UK Childhood Obesity ‘Strategy’

On 18th August 2016 a long awaited childhood obesity strategy was published by the UK government. The report can be seen here. Just as a reminder, in 1999 health was devolved to the four regions of the United Kingdom (England, Scotland, Wales and Northern Ireland). Consequently some reports are still produced for the UK as a whole, but most health reports come from Public Health England and are then adopted by the other regions. Occasionally strategy comes from Wales, Scotland or Northern Ireland, but not often. I’ll clarify where we’re talking about UK vs. England as we unpack the latest strategy document…

The report

The document is called “A plan for action”. The introduction captured well the problem faced: nearly one third of children aged 2 to 15 are overweight or obese [England]. Children are becoming obese at younger ages and staying obese for longer. The report follows this problem statement with the cost implications. We [the UK] spend more each year on the treatment of obesity and diabetes than we do on the police, fire service and judicial system combined. The NHS in England alone spent £5.1 billion on overweight and obesity related ill-health in 2014/15.

Disappointingly, the introduction then moved straight to the classic misrepresentation of obesity “obesity is caused by an energy imbalance: taking in more energy through food than we use through activity.” Worse, it then played beautifully into the big food companies’ hands by emphasising the activity part of the ‘eat less do more’ erroneous message…

There was criticism about the report having been published during the UK government summer break – leaving junior ministers to do the interviews. Public Health Minister, Nicola Blackwood, said “This government is absolutely committed to reducing childhood obesity and one of the best ways to do this is to boost sports in schools.” Those words could have been spoken by the CEO of Coca-Cola, himself.

Summary of actions

There were 14 points in the plan for action. I’ve presented the heading for each action point verbatim and then summarised the text below each headline to capture the aim of that point. I’ve then given a brief verdict on what this aim will, or won’t, achieve…

1) “Introducing a soft drinks levy.”

The report: No detail about a levy was given. It was announced that the Treasury “are consulting on the technical detail” and “will legislate in the Finance Bill 2017.” The word “encourage” was used twice in the text under this point: i) The levy is designed “to encourage” producers to reduce sugar in their products and ii) The revenue generated is planned to be invested “to encourage” physical activity and school breakfast clubs (that’s Kellogg’s happy then).

Please note: This is the one part of the Childhood Obesity Strategy that could have an impact – albeit that the levy should be much wider (sugar and sweeteners in all products, not just soft drinks) and much more dramatic (double the price of any product containing sugar or sweetener, as a starting point, and then see how rapidly producers remove these substances from products).

In the March 2016 UK budget, Chancellor George Osborne announced that, from April 2018, soft drinks companies would pay a levy on drinks with added sugar, with the proceeds being used to fund sport in primary schools. This point is not new, therefore, and I would have expected the Childhood Obesity Strategy to add some detail to the budget announcement, but it did not.

Verdict: The door has been left open for a backtrack on the one point that could make a small difference.

2) “Taking out 20% of sugar in products.”

The report: “All sectors of the food and drinks industry will be challenged to reduce overall sugar across a range of products that contribute to children’s sugar intakes by at least 20% by 2020.” Public Health England has been tasked with making sure that food and drink companies rise to this ‘challenge’.

Not all products are being targeted – just the nine categories that children eat most: “breakfast cereals, yogurts, biscuits, cakes, confectionery, ‘morning goods’ (e.g. pastries), puddings, ice cream and sweet spreads.”

Verdict: It’s the (IR)responsibility deal Part II – working with fake food and drink to try to reduce consumption of fake food and drink. We will reach 2020 and fake food and drink will have failed to rise to the challenge and then what?

p.s. Did you spot the irony of Point 1 encouraging breakfast clubs and then Point 2 noting that breakfast cereals are one of the main sugar delivery mechanisms?!

3) “Supporting innovation to help businesses to make their products healthier.”

The report: This initiative has this aim: “We want to encourage the next generation of innovation in science and technology to allow industry to create healthier, more sustainable products.” i.e. we want more fake food and drink created – just healthier fake food and drink; whatever healthier means. There will be a £10 million prize in a Research & Development competition to reward scientists for making new fake foods.

Verdict: We won’t even mention real food in this entire report, or encourage consumption of real food. Instead we’ll support the invention of fake food in laboratories. You couldn’t make this up.

4) “Developing a new framework by updating the nutrient profile mode.”

The report: The restrictions on food and drink advertising are based on a tool called ‘a nutrient profile’. Each food and drink is assigned a score based on how much sugar, fat, salt, fruit, vegetables, nuts, fibre and protein it contains (presumably the first three are considered bad and the remaining five are considered good). The current nutrient profile is over 10 years old and will thus be updated.

Verdict: This is simply moving the deckchairs on the Titanic. The Children’s Food Campaign have long campaigned for an extension of advertising of junk snack products – not just when children are most likely to be watching TV, but any time they could be watching TV (i.e. move junk snack ads to after the 9pm ‘watershed’). Given that the government has ignored all such calls, tinkering with what may, or may not, be profiled as bad or good is pointless.

5) “Making healthy options available in the public sector.”

The report: Local authorities will be encouraged (that ineffective word again, which appears 10 times in the 13 page report) to have healthier options in vending machines in public settings, such as leisure centres and hospitals.

Verdict: Dispensing with all vending machines in all public places would have been a good plan. Sticking the odd apple (which won’t stay fresh for long) in among the crisps and sweets, or having water as an expensive alternative to the drinks the children really want is, again, pointless.

6) “Continuing to provide support with the cost of healthy food for those who need it most.”

The report: We are re-committing to the “Healthy Start Scheme”, which gave £60 million worth of vouchers to low income families across England in 2015-16. The vouchers can be exchanged for fresh or frozen fruit or vegetables and milk.

