all the other interventions, which were probably not working for you, before you were then offered the thing that you needed, and that would be different. I recognise that the postcode lottery exists, as much as we do not want it to exist or do not think it should exist.
Q900 Chair: What plans are under way to stop it being such a postcode lottery, particularly for something like that? I am very mindful of what you were saying, Professor Fowler, about the new drugs and not knowing the longer-term impact, but the fact is that we have been doing bariatric surgery for decades, and laparoscopically too. It is very safe, it is pretty quick once you get on the table and it is incredibly effective, and yet we have not seen the doubling of bariatric surgeries that some have called for. Why is that? Surely it should be prioritised. I understand why you are a bit more cautious about growing the newer treatments, but this is well established. Why are we not going for it when we know how effective it is?
Professor Fowler: I know that the numbers fell off after covid and have increased again. I think that the number of cases per year is at about the 6,000 mark, or something like that—
Dr Hambling: In ’24-25, it was just under 7,000.
Professor Fowler: More towards 7,000. I know it has an incredibly important place. In the States, demand has fallen off for bariatric surgery with GLP-1s. For the reasons you state, I think we need to be very cautious about that. There will absolutely continue to be a place for bariatric surgery. From the point of view of the postcode lottery, bariatric surgery is not available in every ICB, but every ICB can commission. Clare will talk more about the fact that there are pathways for each ICB to commission bariatric surgery for their health area.
Q901 Chair: But in effect we don’t, right? We keep hearing about this. To come back to the point that my vice-chair Paulette Hamilton raised, it is often the people who understand systems, speak English well and know how to navigate it who are the ones who say, “Right: that door is closing, so I’ll try this one.” We see that all over in the NHS, but it is especially true for this. It is not really good enough that you can fight the system to do it. Given how effective it is, surely it should just be available to everyone in every ICB. Is that not our aim? Why do we not have a clear plan for how we are going to get there?
Dr Hambling: We currently have approximately 49 providers that contribute data to our national obesity audit. That gives us an idea of some of the numbers available. That will be for at least one procedure. I am not able to give details on the proportion of those, whether they are all NHS or whether that includes private providers. As Professor Fowler mentioned, one of the greatest challenges we have at the moment is through patient flows. That has been significantly impacted and has taken longer than we would have hoped to recover, following the pandemic.
On the back of that, we have recently started a piece of work around data validation, looking at waiting times for access to bariatric surgery. Alongside that, we have started a piece of pathway work. You mentioned the importance of patients being able to follow the right pathway for them. We have just started a piece of pathway work, working with our GIRFT team—the Getting It Right First Time team—to improve patient flows. The first challenge is to ensure that we have everything flowing as well as it can within the services we have. We are hoping that that pathway will really help patients with their flow through that journey, and also improve any bottlenecks within that surgical pathway.
Q902 Chair: On that note, we heard very powerfully from a bariatric surgeon who came in front of us and spoke about the issues in primary care with signposting. He pointed out that in medical training, you might get one lecture on obesity. Given that 64% of the adult population in this country are living with overweight or obesity and increasing numbers of children are affected, what are we doing to educate all doctors at the start of their career? They are very likely to encounter this at some point. There was a separate question about whether it should be a specialty. The point was made that when you have this level of an issue, all doctors will come across people who are living with overweight and obesity. Is any thought being given to that in the workforce plan or training, Minister?
Mrs Hodgson: The workforce plan is due imminently—very soon.
Chair: It has been for a while.
Mrs Hodgson: It has, I know. “In due course” is, I think, the phrase that is used. I am absolutely sure it will be getting looked at. It is quite shocking to hear the evidence you were given about the very small amount of training that is given on obesity, considering how prevalent obesity is in this country.
Q903 Chair: We also did a survey as part of this inquiry. We had nearly 1,000 responses, mostly from people who are accessing services or trying to do so in some way. Nearly a third said that when they present to their GP, about this or other issues, they never get asked about their weight management. It is not raised by GPs. We have heard separate issues from the Royal College of General Practitioners. It is around training and it is often about time, but it is also about societal stigma.
I really want to dive into the training aspect. Professor Fowler, do you have something to say?
Professor Fowler: Well, I had one lecture on obesity 40 years ago when I trained, but there was no obesity around. That tells you something about the time range of this: it is relatively short. You have people like me working in healthcare who did not have a lot of training on obesity because it was not an issue. It now is. Training has changed, and undergraduate training now includes obesity training for all healthcare practitioners.
Q904 Chair: How much?
Professor Fowler: Clare, do you know how much they get?
Dr Hambling: I am afraid I cannot give you that information at the moment.
Mrs Hodgson: We could write to you.
Professor Fowler: We can find out more detail on that.
Q905 Chair: Yes, please, because it was clearly a big issue.
Before I bring in Josh Fenton-Glynn, I want to pick up on your point about stigma, Minister Hodgson. One thing that we have quite overtly wanted to achieve through this inquiry is a national conversation around overweight and obesity, what we know about it clinically, and how very different that is from many people’s perceptions. Is work being done in the Department that is actively trying to challenge those stigmas and perceptions, or are we just hoping that society will wake up one day and work it out for itself? What is actively being done about stigma?
Mrs Hodgson: Now that I am in this role and focusing so much on this—I know we will come to prevention, and Natasha, like me, will be champing at the bit to talk about that—I hope that those conversations about stigma will be had, if they are not being had already.
I have my own personal horror story. I know GPs are wonderful and have very important jobs, but when I was first struggling with blood pressure issues—I am now medicated for my blood pressure and have been for years, which is probably caused by being overweight—one of those early conversations with a GP was about the fact that he was going to have to medicate me for my blood pressure.
I asked why my blood pressure was so high and what I could do about it. He said, “Well, it’s obvious: it’s because you’re fat.” I think I was in my early 40s, so it was a good while ago, but still that has never, never left me. I think he was probably thinking it was shock tactics, but I left there crestfallen. It was just the most awful thing.
In the training, I do not think that is the way to encourage someone. There was no conversation about what I was going to do about being overweight. I think he thought it was tough love. He was going, “You know why your blood pressure’s high. It’s because you’re so fat.” So there is a stigma, and there is a lot that we need to do.
Natasha Burgon: All I can say, really, is that in the policymaking process it is something that we are really conscious of in this area. In writing things like the 10-year plan, we are conscious of the language we use. We really want to make sure that we are not doing anything that is stigmatising. I do not know if on the NHS side it is the same, in terms of treatment.
