Recent announcements hint at a softening of government plans to tackle obesity, with an emphasis on personal responsibility rather than industry regulation. Nick Hughes reports.
These are pivotal times for obesity policy in England. With Public Health England in the process of being wound down and its health improvement work due to be subsumed into the Department of Health and Social Care (DHSC) via a new Office for Health Protection, fresh questions are being asked about the intentions of a government that has talked a good game on “tackling the obesity time bomb” through greater state intervention, but has largely failed to implement measures that might actually defuse it.
The case for decisive government action was strengthened in March by new research showing one of the few obesity policies to have been delivered in recent years – the soft drinks industry levy (SDIL) – has been a roaring success, reducing household sugar intake by 30g a week.
But a change of tone in recent government health announcements has hinted at a return to a more hands off approach that puts the onus on the public to make their own healthier choices.
It all begs the question: is the current government for regulation, or against it?
Intervention for prevention
In July last year, following a deadly first wave of covid-19 for which obesity was identified as a key risk factor, the government set out a range of interventionist policies in its obesity strategy. These included mandatory out of home calorie labelling, a ban on volume promotions of unhealthy foods as well as a ban on ‘junk’ food adverts before the 9pm watershed.
Commitments to deliver these proposals remain intact, although they haven’t yet made it into the statute book. Then last week, The Sun reported that a proposed online ban on junk food adverts was to be scrapped, quoting government insiders as saying its impact would be disproportionate on businesses.
This seems to chime with a renewed emphasis on healthy lifestyles in recent government announcements, which in turn suggests that criticism of the scope and timing of new regulations from elements of the food industry are starting to cut through in Whitehall.
Back in February, the DHSC published a whitepaper setting out proposals to overhaul health and social care. In it, the government talked of placing a greater focus on “lifestyles, on healthy behaviours, prevention and helping people live more independent lives for longer”, language that recalled the light-touch ‘nudge’ philosophy favoured by David Cameron during the coalition years.
Then in early March, the government announced the appointment of Sir Keith Mills, the brains behind Nectar points and Airmiles, to advise on developing a new ‘fit miles’ approach that will use incentives and rewards to support people to eat better and move more as part of a wider £100m funding package to support children, adults and families achieve and maintain a healthier weight.
“Somersaults of joy”
For parts of the food industry that have been fighting a rear-guard action against new health regulations, this was the kind of language they have long been waiting to hear. The Grocer reported that food and drink industry leaders were doing figurative “somersaults of joy” at news of the fit miles scheme. High-profile cardiologist Dr Aseem Malhotra, on the other hand, dismissed it as a “massive gimmick which will do nothing whatsoever to tackle obesity”.
The Food and Drink Federation (FDF) in particular has become increasingly desperate in its tactics to stave off the threat of regulations restricting the sale of unhealthy foods. Following confirmation of plans to ban Bogofs and other volume promotions on foods high in fat, salt and sugar (HFSS) from April 2022, the FDF commissioned a survey on consumer attitudes towards promotions. It subsequently put out a press release in February provocatively titled: ‘Bogof! Consumers warn government off meddling with food and drink promotion’, which included the finding that “nearly three quarters of participants (72%) want promotions to continue, finding them useful for saving money, stock[ing] up on food for the future and trying new products”. The problem was that neither the survey questions nor press release made clear that the intended ban was only on products classified as unhealthy under the government’s nutrient profiling model and that healthy promotions would be permitted, and even encouraged. Health campaigners suggested privately that the research was “grossly misleading” (when I raised this point with the FDF they rejected it).
The issue facing the FDF is that retailers and their representatives have not weighed in publicly in its support. Indeed, Tesco’s recent commitment following investor pressure that 65% of its sales will come from healthy products by 2025 suggests it has little interest in trying to halt a policy that will, if anything, help it achieve its target by creating a level playing field for competition on promotions and hastening product reformulation by manufacturers keen to circumvent the ban.
Soft drinks success
The hand of those in favour of regulation has been strengthened further by new evidence that the SDIL –another subject of fierce industry opposition – is doing its job in reducing average sugar consumption (in stark contrast to voluntary reformulation programmes). Research published in the British Medical Journal this month showed that one year after implementation the SDIL was associated with a weekly reduction of 30g per household in sugar purchased from soft drinks that were taken home, compared with the expected amounts had the SDIL not been introduced. This is the equivalent of each person replacing one 250ml serving of a sugary drink every week with a sugar-free alternative.
Significantly, the ban has not had an impact on total volume sales of soft drinks, thereby negating timeworn arguments that so-called ‘sin’ taxes are inherently anti-business. The researchers went on to suggest that sugar consumption could be reduced further by extending the tax to include confectionery and other high-sugar foods.
What comes next?
Where all of this leaves obesity policy is hard to unpick. Last week, the government revealed that a new Office for Health Promotion “will lead national efforts to improve and level up the health of the nation by tackling obesity, improving mental health and promoting physical activity”. An expert lead will report jointly into the health secretary, Matt Hancock, and the chief medical officer, Chris Whitty.
The Royal Society of Public Health immediately expressed concern that the scope of the new body appears narrowly defined, with a focus on prevention of ill-health rather than health creation. “We shall miss an important opportunity if the Office for Health Promotion concentrates on individuals and lifestyles when the evidence shows that the most effective health promotion levers are at the fiscal, tax, planning, societal and environmental levels,” said RSPH chief executive Christina Marriott.
By the end of 2022 we could still realistically be in a situation where calorie labelling on menus – and possibly even alcohol – is mandatory; volume promotions of HFSS products are banned along with adverts for such products online and on TV before the 9pm watershed; and 'traffic light' front-of-pack nutrition labels are mandatory for packaged foods. We might even see a sugar tax extended beyond soft drinks to other foods and beverages.
But equally, we might see none of these things. Boris Johnson, who fronted last year’s obesity strategy after his own brush with covid-19, is a political chameleon. It doesn’t take a huge leap of imagination to foresee a period during which proposed regulations are quietly watered down or dropped entirely.
Perhaps we’ll end up somewhere in-between, with the scale and speed of the industry recovery from covid-19 and Brexit a possible determining factor in the government’s willingness to impose new legislation on businesses. Hospitality sector leaders have already made clear that proposed new calorie labels for alcohol and menus would be burdensome to companies at a time when they are trying to recover from the impacts of the pandemic.
What we can say with certainty is that where obesity policy is concerned, the government is yet to fully remove its mask.