A couple of years ago the Economist Intelligence Unit produced a report entitled Confronting obesity in Europe: taking action to change the default setting. Over 30-odd pages it covers the challenges of producing workable, cost-effective policies to tackle an issue that has become deeply politicised. Of the 19 experts interviewed for the research, this comment from Dr Roberto Bertollini, chief scientist and World Health Organisation representative to the EU, stood out.
“We miss leaders who are able to have a vision,” he said. “We need to look at the long-term benefits for society and for individuals rather than to the wishes of the food and drink industry, while at the same time encouraging innovation.” The looming threat to public finances as Europe obesity crisis expands should be a clear incentive to tackle the problem aggressively, he added.
A year or so on from that report, in August 2016, the UK’s prime minister Theresa May unveiled her vision. “Childhood Obesity: a plan for action” had been a long time coming, but critics said it wasn’t worth the wait. Sure, there was a controversial tax on sugary drinks but aside from that there were no other obvious “aggressive” policies proposed. Instead, as campaigners argued at the time, this was a lightweight, voluntary-led plan that “inexcusably” omitted the expected restrictions on the marketing of unhealthy foods to children. There were also no mandatory sugar reformulation targets.
In the past six months, the plan has attracted a steady stream of criticism – not least when it was exposed that May had watered the proposals down when she succeeded David Cameron following last June’s referendum. Last week the latest attack came – this time in the form of a three-page analysis in the BMJ. The authors reinforce many of the points already made both during and after the strategy’s publication – not least the omission of advice from WHO’s experts as well as those at Public Health England. PHE, in its report to government in October 2015, made eight recommendations, and top of the pile was a reduction in the number and type of price promotions. This was followed by reductions and restrictions on the marketing of sugary food and drink to children and adults across all media. Neither featured in the final plan.
And yet PHE came out all guns blazing last week, clearly annoyed at the accusations made in the BMJ article. Chief executive Duncan Selbie suggested that too much time is being wasted on debating the pros and cons of the plan and it’s time to just get on with it. Meanwhile, the health minister Nicola Blackwood also offered up a refreshingly staunch defence of a strategy that was – it must be said – slipped out during recess and in the middle of the Rio Olympics. “No other country in the world has set such ambitious plans,” she said.
Perhaps true, but does this make the UK’s approach an effective one? Certainly not, according to the experts writing for the BMJ. They argued that the “severely limited” plan could be “considerably strengthened” by including evidence-based interventions, such as an industry levy on sugar-sweetened beverages, nutrient profiling to identify healthy and unhealthy foods, clearer food labelling, and promoting physical activity in schools.
The tax, as the Department of Health pointed out, is already part of the plan, as are new initiatives to incentivise exercise. It’s unlikely that there will be further work or regulation on marketing or promotions but labelling is an interesting one. The obesity plan mentions, specifically, teaspoons depicting sugar content as an option. The idea – backed by one of the country’s most powerful health food campaigners, the celebrity chef Jamie Oliver, but not to everyone’s taste – appears to be firmly on the prime minister’s radar.
Bigger, better, bolder?
Indeed, the food industry and health campaigners have not forgotten that this is reportedly “the start of the conversation”. The prime minister and her colleagues will already be acutely aware that it promises to be a long and difficult one, but the development of a wide-ranging package of policies to tackle obesity was never going to be straightforward. As the EIU’s experts concluded: “There is already a significant body of information about what works and which kinds of policies are less successful, but this knowledge has yet to fully inform national government strategies, in part because the intricacy of the problem clearly makes it difficult to build a broad vision.”
The critiques of the UK’s vision will keep coming. However, if they remain constructive there is always a chance that the 12-page paper can evolve into something bigger, better and bolder. Other European countries will therefore be watching every development very closely.