What are the health and economic implications for the UK of mass producing food high in sugar, salt, saturated fat and refined carbohydrates (S3RC)?
That’s the question we aimed to answer in our Healthy and Wealthy? Report – published in November 2015. We found that:
• Eating too much food high in S3RC is the single biggest cause of obesity – and increases the risk of diabetes, heart disease, stroke, some cancers and depression.
• What we (and our pregnant mothers) eat in the first 1000 days of life, from conception onwards, is particularly important for our long-term health and weight.
• The food industry provides jobs and tax revenue – but also costs the government lost tax revenue (through corporation tax and National Insurance avoidance strategies), increased welfare costs (where employees are low paid) and increased NHS expenditure (where poor diet leads to diabetes and obesity).
• However, producing healthier food provides competitive advantage for food companies and the industry has expertise in reformulation and advertising, new food technologies available and access to Corporation Tax relief for R&D – so the building blocks are in place for a successful transition to mass producing healthier food.
This led us to make four main recommendations i.e.
1. The government to convene a multi-partner task force to reduce pre-school obesity within the lifetime of a single Parliament.
2. To reduce adolescent obesity the government to set targets for reducing sugar in products (and sugar sweetened drinks in particular); to ban the online advertising of foods high in S3RC to children; and to set up arrangements for independent monitoring and assessment.
3. To enable adults to make healthy, informed choices in a less obesogenic environment the advertising budget for Public Health England to be set as a proportion of the commercial advertising budget for S3RC products; and local authorities to be given business rate discretion, to control the number of fast food outlets.
4. Current corporation tax relief on R & D for the food industry to be amended to prioritise the development of healthier food.
So where are we now, one year on from the publication of our report?
• Research suggests that salt contributes to obesity in more ways than originally realised. It doesn’t just make people thirsty and so liable to reach for a sugar sweetened drink. It seems that saltier food encourages people to eat more. It also appears to contribute to obesity in ways that are still being researched but which appear independent of thirst and energy intake.
• New developments in food technology are continuing, making it easier for companies to reduce levels of S3RC without affecting taste. In addition to developments we had flagged up, such as salt microspheres and flavour delivery particles (which provide the same taste with lower levels of salt and sugar), inulin (chicory root fibre) combines soluble dietary fibres and a neutral to sweet taste – providing the potential to reduce sugar and fat and to increase fibre in biscuits, cakes and cereal bars while providing prebiotic benefits for gut microbiota.
• The food industry is increasingly recognising the need to both develop healthier food and indicate which less healthy food should be eaten in moderation. For example the Food and Drink Federation has provided guidance to its members on reducing sugar in food and drink products while Mars has advised customers that some of its products, high in S3RC, like Dolmio sauces, should only be consumed once a week.
• Pro Bono Economics are undertaking more in depth research for us, to follow up our initial health economic assessment.
• The government’s Childhood Obesity Plan, published in August, has taken forward some of our recommendations i.e. it has set targets for the reduction of sugar in the food most frequently eaten by children, asked Public Health England to monitor and report on progress, and committed to a levy on sugary drinks. More action is still needed but this is at least a start.
In addition the Committee on Advertising Practice has announced restrictions on the online advertising to children of food high in sugar, salt and fat. This isn't a total ban but again is a step in the right direction.
This suggests that Healthy and Wealthy? was soundly based and that its recommendations suggest a positive way forward.
We will continue to work to try to ensure the mass production of healthier food, in line with our belief that prevention is better than cure.
Obesity is a clear and present danger. It is a growing threat to public health, the NHS, government finances and the economy – costing the UK over £45 billion a year according to a 2014 McKinsey report.
So what can we do to tackle obesity?
Our review of published research tells us there are two main causes of obesity:
• What we eat and drink, when, where and how. We are now consuming more sugary drinks and snacks, more ready meals and more takeaways and food from fast food outlets than ever before; and there is more ‘mindless’ overeating of this kind of food.
• The way we experience the early months and years of life has also changed - for instance fewer natural births, less breastfeeding and more babies born to obese parents. This also looks to be another potential cause.
The government has usually taken a softly softly approach - like moves to improve food labelling, to provide public health information or to encourage gradual, voluntary reductions in the sugar and salt content of food.
These seem to have helped slow the rise in obesity but not reverse it. Most interventions so far have provided temporary damage limitation – not a long term solution. So how can we get serious about tackling obesity?
Big problems need big solutions.
Here are Health Action Campaign's recommendations:
1. Personal Responsibility is important. We need to be clear that if want the NHS to remain a free, affordable public service that we each have a right to access then we each need to take some responsibility for looking after our health. Controlling our weight isn’t rocket science. We don’t need to pursue endless fad diets. We mainly need to eat a healthy diet.
And eating a healthy diet as parents, from conception onwards, can help our children grow up a healthy weight. Early life is a “critical period” when appetite and regulation of energy balance are programmed, with lifelong consequences for obesity risk.
However, if we want people to follow a healthy diet then we need to ensure the food and drink most widely available and advertised is healthy, from the high street to vending machines to home delivery,
2. The Food Industry has a vital role to play. When McKinsey reviewed ways of tackling obesity the three interventions they considered likely to have the greatest effect were portion control, reformulation and calorie rich availability. The food industry is key to achieving these three changes - and to making healthy choices the easy choices for consumers.
This would also help food companies to be seen as part of the solution rather than part of the problem, with all the positive consequences for the reputation of their brands.
3. Government also has an important part to play. Most politicians agree that vulnerable groups such as young children need to be protected. They already prohibit the sale of alcohol and cigarettes to children. To effectively tackle childhood obesity government needs to act to limit the advertising and availabilty of food for children which is high in sugar, salt, saturated fat and refined carbohydrates (S3RC).
4. Health professionals can also make a difference. Doctors and other health professionals know the health risks arising from obesity. They see patients throughout their lives, so are well placed to observe weight gain. And they are trusted by patients to give medical advice. So they too could potentially play an important role in helping tackle obesity.
However, we need to ensure they have the confidence and skills to address lifestyle issues effectively with their patients before they start to make them ill.
So we can reduce levels of obesity in the UK provided:
• We each take personal responsibility for managing our weight and the weight of our children
• The food and drinks industry helps make healthy choices the easy choices by making healthy food more widely available
• Government protects vulnerable groups (from young children to hospital patients) from exposure to unhealthy food and drink
• Health professionals are trained and supported to take a more active role, recognising that prevention is better than cure
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