Tides are notoriously difficult to turn. But, when the time is right, even the strongest tides will turn—and now is one of those critical moments in relation to overweight and obesity in the UK. This follows 30 years of piecemeal action by governments to address a preventable health crisis that has become even more apparent during the covid-19 pandemic. Covid-19 has shone a light on the underlying health problems that make many of us more vulnerable when a new disease threatens population health and health systems that are already overstretched.
Recently the Obesity Health Alliance (OHA)—a coalition of 45 leading health charities and medical royal colleges—launched their new report “Turning the Tide: A 10-Year Healthy Weight Strategy’” for the UK. Obesity rates have increased significantly across the UK over the last 30 years, despite 14 government health strategies since 1991 that have set targets for obesity reduction in England, with similar failed efforts in the devolved nations. In total, these strategies contained 689 recommendations. Today, the majority of adults in England—68% of men and 60% of women—are above a healthy weight, and over a quarter are living with obesity (27% of men and 29% of women). Excess weight prevalence is highest among the lowest socioeconomic groups in both adults and children.
The OHA’s strategy was developed over two years by a working group chaired by Anne Johnson. Through a process of consensus-building, informed by a series of evidence reviews and expert papers, the strategy includes 30 recommendations for action in the years ahead.
It notes that the commercial food system has fundamentally changed over the second quarter of the 20th century. The key goal of this food system was to eradicate hunger and ensure adequate food supply, however it has led to a complex adaptive system in which the need for readily available and accessible food has driven an explosion of ultra-processed foods that are highly palatable and heavily marketed to both meet and drive consumer demand. This has altered what we eat and how we behave in the same way that commercially mass produced cigarettes made smoking a normal part of life for the vast majority last century. Smoking resulted in hundreds of thousands of preventable premature deaths in the decades that followed until governments took action and changed the system to prevent smoking uptake and support existing smokers to quit.
The evidence is clear that the drivers of healthy weight are even more complex than those involved in tobacco use. The obesogenic environment, to which we are all exposed to from infancy onwards, whereby calorie-dense, nutrient poor food is readily accessible, abundant, affordable, and normalised, and physical activity opportunities are not easily available, affects us all. The pervasive and ubiquitous advertising and promotion of unhealthy food and drinks allows industry to “set the tone” of our food environment, creating, and maintaining this obesogenic environment that makes it inherently difficult to achieve a healthy diet.
Obesity cannot be addressed one person at a time, and behind the statistics are people living with obesity who often experience stigma and discrimination that can affect their mental health and willingness to access healthcare. Stigma stands in the way of public health and must be eradicated.
The strategy makes recommendations across key areas: 1) stigma; 2) food and drink products; 3) the marketing mix; 4) pricing; 5) the environment; 6) advertising and promotions; 7) early years; 8) management, treatment and support; and 9) improved policymaking processes. Each of these areas require addressing in their own right, but combined the recommendations set the clear, long-term, evidence-informed agenda needed to turn the tide and improve healthy weight across the UK population. The 30 recommendations made are set out in a “KIND” framework, aimed at building on existing policy progress as well as identifying new routes for action. The KIND framework includes:
- Keep policies already in place or that are due to be implemented that supports a healthy weight environment;
- Intensify existing policies or approaches to increase impact;
- New proposals that are recommended for evidence-informed actions;
- Develop policies based on the results of new, promising areas for research and investment.
The framework sets out not only the stage of policy development in which each recommendation sits, but also the actor(s) that should enact that recommendation. It is not enough to simply name route for action, but we need to establish clear directives for those bodies and organisations responsible to implement necessary change.
The role of industry is not absent here, and it is vitally important that we acknowledge the power that companies currently has over our food environment, as well as the regulation of the environment. We have clear evidence demonstrating that industry involvement in policy-making designed to remedy the harms industry products contribute to is not conducive to the creation of healthy public policy, and this must be actively managed throughout the policy process.
As we look ahead to recovery from the covid-19 pandemic, progressing efforts to achieve a healthy weight across the UK population must be at the heart of public health. It is time to move beyond individual-level policy recommendations, and implement wide-ranging changes to the system that got us here in the first place. This will not only save lives in the short and medium term, but will also serve to create a better and healthier future for our children and grandchildren, something they most surely deserve.
Linda Bauld, professor, Bruce and John Usher Chair in Public Health, University of Edinburgh and Director of the SPECTRUM Research Consortium
Lauren Carters-White, research fellow, SPECTRUM Research Consortium, Usher Institute, University of Edinburgh
Caroline Cerny, Alliance Lead, Obesity Health Alliance (hosted by Diabetes UK)
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