Jamie Oliver, Hugh Fearnley-Whittingstall & Childhood Obesity

Two chefs have been all over the news in the UK for the past week. Jamie Oliver is probably fairly well known world-wide, Hugh Fearnley-Whittingstall probably less so. Both are passionate about food, cooking and, in more recent years, using their celebrity to try to do something about the obesity epidemic – particularly in children. They have nine children between them! Hence the interest is personal.

The UK statistics are sobering. A comprehensive paper in The Lancet in 2014 reported on the global incidence of overweight and obesity in children and adults (Ref 1). Children were defined as those under the age of 20. I wrote an article in The Guardian on this at the time (Ref 2). UK girls topped the European list with 29.2% overweight or obese. Greece was second with 29.1% and Portugal third with 27.1% of girls overweight or obese. UK boys fared a bit better at 26.1% for overweight and obese combined. This was 10th in the European table, but only because there were many other countries with particularly high rates of overweight and obesity in young males. Greek, Maltese and Israeli boys were topping 30%, for example.

In the Lancet report, 24.4% of Australian boys and 23% of Australian girls were overweight or obese. These figures were 29.6% and 28.7% for NZ boys and girls respectively. South Africa reported 18.8% of boys overweight or obese and 26.3% of girls. Completing the data for the most common nations where recipients of this note reside: 25.5% of Canadian boys and 22% of Canadian girls were overweight or obese. The numbers for the US were 28.8% of boys and 29.7% of girls.

This is not a UK problem, therefore. In the English-speaking so-called developed nations, one quarter to one third of our children are overweight or obese. In 2014, the US Centers for Disease Control and Prevention reported that there were promising signs that US childhood obesity was improving (Ref 3). The data claimed a “significant decline” in obesity among children aged 2 to 5 years. There was talk that Michelle Obama’s “Lets Move” campaign had made the difference. An alternative examination of the data showed that childhood obesity was still growing – just not as fast as it had been (Ref 4). Certainly the Lancet 2014 data suggest that the US problem is as big as anywhere else.

A letter to the Prime Minister

On 25th April 2018, Jamie Oliver wrote to British Prime Minister, Theresa May. The letter was entitled “A comprehensive strategy to tackle childhood obesity” and it was countersigned by the leaders of the other main parties in the UK: Labour; Liberal Democrats; Scottish National Party; and the Green Party (Ref 5). On 1st May, Jamie and Hugh appeared in the British Parliament before a health select committee to present their case for a multi-pronged childhood obesity strategy. The day after their appearance, a number of national newspapers reviewed the session and described their contribution as frank, refreshing and well presented.

I did a couple of radio interviews about their initiative. One of the things that most interested me about Jamie’s letter was the reference to the success that has been achieved in Amsterdam (Ref 6). Success in tackling obesity is so rare; it is wise to gravitate towards anything that has been shown to work. Amsterdam reported a 12% drop in childhood overweight and obesity within the first 3 years of their ‘A Healthy Weight for All Children’ programme. The best results were seen in the lowest socio-economic groups, which was especially gratifying. There were so many aspects to the Amsterdam approach that I won’t list them here. If you are interested in the detail, the reference provides an excellent summary. It is easy to see how this inspired Jamie and Hugh that a multi-faceted approach is necessary to achieve significant change.

Children, junk and brands

On the day that Jamie sent his letter to the Prime Minister, Hugh had a one hour programme on the main UK channel: BBC1. It was called “Britain’s Fat Fight” (Ref 7) and it was the first in a series of three programmes. I really enjoyed the first one. It opened with a powerful and memorable activity. Hugh went into a supermarket with five children (I estimated them to be approximately six to eight years old). He gave them three trolleys between them and invited them to do the family shop for the week. The two key outcomes were i) they went for junk (confectionery, biscuits, crisps, fizzy drinks, sugary cereals) and ii) they went for brands (Kinder eggs, Coca-cola, Pringles, Cadbury, Kellogg’s, Nestle). It was also interesting to note that NO vegetables whatsoever went into any trolley, although a number of fruit items were chosen (sugar in a different form.) The most popular junk/branded product chosen by the young shoppers was sugary cereals. This is one of the products most ruthlessly advertised to children, using cartoon characters, toys in packets, and with adverts at bus stops, online and during popular evening TV programmes.

