Childhood obesity: meet the new plan, same as the old plan

The government’s new research unit looks suspiciously like it was cobbled together to head off claims of inaction, writes David Burrows.

Twelve months ago the UK government slipped out its long-awaited plan to tackle childhood obesity. The document represented “the start of the conversation, rather than the final word”. It ran to 13 pages and suffice it to say health campaigners were not impressed.

“It is an insulting response to the UK crisis in type-2 diabetes, both in children and adults,” said Prof Graham MacGregor, the chairman of Action on Sugar and Consensus Action on Salt and Health, at the time. “This will bankrupt the NHS unless something radical is done.”

But aside from the levy on sugar-sweetened drinks and the publication of technical guidelines for the voluntary 20% sugar reduction targets in nine food categories, there has been little of substance to appease the plan’s increasingly vocal (and numerous) critics in the past year.

Until 18th August. On the plan’s first birthday, the Department of Health and Public Health England (PHE) announced a new £5m obesity research policy unit. But was this (principally) an announcement hastily cobbled together and rushed out to head off the expected – and, some argue, justified – “one year on and nothing’s happened” headlines?

Perhaps. The two press releases accompanying the announcement are short on detail, with both saying pretty much the same thing. Among the new unit’s priorities is the development of a “deeper understanding on the causes of childhood obesity, including marketing to children and families, social inequalities and the early years of childhood”. But first it’s likely to look at excess calories as the government sets about expanding its focus beyond sugar.

“A third of children leave primary school overweight or obese and an excess of calories – not just excess sugar consumption – is the root cause of this,” explains the PHE chief executive, Duncan Selbie. “We will work with the food companies and retailers to tackle this as the next critical step in combating our childhood obesity problem.”

PHE will publish its evidence in early 2018. Then it will consult with the food industry, trade bodies and health groups to develop guidance and timelines for the calorie reduction programme. The aim is to make everything from burgers and pizzas to snacks and sandwiches healthier, principally through a programme of industry-led reformulation and resizing.

Sound familiar? This was the calorie reduction pledge from the responsibility deal, scrapped in 2015: “We will support and enable our customers to eat and drink fewer calories through actions such as product/menu reformulation, reviewing portion sizes, education and information, and actions to shift the marketing mix towards lower calorie options. We will monitor and report on our actions on an annual basis.”

Just 43 companies signed that pledge; many of the big ones, admittedly, but details of their progress in reducing calorie intake remain sketchy. And that’s the inherent problem with voluntary schemes: only the usual suspects sign up, making any assessment of progress at a national scale almost impossible (the DoH has previously admitted as much).

Manufacturers have said they are up to the challenge. “Our industry has a proud track record of reformulation to remove salt, fat and sugar from food and drinks,” said the Food and Drink Federation. But how about caterers, restaurants and hospitality businesses?

During the responsibility deal, engagement proved a perennial problem – whether it was the big high-street brands or the small family-owned takeaways. “We need much more traction from the out-of-home sector on the high street,” said Jo Newstead, then the Food Network lead for the deal at the DoH, at a Footprint roundtable in July 2014. “The contract caterers have been better.”

This reluctance has continued during the initial stages of the childhood obesity plan. In September 2016, it was reported that the health secretary, Jeremy Hunt, was going after the out-of-home sector. In a private meeting, details of which were leaked to the Times, Hunt said: “We can’t ignore the changing habits of consumers. This means we expect the whole of the out-of-home sector – coffee shops, pubs and family restaurants, quick service restaurants, takeaways, cafes, contract caterers and mass catering suppliers – to step up and deliver on sugar reduction.”

Selbie reiterated the need for a “level playing field”, according to the Press Association’s account of the meeting. It’s a message the Food and Drink Federation and British Retail Consortium are also pressing – and perhaps for good reason. In April, PHE admitted that it had found it tricky to obtain data on sales, nutritional information and portion sizing from the out-of-home sector as it prepared details of the sugar reduction targets. Only two firms (JD Wetherspoon and Mitchells & Butlers) provided all the data needed.

The others can’t keep hiding for long – the staggering growth in food-to-go and home delivery has put the spotlight firmly on the sector. The food industry experts IGD said this month that the UK’s food-to-go market is worth £17.4bn, and will rise to £23.5bn by 2022. Meanwhile, data published by the information company NPD Group in March showed the delivery channel was worth £3.6bn in 2016, up 6% compared with 2015 and 50% against 2008. App-led services such as Deliveroo, Just Eat and UberEATS helped demand for home deliveries to rise 10 times faster than dining out last year.

