Dolly Theis: Why Government policy on obesity affects us all

27 Oct

Dolly Theis is completing her PhD at Cambridge University’s MRC Epidemiology Unit.  She contested Vauxhall in the 2017 general election.

This article is the first of a mini-series of three about obesity policy that I have written for Conservative Home this week.

Today, I want to set the scene for you and explain why obesity policy affects us all.

Tomorrow I hope you’ll join me in an exploration of the Conservative Party’s own history, beginning with Sir Robert Peel, to find out what previous Conservative Party “greats” have done to help solve nutrition problems, and to see what we might learn.

Finally, I will set out why I think we have failed to tackle our broken food culture and system, and what I think Government should do going forward.

I am hugely looking forward to reading your comments, from the brutal to the thought-provoking. So without further ado, here is why I think obesity policy affects us all.

I have a strong image of my dream world. In this world, it would be easy for everyone to live a healthy life, regardless of where we live, our budget, our circumstances and, ideally, without having to think too much about it.

It would be easy to eat well, and to be fit and active. Indeed, it wouldn’t just be easy; it would be enjoyable too. In my dream world, we also wouldn’t judge people based on their weight, and we would all have a positive relationship with food.

Tragically, we currently live in a world where it is not easy for everyone to live a healthy life. For some, finding a meal is hard enough – so whether it is healthy or not is irrelevant.

We are all surrounded by constant reminders and/or opportunities to eat, mostly tilted in favour of unhealthier options – at the same time as being told that we need to lose weight, or feel we should aspire towards a certain body ideal.

We are then shamed, or may feel like failures, for not achieving this perfect body.  Or else we are celebrated for doing so, even if we reached it in an unhealthy way.

The more I listen to and read debates about food, health and body image, the more they confirm that my dream world, in which it is easy for everyone to be healthy, would help solve the situation.

So how could we get there? Before answering the question, let us explore the current situation further.

In England, 67 per cent of men, 60 per cent of women and more than a quarter of children aged two to 15 live with obesity, or are overweight.

Obesity and overweight are associated with many long-term physical, psychological and social concerns. A recent YouGov poll found that 46 per cent of British adults were “not very happy” or “not happy at all” with their body image, compared to just seven per cent who were “very happy”.

Pressure to achieve the perfect body has led to almost two thirds of British adults being on a diet “most of the time”, with between 1.25 and 3.4 million people in the UK estimated to suffer from an eating disorder.

We live in a world where the majority of people are not living a healthy life, and where far too many of us are unhappy with our bodies. I find this unacceptable.

I research obesity policy and, when I talk to people about it, many view obesity as being an inevitability of modern life – an issue of poor choice, bad parenting, a lack of education or less cooking.

But it is not. To understand and tackle the issue properly, we need to stop reinforcing these beliefs, and instead understand obesity as being just one of many consequences of our broken food culture and system.

Obesity is a stigmatising word – encouraging us to judge people based on their weight, and divide us up into those who are “the problem” and those who are not. It makes politicians squirm having to speak about the issue, for fear of offending people or being seen to tell us what we should and should not eat. However, obesity is an outcome of that unbalanced food culture. Indeed, this culture and system affects us all.

Food is everywhere. Not only in more obvious places like supermarkets, restaurants and cafes, but also in clothes shops, stationeries and pharmacies. We also see food in deliciously tempting photos and recognisable brand logos. Food adverts are on billboards and TV screens, online and in magazines, in sports venues and train stations.

So food cues surround us, yet we are mostly unaware of them. We don’t exactly go around counting the numbers of times we see a food advert or pass somewhere we could buy food.

However, where and how food is advertised and sold has a profound impact on our health, and so makes free choice-making very difficult, even if we believe that choice is technically present: there is a reason you can recite an entire list of crisp, chocolate and fast food brands without having to think too much.

Unhealthier foods are in the spotlight – despite the official UK national dietary recommendation for foods high in fat, salt and sugar (HFSS) being that these not needed in our diet, so should be eaten less often and in smaller amounts.

