Written evidence submitted by the National Obesity Forum, Tam Fry (IBI0053)

THE IMPACT OF BODY SHAPE ON MENTAL AND PHYSICAL HEALTH 

NATIONAL OBESITY FORUM STATEMENT

The National Obesity Forum welcomes the Health Select Committee’s Inquiry and profoundly hopes that the government responds more positively to it than previous administrations have to previous Committees.  None of the key recommendations in any HSC obesity report since 1992 have received anything more than short shrift as successive cabinets have ducked the issue of taking obesity seriously.   As an example,  the recommendation of the 2003-4 inquiry - that every child’s BMI be measured annually throughout  his/her schooldays still has to be implemented.  This is despite every medical Royal College working with children pleading that it should be. It is the Forum’s opinion, too, that an annual school measurement is central to any strategy attempting to solve childhood obesity.

Regarding the matter body shape and stigma, the Forum must defer to Professor Rachel Batterham's eloquent TV documentaries describing the NHS' prejudice.  Her message far outstrips anything that the Forum could write on the subject.    In her documentaries senior medical practitioners repeatedly and reluctantly confess that stigmatisation in the NHS is still rife . 

As far as confronting prejudice in the community is concerned the Forum has also unashamedly relied on the media.  A decision was made in 2016 to add media relations as a major part of our activity allowing us to get stigmatisation messages across to a wide audience. We have become a 24/7 one-stop shop for any journalist wanting an opinion on this shameful practice and we are very grateful that the UK's principal newspapers and broadcast stations have allowed us constantly to voice our opinion.  Frankly the media like nothing better than a whiff of controversy in their coverage and we dance to their tune.  All too frequently the Forum is pitted against people who deserve only opprobrium for their joy in fat shaming.  The Forum happily meets them head on because fat shaming is vile. No-one has the right to comment on any other person's body size whether or not they know the exact reasons for that size. Enough said.

On the other hand a lot needs to be said about issues that the Committee should not lose sight of in the coming Inquiry, the first being that everything that could prevent children becoming fat in the first place should be considered.  We concentrate on children because, unhappily, preventing adults from becoming fat or fatter may be a lost cause.   The Forum welcomes of course the £100m funding that is now available to set up weight management clinics that might help thousands regain a healthy weight but £100m is quite insufficient to deal with the millions that make up 2/3rds of the country's population.  Worse still is the fear that after the initial funding is spent no more may be forthcoming.

The work to ensure that children maintain a healthy weight throughout their lives has to be entrenched in primary/secondary schools  Thinking ahead, it’s particularly important when reflecting on the fact that that 50% of would-be mothers present at booking-in either overweight or obese.  Good prenatal counselling services are hard to find and it is imperative that women present in shape for childbirth.  Education at school is especially important, too, when  considering that 50%  of pregnancies are unplanned  Whether or not they arrive at booking-in with a healthy BMI range,  mothers-to-be also need to be weighed opportunistically to ensure that they remain within the range of pregnancy weight gain guidelines. Please remember that Anna Soubry, when Minister for Public Health famously declared that it was " bonkers " that the pregnant were not routinely weighed.  The number who increasingly require caesarean sections to deliver their macrosomic babies is heart-breaking.  

Last year's Queen's Speech led the Forum to believe that by now we would have heard something of Andrea Leadsom's plans for the health of a child's early years.  But no.   Entitled " The Best Start for Life " it allegedly promises to demonstrate her passion for improving the care given to every child in its crucial first 1001 days of life - roughly the period between conception and two years of age.   But so far we have not heard a word on the plan’s progress and we believe the Committee should ask why. If it is government inaction that is to blame for any delay it will be very disappointing. The Committee should also find out why recommendations made in a predecessor's Inquiry into the Early Years have not been taken up by Whitehall. For instance, the recommendation that the DHSC fulfil its policy to support, wherever possible, babies being exclusively breastfed to the age of six months.  This intention appears to have dropped by the way side but time was when the UK had breastfeeding coordinators and well publicised breastfeeding awareness weeks. ,Now, because there is a dearth of work being done by the DHSC the number of babies being exclusively breastfed at 26 weeks remains stubbornly at 1% of the eligible population. The Committee should insist that action is taken to increase that figure substantially.

