Tag Archives: obesity

Digesting diet and health: the challenges of eating well

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Diet-related health problems are rarely out of the news. That’s because so many illnesses and diseases are the result of poor diet. There’s no shortage of suggestions for improving our diet, and for educating all of us on the benefits of eating well.

Policymakers are also concerned about this issue. Since the start of the COVID-19 pandemic, the NHS has been under greater pressure than ever, and government has been keen to address diet-related health problems.  

Examples of this include the most recent legislation to add calorie labelling to  restaurants and takeaways, which has been controversial. The new rules for England make it a legal requirement for large businesses with more than 250 employees, including cafes, restaurants and takeaways, to display calorie information of non-prepacked food and soft drinks.  The Scottish Government is consulting on similar proposals.

Sugar and salt taxes

Another example of regulations directed towards diet-related health problems would be taxes on sugar and salt in foods. There have been suggestions to either tax all foods based on their salt content, or specific foods which are classed as “high” in salt.

A sugar tax – the Soft Drinks Industry Levy – was introduced in April 2018 by the UK Government. It was later reported that consumers had bought 10% less sugar through soft drinks, which will also have lowered risks of obesity, type 2 diabetes and high blood pressure.

A report from the Institute of Fiscal Studies in 2021, looked at the impacts a tax on added sugar and salt could have on purchases of food both at home and out of the home in the UK. The report found that a salt tax could potentially see a decrease in risks of coronary heart disease and strokes.

In addition, the study suggested a salt tax could reduce the number of NHS treatments for obesity-related conditions, resulting in  lower NHS costs. The report also indicated an increase in overall economic output due to a healthier workforce.

However, there may also be less welcome consequences. A ‘snack tax’ has been estimated to potentially add as much as £3.4billion a year to families’ shopping bills. Introducing such a tax during the current cost of living crisis would add greatly to the financial stresses being experienced by households across the country.

Counting the calories

Displaying the number of calories in meals on menus has long been proposed as a way to tackle obesity and health issues, as so many people are unaware of just what is in the food they order. Public opinion is extremely divided on this subject, with some being in favour of this extra measure to help them when eating out if they wish to make healthier choices.

However, adding calorie information to menus may have undesirable effects. 1.25 million people in the United Kingdom have an eating disorder, and the COVID-19 pandemic is likely to have increased this number as more people struggle with mental illness and increased stress.

Beat, a UK-based eating disorder charity, has highlighted  that calorie labelling exacerbates eating disorders of all kinds. In addition, pushing a “diet culture” could send the wrong messages about eating rather than embracing a more positive approach towards food.

A further  study by the British Medical Journal reported only a small decrease in calories purchased when trialling calorie labelling in three chain restaurants in the United States. The researchers also found that after one year, that reduction diminished.

Meeting in the middle?

Another suggestion that has been discussed is tackling health-related inequalities, and understanding why certain groups are more vulnerable to these issues than others. For example, the House of Commons library has reported that in England people living in the most deprived areas were 9% more likely to be overweight or obese than those in the least deprived areas. The briefing also reported that  children in the most deprived areas of England were twice as likely to be obese.. More education focusing on not only what is healthy food, but how to be healthy with fewer resources could help reduce such inequalities.

Final thoughts

From tooth decay and high blood pressure to cancer, eating disorders and mental ill health, there are significant health and wellbeing impacts resulting from unhealthy eating habits. These issues also have serious consequences for healthcare services.

As we’ve seen, legislation has already been introduced to tackle diet-related health problems. But it’s likely that government will have to consider further measures to ensure that the food that we eat is both good for individuals and for wider society.

Further reading: more on food and nutrition from The Knowledge Exchange blog

Food for thought: how the UK food strategy is trying to revolutionise the way we think about and access food

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Research has shown that healthy food choices are three times more expensive than unhealthy ones, food bank use is at it highest ever level and the NHS is anticipating significant struggles in long term treatment of people with conditions linked to obesity and unhealthy lifestyles, like cancer, diabetes and heart disease.

A forecast published in a report by the Food Foundation showed that if we continue at our current rate and type of food consumption 22% of children born in 2020 will be overweight or obese by age 5, rising to 46% by the time they reach age 21.

But the impact doesn’t stop there. The food system – agriculture, food production, distribution and retail combined – releases more greenhouse gases than any other sector apart from energy. In the UK, the food system accounts for a fifth of domestic emissions – but that figure rises to around 30% if we factor in the emissions produced by all the food we import.

