ASO Position Statement on the UK Government Narrative around Obesity Prevention

Resource
Site Category
ASO Position
Target Audience
Commissioners of care and other obesity interested organisation representatives
Healthcare professionals
Patients and people living with obesity
Researchers
Status
Current

The UK Association for the Study of Obesity (ASO) is deeply concerned by the current UK Government narrative concerning the scaling back of existing obesity prevention commitments. The ASO alongside other leading health charities, medical organisations, health professionals and patients wrote to the Prime Minister in September 2022 as part of the Obesity Health Alliance demanding urgent action. In October 2022, the Prime Minister's speech at the Conservative Party conference showed no signs of The Government taking our collective concerns on board. 

Dr Nicola Heslehurst, Chair of the ASO and Senior Lecturer at Newcastle University said “Liz Truss appears to be about to walk away from key evidence-based commitments that have taken years of careful consensus to reach, putting in jeopardy the progress we have made as a nation on obesity prevention. Decades of evidence support the UK Obesity Plan, and a decision to abandon that commitment would have a negative impact on child health, public health and health inequalities - for years to come. 

Addressing the impact of obesity in the general population is complex. No one solution exists; prevention requires a whole systems approach and national policy action. The Obesity Plan included a strong, evidence-based health policy commitment from the UK Government, and although there is clearly more to be done, was supported by ASO.

The previous Government’s commitment led the World Health Organisation to classify the UK as a “front runner” country for accelerated action on obesity treatment and prevention. Any reversal of the evidence-based Obesity Plan by this Government would be a threat to our global leadership position on this critical matter."


About the ASO https://aso.org.uk/ 

Founded in 1967, the ASO has become the UK’s foremost charitable organisation dedicated to the understanding, prevention and treatment of obesity. The ASO aims to develop an understanding of obesity through the pursuit of excellence in research and education, the facilitation of contact between individuals and organisations, and the promotion of action to prevent and treat obesity.

Contact: [email protected] 

ASO Chair: [email protected] 

Key arguments for The Government sticking to (and building on) their evidence-based Obesity Plan include:

  1. Obesity is an issue of health inequalities, and the Obesity Plan includes prevention measures that address wider socio-economic and environmental determinants of health necessary to reduce the inequality gap.
  2. The soft drinks industry levy (SDIL) is effective at reducing sugar consumption, provides an incentive for the soft drinks industry to reformulate products with no lasting economic impact, and has public support.
  3. Regulation of food promotion and advertising, including “buy one get one free” deals, are primarily used to promote purchasing of high sugar food and drinks, are more prolific in deprived areas, and have a substantial contribution to purchase and consumption of less healthy foods.
  4. Focusing on UK economic growth as obesity prevention would stimulate export growth in the UK food industry and lead to long term NHS healthcare and societal cost savings.

Summary of some of the evidence supporting these key arguments for The Government to continue with their commitment to deliver the Obesity Plan.

Obesity inequalities: It is well established that both adult and childhood obesity are more prevalent among the most deprived populations, people from Black ethnic groups, and people with disabilities including severe mental illness 1,2,3,4,5. The National Child Measurement Programme shows that childhood obesity prevalence is double among children from the most deprived areas compared to the most affluent 6. Healthy foods cost three times more per calorie than less healthy foods, and between 2021 and 2022 the price of healthy foods increased twice as much as unhealthy foods 7. People with low incomes (bottom fifth) need to spend almost half of their income to meet the Government recommended healthy diet, compared with 11% for the richest fifth 7. The recent Fair Society, Healthy Lives review emphasised the need to address inequalities to prevent further increases in obesity prevalence in the UK 8. However, poverty and food insecurity are at record high levels and further increases are expected as the cost of living crisis continues to unfold 9, which will likely lead to even greater prevalence of obesity 10. Most affected are households with children 9, which indicates a projected increase in obesity prevalence for the next generation. 

