Second’s out, round two: Is the government’s latest childhood obesity plan a knockout?

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Around a third of children aged 2 to 15 in the UK are overweight or obese. Children are becoming obese at an earlier age, staying obese for longer and children from lower income household are more than twice as likely to be obese than those in high income households. This is a population health and an inequalities problem.   

The government’s first childhood obesity plan was simply not good enough to address these challenges; it was widely derided and not only by the usual public health suspects. The plan didn’t measure up in many areas including price promotions, marketing and advertising, labelling, information, or giving local authorities stronger regulatory powers.

But it wasn’t all bad, the soft drinks levy on sugar in soft drinks was widely welcomed. Since then we’ve seen that the industry response has been so dramatic that HM Treasury’s forecasts of how much the levy would raise have turned out to be over-optimistic, as drinks have been reformulated to avoid it. The plan also included work on reformulation of foodstuffs, such as cakes and biscuits, through a voluntary agreement monitored by Public Health England. Public Health England recently announced the results of progress in the first year of this agreement: the 5 per cent target was missed, with an average reduction across categories of 2 per cent.  

The obesity plan, chapter 2 is now here. Is it any better than the first? One way to answer that is to assess it against the Health and Social Care Committee’s refreshed recommendations based on its most recent grilling of the experts. The table below shows how the updated plan measures up against the Committee’s key asks.

How does the obesity plan chapter 2 measure up?

Health and Social Care Committee recommendationThe Obesity Plan 'round two'RAG rating
A whole systems approach Amber
Cabinet Committee for obesity with mandatory reporting across departmentsNo cabinet sub-committee or mandatory reporting of actions across departmentsRed
Targets, with a focus on health inequality reductionAmbitions to halve the rate of childhood obesity by 2030, no specific numerical commitment on reducing inequalitiesGreen
Greater powers for local government including health as a licensing objectiveNo new powers, but will work on ‘trailblazer programme’ to maximise use of existing powers with focus on inequalities; provision of training for planning inspectorsAmber
Extend soft drinks levy to milk-based drinkExtension to be considered in 2020 HM Treasury review; will consult on ending sale of energy drinks to childrenAmber
Advertising, marketing and price promotions Green
9pm watershed controls on advertising of high in fat, sugar or salt (HFSS) productsWill consult on 9pm watershed controls for HFSS products by end 2018Green
Ban on cartoon characters advertising HFSS productsNo new announcement, ‘no new plans’, NIHR obesity unit will continue to monitor Red
Alignment of regulation between broadcast and social mediaIntention to legislate, with consultation by end 2018Green
Calorie labelling for out-of-home food sectorIntention to legislate, will consult by end of 2018; will consider additional simplification of labelling following EU exitGreen
End buy one, get one free (BOGOF) and similar promotionsIntention to ban BOGOF (plus free refills, etc) of HFSS products, consult by end 2018Green
Remove unhealthy products from end of aislesIntention to legislate to end ‘promotion of unhealthy food and drink by location’ eg, end of aisle. Consult by end 2018Green
Early years, schools and their environment Amber
Targets for breastfeedingNo new announcementRed
‘Full implementation’ of 2016 childhood obesity plan commitments on schoolsAction across a range of areas, but not all. Additional activity on ‘daily mile’, updating School Food StandardsAmber
New powers for local government to limit HFSS billboards near schoolsNo new announcementRed
Make it easier for local government to limit ‘unhealthy food outlets’ close to schoolsNothing specific, though trailblazer programme (see above) is likely to include thisAmber
Access to effective services for children and familiesNo new announcementRed

There are six green, five red and four amber ratings. This is progress, and the government has bitten the bullet on one of the areas it was most criticised for last time round – marketing and advertising – with controls on both signalled across a broad range of areas. Chapter 2 signals the intention to legislate in many of these areas with consultation due to start by the end of 2018. 

The government has not moved on some specifics such as banning cartoon characters associated with high in fat, salt or sugar (HFSS) products or improving weight management or breastfeeding services – the latter might come through other means, following the announcement of the recent NHS settlement, we shall have to wait and see. But there is progress– if not yet a green light – on a wide range of the areas that the Health and Social Care Committee highlighted, and strong signals that the government will move again, including on reformulation of foods, if the industry does not speed up progress. 

We welcome the ambition to halve childhood obesity by 2030 and the commitment to narrow inequalities – although it is slightly disappointing there is no specific ambition on the latter beyond ‘significantly’. We also welcome closer working and support for local government around the fitness for purpose of existing planning powers but notice the government has not gone as far as the Committee wanted on new powers. 

Overall, the government has clearly focused on advertising, marketing and price promotions, areas where the original childhood obesity plan was most criticised. But a final red mark: the government has ignored the Health and Social Care Select Committee’s view that a new cross-government committee is required to co-ordinate and hold to account government departments for their contributions to tackling childhood obesity. There therefore remains work for us all to do in holding the government to account for these intentions and commitments.

Comments

Dr Michael Cra…

Position
Associate Professor in Public Health,
Organisation
University of Nottingham
Comment date
02 July 2018

BMJ rapid response ".........In conclusion, we believe that the government has still not created a long-term child healthy eating strategy that is matched to the scale of the problem.(2) There are still significant areas that have not been addressed and there appears to be a lack of urgency. Strong, robust and bold actions are needed now......"

https://www.bmj.com/content/361/bmj.k2775/rr

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