Obesity and Fatty Liver Disease

I beg to move,

That this House has considered obesity and fatty liver disease.

It is a pleasure to serve under your chairship, Mr Efford, alongside my parliamentary colleagues who have kindly come along this morning to debate and highlight the public health emergency that is obesity and fatty liver disease.

The vast majority of us do not often think about the health of our livers. If we do, our biggest concern is how many units of alcohol we drink every week and whether our livers can keep up. But we do talk about our weight a fair amount, either in terms of how we look and how our clothes fit, or, if we are linking it to disease, whether we are blocking up our arteries and risking a heart attack. Today I want to make the case for linking our concerns about being overweight and sedentary with the very real risk of developing fatty liver disease. Before I give the alarming statistics about the huge increase in liver disease in the UK, I want us all to hold on to the fact that a weight loss of 10% can halt and even reverse fatty liver disease progression, and the way to help us all to do that is not to point fingers and tell individuals to try harder. There are much more effective public health solutions than that.

Now for the alarming statistics that should give us all pause for thought: after heart disease, liver disease is the biggest cause of premature mortality and lost working years of life in the UK. In stark contrast with other killer diseases where the mortality rate has gone down, deaths from liver disease have increased by 400%—yes, 400%—over the past two decades. Every year we are seeing 18,000 deaths from liver disease. It is now the biggest killer of 35 to 49-year-olds in the UK. In two to three years it is set to surpass heart disease as the leading cause of premature death in the UK.

Today’s debate matters because fatty liver disease is becoming one of the defining public health challenges of our generation—a disease that already affects as many as one in five adults in the UK, equating to about 1 million people, but one that hardly anyone knows about. When I asked my parliamentary colleagues to speak in today’s debate, they said, “Fatty liver disease? What’s that?” So hopefully this debate will highlight this alarming disease.

Closely linked to our ongoing struggles with obesity, fatty liver disease—for the record, its clinical name is metabolic dysfunction-associated steatotic liver disease; that is the last time I am going to say that today—is deeply rooted in our broken food systems and the stark health inequalities that our communities face.

I congratulate the hon. Lady on securing the debate. She is outlining very clearly the importance of the issue. It is vital that people are aware of it. Does she agree that if we do not deal with the issue, the NHS waiting lists over the coming years will be compounded even further than they have been already?

I thank the hon. Member for making that excellent point. He is absolutely right. The issues of the NHS waiting lists are pertinent and stark. Reducing them will mean that we have to get the left shift right as well as invest in acute services.

Our policies have failed the population for decades. This debate is an opportunity to make the urgent case for a national liver strategy, joined-up public health work and profound reform of the conditions that stop us all living well. Because we have failed to build an environment where healthy food is affordable and accessible, two thirds of UK adults are now overweight or obese, and one in three children in England are above a healthy weight when they leave primary school.

Fatty liver disease is a silent killer, often asymptomatic until at a very advanced stage, meaning many patients are diagnosed too late for effective intervention. Left untreated, as too many are, fatty liver disease can progress to liver inflammation, fibrosis, cirrhosis, liver failure or liver cancer. Fatty liver disease also increases significantly the risk of heart attacks, stroke and heart failure. It is projected to overtake alcohol as the leading cause of liver transplants within a decade.

How do we treat fatty liver disease? Despite high and rising mortality rates, there are limited treatment options for patients with this disease. As I have said, weight loss and lifestyle change are essential.

I thank the hon. Member for bringing this very important subject to Westminster Hall. She is absolutely right. Fatty liver disease is the fastest rising cause of liver cancer death in the UK and highlights the risk of developing a less survivable cancer for people living with obesity. Does the hon. Member agree that improvements to diagnosis of and treatment for fatty liver disease should be covered in the national cancer plan, which I called for a year ago and the Government are to announce early next year?

I thank the hon. Member for his excellent intervention. I absolutely agree that the national cancer strategy is essential. We must make sure that liver cancer is integrated into it, and that diagnosis and treatment are a key part of it and are funded across the country, to make sure that the inequalities that I am going to talk about are addressed sufficiently.

Before we get to the issue of diagnosis and treatment, weight loss and lifestyle change are essential. We know that a Mediterranean diet plus exercise improves liver function and that reducing ultra-processed foods reduces intrahepatic fat. However, for those whose disease has progressed to scarring of the liver, or liver fibrosis, there is an urgent need for therapies that directly target the liver.

Currently, no drugs are licensed to treat fatty liver disease in the UK. We have fallen behind the United States and Europe, as our market is too small for prioritisation. If I might get a bit more political, that is driven in part by our decision to leave the European single market. But this is a rapidly advancing field and we are approaching a potential breakthrough in treatment. With adequate planning, co-ordinated action, investment and leadership, we can ensure that our national health system is patient-ready to deliver the next generation of medications, and that all patients, regardless of postcode, can benefit.

