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 2050” sound?[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).

The story on red meat and cancer has to take the biscuit, however…

The story started to break on 20 February 2011 – we were forewarned that a report from the Scientific Advisory Committee on Nutrition (SACN) was about to be released. “Red meat does increase cancer risk, new report will confirm” screamed the Daily Mail headline. The article opened with the following three sentences:

“Britons should cut their consumption of red and processed meat to reduce the risk of bowel cancer, scientific experts are expected to recommend in a report.”

“The Scientific Advisory Committee on Nutrition (SACN) was asked by the Department of Health to review dietary advice on meat consumption as a source of iron.”

“In a draft report published in June 2009 the committee of independent experts said lower consumption of red and processed meat would probably reduce the risk of colorectal cancer.”

So, SACN was asked to look at meat consumption as a source of iron and are going to conclude instead that lower consumption of red and processed meat would probably reduce the risk of colorectal cancer (bowel cancer)? (All the emphases are mine).

Notice how red meat has become red and processed meat – could these two substances possibly be more different? Real meat (by weight) is the most nutritious food on the planet – offal is best, red meat next best and white meat the next best for essential fats, essential proteins (amino acids), vitamins and minerals. Processed meat should not be ingested by a human being – full stop. Putting these two together is like putting drinking water and coca-cola together or sardines and sugared, breaded fish sticks. This is irresponsible and ignorant in the extreme.

Then notice the word probably - despite the fact that SACN were asked to look at meat and iron – we expect them to recommend that lower consumption will probably … No one reads that caveat – the damage is done in the sensational headline screaming out from every newspaper and on line news tweet on the 20 February.

So, 25 February 2011 arrives and the SACN report is published. All 374 pages of a report called Iron and Health - all about – Iron and Health!

The headline writers obviously don’t read the report – we know the headline already – “red meat causes cancer”.

BBC Breakfast kicks off the day of meat demonisation. Dr Alison Tedstone is the spokesperson from the Department of Health and she doesn’t slip up during the interview in her careful use of the words “red and processed meat.” She specifically says: “Our experts have said that there’s a probable link between red and processed meat and bowel cancer.” Note that probable and red and processed again. Plus note the word link - there is no causation being claimed – so, there might be a link between one terrific food and one evil food and bowel cancer? Um – I wonder which one might be the problem. The fab Susanna Reid starts to ask the right question “Why would red meat?…” and then corrects this to “why would red and processed meat be a particular problem?” Tedstone says that there are a number of “plausible” mechanisms by which “red and processed meat” “might be a problem”, “we don’t exactly know why…” But, despite not knowing why, we are then told to limit our red and processed meat consumption to around 70g per day – approximately 2 slices of meat a day. Boy, those cavemen should have been dropping like flies.

The London Evening Standard was one of the first to run the story: “Eat less meat: Government experts warn Britons.”  Experts from the SACN are expected to tell consumers to eat no more than 70g of “red or processed meat” a day. The headline says meat; the first sentence adds “or processed” in straight away. Is that because processed meat is the real killer? Does the sentence not hold if we just talk about meat?

The article goes on: “Some 1,900 cases of bowel cancer could also be prevented through cutting red meat consumption to under 70g per week.” Hang on a minute – how so?! The very next sentence describes the process by which processed meat is chemically altered. The sentence after says: “It is thought this process causes the formation of carcinogens, which can damage cells in the body and allow cancer to develop.” I have little doubt that processing meat causes carcinogens which can damage cells etc. But Ermentrude, out in the field near my house, grazing on fast growing grass in the Welsh rain and occasional sun – surely Mother Nature didn’t put her there to kill me?

The Evening Standard article ends with two telling sentences:

“Last year, experts from the Harvard School of Public Health in the US found that eating processed meats can increase the risk of heart disease and diabetes… However, unprocessed red meats, such as beef, pork or lamb, do not raise the risk, the study found.” So there is a difference between real meat and processed meat – we’ll just leave it to the end to point it out. This is disgraceful reporting.

BBC weren’t content just with TV coverage. They ran a story and tweeted on it in the morning – no doubt as a matter of urgency – I guess we need to know before we choose our lunch? “Eat less red meat to reduce cancer risk” the story instructed. First sentence? You guessed it: “People should cut back on red and processed meat to reduce their risk of getting cancer, the government says.”

