Andrew Moscrop: Deprivation and the failure of Boris Johnson’s covid-19 weight loss plan

“If we all do our bit,” said Boris Johnson, launching a Government strategy to tackle obesity during the summer of 2020, “we can reduce our health risks and protect ourselves against coronavirus—as well as taking pressure off the NHS.” Following his own coronavirus scare, the prime minister appeared eager to get the nation to lose weight. An online video showed him walking his dog around the grounds of Chequers and referring to his personal battles with obesity and coronavirus.

But a new report by a cross-party think-tank suggests that Government messages on weight loss and coronavirus have done little to help people with obesity address their condition. So what was wrong with Boris Johnson’s coronavirus weight loss plan?

“The evidence is now in: obesity can double your chance of dying from coronavirus,” said NHS England’s chief executive in the run up to Johnson’s strategy launch. Obesity “may be one of the few modifiable risk factors for covid-19”, announced Public Health England. But it had already been shown that obesity was not the only factor to double your risk of death from coronavirus. Nor is it the only modifiable risk factor for covid-19. Living in a deprived area doubles your chance of dying from coronavirus. Social deprivation is another modifiable risk factor for coronavirus mortality. And yet it has attracted little attention from the prime minister and no government initiatives were set up to address it.

Modifying, or eradicating, deprivation demands that the government make progressive changes in policies. Meanwhile, efforts to tackle obesity tend to push the responsibility onto individuals, encouraging them to make different life choices and change their behaviour. This was apparent when the government’s obesity policy described “a call to action for everyone who is overweight to take steps to move towards a healthier weight.” The Health Secretary wrote of the policy that “at its heart is better information:” providing the public with information to help them make healthier choices. The focus on individuals and their personal choices was also apparent when, in an article accompanying his dog-walking video, the prime minister summoned a “spirit of personal responsibility” to tackle the problem of obesity, highlighting how “your health depends on your own choices about how you lead your life.”

But the emphasis on personal choice did not acknowledge the complex social causation of obesity. In particular, it did not acknowledge the higher incidence of obesity among more deprived groups. It ignored the unequal environments in which personal choices are made. Deprived areas have a five times greater density of fast food outlets and fewer shops selling fresh fruit and vegetables. Taking Dilyn the dog for a walk around the lawns of the Chequers estate is unarguably a more appealing option than taking exercise in many urban housing estates. Promoting personal choice also ignored the unequal resources that people have, including the fact that many children grow up in homes that struggle to afford a healthy diet, and food poverty is a real issue. Having to depend on food banks does not facilitate personal choice. And making choices in order to lose weight relies upon a sense of personal agency and control that many people experiencing deprivation have had eroded over time, as life opportunities have been withheld from them, as state benefits have been cut despite their protestations, and as their efforts to secure employment or housing have resulted only in disappointment. Many of these issues have already been exacerbated by coronavirus, because it is people on low incomes who have tended to lose their jobs or be furloughed, and the economic fallout will continue to hit hardest those who are already worst off. People who are more deprived may be more likely to be obese, but they are less able to respond to the government’s “call to action.”

Of course, addressing obesity and addressing deprivation do not need to be conflicting priorities. After all, since rates of obesity are higher among more deprived groups, it might make sense to address these issues together. But when obesity is addressed in isolation it shifts attention, effort, and resources away from the issue of deprivation, and from the unfair impact of deprivation on people’s health.

The government’s coronavirus-inspired weight loss plan was a failure. It marked a failure to acknowledge deprivation as a risk factor for coronavirus mortality. And it failed even to acknowledge the role of deprivation as a risk factor for obesity. Many observers anticipated this failure, with the PM’s strategy branded a “missed opportunity” at the time, showing “little sign of policies that will address the root causes of obesity.” Without addressing those root causes, as a nation we will not only fail to lose weight, but we will continue to fail the more vulnerable members of our society.

“A whole systems approach to obesity” has been advocated; “looking at the wide range of factors that may contribute to higher rates of obesity.” With that in mind, and with recognition of the role of deprivation in relation to obesity, coronavirus, and many other health problems, we should take note of Michael Marmot’s recent invocation to Build Back Fairer. In the wake of coronavirus, priorities should include reducing social and economic inequalities, and ensuring that fair health outcomes are at the heart of government policy. The healthcare professions still have a powerful role in holding the government to account.

Andrew Moscrop, primary care physician, Oxford.

Competing interests: None declared.