Inquiry into childhood obesity

The National Assembly for Wales’ Children and Young People Committee launched an inquiry into childhood obesity. Submissions were required by Friday 3rd May 2013. The remit was as follows:

The overall aim of the inquiry is:

To review the effectiveness of the Welsh Government’s programmes and schemes which are aimed at reducing the level of obesity in children in Wales and to identify areas where further action could be effective.

The inquiry will cover lifestyle factors contributing to childhood obesity, the support available for overweight children and treatment (clinical and non-clinical) for obese children and their families.

To assist with its inquiry, the Committee would welcome your views on any or all of the following points:
1) The extent of childhood obesity in Wales and any effects from factors such as geographical location or social background;

2) The measurement, evaluation and effectiveness of the Welsh Government’s programmes and schemes aimed at reducing the level of obesity in children in Wales specifically:

• Health related programmes including Change4Life, MEND,
• Programmes related to nutrition in schools including Appetite for Life,
• Cross cutting programmes for example leisure and sport related programmes (Creating an Active Wales); planning policy; and

3) The barriers to reducing the level of childhood obesity in Wales;

4) Whether any improvements are needed to current Welsh Government programmes and schemes and any additional actions that could be explored.

You may also wish to submit any other evidence you feel is directly relevant to the above terms of reference.

My submission is contained in the rest of this document. I chose to focus on points 2, 3 and 4 and to leave the data gathering to data gatherers!

Inquiry into childhood obesity
To: The National Assembly for Wales' Children and Young People Committee
From: Zoë Harcombe
Date: 1 May 2013

I am an author and obesity researcher. I read, write and talk about obesity full time and would welcome the opportunity to share my knowledge and insights as part of the oral evidence sessions. I submit a general explanation of the obesity epidemic and then I shall comment specifically on points 2, 3 and 4 of the inquiry. I also submit a one hour presentation recorded at Cardiff Metropolitan University in 2012 on the cause of the obesity epidemic and the measures needed to reverse it. (http://www.theobesityepidemic.org/2012/02/the-obesity-epidemic-lecture/)

The Obesity Epidemic

“The previous nutritional advice in the UK to limit the intake of all carbohydrates as a means of weight control now runs counter to current thinking and contrary to the present proposals for a nutrition education policy for the population as a whole… The problem then becomes one of achieving both a reduction in fat intake to 30% of total energy and a fall in saturated fatty acid intake to 10%.”[1]
Proposals for nutritional guidelines for Health Education in Britain (1983)
And so started the obesity epidemic...

In a study of formerly obese people, researchers at the University of Florida found that virtually all said that they would rather be blind, deaf or have a leg amputated than be obese again.[2] That is the extent of our desire to be slim and yet two thirds of people in the UK, USA and Australia are overweight and one quarter obese. Why?

To be slim, to achieve the thing we want more than our sight, hearing, or mobility, we are told that we just need to “eat less and/or do more.” Quite specifically, the advice is “One pound of fat contains 3,500 calories, so to lose 1lb a week you need a deficit of 500 calories a day.”[3]

So, why don’t we follow the advice? Why do we have an obesity problem, let alone an epidemic, when we so desperately want to be slim?

I set out to answer that question in the late 1980’s and this submission is a summary of my findings. In 1972, World Health Organisation statistics recorded 2.7% of UK men and women as obese. Fewer than three decades later, in 1999, the same statistics found 22.6% of men and 25.8% of women were obese.[4] Two thirds of UK citizens are now overweight or obese.

The USA started from a slightly higher base and displayed a virtually identical trend, with 70% of Americans currently overweight or obese.

The starting point for understanding the obesity epidemic must be: what changed in the late 1970’s/early 1980’s? Was there one occurrence that could explain the sudden and dramatic increase in obesity?

Yes there was. In 1977 the USA changed its public health diet advice. In 1983 the UK followed suit. A more accurate description would be that we did a U-turn in our diet advice from “Farinaceous and vegetable foods are fattening, and saccharine matters are especially so”[5] to “base your meals on starchy foods”. Obesity has increased up to ten fold since – coincidence or cause?

We changed our advice for the wrong reason. We changed it to the wrong advice.

In the 1970’s, the fact that (fewer than six) people (in one thousand) were dying from heart disease was of great concern to America. American public health advisors wanted a solution. Ancel Keys had spent the 1950’s trying to prove that cholesterol consumption was the cause of heart disease. He failed and he acknowledged this. He then tried to prove that saturated fat consumption causes heart disease, despite this having no logic, not least because saturated fat and cholesterol (and unsaturated fat) are found in the same foods. At the time that Senator McGovern was looking for the first Dietary Goals for the United States, the Keys theory was not the only idea available for consideration, but it was the best promoted. The rest, as they say, is history.

The USA changed its dietary advice and the UK followed. We told people that fat was bad and carbohydrate was good not because we knew either fat to be bad or carbohydrate to be good. At the time we changed our advice, the only ‘evidence’ for fat being bad was a suggestion that, in seven handpicked countries, heart disease tended to be related to cholesterol levels, which tended to be related to saturated fat intake and so (that must mean) heart disease tended to be related to saturated fat, (although cholesterol intake was not directly related per se). Association was never proven and causation was never alleged. We had no evidence that carbohydrate was good – just the admission that, if we tell people not to eat fat they must eat something and “it was advised that starchy carbohydrates should replace the reduction in fat as an energy source.”[6]