However, it is not easy to consume unhealthy foods in moderation when we are being purposefully drawn to them by targeted messages and easy availability. For example, Cancer Research UK analysed food adverts on major TV channels and found that around half were for HFSS products, increasing to almost 60 per cent between 6pm and 9pm. Fewer than five per cent of all adverts shown were for fruit or vegetables.

Despite reports showing people can have a cheap healthy diet (which, while true for some, is often based on unrealistic assumptions about people’s lives), research shows that in practice, healthier diets are more expensive.

This is partly because food policies favour the production, marketing and sale of inexpensive, high volume products such as highly processed foods.

When money and time are tight, people turn to these cheap, convenient and often unhealthier foods, which might be the only option for parents who quite literally cannot afford to have their children reject what’s put in front of them.

This imbalance has resulted in what many perceive as a vilification of unhealthy food – with the Government going after junk food. However, were our food culture balanced in favour of healthy foods, then I imagine that unhealthy products would not be vilified at all, since people would more easily enjoy them in moderation, which would reduce the damaging health effects we experience today, and we could all enjoy and celebrate them for what they are: treats, rather than day to day foods.

So how do we rebalance things in practice?

The Conservative Government under John Major during the 1990s first recognised obesity as a problem that it should seek to reduce.

In 1992, it published its Health of the Nation public health strategy, which included the first ever government obesity reduction targets: reduce the proportion of obese men to six per cent and obese women to eight per cent by 2005.

Clearly, these were not met. Indeed, 14 government obesity strategies containing almost 700 policies have been published since 1991 – yet obesity rates continue to rise.

This is due in part to four main problems:

  • Government has proposed hundreds of obesity policies during the last three decades, but many of these have never been properly implemented or evaluated
  • It struggles to reconcile its desire not to be interventionist with its responsibility to protect people’s health.
  • There has been a focus on telling individuals to change their behaviour without helping to create a context in which that is easy; and
  • Government lumps many different policies into the “obesity agenda” – despite there being an important distinction between them.

To solve points one, two and three, government should prioritise transparent policy implementation and evaluation. Most of the obesity policies proposed under David Cameron, Theresa May and Boris Johnson are still waiting to be implemented.

I believe that it is wholly unacceptable that policies are proposed, but not implemented and/or evaluated. Could you imagine the same happening in business – with Jeff Bezos saying “hey guys! I have this great idea for a delivery company”, but then never introducing it?

For those of you reading this article and thinking that government shouldn’t be intervening at all, there is an irony – namely, that it probably would’t need to be considering such interventions now if it had properly implemented and evaluated even a handful of policies proposed previously.

So how do we better hold government to account on this?

To solve my final point – that government lumps many different policies into the “obesity agenda”, despite there being an important distinction between them – there should be a distinction between “obesity policies” (i.e: targeted interventions aimed at helping people living with obesity, such as bariatric surger), and population health policies, i.e: policies that make it easier for the population to live a healthy life such as reducing the bombardment of unhealthy food advertising).

By referring to all policies as “obesity policies”, people not living with obesity may see these as “not my problem” – or may feel government is unfairly intervening in their lives, and is being anti-business if a policy affects them (for example, the Soft Drinks Industry Levy, also known as the sugar tax). Of course businesses – should make a profit.  But not at the expense of our health.

Introducing both obesity and population health policies would make it easier for everyone to live a healthy life. People living with obesity would receive effective and equitable treatment and support. They would then return to a context which facilitates and promotes a healthy life, thus making it easier to maintain their improved health.

Otherwise we risk Professor Sir Michael Marmot repeating his famous line: “What good does it do to treat people and send them back to the conditions that made them sick”?

The policies to deal with the problem are all in the 14 government strategies already published – from reducing the bombardment of unhealthy products while also increasing the provision, convenience and appeal of healthy products. Part One of Henry Dimbleby’s 2020 National Food Strategy is also one of the most comprehensive, “oven ready” policy packages ready for implementation.

We must stop searching for a magical solution, and instead begin implementing and evaluating policies that will help create a world in which it is easy for us all, regardless of circumstance, budget or where we live, to enjoy a healthy life without having to think too much about it.