The food we eat – and the way we produce it – is doing damage to both the environment and our health and the government is now trying to take steps to mitigate the damage, and improve our health and wellbeing in the process through the roll out of a national food strategy.

Fixing a broken system

Figures from the Trussell Trust show that between April 2020 and March 2021, a record 2.5 million emergency food parcels were given to people in crisis. The increasing use of foodbanks shows just how deeply entwined inequality, food and health are, and how important it is for a robust and equitable food strategy to be rolled out.

The Broken Plate 2021 report from the Food foundation provides an overview of the food system in the UK, looking across four main themes:

  • making healthier options more appealing;
  • making healthier options more affordable;
  • making healthier and more sustainable options more available; and
  • addressing inequalities in food so that everyone can have the chance to live longer, healthier lives.

In July 2021 the UK government published a review into how the food system in the UK works and the interventions that could be brought in to prevent the harms from what we eat and the way we eat. The plan sets out recommendations and a strategy for the future which focuses on food being equitable, accessible, healthier, and sustainable.

The recommendations cover a number of key themes:

  • escape the “junk food cycle”, including introducing a Salt and Sugar Reformulation Tax;
  • reduce diet-related inequality, including extending eligibility for free school meals;
  • make the best use of our land – including guaranteeing agricultural payments to help farmers transition to more sustainable land use; and
  • create a long term shift in food culture, including the development of a robust system of data collection and reporting to help monitor long term progress.

Inequality exacerbated by unequal access to food

One of the most pressing issues around food is its availability and its ability to exacerbate existing inequalities, particularly among disadvantaged groups. We have already seen that food bank use is high (disproportionately so among lower income groups) and that eating healthier food is more expensive than unhealthy food.

The shelf life of more unhealthy and highly processed food is also often longer, so it is easier to store, and food can be spread out and eaten across multiple days more easily. Processed foods, which are often higher in sugar, salt and trans fats (unhealthy fats) also often require less cooking (both in terms of heat energy required to cook them and knowledge of how to prepare them) which for people with reduced access to kitchens, experience of fuel poverty or limited knowledge of preparing food can be more convenient. Research consistently shows that people who fall into these groups are significantly more likely to come from lower socioeconomic backgrounds and have experience of poverty.

Steps are being taken to try and improve access to healthier food for people living on lower incomes, including free school meals and (with a bit of persuasion from Marcus Rashford) a wider roll out to also offer meals during school holidays. The government also runs a voucher system for new parents to help them get access to fresh food like fruit and vegetables.

More recently there has also been discussion about the roll out of “food on prescription” services, both for those people on lower incomes and for those people who are at risk of medical complications or disease as a result of being overweight or obese.

Photo by Tim Mossholder on Pexels.com

Sustainable as well as healthy

As has been made clear in the reports, food systems don’t just impact on us as individuals, they also have a significant impact on the environment. The changing climate is at the forefront of everyone’s mind, including multiple extreme weather events, the publication of an IPCC report on climate change, and the run up to COP26, due to be held in Glasgow. So the way we grow and process our food, and how this negatively impacts our environment is coming under greater scrutiny.

Currently, many practices are having a negative and detrimental impact on our environment across a number of areas including carbon emissions, water pollution, reduction in soil health, loss of biodiversity, land use/deforestation.

And commentators are now emphasising that our food system as well as being healthy and accessible should also be sustainable, with programmes developed to reduce food waste, support community-based agriculture schemes, help farmers to transition to more sustainable ways to farm and use land and stimulate demand for in season, sustainably grown, locally sourced food.

Final Thoughts

Food, and our relationship with it is becoming increasingly important, not only for our own personal health and wellbeing, but also for the health of communities more generally, and the health of our planet.

Sustainable, healthy and equitable food systems help to promote healthier choices and reduce our impact on the planet. And food can also play its part in helping to relieve other pressures on society, like food poverty, inequality and the rising use of food banks. Food on prescription services can help support people to make better choices and reduce the risk of diseases like cancer, heart disease, stroke and obesity.

In short, food is not just vital for life, but also for living well.

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Why are we still talking about healthy places?

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In recent years, there has been a wide ranging debate across the housing, planning, health and infrastructure sectors about the development of healthy places in both regeneration and newly approved projects.

In 2016, Town and Country Planning Journal published an article on building health and wellbeing into the built environment (Town and Country Planning, Vol 85 No 11 Nov 2016, Knowledge Exchange customers can login to view the article here) In 2017 and 2018 the talk was all about healthy towns initiatives, and a Design Council report in 2018 looked at the relationship between healthy placemaking and the impact on our communities. In 2019 the Town & Country Planning Association (TCPA) called on members to “reunite” health and planning. 

