Guest post: Some countries have introduced mandatory nutritional labelling on menus – here’s why the UK should follow suit

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Guest post by: Dolly Theis, University of Cambridge

Would you eat a burger if you knew it contained almost 6,000 calories? Some would gladly tuck in while others would recoil in horror. But if you have calories on the menu, at least you know what you’re biting into. And as our latest research shows, menu labelling, as it is called, may be a powerful way to change the nation’s eating habits.

Research shows that the British public is increasingly eating out and ordering takeaways, rather than preparing food at home. Our earlier research estimates that a quarter of UK adults and a fifth of children eat at a restaurant or order a takeaway at least once a week. Food that isn’t prepared at home tends to be less healthy, more calorific and higher in fat, sugar and salt than food prepared at home. While eating out is a triumph for a large and important commercial sector, it is also contributing to the obesity crisis and the increase in diseases such as type 2 diabetes and cancer.

Still not mandatory

Unlike nutrition labelling on pre-packaged food, which has been around for years and mandated under EU law since 2016, menu labelling is still not mandated in the UK. The government included voluntary menu labelling in its Public Health Responsibility Deal in 2011, and several establishments have since introduced menu labelling.

Of the top 100 chain restaurants in the UK, we recently found that 42 publish nutritional information on their websites, and of these, 14 voluntarily provide menu labelling in their establishments. A proposal for mandated menu labelling was included in the UK government’s Childhood Obesity Plan, and a public consultation closed last December, but no announcement on a final policy has been made so far.

Mandatory menu labelling has been introduced in other countries, including the US in 2019 and parts of Australia.

Calories explained.

Labelled menus mean healthier food

We found that food and drink sold at the top largest UK chain restaurants whose menus display energy information are lower in fat and salt than those of their competitors.

Menu labelling has often been touted as a way to provide information that helps people choose healthier dishes, but several reviews, including a recent Cochrane review, found only modest, poor quality evidence of an effect of menu labelling on purchasing and consumption. Our evidence suggests that the benefit of menu labelling may not necessarily be in helping consumers make healthier choices, but in incentivising restaurants to serve healthier food and drink. Without nutritional information, it is difficult to know where improvements are needed.

Nutritional information is only helpful if it is accurate. A 2018 study on the views of Irish food-service businesses towards voluntary menu labelling found that key barriers to implementing it included concerns about potential inaccuracies in calorie information and the lack of training on how best to provide quality calorie information.

If food outlets are mandated to provide menu labelling, they will need greater support and training to do so. But it may also increase the demand for more accurate, efficient and accessible methods of data collection (typically laboratory or electronic database analysis), promising easier ways to account for the nutritional quality of what’s on restaurant menus.

Should nanny stay at home?

Mandatory labelling will not be popular in all corners. After all, who doesn’t enjoy blowing out at the occasional all-you-can-eat buffet? The challenge is that eating out is not occasional anymore. It is has become habitual.

Fortunately, as we increasingly ditch the kitchen for the restaurant and takeaway, government has found that there is strong public support for menu labelling. Through the Childhood Obesity Plan, the government is exploring many ways to help make it easier for us all to make healthier choices and menu labelling should be considered as one of many policies, not as a silver bullet.

The 6,000-calorie burger is an extreme example. But think about it, when you last ate out, did you know how many calories you were consuming?The Conversation

Dolly Theis, PhD Candidate, University of Cambridge

This article is republished from The Conversation under a Creative Commons licence. Read the original article.


Read more: further reading on food from The Knowledge Exchange blog

Daily exercise can boost children’s exam grades – new research

Guest post by Michael McCluskey, Keele University

 

Most parents are aware that physical activity is good for children – as it can help to improve their sense of self and have a positive impact on their mental health and well-being. But it’s less well known that being fit and active can also help to boost children’s academic performance.

Our recent review of primary school children from Stoke-on-Trent, England, shows that children who are more active perform better in key stage one results in reading, writing and mathematics than less active children – achieving grades that were either average or above average for each subject.

We also looked at how the children’s weight and height changed over the school year in our enjoy exercise. All the children gained weight, but less active children appeared to gain weight at a steeper rate than active children. This may mean these children – who currently have a normal weight and body mass – may be at risk of becoming overweight or obese in the future.

Not enough exercise

A report from Sport England shows that children who enjoy exercise, have confidence in their physical abilities and understand why exercise is important, are more likely to be active regularly. The same report also shows that these children do, on average, twice as much physical activity compared with children who don’t enjoy sport and exercise.

