We welcome recent government initiatives to tackle obesity. Measures like banning the advertising of food high in sugar, salt and fat on TV and online before 9pm are a positive step forward.1 However, tackling obesity is a particularly tough problem, so more action will be needed. Here are seven reasons why:

1. We live in an obesogenic world

Some of us may be more genetically predisposed to put on weight. However, until around the 1980’s this didn’t result in widespread obesity because there wasn’t a conducive environment.2 Now food and drink are readily available 24/7; portion sizes are usually larger; and there’s more processed food – meaning we don’t feel full for long, so are more inclined to snack. We’ve also moved from occupations that involved physical activity (such as coal mining and the steel, shipbuilding and manufacturing industries) to more sedentary office-based occupations.

To an unprecedented extent and difficult to easily reverse, there are greater opportunities to consume a high volume of unhealthy food than ever before, at a time when opportunities to undertake physically active work are at an all-time low.

2. Our taste for unhealthy food can start in the womb

Our taste for different types of food starts in the womb and continues through breast milk.3 Mothers who eat more ‘junk food’ are therefore unwittingly priming their children to develop a preference for ‘junk food’. Baby foods are another issue. Glasgow University found that even those containing fruit and vegetables in their name mainly consist of fruits and relatively sweet vegetables which are unlikely to encourage preferences for bitter-tasting vegetables or other non-sweet foods.4 Then there’s the ubiquitous availability of sweet foods at children’s parties and the use of sweets to both reward and pacify children.

Add all these influences together and it is easy to see how children can grow up predisposed to unhealthy food.  

3. Our bodies aren’t passive bystanders

This is a fatal flaw in the plethora of dieting plans and weight loss programmes now available. If diets worked the dieting industry would go out of business. In practice our bodies actively work to achieve homeostasis or equilibrium. We see this, for instance, in the way that our bodies usually manage to maintain a constant temperature whether it is hot or cold outside. In the same way our bodies seek to compensate and bring our weight back after we diet or exercise. Some researchers even argue that dieting may actually be causing obesity. For example, research suggests our appetite regulating hormones can be upset when we go on a diet, for at least a year afterwards.5

Obesity is a classic example of prevention being better than cure. Once you become obese, your body’s own search for homeostasis makes it harder for you to lose weight long-term. And a healthy diet is more effective at helping us manage our body weight than yo yo dieting once we’ve already become overweight.  

4. Obesity often affects those least well placed to respond

We know obesity is more common in deprived areas. Public Health England report that childhood obesity rates are more than twice as high in the most deprived areas compared with the most affluent parts of the country.6

It is often argued that people need to take responsibility for their own actions. As Rod Liddle argued recently in The Spectator, ‘lardbuckets’ shouldn’t be consuming so much ‘crap’ and would benefit from a bit of fat-shaming.7 Interestingly he only singled out for censure those who consume ‘crap’ not those who manufacture, market and distribute it. However, even he would probably have to admit that people living in deprived areas have less money available to buy healthy food or gym membership; are more likely to live near takeaways than greengrocers; and that exercise in polluted, traffic-clogged inner city streets is a less appealing prospect than in more affluent areas with parks and gardens.

The Food Foundation also reports that across much of mainland Europe, the healthy choice is often the cheaper one, meaning the UK is unusual in unhealthy choices often being cheaper.8 Making healthy food cheaper would be one obvious way to start to redress the balance.

5. Health versus Food Industry = David versus Goliath

In 2018 the government committed £4.5 million to promote the Change4Life healthy snacks campaign. This was welcome. However, every year £5 million is usually spent promoting the chocolate bar Kit Kat.9 With the entire budget for government advertising of healthy snacks less than the budget to advertise a single chocolate bar there is clearly a serious imbalance. In 2017 the BMJ reported that spending on junk food advertising was nearly 30 times what government spends on promoting healthy eating.10

So, when the government proudly announces it will be spending £10 million to promote a Better Health campaign to tackle obesity, we shouldn’t hold our breath. 

6. Food industry lobbying

A former Conservative Health Secretary once commented that it was hard enough taking on the tobacco industry. The government couldn’t be expected to take on the food industry as well. This may help explain why, until Boris Johnson’s near-death experience prompted a rethink, successive governments have pursued a voluntary approach (as with the coalition government’s Responsibility Deal) rather than seeking to regulate.11 Despite the food industry being the main source of the types of food that are fuelling obesity.

In practice, behind the scenes, the food industry has been looking at ways to reduce sugar, salt and fat in its products – whether to respond to future government intervention or to take advantage of growing consumer interest in healthier products. The speed with which companies responded to the Soft Drinks Industry Levy in the UK is a good example.12 This suggests that the food industry may face fewer problems and enjoy greater opportunities than its lobbyists suggest, in the event of further government regulation.

