Obesity plan: game-changer or missed opportunity?

The prime minister has taken decisive action where his predecessor dithered and delayed, but questions persist over whether new measures to reduce obesity will tackle its root causes. Nick Hughes reports.

Boris Johnson wants to be remembered as a prime minister who got things done. In this respect, his government’s new obesity plan positions him favourably against his most recent predecessor.

The plan contains few if any new ideas but finally makes flesh a range of policies first proposed by Theresa May’s administration in 2016 which the former PM never quite had the conviction, or support, to act upon. Most significantly, it marks a decisive departure from a longstanding government position that self-regulation and personal responsibility are sufficient to turn the tide on obesity.

New laws will come into effect mandating calorie labelling in out-of-home settings and banning advertising of junk foods before the 9pm watershed. Buy one get one free (BOGOF) promotions are also for the chop as are unhealthy foods situated at checkouts and other prominent areas.

The irony of the timing will not be lost on businesses which, after four years wondering whether costly new rules would come into effect, now face the prospect of abiding by them at a time when the hospitality sector is on its knees due to coronavirus and a disorderly Brexit threatens future food security.

It’s little wonder that the response from the business community has been combative to say the least. The Food and Drink Federation (FDF) described the new plan as a “punishing blow” for food manufacturers. UKHospitality said it was a “slap in the face” for out-of-home businesses. The Advertising Association, whose industry is so reliant on revenue from food brands, declared itself “bitterly disappointed” with proposals it described as “misguided” and “unfounded”.

The response from health campaigners has been altogether warmer albeit with the caveat that the plan risks failing to address systemic drivers of obesity including poverty and the environment and circumstances people live in. Ben Reynolds, deputy chief executive of Sustain, said the inclusion of “world leading” restrictions on junk food advertising was “a real game-changer” although not “a silver bullet” for tackling obesity.

So what’s in and what’s still missing from the government’s new plan to make the nation healthier?

IN THE PLAN

Adults

One decisive shift is the explicit focus on adult rather than purely childhood obesity which was the focus of all three iterations of the previous government’s plan. The trigger for the shift in positioning is covid-19 and consistent evidence (reviewed in a report just published by Public Health England) showing people who are overweight or living with obesity who contract covid-19 are more likely to be admitted to hospital, to an intensive care unit and to die from the virus compared to those of a healthy body weight.

Labelling

The government pledged to introduce mandatory calorie labelling for the out-of-home sector in England back in 2018 but the policy never got beyond the consultation stage. Now it has been confirmed that new legislation will require large out-of-home sector businesses – including restaurants, cafés and takeaways with more than 250 employees – to provide calorie labels at the point of choice on the food they sell. Smaller businesses will be asked to voluntarily provide calorie information in the short term, although the government has said it will consider extending the requirement to include them in future.

The government has pressed ahead despite opposition from a majority of businesses that responded to the consultation. UKHospitality CEO Kate Nicholls warned that menu labelling could cost as much as £40,000 per menu run for some businesses, adding that the policy risked “stifling efforts to offer exciting and healthy meals to customers”.

The government claimed the majority of large businesses already have calorie information for their products and so the requirement would be “minimal”. However, a 2018 study published in the BMC Public Health journal found it rare for eating out and takeaway chains in the UK to provide point of choice calorie labelling and when labelling is provided it does not adhere to recommended labelling practices.

Businesses required to implement the changes, which the government said would not be required immediately, include restaurants, cafés, takeaways, bakeries and caterers as well as supermarkets, entertainment venues such as cinemas, and hotels where food is served. Workplaces, where a large catering company provides the food and drink on sale, will also be required to label calories; in-house workplace canteens where the food and drink on sale is solely for employees are excluded however. Calorie labels will be required on all items that are prepared and sold for immediate consumption by the final consumer including side dishes and toppings.

Businesses selling alcohol are not off the hook. The government said it plans to consult before the end of the year on its intention to make companies provide calorie labelling on all pre-packaged alcohol they sell. The consultation will also cover calorie labelling on alcoholic drinks sold in the out-of-home sector, for example bought on draught or by the glass.

Advertising and promotions

Pressure from campaigners to ban advertising of foods high in fat, salt and sugar (HFSS), has finally paid off despite fierce resistance from manufacturers and advertisers. The government cited Cancer Research UK analysis from September 2019 showing that almost half (47.6%) of all food adverts shown over the month on ITV1, Channel 4, Channel 5 and Sky1 were for HFSS products as evidence for introducing more stringent measures. It intends to ban HFSS products being shown on TV and online before 9pm by the end of 2022 and will also consult on introducing a total HFSS advertising restriction online.

BOGOF and other volume promotions which encourage over-consumption will also be banned for HFSS foods, although there is no mention in the plan of banning value promotions such as one-off price reductions. There will also be a ban on HFSS items being placed in prominent locations in stores, such as at checkouts and entrances, and online – measures that many retailers have already taken voluntarily.

The move polarised opinion among campaigners and business representatives. Katharine Jenner, campaign director at Action on Sugar and Action on Salt, expressed the NGO’s delight that “the government has finally recognised that these huge food and drink companies have not been acting in our best interests when they advertise and discount their heavily processed, high in fat, salt and sugar, food and drinks”.

However, Tim Rycroft, chief operating officer at the FDF said it was “extraordinary that the government is proposing a ban on promotions of food and drink in retail at such a precarious economic time”. Rycroft also made the point that the government’s new “eat out to help out” scheme that offers people 50% off a meal out in August amounted to the government “pulling in different directions” on promotions.

WHAT’S NOT IN THE PLAN

Reformulation

In spite of snail-like progress with voluntary reformulation programmes on sugar, salt and calories, exacerbated by covid-19, the government revealed no plans for them to be accelerated, extended or made mandatory. Instead, it said it would continue to work with businesses through existing programmes and remained committed to further action if results are not seen. Jenner described it as a “missed opportunity” that mandatory targets for reformulation were excluded from the plan.

Taxation

The government also resisted pressure to extend the soft drinks industry levy to other food and beverage items, including sugar-sweetened milk and milk-alternative drinks. Jenner said the omission was “absurd”, while chef and campaigner Hugh Fearnley-Whittingstall tweeted: “This is a good plan… [but] extending the sugar tax would have made it an even better one.”

Public procurement

Previous obesity plans have pledged to update government buying standards for food and catering services to favour healthy, sustainable foods. However, public procurement was not mentioned in the latest plan other than to note that the government would discuss how public sector procurement of food and drink can be improved as part of the national food strategy, the first part of which is due to be published this week.

A MISSED OPPORTUNITY?

The plan itself, while high on headline-grabbing policies, made little attempt to analyse the structural causes of obesity, focusing instead on piecemeal interventions. Adam Briggs, senior policy fellow at the Health Foundation, said there was “little sign of policies that will address the root causes of obesity”. He added: “A credible strategy would go further to modify the environment and the circumstances in which we live – the multiple factors that shape whether we can be active or eat healthily. It would acknowledge the role of economic and social factors like poverty and unemployment that drive poor health and inequalities, and the impact of year-on-year cuts to local authority budgets and social factors like poverty and unemployment that drive poor health and inequalities.”

Continuing the theme (and possibly seeking to deflect attention from advertisers), Sue Eustace, director of public affairs at the Advertising Association, said the proposed bans on HFSS advertising “will not solve the structural inequalities linked to deprivation that cause higher rates of obesity among people, just as attention-grabbing new regulations will not undo decades of under-investment in targeted and community-based health initiatives”.

With this new plan Johnson has shown himself to be a man of action on obesity. However, the question of whether he is a man of detail and long-term vision remains unanswered.

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