This essay is part of our ‘The NHS if’ series that explores hypothetical scenarios and their impact on the future of health and care.
It is now 2050. And as an independent policy technician at Cybersocial Systems, I’m looking back at the impact of the ‘obesity epidemic’ in the first years of the 21st century.
It seems odd now, but at the time there was serious scientific debate about what ‘caused’ obesity, the role of the state – should it be a nanny or get out of people’s lives – and the relative effectiveness of the state, businesses, communities and individuals to influence outcomes.
In England, things came to a head in 2017, a year after the government published its ‘childhood obesity plan’. This suffered from a weight of expectation, delay and the random play of being delivered under a change at the top of government. There was predictable outrage from the usual suspects in the public health lobby, but, more quietly at first, disappointment too from some major retailers. Among the public the realisation was starting to bite that the West could be witness to the first generation that would die earlier than its predecessors, not because of an external health threat, but because of obesity – an issue manufactured within society itself.
But perhaps the clincher was that the food retail industry was more ready for change than the government had realised. Competition and transparency over price had reached such a pitch that the big supermarkets realised their long-term survival depended on ‘loyalty beyond price’ to capture the hearts and minds of consumers. The large food retailers rapidly developed strategies focusing on supporting long-term health and wellbeing, asking customers how they wanted to be helped, and following up by introducing loyalty points for reduced alcohol consumption for those that were worried about their drinking, and other incentives to achieve wellbeing goals.
“Among the public the realisation was starting to bite that the West could be witness to the first generation that would die earlier than its predecessors.”
They joined with public health organisations and urgently lobbied the government to regulate more strongly on sugar, fat, portion size and minimum pricing. What they were looking for was a level playing field on which to compete on long-term health gain, and only the government could help them deliver that. This happened far faster than people could have predicted just a few years earlier, being introduced in 2020, alongside strong regulation over food advertising, controlled by the Chief Medical Officer.
But the battle against obesity took place on more than one front. Starved of funds from central government, but liberated through devolution deals (remember them?) and responding to the news that the UK remained rooted to the bottom of the world fitness league, by the mid-2020s local government had become a much more confident and fierce player in the design of neighbourhoods. The root cause of this was the need to attract business, and therefore income through local taxation (the UK government had continued the downsizing of the central state, and local areas were becoming city states in all but name) and this meant a focus on designing more desirable neighbourhoods including more green space, and prioritising cycling and walking over other forms of transport.
“By the mid-2030s, obesity and obesity-related health problems such as diabetes and musculoskeletal problems were in long-term decline.”
The NHS – focusing on prevention as well as cure – was by now investing billions in its workforce, supporting behaviour change, promoting healthier lifestyles and equipping its 1.4 million ‘partners’ (no longer simply employees) to be advocates for change in their local communities. By 2030, after much ethical debate, and through a campaign led by major celebrities, many people were agreeing to cede control over their diets to the new ‘digital food and wellbeing’ companies, such as Cybersocial Systems, in return for long-term deep price discounting, and the offer of virtual wellness coaching. This was approved by NICE, as long as the data was shared with the NHS.
In the early 2030s, the dynamics of devolution and these social changes had started to weaken the economic pull of global cities like London. With redesigned local neighbourhoods and telecommuting, more people worked closer to home, and cycling became the norm in many cities. The impact of the world’s toughest TV and social media advertising regulation, led by the Secretary of State for Public Health, had also started to bite.
“This meant a focus on designing more desirable neighbourhoods including more green space, and prioritising cycling and walking.”
By the mid-2030s, obesity and obesity-related health problems such as diabetes and musculoskeletal problems were in long-term decline, but although many people were benefiting, inequalities were becoming more entrenched. For those with access to healthy food, for whom exercise and physical activity were the social norm, and who had a supportive local and work environment, obesity was rarer and rarer. But for far too many, life continued to be challenging and the stigma of obesity was far stronger than before. No longer a social norm, it was becoming seen as a social sin by the population as a whole. Being obese was as socially unacceptable as being a tobacco smoker had been in the 2020s.
Fortunately, among all this change, basic science has not stood still. By 2040 foods engineered to avoid obesity were on their way; the approach to food reformulation of the 2020s was being left behind. Rather than engineering out fat and sugar, science had managed to engineer the physiological response to fats and sugars. In short, people could eat what they liked and still remain a reasonable weight. These ’superfoods’ offered the possibility of the first generation without obesity. But because of their cost, they were also out of reach of those who could benefit from them most – the poor.
“Public policies need no longer be constrained by all the regulations that have been introduced to tackle obesity, stifling and distorting our economy.”
This is why I am proud to work for Cybersocial Systems. We took the momentous decision to subsidise these superfoods, so that every family can have access to them. All the effort involved in physical activity, staying fit and being careful about what you eat need no longer be constraints. As importantly, these superfoods mean that public policies need no longer be constrained by all the regulations that have been introduced to tackle obesity, stifling and distorting our economy, which needs to be free to face the threat of the African lion economies. We are also proud that the government has decided to respond to our gift of subsidisation by granting a licence for our gene-editing technology. Not only can we offer superfoods, but from 2050 we will also work with local social health insurers to offer genetic care to remove the possibility of obesity for 95 per cent of children before they are born. The stigma of obesity will soon be a thing of the past; we expect soon to become the first country in the world to eradicate obesity
Would the person in my ‘policy technician’ shoes in 2016 have predicted that? I suspect she wouldn’t.
The views expressed in this article are those of the author and are not presented as those of The King’s Fund. We have commissioned external authors to write for ‘The NHS if’ series as a way of presenting different perspectives on the future of health and care. We welcome a diversity of views on this issue and encourage you to leave us your feedback.