7. Short term, one-off initiatives aren’t enough

Obesity has been reduced in some countries. This is typically childhood obesity (as prevention here is easier than cure) and usually involves a ‘whole systems’ approach. This may sound technically complex but is actually very simple. There are major forces (and social, economic and political ‘systems’) in society encouraging obesity and much smaller forces pushing back. So, short term, one-off initiatives, along the lines we’ve seen in England, rarely make much sustained progress. To tackle a problem as big and complex as obesity, initiatives need to take a systematic approach i.e. to identify and address all the causes of childhood obesity and then get everyone, at all levels, working together to tackle the causes - parents, schools, health professionals, communities, businesses, the media, central and local government. EPODE (Ensemble Prévenons l'Obésité Des Enfants) i.e. Together Let’s prevent Childhood Obesity – led the way in France.13 It has been adopted in a number of other countries – most successfully in the Netherlands, where EPODE was repositioned as JOGG (Jongeren op Gezond Gewicht) i.e. Young people at a Healthy Weight.14 Together they have demonstrated that it is possible to reduce childhood obesity - from dozens of French towns to the largest cities in the Netherlands.

Conclusions

• Once people become obese their bodies work on autopilot to maintain that weight, making it difficult to lose weight on a sustained, long term basis.
• It is therefore easier to prevent people becoming obese in the first place.
• This ideally means action before pregnancy, encouraging mothers-to-be to follow a healthy diet, so their babies will become accustomed to the taste of healthier food - in the womb, through breastfeeding and by avoiding overly sweet baby food.  
• A healthy diet is more effective than dieting for managing weight – it contains more nutrients and more fibre, which is good for your health also helps you feel fuller longer.
• Growing up in a deprived area is a particular risk factor, so action is needed to ensure healthy food is cheaper than unhealthy food (with VAT one potential lever here) and to make exercise easier and more attractive.
• If the government is serious about tackling obesity it needs to ensure that providers of unhealthy food can’t continue to significantly outspend healthy eating messaging when it comes to advertising budgets.
• Because so many forces have combined to increase obesity in the modern world, a major pushback is needed if the trend is to be reversed i.e. what has been described as a ‘whole systems’ approach.
• There are successful examples we can learn from in other countries, in particular France and the Netherlands.

Michael Baber   August 2020.

Continue the conversation with us on Twitter - @Health_ActionUK

References

1. Tackling obesity: empowering adults and children to lead healthier lives. Department of Health & Social Care July 2020 https://www.gov.uk/government/publications/tackling-obesity-government-strategy/tackling-obesity-empowering-adults-and-children-to-live-healthier-lives

2. Brandkvist M, Bjørngaard JH, Ødegård RA et al. Quantifying the impact of genes on body mass index during the obesity epidemic: longitudinal findings from the HUNT Study. BMJ 2019. https://doi.org/10.1136/bmj.l4067

3. Fleming A. How a child’s food preferences begin in the womb. The Guardian 2014. https://www.theguardian.com/lifeandstyle/wordofmouth/2014/apr/08/child-food-preferences-womb-pregnancy-foetus-taste-flavours

4. Garcia AL, McLean K, Wright CM. Types of fruits and vegetables used in commercial baby foods and their contribution to sugar content Maternal & Child Nutrition 2015  https://doi.org/10.1111/mcn.12208

5. Benton D, Young HA. Reducing Calorie Intake May Not Help You Lose Body Weight. Perspect Psychol Sci 2017 DOI: 10.1177/1745691617690878

6. Childhood obesity: applying All Our Health. Public Health England May 2020

7. Liddle R Fat-shaming didn’t do me any harm The Spectator 1st August 2020

8. Selous A. It’s time for the government to step up the war on obesity. Conservative Home. July 2020. https://www.conservativehome.com/platform/2020/07/andrew-selous-its-time-for-the-government-to-step-up-the-war-on-obesity.html

9. Millington A. Kit Kat doubles media spend to reclaim lost sales. Marketing Week 2015. https://www.marketingweek.com/kit-kat-doubles-media-spend-to-reclaim-lost-sales/

10. O’Dowd A. Spending on junk food advertising is nearly 30 times what government spends on promoting healthy eating. BMJ 2017 https://doi.org/10.1136/bmj.j4677 

11. Durand MA, Petticrew M, Goulding L et al. An evaluation of the Public Health Responsibility Deal. Health Policy 2015. https://doi.org/10.1016/j.healthpol.2015.08.013

12. Wells L. Sugar levels in UK soft drinks lowered, research finds. Talking Retail 2020 https://www.talkingretail.com/news/industry-news/sugar-levels-uk-soft-drinks-lowered-research-finds-12-02-2020/

13. Borys JM, Bodo Y Le, Jebb SA et al. EPODE approach for childhood obesity prevention: methods, progress and international development. Obesity Reviews 2012. doi: 10.1111/j.1467-789X.2011.00950.x 

14. Amsterdam Healthy Weight Programme https://www.amsterdam.nl/sociaaldomein/blijven-wij-gezond/amsterdam-healthy/#h7eda8ded-acfe-4353-b42a-a8a15e1a78a5