England’s Obesity Strategy (not)

On Thursday 13 October, 2011, the Department of Health issued this press release, optimistically called “Government calls time on obesity.”  The government has done anything but.

We need to remember that the UK health service was devolved in 1999, with England, Scotland, Wales and Northern Ireland managed separately from this point forth. Hence, this Department of Health announcement was for England only.

On 15 March 2011, the Department of Health issued a press release on what they call “The responsibility deal.” The government believes that  partnering with the food and drink industry “can be the most effective way of tackling some public health objectives.” The purpose of the food and drink industry is to sell as much food and drink as possible. The government believes that we need to be consuming less food and drink to lose weight. How these aims can be compatible, therefore, baffles me.

The pledges announced in the March press release include:

– Calories on menus from September this year;
– Reducing salt in food so people eat 1g less per day by the end of 2012;
– Removal of artificial trans-fats by the end of this year;
– Achieving clear unit labelling on more than 80 per cent of alcohol by 2013;
– Increasing physical activity through the workplace; and
– Improving workplace health.

We know that putting “Smoking kills” and “Smoking will harm your unborn child” on cigarette packets makes no difference, so why would putting a calorie number on food make any difference? It won’t and we know already that it won’t – here is an article about a study done in the British Medical Journal to prove this.

The October ‘new’ news

Health secretary, Andrew Lansley, and England’s Chief Medical Officer, Professor Dame Sally Davies, launched the ‘new’ proposals, but there really was only one thing new:

1) Davies called for everyone to be more  honest about their eating and drinking habits – so, not only are we greedy and lazy, we are now liars too!

2) We have been told to “slash” five billion calories a day. If the population of England approximates to 50 million people, that’s 100 fewer calories per person per day. No knowledge whatsoever of the difference between calories has been demonstrated with this headline grabbing number.

3) Astonishingly – this was the only new bit – the Scientific Advisory Committee on Nutrition (SACN) – advised that the recommended daily calorie intakes for both men and women should be raised. We are told to eat less, but our intake guidelines should go up? Davies tried to explain this by saying – our daily intake should be raised but we are still eating more than this, so we still need to cut back. This is confusing at best and ludicrous at worst. I do not think that we should be raising calorie recommendations in the midst of an obesity epidemic. Not because the obesity epidemic is about calories (because it isn’t), but because it sends the wrong message. If health were going to suffer by not raising these calorie limits then raise them – but at a completely different time, so as not to confuse the public. However, I am far from convinced that anyone’s health would suffer if we did not raise calorie limits – health is about what we eat and the vital nutrients that we consume – not the amount of petrol we put in our tank. Putting petrol in a diesel car is the worst thing we can do to a vehicle. Putting sugar, transfats and empty calories in a human body is equally harmful.

The calorie intakes, just for the record, have been increased from 2,550 to 2,605 for men and a whopping 1,940 to 2,079 for women.

The chair of the SACN working group, Alan Jackson, has declared interests in Nutricia (a specialised unit of Danone food company) and Baxter Healthcare (see page 32). The full list of members of the energy requirements sub committee is on p19 of that link. Ian Macdonald has declared interests with Mars Inc, Mars Europe, Unilever, Nestle and Coca-Cola – just what we want on a Scientific Advisory Committee on Nutrition! Andrew Prentice, also on the group, ‘only’ has connections to Tanita Scales and Danone. His wife, however, (see p34) has the most extraordinary list of declared interests: Beveridge Institute for Health and Wellness, Diabetes UK, Institute of Brewers & Distillers, Milk Development Council, Optimal Performance Ltd, The Rank Prize Funds, Tanita UK Ltd, World Cancer Research Ltd, Weight Watchers UK Ltd, B Kassardjian Fund – Zurich, Dee Caffari Ltd, Mars, BBC, Rosemary Conley Diet & Fitness Club, National Trust, Coca Cola, Outsights, Nestle, Emap, Kelloggs, Almond Board California, Nunwood Consulting, Pepsico, GlaxoSmithKline, British Institute of Sport, The Pelican Buying Co, National Institute of Nutrition and J Sainsbury. Go girl!

