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The Government ’ s latest obesity strategy received a £ 100m boost in March this year , as Boris Johnson upped his commitment to tackling rising rates in the UK . 1 But the promises of changes to food labelling and advertising and of new health campaigns mean much of the new strategy sounds all-too familiar . At a time when the obesity crisis has collided with Covid-19 to chilling effect , could we be missing a unique chance to imagine a radically different obesity policy ?
In the UK , obesity levels have been high for some time , but the health risks have been thrown into sharp focus by the pandemic . After his own serious brush with Covid , the Prime Minister pronounced : ‘ I had a very common underlying condition ... I was too fat .’
While experts have pointed out this is a rather simplistic way of looking at it , he is not alone in being overweight and not totally wide of the mark . According to NHS Digital , 63 % of adults in the UK are above a healthy weight 2 , while one in three schoolchildren leaves primary school overweight . 3 In July last year , Public Health England ( PHE ) announced that ‘ living with excess weight puts people at greater risk of serious illness or death from Covid-19 ’, affecting the respiratory system as well as inflammatory and immune functions . 4
‘ We knew very early on in the pandemic about the link between the severity of Covid-19 and obesity , the likelihood of ending up needing ventilation and , ultimately , the mortality risk associated with obesity ,’ says Dr Matthew Capehorn , a GP and clinical manager of Rotherham Institute for Obesity .
And being overweight does not just aggravate the threat of Covid-19 ; it also increases the risks of heart problems , cancer , liver and respiratory disease , and type 2 diabetes . Obesity-related illness costs the NHS £ 6bn a year . 5
Obesity policies miss the mark Obesity was first recognised as a population health challenge in England in 1991 . 6 The policy paper Tackling obesity : empowering adults and children to live healthier lives 7 , published in July 2020 , is the 14th such government strategy in England , yet obesity prevalence and associated inequalities have not been consistently reduced .
Given the complex causes of obesity , Dr Capehorn believes the policy may have missed a golden opportunity by concentrating on prevention rather than management . So will the latest funding injection go some way to addressing that ?
According to Dolly Theis , a researcher at the Centre for Diet and Activity Research at the University of Cambridge , the success of such policies ‘ is not just about the policy ideas as such , it ’ s also about the way they ’ re proposed ’.
In a recent article examining government obesity policies , Ms Theis found they were largely set out in a way that was ‘ unlikely to lead to implementation ; the majority were not interventionist and made high demands on individual agency ’. 6 Elements such as a time frame and an evaluation plan that would support implementation have also been largely absent . She adds : ‘ The approach has tended to focus on policies that try to get people to change their own behaviour , without necessarily shaping the environment to make it easier .’ She also says successive governments have not sought evidence from earlier unsuccessful strategies .
Tackling obesity does go further than earlier efforts , with the Government outlining measures to change the environment around us and make unhealthy foods less prominent – particularly those high in sugar , fat and salt . Meanwhile , two-thirds of the new £ 100m funding will go towards weight management services , and councils and service providers receiving grants will be supported and monitored by Public Health England .
Obesity-related illness costs the NHS £ 6 billion
a year
Children and obesity
The World Health Organization states that overweight and obese children are more likely to stay obese into adulthood and have a higher risk of developing cardiovascular and diabetes at a younger age . 14
In the UK , nearly a third of children aged between two and 15 years are overweight or obese , with younger generations becoming obese earlier .
Children from low-income families are more at risk of obesity . By the age of 11 , children from the poorest income groups are three times more likely to be obese compared with more well-off counterparts .
The Department of Health and Social Care launched Childhood obesity ; a plan for action in 2016 , updating it in 2017 . 15 Its main aims are tackling the amount of sugar in products , supporting businesses to make healthier products , providing support for low-income families to access healthier food , encouraging childhood physical activity , working with schools and nurseries to provide healthier food and enabling health professions to support families .
Obesogenic environment Today in the UK , we live in what has been termed an ‘ obesogenic ’ environment , where we are surrounded by unhealthy food that is convenient and relatively cheap . Every day we are primed to make unhealthy choices , often without even realising it .
Professor Susan Jebb , a nutrition scientist and professor of diet and population health at the University of Oxford , sees the latest policy as a step in the right direction .
‘ For most people , our biological stop-eating signals are just not strong enough . Our genes are essentially hungry genes that are designed to encourage us to eat , and [ historically ] that was a survival advantage . But now , we ’ re in a world where that ’ s not very helpful .’
She added , ‘ Everywhere you turn , there ’ s a food store . Even when you ’ re in your sitting room watching the television , there ’ s another advert for food . The obesity plan [ does say ], let ’ s get the food adverts off the television , let ’ s get them off online and let ’ s control the way food is promoted in supermarkets .’
From April 2022 , the Government will introduce restrictions on the promotion of less healthy food and drink in large retail stores , focusing particularly on products that are contributors to sugar and calorie intake in children . Calorie content will be printed on restaurant menus , and changes will be made to labels on food and alcohol to make calorie levels more visible . 8
Despite these planned changes , the policy will still rely on a high level of individual agency . There are also concerns that calorie labelling can be counterproductive . Eating disorders charity Beat has accused the Government of ignoring the lack of supportive evidence for labelling . 9
And the fact that healthier food is often more expensive 10 means making better choices can be difficult . Royal College of Physicians special adviser on obesity Professor Rachel Batterham , writing on the college ’ s blog , said : ‘ Access to healthy food should be a right and not a privilege . It is clear that socio-economic factors such as under-employment or poverty play a key role in driving obesity and poor health .’ 11
Prevention or treatment ? The reasons we become overweight are complex and are not only determined by environmental factors . Genes account for some of the predisposition to be overweight , and any government policy needs to take into account that for some , weight management will be a lifelong part of their health plan .
For Dr Capehorn , the proposed expansion of weight management services within the NHS is the key to reducing obesity . ‘ There ’ s far too much emphasis on trying to prevent obesity where the evidence just isn ’ t there that we can prevent it ,’ he says . ‘ There ’ s not enough emphasis on treating the individual . And we ’ ve got evidence on how to do that .’
Summer 2021 nursinginpractice . com