Dr Hambling: I hope that there is growing awareness among healthcare professionals too. I think that is now reflected in national guidance: there is a section in the weight management guidelines from NICE that addresses stigma, for example, and NICE has created a couple of nice little tools to support conversations.
It is clearly important that healthcare professionals reach a point where they are able to have conversations in a sensitive fashion with all people, where a discussion about weight management needs to be had. I am also conscious that many educational modules now being developed will have a section on how to have those conversations and how to be sensitive, be sympathetic and address concerns about stigma. It is understandably very disappointing when people feel that they have faced that, but I think there is growing awareness of it.
Chair: Thank you for sharing your story, Minister. It was very moving.
Q906 Josh Fenton-Glynn: Before I start, I want to reflect quickly on something I have noticed from the panel. Every time I have heard a question about targets, someone has come back and said, “Well, we have an ambition to do that.” With the greatest of respect, I have an ambition to be 6 foot, but it ain’t gonna happen. Ultimately, we have targets because what gets measured gets mended. It concerns me that there is a lack of drive with these targets. Ambition is lovely, but it has no meaning if you do not have action to meet it.
We have discussed briefly the medical training issue, and the fact that, as Dr O’Brien said in a previous session, there is only one lecture on weight management. Research has found that only 20% of the post-qualification training that doctors are offered has a firm evidence base. What will we do to make sure that continued development for doctors has a firm evidence base so they get the latest knowledge and effective solutions to weight management?
Mrs Hodgson: In response to an earlier question, I mentioned that in the Department we are looking at modern service frameworks. If one of your recommendations were about the need to set a national strategy on modern service frameworks around this, we would definitely take that on board. I hear what you are saying; we are very ambitious in this regard, but we have struggled to answer the questions on putting numbers towards targets. It will feel very wishy-washy. What gets measured gets done, so I do take that on board.
Q907 Josh Fenton-Glynn: Can I suggest a target? Mr Pournaras, a gastric surgeon in Bristol, has said that at the moment we are doing 8,000 gastric surgeries. With the staff we have at the moment, but with more efficient use of their time, we could get that up to 20,000. So let’s find something in the middle, say 15,000 a year. Could we look at that as an ambition? Sorry, I don’t mean an ambition; I mean a target.
Mrs Hodgson: That is a very good point. I will take that away. I will not put my officials on the spot, but we hear the challenge loud and clear. It is needed—the numbers. You have had seven sessions before this with a whole host of experts, so you are very aware of the scale of this problem. We absolutely hear what you are saying.
Q908 Josh Fenton-Glynn: More to the point, that post-qualification training needs to be better. Only 20% is evidence-based. Are we going to look at what is available and make sure that better ongoing development is available to doctors?
Mrs Hodgson: As Aidan said, the training is much better now than it was, but that does not mean that it is as good as it could be. Is that fair?
Professor Fowler: We will have to look at that. I could not comment on it.
Q909 Josh Fenton-Glynn: Ultimately, there is an assumption with weight loss that being overweight can be cured. It does not seem to be the case. In fact, throughout our inquiry, we have heard that it is a chronic and relapsing condition. Do we need to factor that into our plans for the future of the service?
Mrs Hodgson: The Department recognises that obesity is a chronic and relapsing condition that can cause numerous other comorbidities, health conditions and diseases, so I think that is factored in. The Department and the NHS recognise that. What we do about that is, I suppose, the challenge.
Q910 Josh Fenton-Glynn: With most relapsing-remitting conditions, you would not expect a single treatment to fix them, yet when we look at the treatment for obesity, it is, “We will do a gastric band and hopefully that will fix it.” We talked to the experts with experience, and they all talked about a lack of wraparound supportive care. Do we need to move to a position where we have supportive care, because we are dealing with a relapsing-remitting condition, not a personal failing?
Mrs Hodgson: I would hope that nobody in the NHS currently—and definitely not going forward—is treating this as if it is a personal failure any more. We have numerous pathways, maybe too many pathways. Because of the new, emerging treatments, we have what I called in a session the other day a “patchwork quilt” of different treatments, all layered on top of each other. The tier system was part of that: you had to jump through the various hoops.
There are a lot of pathways out there, so it is about bringing them all together and finding a route through for patients. I take on board Alex’s point that GLP-1s might not be for everyone; it could be the path to remission. That is where we need GPs and clinicians to have that training so that they can help to advise people on the best pathway for them. That might be bariatric surgery. I took on board your interesting point, Chair, about the QALY for bariatric surgery being much more cost-effective, given the cost of GLP-1s. I had not heard that before; I will take that away. Part of it is that we need the price of GLP-1s to come down as well. Does anyone else on the panel have a response to Josh’s question?
Dr Hambling: I come back to the fact that it is great that we are now accepting it. Although there is always more that we can and arguably should do, we are now building pathways of care in primary care. We are at the start of a journey that I would expect to evolve considerably over time.
Q911 Josh Fenton-Glynn: That is good. To pick up on that, Dr Hambling, one of the issues is that we do not treat obesity as a disease. Should the NHS move to a position where they are treating it as a disease?
Dr Hambling: We certainly recognise that it is a chronic and relapsing condition. It is important to understand it as a risk factor for many other conditions, too. What is important is not so much what we call it but how we manage it. Going back to the learning, because we have such an evolving space around the evidence base and the therapies that work, we are all learning much more about weight management and obesity, and we are beginning to address that with new pathways of care. That is what is important: the health consequences of living with overweight and obesity, and what we do to support management of that.
Q912 Josh Fenton-Glynn: I accept that it is about how we manage it; however, how we understand it is important. I have now heard both Dr Hambling and Minister Hodgson say that it is a relapsing-remitting condition, but we have not seen that written down anywhere during our research. I think it is very important that we understand that when developing policy. Can we get it as a clear Department of Health policy that obesity should be treated as a relapsing-remitting condition?
Mrs Hodgson: I would have thought that it was already being viewed as that.
Chair: We have not seen it in any documents.
Mrs Hodgson: Really?
Chair: If you could show us documents where it is written down and defined, it would be very helpful.
Q913 Josh Fenton-Glynn: More to the point, can you commit to going away and making sure that it is reflected in NHS policy?
Professor Fowler: My understanding is that is exactly how we consider it. That is what we have been talking about all along when considering this session.
