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After months of waiting and numerous delays, the government’s childhood obesity plan was finally published in mid-August (which also happened to be during the Olympics, when most of us were sitting and watching comfortably from our sofas – and when parliament was not sitting, in this case definitely a bad thing).
Expectations were high. Writing in the Daily Telegraph just a month ago, Simon Stevens labelled obesity ‘the new smoking’ and called for an ‘activist’ strategy with comprehensive action on food reformulation (changing the nutritional content of processed foods) and on promotions and advertising of unhealthy food and drink. Jeremy Hunt has described the rise in childhood obesity as a ‘national emergency’ and promised a ’game-changing’ response from the government. Now that the dust has settled, was it worth the wait?
The childhood obesity plan (no longer a strategy) is certainly slimline at a mere 13 pages, but it is no tonic. It dutifully sets out the scale of the challenge, including the cost of obesity to the NHS (£5.1 billion every year) and recognises inequalities in obesity. But it essentially stops there, failing to mention its estimated cost to the economy of £27 billion, due, for example, to its effect on productivity, earnings and welfare payments. This is a telling omission, and indicative of the extreme narrowness with which those in the upper tiers of government appear to understand obesity, its causes, effects and therefore its solutions. It is also particularly ironic given that the impact on the food and drink industry – and therefore on jobs and the economy – was reportedly one of the reasons we have ended up so far from a game-changing strategy.
Ever since the government’s Foresight report on obesity was published back in 2007, it has been widely known and accepted that obesity is not an issue that can be tackled through the selective use of one or two approaches. It requires a cross-society, cross-government response. Especially as – revealed in the week before the launch – we have all been systematically undercounting the calories that we consume.
The Health Select Committee looked at childhood obesity in depth last autumn, prioritising nine recommendations in its report Childhood obesity – brave and bold action. The table below illustrates my take on how the plan stacks up against these.
How does the childhood obesity plan measure up?
| Health Select Committee recommendation | Childhood obesity plan | RAG rating |
|---|---|---|
| Strong controls on price promotions of unhealthy food and drinks | No mention of price promotions | Red |
| Tougher controls on marketing and advertising of unhealthy food and drink | No mention of marketing and advertising | Red |
| A centrally led reformulation programme to reduce sugar in food and drink | Targets in nine categories of food contributing most to children's sugar intake, but action is voluntary until 2020 and no mention of penalties or sanctions | Amber |
| A sugary drinks tax on full sugar soft drinks, with all proceeds targeted to help those children at greatest risk of obesity | Benefit of the doubt but devil is in the detail - proceeds to go to school sports and unclear whether targeted on those at greatest risk | Green |
| Labelling of single portions of products with added sugar to show sugar content in teaspoons | Labelling mentioned, in context of Brexit and greater flexibility, but no details or commitments | Red |
| Improved education and information about diet | No mention of education and information about diet | Red |
| Stronger powers for local authorities to tackle the environment leading to obesity | No mention of stronger powers for local authorities | Red |
| Early intervention to offer help to families affected by obesity | 'Recommitting to Healthy Start voucher scheme; income from sugar levy to schools including an incentive premium | Amber |
The plan re-affirms the government’s commitment to a sugar levy (already announced by the last Chancellor in the Budget). It also commits to calorie reduction through product reformulation in nine categories of food (those that contribute the most sugar to children’s diets, such as cereals, biscuits and cakes) on a voluntary basis, with Public Health England given the job of monitoring progress. Product reformulation is a good thing. But the danger is that, like the last government’s Responsibility Deal, which placed the onus on the industry to lead the way in tackling obesity, it will fail.
Sainsbury’s and the British Retail Consortium are among those who have criticised the plan and called for mandatory targets. It beggars belief that the government has misjudged the response of leading voices in the food retail industry, who recognise the need for the government to play a stronger co-ordinating role. To have any chance of working, voluntary action must be backed up with strong, swift and credible threats of regulation. But the plan is unbearably weak on this, stating that if there has not been sufficient progress by 2020 then the government will ‘use other levers to achieve the same aim’.
But even more worrying than this – as the table shows – is that the plan either ignores, or only weakly responds to, most of the Select Committee’s recommendations. If this RAG rating was on the front of a sandwich it would be seen as very unhealthy indeed. Where is the reference to the ‘radical upgrade in prevention’ from chapter two of the NHS five year forward view? Where is the role of the voluntary and community sector? Where is the challenge to – and recognition of – the role of local government? As the chair of the Committee Sarah Wollaston has said, with their public health budgets being cut local authorities are in dire need of other levers, such as stronger planning powers, if they are to play their full role in tackling obesity.
In short, where is the delivery plan for a cross-society, cross-government approach to childhood obesity? A bold and brave strategy? Not in those 13 pages. The plan concludes with a promise that this is the start of a conversation, and that government will ‘monitor action and assess progress, and take further action where it is needed’. Personally, I won’t hold my breath.