A new recipe for fighting obesity

In an age of austerity, reformulation rather than regulation is the policy of choice for tackling the crisis. By Professor Jack Winkler.

SPs on the health and sport committee in Holyrood wrote to the health minister, Aileen Campbell, last month urging her to take a “bold approach” to tackling obesity. It was an entirely sensible letter, but one that has been written before.

Scotland has long had bad statistics on most nutritional variables, such as heart disease, as well as obesity. However, it has also long been engaged in constructive policy development to deal with them. The Rowett Research Institute in Aberdeen has long been a leader in this field. Various Scottish governments have also created agencies to deal with many aspects of the problems, from school feeding to product reformulation. I used to deal with a number of very intelligent and committed officers in diverse agencies. I have long thought Scotland was more advanced in my particular field – nutrition policy – than England, or indeed most other countries.

But the problems persist. And in some cases get worse. Scotland has the worst weight outcomes of all the UK nations and among the worst of any Organisation for Economic Cooperation and Development nation. In 2015, 65% of adults were overweight, including 29% who were obese. In children 28% were at risk of becoming overweight, while 15% were at risk of obesity.

“It is disappointing that whilst the government has good policies in place to try and tackle this issue, they don’t seem to be working and there was an inconsistent approach to resourcing these policies,” the committee told Campbell.

So the issue for Nicola Sturgeon’s cabinet would appear to be a familiar one: policy design is the easy part, policy implementation is the difficult bit. I have not studied the particulars of Scotland, but the difficulty they face is not an unusual one – applying good ideas on the ground.

In fact, implementing a comprehensive obesity policy, such as the committee would like, is more difficult now than before. We live in times of austerity, and Scotland in particular is suffering from falling oil revenues. This makes it harder to implement any policy, much less the grand one the committee (as well as Food Standards Scotland) would like.

The problem on which they focus special attention – the high frequency of promotions of less healthy products – is an important one. Control of promotions, after all, was number one on the list of recommendations from Public Health England in its review of the evidence in 2015. And the health committee noted that more than 40% of food in the UK is bought on promotion (the highest rate in Europe) and that the vast majority of promoted food is junk food, with unhealthy food being more available and more heavily promoted than in other countries. The government needs to “tackle this to the extent possible through regulation or fiscal control”. There also needs to be a clampdown on advertising of unhealthy food to kids, they suggested (nearly 75% of the food and drink marketing seen by children in Scotland is for junk food).

But it is no accident that promotional control was not adopted in the new Childhood Obesity Strategy. It is a form of price control – and that is a big step in any market economy, especially one governed by the Conservatives. Which is why England and other countries have decided on reformulation as the policy of choice.

Reformulation is voluntary and uncertain, but it has the great advantage of benefiting everyone, not just those interested in healthy eating. Scotland’s Food and Drink Federation suggested in January the sugar reduction targets in the UK’s obesity plan are challenging but achievable. And the best news of all from the committee’s point of view is that the far-from- trivial reformulation bill is paid by companies rather than from the public purse. Reformulation is therefore a policy for our times.

Jack Winkler is emeritus professor of nutrition policy at London Metropolitan University.

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