Early diagnosis offers significantly better outcomes and a wider range of treatment options, but despite fatty liver disease being medically recognised in the 1980s, clinical and public awareness of it remains far too low. We urgently need to increase public understanding and encourage early liver checks, particularly for those at higher risk because of obesity or type 2 diabetes. What is more, we have seen primary care systemic failures to improve early detection, such that three quarters of people are diagnosed with cirrhosis at hospital in an emergency, when it is too late for effective treatment or intervention.

I, too, congratulate my hon. Friend on an excellent and really important debate. May I take her back to what she was saying about the food industry, wider population prevention measures and what this means for school meals and for our poorer communities, who are reliant on food supporters, such as the Trussell Trust and others, in terms of the type of food made available to them?

I thank my hon. Friend for that excellent intervention. She is absolutely right. With her public health expertise, she highlights the very real problems that lead to fatty liver disease: our broken food system, the issue with access to good, nutritious food for children in school, and the need to ensure that our stark health inequalities are addressed. I will come to that later in my speech.

To go back to the issue of diagnosis and treatment, we should note that a staggering 80% of England currently has no effective detection and treatment pathway—yes, a staggering 80%. The British Liver Trust, whose representatives are here today, is rightly calling for an end to this postcode lottery, so a key ask raised in this debate is that every integrated care board, every regional and national health area that we have, should have a full pathway for early detection of liver disease.

There is some excellent, innovative work out there that can help us to get to a much better place in tackling this disease. I recently met the team at Predictive Health Intelligence—whose representatives I think are also here today—who have developed hepatoSIGHT, which is a great name; well done. That is an inspiring example of how technology can transform early detection. The system uses existing NHS data to identify people at risk of liver disease before symptoms develop, allowing GPs proactively to invite patients for screening and support. I am delighted to say it is now being implemented across NHS South West. It is proof that, with genuine support from senior NHS management, clinical and digital teams at all levels can come together for the good of patients. That system is exactly the kind of innovation we need in order to make early diagnosis and prevention the norm and not the exception.

I now come to prevention. Screening and early diagnosis are vital but, as for all population health issues, as my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) rightly highlighted, we must have a laser focus on preventing the root causes of fatty liver disease.

I thank my hon. Friend for raising this debate. We are calling obesity the enemy, but the liver does not count in pounds or kilograms. The real culprit is not body weight; it is metabolic dysfunction, as she points out—insulin resistance, poor diet, genetic risk and so forth. Lean people also get fatty liver disease, not always people who are overweight. Does my hon. Friend agree that we should talk less about obesity and more about screening early, taxing junk food and treating metabolic disorders and disease rather than strictly BMI? If we chase the scales, we might miss the science.

I thank my hon. Friend for that excellent point and agree absolutely. In our society, we focus on how people look for many reasons, cultural and commercial, but this is purely about health. This is about keeping people healthy on the inside and allowing them to live good quality lives. My hon. Friend is absolutely right in that sense.

Poor diet is now the leading risk factor for death and disability. It is responsible for millions of preventable deaths each year. In the UK, almost two thirds of adults are overweight or are living with obesity, increasing the risk of fatty liver disease, cardiovascular disease and a multitude of cancers. In my job as a public health consultant, I see a lot of data and read many papers, but this statistic shocked me: four in 10 children with obesity may already have fatty liver disease. That demonstrates the urgent need to act now to prevent an even greater epidemic of disease in future.

That has not happened by accident; it is the result of a broken food system, which has made the UK Europe’s third most obese country and one of the world’s biggest consumers of ultra-processed food. We have a system that makes the unhealthy choice the cheapest, easiest and most available choice. Healthier food now costs more than twice as much per calorie as unhealthy food. That is £10.24 per 1,000 kilocalories compared with £4.50. For fruit and vegetables, the cost is even more at £11.90 per 1,000 kilocalories.

For the lowest income households, following a recommended healthy diet would swallow half or more of their disposable income. It is no surprise that obesity and fatty liver disease hit hardest in poorer communities. As I said at the beginning, this is not about personal failure. As hon. Members have said, sometimes people feel that that they are failing to lose weight and failing to keep themselves healthy. This is not about personal failure; it is a political failure. It is our collective failure to create a food environment that protects rather than undermines public health. If we are serious about prevention, we must be serious about reform—the right type—with stronger fiscal and regulatory measures to reduce the availability and marketing of foods that are high in fat, salt and sugar, and to rebuild a food system that serves public health and not profit.

I remind Members to bob in their places if they intend to speak.

Right, that gives me a better idea. We will bring in the Front Benchers at 10.28 am, so that gives an idea of how much time there is for the six or seven Members who wish to speak.