In my 2010 obesity book I mentioned a fabulous programme, which was presented by Nick Cohen on Channel 4 in 2004 where Nick showed that children could more readily recognise Tony the Tiger (Frosties) and Ronald McDonald than they could Jesus or their Prime Minister! It would appear that nothing has changed in 14 years.

What might work?


1) Marketing and selling to children.

Because of the power of junk food, brands and advertising, the following measures outlined in Jamie’s letter are highly likely to be effective:

– “An end to junk food marketing on TV before 9PM, and mandatory measures to stop junk food marketing to children online.

– “An end to ‘buy one get one free’ and other multi-buy junk food offers.

– “A ban on licensed characters, cartoon characters and celebrities being used to promote junk food to children.

– “Age restrictions on the sale of energy drinks to under 16s.”

These are excellent initiatives and are likely to be strongly resisted by the processed food industry precisely because they would be so effective. Just one of these – stopping the cartoon and celebrity promotions – would be a momentous strategy. Pepsi alone has a long history of paying the best known entertainers in the world – from Michael Jackson to David Beckham to Beyoncé to One Direction – to make it seem cool to drink sweet fizzy crap. I’m not sure how the UK could unilaterally ban global celebrity endorsed promotions, but the aim is laudable.

My one concern with these measures is that Hugh and Jamie repeatedly refer to “Sugar, Salt and Fat” as the key words to define junk food. If the definition of junk food is established as any product with all three of these items, this might capture the right things. However, the problem with the phrase is twofold: i) Only one of these three things is unhealthy – salt and fat, as found in real food, are both utterly life vital. The repeated use of this ‘holy trilogy’ will only serve to continue to spread misinformation and misunderstanding about salt and fat. ii) As we will see when we move on to the traffic light recommendation, demonising foods high in salt and fat turns anchovies, herring and olives into junk food and this is clearly absurd.

2) Fiscal measures.

Jamie’s letter included the proposal: “Further use of the tax system to make healthy food cheaper and discourage unhealthy choices both at home and on our high streets.”

Drastic problems require drastic measures and childhood obesity falls into this category. I am a supporter of using taxation to make junk less affordable and real food more affordable (and the two must happen in parallel). The major caveat I have with taxation is that the government is clueless about what is UNhealthy and thus a fat or salt tax could be imposed when the focus of fiscal measures needs to be sweetness.

As I explained in one of the radio interviews, there is a concept called “price elasticity” – how much consumer demand changes in response to price changes. For items deemed necessities, demand changes little even if prices change a lot (we need water/fuel etc – if the prices goes up, we still buy these essentials). The same goes for items to which we may be addicted. Many people continue to buy cigarettes, despite substantial taxation, because they ‘can’t live’ without their fix. To an extent, the same goes for junk (sugary) food. To change behaviour therefore, taxation on sugar needs to be large. The target for taxation needs to be sweetness, and thus it needs to include sweeteners, or manufacturers will just harm us with aspartame instead of sucrose and our cravings for sweet things will remain unabated.

In my 2010 obesity book, I proposed doubling the price of any product containing non-naturally occurring sugar (any added ‘ose’)/sweetener. That 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. The proceeds from taxes on sugar 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.

The recent UK soft drinks levy is too small. It doesn’t go far enough (the soft drinks association is right to point out that soft drinks form barely 2% of UK calorie intake (Ref 8)) – the sugar tax should apply to all added sugar. It doesn’t include sweeteners and there may be unintended harm from this (Ref 9). Finally, one of the daftest things I have ever seen is the plan for using the revenue from the soft drinks levy. It is planned to fund breakfast clubs, so that the money raised from reducing consumption of sugary drinks can be delivered in the form of sugary cereal and bagels instead (Ref 10). You couldn’t make it up!


What won’t work?

I am less positive about a number of other recommendations in Jamie’s letter:

– I don’t agree with “Reformulation of junk food to reduce sugar, calories, salt and fat.” We need to educate children and parents to avoid junk, not to make junk products smaller or with more sweetener/less sugar. Again we have salt and fat lumped in with sugar.

– I don’t agree with “Mandatory traffic light front of pack labelling and an end to fake health claims.” I wrote about the Traffic Light Label plan in 2012 and my view hasn’t changed (Ref 11). Whiz down to the “unintended consequences” in that post to see the problem: diet coke sails through the traffic light scheme, as do nutritionally pointless white bread and pasta. Meanwhile olives, sunflower seeds and oily fish all clock up warnings.