The Department of Health recommends children do at least 60 minutes of physical activity every day – but many children fail to meet these recommendations. This is in keeping with national figures that show only 17.5% of English, 38% of Scottish, 51% of Welsh and 12% of Northern Irish children meet the recommended minimum exercise levels.

But inactivity is not just a problem in the UK. Levels of childhood physical activity have recently been described as a global crisis by the World Health Organisation. Increasing urbanisation, changing patterns in transport, increased use of technology and high levels of poverty are considered to be reasons for the decline.

Of course, not all children naturally love exercise – and many dread PE lessons. Indeed, research shows that children who get regular encouragement and who have access to affordable facilities are more likely to be and stay active.

Be a role model

Given that our research shows the impact physical activity can have on academic performance and growth, it’s clear that children need to be encouraged to be active and given time to play regularly at home, in school and in the local community.

Children should walk more, run, cycle, use their scooter, go to their local playgrounds, dance, swim and play sports. Children should also be encouraged to travel to school on foot or by bike where possible and sit less often and for shorter periods of time.

Playing outdoors can help children to develop creative thinking Rawpixel.com/Shutterstock

Importantly, children also need to have positive role models. They need to see parents, family members, teachers and members of the community, enjoying being physically active on a regular basis.

 

This is important because children who are active regularly during childhood are more likely to develop into adults who are active and exercise. And adults who exercise regularly are more likely to live happier and healthier lives than those who do not.The Conversation

Michael McCluskey, Lecturer in Physiotherapy, Keele University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


Read more: articles on children and health on The Knowledge Exchange blog:

Banning fast food outlets near schools: have takeaways had their chips?

A number of organisations – including the Academy of Medical Royal Colleges, Public Health England and the Royal College of Paediatrics and Child Health – have called for the creation of ‘fast food exclusion zones’ – banning fast food outlets from opening within 400m of schools and other places where children congregate.

In this blog post, we consider the arguments in favour of restricting the growth of such fast food outlets near to schools, and whether the evidence supports this.

More children becoming obese, earlier and for longer

The UK is now ranked among the worst in Western Europe for childhood obesity. Not only are more young people overweight or obese, they are also becoming obese at earlier ages and staying obese for longer.

Indeed, recent statistics show that nearly a quarter of children in England are obese or overweight by the time they start primary school aged five, rising to one third by the time they leave aged 11.

Increased risk of social, psychological and long-term health problems

In addition to the social and psychological problems associated with obesity, obese children are at a greater risk of developing serious diseases, including coronary artery disease, high blood pressure and type 2 diabetes.  They are also 20% more likely to develop cancer as adults than those of a healthy weight.

There is also a financial incentive for addressing obesity in both adults and children – recent estimates suggest that obesity-related conditions cost the NHS around £6.1 billion per year.  The total estimated cost to society is even greater – at least £27 billion per year.

Indeed, the annual spend on the treatment of obesity and diabetes is greater than the amount spent on the police, the fire service and the judicial system combined.

Deprived areas have greater levels of both obesity and fast food outlets

There are also strong reasons to address obesity from an equalities angle.

Recent data compiled by Public Health England shows that there is a strong association between area level deprivation and the density of fast food outlets.  Some areas, such as Blackpool, and parts of Manchester and Liverpool, have up to five times more fast food outlets than more affluent areas.

The evidence is generally clear that deprivation is associated with higher levels of overweight and obesity, and lower levels of vegetable consumption.

The evidence suggests that the food environment does influence food choice

During the past 10 years in the UK, there has been a significant increase in the number of fast food outlets, and the consumption of food away from the home has increased by 29%.

Researchers and policymakers have sought to understand whether unhealthy food environments – such as those with a high density of fast food takeaways – may encourage unhealthy food choices, and thus contribute to obesity.

Last year, the Scottish Government published a research paper on the link between the food environment and the planning system.

In relation to the link between the food environment and obesity in general, the report concludes that while the evidence is mixed, “overall the evidence would suggest that increased exposure to outlets selling unhealthy food increases a person’s likelihood of gaining weight”.

In relation to the effect of the food environment around schools on children and young people specifically, the evidence is less clear cut – with some research showing a link to obesity while other research does not.

Interestingly, there was evidence that access to outlets selling healthy food decreased the odds of being overweight or obese.