It is a pleasure to serve under your chairship, Mr Efford. I thank the hon. Member for Worthing West (Dr Cooper), who is co-chair of the all-party parliamentary group on liver disease and liver cancer, for setting the scene incredibly well. I thank her for the detail and for her requests to the Minister. It is, as always, a pleasure to see the Minister in her place. I wish her well and I look forward to her answers. I also thank the British Liver Trust and the Foundation for Liver Research, which supplied me with a briefing that made clear the excellent work at the Roger Williams Institute of Liver Studies, which continues to drive world-leading research into metabolic liver disease to shape how it is diagnosed and treated.

Liver disease is a growing cause of premature mortality and lost years of working life in all four nations of the United Kingdom. It has been estimated that some 4,878 potential years of life were lost due to chronic liver disease in Northern Ireland. It is clear that the UK is in the midst of a liver disease crisis, to which the hon. Lady referred. It is as serious as that, and we should all take note. While premature mortality rates from other major diseases have fallen over the past two generations, deaths from liver disease have risen 400% since the 1970s. There are more than 18,000 deaths from liver disease and liver cancer each year in the United Kingdom.

Order. Members are asking that you speak into the microphone, Mr Shannon, so that they can hear you.

That has never been a problem in the past, Mr Efford. Do I need to lift it up to my mouth? I thought it was good enough to carry my voice; apologies if it is not. This would be the first time it has not worked.

Two thirds of adults are overweight or living with obesity, and one in three children are classified as overweight or obese when they leave primary school. Sadly, four in 10 children with obesity may already have liver disease. One in five people are affected by liver disease and liver cancer in the UK, and as many as 12% of those—more than 1 million people—go on to develop the more severe form of fatty liver disease.

The stats for Northern Ireland are unreal. That is not the Minister’s responsibility, but it gives a flavour for the debate. Some 64% of adults in Northern Ireland were overweight or obese, a marked increase from 23% in 2010-11. My goodness me—if ever we needed a reality check, that is one for us. Shockingly, Northern Ireland has the highest rate of overweight or obese primary 1 children in the UK, with 25.3% of children fitting that category. In my constituency of Strangford, 27% of year 8 children were overweight or obese. It is estimated that 70% of adults and 40% of children who are overweight or obese have fatty liver disease, so urgent work must be done to prevent this health crisis in the making.

Shockingly, 37 million extra sick days are estimated to be taken by people living with obesity, harming economic output on a massive scale—a figure of 1% to 2% of UK GDP as estimated by the Institute for Government. The NHS alone is expected to shoulder an estimated £10 billion per year obesity bill by 2050, with obese patients costing twice as much as those of a healthy weight. Reducing obesity prevalence by 10% could save £6 billion per year in the UK economy.

Let me tell a personal story. I am a type 2 diabetic. Some 16 or 17 years ago, I realised that I needed to drastically change my eating habits. I was 17 stone. To be honest, to put it very starkly, I was a big fat pudding. I realised that if I did not lose weight for my diabetes, I was going to be in trouble, so I reduced my weight quite substantially, by 4 stone. I have managed, by and large, to keep at that reduced level. First, it was down to stress but, secondly, it was down to Chinese takeaways five nights a week with two bottles of Coca Cola. That just does not work; when it is added up, you just get fatter and fatter. I took that away and tried to reduce my chocolate intake.

I thank my hon. Friend the Member for Worthing West (Dr Cooper) for securing this very important debate. I also thank the British Liver Trust and the Foundation for Liver Research for providing me with a lot of data and information. As a GP, I have learned quite a lot from preparing this speech—we will come to that a little later.

As my hon. Friend said, what we really need is the right type of reform. My Government are proposing three shifts in care. Probably the most important is from cure to prevention, and this issue fits in very well with that. It also fits into the other shifts that we want. We want to get out of hospitals and into the community, and a lot of work around fatty liver disease can be done in the community. We also need to use data properly to target people and to look at the digital ways in which we can identify high-risk people.

Fatty liver disease affects 20% of the population. I do not want to repeat all the statistics that we have heard, but 12% of those people go on to develop very severe disease, and that is 90% preventable. That is a perfect example of our being able to prevent disease rather than just allowing it to happen.

As GPs, we often do a liver function test—often if someone is on a statin or something similar—as a screening test, and we find that the alkaline phosphatase is slightly raised. We then do an ultrasound scan and, lo and behold, people who are overweight often have fatty liver disease. That is often as far as it goes in GP land, so we need to change that pathway. There is an obesity epidemic and two thirds of adults are overweight. As my hon. Friend the Member for Worthing West said, children also carry a great burden of obesity and overweightness—by year 6, 32% of children are obese.

As my hon. Friend also said, there has been a massive increase. Most diseases are going down in frequency, but there has been a 400% increase in fatty liver disease. That leads first to fibrosis, then cirrhosis and even liver cancer. As she pointed out, detection is often at the acute stage when people are admitted to hospital with cirrhosis and sometimes hepatic failure. That is a sign of a poor medical system. We are failing those people.