Then the Department of Health tweet arrived: “Red meat link to bowel cancer.” Followed by the, now very familiar: “It  (SACN) concludes that red and processed meat probably increases the risk of bowel cancer…”

At this point it is important to go to the original source and see what SACN actually said. I haven’t read all 374 pages – I usually start any report with the conflict of interest and then look at the summary. If anything in the summary is not clear – you can always delve deeper.

The conflict of interest is always interesting. In this case we have the chairman, Professor Peter Aggett with the SACN 2008 annual report declared interests as: Astra-Zeneca; Nestec; ILSI (I cover this ‘sugar protecting’ body in my book “The Obesity Epidemic“), Wellcome; Yakult and Cadbury Schweppes. The vice chair, Dr Ann Prentice, has declared interests as: Institute of Brewing & Distilling; Mars; National Association of British & Irish Millers; Optimal performance limited; Tanita; Coca-Cola; The Beverage Institute for health and wellness (yes, really) and Weight Watchers. Professor Sue Fairweather-Tait has declared interests in Coca-Cola, GlaxoSmithKline, British Egg Information Service, Unilever and Totus Medica. Those are the worst.

The headlines of the report are then:

- In a 1998 Department of Health report, the COMA (Committee on Medical Aspects of Food & Nutrition Policy – the predecessor for SACN)  “highlighted possible links between red and processed meat and colorectal cancer”. Since red meat is an important source of iron in the human diet, SACN were asked to look at “the possible associated adverse implications of a reduction in meat consumption on other aspects of health, particularly iron consumption.” That was the brief – the possible link between processed meat and bowel cancer had been mentioned 13 years ago.

- The Terms of Reference were (and I quote) “To review the dietary intakes of iron in its various forms and the impact of different dietary patterns on the nutritional and health status of the population and to make proposals.” Hence calling the report “Iron and Health” – ‘cos that’s what it’s about.

- SACN started off the report with a bunch of excuses for why it has taken 13 years to write a report, which is so critical that the BBC needs to tell us (the wrong headline) about it twice before lunch.

- The conclusion of their task was as follows: “The modelling exercise indicates that reducing total red meat consumption (*) of consumers in the upper range of the distribution of intakes, down to 70g/day, would have little effect on the proportion of adults with iron intakes below the LRNI” (Lower Recommended National Intake).

(*) Note – in this paragraph (30) “Red and processed meat” is mentioned three times in as few lines before this summary sentence that seems to change this to “total red meat”. It is clear that red and processed meat is what we’re talking about. The title above para 30 is “The potential impact of reducing red and processed meat consumption on intakes of iron and zinc.”

Paragraph 36 reiterates that there is merely a possibility of a link between red and processed meat and bowel cancer. The logic then goes:

- “red and processed meat is a source of iron”

- “it is not possible to quantify the amount of red and processed meat that may be associated with increased colorectal cancer risk“

- “It may be advisable for adults with relatively high intakes of red and processed meat to consider reducing their intakes”

- “Modelling indicates that this would have little effect on the proportion of adults with iron intakes below the LRNI”

So, we’re not worried about population iron intake if the high red and processed meat consumers cut back.

And that’s what the SACN report was about.

But, never let the science get in the way of a good story…

Red meat is going to kill you!

Let’s start positively:

There are some things that I like about the White Paper
1) Creation of a Public Health England – we have a Public Health Wales and with the right independence and leadership and remit this can be a positive force. However, there needs to be clarity of role. Each country has a Chief Medical Officer whose role includes public health, indeed majors on public health. As with all public bodies, roles and responsibilities need to be clearly determined with CAN DO (as I coined the phrase when I worked as an HR Director) Clear Accountability; No Duplication or Overlap.

2) The Professor Sir Michael Marmot work on health inequalities. I had the privilege of hearing the Cochrane lecture, delivered by Professor Sir Michael Marmot, at the Wales NHS conference on 11 November 2010. The comparative health and longevity and healthy years of life are indefensibly different for people from different income groups and this cannot be allowed to continue. However, I remain to be convinced if handing responsibility for this to local government will make any difference. It hasn’t for education or economic development, so what will be different to make this work?

