Food environment ‘undermines’ weight-loss efforts: 'It’s just not about willpower or self-control'

The UK has among the highest obesity levels in Western Europe, with two in three adults overweight or obese. Obesity rates in UK primary school children also saw their ‘highest annual rise’ in 2020-21' statistics collected for the National Childhood Measurement Programme revealed. Obesity in four- and five-year-olds in reception classes rose to 14.4% in 2021, compared to 9.9% the year earlier. Among pupils in year 6, aged 10 or 11, obesity levels increased to 25.5% from 21%.

These figures can be linked to the food environment in which individuals operate, new research highlights.

The British food environment – where people buy and eat food outside of the home as well as the advertising and promotions they are exposed to - ‘actively undermines’ people’s attempts to lose weight and maintain a healthy body mass index, according to the conclusions of a systematic review from the National Institute for Health Research (NIHR) Obesity Policy Research Unit.

The review contends that the ‘ubiquity and appeal’ of unhealthy foods mean people actively trying to lose weight are forced to avoid parts of the food environment – an isle in the supermarket, the work canteen, or certain social situations - to steer clear of temptation. 

“This review highlights not only how difficult it is to lose weight in Britain, and keep it off, but also that it’s just not about willpower or self-control: even people trying really hard are thwarted in their efforts by unhealthy food options that are everywhere – they’re easy to find, cheap to buy, quick and appealing,”​ Kimberley Neve, co-author of the review and Research Assistant at the Obesity Policy Research Unit, Centre for Food Policy, City, University of London, explained.

The link between obesity and price

Price is an important issue linking diet and health outcomes. The review found that the relatively lower cost of unhealthy food options – which they said was either perceived or actual – makes weight management particularly difficult for people on a low income. The researchers stressed that unhealthy food is also more frequently on promotion than healthier options.

Government data would seem to confirm this conclusion, with National Childhood Measurement Programme research pointing to deepening health inequalities in the UK. According to the official data, the prevalence of obesity was more than doubled for children living in ‘the most deprived areas’ at 20.3% versus those living in the ‘least deprived’ at 7.8%.

Meanwhile research released last year by the Institute for Public Policy Research also underlined the link between childhood obesity and poverty. The think-tank concluded that if health outcomes across the country matched those in more affluent areas, such as the home counties and parts of London, around 40,000 fewer 10- and 11-year-olds would be overweight or obese.

Policy recommendations

The NIHR peer-reviewed publication suggested that the use of ‘well-designed’ weight management services will have a ‘limited impact’ on long-term weight loss and maintenance efforts if the Government fails to employ ‘effective policy’ that addresses the food environment.

The systematic review included 26 studies that focused on people’s experience of losing weight, or maintaining weight loss in their normal, every-day environment. These were published between 2011 and 2020 from across 12 high-income countries and included the accounts of 679 adults. The ‘relatively small number’ of relevant studies included reflects a ‘general paucity of evidence in this important research area’, the researchers noted.

The NIHR Obesity Policy Research Unit released a series of what it termed ‘key’ recommendations for policy makers to address issues in the UK food environment:

• Shift the balance so that there are more promotions and offers on healthy foods, such as fruit, vegetables and nuts, and fewer promotions and offers on ‘High in Fat, Salt and/or Sugar’ (HFSS) foods;
• Support businesses and the public sector to provide healthier options in the workplace for both lunchtimes and social occasions;
• Provide clearer labelling on foods detailing portion sizes and nutritional information;
• Restrict marketing on HFSS food and drink;
• Develop incentives for the introduction of more fast-food outlets selling healthy options, particularly around popular work locations;
• Provide sustained financial support for those at the lower end of the socioeconomic spectrum to make healthy food access more equitable;
• Ensure weight management services recognise the significant impact of the food environment on the people they aim to support and build strategies around food shopping and social occasions into all programmes.

Will new HFSS rules alter food environment? 

To an extent, some of these suggestions will be addressed with the UK implements new HFSS restrictions later this year.

From October, HFSS food and drink products - as defined by the Department of Health’s Nutrient Profiling Model - will be banned from prominent positions in store, such as end of aisle; they will no longer be sold on volume-based promotions, such as buy-one-get-one-free; and their advertising will be prohibited before a 9pm watershed.

Industry experts expect these changes could have a negative impact on sales trends in some HFSS categories. According to Kantar Worldpanel, the proportion of UK take-home food and drink sales affected by ‘in scope’ HFSS products stands at around 15%, which equates to £17bn of annual spending.

A recent investor note from Barclays Capital analyst Warren Ackerman highlighted that the UK regulation is likely to impact HFSS categories in different ways, with manufacturers able to reformulate expected to up their game.

“We would expect to see significant product reformulation from manufacturers. A category such as cereals has seen a lot of reformulation already, so that many products can now be classified as non-HFSS. However, there are some product types, such as chocolate bars, where reformulation will struggle to ensure compliance without undermining customer acceptance of the product,”​ he noted.

But, according to the University of London’s Neve, this more interventionist approach to the food environment is necessary to support the kind of long-term dietary change that is needed to address the obesity crisis in the UK.

“The narrative needs to shift so that instead of going on the usual January diet, people ask for a food environment that supports them to be healthy. For that, you need policy to level the playing field for industry to start making changes,”​ she argued.

Source​
'How does the food environment influence people engaged in weight management? A systematic review and thematic synthesis of the qualitative literature'​
Obesity Reviews​
DOI: 10.1111/obr.13398
Authors: Kimberley L. Neve, Anna Isaacs