Natasha Burgon: If it is reassuring to the Committee, maybe it is not written down, but that is certainly how we refer to it in our conversations between NHS England and the Department, and in our briefings with the Minister.
Mrs Hodgson: So nobody has used that phrase so far?
Josh Fenton-Glynn: The first time it was introduced was by our experts through experience, and we have then heard it reflected by some of the medical experts. However, at the moment it is not, as far as we can find, referred to as a relapsing-remitting condition in DHSC policy. I think that would be key in terms of how we look at it going forward. Can we get a commitment from all of you here? It seems like we are in a similar place, but we have not actively said it.
Chair: We are pushing at an open door.
Josh Fenton-Glynn: Can we go away and make sure that it is engrained in our policy when looking at weight loss?
Mrs Hodgson: Yes, absolutely.
Q914 Dr Cooper: We are going to move on to food advertising and regulations. Starting with advertising, obviously we know that, as of January 2026, advertising restrictions have come into place. However, during our inquiry, we have heard about the issue of brand promotion. The Government have chosen to exclude brand advertising from restrictions. I would like to start by asking how you justify that decision, given the stated aim of reducing children’s exposure to harmful advertising?
Mrs Hodgson: It was a manifesto commitment, as you are aware, that we would restrict junk food advertising targeted at children, which we have done. We expect it to remove 7.2 billion calories from UK children’s diets per year.
I hear what you are saying about the brand advertising. I do not want to mention a particular brand and give them free advertising, but we can all think of certain brands where, even if it might be different junk food in our heads, we do not need to have had that particular food advertised. I do hear what you are saying.
Q915 Dr Cooper: To highlight some Nesta analysis, Nesta has argued that industry lobbying has resulted in brand-owned media and brand advertising being removed from the restrictions. Do you accept that industry lobbying has led to this decision?
Mrs Hodgson: As you know, I am relatively new to this post. I will bring Natasha in, but from what I have read, I do not think that anything changed. I think we have clarified the position.
Q916 Dr Cooper: Would anybody else like to comment on whether industry lobbying has led to brand advertising being removed?
Natasha Burgon: It is probably helpful to do a bit of the history on this.
Dr Cooper: We do not have lots of time, so if you could just answer the question, that would be great.
Natasha Burgon: The short answer is no.
Q917 Dr Cooper: So industry lobbying has not led to brand advertising being removed? Is that a no?
Natasha Burgon: No is the short answer. During the passage of the original legislation, Ministers were clear at the Dispatch Box that the intention was never to include brand advertising. That is partly because the evidence base is not as strong as it is for product—
Q918 Dr Cooper: Nesta say that closing these loopholes “could lead to 33% of food and drink advertising spend being in scope of regulations” and that currently, once “unrestricted channels and brand-focused advertising is accounted for”, the restrictions will likely cover “around 1% of food and drink advertising spend.” Let’s be clear about online advertising spend, which grew from “£1.7 million in 2004 to £574 million in 2024.”
Is it reasonable to suggest that the food and drink industry sees value in advertising, and that closing loopholes that could lead to 33% of food and drink advertising spend being in scope of regulations is not necessarily something that the industry would be in favour of?
Natasha Burgon: We are obviously following that evidence base as well. The point I am making is that the original intention of the policy was not to include brand advertising. The reason that we laid the additional legislation to make that clear—
Q919 Dr Cooper: To be clear, why was brand advertising out of scope, when Nesta clearly demonstrates that food and drink advertising spend would be a third, as opposed to 1%?
Natasha Burgon: That was the original decision made at the time the legislation came in back in 2022. Having implemented that policy, we are, through the post-implementation review, actively looking at the implications for branding.
There is not a strong evidence base. You quoted Nesta; that is exactly what we are following as well. We are interested in doing our own research into that to see the effect of brand advertising. When we have got that strong evidence base, we can look at it again. But the decision was made originally.
Q920 Dr Cooper: Lovely. I should declare that I am a public health consultant, so my interest is in public health. Nesta does go on to say that “Governments need to balance public health requirements with those of business, but the much-amended version of the restrictions ‘appear to strongly favour the latter’”. Does anybody have any thoughts on whether we are favouring business over public health here?
Natasha Burgon: I would just say that is a balance that we always have to make in defining the—
Dr Cooper: There is a balance, but Nesta suggests that we are not getting the balance correct. If the stated aim of reducing children’s access to unhealthy advertising is what we are trying to achieve, that would suggest that we are not achieving what we are setting out to.
Natasha Burgon: What we are trying to achieve is banning the advertising of unhealthy products, and we have focused on those products. As I say, we are monitoring the implications on branding. The reason that we laid the legislation was to make that clear, but that was always the policy intent. Industry was lobbying us to make that clarification, but the clarification on the policy was already there. We knew that was the policy. We tried to then give it a legal basis, essentially.
Q921 Dr Cooper: You say you are monitoring this issue around brands. Bite Back has described the brand exemption as “misaligned with the evidence” and suggested that it “clearly privileges the industry over protecting children’s health.” At what point will you have sufficient evidence to say whether Bite Back and Nesta are describing the case as it is?
Natasha Burgon: We are looking at it through the post-implementation review. The legislation requires us to do that within a five-year timeframe. It is worth saying that we also have a live consultation out there on strengthening the advertising regulations in line with updated dietary advice. It is not that Ministers are not interested in making sure we are doing—
Q922 Dr Cooper: I am sure Ministers are very interested, but for the time being, the public still see that 1% of the spend on food and drink advertising will be affected, and the brands remain in place.
Let us move on to brand-owned advertising. In June 2021, the Conservative Government committed to a 24/7 online advert ban. However, a brand’s own direct channels are no longer in scope of the ban—that is websites; apps; non-sponsored social media content, including a brand’s own accounts; customer emails; and SMS and app notifications—who hasn’t had those? The top 10 out-of-home food companies collectively have more than 5 million followers across their UK Instagram and TikTok accounts. What is your approach to reviewing the scope of these regulations, including whether exemptions for brand-owned media and direct digital marketing are being used to avoid the restrictions and should therefore be brought into scope?
Natasha Burgon: It is one of the things that our post-implementation review will look at. Obviously, online is a very broad and developing emerging market, so it is something that we are interested in. It is very difficult to define exactly what brand-owned advertising is, and that is why we tried to give legal certainty.