Things I disagree with:

1) In the Foreword, Lansley says: “It is simply not possible to promote healthier lifestyles through Whitehall dictat and nannying about the way people should live.”
I completely disagree.

- We introduced a clunk click every trip seatbelt campaign. Robert Gifford, of the Parliamentary Advisory Council for Transport Safety charity, said seatbelts had saved 35,000 lives in the UK during the last 25 years.
– We introduced a smoking ban and an estimated 40,000 lives have been saved.

The UK government could and should introduce a sugar tax, as has been introduced in Denmark and Finland. Finland have also taken steps to get Pepsi out of schools by 2012 – still not soon enough in my view, but way ahead of the UK. The government could make an enormous difference to our health (obesity and diabetes especially) by banning food companies from advertising to children (as Sweden has done since 1991); banning sugary drinks and confectionery in school; banning cartoon characters in sugary cereal marketing and attempts by the cereal makers to get children (and adults) to eat more of their processed food; banning similar marketing by the fast food industry who want humans eating more burgers, more fries, more milkshakes, more white flour pizza, more chicken in ‘secret’ ingredients and so on.

This is the biggest outrage of the white paper – it is possible. Lansley doesn’t want to go this route because he is more concerned about the food and drink industry than the nation’s health. I challenge him to prove me wrong on this and take decisive action against the food and drink companies.

2) Lansley is doing the exact opposite to taking decisive action against the food and drink industry. He is meeting with them at Unilever house, with Unilever in the chair. His Foreword goes on to say: “All of this will be supported by work with industry and other partners to promote healthy living”.

As Professor Philip James, Chair of the International Obesity Taskforce, said on BBC Newsnight last week – this is utter madness. Food and drink companies have one purpose – to grow. They need to deliver increasing returns to shareholders and their ‘well being’ depends on them selling more of their food and drink. The biscuit companies need humans to eat more biscuits; the cake companies need humans to eat more cakes; the cereal companies need humans to eat more cereal; the confectionery companies need humans to eat more confectionery; the fizzy drink companies need humans to drink more fizzy drinks – human beings end up being nothing more than consumers in the food and drink companies’ pursuit of growth.

The food and drink companies love the current dreadful public ‘health’ dietary advice. They love everything being about calories and energy in and out. They will happily keep the focus on exercise – we need to exercise more; we’re fat because we’re sedentary kind of thing. Heaven forbid that the public stops eating processed food because they realise it makes them fat.

As I detail in my latest book “The Obesity Epidemic: What caused it? How can we stop it?” , many food and drink companies actually have the government “eatbadly plate” (I think it is supposed to be called “Eatwell Plate“) on their web sites. They love the box of cornflakes on there (branded Kellogg’s in earlier versions of the plate); they love the cola on there (yes really); the Battenberg cake, sweets, biscuits, white bread, sugary baked beans, fruit in syrup, fruit juice – and many more – all the processed food that they love to sell us and they want us to consume more and more of.

Our waistlines grow in sync with the growth in sales of processed food and drink. How on earth can we think that food and drink companies will lead a campaign to reduce waistlines and, inevitably, their sales in parallel. The cure to the obesity epidemic lies in returning to eating food – real food – the food we ate before two thirds of us were overweight. It does not lie in eating the processed food that we have eaten during the time in which obesity has increased nearly 10 fold – the stuff that Lansley’s partners make. It really is utter madness.

3) I disagree with point 7 in The Executive Summary: enhanced nutrition is heralded as a “formidable public health achievement”. Our nutrition could be the best it has ever been, but it is far from this. I analysed the UK Family Food Survey (2008) with the following conclusions:

a) Vitamins: If you take the higher of the Recommended Dietary Allowances (RDA’s) for the USA and Europe, UK intake falls short for Vitamins A, C, D, E and Folic Acid. Interestingly the fat soluble vitamins (those delivered in foods with a fat content) are A, D, E and K. K was not recorded, but the deficiencies in A, D and E make it likely that our low-fat obsession is making us deficient in all the fat soluble vitamins. This should be of deep concern to our governments. Instead, when they present the latest annual food survey we are again told to eat less fat – and to become even more deficient in these vital nutrients. The vitamin E deficiency is both interesting and worrying – vitamin E is the body’s natural antioxidant and is known to repair damage in the blood vessels. I wonder if that has anything to do with heart disease?

b) Minerals: The average UK citizen is lacking in every mineral recorded by the National Food Survery, compared to the higher of the RDA’s for the USA and Europe. The UK is missing even the low European target in all but calcium. (No wonder so many people are now taking osteoporosis tablets with 500mg assumed to be adequate for calcium). Since so many of the minerals are not even recorded, we may be able to assume from the deficiencies in those that are recorded, that the overall picture is bleak.

