Government on naughty step for childhood obesity failures

The government’s lack of action on childhood obesity has been criticised in a recent inquiry, which has also called for a prompt demonstration of political will in order to make real progress, writes David Burrows

The first oral session of the House of Commons’ Health and Social Care Committee’s follow-up inquiry into childhood obesity considered whether the government’s childhood obesity programme is fit for purpose. Ministers, academics, and Public Health England (PHE) experts were quizzed.

The inquiry was closed when the election was announced, so let’s ignore the responses from ministers for now. However, Footprint has unpicked the rest of the session, to offer a flavour of what the holes in government policy are, how the food sector has to up its game, and where campaigners will be applying the pressure to whoever enters Number 10 next month.

What’s the current state of play?

Basically, there is lots of hand-wringing and myriad consultations but very little is being done, according to some of those quizzed. Professor Dame Sally Davies, chief medical officer until September 2019, summed it up:

“We have bold plans, but they will not get us where we need to go, and they have stalled.”

 Susan Jebb, professor of diet and population health at the University of Oxford, was even more damning:

“What this committee really needs to think about is why, despite the strong support from the public to take action, and despite the rhetoric we are hearing from government, when it comes to it almost nothing is happening. This is not a great geopolitical discourse. Some of these things are very simple, but government is choosing not to do them.”

Instead, the current government (as well as past ones) has been holding onto the hope that the food sector will come good on its own. Unfortunately, this is not the case.

Ditch voluntary agreements

Fingers were pointed at the sugar reformulation work in particular. Of the 20% reduction by 2020 target, Professor Jebb said bluntly:

“We are never going to get there. I think we are a bit too wedded to believing that somehow we can reformulate our way out of this problem. We have to do something to reduce the overall sales.”

 Representatives from PHE tried to defend the results, with the suggestion that some companies (and categories) are letting the side down. The poor data for the out-of-home sector came up (briefly) and there were pats on the back for categories such as breakfast cereals and yoghurts, but the feeling was still one of disappointment, according to PHE chief executive Duncan Selbie, who said:

“We are at 2.9% at year 2 and we were hoping to be closer to 10%.”

Of the 326 retailer own-brands and manufacturer brands in PHE’s report: 110 have shown a decrease in sugar of more than 2%; 62 (19%) have increased the sugar in their products; and 154 (45%) have made no change. The big concern, though, was that sales of sugar continue to rise. Selbie explained:

“Although products have less sugar in them, we are selling more of them. We can take the sugar out of the food but if industry is selling more food that has sugar in it, we are not going to see an improvement.”

 And Dame Sally added:

“What is happening is that some of them are reducing sugar in food, but through marketing more is being bought.”

Marketing: when less is more

Advertising restrictions are one of the most hotly debated policies. Again, there was little for industry to cheer. PHE chief nutritionist Dr Alison Tedstone highlighted the Advertising Standards Authority’s very recently released data on how the voluntary controls on social media and the internet aimed at children are doing:

“[The ASA] reported that there were 1,000 breaches within a fortnight, including by big-named companies. The voluntary controls certainly do not feel as though they are working.”

Tedstone also offered up some new information on the Transport for London (TfL) ban on the advertising of food on the London Underground:

“[TfL] has told us – and is happy for us to say it publicly – that it has had no loss of revenue through that ban. Healthier foods are being advertised.”

However, the general trend was for more and more advertising of junk food, it seems. Food manufacturers are apparently spending £300m a year on advertising unhealthy food compared with £16m on fruit and veg.

Caroline Cerney from the Obesity Health Alliance wondered whether the high-profile Veg Power campaign had already become a low priority. Citing recent research during ITV’s Britain’s Got Talent programme, she said:

“We … did not see any adverts for Veg Power, which is the initiative to get children to eat more vegetables, which ITV is very vocal in its support of. But it did not show a single one of the Veg Power adverts in a programme that is most popular with children.”

Professor Jebb also offered up the findings of a “lovely experiment” by Emma Boyland at the University of Liverpool:

“The researchers brought children into the laboratory and showed them some TV with an advert break in the middle. It was either for food or toys. Before the children went home, they were allowed to have something to eat. After they had seen the food adverts, they ate significantly more snacks than after they had seen the toy adverts. She then went on to show them particular branded adverts and showed that that specifically increased consumption of those branded foods.”

It’s too expensive to eat healthily

Well, actually it’s not, as Professor Jebb explained:

“One of the reasons why fruit and veg seem expensive is that chocolate and biscuits seem remarkably cheap.”

 The experts were under no illusions that pricing is a complicated business, but the fact that Britain’s food industry relies heavily on price promotions for junk food isn’t helping. Extending the sugary drinks industry levy to snacks is one area where pressure will be applied to the next government (and it will find it hard to resist given that the levy is being touted by many politicians as a big success).

Professor Jebb said increasing the price of, say, confectionery or other high-sugar snacks will likely result in a very significant reduction in purchases. In fact:

“You would get an effect that was probably more impressive and more helpful even than the sugary drink levy. As we have done with tobacco, price can also be used just to reduce overall sales. I would really urge you to think seriously about that option.”

Other policies could well have a smaller impact, but that shouldn’t mean they are cast aside. Nutritonal labelling, for example, can lead to lower-calorie purchasing but the impact is small. However, Professor Jebb’s opinion was that every little shift helps.

Calorie labels for menus

Where mandatory labelling could have a more significant impact is out of home. Professor Jebb said:

“[Studies] have shown a significant reduction. It may be that business, when it starts labelling the calories, polices itself to some extent and thinks: ‘Maybe that is not so acceptable, so I will offer a lower-calorie choice.’”

What happens next?

Well, an election to start with. However, no government will be able to avoid the issue of obesity and the little to no progress in recent years. The heavy reliance on voluntary approaches is also beginning to grate with those looking for action.

Dame Sally suggested that the industry needs to be given a fiscal boot up the backside:

Unless the industry knows that we are going to take action at the fiscal level, they will not move. We need to put them on notice now.”

The likes of Professor Jebb, Dame Sally and Cerney felt that the government’s approach relied on a light touches and heavy consultations. And the longer it took to implement some of the policies mooted in chapters 1 and 2 of the obesity plan, the harder the kick will be. Dame Sally warned:

“If we do it now, it will be less draconian than if we leave it to later. It is a bit like tobacco: the longer you leave it, the stronger you have to be.”

Cerney added: “… it is not about the evidence any more. It is about political will. It is about standing up and doing something – and doing it now.”

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