The medical profession’s prescription for the nation’s obesity crisis
Back in April 2012, The Academy of Medical Royal Colleges announced that they were launching a review into the UK obesity crisis. The initiative was launched in a front page article in The Observer 15th April 2012. The idea was that the body that represents 220,000 doctors in the UK would seek evidence from any individual or organisation that wished to contribute to the debate. An excellent initiative. A great opportunity and yet, having seen a copy of the report yesterday in preparation for media interviews today, tragically, a completely failed chance to do something that really could make a difference to the obesity epidemic.
I made a submission to the steering group – I posted it in full on line on this site yesterday.
The press release and the full report can be found here.
THE 10 KEY RECOMMENDATIONS
The 10 key recommendations from the report, or the campaign as it wants to be called, are as follows – they are grouped into three areas. (These 10 recommendations are verbatim, as they appear in the document).
Action by the healthcare professions
1. Education and training programmes for healthcare professionals: Royal Colleges, Faculties and other professional clinical bodies should promote targeted education and training programmes within the next two years for healthcare professionals in both primary and secondary care to ensure ‘making every contact count’ becomes a reality, particularly for those who have most influence on patient behaviour
2. Weight management services: The departments of health in the four nations should together invest at least £100m in each of the next three financial years to extend and increase provision of weight management services across the country, to mirror the provision of smoking cessation services. This should include both early intervention programmes and, greater provision for severe and complicated obesity, including bariatric surgery. Adjustments could then be made to the Quality and Outcomes Framework, providing incentives for GPs to refer patients to such services
3. Nutritional standards for food in hospitals: Food-based standards in line with those put in place for schools in England in 2006 should be introduced in all UK hospitals in the next 18 months. Commissioners should work with a delivery agent similar to the Children’s Food Trust to put these measures into place
4. Increasing support for new parents: The current expansion of the health visitor workforce in England should be accompanied by ‘skilling up’ the wider early years workforce to deliver basic food preparation skills to new mothers and fathers, and to guide appropriate food choices which will ensure nutritionally balanced meals, encourage breastfeeding and use existing guidance in the Personal Child Health Record as a tool to support this.
The obesogenic environment
5. Nutritional standards in schools: The existing mandatory food- and nutrient-based standards in England should be applied to all schools including free schools and academies. This should be accompanied by a new statutory requirement on all schools to provide food skills, including cooking, and growing – alongside a sound theoretical understanding of the long-term effects of food on health and the environment from the 2014/15 academic year
6. Fast food outlets near schools: Public Health England should, in its first 18 months of operation, undertake an audit of local authority licensing and catering arrangements with the intention of developing formal recommendations on reducing the proximity of fast food outlets to schools, colleges, leisure centres and other places where children gather
7. Junk food advertising: A ban on advertising of foods high in saturated fats, sugar and salt before 9pm, and an agreement from commercial broadcasters that they will not allow these foods to be advertised on internet ‘on-demand’ services
Making the healthy choice the easy choice
8. Sugary drinks tax: For an initial one year, a duty should be piloted on all sugary soft drinks, increasing the price by at least 20%. This would be an experimental measure, looking at price elasticity, substitution effects, and to what extent it impacts upon consumption patterns and producer/retailer responses
9. Food labelling: Major food manufacturers and supermarkets should agree in the next year a unified system of traffic light food labelling (to be based on percentage of calories for men, women, children and adolescents) and visible calorie indicators for restaurants, especially fast food outlets
10. The built environment: Public Health England should provide guidance to Directors of Public Health in working with Local Authorities to encourage active travel and protect or increase green spaces to make the healthy option the easy option. In all four nations, local authority planning decisions should be subject to a mandatory health impact assessment, which would evaluate their potential impact upon the populations’ health.
I was due to be on BBC Radio Wales at 6.05am this morning to talk about the report, but the BBC went out on strike at midnight, so it will likely be rescheduled for tomorrow. My points on the campaign are as follows:
* This was a great initiative – the Academy of Medical Royal Colleges represents the views of the majority of the UK’s 220,000 practising doctors – this was an incredible opportunity to make a significant difference to the biggest public health crisis that humans have ever faced. It has tragically failed.
* Professor Terence Stephenson, the chair of the steering group, says in the opening remarks “There is no single simple solution – if there was we wouldn’t be in the position we are now.” I disagree. We just need to go back to eating what we ate before we created an obesity epidemic. Make no mistake – this crisis is of our making.
* The report describes this epidemic in the Executive Summary as “It is a problem that has crept up on us…” I disagree. Obesity increased almost 10 fold in the UK in the three decades following the change in public health dietary advice. This did not ‘creep up on us’. We made it happen and we need to admit that we were wrong and return our dietary advice back to what it was.
