Why Boris needs to join up the dots on obesity

Public health may be a devolved matter, but the measures required to tackle obesity involve reserved powers and so therefore need a joined-up approach both across the UK and between departments both locally and centrally.

In that respect Johnson’s conversion to the cause is welcome but many experts will be aghast at the timidity of the measures proposed and the lack of cohesion between central government departments does not auger well.

To reprise – rising obesity is a global problem. According to the WHO it is “caused by  an increased intake of energy-dense foods that are high in fat and sugars; and an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanisation.”

Tackling it involves developing the right policies in a range of different areas: health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education.

All four UK nations have well-developed policies and work together on best practice. All are struggling to make the impact they desire. Northern Ireland’s framework document A Fitter Future for all states: “It should be recognised that the Framework is trying to change established habits and inspire healthy lifestyle choices across the life course of the population and this will take time to take effect. Despite the good progress being made on the actions in the framework, there has yet to be significant statistical change in the levels of overweight and obesity.”

Obesity comes at a staggering price. Adding direct medical costs and its impact on productivity, it costs the UK around £60 billion a year - 3% of its GDP.

On current trends one in three children in the most deprived areas will be obese by 2030. This was therefore a major crisis long before the linkages between obesity and Covid-19 fatalities were established in the past few weeks. There is an urgent need for central government intervention to force the pace of change.

So let’s start with the good news. Almost exactly a year ago Health Secretary Matt Hancock declared: “Boris himself is a great example of how we can all get fit and svelte without the need for the nanny state by getting on and doing more exercise and cycling to work.”

Apparently spoken without irony Hancock’s statement came at a time when Johnson was endorsing The Sun’s   Hands off our Grub campaign which aimed to end taxes on sugary drinks. 

Since then the clinically obese Johnson has had an epiphany after his near-death experience with Covid-19. Hence the new obesity policy published on Monday.

It declares an intention to end the promotion of foods high in fat, sugar or salt (HFSS) through marketing initiatives such as buy one get one free, and the placement of these foods in prominent locations. It also intends to ban such products being shown on TV and online before  9pm as a prelude to a total ban.

This will be greeted with rejoicing by campaigners in Northern Ireland. Not just because these initiatives will bring new momentum to work underway here, but also because it signals that the libertarians within Tory ranks have lost. Hancock is supporting the new policy just as enthusiastically as he previously celebrated the 5ft 10inch and 17 stone Johnson’s  “fitness and svelteness.”

The trouble is that although this is progress for Johnson it is actually a backward step for central government.

The sugar tax has proved remarkably successful. Sales of soft drinks increased by 10.2% in 2018, after the levy’s introduction. At the same time the total sugar content within them decreased by 21.6% removing 30,100 tonnes of sugar from soft drinks a year.

That’s why a Green Paper produced in the dying days of Theresa May’s government recommended extending the sugar tax to sugary milk drinks. This proposal does not appear in Johnson’s strategy.

Nor does he pick up on a raft of measures suggested by the then Chief Medical Officer Dame Sally Davies in her report on childhood obesity last year.

This well-argued document starts from the premise:  “Being overweight or obese in childhood has profound impacts on the health and life chances of children.  Children living in the most deprived areas are disproportionately affected.”

It contains a number of recommendations which go far beyond Johnson’s policy statement. These include:

Addressing the problem of healthy food being more expensive than junk food by taxing unhealthy food and using the revenue raised to subsidise healthy diets;

Creating health zones around schools making it safe for children to walk and cycle to school and restricting fast food outlets in the vicinity;

Applying an upper level cap on calories per serving for all food and drink sold by take aways and shops;

Free drinking water fountains to be  available in all public places, including parks, leisure centres, shopping centres and at major sporting events and facilities.

Dame Sally’s approach provides a much greater urgency to a growing health problem than the current administration. Her document deserves another airing.

Sadly there is more muddle and mess. Just as Mr Johnson was announcing his campaign  to reduce obesity the fast food industry was preparing to cash in on double helpings of support from his chancellor Rishi Sunak through VAT cuts and the Eat out to Help Out scheme. As the Daily Mail helpfully points out this will reduce the price of a Big Mac Meal to £2.45 from £4.89.

Even connections between helpful government policy seem to be being missed. The day after Johnson’s announcement came good news for cyclists, which will presumably be replicated in Northern Ireland. This not only pledges more cycling routes and a regulator for cyclists it also will give local people a chance to choose whether residential side streets should be closed to through motor traffic to make them safer for pedestrians and cyclists.

This is excellent, but it should have been packaged with the obesity announcement because promoting cycling (and walking) is the other side of the battle – losing weight involves exercising more as well as eating less.

The same could also be said about the National Food Strategy announced two days later. Henry Dimbleby’s report which was commissioned by Michael Gove calls for more children to receive healthy, free school meals and warns of the “slow motion disaster of the British diet.”

This all a few weeks after footballer Marcus  Rashford’s campaign, forced the same government to re-instate school meal vouchers it had scrapped for the holiday period.

So although there have been positive movements in the past week there is also a sense that government is not joining up the dots between its own policies. Given tackling obesity requires co-ordinated policies across government, that’s quite troubling.