The bottom line

The bottom line is that the English government thinks that people just need to eat less and do more and they will lose weight. As I detail at length in my book The Obesity Epidemic this has been Plan A for more than three decades and we have continued to get more and more obese. We have known since Benedict’s 1917 study that eating less leads to short term weight loss and then regain to beyond the starting weight. This was confirmed in the definitive eat less experiment – the Minnesota Starvation Experiment – initial weight loss, followed by regain plus 10%. At least 9 out of 10, if not 19 out of 20, of the personal consultations that I do start with the explanation “I didn’t really have a weight problem until I went on my first diet. I lost weight, regained and more. I went on another diet, lost weight, regained and more.” When they say ‘diet’, my clients mean a calorie deficit diet – the eat less/do more that the government thinks will get us out of this mess.

Here’s an interesting statistic for you:

The MAFF (Ministry of Agriculture Fisheries & Food) National Food Survey tells us that we were eating 2,290 calories per person per day in 1975 and, by 1999, this had fallen to 1,690 calories per person per day. If we apply the 3,500 calorie formula (notwithstanding that this formula is also wrong, but it’s the one that government and all calorie advisors rely upon), to the change in annual average calorie intake, all other things being equal, we should have lost an average of 62.6 pounds per person during this period. Instead obesity rose nearly ten fold during this time.[i]

The DEFRA (Department for Environment, Food & Rural Affairs) report notes the continual decline in calorie intake. The Family Food Survey for 2001-02 comments on the short term: “Energy content of the household food supply has decreased considerably over the last 5 years.” The Family Food Survey for 2002-03 notes the same trend over the longer term: “Average energy intake per person in the UK is unchanged in 2002-03 compared with the previous year, although it has been declining since 1964.”[ii]

The Food Standards Agency (FSA) web site also acknowledges the above conundrum, “Since the 60s we’ve been consuming fewer calories from household food (this doesn’t include eating out). However, there are an increasing number of people who are overweight or obese. The reasons for this are not clear.”[iii]

We need to eat better, not less. We need to return to eating real food, not the empty calories dominating the eatbadly plate. We need to eat naturally produced meat, fish, eggs, dairy products, vegetables and salads to ensure that our bodies can use the calories that we eat for our basal metabolic needs. We absolutely cannot afford to eat the empty sugar and flour calories, which we are eating.

World Health Organisation data tells us that the average UK citizen consumes 38 kilograms of sugar per year.[iv] Statistics from the Flour Advisory Bureau note that UK per capita flour consumption reached 74 kilograms in 2008/9.[v] This represents a few calories short of 1,150 per person per day from those two ingredients – when did that become a healthy balanced diet?

What the government should have done

I set out in Chapter 16 of The Obesity Epidemic what should be done to reverse the obesity epidemic. Here are the headlines:

1) Tear down the eatbadly plate from every surgery, hospital and school in the country and never allow it to be shown again. Tell people to eat real food from now on and nothing but real food. If nature provides it – eat it; if food manufacturers provide it – don’t. That’s the only healthy eating food message that the government needs to have  to start to reverse the obesity epidemic.

2) Ban trans fats. In the unlikely event that we were bold enough to ban sugar, trans fats and sweeteners, this one step would be sufficient to reverse the obesity epidemic (whether such bans are necessary is a matter for debate). Trans fats should be singled out for an immediate ban (as has happened in Denmark and Switzerland). The National Heart Forum summed up their position on trans fats in the opening to their paper calling for a ban on these substances: “Industrially produced Trans fats (IPTFAs) are harmful to health, they have no nutritional benefits and there is no known safe level of consumption.”[vi]