Q923 Dr Cooper: I hear you, and you are looking at Nesta research, which is great. Again, I have the Nesta research here. It found that 73% of adults in the UK receive at least one direct message each day, and 64% of direct messages featured either an unhealthy product or came from a brand associated with less healthy food and drink categories.
Mrs Hodgson: Was that via social media?
Dr Cooper: That is through direct messaging. From a public health point of view, do you think that is acceptable? If our stated aim is to reduce adults’ and children’s access to this unhealthy advertising, do you think we should wait five years for a post-implementation review to look at this?
Mrs Hodgson: How far through the post-implementation period are we?
Natasha Burgon: Early on, because the advertising regulations came in at the start of this year. All I can say is that I share your concerns—
Dr Cooper: Great!
Natasha Burgon: It is something that we are actively looking at. That is partly why we have an ambitious delivery plan in the 10-year health plan on trying to go as far as we can on childhood obesity from a prevention point of view. This is one of the tools in our toolbox. We have some others as well and, like I say, we are consulting on strengthening those regulations.
Q924 Dr Cooper: Let’s move on to another tool, because time is tight. Let’s talk about smarter regulations. The 10-year health plan proposes moving to smarter regulations. Existing promotion and placement rules could be repealed because of these smarter regulations, which I believe are coming through the Department for Business and Trade. Can you explain what smarter regulation looks like in practice?
Mrs Hodgson: Is that the nutrient profiling model?
Dr Cooper: No, it is smarter regulations.
Natasha Burgon: The line in the 10-year health plan is linked to the world-leading policy that we are developing and implementing around healthy sale reporting and targets. The intention is that we would require all businesses across the food industry to report on the healthiness of their sales, to try to drive accountability. That would be stage 1. Stage 2 would be that you then apply a target to that to try to drive that improvement.
What we were alluding to in terms of smarter regulation is that the purpose of that reporting and targets policy is that it gives businesses the freedom to work out themselves how they want to meet that target, rather than having prescriptive legislation that tries to do certain things. However, we will absolutely follow the evidence. We will not think about repealing those regulations unless we know that that policy is working, and we are still at the relatively early stage of policy development in terms of that reporting and targets policy. That is all within our remit. It is not a different Department.
Q925 Dr Cooper: You will forgive me for being slightly cynical about encouraging these people, given that we have seen what happened in the tobacco industry, but let us have a look.
The Department for Business and Trade describes smarter regulation as using regulation only when necessary and talks about ensuring that its design and use are both proportionate and future-proof. Let’s just check what that means. The Department says that the objectives of smart regulations are “to increase the consideration and use of alternatives to regulation”, “earlier and more holistic scrutiny of regulatory proposals through consideration of wider impacts beyond direct costs to business” and “earlier and more consistent evaluation”.
Let us balance that with what we know about the regulations that this potentially replaces. Research analysed 11.6 billion rows of supermarket sales data from the big supermarkets, and it found a reduction in the sales of food and drinks subject to the legislation, as a proportion of total food and drink sales, equivalent to 2 million fewer in-scope high fat, salt and sugar products sold per day across England. The researchers conclude that it is “likely a combination” of reformulation and product placement—the regulations—and that “it is clear that without the legislation neither of these changes would have happened”. So why are we thinking about stopping these regulations and going to what frankly do not sound like terribly smart regulations?
Natasha Burgon: The first thing to say is that it is not even on the radar to think about getting rid of these regulations.
Dr Cooper: We are keeping them?
Natasha Burgon: We are keeping them unless we find something that does the same thing and meets exactly the statistics that you are talking about through a different means. The purpose of having a target for all food businesses is that they can then use their own innovation to work out how to meet that target. It might be different things like where products are placed or whether they do it through reformulation. The point is to put the incentive on them to work out how to do it.
Q926 Dr Cooper: But if you know how to do it—and I presume you do—why would you not regulate and enforce? When we had the supermarkets in front of us, they said that they would rather it be mandatory. They would rather have a level playing field for everybody, so why would you not regulate?
Natasha Burgon: They also want the reporting and targets policy for exactly that reason: it creates that level playing field. We would not even think about repealing the legislation that, as you say, tells them how to do it unless we were confident that the new policy around reporting and targets replaced that for the same benefit or more. There is absolutely no plan to change those regulations without clear evidence that what would replace them, which is also regulation—the Minister is not shying away from regulating in this area—had the same or more benefit. If there is an opportunity to bring all that together through a single policy and a single regulation that creates a balance between public health and business burden, it is right that we look at that.
Q927 Dr Cooper: We will wait to see that with interest.
Finally, I want to ask you about the healthy food standard. Can you describe for the Committee how the standard is going to operate in practice?
Natasha Burgon: That is exactly the policy I have just been talking about. I am sorry that I referred to it as reporting and targets; that is the kind of language that we use.
Q928 Dr Cooper: If you could just explain the healthy food basket, in terms of what you are asking companies to do, that would be great. Large companies in the food sector will be set a new standard about the average shopping basket of goods.
Natasha Burgon: I think we might be conflating two different things. In terms of what was referred to in the 10-year plan as the healthy food standards, we now refer to that as our reporting and targets policy. The intention of that policy is to create accountability across the whole food sector by requiring food businesses to report on the healthiness of their sales. We are at the early stage of policy development. We have run a series of workshops with industry, and we have had a lot of engagement with NGOs and academics about exactly what the shape of those metrics and the design of the policy should be, and we will then go out to full public consultation. That is the stage that we are at, and that is where we are heading.
Q929 Dr Cooper: Going back to the issue of the targets, are you considering setting specific mandatory targets for supermarkets around this issue?
Natasha Burgon: As set out in the 10-year health plan, it is a two-stage process. The first thing we need to do is get reporting in place so that we can have accountability across the whole sector and know what the numbers are. One of the big issues—you will be well aware of this, Dr Cooper—is that we do not know the numbers. That is about getting the level playing field evidence base. Once you have that and can work out where people are, you can set a target, which can get incrementally more ambitious. Alex, you talked about not necessarily having incremental change, given the stats in this area, but actually, in terms of the food environment, sometimes acceptability takes time, and therefore having the ability to incrementally increase the target could help us on this journey, so that people accept the changes and make those changes to their diet and healthy eating.
Q930 Dr Cooper: Forgive me if I have missed it—lots of reports are published every day—but the Department committed to consult on healthier food targets and reporting, and to launch that by spring 2026. We are in June—I don’t know whether that still counts as spring. Where are we in terms of that timeline?