– I don’t agree with the education measures in Jamie’s letter “Adequate training, tools, and time for health professionals to better support patients’ nutritional needs” and “Support for food education and improvement of the wider food environment for workers. More support for working parents.” This is because our dietary guidelines are wrong and for as long as they are wrong, any training to reinforce them will be counter-productive. We’re back to the ignorance about fat and salt again.

What also won’t work, however, is the childhood obesity strategy published by the UK Government in August 2016 (Ref 12). This was a fourteen point plan (no – I can’t remember any of them either). To this end, the sentiment of the UK activity over the past week is spot on. I whole heartedly support the intentions of Hugh and Jamie and his counter-signatories, albeit that a couple of the measures are misguided. I admire their commitment to the childhood obesity cause and I fully agree with them that something serious and impactful needs to be done.

The final bullet in Jamie’s letter is:
The ambition to halve child obesity by 2030, with a clear definition and baseline, and clear milestones to measure progress towards this goal.”

This surely must be an ambition that we should all share – let’s work to agree on the best way to achieve this and much of what a couple of UK chefs have come up with is a great place to start.

 

References
Ref 1: Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2014
Ref 2: https://www.theguardian.com/commentisfree/2014/may/30/diets-fat-real-food-obesity
Ref 3: https://www.cdc.gov/media/releases/2014/p0225-child-obesity.html
Ref 4: https://www.eurekalert.org/pub_releases/2016-04/dumc-dec042016.php
Ref 5: https://cdn.jamieoliver.com/home/wp-content/uploads/2018/04/Childhood-Obesity-Letter.pdf
Ref 6: http://www.obesityactionscotland.org/international-learning/amsterdam/amsterdam-tackles-childhood-obesity/
Ref 7: https://www.bbc.co.uk/iplayer/episode/b0b0y27w/britains-fat-fight-with-hugh-fearnleywhittingstall-series-1-episode-1
(UK residents only sadly and only available in the UK for 30 days from 25th April 2018)
Ref 8: http://www.zoeharcombe.com/2017/02/what-the-uk-eats-2014/
Ref 9: https://drmalcolmkendrick.org/2018/04/28/will-taxing-sugar-end-up-damaging-the-health-of-the-nation/
Ref 10: https://www.cypnow.co.uk/cyp/news/2005036/sugar-tax-to-provide-gbp26m-for-school-breakfast-club-expansion
Ref 11: http://www.zoeharcombe.com/2012/10/traffic-light-labelling-how-does-it-work/
Ref 12: http://www.zoeharcombe.com/2016/08/uk-childhood-obesity-strategy/ (I do have to eat my words here, as I predicted that the soft drinks levy wouldn’t happen and it did).

15 thoughts on “Jamie Oliver, Hugh Fearnley-Whittingstall & Childhood Obesity

  • avatar
    May 13, 2018 at 11:11 am
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    Hell 200%! For the last few years I’ve been beating the drum for a 110% tax on cheap and nasty white bread, breakfast ‘cereals’ that should be in the confectionary aisle and other such junk, and people think it sounds draconian, but now it seems I’m fairly lenient.

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  • avatar
    May 10, 2018 at 8:51 pm
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    SADly (pun intended) HFW concentrates too much on “calories” as well as sugar. Replacing sugar with more starch, as per your example of the sugar tax money funding “breakfast clubs”, isn’t going to help much. Then there are the industrial Omega 6 seed oils which may be the elephant in the room in breaking carbohydrate metabolism. All too reminiscent of rearranging the deckchairs on the Titanic.

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  • avatar
    May 10, 2018 at 11:04 am
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    As Hugh seems very keen on dialogue (note his persistence in trying to interview the minister) perhaps you should request an on camera interview with him and put your thoughts to him? Or have you already done so and failed? Surely not! (Looking forward to your talk at the PHC conference).

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  • avatar
    May 8, 2018 at 5:38 pm
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    Hi Zoe, I agree 100% with your appraisal of the 2 chefs well intentioned initiative. I’m a retired restaurateur and former 3 times UK steak pie champion would you believe!
    Delicious but carb loaded. I’ve been LCHF since I retired 2 years ago and in the best shape of my life. I would like to support folk struggling with obesity and sugar addiction possibly through the U3A to which I belong. I’ve got a degree in hotel and catering mgt from about a million years ago but feel I should really try and get some sort of accredited nutrition qualification for credibilty. I’m struggling to find UK based ketogenic/low carb courses. Any thoughts?

