England is ‘nowhere near’ achieving its ambition of halving childhood obesity by 2030, according to the country’s outgoing medical officer Dame Professor Sally Davies.
“In the last year of primary school, on average, six children out of a class of thirty are obese and a further four are overweight, twice as many as thirty years ago,” she stated, adding that kids are ‘drowning in a flood’ of unhealthy food and drink options.
In an independent report addressing politicians and policymakers – published today (10 October) – Davies noted that physical activities, ‘although important’, will not solve the obesity crisis. Instead, the CMO is turning to regulation for answers.
Rebalancing food prices
As it stands, it is ‘too easy’ for the food industry to make money from the sale of unhealthy food, lamented Davies. The CMO has called for a ‘rebalance’ of food prices to ensure greater consumer access to healthy foods.
As it stands, the ‘playing field’ is not level, she explained. “It is too easy to make money from selling unhealthy food and too hard to make money from selling healthy food.”
The government should not ‘shy away’ from regulation, she said, praising its Soft Drinks Industry Levy (SDIL) which has succeeded in cutting 30,100 tonnes of sugar from soft drinks a year in Great Britain. The levy has not negatively affected business, with overall sales increasing by at least 10.2% since it was introduced.
Following the success of this strategy, Davies recommends SDIL be expanded to include sugar-sweetened milk based drinks.
Value Added Tax (VAT) is also addressed in the report, with Davies encouraging rates on food and drink be reviewed following the UK’s exit from the EU. “The review should rebalance the cost of food and drink in favour of health,” she states. This would mean that all healthy food continue to have no VAT applied, with VAT consistently applied to unhealthy food.
“The review should consider a tiered VAT approach so the unhealthiest products have a higher rate of VAT which could be used to subsidies healthy food, starting with fruit and vegetables,” she added.
In the out-of-home food and drink sector, the CMO has also urged policymakers to develop an upper level cap on calories, as well as consistent nutrition labelling on all front-of-pack, menus, and product shelf labels.
Voluntary reformulation scheme under fire
Progress from Public Health England (PHE)’s voluntary reformulation scheme has so far proved ‘disappointing’, noted the CMO.
Indeed, two years after the government agency challenged industry to cut 20% sugar from food categories by 2020, progress is lacking. The PHE’s most recent report reveals an overall 2.9% reduction (sales weighted average sugar per 100g) since 2015. Just breakfast cereals and yoghurts are on track to achieve the 2020 target.
At the time, the PHE stated that in fact the amount of sugar consumed in England had risen since 2015: “Overall the total tonnes of sugar sold in foods included in the reformulation programme from the in-home sector has increased by 2.6% between 2015 and 2018 (excluding cakes and morning goods), whereas the sugar sold in soft drinks subject to the soft drinks industry levy has decreased by 21.6%.”
In Davies’ report, she urged PHE’s reformulation programme be ‘accelerated’. If insufficient progress continues, the CMO recommends the government apply either a fiscal lever – as has been successfully implemented for the soft drinks industry – or standardised packaging, as has been used for tobacco.
Industry responds: ‘Manufacturers alone will not solve this’
Industry trade group the Food and Drink Federation (FDF) has defended manufacturers’ work in responding to the government’s childhood obesity plan.
"FDF member companies are committing time and resource to deliver the government’s various reformulation programmes - cutting salt, sugars and calories. In fact, FDF members are selling 57.3 million fewer kilograms of sugars and 1 trillion fewer calories than they were back in 2015,” noted FDF head of UK diet and health policy, Kate Halliwell.
“As Public Health England acknowledge, reformulating products takes time, and we must always take the consumer with us. We want government to support us in this work and not introduce punitive measures which might hinder it.”
The trade group agreed more must be done to reduce obesity levels, and highlighted Davies’ point that everyone need play a role – including schools, local councils, and the NHS.
“Manufacturers alone will not solve this,” Halliwell continued. ”We believe money should be put behind specific, targeted measures for those most affected by the burden of obesity."
Ban food and drink consumption on public transport, urges Davies
The promotion of unhealthy food has attracted attention from advertising authorities of late. Strict rules banning adverts for products high in fat, salt and sugar (HFSS) in children’s media have been in place since 2017, and earlier this year Transport for London (TfL) banned the promotion of HFSS food and drinks in public transport.
Yet not all unhealthy food ‘promotion’ is currently regulated, suggested Davies.
“Unhealthy options dominate the checkouts. Planning frameworks make it very hard for local authorities to limit the growth of takeaway outlets, even in areas near schools.
“Children are constantly exposed to advertising for unhealthy food and drink. Companies often use children’s cartoon characters and sponsorship of major sporting events to market these items, casting them as the shining star in children’s minds.” - Chief medical officer Dame Professor Sally Davies
Davies has called for all tax-deductible expenses, including advertising expenses, to be reviewed for the food and drink industry to ensure they align with health policies. This would mean that only businesses advertising healthy products would be eligible for related tax benefits.
Less healthy food and drink products should also be phased out from marketing, advertising and sponsorship across all mediums, she continued.
To ensure unhealthy food is not unwillingly promoted in public places, the CMO recommends the government prohibit eating and drinking on urban public transport, with exceptions made for fresh water, breastfeeding, and medical conditions.
CMO’s recommendations are ‘exactly what’s required’
Davies’ ‘bold’ recommendations – which she says can help achieve the government’s 2030 obesity target – have been welcomed by health campaigners.
Describing the report as a ‘beacon of hope’, campaign director at Action on Sugar Katherine Jenner said the recommendations are “precisely what’s required if we are to ever achieve the government’s target to halve childhood obesity in 10 years”.
While legislation and fiscal measures are not always popular in parties, ‘that doesn’t mean they aren’t right’, she continued. “The unprecedented results of the sugary drinks levy speak for themselves.”
Action on Salt has similarly voiced its support for the CMO’s report. "Professor Davies speaks for us all by saying the government must be bold, decisive and has a responsibility to act,” according to campaign manager Sonia Pombo.
“We now urge the Secretary of State for Health, Matt Hancock, to commit Public Health England to set new and ambitious salt targets for 2020, with strict monitoring mechanisms to ensure all members of the food industry comply.”