Mrs Hodgson: The consultation closes on the 17th.
Natasha Burgon: A different consultation. We are basically looking to publish that consultation soon. It might be a stretch on spring—we have a few more weeks—but we have been doing lots of engagement and it is our clear intention to launch that consultation shortly.
Q931 Dr Cooper: It has been really interesting hearing what you have to say. I have concerns about the advertising issue and about engaging with industry in a particular way, but I think we are going to come to that.
To summarise, it sounds like you, Minister and colleagues, are keeping a close eye on the evidence and the data as it comes through, and you are willing to review what is and what is not working for advertising. You are keeping a close eye on the digital space, because there is very good evidence to say that our advertising, home delivery and social media patterns have changed hugely. Are you committed? You mentioned a five-year period, but obviously five years is a long time in an evolving world.
Natasha Burgon: We will get interim reports within that period.
Q932 Dr Cooper: Will there be annual reports on the effectiveness of—
Natasha Burgon: I am not sure on the exact timeframes, but to your general point about us looking at the evidence base and reviewing whether we need to do more, that is the entire intention of having an obesity moonshot. We have set out a list of ambitious policies, and it is exactly our job to look at where we need to go further.
Q933 Dr Cooper: If we asked you to come back in 12 months’ time to tell us if the advertising ban has been successful or if you are going to widen it, if mandatory targeting has been successful, if the healthy food standards have worked or if you need to enlarge those restrictions, would it be reasonable to have an interim report with some evidence available?
Mrs Hodgson: Yes.
Natasha Burgon: On whether 12 months is reasonable, I think we could see where we are at that point. The linked point to make is that we are not shying away from strengthening these restrictions, which is why we have a live consultation on strengthening the advertising, promotion and product placement regulations to make sure that they are in line with the most up-to-date dietary advice. That shows that we are willing to keep pushing the boundaries.
Q934 Dr Cooper: That is very welcome. From a public health point of view, there is a lot of evidence out there, so it does not necessarily need to be about creating evidence in the future. As my colleagues have alluded to, there has been a lot of evidence on advertising and healthy foods being available.
Natasha Burgon: And you would want us to be robust in order to legislate in a way that will not be challenged.
Mrs Hodgson: We have spoken at length, Beccy, and you know where I am coming from on lots of these issues. I want all three. I want the nutrient profile modelling, which is the one that is still out for consultation—I want that to go through. I want reporting and mandatory targets as well. All three are what we need. I am very clear within the Department that that is where my ambition lies, but we absolutely accept the challenge on everything you have put to us today. Thank you so much for that.
Q935 Alex McIntyre: On that point, Sharon, it is great to hear your commitment to that in your role as Minister. Have you, or has the Department, come under any pressure from the Treasury or the Department for Business and Trade to water down our obesity commitments in order to appease the argument from the supermarkets and food manufacturers that measures are too expensive for them to introduce?
Mrs Hodgson: I do not accept that any of our obesity measures are inflationary.
Q936 Alex McIntyre: I would agree with you on that, but has there been pressure from other Departments to scrap them?
Mrs Hodgson: Obviously, governmental conversations take place all the time, as I am sure you appreciate, and we are also working constructively with industry, supermarkets and food producers.
Q937 Alex McIntyre: I am glad they are being constructive with you, because, I must say, when we had Asda and the other supermarkets in front of us, I did not find it particularly constructive at all. In fact, when we challenged them, Asda said that it would be far too expensive to change nutrient profile modelling regulations and that they had spent fortunes on the previous sets of regulations.
We asked them the really simple question of how much they had spent. They did not have that information. We asked them how much, as a percentage of the £5 billion revenue they took last year, they had spent on nutrient profile modelling. They did not have that information. I am really concerned that the immediate response from the supermarkets and food manufacturers will be, “This is going to be really hard on our margins; there is a cost of living crisis.”
As a Committee, we are responsible for looking at the public health angle, as is the Department. Asda—to use it as an example, as it was the one that raised it—has made £2 billion in profit over the last two years, at a time when the cost of the weekly shop is already going up and up. Its suppliers, certainly the farmers across Gloucestershire, are not seeing an increase of that kind.
Are you as a Department prepared to push back in the strongest terms, by saying, “Hands off our obesity strategy! This is costing us billions of pounds in public health”? As you say, this is not a choice between the cost of the weekly shop and the fact that one in three kids is now living with obesity.
Mrs Hodgson: I am really robust on this, as you would expect. I do not accept any of the—I am trying to pick my words carefully—arguments that this is going to cost them a fortune in reformulation. I come from the position that the old nutrient profile model is over 22 years old—it is from 2004—and we want to update it to one from 2018, which is already becoming out of date.
It would be like accepting that the Department of Health has a new treatment for cancer or heart disease, but we are going to work with the 20-year-old one because we do not want to have to update the systems. We have to move forward and use the new evidence and knowledge.
Q938 Alex McIntyre: Obviously, the food strategy and the public health aspect of it are cross-departmental, so not all of this sits in your Department. Is there buy-in from the other Departments that this is a major issue for the Government as a whole?
I will give an example that is just outside my constituency, but I drive past it every day: a new KFC—I have used this example before, and they do not like me for it—has just opened 150 metres from a primary school. Clearly that is not in the best interests of public health, but other Departments and local government are not taking the action to stop these things happening. Is public health being seen as a priority across Departments? If not, how can we drive it forward?
Mrs Hodgson: With regard to planning, I believe that we have stricter regulations around fast food outlets in proximity to schools. If they are not strong enough, that is something I will be working on. In the short time I have had in this role, I have had numerous conversations across Government, and I constantly remind my ministerial colleagues of our manifesto commitment to have the healthiest generation of children ever. That is not going to happen by accident, and it is not going to happen by colleagues being a bit—to use colourful language—lily-livered or a bit slower. I want to be at pace. I want it to happen sooner rather than later. I definitely want it to happen within this Parliament.
Our manifesto commitment was clear, and the 10-year health plan is clear, that we have to do something to tackle obesity. I am absolutely committed to all the stuff around planning and our conversations around the nutrient profile modelling. In my first full day in the job, I had a roundtable, together with the Food Minister, Angela Eagle, with the food industry and retailers; I think I straightaway left them in no doubt as to where I would be coming from on this. We are having constructive conversations with them—it is out for consultation, and we will respond in due course to that consultation—but I want the Committee to understand that I am robust on the need to sort this out.