It is clear that everyone involved in placemaking agrees building places that promote health and wellbeing for all is of vital importance to our communities, The Covid-19 pandemic brought this into sharp focus, and the idea remains at the forefront of design policy, particularly in urban city contexts. But, over four years after the initial conversations and thought pieces, why are we still talking about it, and what actions still need to be taken to integrate the idea of a healthy place into planning to the extent that it just becomes the norm in the planning and design of our places?

Preventing avoidable disease

The phrase ‘healthy placemaking’ has been defined by Design Council as: “Tackling preventable disease by shaping the built environment so that healthy activities and experiences are integral to people’s everyday lives”.

Public Health England defined healthy placemaking as: “Placemaking that takes into consideration neighbourhood design (such as increasing walking and cycling), improved quality of housing, access to healthier food, conservation of, and access to natural and sustainable environments, and improved transport and connectivity”

Research has shown preventable diseases linked to lifestyle and environment are among the most significant threats to public health. Lifestyle-related conditions like heart disease and cancer, as well as being health problems in their own right, can also contribute to the development of other chronic conditions, exacerbate symptoms and create complications with care which are costly to the NHS.

Creating healthy spaces is not just about encouraging people to live more active lifestyles by facilitating active travel and improving the environment around buildings, although this is a significant part of it. “Healthy places” include approaches to improve air quality, reduce loneliness, allow people to age well in place, promote mental as well as physical wellbeing, reduce deprivation and inequality through projects like housing, infrastructure development, and high street regeneration.

Healthy places also have a preventative role to play in public health management, not just a health improvement role; such interventions are essential to help avert the onset of disease, improve people’s quality of life and reduce health inequalities. And evidence shows the return on investment from public health interventions is high and creates value of different kinds – economic, social and personal.

In short people who live in healthy places, tend to live healthier lives, place less strain on services and “contribute” more to society, both economically through work or spending and socially through community engagement.

Victoria Park, Belfast. Image: Fiona Ann Paterson

Enabling planning practitioners to think about creating healthy places

Research published in 2020 by the Royal Town Planning Institute (RTPI) explored local, national and international planning practices that enable the creation and delivery of healthy places. While a lot of research draws attention to the barriers to building healthy places – including a lack of funding, different requirements from developers and conflicting policy priorities – the RTPI report instead sought to identify important challenges faced by planners who try to integrate healthy placemaking principles in their decisions and then offer potential solutions to these in practice. Key themes emerging from the report include a need to improve collaboration, knowledge sharing and the skills of planners.

The report provides case studies looking at: the place standard tool; the livewell development accreditation; connecting communities in Tower Hamlets; health planning in South Worcestershire; and train station district rejuvenation in Grasse, France. It also identifies seven steps to plan for healthier environments

Across the sector there have been calls for planners to be allowed to be innovative, creative and take a “visionary” approach to planning to help make places healthier in order to address the convergence of challenges around public health, the climate emergency, and economic recovery from Covid-19.

How has the coronavirus pandemic changed how we think about healthy spaces?

The lockdowns  imposed as a result of the coronavirus pandemic have thrown the importance of quality space into sharp focus. Places that facilitate health and wellbeing among the people who live there, and places where the indoor living quality is as important as the outdoor space have become incredibly important.

The pandemic has highlighted what it really means to have a healthy space. It has also demonstrated how wider socioeconomic deprivation and inequality – linked to living conditions as well as other factors – is having an impact on infection and hospital admission rates, with those groups who live in more deprived areas being found to be at a higher risk of becoming seriously ill or being admitted to hospital with Covid-19. 

The 2018 Design council report found in its survey of practitioners that focus was given far more to outdoor space than to indoors, as it was easier and more cost effective to make changes that could produce demonstrable impacts (an increase in cycling, for example). But the pandemic and the increased time we have been forced to spend indoors has encouraged designers and urban planners to think even more creatively about quality space in their developments.

Where now?

Public Health England (PHE) which for many years was a strong voice in the conversations around healthy placemaking has been disbanded and will be replaced by a National Institute of Health Protection. It remains to be seen how, or if this new organisation will fit into the conversation going forward. But reflecting on recent reports on the significant public health crisis facing the UK in the long term, it is clear that the work must continue, driven collectively by those in planning, urban design and public health.

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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

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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.

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

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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?

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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?

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Child obesity – public health or child protection issue?

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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

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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?

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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 →