Quis Custodiet Ipsos Custodes?
(Who is guarding the guards?)
The National Audit Office's 'Vision' statement is "To help the nation spend wisely" – a laudable aim which reflects nicely Gordon Brown's shrewd insistence on prudence in all matters fiscal. Its role is to scrutinise how government departments and agencies spend public money and to identify areas of unwarranted profligacy. All fine, laudable stuff which, according to the NAO, "saves the taxpayer millions of pounds every year". But who, we wonder, audits the NAO's own activities and spending?
The NAO's latest report Tackling Obesity in England is a 72-page document which summarises costly research on a wide range of nutritional and clinical issues, a task more normally, and more appropriately, conducted by specialists within the Department of Health, the Food Standards Agency or the many other statutory bodies with a specific interest and expertise in this field. The rationale given by the NAO for their involvement in the debate is that since obesity costs the country, they claim, £2 billion per year, the NHS needs to get its act together and develop a more consistent approach to the problem, including the promotion of "long-term changes in lifestyles".
The British media, of course, love pronouncements such as these and have seized upon the announcements of the head of the NAO, Sir John Burn, as a welcome opportunity to berate once more the fat cats of the fast food industry, the purveyors of nutritional pornography and those who supply irresistible inducements to gorge ourselves. Mary Killen in the Telegraph, for example, treats us to this:
"Temptation is at the root of our problems. Just as pornography corrupts people into performing sex acts that they would never have thought of alone, so we are titillated and tormented by gastro-porn shoved at us from every angle, which sets us slavering for things we were once perfectly happy to do without . Today, we are assaulted by food pornography, even on our way to work, when cappuccinos, or ciabatta with American bacon, or smoked salmon and scrambled egg breakfasts offer themselves to us. At lunchtime, having chosen between sandwich outlets, we will be lucky if we can bring ourselves to leave with just our BLT – how can we resist a fruit smoothie, a low-fat carrot cake, a mocha cappucino or a bio yoghurt?"
The Guardian manages to find a rather strange lady called Suzanne Pearce to make its point – a woman who says: "I didn't know how big I was because I had no scales. I didn't realise I could cut the size of my portions." Perhaps the NAO should be investigating the apparent rise in manifest stupidity as well as in obesity.
No one doubts that more people in the UK, like their even chubbier counterparts in the United States, are now overweight or clinically obese than was the case 10 years ago. We didn't need the NAO to tell us that because not only have other recent reports come to the same conclusion, the evidence is before our own eyes. But this rise cannot be attributed to the new gluttony that Killen so luridly describes. Average calorie intakes have steadily fallen in recent years – a point made by Prentice and Jebb in their BMJ article:
". in sharp contrast with the suggestion that a secular drift towards high fat diets has induced people to overeat, there is evidence, based on the National Food Survey's annual measures of household food consumption, that the British are becoming fatter in spite of consuming less energy than in the 1970s. Even after adjustments for meals eaten outside the home, and for consumption of alcohol, soft drinks, and confectionery, average per capita energy intake seems to have declined by 20% since 1970 ."
A similar pattern has been identified in the United States, where obesity has also been rising in a period when food intake has been declining. The obvious conclusion, therefore, and one which is almost universally accepted in the nutritional and clinical fields, is that sloth is probably a bigger culprit than gluttony. While our calorie intake is less than it was in the past, it is relatively higher in relation to diminished energy needs resulting from inactive and sedentary lifestyles.
The NAO report, of course, acknowledges all this and calls on the Department for Culture, Media and Sport to "promote the health benefits of physical activity", even suggesting that they encourage children to walk and cycle a bit more. In truth, however, the NAO does little more than suggest that obesity (and therefore costs to the taxpayer) might be reduced if people ate a little less and exercised a little more. But did we need yet another costly exercise to tell us this? Isn't it the case that a good way of saving the taxpayer money is through reductions in duplication of effort among government departments? And isn't ensuring this one of the key roles of the NAO?
February 15th 2001