Q939 Alex McIntyre: Some of the evidence that we got earlier from Professor van Tulleken, for example, is that one challenge we have in the food environment and the food strategy is that the people who are often invited to sit at the very top table in these discussions—as on your first day—are food manufacturers. I come from a private business background—I get this—but they have an interest in making us over-consume their products. If you are making chocolate bars, and suddenly people start eating fewer chocolate bars, you ain’t making as much money.
Do you think we have the balance right, as a Government, when it comes to who is sitting at that top table? For example, is the public health perspective being consistently asked to sit at the top table when we are having discussions about the food strategy and the food environment we are living in? If not, how can we make sure that the voices of the 28% of people living with obesity are being properly represented and not drowned out by the millions that these companies can pump into their lobbying efforts?
I am not saying that is wrong—we should of course engage with industry, as they are a partner in this. But are they being given a massive voice while people in Gloucester, who are struggling with their weight and being pumped adverts and food that is not good for them, are not getting a voice at the top table in the same way?
Mrs Hodgson: As you would expect, the people on the other side of this—our constituents, the Obesity Health Alliance, the public health professionals and directors of public health—are all at my top table as well. I give as much time to them, probably more—
Q940 Alex McIntyre: Do other Departments listen to them?
Natasha Burgon: We as the Department of Health sit on the Food Strategy Advisory Board alongside the chief medical officer for England. The public health voice is very much heard in that forum.
Q941 Alex McIntyre: It’s great that it is there, but what is the driving factor of the other Departments when making these decisions? Is it the public health aspect? I appreciate they have to make a balanced decision, but do you think we are getting that balance right between industry involvement and the public health angle at the moment?
Natasha Burgon: To speak to your point on cross-Government, I guess the majority of the commitments listed under the obesity moonshot in the 10-year health plan are cross-Government agreements. We worked with the Treasury on the soft drinks industry levy.
We talked about planning with MHCLG. We work with DFE on the school food standards and with DWP on Healthy Start, so we are locking in, for want of a better word, those other Departments and their commitments. Particularly from the Treasury, as you mentioned, there is real cross-departmental working and joint policy in this area.
Mrs Hodgson: With the Treasury, I have been really robust and will not have any truck with the policy on obesity being classed as an inflationary measure.
Q942 Chair: Is that what they tell you?
Mrs Hodgson: No, it is what the industry is saying. It is what the industry is telling the Treasury, and I robustly defend against that and say it is not. The policies that we are talking about today and our commitment in the 10-year health plan and our manifesto are not inflationary, but obesity is. Not doing anything about obesity is going to cost the country. It is costing £107 billion—£9 billion to the NHS directly. That will just go up. It is a crazy angle if we do not do anything. That is what I robustly tell colleagues across Government when we discuss this.
Q943 Alex McIntyre: I have one final question. The food strategy is obviously placing a lot of emphasis on industry action and non-Government delivery. We have to look at what we can do to incentivise healthier food production and sales. We put this to the supermarkets who we had here and they all said, “We are really committed to increasing our sales of healthy food.” Then I went through their websites to look at their offers and it was chicken dippers, potato waffles, the unhealthy ultra-processed foods. No one had a three for two on bananas as the top offer on their website.
Mrs Hodgson: We are stopping those promotions. We are restricting them.
Q944 Alex McIntyre: If we are saying, “It is up to you; it is voluntary”, how are we going to say, “We want you to put those deals on healthier products”? What else can we do to force that issue? They all talk a good game and say, “We are really passionate about advertising healthy food.” They all said that in front of us. I went through their websites—
Mrs Hodgson: You never see it.
Alex McIntyre: You never see it.
Mrs Hodgson: I think the mandatory targets and reporting will be a game changer because it will encourage investment in healthier foods, because they will be the foods they will be able to advertise and they will be the foods that—
Q945 Alex McIntyre: Is there mandatory reporting and mandatory targets?
Mrs Hodgson: Yes.
Alex McIntyre: Okay.
Mrs Hodgson: That is what I want.
Natasha Burgon: Subject to consultation. We will obviously do a full consultation on that. The Minister says this to me all the time: in certain areas, one in three children is leaving primary school overweight or obese. There is a market failure here and we are not shying away from regulating.
Most of the commitments in the 10-year health plan in this area are about food industry regulation. Some of that is welcomed by them. You are right about some aspects of the food industry, but the main thing they want is a level playing field, and that is where regulation can also help.
Q946 Alex McIntyre: I made this point in the evidence session. To my two-year-old they can advertise Coco Pops as a healthy breakfast, chicken dippers and potato waffles as a healthy lunch, and fish fingers and oven chips as a healthy dinner. For lots of my constituents that food is readily accessible. It is cheap and easy to give their kids. They are looking after their kids as best they can. But what we are doing is fuelling childhood obesity, which means those kids will have fewer life chances and more stigma. We need bold action.
Natasha Burgon: That is exactly why we want to move to the updated nutrient profile model, because that will capture some of those foods.
Mrs Hodgson: On the obesogenic environment, I heard the Chair’s speech in the debate on Monday and it was so true. That environment is what drives my obsession in this area, starting with children as early as possible. I am so happy that I have been able to be involved with the fine-tuning of school food standards. That consultation ends in June, and we will publish the new standards and respond to the consultation by September this year. There will then be a year for them to be implemented, so they will come in during the following September.
Q947 Chair: Will they have teeth?
Mrs Hodgson: Yes.
Q948 Chair: So there will be sanctions if people don’t meet the standards?
Mrs Hodgson: They will be the new food standards. They will have to be monitored by Ofsted, and they will have to be abided by. I will certainly be keeping a very close eye on them; Liv Bailey, as the relevant Minister in the Department for Education, is all over this as well.
It is so important that we start as early as possible. I know that you know all this, but when children start school one in 10 of them is overweight or obese—that is when they are starting in reception. The figure is one in five by the time most children leave primary school, but in a lot of our constituencies, the figure is one in three in the poorest areas. That will carry on through secondary school, and more than likely those children will be even more overweight and obese by the time they leave secondary school.
I know that we have been talking about obesity pathways and GLP-1s. What we do not want, and what I certainly never want to see, is an acceptance: “Oh, well, don’t worry, they can just go on to GLP-1s and all these great obesity pathways that we have for them.” No—this is two sides of the same coin that we have to tackle at the same time. We have to deal with the current obesity epidemic while preventing that pipeline, so that children are leaving school fit and healthy, not destined to a lifetime of obesity and being overweight and having to go on these pathways that we spoke about at length.
