Thursday

21st Sep 2017

Analysis

UK’s childhood obesity strategy - an EU blueprint?

  • Despite disapproval by health campaigners, the UK's childhood obesity strategy has been lauded as inspiration for other European countries.

Friday (18 August) marks the first anniversary of the UK’s childhood obesity strategy, but there’s little to celebrate according to public health campaigners.

Could the criticisms levied at politicians in Westminster put their counterparts in other European countries off the idea too?

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  • One in three children aged between six and nine in Europe is either overweight or obese. (Photo: iStock)

Just last week, the influential healthy eating campaigner and celebrity chef Jamie Oliver claimed the UK’s plan was “awful”.

"What’s even more scary is that when May [the prime minister] released the strategy that she had ruined, I believe her team were genuinely chuffed with what they had done,” he told the Sunday Times magazine.

Oliver has been one of the most vocal critics of a UK strategy that commits to “significantly reduce” the country’s rate of childhood obesity within the next 10 years.

The strategy, however, is simply 12 pages of policies that largely place the onus on industry to self-regulate.

Pizzas to sandwiches

Despite Friday’s announcement of £5m (€5.5m) in funding for a new obesity research unit and a calorie reduction programme, spanning across everything from pizzas to sandwiches, it’s hard to find support amongst the country’s health campaigners – and this has been the case for the past 12 months.

The package was “snuck out” last year, with little publicity, and was met with strong disapproval by campaigners and retailers. This was a plan that had been torn apart in the aftermath of the Brexit vote and a change in prime minister, they said.

A sugar tax on sweet drinks remained, but gone were the hoped-for restrictions on marketing and advertising of junk foods and fizzy drinks. Targets to cut sugar in a range of products by 20 percent, which food manufacturers have said are impossible, are voluntary.

Caroline Cerny, head of the Obesity Health Alliance, a coalition of 40 health charities, medical royal colleges and campaign groups, said current regulations on marketing junk food to children are “full of loopholes”.

Failing to tackle advertising “is significantly undermining the impact of the Childhood Obesity Plan”, she added.

It is well understood that in order to tackle obesity, a number of policy triggers must be pulled – from reformulation of products to the promotion of healthy foods and encouraging exercise.

Governments can take a soft touch or hard line approach with these interventions and many campaigners and academics believe relying on the former won’t curb the epidemic.

In March, three health experts writing in the British Medical Journal (BMJ) said the “severely limited” strategy “watered down the desired discussion of anti-obesogenic medicine”. Advice from advisers at Public Health England (PHE) had by-and-large been ignored.

Yet PHE, an executive agency in the UK's health department, has become a staunch defender of the strategy. Duncan Selbie, the chief executive, has said complaining about what the plan doesn’t include rather than focusing on the “significant action being taken” is “quintessentially British”.

“Let’s implement the plan and start making a difference,” he added.

Inspiration for other EU countries

As the fat hits the fan in the UK, will other countries be inspired to produce more robust obesity strategies of their own, or shy away from the idea altogether?

Nikolai Pushkarev, policy coordinator for food, drink and agriculture at the European Public Health Alliance, believes more national obesity strategies are on the way. “Our hope and expectations is that they will be designed to deliver,” he told EUobserver.

He added: “Without wanting to pass judgment on whether the UK strategy is up to the challenge of fighting child obesity or not, I think the principle of introducing a strategy should act as inspiration for other European countries.”

Europe’s health ministers recently criticised efforts to tackle obesity.

Members of the employment, social policy, health and consumer affairs council (EPSCO) said measures to date “have not been sufficiently effective”. They also questioned the self-regulatory approach: “… experience and evidence point to the fact that voluntary action may require regulatory measures in order to be effective.”

Whether the food industry can be trusted to police itself is a moot point. The World Health Organization (WHO) wants tighter marketing restrictions, especially online, and the World Bank appears to agree.