Verdict: i.e. we won’t scrap something already in place. How will that make a difference to the obesity epidemic also already in place?

7) “Helping all children to enjoy an hour of physical activity every day.”

The report: “We need to do more to encourage children to be active every day.” Every primary school child should get at least 60 minutes of activity. The soft drinks levy will provide “considerable new funding” for school sports.

Verdict: The government clearly thinks that children can outrun a bad diet. The more soft drinks that are consumed, the more money there will be to fund children to try to burn off the soft drinks. It’s so daft it’s almost funny.

8) “Improving the co-ordination of quality sport and physical activity programmes for schools.”

The report: We have asked County Sports Partnerships to work with National Governing Bodies of sport to ensure that every primary school in England has access to co-ordinated high quality sport.

Verdict: We’re back to trying to outrun the bad diet. It can’t be done. In my diet books, I reference a quite brilliant Channel 4 “30 Minutes” programme from 2004. The presenter, Nick Cohen, took a boys’ football team from London, England, and split them into three groups. One third of the team were given an apple; another third a bag of crisps and the final group a confectionery bar. The teenagers were then asked to run around an athletics track continuously until they had burned off what they had eaten. The apple group needed to run for 13 minutes to burn off the apple. The crisp group needed to run for 42 minutes to burn off the crisps and the confectionery group needed to run for one hour and five minutes to burn off their item. The presenter explained that, if a child ate a bag of crisps, a confectionery bar, a burger and chips and had a fizzy drink, they would need to run for five hours to burn that off!

9) “Creating a new healthy rating scheme for primary schools.”

The report: From September 2017, we will have a voluntary rating scheme for primary schools to help children to eat better and move more (the word “help” is another favourite – used 13 times in the report). This scheme will be taken into account during Ofsted inspections (this is the current rating scheme for schools in the UK).

Verdict: The government’s idea of eating better is flawed and no amount of moving more will make up for this.

10) “Making school food healthier.”

The report: We will update the School Food Standards in light of refreshed government dietary recommendations. (Presumably this means to reflect the move from the eatbadly plate to the eatbadly guide). The Secretary of State for Education will lead a campaign encouraging all schools to commit to the standards.

Verdict: As above, food standards are making obesity worse, not better. Anything that reinforces adherence to the fattening, starchy foods advice, will therefore make things worse, not better.

11) “Clearer food labelling.”

The report: We have worked with industry to implement a voluntary front of pack traffic light labelling scheme, which now covers two thirds of products. We want to build on this success and review opportunities to go further.

Verdict: “We want to build on this success” – hopefully you are getting the sense of just how woolly this whole report is. There’s nothing specific whatsoever. If you want clearer food labelling, how about “Don’t eat anything that requires a label!”

12) “Supporting early years settings.”

The report: “One in five children are already overweight or obsess before they start school and only one in ten children after two to four meets the UK Chief Medical Officer’s (CMO) physical activity guidelines for this age group.”
Public Health England have commissioned the Children’s Food trust to develop revised menus by December 2016. These will be incorporated into voluntary guidelines. In early 2017 we will update the school framework to make specific reference to the CMO guidelines for physical activity.

Verdict: There’s the eat less/do more principle again and, again, there’s the view that reinforcing the current guidelines (which aren’t working) will suddenly make a difference.

There’s also an interesting conflict in this action point. The Children’s Food Trust are happy to tell us what they’ve achieved, but click on the mentions of the “Tesco Eat Happy Project” or the “Iceland Food Charitable Foundation” and you won’t be able to see any further details. That’s fake food designing our children’s menus, as I have highlighted previously.

13) “Harnessing the best new technology.”

The report: We need to use technology to support healthier choices. We will work with Public Health England, Innovate UK and commercial companies to investigate opportunities to enable customers to use technology to make better eating decisions. The Change4Life Sugar Smart app was quoted as the kind of thing that they’re after.

Verdict: You don’t need an app to eat real food.

14) “Enabling health professionals to support families.”

The report: We are asking healthcare professionals to always talk to parents about their family’s diet, working towards making it the default to weight everyone.

Verdict: Now you’re counting the deckchairs on the Titanic! You already know the scale of the problem – the numbers and cost in the introduction to the report were just fine. Stop weighing and do something!

The bottom line

Jamie Oliver, who has been a fearless campaigner in this arena, described the report as “frankly underwhelming”. I think he was being generous. The report is complete waffle and vagueness. There is nothing tangible; no targets; no key performance indicators; nothing measureable. The one measure, which had already been announced (the soft drinks tax) and which could make a small difference, was left deliberately open to consultation and thus possible reversal.

Going through the 14 points, 1 may not happen; 2 won’t happen and 3 – 14 would make no difference or make things worse (by reinforcing current bad dietary advice) if they did happen. (Bearing in mind most won’t happen as they rely upon being encouraged).

Looking at the same 14 in terms of content, 1 and 2 would be useful to an extent if they happened. 4, 9 and 14 are pointless measuring games. 3-6 inclusive and 9-13 inclusive will serve to reinforce the current bad dietary guidelines and doing more is at the heart of points 1, 7, 8, 9 and 12.

The dietary advice, based as it is on starchy foods (sugar in different forms) is the problem, not the solution. If the dietary advice were sound, children would not need to outrun it. Given that it’s not, children have got no chance.

The report concluded: “The actions in this plan will significantly reduce England’s rate of childhood obesity within the next ten years.” My verdict? There are no SMART (Specific, Measurable, Achievable, Relevant and Time-bound) actions in this plan and nothing in this document will reduce England’s rate of childhood obesity, let alone significantly, in any number of years.

What should the report have said? “Eat real food; three times a day and do fun things.”