That has got to be our driving force, and it is my driving force every day. For whatever short period of time that I am privileged to hold this position, I want to make sure that I leave things better than I found them.
Natasha Burgon: Chair, on your point about enforcement of school food standards, that will be part of the consultation response. In the consultation, they are looking at a kind of lead governor model, and also publication of menus and similar things. It is part of the consultation and will be responded to. However, as the Minister said, she is very keen to make sure that there is a compliance mechanism.
Q949 Andrew George: I will just crowbar this one in before the end. On the back of that, the Healthy Start programme is widely applauded as being the right way forward, but why is the take-up of the equivalent scheme in Scotland significantly higher than that south of the border?
Mrs Hodgson: We have to look at that. I am very proud that we have increased the Healthy Start voucher by 10%; it is going to be £4.65 per child and £9.30 per child under the age of one.
Andrew George: We realise that. That is good.
Mrs Hodgson: That is great, but it is only great if people are accessing it and getting it. There is a whole piece of work to be done around looking at auto-enrolment and—
Q950 Andrew George: You are looking at that? Definitely?
Mrs Hodgson: Yes. What I am told is that the issue is that it cannot just be given. It has to be sort of—Natasha can explain why.
Natasha Burgon: The Minister is right that she wants to get us as close as we possibly can to auto-enrolment. What we cannot do is actual auto-enrolment, because it is a financial product and, by law, people have to sign up to a financial product. However, we are keen to drive uptake as much as we possibly can, because I completely agree with you that it is an excellent scheme, and it is really targeted at our families that need it.
Q951 Alex McIntyre: Could we change the law?
Chair: Well, we can.
Alex McIntyre: I know we can. But could Parliament change the law to exclude Healthy Start vouchers from being considered as a financial product?
Natasha Burgon: Parliament can do whatever it wants to, can’t it? [Interruption.] Having moved to the card, we have seen uptake increase, so there are some benefits there. There are probably things that we can do, short of legislation, that will help to drive uptake.
Mrs Hodgson: That was one of my first questions: “Why can’t we have auto-enrolment?” I asked it because I believe in auto-enrolment for free school meals as well. If a child is entitled to a free school meal, they should just get it automatically. It shouldn’t be something that their parent has to sign for on a form.
Andrew George: It does not sign you up to a particular commercial provider, so I would have thought that it was not the same, but nevertheless.
Q952 Chair: Can you take that away?
Mrs Hodgson: We will.
Q953 Andrew George: If you could do that, it would be really useful. In terms of the administrative impediments, I am surprised to hear about the clunkiness of the whole thing. For example, four-year-olds are left in abeyance until they enter school. There is a big gap in provision there where you could lose your way in the system. I will wrap this all into one question. Sainsbury’s, which had a top-up arrangement, has said that the card makes it administratively impossible for it to continue or offer again a top-up arrangement. If you are trying to get retailers involved, there must be a method in this sophisticated technological age to work with retailers to engage in top-ups.
Natasha Burgon: Yes, and we are working really closely with them. If they can do a top-up, that is absolutely what we want. We are engaging with a whole range of different supermarkets. What we have done is provide supermarkets with the bank identification number, or BIN, which means that when the Healthy Start card is swiped at a till, you can identify that it is a Healthy Start customer. That is part of the solution. It does not work for all retailers because they all have slightly different till systems. Sometimes that means that it cannot work on the transaction itself, but you could issue something post-transaction. I hope I am reassuring you that we are actively talking to retailers about whether we can provide those top-ups.
The basic answer is also that the card itself is clearly identifiable. It says “Healthy Start” on it. In its most basic form, you can present that card at checkout and people know that you are a Healthy Start customer, which is very similar to what the paper system would have done previously. There are solutions.
Q954 Andrew George: But retailers are reporting that it makes it administratively difficult for them for some reason.
Natasha Burgon: For certain retailers on certain systems, it is more complicated than for others, but we are trying to get past that. You are right that the point at which you turn four in the school year means there is a potential gap before you start school and might be eligible for things like free school meals, but that is set out in the legislation.
Q955 Andrew George: Finally, I understand that the Department undertook a consultation that closed in October 2024 on potentially extending eligibility for the Healthy Start programme. There has been no report since October 2024. What is happening?
Natasha Burgon: We are considering that consultation response and will provide advice to Ministers.
Q956 Andrew George: It is a long time to wait. It was October 2024.
Natasha Burgon: I do not have a timeline for you, but we are actively considering the responses and will provide advice to Ministers.
Andrew George: Straining every sinew.
Mrs Hodgson: I commit to following up on that. I am not letting the auto-enrolment point die just yet. I am going to keep an eye on that as well. It is such a useful mechanism to get actual food to some of our poorest families. We have to make sure that uptake is as high as possible.
Q957 Chair: I have a few broader follow-ups. I will start with the moonshot itself. The wording is that the moonshot is committed to “end the obesity epidemic”. Minister, to be really clear, given that 64% of the population is living with overweight and obesity, if an ordinary person heard that the moonshot commits to ending the obesity epidemic in the 10-year plan, what would they expect at the end of that 10-year plan?
Mrs Hodgson: That we would not see what we currently see.
Q958 Chair: Which is what exactly?
Mrs Hodgson: There are two aspects to it. It is the physical bodies that we see. When I go into my schools now, I see overweight and obese children. That breaks my heart, because I know the life path we are putting them on. By “we”, I mean society. I see fast-food takeaways everywhere, especially in poorer places. The high streets in my constituency are very different environments from the very wealthy, leafy suburbs. I do not have those lovely delis and greengrocers. I have lots of fast-food takeaways and charity shops, all within walking distance of schools. I see people walking down the high street looking very unhealthy—overweight and obese—and they are struggling with that.
Chair: So your vision—
Mrs Hodgson: I want that vision. What we see for everyone should look very different in 10 years. If it does not look different—if society does not look smaller, thinner and healthier, and if the kids in our schools do not look less overweight and obese—we have not solved the obesity epidemic.
Q959 Chair: Thank you for painting the picture, but in cold, hard numbers there are two ways to look at this. One aim could be that there aren’t any overweight and obese children, which would be a very strong target, but this is an increasing issue as we have heard. Is the aim simply to level it out, so that we actually stop seeing the increase, at which point obesity, living with obesity and living overweight become endemic, rather than an epidemic? Or is the aim to have less than half the population living overweight or with obesity?
