In a new bid to improve the health of Britons and crackdown on obesity, last summer the Government announced that it will ban TV advertising of food and drinks high in fat, sugar and salt before the 9pm watershed. HFSS ads will also be banned online. Furthermore, from October 2022, large hospitality businesses and restaurant chains will be required to display calorie information on their menus and food labels and restrictions will be imposed on in-store promotions of high fat, sugar and salty foods and beverages.
Rumour has it that Westminster might delay the HFSS ban, however the obesity epidemic is not something Boris Johnson can shy away from.
According to a report by the NHS, in 2018 63% of British adults were overweight, and 28% were classified as obese. One in three children are overweight or obese by the time they leave primary school. In reception year (children aged 4-5) 9.7% were considered obese in 2018, with that figure being more than double (20.2%) in children in year 6, aged 10-11.
The World Health Organisation’s data from 2016 shows that Britain is the second country in Europe with the highest incidence of obesity among adults – with the first being Malta – whilst Italy and Denmark have the lowest rate. Globally Britain doesn’t fare much better, ranking at number 36 out of 191 countries.
“Some European countries such as Italy, Spain and France have a much stronger ‘everyday food culture’ than in the UK. Here, people prepare simple and healthy meals to consume with family or friends daily.”, says Roberta Alessandrini, a dietitian, nutritionist and doctoral researcher in Public Health Nutrition at Queen Mary University. “In the UK, one out of five households do not have a dining table, and meals are often consumed while sitting on the sofa and watching television or at the desk while at work. On the other hand, obesity prevalence is also on the rise in countries with traditionally more robust food culture, indicating that food habits are also changing in these settings.”
Obesity is a global problem, not just a British one. According to the World Health Organisation, since 1975 obesity has tripled worldwide. Their data shows that in 2016 1.9 billion adults over the age of 18 were overweight, out of which 650 million were obese – 13% of the overall population.
The Republic of Nauru in Oceania has the highest percentage of obese people per capita in the world – 61% – whilst Vietnam has the lowest: only 2.1% of its population is considered obese.
Obesity was thought to be a problem that mainly affected middle and high-income countries, however recent studies have shown that obesity is on the rise in many low-income countries too. Furthermore, not all high-income countries have an obesity problem; only 4.3% people in Japan and 4.7% in the Republic of Korea are obese.
“In the past decades, European countries underwent the nutrition transition. Diets shifted from being suboptimal, scarce, and based on a few plant-based staples to affluent ones high in meat, dairy, and manufactured foods high in sugar, fat, and salt.”, says Roberta Alessandrini. “Affluent diets are linked to increasing levels of obesity and chronic disease. The nutrition transition has been occurring in different world regions at different speeds, and it usually correlates with economic development. Many low and middle-income countries are currently undergoing the nutrition transition. As a result, obesity prevalence is growing in these settings.”
What is obesity and how does it affect our health?
The WHO defines obesity and overweight as “… abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese.”
BMI is calculated by dividing a person’s weight by their height. Whilst the body mass index is not a perfect tool for measuring obesity as it doesn’t take in consideration other factors, such as muscle weight, it is the only one that gives us an approximate indication of a person’s weight health.
Obesity is a problem because it negatively affects the health of those living with it. It’s linked with lower life expectancy and puts people at risk of several chronic diseases, including cardiovascular disease, type 2 diabetes, at least 12 types of cancer and respiratory, reproduction and mental health issues. Evidence from Public Health England has also shown that people with obesity are affected more negatively by COVID-19. Individual carrying excess weight are more likely to test positive for coronavirus, be hospitalised and undergo advanced levels of treatment (including mechanical ventilation or admission to intensive or critical care) and even die from the virus. “The COVID-19 pandemic has brought the health crisis caused by overweight and obesity to the fore. The case for action at scale and over the long term to prevent excess weight and support people living with obesity is strong. Doing more for those groups most affected can help improve health overall and help address some of the inequalities in health.”, the Public Health England study states.
A 40-year-old man with a BMI between 25 and 30 has a life expectancy 4.2 years shorter than a male with a healthy BMI, whilst in women it’s 3.5 years shorter.