3) Fiscal policy (taxation). I cannot conceive of any government having the courage to ban sugar, trans fats and sweeteners. Hence, if we lack the leadership qualities to ban nutritionally void substances, the minimum that we need is a deterring and punitive tax on each of them. We need to be very specific about the targets. In May 2009 Dr. Tim Lobstein called for a ‘fat tax’,[vii] while talking about junk food and pizza. The reiteration of the notion that ‘fat is bad’ is incessant. We must stop this forthwith. Here is a blog on the October 2011 Denmark fat tax and how misguided this is. The target of fiscal measures needs to be processed foods and no real food should ever be demonised again. Again, although this step may not be necessary, it would be sufficient and we are almost expecting the impossible from our populations to tell them to avoid processed food while the food manufacturers are simultaneously promoting BOGOF’s (Buy One, Get One Free) on biscuits, cakes, confectionery and all the things that we need help to resist. David Kessler’s book, The end of overeating, gives full details of what humans are up against in terms of food industry tactics.[viii]

Taxation would merely be a return to previous public policy, albeit from centuries ago. Adam’s Smith’s The Wealth of Nations (1776) noted “Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.” Just under one hundred years later, the sugar tax was repealed. If sugar is not banned, the tax needs to be reinstated.

The objective of such taxation should primarily be to reduce consumption, but any revenue generated can have an added benefit of subsidising real food and/or the health services that are impacted by such consumption. Using sugar as an example, I would put a minimum 100% (double the price of the product) tax on any product containing non naturally occurring sugar (any added ‘ose’).[1] This would immediately discourage food manufacturers from adding sugar, completely unnecessarily, to ham, cottage cheese, tins of chick peas, kidney beans and other healthy products. I would put at least a 200% tax on any product where all sugars added together are the majority of the composition of the product. For any product (e.g. children’s sweets) where the entire product is essentially sugars (with a bit of crushed animal innards, gelatine, for bonding), we should multiply the current price by four or five fold. The proceeds from taxes on sugar, trans fats and sweeteners should subsidise real food for people who are currently least able to afford it. We cannot hope to solve an obesity epidemic when we can buy ten doughnuts or one cucumber for the same price.

Other fiscal measures should be considered. Corporation tax can be raised on companies that make processed food and lowered, or eliminated, on companies that provide completely unadulterated natural food. The local butcher must become the provider of choice for meat, not McDonald’s. Today, I can buy one pound (454 grams) of grass fed steak for the same price as a regular cheeseburger and medium fries and mayo chicken and a McFlurry original and a medium drink and a double cheeseburger.[ix] This is not conducive to healthy eating – particularly in the sections of our population who can least afford, and most need, real food. Kessler details some of the most contemptuous examples of fast food: “One of the signature hamburgers at Hardee’s is called the Monster Thickburger, which famously contains 1,420 calories and 108 grams of fat.” “Yet even that pales in comparison to a slice of Claim Jumper’s Chocolate Motherlode Cake … 2,150 calories a slice”. (Note the use of the word ‘mother’ to imply approval). Such inhumanity to man should be met with an “Inhumanity Tax”. It’s not far away from manslaughter, if you are familiar with the legal definition.

If this sounds extreme, how does “90% of today’s children being overweight or obese by 2050sound?[x] And, why would this be considered extreme? I am merely suggesting that we return to eating what we used to eat before we got too obese to function as human beings.

England has one of the worst obesity epidemics in the world. Thanks to the conflict of interest and ignorance of the English government, they now have one of the worst obesity strategies in the world. Relying on the profit motivated organisations that want us to eat ‘fake’ food instead of real food, to lead a return to the real food that would signal their demise, is naive at best and fatal at worst.


[1] As an example, fructose in a whole apple is fine, as this is the form in which nature intended us to eat fructose. Fructose added to sweeten other products is not necessary.


[i] I calculated this mathematically year on year and analysed the average calorie intake for 1975 and then that for 1976 and used the 3,500 calorie formula to work out what the average person should have gained/lost between these two years and repeated this for each year between 1975 and 1999 to calculate the overall number of pounds that should have been lost on average. The overall number was calculated cumulatively, as some years people should have gained weight and most should have produced weight loss – all according to the calorie theory.

