Evidence that weight is a risk factor for Covid-19 has led campaign groups to push for a more ambitious anti-obesity drive. Will a looming recession scupper their proposals? Nick Hughes reports.
What a difference a year makes. Back in July 2019 BC (before Covid-19), when Boris Johnson was campaigning to be Conservative leader and de facto prime minister, he made headlines with a promise to review so-called “sin taxes”, including the Soft Drinks Industry Levy (SDIL).
Ever the political weathercock, Johnson had no doubt calculated the pledge would help curry favour with the many free marketeers within his party whose support would be key in smoothing his path to Downing Street.
Now, following a brush with death from Covid-19, the PM has reportedly changed his mind and is supportive of a renewed drive to tackle obesity.
Johnson is said to believe his own weight contributed to his hospitalisation with the deadly virus. The early evidence suggests he is right, with data showing that 78% of those infected and 62% of hospital deaths caused by Covid-19 are in overweight or obese individuals.
Last month, the government announced a review into how different factors – including obesity – can impact health outcomes for people with Covid-19. Assuming the results back up the initial studies, the review is likely to provide further impetus behind a policy rethink.
Johnson’s U-turn is significant as it comes at a time when the UK’s public health resources are being diverted to tackle the virus to the detriment of existing work on non-communicable diseases. Last month, Footprint revealed that Public Health England has paused work on its underperforming sugar-reduction programme and its already delayed calorie and salt programmes until normal business is resumed.
With a host of other policy commitments yet to be delivered campaigners have seized on the link between Covid-19 and obesity to push for a new approach.
So what are they asking for and how likely are they to get what they want?
Action on Sugar and Action on Salt have led the charge with a 10-point plan to treat and prevent obesity, which affects almost one in three British adults. Students of previous obesity plans will be familiar with the themes, with junk food advertising, calorie labelling, and public sector food provision all in the line of fire.
Where the campaign groups have been particularly clever is in aligning their asks with existing commitments set out in the government’s own childhood obesity plan (chapter two) and Advancing our Health green paper (which served a dual purpose as chapter three of the plan), many of which have yet to be delivered.
Four of the recommendations focus on the treatment of obesity, but it is the six that concern prevention that merits the close attention of food businesses. The first calls for a ban on advertising any food high in fat, salt or sugar (HFSS) alongside restrictions on promotions on HFSS foods. Both measures were set out in the childhood obesity plan and both were consulted on over a year ago, but in both cases the government response has yet to be published.
Another recommendation is for the government to adopt fiscal measures to promote healthy food. This includes the extension of the SDIL to include sugar-sweetened milk and milk-alternative drinks, an exemption HM Treasury has previously promised to keep under review, as well as financial penalties for failing to meet mandatory (not voluntary) reformulation targets.
Campaigners also want calorie labelling to be made mandatory for the out-of-home sector, legislation that was promised in the childhood obesity plan and subsequently consulted on, yet remains on ice.
Public sector food provision is also on the agenda. Campaigners want the government to ensure all food provided to key workers in their workplaces is healthy in line with the Government Buying Standards (GBS). Last year, the Department of Health and Social Care (DHSC) consulted on strengthening the nutrition standards within the GBS to bring them into line with the latest scientific dietary advice. However, the current standards are only mandatory for central government departments and their agencies and remain voluntary across the wider public sector.
Out-of-home businesses should also be subject to new planning restrictions, campaigners claim, that make it more difficult to open unhealthy food outlets by using a ‘nutrition rating scheme’ monitored by a new food watchdog. The government has previously stressed that councils have the power under the National Planning Practice Guidance to limit over-concentration of fast-food takeaways, particularly around schools. However, research published last year by Sustain found that fast-food giants like McDonald’s and KFC continue to eye up hundreds of new sites, while local authorities lack the capacity to provide adequate evidence to stand up to the resources of multinational chains.
On the surface, the recommendations appear reasonable, aligned as they are with the government’s own obesity plans. But the landscape has changed. Just as Covid-19 has highlighted the need to tackle obesity, the economic damage wrought by the UK’s lockdown means those businesses that policies seek to target are fighting for their survival. For calorie labelling alone, the DHSC’s own impact assessment calculates a total cost to out-of-home businesses of £290m. This level of cost will be hard to stomach for operators whose income disappeared overnight back in March.
Action on Sugar and Action on Salt acknowledge the impact the virus has had on the out-of-home sector, although they add that large, multinational food companies have been able to reopen, largely in more deprived areas and with limited menus that predominately feature HFSS products.
Yet despite the prime minister’s apparent Damascene conversion to the obesity cause, it remains to be seen how politically acceptable it will be to force through burdensome and costly new rules for food businesses as the UK looks set to enter the deepest recession since the Great Depression (and possibly worse than that).
Campaigners, on the other hand, believe the cost of inaction is greater still. Graham MacGregor, chairman of Action on Sugar and Action on Salt, and professor of cardiovascular medicine at Queen Mary University of London, describes it as “unbelievable” that outstanding government measures have been put on hold at a time when they “have never been more necessary”, adding that the government has a “moral duty to intervene”.
Katharine Jenner, campaign director of Action on Sugar and Action on Salt, adds that the British public are being failed by the current food environment. “Although there is an element of personal responsibility in both the treatment and prevention of obesity, this can only be achieved with equitable access to healthy, affordable food – this is far from a reality,” says Jenner. “It is even more critical than ever for the food and drink industry, including the hospitality sector, to stop flooding us with unhealthy food options to keep us healthy – both now and in the future.”
Ultimately, the decision will rest with Johnson and his senior ministers and advisers. Has his brush with death really changed his view on obesity? Or on this weighty issue, is there fat chance of the PM changing his spots?