* The major cause of the obesity epidemic is our public health dietary advice. The introduction (1977 USA, 1983 UK) of advice telling us to “base our meals on starchy foods” (foods that we previously held to be uniquely fattening) has made us fat and sick. The majority of the 10 key recommendations are about extending and reinforcing current dietary advice and increasing the army of dietary advisors to give this advice – this will only make the situation worse.
We need to admit that our current dietary advice is wrong. That the government ‘eatwell’ plate is a shocking diagram – the antithesis of healthy eating.
The idea of a campaign to extend these ‘nutritional standards’ into schools and hospitals horrifies me. It will make matters worse, not better. We need to completely change our dietary advice before telling one more person about it. Every dietician needs to be retrained and to go forth with evidence based advice alone (which excludes “five-a-day”, “carbs are good” and “fat is bad” – none of which are evidence based).
* Three recommendations are along the right lines, but still wrong:
- 6. Fast food outlets near schools: It’s a good idea to make sure that children have minimal access to junk. However, school dinners, based as they are on nutritionally poor and fattening carbohydrates (pasta, pizza, potatoes etc) are no different to what children can get outside the school gate. Here’s a sample menu - this was just the one at the top of the google search – I didn’t have to look for a particularly bad example. You can probably find your own local authority’s menu on line – they seem to be proud of serving pizza, pasta, chips, ketchup, chocolate brownies, ice cream, cake, jelly and other junk to our next obese generation.
- 7. Junk food advertising: This is the right idea, but the report names the wrong foods – saturated fat, salt and sugar. This shows that the Academy of Medical Royal Colleges is ignorant about the basics of nutrition…
Saturated fat is a natural component of the most nutrient dense real foods on the planet (meat, fish, eggs, dairy products, nuts, seeds, olive oil, avocados etc). We cannot eat or avoid saturated fat alone. Every food that contains saturated fat also contains monounsaturated and polyunsaturated fats. There are no exceptions. Saturated fat should not be targeted in any circumstances. One of the 15 steering group members, Professor Mike Lean, has a nice little side line doing low-fat pizza - gotta keep fat in jail eh?
Salt is irrelevant to obesity. It is another natural component of real food. Water contains sodium – should we tax water?!
The standard trilogy of saturated fat, salt and sugar is ignorant. The three occur together 15 times in the report – this is like putting Luke Skywalker, Yoda and Darth Vader together. Only sugar is an issue. Any product containing sugar should be banned or taxed out of the reach of most consumers.
- 8. Sugary drinks tax: Right tax, but with three caveats:
a) This is not new – Sustain called for a 20p per litre tax on sugary drinks on 29th January 2013. Kelly Brownell called for them back in 2009.
b) Any call for a sugar tax needs to include sweeteners, or the ‘food’ industry will just replace one bad thing with another.
c) The tax needs to be much higher than 20% to have any effect. A study in the British Journal of Nutrition, March 2011, suggested that a 10% tax on sugared drinks would possibly decrease consumption by 7.5ml per person per day. That’s barely a sip. I would at least double the price of any product containing sugar OR sweetener.
Lest we forget, the British Dietetic Association were one of the 60 supporters of the Sustain campaign for a sugary drinks tax. They have a can of cola on their plate of role model healthy eating – yes – that eatbadly plate!
It is so tragic that the doctors of the UK have missed this opportunity to make a difference. Nothing in this report will halt, let alone reverse, the obesity epidemic and a number of the measures will actually make things worse.
Also, we didn’t need a 60 page report – we just needed the medical profession to come out with those three little words – Eat Real Food!
The first reaction to the campaign
From the 10 recommendations, the BBC led on the call for a fizzy drinks tax. The call for foods high in “fat, sugar or salt” to be relegated to after the 9pm watershed also got a mention, as did the fact that recommendation 2 calls for extra money for weight loss surgery (don’t get me started on that one!) The bariatric surgeons on the steering group, Professor Mike Larvin and Mr Vivek Chitre, wouldn’t have minded the call for £300 million over the next three years for surgery. Dr Rachel Pryke, another member of the steering group, has written to the BMJ in the past expressing her concern over the lack of access to barbaric surgery.
The print media (Guardian, Times, Daily Mail) have similarly led on the fizzy drinks tax.
However, if you watch the BBC report, you’ll see the biggest problem of all – the government has responded to the initiative already by saying its focus is on working with the ‘food’ industry to get companies to voluntarily reduce the calorie content of their food.
As Dilbert used to say “we are doomed!”