[ii] http://www.defra.gov.uk/evidence/statistics/foodfarm/food/familyfood/index.htm

[iii] http://www.eatwell.gov.uk/healthydiet/seasonsandcelebrations/howweusedtoeat/ changingtastes/

[iv] http://www.whocollab.od.mah.se/expl/globalsugar.html

[v] http://www.fabflour.co.uk/content/1/31/facts-about-bread-in-the-uk.html

[vi] http://www.heartforum.org.uk/Policy_Consultations_2093.aspx

[vii] http://www.medindia.net/news/British-Expert-Calls-for-Fat-Tax-on-Unhealthy-Foods-to-Save-Children-51144-1.htm

[viii] David Kessler, The end of overeating, published by Rodale, (2009).

[ix] Rump steak was £14 per kilo (£6.36 per pound) and McDonald’s had the first five items listed for 99p and the double cheeseburger listed at £1.29 (June 2010). http://www.mcdonalds.co.uk/food/saver-menu/saver-menu.mcdj?dnPos=0

[x] One of the forecasts of the Foresight Report: “Tackling Obesities: Future Choices” (October 2007).

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8 comments on “England’s Obesity Strategy (not)
  1. Bravo! When are you going to become a government advisor? I wish!!!! They so need a sane person with ideas .

    Personally, I’m hopeful that intermittent fasting is going to be the way that helps me establish better eating habits long term, beacuse I am eating less every day and eating well every day. There must be thousands trying it, but sadly many are still eating junk every day and thinking it is okay because you can ‘eat what youwant’ 5 days out of 7….

  2. avatar Cekestria hales says:

    If you could stop every newspaper and magazine saying ‘fatty’ food it would be a huge achievement. Also I am old enough to remember exactly when diet advice changed and we were told baked potatoes with no fat or wirse’lo fat’ gunk wre the answer

  3. The tax on sugar idea is fantastic. I too was reduced to a head banging mess when I heard about the governments ‘new initiative’. A few more calories to eat, do more, eat less, food companies to help us make healthier eating choices. People don’t know what they are eating. Ergo everybody is stupid and has yet to hear the message that fat is fattening and we must all stop eating it – and buy those processed low-fat foods so we will stop turning into a nation of blubber bottoms. The old quote: Insanity defined: keep doing the same thing and expect a different result.
    Of course, the sugar tax can never take off. Too much at stake with food company profits – and pharma profits from all the resulting illness (not to mention profits for the outsized clothes companies). I have heard that the food companies lobby the government here in much the same way as they do in America. Is this true?
    More power to your elbow!!

  4. avatar hakirby says:

    What’s wrong with the NHS plate? It’s a bit carb heavy and the protein portion’s a bit on the small side compared to some other approaches (zone and bikini diet) but what else do you see wrong with it?

    • avatar Zoë says:

      Hi Hakirby – have you looked at it? I mean really looked at it? Seen the cornflakes, weetabix, white rice, white bagels, white bread, sugary baked beans, sugary yoghurt, fruit in syrup, battenberg cake, Victoria sponge, biscuits, chocolate, sweets, cola (yes really)? None of those substances have a place in a healthy diet – let alone a diagram of government role model healthy eating.

      Here’s an extract from my book The Obesity Epidemic to give more detail about this plate:
      “I started with 100 grams of starchy foods and then calculated the weight of the other categories, to maintain the proposed proportions. The weight of fruit and vegetables would also be 100 grams; non dairy protein would be 45 grams; there would be 36 grams of milk and dairy and 24 grams of foods high in fat and sugar. I estimated the calorie averages for 100 grams of each of these food groups as 333, 42, 188, 183 and 595 respectively. This would give the estimated calorie values (for each of these weights) of 333, 42, 85, 67 and 144 respectively. If these are then scaled up in proportion for a 2,000 calorie a day diet, the five groups end up with 992, 125, 255, 198 and 430 calories respectively. The numbers will vary for each person’s interpretation of the plate, but you can see how one third of intake in the form of starchy foods can represent half of calorie intake and another third from fruit and vegetables just 6% of energy. The supposedly smallest segment, being so energy dense, can form a perhaps unanticipated 21% of calorie intake.