In a recent report, the Bank noted the “aggressive and sophisticated” way in which processed foods are marketed. This, explained the authors, can “undermine the normal processes of appetite control, cause overconsumption, and therefore obesity, and diseases associated with obesity”.

The Bank suggested government must take the lead; self-regulation is a “highly risky approach” and should “be accompanied by other measures including regulatory actions by the government to enforce certain restrictions”, the authors concluded.

Whilst Europe’s health ministers might agree on paper, the current review of the EU's Audio Visual Media Services Directive suggests the statements are rhetorical rather than revolutionary.

Few politicians have warmed to the idea of nanny-statism but this interventionalist approach seems to be working.

Observers often point to smoking – which according to the McKinsey Global Institute is on a par with obesity in terms of global economic impact – as the model to follow.

“What worked were scary messages on cigarette packets, plus taxation,” noted the Financial Times columnist Simon Kuper in July. “Telling people to exercise and eat healthily doesn’t work. Medics need to hand over the issue to advertising agencies and other people who know how to change behaviour.”

Professor Mark Hanson from the British Heart Foundation, and one of the co-authors of the BMJ paper, said governments “should not hold back” from fiscal measures like taxes and new laws on marketing and packaging that have “brought enormous benefits to child and population health” when applied to the tobacco industry.

Fat taxes

Unlike having a cigarette, recent research shows that Europeans are largely free to eat as they please, with relatively few punitive taxes or restrictions in place.

And while there is certainly an appetite for more taxes on sugary drinks, those alone, as campaigners have long argued, won’t curb obesity. Rolling more levies out to other ingredients or foods is fraught with complications, and bad experiences – consider Denmark’s fat tax that was repealed after just a year. But that doesn’t make the concept a non-starter.

EU health commissioner, Vytenis Adriukaitis, has claimed taxes can be a “very powerful” tool for tackling health issues, though the food industry, generally, is vehemently opposed to the idea.

Research published by the University of Edinburgh in Scotland last month showed that taxes can reduce consumption of target products, generate revenue and become “politically sustainable”.

In their review of more than 100 papers, Alexandra Wright and her colleagues concluded that “there is considerable evidence that taxes on sugar-sweetened beverages and unhealthy food products can have positive health impacts”.

Most of the studies available, however, are based on models or experiments involving “potential” taxes.

Wright called for further assessments of the impact taxes on salt, sugar and/or fat in countries like Finland, Latvia, France, Portugal and Hungary have had. “With more and more countries implementing new kinds of health taxes, there are numerous opportunities for real-world evaluations to substantially strengthen the current evidence base,” Wright explained.

Speaking at the European Congress on Obesity in Portugal back in May, Dr Janas Harrington from the HRB Centre for health and diet research at the University of Cork said there is a “compelling case” for taxing sugary drinks.

Ireland published its obesity strategy last September. “This will be a fascinating experiment in public health policy,” she said.

Whether it is taxes, mandatory (and uniform) application of nutritional labels or restrictions on the promotion of unhealthy foods, many member states will be weighing up how best to tackle soaring levels of obesity.

Nanny-statism

It will take time and patience to determine how effective these are, but it is clear that a package of interventions is required.

Politicians and policymakers shouldn’t be put off by the critiques of the UK’s strategy; rather they should use them to push through better plans of their own, explained Malcolm Clark at the Children’s Food Campaign.

"The UK government may have the cheek to call theirs a 'world-leading' obesity plan, but only a couple of elements come anywhere close. It would be straightforward for other countries to avoid the pitfalls in the UK’s plan,” he told EUobserver.

First, governments must set out a comprehensive strategy which “doesn't shy away from contentious areas”, he said. “They then need to maintain effective cross-government oversight and leadership. And finally they need to have a Plan B up their sleeve of further regulations and fiscal measures to ensure industry compliance."

Given that one in three children aged between six and nine in Europe is either overweight or obese and the epidemic is threatening to bankrupt health services, the pressure is on European ministers to get things right the first time.

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