Why do we need to reduce obesity levels?
Obesity is a clear and present danger.The challenges it poses need no rehearsing. It is a growing threat to public health, the NHS, government finances and the economy – costing over £45 billion a year according to a recent McKinsey report.
What causes obesity?
We’ve looked at this from two directions. What has changed significantly since the early 1980’s when obesity rates began to rise? And what does research tell us? Both come to the same conclusion.
- What we eat and drink, when, where and how is the biggest cause of obesity. In particular we are now consuming more sugary drinks and snacks, more ready meals and more takeaways and food from fast food outlets; and there is more ‘mindless’ overeating of this kind of food.
This has led to an increase in food which is calorie rich but nutritionally poor (and often relatively cheap and widely available). In turn this can potentially lead to people becoming overweight but undernourished. Emerging research is also suggesting other ways this might impact on weight, for example through lack of fibre in our diet and the harmful effect of fast food on our gut microbiota.
- The way we experience the early months and years of life has also changed - for instance fewer natural births, less breastfeeding and more babies born to obese parents. This also looks to be another potential cause.
Other suggested causes (from genes to lack of exercise, from levels of unhappiness to lack of sleep) don’t appear to have a significant effect on most people’s weight. However we strongly recommend exercise for its many non weight related health benefits.
What approaches have been tried to tackle obesity?
Current approaches face a number of obstacles:
- Most of us don’t like to be told what to do with our lives.
- Doctors are trained to diagnose illness and prescribe medication or surgical treatment – not to help people make healthy lifestyle choices.
- The food and drinks industry has a strong commercial interest in continuing to provide products high in sugar, salt, fat and refined carbohydrates.
- Most governments don’t want to be accused of taking a Nanny State approach – for example by regulating the quality of food and drink. So they tend to prefer a voluntary approach, like the Change4Life health information programme or the voluntary Public Health Responsibility Deal with the food industry.
What this means is that most approaches so far have been of the softly softly kind - like moves to improve food labelling, to provide public health information, to encourage weight management programmes or to encourage gradual reductions in the salt content of food.
These seem to have helped slow the rise in obesity but not reverse it. In practice then most interventions have provided temporary damage limitation – not a long term solution.
So how can we get serious about tackling obesity?
Big problems need big solutions. Here are our recommendations:
Personal Responsibility is important
Do we want the NHS to remain a free, affordable public service that we each have a right to access? If so, we each need to take some responsibility for looking after our health and our weight – and helping our family and friends do so too. Otherwise the NHS will end up being overwhelmed by preventable conditions like obesity and its complications (from type 2 diabetes to depression).
Controlling our weight isn’t rocket science. We don’t need to pursue endless fad diets. We mainly need to eat a healthy diet. People who increased their intake of whole grains, whole fruits (not fruit juice), and vegetables over the course of a 20-year study gained less weight. That’s the verdict of a Harvard School of Public Health diet and lifestyle change study.
And eating a healthy diet as parents, from conception onwards, can help our children grow up a healthy weight. Early life may be a “critical period” when appetite and regulation of energy balance are programmed, with lifelong consequences for obesity risk.
Unhealthy food can seem more expensive if we just do a calorie comparison. That’s because unhealthy food is often calorie rich. However, if we look at volume, nutritional content and what makes you feel full then healthy food is often better value.
Having said this, it is important to help people follow a healthy diet not hinder them – and government may have a role to play in helping ensure this.
For example if the food and drink most widely available to people is unhealthy, from the high street to vending machines to home delivery, then we’re making healthy choices the difficult choices. If the advertising budgets for this kind of food dwarf the budgets for healthy eating then we don’t have a level playing field.
And, if people are to make informed decisions, they need to be provided with easy to understand information about what the food and drink they are presented with contains and what the health implications are.
The Food Industry has a vital role to play
Many people now believe that that the food industry is more important for health than government and doctors. That’s according to consumer research organisation Dunn Humby.
When McKinsey reviewed ways of tackling obesity the three interventions they considered most likely to have the greatest effect were portion control, reformulation and calorie rich availability. The food industry is key to achieving these three changes.
Many food companies have signed up to the government’s Public Health Responsibility Deal and this seems to have had some success in reducing levels of salt and trans fat in food. However, there has been limited progress on reducing sugar and even some backsliding (with the introduction of new high sugar breakfast bars and drinks). Importantly too there has been no independent evaluation of what companies have achieved.
If food and drink companies can achieve significant, verifiable reductions in sugar, an increase in fibre, better portion control and a reduction in the availability of high calorie products this would make a significant contribution to tackling obesity. And it would help make healthy choices the easy choices for consumers.
This would also help food companies to be seen as part of the solution rather than part of the problem, with all the positive consequences for the reputation of their brands.
Governments also have an important part to play
Governments appear reluctant to be seen as the Nanny State, even though there is a positive story to tell from previous state interventions to improve public health, from the creation of the NHS to compulsory seat belts.
However, most politicians would probably agree there is a case for intervening when other people are placed at harm’s risk as a result of an individual’s actions. And most politicians would agree that vulnerable groups such as young children need to be protected.
So, whereas there is a good case for adults being free to make lifestyle decisions so long as these don’t adversely affect others, this argument doesn’t apply so obviously to young children – who may merit government protection, for instance from the advertising and sale of unhealthy food and drink.
Sadly obese parents are twice as likely to have obese children and increasingly don’t recognise that their children are obese. This means that other people (i.e. their own children) are being placed at risk as a result of their actions. There are difficult issues here as regards the rights of parents to bring up their children as they consider fit but equally they and their government have a responsibility to protect those children whose health is being placed at risk.
That’s why we propose that the government should aim to reduce obesity rates in pre school children within a single 5 year Parliament. As obese children usually grow up to become obese adults this would help tackle the problem at source.
Health professionals can also make a difference
Doctors and other health professionals know the health risks arising from obesity. They see patients throughout their lives, so are well placed to observe weight gain. And they are trusted by patients to give medical advice. So they too could potentially play an important role in helping tackle obesity.
However, doctors are primarily trained to wait until people fall ill and then diagnose the illness and refer to a specialist or prescribe medication. Waiting until patients exhibit lifestyle related illness such as obesity and type 2 diabetes doesn’t seem the most sensible option. How can we ensure doctors (and other health professionals) have the confidence and skills to address lifestyle issues effectively with their patients before they start to make them ill? Three questions may help here:
- What training and support do doctors and other health professionals need to achieve this? ideally starting at medical school, with CPD (Continuing Professional Development) throughout their career?
- Where and when can they most effectively intervene? Ideally as early as possible in life (e.g. antenatal care)?
- How can we ensure health professionals are effective role models? Overweight nurses, midwives and doctors are unlikely to have credibility when advising patients to lose weight. Should this perhaps (with support) become a Fitness to Practice issue?
Hospitals also need to lead by example, through the quality of food they provide to patients and staff, in canteens and in vending machines – a point the Chief Executive of the NHS has recognised, although progress here needs to accelerate.
We can reduce levels of obesity in the UK provided:
- We each take personal responsibility for managing our weight and the weight of our children
- The food and drinks industry helps make healthy choices the easy choices by making healthy food more widely available
- Government protects vulnerable groups (from young children to hospital patients) from exposure to unhealthy food and drink
- Health professionals are trained and supported to take a more active role, recognising that prevention is better than cure