      I did the above calculation for interest and to show the law of unintended consequences, not because I want to legitimise the ‘eatwell’ plate in any way. I consider it to be an appalling proposal for healthy eating advice. Please do look up the diagram on line and see for yourself the products we are being encouraged to eat. The “Starchy foods” segment features a box of cornflakes – not Kellogg’s branded on the ‘eatwell’ plate, but Kellogg’s branded on my version of the Balance of Good Health plate from the National Obesity Forum conference, which I attended in October 2004. Even without branding, the starchy foods segment on the ‘eatwell’ plate also features Weetabix cereal, white pasta, white rice, white bagels, white bread and other refined carbohydrates.

      The fruit and vegetable segment makes no distinction between fruit (we will see the problem with fructose in Chapter Thirteen) and vegetables. The poster also features dried fruit, fruit juice, tins of vegetables (often containing sucrose) and other fruit and vegetables, which are not in the form that nature delivers them.
      The non dairy protein can all be consumed in carbohydrate form – and presumably is by vegans and mostly will be by vegetarians. This section has baked beans prominently shown at the front (not branded) and tins of chick peas and kidney beans are also in the segment. There is no caution to look out for the sugar and salt added into many such tinned products.

      The dairy section also contains carbohydrate. As a rule of thumb, dairy contains approximately 5% carbohydrate levels. The (likely) sugared yoghurts in this segment will be even higher in carbohydrate levels and sugar content.

      The final segment is astonishing – 8% of our weight intake for foods high in fat and sugar, which becomes over 20% of our calorie/energy intake. The products featured include a can of cola, sponge cake, Battenberg cake, sweets, biscuits, pies, pastries, chocolate and crisps alongside what looks to be sunflower oil and butter – surely two real and good foods.

      Each of the five segments therefore features carbohydrate, to a greater or lesser extent. Every food consumed, as recommended by this “model of healthy eating” can have an impact on insulin. Add to this the often heard advice “Graze – eat little and often” and you can see how our government advice is keeping UK citizens in a fat storing, not a fat burning, environment all day long. It is no wonder that insulin sensitivity and insulin resistance are becoming increasingly commonplace, as the human pancreas has never before had to cope with this quantity or frequency of carbohydrate, let alone this poor quality of carbohydrate.”

      Hope this helps!
      Best wishes – Zoe

  5. avatar Sharon Jamieson says:

    If only the government would change the whole thing around by sending out a brand new message (which would also allow them not to lose face in admitting that they have been pushing out all the wrong dietary advice all along). The brand new message could be about eating all the right (natural and as nature intended) foods to provide us with the right NUTRITION for health. Forget calories, forget carbohydrate (although consumption of the latter would go down if you had to up your nutrition levels anyway). The message should be about eating protein for repairing and building muscle in our bodies, natural fats in order to absolve those all important fat soluble vitamins, vegetables for vitamin C, and treats should be a little fruit. BASE meals on natural foods in order to provide our bodies with the optimum nutrition it needs!

    Young people today think of food in terms of calorie and fat content. They don’t ever think about the benefits of eating good wholesome food for health. They believe that sugar is harmless as long as they brush their teeth after eating it. They will happily consume low fat biscuits, because they believe it will do them no harm! We should teach them to consider everything they put in their bodies in terms of “is it beneficial for their health, is it a food that will nourish them “. Schools should have classes in nutrition – and these should be based on teaching kids to think in terms of healthy balanced meals. They don’t need to learn how to make pizza, pasta and bread!

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