How big a problem is obesity in the UK? Does what we know about health behaviour change improve our chances of tackling obesity?

Here are some extracts from a Q & A session with Health Action Campaign’s Director, Michael Baber, which will feature in a forthcoming Food Matters Live podcast.

Q: Just how bad is the obesity problem in the UK?

A: For me there are three particularly worrying aspects about obesity in the UK:

  • First, it is disproportionately concentrated in disadvantaged areas, so it is reinforcing existing, deep seated health inequalities in the UK.
  • Second, research suggests that fewer than 5% of obese adults will get back to a healthy weight, which is a pretty scary scenario.
  • Third, obese parents are twice as likely to have obese children and they are also less likely to recognise they are obese – which means that, unless we can break the cycle, obesity is going to embed itself in generation after generation here in the UK.

Q: How can behaviour change contribute to reducing the epidemic?

A: We can learn from action taken to reduce smoking. In the 1940’s a majority of adults smoked. Now it is down to less than one in five. That has been mainly due to government action to make it harder to smoke and easier not to smoke. As a result smoking is now also less socially acceptable.

This kind of approach is likely to be particularly effective when it comes to preventing obesity. There’s more of a challenge where people are already obese.

That’s because the human body is very good at self-regulating. For example, our bodies are very good at maintaining a constant temperature – they do this automatically. In the same way, when we have put on a lot of weight, whatever we might try to do to reduce that weight by dieting or exercise, behind the scenes our body will usually be trying its best to limit our weight loss.

So, behaviour change to prevent obesity should be easier. That way we can work with our body’s natural desire to self-regulate rather than against it.  

For people who are already obese – we should also encourage behaviour change but probably be realistic and recognise the main benefit is likely to be for the overall health benefits rather than significant, sustainable long term weight loss.

Q: What do you see as the biggest cultural and social challenges to behavioural change?

A: We live in a country where health is viewed as an absence of diagnosed illness, maintained primarily through medical treatment on the NHS. So people tend to underestimate factors that predispose us to illness, like obesity, and the importance of avoiding them.

The media don’t always help either. Articles and stories on obesity usually include an image of someone who is severely obese – leading people who are still obese but less severely so to be seen as simply overweight. Effectively this is hiding obesity in plain sight. And some sections of the press tend to label any action to tackle obesity and improve health as Nanny State-ism, without themselves offering any realistic solution.

Also, healthy food doesn’t get much advertising commitment compared with less healthy food. Less than 2% of food advertising is spent on fruit and vegetables. Last year the government committed £4.5 million to support the advertising of healthy snacks. That sounds a lot until you realise that a chocolate manufacturer can spend more than that advertising a single chocolate bar.  

Q: You have researched a number of international projects to tackle obesity. What do you consider the biggest determinants of success?

A: The two most successful obesity prevention projects internationally are probably EPODE (Ensemble Prevenons L’Obesite Des Enfants) in France and JOGG (Jongeren op Gezond Gewicht) in the Netherlands.

EPODE is now in place in nearly 300 towns across four different European countries and JOGG is in place in over 100 towns and cities across the Netherlands. The main reasons for their success are probably that:

  • They understand that people haven’t changed but the environment they are living in has. So, you need to provide practical support to parents, teachers, health professionals and community organisations so they can help protect children from an obesogenic environment – and also make the environment less obesogenic where you can.
  • They employ an approach which is well thought through and structured, so it can be rolled out wherever it is needed.
  • They recognise that big problems need big solutions – so you need to put together a powerful coalition of local stakeholders to tackle them, including parents, teachers, health professionals, community organisations, local authorities and sympathetic businesses and you need resources to sustain what you’re doing – because the forces that have fuelled obesity are still alive and well and will push obesity back up if you drop your guard.

EPODE and JOGG are sometimes described as taking a ‘whole systems’ approach. This is probably technically correct but to me sounds a bit academic and not something ordinary people can relate to. The way I see it powerful forces are fuelling obesity, so you need powerful forces to push back – and that’s what these initiatives do.