Research by Brent Council, involving seven secondary schools – four of which were within 400m of a fast food outlet – found that 27% of students said they would not bother going out at lunch if they had to walk more than 8 minutes.

It does seem like common sense – make fast food less readily obtainable and children will be less likely to consume it.

Prof Russell Viner, of the Royal College of Paediatrics and Child Health, has said “This food is tasty and cheap – it’s easy to blame the individual, but humans, particularly children, will find it hard to resist tempting food.”

England already making progress, Scotland likely to follow

In England, the National Planning Practice Guidance (PPG) outlines the role that planning can have in reducing obesity by limiting over-concentration of fast food takeaways, particularly around schools.  It also encourages planning authorities to limit takeaways in areas with high levels of obesity, deprivation and general poor health, and in areas with over-concentration and clustering of outlets within a specified area.

Similarly, the Child Obesity Strategy commits to developing resources to support local authorities who want to use their planning powers to restrict fast food takeaways, and providing up to date guidance and training for planning inspectors on the creation of healthy food environments.

A number of councils have already implemented 400m exclusion zones.  Some notable examples include St Helen’s Council, Sandwell Council, Dudley Council, and Milton Keynes.

Sadiq Khan has included proposals for a 400m exclusion zone around schools in the new Draft London Plan, and plans to limit the number of fast food takeaways near schools in Luton were approved in 2018.

At present, there are no powers to restrict fast food outlets on health grounds in Scotland – however, it is likely that this will change in the near future.

As well as the aforementioned research project, last year, the Scottish Government published the consultation, ‘A Healthier Future’, which commits to exploring the opportunity for the planning system to contribute to an improved food environment:

We will research precedent, evidence and good practice on the relationship between the planning system and food environment, including exploring how food outlets in the vicinity of schools can be better controlled, with a view to informing the review of Scottish Planning Policy”.

In the December 2018 issue of Scottish Planning and Environmental Law (SPEL), Neil Collar of Brodies LLP concludes that:

Taking account of Action 2.12 in ‘A Healthier Future’ and the research project, it seems likely that the draft National Planning Framework, expected to be published by the Scottish Government in 2019, will contain policies to control hot food takeaways and the food environment around schools. An evidence base to justify controls in local areas will be important”.

Creating a robust evidence base is crucial

Children have a right to grow up in an environment that supports them to attain the highest possible standard of health – and the planning system has a key role to play in facilitating this.

Of course, the planning system cannot address obesity on its own, and the causes of obesity are far wider and more complex than just the food environment.

Other approaches are also being put in place – including supporting food outlets to provide smaller portions and healthier options – some of which have been very successful already.

The creation of a robust evidence base upon which to make informed decisions regarding the location of fast food takeaways and the creation of healthy environments is essential.

There are already a number of useful datasets available for local authorities to use, including the Food environment assessment tool (Feat) and guidance on the creation of healthy food environments.

As more local authorities make use of their powers to restrict fast food outlets, it will be interesting to see whether more evidence emerges of the link between fast food and childhood obesity. We at the Information Service will, of course, be watching this with interest.


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Should the UK introduce a tax on sugar?

An assortment of liquorice allsorts sweets.

by Stacey Dingwall

Recent months have seen two enquiries to our Ask a Researcher service for evidence on sugar consumption in the UK. Namely: should this be taxed?

Sugar has become somewhat of a villain in the UK, with magazine articles, research and governments all telling us that we should be greatly reducing, or even eradicating completely, our consumption of added sugars in particular. The week beginning 30th of November even saw the first National Sugar Awareness Week, part of a campaign to encourage the government to establish a sugar reduction programme in the UK. However, is a ‘sugar tax’ really necessary?

Sugar consumption: a public health issue?

According to the Royal Society for Public Health (RSPH), absolutely. Last month, they published a review of how to tackle obesity in the UK, which included the introduction of a sugar tax. The report notes that, according to the latest forecasts, half of all adults in the UK are expected to be classed as obese by 2050. Key to reversing this trend, it is argued, is to tackle issues around diet and nutrition among children, who are now spending double the amount of time per day in front of screens than children in 1995 (something that has been shown to increase cravings for food and drink, but not for nutritionally sound items). Alongside other developed nations, the UK is also seeing an ever increasing rate of consumption of high-sugar carbonated drinks.

