Demands for government intervention on obesity to help cut 'increased but preventable' COVID-19 death risk
Its proposals include bans on the advertising of unhealthy products, limits on fast food portion sizes, mandatory nutrition labelling and mandatory reformulation targets for salt, sugar and calories – all policed by a new independent food watchdog.
The proposals come ahead of the British Government’s imminent review which will analyse how factors including obesity, ethnicity, income and gender can affect the impact of the coronavirus on people’s health.
Britain has suffered a heavy toll from the pandemic, experiencing the second-highest rate of deaths per capita after Spain, according to the Financial Times and based on excess mortality figures. The government, however, said it was “wrong and premature to be drawing conclusions at this stage” and that excess deaths should be adjusted for age.
Action on Salt, meanwhile, maintained there is increasing evidence demonstrating that obesity is an independent risk factor for more severe illness and death from COVID-19.
It believes obesity is the major risk factor that can ‘potentially be modified meaning millions of people are living with an increased, but preventable, risk from COVID-19’.
“The current NHS treatments recommended for severe obesity are bariatric surgery, supported weight loss services, advice, and orlistat, which can be prescribed by a GP. Not all treatments are available or accessible,” it said.
“Beyond this, although there is an element of personal responsibility in both the treatment and prevention of obesity, this can only be equitably achieved with access to healthy, affordable food in an environment that supports the individual at every turn – not the current obesogenic environment within which we live. Long planned and vital governmental measures to address this have been delayed by food industry lobbying and have now been put on hold due to the COVID-19 outbreak, at a time when they have never been more necessary.”
It is urging ministers to act on previous government commitments to tackle the obesity crisis that the nation faced prior to COVID-19 and will “continue to face if government continue[s] to dither".
Katharine Jenner - campaign director of Action on Sugar and Action on Salt, Queen Mary University of London - said: “The British public are being failed by the food environment within which we currently live. Although there is an element of personal responsibility in both the treatment and prevention of obesity, this can only be achieved with equitable access to healthy, affordable food – this is far from a reality. It is even more critical than ever for the food and drink industry, including the hospitality sector, to stop flooding us with unhealthy food options to keep us healthy – both now and in the future.”
Action on Sugar has called for immediate government intervention on obesity to help prevent further deaths from COVID-19.
Among its proposals are to ensure ‘only healthy products are advertised and promoted’. According to the group, the advertising, price and placement promotions (such as end of aisles, point of sale) of more unhealthy foods and drinks ‘manipulates choice, creating an environment where products high in salt, sugar and/or fat are more desirable’.
It has called for fiscal measures to promote healthy food (with income ringfenced to subsidise treatments), as well as mandatory nutrition labelling. “The Soft Drinks Industry Levy has been successful in reducing sugar intakes via reformulation, and in raising much needed revenue for children’s services,” it said. “The current sugar levy thresholds should be reduced, the rates increased, and it should be immediately applied to a calorie threshold in sugar sweetened milk and milk-alternative drinks.”
It wants reformulation efforts to be policed by a new independent food watchdog. The current voluntary reformulation programmes have failed, it said, and it wants incremental mandatory reformulation targets set for salt, sugar and calories.
It also wants to make colour-coded signpost labelling mandatory on all food, drinks and alcohol sold in retail, and for the nutritional profile of processed food and drink to be improved via government implementation of portion size restrictions.
Graham MacGregor, chairman of Action on Sugar and Action on Salt, and Professor of cardiovascular medicine, Queen Mary University of London, said: “With data showing that 78% of coronavirus infections and 62% of hospital deaths occur in overweight or obese individuals – with Boris Johnson himself is reportedly to be concerned about his own weight with an estimated BMI of 36 – the government has a moral duty to intervene.
"Obesity is also the main underlining cause of type 2 diabetes which in itself is another potentially modifiable risk factor for more severe COVID-19. However, long planned and awaited governmental measures to address this have been unbelievably put on hold due to the COVID-19 outbreak, at a time when they have never been more necessary.”
Can these measures really help prevent further deaths from Covid-19?
Speaking to FoodNavigator, Professor MacGregor agreed there was 'no quick fix' to tackling obesity, and that the evidence was currently lacking to suggest reducing weight 'reduces the risk of infection or the severity of the infection with COVID-19'.
But he added: "There's a lot of evidence out there showing that eating a more healthy diet with less salt, fat and sugar, and particularly more fruit and vegetables, does give you a positive increase in your immunity and your ability to fight infection, an that's the same for exercise.
"You can't just lose weight tomorrow, but it's more the change in diet than the weight loss per se."
But is it wrong to blame the big food companies for the rising incidence of obesity? Should we be talking more about choice and personal responsibility instead of government intervention?
"The food industry makes very cheap, processed food that's stuffed with salt, fat and sugar. It then spends billions of pounds marketing and advertising it and making it available everywhere. The reason counties are becoming obese all over the world is not the fault of individuals," contended MacGregor.
“The food industry is to blame. They already know that and are taking action. Now we have a new COVID-19 pandemic which quite clearly is far worse in people who are obese. The food industry has created this environment and they need to do something about it. I think anyone reasonable in the food industry would agree."
What intervention measures is the group proposing?
- The introduction of guidance for identifying modifiable risk factors to improve understanding of the many causes of obesity
- Increased access and funding for bariatric surgery
- Increased access and funding for evidence-based weight loss support
- Measures to ensure that only healthy products are advertised and promoted
- The adoption of fiscal measures to promote healthy food (with income ringfenced to subsidise treatments)
- For nutrition labelling to be made mandatory
- Measures to ensure only healthy food is provided to key workers in their workplaces
- Incremental reformulation measures to improve the nutritional profile of processed food and drinks
- For the current sugar levy thresholds to be reduced, the rates increased, and applied to a calorie threshold in sugar sweetened milk and milk-alternative drinks
- The setting up a new, independent and transparent food watchdog
Fiscal measures that could be explored to enforce this could include:
- Reformulation Levy: for non-compliance with the reformulation targets within the sugar and salt reduction programmes and the overdue calorie reduction programme
- Energy Density Levy: for all calorie dense, nutritionally poor, processed foods
- VAT Reform/subsidies: Using the VAT system to promote healthy food, as defined by the new Nutrient Profile Model (NPM)