 

09:59, 20 Mar 2019 by Michael Baber
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Here is our draft response to the government’s consultation. If you’re reading this, we would welcome your comments. This will help us finalise our response before the deadline of April 6th. You can send your comments to us at info@healthactioncampaign.org.uk 

 

                          DRAFT RESPONSE FROM HEALTH ACTION CAMPAIGN

At Health Action Campaign our guiding principle is that prevention is better than cure. As the government’s 2018 vision paper on Prevention identified:

  • Prevention means stopping problems arising in the first place; focusing on keeping people healthy, not just treating them when they fall.
  • There is role for government to create the environment that makes healthy choices as easy as possible, and to address the conditions that lead to poor health.

Our own research has identified that eating too much food high in sugar, salt and saturated fat:

  • Increases the risk of people becoming overweight or obese but undernourished, with what we eat and how much (rather than physical inactivity) being the single biggest cause of obesity.
  • Increases the risk of diabetes, heart disease, stroke, some cancers and depression and may weaken the body’s immune system.

This research includes our 2015 report Healthy and Wealthy? which explored the health and economic implications for the UK of mass-producing food high in sugar, salt, saturated fat and refined carbohydrates.

In this context we very much welcome the Government’s consultation on restricting the promotion of food and drink which is high in sugar, salt and fat. We see this as a positive step towards the Government’s ambition of halving childhood obesity by 2030.

Making healthy choices the easy choices

To achieve the changes in food consumption necessary to improve public health it will be important to make healthy choices the easy choices. We therefore agree that action needs to be taken in relation to each part of the food and drink marketing mix i.e.

Product

We consider the 2004/5 Nutrient profiling model (NPM) developed by the Food Standards Agency for Ofcom provides a recognised and established way of defining products high in sugar, salt and fat. It was specifically designed to determine whether individual products should or should not be advertised to children and is therefore particularly relevant in the context of prevention being better than cure.

The Nutrient Profiling Score is derived by comparing the 'healthy' content of a food product (protein + dietary fibre + fruit and vegetables) with the 'less healthy' content (energy + saturated fat + sugar + sodium). We consider this to be an appropriate approach.

Price

Retailers should be required to ensure that all their volume-based price promotions on food and drink (including BOGOF) are on products which are low in sugar, salt and fat.

This means these price promotions should not apply to pre-packaged products which fall into the categories included in Public Health England’s (PHE) sugar and calorie reduction programmes and in the Soft Drinks Industry Levy (SDIL), and are classed as high in fat, sugar or salt (HFSS).

This means that such price promotions should not apply to:

  • Breakfast cereals, yoghurts, biscuits, cakes, confectionery, morning goods (e.g. pastries), puddings, ice cream, sweet spreads, fruit-based drinks and milk based drinks with added sugar.
  • Ready meals, pizzas, meat products, savoury snack products, sauces and dressings, prepared sandwiches and composite salads.

Place

We support restricting the promotion of food and drinks high in sugar, salt and fat from prominent locations typically chosen to boost sales by encouraging impulse buying and pester power i.e. shop entrances, aisle ends and checkouts.

Promotion

Less than 2% of food advertising in the UK is currently for fruit and vegetables. It is now time to begin to redress the balance, including by limiting the promotion of food high in sugar, salt and fat - which is currently the main focus of foood advertising in the UK.   

To ensure a level playing field and avoid the exploitation of loopholes we believe that restrictions on the promotion should apply across the board, including:

  • to all retail businesses in England that sell food and drink products, including franchises
  • to retailers that do not primarily sell food and drink, for example newsagents
  • to online shopping

 15th March 2019

Is it time for the government to follow the lead of many of its citizens – and adopt some new year’s resolutions of its own when it comes to health?

There’s clearly a need for some new thinking by government as it faces yet another NHS winter crisis.