Soft drinks industry levy (SDIL): UK adults consume double the recommended amount of sugar, and children consume triple - with up to 1/3 from soft drinks 11. Research comparing pre- and post-SDIL purchases showed that the volume of drinks meeting the SDIL criteria decreased while the volume of low/no sugar drinks increased, with an overall decrease in sugar of 29.5 g per household per week (equivalent to a 9.8% reduction) 12. The SDIL had no lasting negative impacts on the UK soft drinks industry 13, is acceptable to the public 14,15, and increasing sales in the market will contribute to The Government’s plans for economic growth. There is also evidence showing the greatest effect of SDIL is on less affluent consumers 16, therefore addressing the inequality gap. Tax revenue from SDIL has also funded strategies that help to reduce inequalities, such as school breakfast clubs and sports equipment 17. Therefore, removal of the SDIL will not only negatively impact on sugar consumption and ultimately obesity prevalence, but also continue to widen existing inequalities through disproportionate impact on more deprived groups and loss of tax revenue to tackle inequalities.

Food promotions and advertising: A Government report published in December 2020 showed that deals, such as “buy one get one free”, are more likely to promote higher sugar food and drinks 18. The report stated that 5.5% of take home sugar results from an incremental consequence of promotions, with a projected 4.0% saving in sugar volume purchases if restrictions were placed on promotions18. In October 2022, a report by Food Active showed that 81% of on-pack promotions in the main six UK supermarkets were for less healthy food and drink products19, demonstrating that voluntary changes to marketing are unlikely to be implemented and policy intervention will be required. Claims that removal of promotions during a cost of living crisis will increase inequalities is not supported. Evidence shows that shoppers from lower socio-economic groups and on lower incomes were slightly less likely to buy into promotions18. Unhealthy food advertising has detrimental effects on diet, especially among children20. Exposure to advertising is highest among more deprived, low income, young adults and minoritised ethic groups, which drives additional consumption of unhealthy food and drink and contributes to the substantial health inequalities21, 22. The Government plans to restrict advertising will further address existing inequalities, and there is public support for the implementation of the planned junk food advertising watershed by a majority of people across deprivation strata23.

Economic growth: Obesity prevention should be integral to Government strategy for economic growth in the UK. Cost of obesity in high income countries is estimated to be USD 1545.52 billion in 2019, 2.86% of GDP24. A Government report stated that “obesity has a serious impact on economic development”5. In 2014-2015, the NHS was estimated to have spent £6.1 billion on overweight and obesity-related ill-health and the cost to wider society was estimated to be £27 billion5. A more recent report included wider costs than have historically been modeled25 and estimated the UK cost of obesity was £58 billion; equivalent to around 3% of the 2020 UK GDP. The estimated annual NHS spend on obesity-related diseases was £6.5 billion; equivalent to 40% of the budget allocated to police forces. This report suggests that a 10% reduction in obesity prevalence could help save £6 billion every year.