Will " The Best Start For Life “ have to fight for space or clash with a second programme, “ Time to solve Childhood Obesity “, covering the same early years period?  Written by England's former CMO, Dame Sally Davies, this strategy was sent to Downing St in October 2019. But that is the last we have heard of it. The Forum believes that the Committee should demand to know why, and why Davies’ work was pointlessly followed eight months later by Boris Johnson's own attempt at a strategy. His less-than-comprehensive plan to deliver a 50% reduction in childhood obesity by 2030 looks childish  by comparison.  Although the UK should welcome action on calorie labelling in April and restrictions on food advertising and bogof promotions in October, Johnson’s measures are nowhere enough to meet his target.  The National Audit Office and a host of other obesity experts agree.  Before moving on, it is noteworthy that amongst the 49 measures put forward by Dame Sally, she singled out the need to address weight-related stigma.  For good measure she printed her recommendations in bold type.

Every previous administration this century has ignored the need to prevent obesity in children.  Ever since CMO Sir Liam Donaldson wrote about the  " ticking obesity timebomb " in his 2002 Annual Report, Whitehall has allowed itself to be manipulated by Big Food and other vested interests and disgracefully failed to act as it should.

Every cabinet has consistently thwarted any meaningful attempt to tackle obesity apart from the single exception of the 2018 Sugary Drinks Industry Levy. This had to be pushed through almost single handedly by  Chancellor George Osbourne who slipped it into his 2016 Budget Speech despite opposition from Nr 10. ,  Unfortunately the Prime Minister didn’t take the same initiative when he had the chance,  The Forum had great hopes that he would wage a personal war on obesity after being told in St Thomas Hospital that his owthe war has quickly soon became a whimper.

Before finalising this Statement the Forum must comment on an issue that it finds particularly galling. This is the DHSC's continued opposition to allow parents to monitor their children's weight management at home.  It has consistently refused to include paediatric body mass index charts in the parent held Personal Child Health Record [PCHR], promoted as being the definitive record of a child's growth and development. The charts which were first published as long ago as 1995 have the potential to pick out disturbing weight gain from the age of 2 yrs.  The Forum holds a firm belief that, if they could be available now, undesirable weight gain could be spotted and dealt with quickly and millions of overweight children could avoid being stigmatised during their primary and secondary school years. BMI charts should be included in the PCHR because the Record's standard growth charts are far less efficient for parents to identify unhealthy weight gain, 

There is no reason to believe that weighing children makes them fat.  The NCMP, which has been successfully carried out for 16 years, would have been discontinued long ago if it had.  The Forum believes that it is probably the way that NCMP  results are communicated to parents that has caused problems in some iquarters,  The RCPCH believes that the NCMP should be extended and that would certainly not have been proposed if the acknowledged experts in child health thought that the move would cause harm.

What is missing of course is the lack of published evidence demonstrating that annual measurement is worthwhile, Since 2003, the DHSC has not bothered to seek any evidence that it is. 2003 was the year in which Derek Wanless, a banker who was writing to the Treasury on securing good health for the nation, stated that " interventions should be evidence based though the lack of convincing evidence should not, where there is a serious risk to the nation's health, block action proportionate to that risk ". Wanless accepted that obesity was a risk but the research could which could have provided the conclusive evidence was never commissioned.  The Committee may find that it’s a bit too late in the day to rectify the omission of a generation ago but such research would silence the doubters.  In a 2018 hearing the Committee was informed by the team running the CHAMP  programme in Manchester that serial measurement was not only worthwhile but was cost neutral.  It would be interesting to see if the success of CHAMP could be replicated nationwide.

June 2022