A recent report confirmed that one in five middle class children are effectively suffering rickets – what was considered to be a disease of the Victorian period. This is a direct result of our negligent low fat dietary advice, telling people to avoid the health benefits of the sun and cereal companies ruling our breakfast choices, when we should be eating eggs. (Doubly ironically, on p11 of the white paper – bullet 1.1 says “once common conditions such as rickets” have been “consigned to the history books”. If only….)

This is not a formidable public health achievement Mr Lansley – it’s a disgrace.

4) Bullet 9 of the Executive Summary is, as a number of media commentators have already noted, “high on rhetoric” and “low on substance”. It is described as a “Radical new approach”. It is far from radical, although inviting food and drink companies to set policy may be new and catastrophic. A sugar tax would be new and radical; banning food and drink company marketing to children would be radical; using a tax on processed food to subsidise real food (especially directed towards people less able to afford real food) would be radical. All of these could have an enormous impact on obesity and health. Having a “ladder of interventions” and adopting “the least intrusive approach” is only radical and new in its certainty to be ineffectual.

A few other points:

In the main body of the paper:

1.6 – “People in England are healthier and living longer than ever”.

I disagree. I rarely see a healthy person. Two thirds are overweight; one quarter obese; one in three will die from a modern illness – heart disease; another one in three will die from another modern illness – cancer. Approximately three million British citizens are suffering diabetes – another modern illness. The average person that I see walking around the UK is fat and sick; tired and depressed – all, I would argue, as a result of the appalling dietary advice that they have been given over the past 30 years. We are keeping people alive longer, as a result of modern medicine and pharmacology (not always in a good way), but there are too many people “existing” rather than “living”. As point 1.10 says, and surely this is contradictory, “some 15.4 million people in England have a long standing illness.”

1.30 – “only 3 in 10 adults eat the recommended 5 portions of fruit and vegetables a day”.

This is bad science. 5-a-day has no scientific foundation whatsoever. It was a marketing campaign started by the American National Cancer Institute and c. 20 fruit and vegetable companies in California in 1991 – the influence of the food industry in demonstration. Nearly 20 years later, this marketing slogan still has no evidence base (see reference 278) and yet it features in government, Department of Health, documents as if it is scientific. A 5-a-day marketing slogan, which could have had a significant impact on the health of English people, would have been liver, sardines, eggs, sunflower seeds and a green leafy vegetable. The fruit juice that mums are trying to get into their children, thinking they are following sound government advice, is fuelling the obesity epidemic and damaging our children’s livers. (There is more nonsense implying that 5-a-day is sound in point 3.31).

There are then 5 questions for consultation on which public comment is invited:

a. Are there additional ways in which we can ensure that GP’s and GP Practices will continue to play a key role in areas for which Public Health England will take responsibility?

b. What are the best opportunities to develop and enhance the availability, accessibility and utility of public health information  and intelligence?

c. How can Public Health England address current gaps such as using the insights of behavioural science, tackling wider determinants of health, achieving cost effectiveness and tackling inequalities?

d. What can wider partners nationally and locally contribute to improving the use of evidence in public health?

e. We would welcome views on Dr Gabriel Scally’s report. If we were to pursue voluntary registration, which organisation would be best suited to provide a system of voluntary registration for public health specialists?

- nothing about should we have food and drink companies writing our obesity and drinking strategy. Just the usual vacuous ‘consultation’ questions that are designed to only invite comments on the least contentious areas in the secure knowledge that consultation won’t change the government’s plans anyway. As for evidence in public health? 5-a-day?!

I await the obesity paper in the spring.

Zoë Harcombe

1)  I subscribe to the Children’s Food Campaign newsletter and support their campaigns.

