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Food for thought: Getting the recipe right

How can we encourage children to eat healthily when they are confronted by sugary snacks and drinks and fast food almost everywhere they go? A new BMA report attempts to set out practical ways of tackling the growing problem of diet-related ill health and promoting healthy food

Why don’t our children eat healthily? When you see the complex and pernicious range of forces lined up against them, the question is rather: why ever would they?

As BMA board of science chair Baroness Hollins asks in her foreword to a new report: ‘How can we expect a child to develop normative behaviours about eating healthily when so many of the messages they are exposed to promote the opposite?’

The report, Food for Thought: Promoting Healthy Diets among Children and Young People, sets out a wide range of measures to tackle the enormously harmful impact of poor diet.

The need for effective action could hardly be greater. The report says diet-related ill health is estimated to lead to 70,000 premature deaths a year, and has a greater impact on the NHS budget than alcohol consumption, smoking or physical inactivity.

By the time a British child reaches — as if instinctively — for the shiny, wrapped confectionery, and decides, with similar conviction, that there is something rather sinister about vegetables — they have been assailed by a huge number of influences.

Parents, schools, marketing, Government policies, availability, and the relative price of commodities all have a role in influencing children, some directly and others indirectly, and the cumulative impact is so often negative.


Tax on sugar

It’s not surprising then, that the report proposes an equally wide range of initiatives to tackle the problem.

One of the most eye-catching is for a tax on sugary drinks, to raise the price by at least 20 per cent. The proceeds could subsidise healthier foods.

It is clear that relying on market forces alone is not working because, as Baroness Hollins says, since the start of the recession the price of fruit and vegetables has increased by more than 30 per cent.

'Taxation on unhealthy food and drinks can improve health'

Baroness Hollins

Meanwhile, sugar is shovelled into cheap and plentiful soft drinks. If a spoonful of sugar in a mug of tea can, for many people, render it sickly sweet, it’s worth considering that there is nine times that amount in some soft drinks.

Baroness Hollins says: ‘We know from experience in other countries that taxation on unhealthy food and drinks can improve health outcomes, and the strongest evidence of effectiveness is for a tax on sugar-sweetened beverages.

‘If a tax of at least 20 per cent is introduced, it could be expected to reduce the prevalence of obesity in the UK by around 180,000 people.

‘Financial measures should be considered to regulate the price of healthier products, such as fruit and vegetables, through subsidisation.

'This is an important way to help redress the imbalance highlighted previously between the cost of healthy and unhealthy products, which particularly impacts on individuals and families affected by food poverty.’


Aggressive marketing

All too often, unhealthy foods and drinks are an attack on the senses as well as the waistline. The marketing is carefully planned, aggressive, and children are often readily exposed to it.

The report calls for a revision of broadcast guidelines to prohibit adverts in or around any programmes that appeal to children and young people in any way.

It also says there should be provisions to stop such marketing around social and other non-broadcast media, and an end to the marketing of such products in schools, for example through sponsorship or branding of educational goods.

This would bring an end to the bizarre situation where, for example, tokens from innumerable packets of crisps have to be collected to buy a football for your child’s school — and the resulting calculation of the astronomical number of kicks that football would have to receive to equal the calorific intake of the crisps.

If advertising can seem ‘in your face’, then in many supermarkets this is even more literally the case.

The low-lying confectionery shelves near the checkout, for long the sworn enemy of the harassed parent, should go, says the report, and so too should the practice of ‘upselling’ unhealthy snacks at the time of payment in many shops.

A major emphasis of the report is on better education and consumer information. The current system for nutritional labelling is symptomatic of the Government’s reliance on a voluntary commitment from manufacturers. It has led to multiple schemes, providing different information, to varying designs — not ideal for a consumer who has dozens of other items to buy.

It calls instead for a mandatory, standardised approach based on the ‘traffic light’ system of colour coding, and unambiguous words such as ‘low’, ‘medium’ or ‘high’ to describe nutritional content.

The system has proved popular and accessible where it has been used.


Hospitals and schools

One of the most striking observations in the report is that, even in places where health is supposed to be promoted, there are huge shortcomings.

Hospitals can often be dominated by high street franchises selling unhealthy food, with the only alternative being a vending machine stacked with chocolate and fizzy drinks.

‘This is commonplace, to the extent that doctors have described their workplaces as a toxic hospital food environment,’ says the report.

While recognising that the NHS is tied up contractually with many of the suppliers, ‘doctors would ultimately like to see an end to the sale of all unhealthy food and drink products in all NHS hospitals across the UK’.

In schools, meanwhile, the well-intentioned items in the curriculum are often not matched by the food served up to youngsters.

In England, there is a curious anomaly where children at some schools with academy status are not guaranteed the same nutritional standards as those whose schools are grant-maintained, and which apply elsewhere to all state schools in the UK.


Fresh fruit

Schools are also patchy in their provision of free fruit and vegetables to primary school children, with legal obligations varying around the UK.

'Whose job is it to deal with the presence of fried-chicken shops?'

Dr Drage

Baroness Hollins says: ‘All academies and free schools must be subject to the same mandatory standards as state schools, as without them they are more likely to provide poor-quality food.’

Whatever children are fed in school, they will most likely face a gauntlet of fast-food shops as soon as they leave the gates. It was an issue brought up at the BMA annual representative meeting last month when Londonwide LMCs chief executive Michelle Drage said: ‘In Tower Hamlets, you can walk along the Mile End Road and see row after row … of fried-chicken shops, and that’s where the kids go.

‘Whose job is it to deal with the presence of fried-chicken shops and other fast food? It’s the local authorities but … even if they have the will, they don’t have the ability, or the law is not necessarily on their side to license or not license.’

The report agrees strongly with Dr Drage that local authorities should be given greater licensing powers to limit the ‘future number, clustering and over-concentration of fast-food outlets locally’.


Staged approach

Most fundamentally of all, the report addresses the content of processed food and drink.

Trans fats, saturated fats, salt and sugar can often be added during manufacture.

Recognising that the processes cannot change overnight, a staged approach is recommended. Within a year, no food or drink containing trans fats should be sold.

By 2017 there should be action to reduce salt levels systematically, and by 2020 there should be UK-wide targets on reducing calories, fat, saturated fat and sugar levels in a range of products.

For each — reflecting the signal failure of the voluntary approach to achieve comprehensive action — the report says regulatory measures should be implemented if the target is not met.

It’s perhaps the case that poor diet has been a less prominent public health issue in recent years. It is certainly the case that Government regulation has been far more lax than for tobacco.

But it matters hugely to the medical profession. For the individual patients, the consequences can be tragic, and for society as a whole — with a health service looking to make up a multi-billion pound shortfall — it can no longer be ignored.

Read Food for Thought

Find out more about improving the diets of children and young people