Solving the obesity crisis in the UK was never going to be simple. If it were, we would not be in a situation where the majority of adults in England are overweight or obese (64%), and 28% are obese. For children leaving primary school, 35% are living with overweight or obesity, and 21% are obese.
It’s a complex issue, with the economy, the environment, and the powerful role that industry plays all shaping the nation’s dietary behaviours. That is why the National Food Strategy, an independent review commissioned by the UK government and led by Henry Dimbleby, must be commended for its ambition and the sheer scale at which it explores the entire food environment and the impact it has on our health.
Perhaps one of the most significant recommendations to come out of the report is the call to introduce a sugar and salt reformulation tax. Critics of this policy using the argument of a “nanny state” would do well to examine the stark findings from the King’s Fund report earlier this month. It found that last year, more than a million hospital admissions were linked to obesity in England; an increase of 17 per cent compared to 2018/19.
From this we can see that the junk food industry has been winning for far too long. The voluntary sugar tax failed to achieve any real progress. The mandatory tax placed on soft drinks, by contrast, has been very effective. It’s clear mandatory requirements and levelling the playing field for competition is the only way the junk food giants will play ball.
Junk food advertising has been very good at making us associate high sugar, salt, and fat content with pleasure, enjoyment, and a well-deserved reward. The food is designed to be addictive and this, alongside relentless advertising and the low cost of junk food and multipack offers, can make it much harder for individuals to regulate their intake and make healthier choices.
Of course, the dangers of obesity-related illnesses such as heart disease, stroke, and cancers, which kill 64,000 people a year, are much less likely to have a starring role in a junk food company’s advertising campaign.
The report rightly addresses the need to tackle the significant increase in obesity rates in the most deprived communities in England and the widening health gap between the richest and poorest parts of the country. The rate of obesity in the most deprived parts of the country are 2.4 times higher than in the least deprived areas.
Some may argue a sugar and salt tax will just hit lower income families hardest, who will end up paying more for food without changing their diet. What’s clearer to me is that those on lower incomes should not have to put up with unhealthy products being the most affordable option. As the strategy suggests, the tax raised could help to narrow the affordability health gap. Junk food manufacturers will have more incentive to make their products healthier rather than only to charge more.
The strategy proposes that the estimated £2.9bn-£3.4bn a year raised by the tax would go towards supporting the diets of those in more deprived communities, with recommendations including the expansion of eligibility for Free School Meals to all households likely to be at risk of food security.
The BMA has been calling for the Universal Credit uplift to be made permanent, and Henry Dimbleby’s strategy provides us with yet another reason. The report importantly debunks the notion that giving low-income households extra money to spend on food will result in it being spent on cigarettes and alcohol instead. The evidence actually suggests that as poorer families’ income goes up, they spend more on fruits, vegetables, and other healthy foods, while alcohol and tobacco expenditure decreases. Income security provides more flexibility to families when it comes to making healthier food choices.
Threatening to undermine the success of the strategy, and indeed the very integrity of our food environment in the UK, are future trade deals following Brexit. As this report acknowledges, it is vital that any future trade deal does not mean a compromise on key areas such as food standards, labelling, sugar content, pesticides and antibiotics in foods, and the transparency of deals themselves. The protection of our children’s health should be a clear priority here.
Government need look no further than the National Food Strategy to find the impetus to change the harmful food environment in the UK, which has been inflicting ill health on the population, young and old, for far too long. This is an important blueprint to progress and one which they must follow.
Parveen Kumar, BMA board of science chair.
Competing interests: none declared.