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Dr Michael Thomas is chair of the Welsh Committee for Public Health Medicine.
Obesity remains one of the biggest public health challenges facing us in Wales, where over a quarter of children and more than half of adults are overweight or obese.*
The development of a strong and ambitious all-Wales strategy on preventing and reducing obesity is something that BMA Cymru Wales has consistently called for. We have actively lobbied to ensure action on obesity is included in the Public Health (Wales) Act when it was reintroduced in 2016, and by requiring specific actions in local well-being plans, we laid the groundwork for the introduction of a national obesity strategy.
The Healthy Weight: Healthy Wales consultation helps to take forward the development of this strategy and I am pleased to say that BMA Cymru Wales was able to provide a thorough response – thank you to everyone who took their precious time to feed into it.
It is encouraging that the consultation’s four key themes – leadership and enabling change, healthy environments, healthy settings and healthy people – reflect the holistic and collaborative approach we have been promoting for a long time. The Welsh Government’s commitment to shift Wales’ focus and resources to prevention and early intervention, reducing the number of adults and children becoming obese or overweight each year, is also something that we should welcome.
Yet, such aspirations have no real value if they’re not achievable in practice and we found that several elements of the strategy require clarifications.
Achieving clarity starts with using the right terminology. Throughout the consultation, the Welsh Government talks about improving people’s ‘lifestyle choices’. We’ve expressed concerns that this pejorative language distracts from the causes of the problem and latently blames on individuals without accounting for the role of the obesogenic environment in the obesity crisis.
As we have said before and will say again, personal responsibility cannot be blamed alone. To reverse the trend, we need sensible measures that do not put all the responsibility on individuals – people can only choose what they can afford.
Finding the right balance
The Healthy Weight: Healthy Wales strategy emphasizes the importance of creating environments that facilitate physical activity. We’re very supportive of this, particularly the call to promote the use of Health Impact Assessments as part of the planning process for development, which BMA Cymru Wales lobbied for strongly.
However, the Welsh Government could take a stronger stance on removing fast food take-aways near schools and on restricting the advertising and promotion of unhealthy food in public places. It is important to balance out positive and restrictive measures, otherwise our efforts to encourage people to live healthily can quickly be annulled by corporate interests.
BMA Cymru Wales has already fought for the introduction of the sugar levy, and we are very supportive of its extension to reduce sugar consumption from sugary milk drinks. Imposing calorie labelling for food purchased and eaten out of home, as outlined in the consultation, also seem like an interesting measure. We now hope to see more detail about the resources that would be made available to implement these propositions and achieve these goals.
Leading the way
However, the Healthy Weight: Healthy Wales consultation offers little clarity as to what these aspirations mean in practice: how will hospital catering establishments promote a healthy diet, who would provide training for NHS staff, which sectors will be involved, and how this will be funded?
Given the immense pressures on all aspects of the health sector at present, we’ve also advised the Welsh Government that a more targeted approach at staff who would have the greatest potential influence on achieving behaviour change may be more appropriate.
Tackling obesity will require collaborative effort over a long period of time, and we all have a role to play to stop its rise. The Welsh Government understandably wishes to build greater accountability to drive forward change, but as I am sure you will agree, there is no point setting standards if no concrete measure is taken to ensure these are met.
The All Wales Obesity Pathway was launched in 2010, and evidence suggests that the availability of services remains sporadic. It is disappointing that almost a decade later, the Welsh Government is still reviewing the pathway and we urgently need to see investment put against it.
The same applies to the Child Measurement Programme for Wales. Whilst it is good news that the Welsh Government is committed to reviewing the data gathered so far and introducing a second measurement, there is no precision on when or how the latter will be taken.
I am not one to caution the government interfering unduly with people’s lives, but when it comes to obesity, the little state intervention we have seen so far is clearly not working. We do need intervention, and the Welsh Government must rapidly clarify and implement its strategy if it really wants to tip the scale.
* Obesity in Wales, Public Health Wales Observatory, 2019.
Click here to read our full response to the Healthy Weight: Healthy Wales consultation.