References

National Child Measurement Programme, England 2020/21 School Year. Available online at: https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year. [Accessed 07/10/2022]
2 Obesity Profile: short statistical commentary July 2022 Available online at: https://www.gov.uk/government/statistics/obesity-profile-update-july-2022/
obesity-profile-short-statistical-commentary-july-2022#:~:text=Data%20from%20the%20Active%20Lives,to%202016%20(Figure%201)
 [Accessed 07/10/2022]
3 Health and Care of People with Learning Disabilities Experimental Statistics 2020 to 2021 Available online at: https://digital.nhs.uk/data-and-information/publications/statistical/
health-and-care-of-people-with-learning-disabilities/experimental-statistics-2020-to-2021
 [Accessed 07/10/2022]
4 Afzal M, Siddiqi N, Ahmad B, Afsheen N, Aslam F, Ali A, Ayesha R, Bryant M, Holt R, Khalid H, Ishaq K, Koly KN, Rajan S, Saba J, Tirbhowan N, Zavala GA. Prevalence of Overweight and Obesity in People With Severe Mental Illness: Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021 Nov 25;12:769309. 
5 Health matters: obesity and the food environment Available online at: https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2 [Accessed 07/10/2022]
National Child Measurement Programme, England 2020/21 School Year. Available online at: https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year [Accessed 07/10/2022]
7 The Broken Plate 2022 - The Food Foundation. Available online at: https://foodfoundation.org.uk/sites/default/files/2022-07/FF_Broken_Plate_Report%202022_DIGITAL_3.pdf [Accessed 07/10/2022]
Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health Equity in England: The Marmot Review 10 Years On. The Health Foundation; 2020. Available online at: http://health.org.uk/publications/reports/the-marmot-review-10-years-on [Accessed 07/10/2022]
New data shows food insecurity major challenge to levelling up agenda - The Food Foundation Available online at: https://foodfoundation.org.uk/press-release/new-data-shows-food-insecurity-major-challenge-levelling-agenda [Accessed 07/10/2022]
10 Nettle D, Andrews C Bateson M (2017) Food insecurity as a driver of obesity in humans: The insurance hypothesis. Behav Brain Sci 40, e105. 
11 NDNS: results from years 7 and 8 (combined). Results of the National Diet and Nutrition Survey (NDNS) rolling programme for 2014 to 2015 and 2015 to 2016. Public Health England. Available online at: https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined [Accessed 07/10/2022]
12 Pell D, Mytton O, Penney T L, Briggs A, Cummins S, Penn-Jones C et al. Changes in soft drinks purchased by British households associated with the UK soft drinks industry levy: controlled interrupted time series analysis. BMJ 2021; 372 :n254. 
13 Law C, Cornelsen L, Adams J, Penney T, Rutter H, White M, Smith R. An analysis of the stock market reaction to the announcements of the UK Soft Drinks Industry Levy. Economics & Human Biology, Volume 38, 2020, 100834, ISSN 1570-677X. 
14 Adams J, Pell D, Penney TL, et al (2021) Public acceptability of the UK Soft Drinks Industry Levy: repeat cross-sectional analysis of the International Food Policy Study (2017–2019) BMJ Open 2021;11:e051677. 
15 Jones CP, Armstrong-Moore R, Penney TL, Cummins S, Armitage S, Adams J, White M. Adolescents' perspectives on soft drinks after the introduction of the UK Soft Drinks Industry Levy: A focus group study using reflexive thematic analysis. Appetite. 2022 Dec 1;179:106305. 
16 Fearne, A., Borzino, N., De La Iglesia, B., Moffatt, P. & Robbins, M. (2021) Using supermarket loyalty card data to measure the differential impact of the UK soft drink sugar tax on buyer behaviour. Journal of Agricultural Economics, 00, 1– 17. 
17 Sugar reduction: progress report, 2015 to 2019 - Public Health England. Available online at: https://www.gov.uk/government/publications/sugar-reduction-report-on-progress-between-2015-and-2019 [Accessed 07/10/2022]
18 An analysis of the role of price promotions on the household purchases of food and drinks high in sugar, and purchases of food and drinks for out of home consumption - Public Health England. Available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/947412/
Sugar_Reduction_analysis_of_price_promotions_on_the_household_purchases_of_food_and_drinks_
high_in_sugar__4_.pdf
 [Accessed 07/10/2022]
19 ‘On-Pack Promotions’ on Less Healthy Food And Drink: A Fieldwork Report - Food Active and the Health Equalities Group. Available online at: https://foodactive.org.uk/wp-content/uploads/2022/10/Coupons-Passes-And-Prizes-On-Less-Healthy-Food-And-Drink-Food-Active-FINAL-4th-Oct-6.pdf [Accessed 07/10/2022]
20 Smith R, Kelly B, Yeatman H, Boyland E. Food Marketing Influences Children’s Attitudes, Preferences and Consumption: A Systematic Critical Review. Nutrients. 2019; 11(4):875. 
21 Yau, A et al. 2021 ‘Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data’ BMJ Open 11: e048139

22 Backholer, K, Gupta, A, Zorbas, C et al. (2021) Differential exposure to, and potential impact of, unhealthy advertising to children by socio-economic and ethnic groups: a systematic review of the evidence. Obes Rev 22, e13144
23 Unpublished findings from Cancer Research UK’s Public Polling (July 2022) online survey weighted to be nationally representative of the UK (N=2119). Data collected by YouGov Plc. Cited in the Obesity Health Alliance letter to the Prime Minister. Available online at: https://obesityhealthalliance.org.uk/wp-content/uploads/2022/09/OHA-Letter-to-Prime-Minister-21.09.2022-1.pdf [Accessed 07/10/2022]
24 Okunogbe A, Nugent R, Spencer G, et al. Economic impacts of overweight and obesity: current and future estimates for 161
countries. BMJ Global Health 2022;7:e009773.
25 Frontier Economics. Estimating the Full Costs of Obesity. A report for Novo Nordisk. 28 January 2022.  Available online at: https://www.frontier-economics.com/media/5094/the-full-cost-of-obesity-in-the-uk.pdf [Accessed 07/10/2022]