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    • avatar
      May 9, 2018 at 9:06 am
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      Hi Carl
      I’ve not come across one. I just googled “low carb qualification” and a couple of “Paleo Nutrition Diplomas” came up – online learning courses. I’m not sure if they’d tell you anything useful and/or if the qualification would be of any value at the end.

      I blogged on the problem here (http://www.zoeharcombe.com/2011/09/nutrition-where-will-a-student-be-taught-the-truth/)

      The BANT and ION courses are far more about real food/not fearing fat etc – they may be a good place to explore. You can always learn lots about nutrition (without the eatbadly plate non-sense) and then focus your own research in the low carb area of real food.

      Best wishes – Zoe

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      • avatar
        May 9, 2018 at 11:41 am
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        I really appreciate your prompt response Zoe. Your blog from 2011 was very informative.
        I too googled “low carb qualification” and came up with a number of Paleo courses plus U.S based on line courses such as ketogenicliving101.com and ketocarole.com. I’m not sure about these. The Real Meal Revolution run a Banting coaching programme but there seems to be mention of Professor Tim Noakes anymore?
        My principal motivation in seeking some sort of accreditation is able to respond to folk who might reasonably enquire “and what makes you qualified to offer advice and support on my health?” I’ve got a fair bit of knowledge from studying the subject for the last 2 years. I subscribe to dietdoctor.com (which is where I came across your good self) and have read many books on the subject. Your website is another (just discovered) great resource. Your writing is terrific by the way Zoe.
        I think I might begin by offering healthy cooking classes through the U3A and see how it goes. These are free to members. I’ve updated many of my recipes using a great app called Paprika. The criteria of recipe inclusion being if the dish is not as good or better that the carb loaded version it doesn’t make the cut!
        Thanks again Zoe.
        Carl Smith

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        • avatar
          May 9, 2018 at 2:18 pm
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          Hi Carl
          Thank you for your kind words and for your support for what I do :-)

          Tim isn’t anything to do with Real Meal Revolution as an organisation. He focuses all his efforts on The Noakes Foundation – a not for profit trying to improve the health of south African people – especially the least advantaged.

          As Gary Taubes and Nina Teicholz have shown – the people most likely to challenge the status quo are those not formally trained in that status quo. Journalists have a successful history in this regard in many disciplines. Those least likely to challenge the status quo are those with the ‘official’ (i.e. official advice) qualification, aka dietitians.

          I chose to do a PhD because there was no nutritional qualification worth spending 3-4 years on and so that I could study what I wanted to study – not be told what other people wanted me to be told. Anyone worth their salt (ha ha) will judge you on your food and food advice and not on a piece of paper. Those more interested in that piece of paper are unlikely to be open to free thinking anyway!

          Best wishes – Zoe

          Reply
  • avatar
    May 8, 2018 at 9:12 am
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    Reconfirmed: Artificial Sweeteners Make You Fat and Sick
    https://articles.mercola.com/sites/articles/archive/2018/05/08/artificial-sweeteners-obesity-diabetes.aspx
    Sources and References
    1 JAMA March 23, 2018 doi:10.1001/jama.2018.3060
    2 Experimental Biology Conference Publication # A322 603.20
    3 US News April 23, 2018
    4 Medical News Today April 23, 2018
    5 Gizmodo April 22, 2018
    6 Preventive Medicine 1986 Mar;15(2):195-202
    7 Physiology & Behavior 1988; 43(5): 547-552
    8 Physiology & Behavior March 1990; 47(3):555-9
    9 J Am Diet Assoc. 1991 Jun;91(6):686-90
    10 Int J Food Sci Nutr. 2003 Jul; 54(4):297-307
    11 Int J Obes Relat Metab Disord. 2004 Jul;28(7):933-5
    12 San Antonio Heart Study June 14, 2005
    13 UT Health Center San Antonio Press Release, “New analysis suggests ‘diet soda paradox’ – less sugar, more weight”, June 14, 2005 · Volume: XXXVIII · I
    14 J Am Coll Nutr. 2005 Apr; 24(2):93-8.
    15 J Pediatr. 2006 Feb; 148(2):183-7
    16 Yale Journal of Biology and Medicine 2010 June; 83(2): 101–108
    17 Appetite January 1, 2012, Volume 60, Pages 203-207
    18, 28 Trends in Endocrinology & Metabolism 2013 Sep;24(9):431-41
    19, 29 CNN.com July 10, 2013
    20, 30 Drugs.com July 10, 2013
    21 The Journal of Physiology 2013 Nov 15;591(22):5727-44
    22 Scientific American September 5, 2013
    23 Nature October 2014; 514: 181-186
    24 PLOS One October 14, 2014
    25 Journal of Toxicology and Environmental Health, Part B: Critical Reviews, 16:7, 399-451
    26 J Toxicol Environ Health A. 2008;71(21):1415-29
    27 Diabetes Care. 2013 Sep;36(9):2530-5.
    31 Whilesciencesleeps.com
    32 Nature January 18, 2018; 553: 291-294
    33 New York Times April 6, 2018
    34 Journal of Toxicology and Environmental Health 2008;71(21):1415-29
    35 GlobeNewsWire.com September 22, 2008