While the RSPH recommends placing restrictions, or ending, the use of advertising and sponsorship by junk food and drinks companies around family and sporting events, it also argues that this is not enough to tackle the country’s obesity problem. The RSPH supports the introduction of a tax on sugary drinks of 20%, or 20p per litre. Their report highlights evidence which suggests that this could prevent or delay around 200,000 cases of obesity per year, and points to the experience of Mexico, who introduced a tax of 10% at the start of 2014. During that year, sales of sugary drinks declined by 6% overall, and by 9% among those living in the most deprived areas of the country (the demographic group most likely to be obese).

What does the government think?

After a delay, the UK government published Public Health England’s (PHE) review of the evidence for action with regards to sugar reduction in October. The report:

  • agrees that too much sugar is consumed in the UK
  • favours a reduction in advertising to children
  • recommends the introduction of a tax on full sugar soft drinks of 10-20%

This, combined with a range of other measures, it is argued, could save the NHS £500 million per year. The PHE recommendation was also supported by the House of Commons Health Committee, in their recently published Childhood obesity – brave and bold action report. Having heard evidence from parties including Sustain and Jamie Oliver, a key figure in the campaign for the introduction of a sugar tax, the Committee recommended that such a levy should be introduced at 20%, in order to achieve maximum impact.

The Prime Minister, however, is still not convinced, stating that he believes there are “more effective” ways of tackling obesity. The government is due to publish a strategy on childhood obesity in the New Year.

What does the evidence say?

A number of countries have implemented a form of taxation on sugar or saturated fats. These include:

  • a tax on saturated fats in Denmark
  • Finland’s tax on sweets, ice cream and soft drinks
  • Hungary’s public health product tax
  • France’s tax on sugar- and artificially-sweetened beverages

According to a review of using price policies such as these to promote healthier diets by the World Health Organization, food pricing policies are feasible, and can influence consumption and purchasing patterns as intended, with a significant impact on important dietary and health-related behaviour. Crucially, however, the same review notes a lack of formal evaluation in this area.

A report published earlier this year by the activist group Taxpayers’ Union of New Zealand, Fizzed out: why a sugar tax won’t curb obesity,  questioned the validity of nutrition related taxes. Reviewing the experience of Mexico, they suggested that the reduction in consumption of sugary drinks following the introduction of an excise tax of one peso per litre in January 2014 had been overplayed.

It’s also the case that the Danish tax on saturated fats was repealed by the government after only one year. This was due to a number of economic impacts that quickly became apparent after the tax was implemented, and resulted in plans for similar taxes to be abandoned. In fact, fat consumption in Denmark has been on a downward trend for some time now, therefore no tax incentive was required. And according to the Danish minister of finance, “to tax food for public health reasons [is] misguided at best and may be counter‐productive at worst”.

Whether the UK Prime Minister will be swayed on this matter remains to be seen. It’s likely that a ‘sugar tax’ will continue to be deemed too politically sensitive to introduce, especially as one in five people continue to live below the poverty line.


Related reading
Child obesity: public health or child protection issue?

Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

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Child obesity – public health or child protection issue?

By Heather Cameron

The issue of childhood obesity is in the spotlight again. Just weeks after the Channel 4 series Junk food kids: who’s to blame? highlighted shocking stories of children having gained several stones in weight and children as young as four with rotten teeth, a new study reveals that parents rarely spot obesity in their children.

The results of the survey, given to nearly 3,000 families, showed that nearly a third, 31%, of parents underestimated the weight of their child. It would therefore be fair to say, as highlighted by one of the researchers, that “if parents don’t recognise a child is obese then they’re very unlikely to do anything to help their child move to a more healthy weight. Then it’s a potential major public health crisis being stored up.”

Obesity experts have called for stricter rules on the advertising of unhealthy foods and drinks in a bid to help address this public health issue. And the public would seem to support this, according to a recent poll, which revealed that almost two-thirds of Britons surveyed want a ban on junk food TV ads until after the watershed.

But is the childhood obesity epidemic just a public health issue?

There has been a high degree of contention for some time over whether obesity should also be considered a child protection concern. Numerous news reports have questioned whether children should be taken into care if they are considered obese and potentially at risk of harm.

Just last year it was reported that up to 74 morbidly obese children in the UK were estimated to have been taken into care over the previous five years, according to figures obtained under Freedom of Information laws.

Prior to this, an article from Protecting Children Update that looked at physical abuse in children highlighted obesity as a form of abuse, suggesting that many professionals see obesity as a form of neglect.