The CFC got a great article in The Independent, which can be seen here.

2) This was an extract from the Children’s Food Campaign January newsletter: “Ever thought of avoiding Coco Pops after school?”

“A new advertising campaign from Kelloggs, suggesting to children “ever thought of Coco Pops after school?” has been eliciting outrage from parents on forums such as Netmums and Twitter. We think it’s shocking that Kelloggs, who are partners of the Government’s Change4Life health campaign, are encouraging children to eat more sugary cereals (Coco Pops are 35% sugar) when one of the key messages of the Change4Life campaign is “sugar swaps”, encouraging families to swap snacks with added sugar for low sugar or sugar-free alternatives. If you’d like to complain, you can email Kelloggs at corporateresponsibility@kellogg.com. You might also like to copy the Department of Health into your email to make them aware of your concerns: dhmail@dh.gsi.gov.uk .”

3) So, of course, I emailed Kelloggs Corporate responsibility and the Department of Health as follows:

Dear Department of Health and Kellogg’s (30/1/2010)
I am writing to complain about the advert encouraging children to eat Coca Pops after school. It is bad enough that our young people start the day with a bowl of sugary cereal (coca pops being 34% sugar). It is even worse to think that children are being encouraged to have another bowl after school. We are fighting an obesity epidemic and any sugar (empty calories) either displaces other nutritional food, which adversely impacts health, or it is eaten on top of other nutritional needs, which adversely impacts weight. There is no room for sugar in a healthy diet – let alone this amount being pushed on parents and children alike as a fun thing to do with cartoon animation etc.
That Kellogg’s does this is not a surprise – it’s a private company looking to maximise brand profitability for shareholders. That the Department of Health has Kellogg’s as a Change for Life ‘partner’ is a disgrace. Department of Health – you lose all credibility as an advisor to UK citizens having such blatant affiliations with the food manufacturers.
I look forward to your response
Kind regards – Zoe Harcombe , Obesity researcher

4) You then get an auto reply from the Department of Health saying they will reply within 20 days,  but I did get a letter back from Kellogg’s on 3/2/2010 – fair do’s – pretty speedy. Here is the response (I’ve put in my comments along side each ‘defence’):

Dear Zoe

Re: COMPLAINT TO KELLOGG’s ABOUT COCO POPS ADVERTISING

I wanted to contact you following your recent email to Kellogg’s about us promoting our Coco Pops cereal as an after school snack.

The reason for recommending Kellogg’s Coco Pops with milk as an after-school snack is no different from recommending it for breakfast – it’s a nutritionally sound product that is suitable as part of a healthy balanced diet.

The fact is Kellogg’s Coco Pops is a low fat, low saturated fat food, containing just 175 calories per serving with semi-skimmed milk.  It provides 25% of the RDA (recommended daily allowance) for six B vitamins and 17% of the RDA for iron and calcium, as well as encouraging the consumption of milk which is normally eaten with our products.  In fact, 40% of milk consumed in Britain is with cereals. , and breakfast cereals are the leading source of iron in the diet of UK children . (Zoe comment: Coco Pops are low fat because they are a cereal and cereals are predominantly carbohydrate! Coco Pops have vitamins because they are ‘fortified ‘ because they would be nutritionally lacking if they weren’t and even more vitamins are added when people drink milk  – so give your child a glass of milk when they get home).

When it comes to sugar, one portion of Kellogg’s Coco Pops has just 10.5g – approximately two teaspoons.  To put this into context: a portion of fruit yoghurt contains 20g of sugar and toast and jam has 13g . (Zoe comment: sugary yoghurts and jam are also full of sugar  – this doesn’t make our product good, but we’ll compare it to other bad stuff to try to make it look good).

Breakfast cereals provide only 5% of the adult daily intake of added sugars in the diet – compared to 37% from drinks, 32% from sugar, preserves and confectionary and 14% from other cereal products such as cakes .  Breakfast cereals contribute 6% of the average daily intake of sugar in children yet up to 30% of some micronutrients such a B vitamins and iron. (Zoe comment: so let’s double the intake of sugar from cereals, by getting kids to eat them after school, as well as before school, as cereal manufacturers are missing out on their share of the ‘junk’ market. Check spelling of confectionEry also).