    Reply
    • avatar
      May 8, 2018 at 9:57 am
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      Crikey! Thanks so much for listing these – I remember in my 2010 obesity book just putting it as follows:

      Dr. Ralph Walton, Professor and chairman of the Department of Psychiatry Northeastern Ohio University Colleges of Medicine, undertook a comprehensive review of studies available for just one sweetener: aspartame. It was called “Survey of aspartame studies: correlation of outcome and funding sources.” The summary of the report stated: “Of the 166 studies felt to have relevance for questions of human safety, 74 had Nutrasweet® industry related funding and 92 were independently funded. One hundred percent of the industry funded research attested to aspartame’s safety, whereas 92% of the independently funded research identified a problem.” Walton’s overall conclusion was “We have also become much more sophisticated about the impact of a variety of toxins on psychological processes. I am convinced that one such toxin is aspartame.”

      Reply
  • avatar
    May 7, 2018 at 8:34 pm
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    I noticed this weekend that they are teaming up with Dr Rangan Chatterjee to promote eating more vegetables. To me piling veg onto an unhealthy diet isn’t going to make it any better for health.

    I don’t know if either of these celebrity chefs have a hidden agenda, but they certainly do not seem keen on recommending what we all know is a healthy diet. One look at nutrition labels on Jamies Italian website speaks volumes. The five a day picnic box for children boast 50g of carbs and 34g of sugar and is labelled as a healthy option.

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    • avatar
      May 8, 2018 at 10:00 am
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      Hi Excalibur
      I’m with you on this – I’ve seen the veg initiative and it’s well meant, but I don’t think that it will make a difference. It may also have unintended consequences as the five a day non-sense has – there have been recommendations to put sweetcorn on pizza and to eat beans (tomato sauce) to get the made up 5-a-day, for example.

      As I have often said – vegetables are a marker of a good diet, they are not a make of one. As you say – add veg to a bad diet and it doesn’t make it a good one. Swap baked beans for green things might be a better message or just “eat real food” – how about that eh?!

      Best wishes – Zoe

      Reply
      • avatar
        May 11, 2018 at 8:43 pm
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        I really like Dr Rangan Chatterjee and am a bit concerned about him teaming up with Jamie. In their recent podcast chat Jamie tells Rangan he has taken a nutrition Diploma and is now working on a Masters.

        Reply
        • avatar
          May 11, 2018 at 9:20 pm
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          Hi Jim
          That’s really interesting – Jamie may be being taught the status quo – that would explain the salt and fat :-(
          Best wishes – Zoe

          Reply
  • avatar
    May 7, 2018 at 1:00 pm
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    Things will have to get much worse before they get better. Sugar, starch, and seed oils are woven into the culture at this point and form a significant basis for national economies, both directly in terms of consumption and indirectly in terms of the resulting medical costs. They cause chronic disease, which for the most part cannot be cured with drugs. Health is largely determined by the food supply, and not the availability of so-called healthcare, which has little to do with health. In fact, healthcare is pretty much a financial model more than anything else, and it makes little difference whether the state provides the service through taxes, or you have a mixed provider as in the US. Either way, you will end up fat and sick, and it is only a matter of time.

    I am afraid that this is not changing any time soon. However, there is a small minority of the population that will eventually comprehend the problem and navigate to a solution. Even that number, although a small percentage of the population, can make an impact. Maybe
    this will be enough to eventually work out of this hole, but it will take decades.

    Reply

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