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.
This letter was published in The Times letters page on 6th February, with Health Action Campaign as a signatory, as a member of the Obesity Health Alliance.
As representatives of the Obesity Health Alliance, a coalition representing over 35 leading health organisations and medical royal colleges, we strongly challenge the partnership between the Premier League and Cadbury.
Over a third of children are overweight or obese by the time they leave primary school, setting them up for a lifetime of poor physical and mental health.
It is our concern that the partnership will create an association between healthy lifestyles and unhealthy foods, such as sugary confectionery which is a key driver of obesity, and are particularly concerned about the impact this may have on our children’s diets.
We need the Government to take action to plug the loopholes in existing regulations. We all have a duty to protect children from junk food marketing, including family TV programmes before 9pm, digital media and sports sponsorship.
John Maingay, Head of Policy & Public Affairs, British Heart Foundation
Professor Parveen Kumar, Board of Science Chair, British Medical Association
Professor John Wass, Special Advisor on Obesity, Royal College of Physicians
Helen Dickens, Head of Prevention and Engagement, Diabetes UK
Professor Simon Capewell, Vice President for Policy, Faculty of Public Health
Professor Russell Viner, Officer for Health Promotion, Royal College of Paediatrics and Child Health
Alison Cox, Director of Prevention, Cancer Research UK
Malcolm Clark, Coordinator, Children’s Food Campaign
Dr Modi Mwatsama, Director, Policy and Global Health, UK Health Forum
Robin Ireland, Chief Executive, Health Equalities Group
Andrea Crossfield, Chief Executive, Healthier Futures
Lesley McCormack, Founder/Chief Executive, HOOP UK
Caroline Moye, Head of World Cancer Research Fund
Linda Cregan, Chief Executive Officer, Children’s Food Trust
Jenny Rosborough, Campaign Manager, Action on Sugar
Michael Baber, Director, Health Action Campaign
Martin Tod, Chief Executive, Men’s Health Forum
Andy Burman, Chief Executive Officer of the British Dietetic Association
Anna Taylor OBE, Executive Director, The Food Foundation
Dr Liam Brennan, President of the Royal College of Anaesthetists
Dr Andrew Furber, President, The Association of Directors of Public Health
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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