A string of broken promises on obesity

Three years on from the Government’s obesity strategy, a lack of action is still harming public health, writes BMA board of science chair David Strain

Location: UK
Published: Thursday 27 July 2023
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In July 2020, the public health policy world rejoiced. After years of campaigning by the Obesity Health Alliance (of which the BMA is a leading member), the Government had finally produced an obesity strategy, to be supported by legislation, to address rising rates of obesity.

Two thirds of adults are overweight or living with obesity, and more than one in three children are above a healthy weight by the time they leave primary school. In deprived communities, childhood obesity rates are over twice as high as in the most affluent areas. The NHS spends £6.5bn annually on diet-related ill health, piling pressure on the NHS, driving down economic productivity, and forcing thousands of people out of the workforce. As doctors, tackling obesity was therefore high up our wish list.

Despite all the evidence indicating otherwise, the accepted narrative was that all people needed to do to lose weight was eat less, and exercise more. Such a narrative places the responsibility to stay healthy on the individual, instead of the environment in which we all live, which is doing its best to make us unhealthy. Junk food marketing is everywhere we look, and when we go to the supermarket, it’s hard to escape the ‘buy one get one free’ offers on flashy but incredibly unhealthy products.

Now, here was a strategy which finally recognised the role of industry in rising rates of obesity. Some of its key policies included legislating for menus to include calorie information, for a junk food marketing TV watershed, and for a ban on supermarkets offering ‘buy one get one free’ deals on unhealthy food. For too long, industry had cast undue influence over successive governments; this strategy delighted both doctors and public – with 8 out of 10 UK adults supporting the Government banning advertising of unhealthy food on TV.

Unfortunately, the honeymoon period didn’t last.

Doctors are seeing the consequences of government failure to act on obesity

Whilst one or two of the strategy’s policies have been implemented, such as the introduction of calorie labelling in restaurants and cafés, some upstream, population-level interventions with overwhelming evidence for their effectiveness remain shelved. In July 2021, the Health and Care Bill was introduced in the House of Commons which received Royal Assent in April 2022, and placed restrictions on advertisements of high fat, salt and sugar foods on TV and online. However, these restrictions, as well as efforts to make it easier for families to choose healthier options in supermarkets, have been delayed more than once and are at risk of being scrapped altogether.

The flawed argument that we can’t pursue such policies in a cost-of-living crisis ignores the evidence that multi-deal promotions only lead to people spending more money than they would otherwise. The Government’s own data shows they can increase food and drink purchasing by around 22%. Why should it be cheaper for families to eat unhealthily?

Three years on from the obesity strategy’s publication, doctors are seeing the consequences of government failure to act on obesity in their clinics. Indeed, this week’s Health Foundation report Health in 2040: projected patterns of illness in England suggests rising rates of obesity have counteracted the public health gains that have been achieved by reduced smoking rates and alcohol intake in the UK. The report shows that the number of people living with a major illness, many of which are associated with obesity, is projected to rise by over a third (37%) by 2040.

To ensure everyone has the best chance of a healthy life and the sustainability of a health service, the Government must reverse its decision to delay these policies. The NHS and families require it.