Sugar adds to the enjoyment of food with no detrimental effect to health – there is no scientific evidence showing a link between sugar and obesity, cardiovascular disease, diabetes, hyperactivity or cancer. (Zoe comment: I love this one! I didn’t actually suggest that sugar is behind the major killer diseases of the modern day, but, now you mention it… See Warburg, see Yudkin… what was my quote again? “If we have been eating food as nature intended for 24 hours then agriculture, which gave us large scale access to carbohydrates, started 4 minutes ago and our consumption of sugar has increased 20 fold in the past 5 seconds. I wonder which substance is more likely to be responsible for obesity, diabetes, or indeed any modern disease…”)

What I hope we can agree on is there’s an established link between excess calorie consumption and weight gain.  So – given the obesity challenge we all face – it seems prudent to compare the amount of calories in Kellogg’s Coco Pops and milk to many typical post school snacks. A serving of Kellogg’s Coco Pops with milk contains around 10% of a child’s calorie GDA, a suitable amount for a snack. A typical milk chocolate bar is 255 calories; a 4 finger chocolate and wafer bar is 213 calories and a bag of chewy fruit flavoured sweets is 222 calories. Kellogg’s Coco Pops with milk have noticeably fewer calories and less sugar then most of these options and provide many positive nutrients the other snacks do not. (Zoe comment: No. We can’t agree on this. I actually don’t care about calories – they are just fuel. I care about empty calories – sugar – which deliver fuel with no nutrition. This is what an obese society cannot afford to consume).

As a mum of two I understand the need for kids to have a quick snack when they got home hungry from school.  But, we don’t see any evidence that encouraging Kellogg’s Coco Pops as an after school snack prevents children from snacking on fruit. (Zoe comment: Are they eating both?! Not much room left for a good dinner eh?)

Independent research shows 90% of mums  give their children a snack after school, therefore we are not encouraging an eating occasion that would not normally happen.  The top six foods eaten being crisps, fruit, sweets, yoghurt, chocolate and biscuits.  Those who said that they would choose Kellogg’s Coco Pops with milk as an alternative said it would replace (in descending order) crisps, chocolate, sweets and biscuits – not fruit or yoghurt. (Zoe comment: So parents who give their kids junk now have another option. The parents that give fruit will still do so. This is the argument used by cigarette manufacturers – we don’t increase the size of the market – we just encourage people to swap brands).

Therefore, having Kellogg’s Coco Pops with milk as an after school snack does not discourage the selection of fresh fruit, and also encourages the consumption of milk and provides essential micronutrients – an accepted dietary recommendation.

It’s for these reasons we don’t see promoting Coco Pops as an after school snack as being counter to our involvement with Change4Life. (Zoe comment: see what else Kellogg’s sponsor below…)

I’d like to assure you that at Kellogg’s we ensure all of our marketing and advertising is rigorously reviewed so that it complies with the relevant CAP broadcast and non-broadcast advertising codes.  (Zoe comment: None of this matters much because we comply with the advertising standards code, so we can do what we want!) I’d also like to advise you the current Coco Pops outdoor advertising campaign comes to its natural end this Friday.

I appreciate dialogue via a letter isn’t always the most productive.  So, I or a member of my team of nutritionists would be more than happy to meet with you and discuss your concerns in person.

Yours sincerely

(Zoe: I’ve left out the name and contact numbers for privacy, but after the job title is “State Registered Dietitian”) (Zoe comment: why am I not surprised?! The Kellogg’s Senior Manager for nutrition is a dietitian. The head of the Sugar Bureau is a dietitian. The British Dietetic Association (BDA) is “delighted” (their word) to be ‘in bed with’ the sugar and flour organisations. Kellogg’s are the sponsors of the British Dietetic Association’s annual conference on obesity. The American Dietetic Association is sponsored by Mars, PepsiCo, Kellogg’s, Unilever, General Mills and Coco-Cola. The BDA won’t tell me their sponsors – can’t think why. And then the dietitian primary slogan is “Trust a dietitian to know about nutrition”. Not when every dietitian I have met defends sugar I won’t!)

Finally – check out the Children’s Food Campaign competition for a new Coco Pops slogan - great fun! x