Similarly, the researchers of a much cited paper published in The BMJ in 2010 – When does childhood obesity become a child protection issue?argue that parents who refuse to help their overweight children to lose weight are neglectful. They say that whilst obesity alone is not a child protection issue:

consistent failure to change lifestyle and engage with outside support indicates neglect… childhood obesity becomes a child protection concern when parents behave in a way that actively promotes treatment failure in a child who is at serious risk from obesity.”

The report raises questions over how obesity should be addressed in terms of child protection, however, noting that there is evidence that families of obese children were being unfairly accused of abuse where rare genetic conditions were involved. It also suggests that removing obese children from their parents may in fact make matters worse.

With a lack of published evidence and guidelines for professionals, the report therefore suggests the following framework for action:

  • Childhood obesity alone is not a child protection issue
  • Failure to reduce overweight alone is not a child protection concern
  • Consistent failure to change lifestyle and engage with outside support indicates neglect, particularly in younger children
  • Obesity may be part of wider concerns about neglect or emotional abuse
  • Assessment should include systemic (family and environmental) factors

There is certainly no room for complacency, considering the knock-on effect the failure to recognise obesity could have on the nation’s health, not to mention health and social care services.


 

The Idox Information Service can give you access to a wealth of further information on public health and social care topics, to find out more on how to become a member, contact us.

Further reading

Some resources may only be available to Idox Information Service members.

Overcoming obesity: changing hearts and minds, IN Community Practitioner, Vol 87 No 3 Mar 2014, pp16-18

Process evaluation outcomes from a global child obesity prevention intervention, IN BMC Public Health, Vol 14 No 757 2014

The inactivity time bomb: the economic cost of physical inactivity in young people (CEBR, 2014)

Preventing child obesity: a long-term evaluation of the HENRY approach, IN Community Practitioner, Vol 83 No 7 Jul 2013, pp23-27

Is obesity a child protection issue?, IN Community Care, No 1833 2 Sep 2010, pp16-17

Public Health Information Network for Scotland (PHINS) – 14th Seminar

Image of outside of the Glasgow Royal Concert Hall.

Image by Neil Turner under Creative Commons License, via Flickr

By Steven McGinty

On the 10th October I attended an annual event organised by the Scottish Public Health Observatory (ScotPHO) in the Royal Concert Hall in Glasgow. The event focused on health inequalities and the factors driving them. It brought together individuals from a variety of areas, including academia, public health organisations, local and central government, and the voluntary sector to review current evidence, highlight upcoming research and debate key issues with fellow professionals. Continue reading

World Alzheimer’s Day: can we reduce dementia risk?

Older woman with Alzheimer's in a chair

Image courtesy of Flickr user Vince Alongi using a Creative Commons license

By Steven McGinty

On the 21st September, Alzheimer’s organisations across the world will be carrying out events to raise awareness about Alzheimer’s and dementia. The event, a key part of World Alzheimer’s Month, was launched by Alzheimer’s Disease International (ADI) in 1994, with the aim of highlighting the tremendous work carried out by Alzheimer’s organisations.

Each year, a new theme is selected for World Alzheimer’s Month, and this year the focus will be on how we can reduce the risks of developing Alzheimer’s and dementia. In support of this event, I’ve decided to look at some of the statistics on dementia, as well as review the latest evidence on reducing the risks.

Continue reading

How should we address loneliness and social isolation among older people?

For elderly men sitting on a bench

Image courtesy of http://goo.gl/A8ykMA using a Creative Commons licence.

By Steven McGinty

“Loneliness and the feeling of being unwanted, is the most terrible poverty“– Mother Teresa

Yet, for many older people, loneliness and social isolation are the normal state of affairs. A recent study by the Office for National Statistics (ONS) found that 34% of people aged 52 and over felt lonely often or sometimes, with this figure reaching 46% for people aged 80 or over. Rather worryingly, a report by Age UK also suggested that over half of older people consider the television as their main source of company.

In many respects, these figures may not be too surprising, with some arguing that this is simply the by-product of changing societal attitudes. Conversely, it could also be said that these changes are a response to the demands of busy modern life. For example, a report published by the Royal Voluntary Service highlights that, because of uncertainty in the job market, many children have to move away from their parents for work reasons. The impact of this is that many older people are seeing their families less and less, with 48% of parents only seeing their children once every two to six months. Continue reading