An overwhelming problem unresolved

Health Business Editor Michael Lyons provides an analysis of the government’s long delayed and highly contested Childhood Obesity Strategy.

To say that the majority response to the government's childhood obesity plan for England has been critical, would be as underwhelming as the strategy's content.

When Theresa May became Prime Minister in July, she was urged by NHS England chief executive Simon Stevens to unveil the already delayed Childhood Obesity Strategy. Less than a week into her new role, and the pressure was on to shelve an already criticised strategy, with Stevens claiming that the obesity crisis costs the taxpayer more than the police and fire services combined.

With leading health experts voicing their anger at May’s plan to delay its unveiling until the Autumn, the now published plan has failed to extinguish those raised voices.

Obesity is a growing problem in most developed countries and is responsible for a significant degree of morbidity and mortality in the Western world. More than 2.1 billion people, nearly 30 per cent of the global population, are overweight or obese. The UK has the highest rates of obesity in Europe, more than doubling in the last twenty five years.

According to a McKinsey Global Institute report, titled ‘Overcoming obesity: An initial economic analysis’, obesity currently costs Britain’s economy £47 billion a year. It also estimated that the NHS currently spends about £6 billion a year on the direct medical costs of conditions related to overweight and obesity, five per cent of the entire NHS budget, and a further £10 billion on diabetes. It is forecast that the cost to the NHS will increase to almost £50 billion by 2050, prompting the 2011 Department of Health policy ‘A call to action on obesity in England’.

One in ten children starting school in England are obese at the beginning of primary school, with that figure changing to one in five by the time they leave. Such figures are devastating and dangerous. Additionally, figures released in June by the National Paediatric Diabetes Audit also suggested that there are now more than 500 children in England and Wales suffering from Type 2 diabetes, which is often caused by obesity - compared to virtually none at the turn of the century.

What’s in the plan?
The main discussion point emerging from the plan is the intention to ask the food and drink industry to cut five per cent of the sugar in products popular with children over the next year. This is the start of an ultimate target to cut 20 per cent of sugar.

Public Health England will monitor voluntary progress over the next four years, and will set targets for sugar content per 100g, and calorie caps for certain products. If insufficient progress is being made, the government will consider ‘whether alternative levers need to be used’.

The initial details of a sugar tax were highlighted in George Osborne’s March Budget speech, with the then Chancellor also stating ambitions to help school children get more active.

The publication of the strategy also calls on primary schools to deliver at least 30 minutes of physical activity a day and to help parents and carers ensure children get the same amount at home. The tax on sugary drinks, not in place until 2018, will create funds that will boost school sports.

What’s not in the plan?
It appears, however, that the strategy seems to have been dramatically altered from the original draft. These include measures on advertising junk food to children and on promotions such as two-for-one deals. Such changes are being considered as having the potential to make fast changes that are necessary, rather than awaiting on underwhelming policies.

Tackling advertising marketers and the food and drink industry would never have been easy, and many appreciate May’s decision to stay clear, but it does, however, set a precedent. As Dr Wollaston, chairwoman of the health select committee, said, the ‘interests of advertising marketers’ are being put ‘ahead of the interests of children’.

Many campaigners, including the the Obesity Health Alliance, have contested the government’s claim that the strategy is ‘the most ambitious programme of reformulation that any developed country has taken’. The Alliance argues that the strategy will ’let down the next generation who will pay the price for the government’s failure to take strong action’.

Opportunity wasted
And that is perhaps the most poignant point. The strategy presented a real opportunity for the new cabinet to take strong action, act boldly and decisively delivery a plan to tackle the obesity crisis. Strong action is vary rarely delivered ‘voluntarily’, but so much of the plan is suggestive, tentative and lacking strength of will.

Jamie Oliver, a regular and popular campaigner for healthier food, particularly in schools, has questioned ‘where are the mandatory points?’ in the plan. He said that there was ‘so much missing’ from ’the most important health initiative of our time’.

The previous Responsibility Deal, orchestrated by the then health secretary, Andrew Lansley, in 2010, demonstrated that the public can’t rely on the food and drink industry to take these decisions with enough boldness on their own. Therefore, would it not have been more beneficial, to the government and the public, to issue penalties for non-compliance?

The current environment is heavily weighted towards profit margins and capturing the audience in such a way that they buy your product. Compliance is necessary, as unhealthy food advertising is unlikely to be altered on its own.

While the majority of the food and drink industry has been quick too defend its position, arguing that many soft drink companies are making progress already, it is interesting that Mike Coupe, chief executive of Sainsbury’s, decided to urge the government for a ‘holistic approach’ with ‘mandatory traffic light labelling across all products’.

Health Secretary Jeremy Hunt has not distanced himself from the rhetoric surrounding the importance and magnitude of obesity in the UK. Norman Lamb, health minister in the Coalition government, summed it up quite nicely in saying: “Is this really the best response to a ‘growing public health catastrophe’, or ‘national emergency’? Can it really be described as a ‘game-changing moment’?”

Activity versus intake
The Childhood Obesity Strategy appears to echo the calls of George Osborne in March. There is a real emphasis on promoting physical activity among children, starting ins schools. The proceeds of the sugar levy will be used on funding school sport. The compulsory two hours of PE per week will be extended to a minimum of 30 minutes a day.

Theresa May seems satisfied with the sugar levy proposals of her predecessors, so much so that further changes are limited. But while more activity should be encouraged, the obesity problem doesn’t start at the school desk. School playing fields should be full of active, energy filled students. But until the government monitors and limits the amount of sugary drinks and cakes that students have as part of their lunch and dinner, never mind snacking before, during or after school, then the playground will remain a wasted exercise space.

This strategy publication is a statement, and unfortunately it is an underwhelming and weak one from the government.