The number doubles in those with a BMI between 35 and 40, whose life expectancy is reduced by 9.1 years for men and 7.7 years for women, respectively.
But whilst obesity has been blamed on rich foods, lack of physical activity and humans largely living sedentary lives, research studies are now looking at other factors that could have an impact, such as genetics and metabolic mechanisms. Whilst genetic evolution moves at a slow rate and is unlikely to be the cause of obesity and explain this epidemic, scientists are looking into whether genetic predisposition might be linked to weight problems.
“The causes of obesity are multifaceted, and it is not all about individuals choosing a healthy diet and exercising more. The food environment plays a major role in the onset of obesity. We live in a society where unhealthy foods are cheap, widely available, and heavily marketed. Also, as a society, we cook less and eat out more often because we do not have the time and skills to prepare simple and healthy meals at home. As a result, we primarily consume foods that require minimal or no preparation, which are available in supermarkets and restaurants.”, says Ms Alessandrini.
Tackling the obesity epidemic
The British Government has been working on several initiatives to tackle the obesity pandemic, such as increasing weight management programmes available through the NHS, launching the Public Health England’s Better Health and the free NHS 12-week weight loss plan app and introducing the Sugar Tax in 2018. Local Government initiatives are also taking place to help people manage their weight and lead a healthier life, using exercise and cooking classes as tools.
The HFSS advert ban has already proved controversial, with many welcoming it and others fearing that it will only have an adverse impact on food companies.
Roberta Alessandrini believes that food marketing and advertising plays a role in the obesity epidemic. “Data consistently shows that manufactured and out-of-home foods are too high in fat, salt, sugar and often come in large portions. This can lead people to consume too many calories over time. Therefore, acting on the food environment by reducing the exposure to unhealthy foods (e.g., banning unhealthy food marketing or price promotion on healthy foods) and reducing the calorie density of manufacturers and out-of-home foods is of paramount importance to halt the current obesity epidemic.”.
Others disagree. In a recent Table Talk podcast, Stephen Woodford, Chief Executive, Advertising Association commented: “I just think it’s (the HFSS ban, ed) poorly thought through and I think it is the evidence base that just does not stack up. And, I think, this is why the industry is so up in arms about it, because this is a big hit to industry. … The food industry is Britain’s biggest manufacturing industry. This – and it’s not just about big companies that it tends to be portrayed as the big fast-food brands and confectionery brands and so on – particularly the online band, this affects firms of all sizes, and particularly when you think about the huge amount of SMEs for whom this is their primary route to market”.
In the same podcast, Phil Smith, Director General ISBA, agrees. “I think what businesses are already doing that have been doing it for a very long period of time (reducing fat, sugar and salt content in their foods, ed). But as we said, it’s not simple. It’s not overnight. You have to create products that people will accept, both conceptually and also can elliptically. Now they (the products, ed) have to taste good. And sometimes that’s not so easy. And tastes don’t change overnight, so you have to have a gradual change.”
For Phil Smith, one of the issues with the ban is that food manufacturers need to generate money from the sale of their current products to invest in R&D and create healthier products. “There’s a rather gross assumption on the part of the pundits that if advertising for excess foods is banned, then the investment will have to come into the healthy alternatives. It just doesn’t work like that. Business needs revenues to be able to invest in the R&D and in the marketing and promotion of these new alternatives… So the ability to make this transition is a very long and slow one, which requires a degree of certainty on the part of the regulatory regime.”
According to the NHS adults shouldn’t consume more than 30g of sugar per day, whilst children between the ages of 4-10 shouldn’t have more than 19g-24g. However, the Public Health England (PHE) and the UK Food Standards Agency (FSA)’s National Diet and Nutrition Survey (NDNS) found that children in the UK consume a whopping 52g of sugar per day, more than double the recommended allowance.
The Government has calculated that the HFSS ban will cut down 700 calories per person per year. That’s just under three 45g of milk chocolate or 2.6 50g bags of ready salted crisps. Would cutting down less than a 1000 calories per person over 12 months really solve the obesity pandemic, or does more need to be done?