“Going out to eat is no longer a treat,” said Hunt. “It’s a regular habit for many families and is contributing significantly to the extra calories and sugar that we all consume on a daily basis.”

His intention, reportedly, is to make the efforts of companies publicly available. It’s not an approach the government has been comfortable with in the past – naming and shaming those not pulling their weight runs contrary to the “friendly approach” on which voluntary schemes in the past have been based. Nevertheless, as pressure mounts and inaction continues, ministers’ patience will only stretch so far.

The government can’t escape its own idleness, either. The new obesity unit may well have provided a few positive headlines and doused the flames campaigners tried to fan, but concerns persist over the direction of the plan. The healthy ratings scheme for primary schools should be in place next month, but no details have yet emerged from the Department for Education. And where is the promised campaign to encourage all academies and free schools to meet the School Food Standards, or the revision of those standards to meet new nutritional guidance?

“This list of inaction goes on,” explains Malcolm Clark, the coordinator of the Children’s Food Campaign (CFC). In order to bring recalcitrant departments into line there needs to be “proper Cabinet Office or prime ministerial leadership and oversight of the plan”, he says.

This was a plan that David Cameron wanted to make his own – a legacy, even (having failed to deliver his promised “greenest government ever”). “It took ages to convince [David Cameron] on this kind of stuff,” one source told Footprint recently. “It’s very personal, but he got comfortable with the idea that it was time to intervene.”

But the Brexit vote put paid to his premiership and, it appears, any hopes of a robust strategy. Theresa May, together with her close-knit team of advisers, wasted no time in tearing up her predecessor’s plans and distancing herself from the policies. The lack of PR surrounding the strategy’s publication this time last year was code for “we don’t give a f***”, suggested Jamie Oliver this month. “What [Theresa May] did was awful, how she did it was awful,” the celebrity chef told the Sunday Times magazine. “When I saw Cameron running those sessions, he had legit people debating the right thing.”

So, after only 375 days, is it too early to suggest that May and her government have got it all wrong?

Or, given time, will the package deliver on the (vague) commitment to “significantly reduce England’s rate of childhood obesity within the next 10 years”?

Yes and no: it would indeed be premature to call the strategy a dud, but the way in which it picks and mixes the recommendations of PHE could severely limit its effectiveness. Discarding proposals to tighten up the marketing and promotion of junk foods is seen as the major flaw in the current strategy. “We can’t ignore the fact that the food industry continues to get away with bombarding children with adverts that we know encourage unhealthy food choices,” says Caroline Cerny, the lead at the Obesity Health Alliance.

Under rules that came into force last month, ads for high fat, salt and sugar (HFSS) products are banned from all children’s media, including YouTube, Facebook and Twitter. Restrictions are already in place for TV, and the Committee on Advertising Practice claims that expanding them to online “will mean a major reduction in the number of ads children see for HFSS products”.

But campaigners have said the rules don’t go far enough, not least because they still fail to manage exposure during popular family shows such as The X Factor. The World Health Organization, the World Bank and Europe’s health ministers have all raised concerns about the aggressive and sophisticated way in which marketers target children with junk food ads. Is it time for regulation?

In a recent (unpublicised) report, the Bank said the way in which HFSS products are pushed can “undermine the normal processes of appetite control, cause overconsumption, and therefore obesity, and diseases associated with obesity”. Government needs to step in, the authors said: self-regulation is a “highly risky approach” and should “be accompanied by other measures including regulatory actions by the government to enforce certain restrictions”.

Linda Bauld, a professor of health policy at the University of Stirling, said: “The [UK] government recognises that junk food marketing directly impacts children’s diets and obesity, but its rules to stop it don’t work. They haven’t been updated for a decade and are riddled with loopholes.”

Like others, she believes this is “jeopardising good progress in other areas”.

In order to tackle obesity a number of policy levers need to be pulled, but loosen the grip on one and it becomes harder to make the others work. “Companies can make all the lower-sugar sweets they like,” said Bauld, “but if kids are bombarded by adverts for them, large amounts will still end up in our baskets and bellies.”

The childhood obesity plan is not grade-A material, but it’s unclear whether there is a plan B in place. If anything, this month’s announcements offer further proof that this is the responsibility deal repackaged and now reliant on a tax on sugar-sweetened drinks. As Clark suggests, the policies in place amount to “thin gruel” rather than a “world-leading plan”. And all the while children are getting fatter.

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