I want you to drill down specifically into what the words “end the obesity epidemic” mean. We will be coming back and judging the progress. However, at the moment, following the questions from Danny Beales at the very beginning, I am not totally clear what we are aiming at. I hear you, and I share your vision, but I am not sure that we are going to get there in 10 years. What exactly are we aiming for, Minister?
Mrs Hodgson: I take on board the challenge that we have not been able to give you numbers and targets—
Chair: Even a bit.
Mrs Hodgson: It sounds like a passionate, warm ambition. I am very passionate, and it is an absolutely true ambition, but I take on board what you are saying about what will happen unless we have something to measure it against. One measure could be the one I just described: what we see now versus what we could see at the end of 10 years. I do not want it to be just a stemming of the tide; I want it to be a reversal of that epidemic.
Q960 Chair: In 10 years, you would like the numbers to be going down, rather than up?
Mrs Hodgson: Not just levelling; I want them to be going down. We have accepted the challenge, and we are probably going to have to set some targets. We have all quoted these numbers—whether it is more bariatric surgery, the need for the 64% to be less, the need for the 34% to be less, and the one in 10 kids starting school or the one in three leaving school—so maybe we will have to set some firm targets that we can be measured against. When I go back to the Department, I might be told that that is impossible. However, what gets measured gets done, as Josh said. Even if they are not that ambitious, maybe we need to have some targets at least.
Q961 Chair: We always strive in this Committee for specificity, and we get concerned when we see things that are not very clearly defined with clear timeframes. We know there is a conversation happening about targets, not targets or whatever.
At the moment, to be very honest, I think there are a lot of warm words, and I know those are in there with good intention. However, from the pace of change—or lack of it—that we have seen in the difference between whether we are treating 1%, 2% or maybe 6%, versus the challenge of 64% of the population, which is getting worse over time, not better, there is this huge gulf between where we are as a society now and what we are doing about it.
I do not doubt your commitment to this, Minister; I knew you before you were in this role, and I know that it is long standing. My next question is: what conversations have you had about this with the Secretary of State and, secondly, with the Prime Minister? Do they get it?
Mrs Hodgson: Both do, I would say. Obviously, James, our new Secretary of State, is new in position. I have had one one-to-one with him already, and I think I have another one this afternoon. You have my assurance that I will be feeding back, in the strongest terms, how the Committee feels about it, and how strongly I feel about it.
If I get to have a similar conversation with the Prime Minister, I will. I was his PPS for a couple of years, and I think that all the conversations I had with him about my passion for universal free school meals did not fall on deaf ears because we have increased access to all families on universal credit, which is something I am so proud of. However, it will not be job done until all children have access to healthy food, so I will still be fighting this fight.
I will continue those conversations. Any challenge you give us in this area will be welcomed, especially by me. The obesity moonshot is not just warm words. We do not want it to be warm words; it is a firm commitment. However, I hear what you are saying. It is hard to measure because we have not put any targets with it.
Natasha Burgon: The “moonshot” wording is useful to us in terms of our engagement with colleagues across Government, because the whole of Government have signed up to this 10-year health plan, and they have signed up to that language. That is a useful opener, and we obviously engage with the Prime Minister.
Q962 Chair: I just worry about the wording “end the epidemic”. We know that covid is still around, although we ended the pandemic. To an ordinary person, “end the epidemic” is more akin to what you were describing, Minister. However, the wording in this is not that. Some specificity from the Department about what exactly it is aiming for—let alone how we are going to get there, with interim targets and so on—would be genuinely useful.
Natasha Burgon: The list of deliverables in the 10-year health plan is ambitious. I would definitely encourage you to hold us to account against that list of ambitions.
Q963 Chair: Yes, against those, but I am still not totally sure if they are going to deliver the end product, because you have not defined what the end product is. You have a list of things in there aiming at something that is going to make it a bit better. However, on the definition of what better is, I am still unclear as to whether it is a levelling out or a going down. The Minister has just said very clearly that it is a going down, but going down is not zero. We still do not know. That is my challenge.
I end by mentioning another report that the Committee put out that is very much linked to this: “Healthy Ageing: physical activity in an ageing society”. It should be on your desk, if it is not already, Minister. In it, we recommend that: “The government should restore the health mission and develop a cross-government 10-year plan to embed prevention and reduce inequalities in healthy life expectancy”. I wanted to raise this with you now, because it is the first time you are in front of us as Prevention Minister. We have a genuine concern, as a Committee, that of the three shifts, prevention is the one being most forgotten. Do you share our concern? What can you tell us to reassure us, if you do not? And do you accept our recommendation?
Mrs Hodgson: I have to admit that I have not read the “Healthy Ageing” report yet.
Chair: I think you will enjoy it.
Mrs Hodgson: I have piles of reports, but I will read it. It will be top of my list. One assurance I can absolutely give is on prevention and improving healthy life expectancy. In deprived constituencies, like those of a number of us in this room, life expectancy can often be 10 years less than in more affluent areas, but healthy life expectancy can be 15 or 20 years less. That concerns me even more, because if we fix healthy life expectancy, we are also fixing life expectancy. That is health inequality, and there is so much that I want to try to fix, but it is absolutely one of the things that drives me. I will be looking at your “Healthy Ageing” report to see what you have said about healthy life expectancy and the recommendations around that, and those inequalities. If we do not fix that, there is a huge cost to the NHS, as we know.
Q964 Chair: Do you think the health mission is still alive?
Mrs Hodgson: Yes.
Chair: Really?
Mrs Hodgson: I would hope so.
Q965 Chair: How do you see it?
Natasha Burgon: It comes back to what I said to Alex. The commitments we have in the prevention chapter of the 10-year health plan are a cross-Government, joined-up strategy. I could literally go through it point by point and say that planning is with MHCLG, school food is with DFE and the soft drinks industry levy is with the Treasury. There is still a whole-Government approach, whether you call it a health mission, a joined-up strategy or whatever. We are working with other Government Departments to make sure that we are using their levers as well as the levers that we have ourselves. Certainly, in the primary prevention space, we have already started delivering on a lot of those commitments, and not just in diet and obesity. We also recently passed the landmark Tobacco and Vapes Act. Progress is being made on the shift to prevention under this Government.
Chair: Thank you very much. We have gone way over time, and I am very grateful to you all.