At the risk of stating the obvious, we need:

  • To address the root causes of ill-health, like our current obesogenic environment and high levels of social inequality.
  • A true National HEALTH Service – which gives higher priority to stopping people falling ill in the first place, rather than simply waiting until they fall ill and then trying to treat them.
  • To recruit and importantly RETAIN health professionals – and ensure they have the training and the skills to encourage health, not simply treat illness.
  • To provide practical carrot and stick incentives for businesses to produce goods and services which are good for our health and for employers to ensure healthy working environments.
  • Central and local government to lead by example – including considering the health implications of ALL their policies and ensuring they too provide healthy work places.

So, taking each in turn, we recommend these New Year’s Resolutions for government.

1. To address the root causes of ill-health

1.1 Consider what action is needed in relation to fast food, takeaways and home delivery (on which UK consumers currently spend £30 billion p.a.) – to complement existing action on sugary drinks.

1.2. Consider how to make physical activity at school a varied, fun and enjoyable experience, as an integral part of the learning environment – to build a commitment to physical activity that can be sustained into and rekindled in adult life.  

1.3. A simpler, fairer tax system, where the amount of tax you pay doesn’t depend on whether or not you can afford expensive tax avoidance advice – to reduce the social inequality that fuels health inequality.

1.4. Many more affordable homes to buy and rent, by enabling Local Authorities and Housing Associations to contribute more, encouraging more factory-built homes (to avoid weather delays during construction) and reducing commuting costs to better connect affordable housing and employment.

1.5. Actively encouraging and supporting volunteering, both to increase support for those in need and for the mental and physical health benefits experienced by those volunteering.

2. To create a true National HEALTH Service

2.1. Ensure Clinical Commissioning Groups (CCGs) commission health improvement, not just the treatment of accident and illness – with a particular focus on the importance of the early years for long term physical and mental health.

2.2. Ensure NHS Trusts report on the action they have taken to improve health, over and above the treatment of accident and illness, in their Annual Reports.

2.3. Find ways to fast track career progression for health professionals who are actively engaged in health improvement – to encourage a move away from paying lip service to the importance of prevention to making this a reality.

3. To recruit and importantly RETAIN health professionals with the right skills

3.1. Write off student loan debts for doctors and nurses who complete eight years continuous full-time employment with the NHS after qualifying - to help reverse the fall in applications for medical school and nursing courses, following changes in student funding. 

3.2. Set up a task force to consider how to make the NHS an employer that qualified health professionals actively wish to continue working in – to reduce the record number of health professionals currently leaving the NHS.

3.3. Continue the modernisation of the medical school and nursing curriculum, and Continuing Professional Development (CPD) post qualification, to include a significant focus on preventative health – including providing trainee health professionals with not only the academic knowledge but also the practical skills and expertise to help their patients adopt healthier lifestyles (like motivational interviewing) and ensure the effective implementation  of initiatives such as GP-based social prescribing and the hospital-based Ottawa Model of Smoking Cessation.

4. To provide practical carrot and stick incentives for businesses to produce goods and services which are good for our health and for employers to ensure healthy working environments - recognising that voluntary approaches have failed to achieve the progress needed and that financial incentives or regulatory action are now needed:

4.1 Start with clear regulation to limit the mass production of food high in sugar, salt and saturated fat, as recommended by the British Retail Consortium – and make R & D corporation tax relief only available to food and drink companies undertaking R & D to develop healthier products.

4.2. Ban added sugar in baby and infant formula, to avoid ‘hooking’ children on sweet tasting products, as recommended by the UK’s Chief Medical Officer.

4.3. Incentivize Investors in People to add a new indicator to IIP accreditation i.e. supporting the  health of employees (to reach the thousands of employers nationally with IIP accreditation – and the millions of people who work for them.)

5. Central and local government to lead by example:

5.1. As public health is the front line when it comes to preventing illness, increase funding for public health annually, in line with inflation, and consider establishing project funds local authorities can bid for e.g. to tackle childhood obesity using 'whole systems' approaches which have proved successful in several other countries.

5.2. Agree a mechanism to ensure that the health implications of all government policies are seriously considered, including those for transport, housing, education, the environment, agriculture, business, energy, work and industrial strategy.

5.3. Seek appropriate Health at Work accreditation for all central and local government organisations and their component parts (including hospitals and schools).

 Michael Baber