Fat man of Europe

Fat man of Europe
13/01/2017 - 12:33
The UK tops the continental obesity league and, with the launch of the Childhood Obesity Plan, the government is promising action to change this by targeting young people. David Foad reports.

Following the launch of the UK Government’s long-awaited Childhood Obesity Plan in August, there was a sense of anti-climax among schools, caterers, dietitians and campaigners who felt it had opted for an over-cautious approach.

The mood was summed up by Dr Sarah Wollaston, a Conservative MP and chair of the Commons Health Select Committee, who said: “The childhood obesity strategy has been downgraded. The final paragraph sums up the tone that it will be “respecting consumer choice, economic realities and, ultimately, our need to eat”.

“This crass statement entirely misses the point; of course children need to eat, but the childhood obesity strategy needed to make sure that they benefitted from a better diet.”

A few months on, and the tone of commentators has changed to one of recognition that, for all its flaws, the current plan is what we’ve got to work with and we might as well get on with it. They feel that the problem of obesity is only going to get worse until action is taken.

At November’s Childhood Obesity Summit, the chief medical officer Professor Sally Davies spelled out a few obesity home truths about the current state of the nation.

“The UK is tenth in the world obesity league at the moment, the US is number one. Trends over the past 30 years show the rate of increase is higher in the UK than the US and is one of the worst in Europe. In fact, the UK is the ‘fat man of Europe’,” Davies daid.

“The policy agenda needs the public to recognise that if you normalise weight gain then you can’t take people with you when you try to talk about healthy eating.”

She added that when it comes to children, then the UK comes ninth among two to 19-year-olds in terms of prevalence among the 34 Organisation for Economic Cooperation and Development (OECD) nations. However, while boys are 15th, UK girls rank fourth.

“And the prevalence is rising. In the UK, it has risen by 39% since 1980, though that rise is actually 48% for boys. We are not the worst, but we are pushing it.”

Davies adds that the National Children’s Measurement Programme was a wonderful resource and was helping to provide a good picture of children’s weight at ages five and 11.

“Unfortunately, the figures are showing that over time more of our children are coming out of primary school fat. What on Earth are we doing?,” she asks.

“We know this has a serious effect on self-esteem and it can contribute to physical health problems such as Type 2 diabetes, asthma, and back and joint pain.

“We also know that if they stay obese it’s linked to one in ten deaths among adults. The health problems they end up dealing with include stroke, some types of cancer, liver disease and depression.

“Obesity costs £5.1 billion in NHS costs in England alone; the wider economic cost is estimated to be closer to £27 billion. It is the biggest human-generated cause of ill-health.

“In fact, we spend more in the UK on treating health problems associated with obesity than the annual budget for the police, fire service and judiciary combined.”

She adds that obesity was strongly correlated to social and economic deprivation; it was twice as prevalent in the most deprived areas than the best-off areas.

“One of the most worrying aspects of the problem is what I call the normalisation of obesity. Fewer than one in ten obese people consider themselves obese, and parents don’t recognise their children as obese, and often dismiss the idea of a BMI score for their children as irrelevant,” Davies stated.

“If we can’t recognise it, then how can we prioritise it? And the problem is far wider than this because research shows that even healthcare professionals don’t accurately rate patients as obese, regularly under-estimating their weight.

“I quite like the idea that if you can see a child’s ribs they are a healthy weight.

“But we need teachers on board to help monitor and we can’t water down the letter parents of obese children get after they are measured at Reception and Year 6. It’s a medical term and we need to tell the truth.”

She said that, on current trends, half the population would be obese by 2050.

“It’s not just individuals over-eating. It’s social, behavioural, genetic, epigenetic – a whole mix of factors,” Davies continued.

“Take as examples the fact that our plates have got bigger over the past 40 years or so and the size of the average loaf of bread has risen from 36g in 1970 to 40g today.

“There’s also the trend of snacking and grazing. We need to move back to three meals a day.”

The first steps in the Childhood Obesity Plan (COP), though, included the headline-grabbing soft-drinks levy, and she urged caterers, manufacturers, dietitians and children’s health experts to get behind it.

“This is a strong, world-leading move and I ask you all to support it as we move it forward,” Davies said.

“But if the plan is to succeed it needs local government to play a role, and especially schools because it’s much easier to start right with our eating and carry on rather than trying to change people’s eating habits after they’ve been formed.”

Emma Reed, programme director on childhood obesity with Public Health England, says the COP includes 20 actions based on the ‘best available evidence’.

“The biggest one, of course, is the sugar levy on soft drinks, and the reason it was chosen is that UK teenagers are the biggest consumers of soft drinks in Europe, with consequent problems of obesity and tooth decay,” she says.

“The government doesn’t actually want to raise money from it but to drive changes in product formulation and the eating behaviour of young people.

“Sugar in drinks is not the only source – there are also cereals, yogurts, biscuits, cakes, sweets, morning goods, puddings, ice cream and sweet spreads – and industry has already taken up the challenge of reformulating its products in all these categories.

“And how are caterers tackling the issue? In hospitals and leisure centres, we see them selling sugary foods and drinks in the foyer.

“I know that sometimes hospitals are in contracts and it will take time to move on from these, but I believe we will see changes over the next few years as the message gets through that you can offer attractive snacks and foods that are healthy.

“Schools are already doing a fantastic job; the COP looks at doubling the school physical education premium, using money raised from the soft-drinks levy, with Ofsted inspectors assessing how well schools are using the extra money.

“And there is to be a healthy schools rating scheme, which will also form part of Ofsted inspections and will be introduced from September 2017. The rating criteria will be decided after consultation with schools and experts.

“The COP strategy is that primaries should deliver 30 minutes of ‘moderate to vigorous’ activity for pupils every day through active breaktimes, extra-curricular physical education (PE) clubs and active lessons – with parents responsible for providing another daily 30 minutes.

“The primary setting is very important, as children get fatter as they go through school. One in ten is obese when they start primary school, but this has risen to one in five by the time they are 11 years old.”

Reed adds that the initial aim of the plan would be to reduce obesity by a fifth over the next ten years. This was less a target, more an expectation of what will happen once the plan’s actions start being put into place.

“Public Health England will be checking on progress and the impact of the actions, and reporting every six months. We will be using data from the National Child Measurement Programme and the Health Survey for England.

“It’s complex, but it’s about government, schools, industry, families, the NHS and local authorities working together.

“We already know of lots of good work going on in different parts of the country – we now need to make these initiatives scalable so we can use them more widely.”

The point that to successfully reduce levels of obesity needs a range of initiatives and multiple players is echoed by Richard Dobbs, senior partner with McKinsey and lead author of ‘How The World Could Better Fight Obesity’.

He told the summit: “Obesity is becoming a bigger global problem than malnutrition. With only a couple of exceptions – for example, Singapore and Hong Kong – no country has been able to get rich without getting fat.

“Obesity creates social deprivation and the two work together in a downward spiral, so what do we need to do?

“Most of the actions needed are economic, and some even pay for themselves. These include portion control, reformulation, access to food and even taxes can have some impact, though consumers are not always as price sensitive as we think.

“The bad news is that you need to pull about 30–40 of such levers and have lots of ‘players’ involved to do it. This means everyone has a part to play.

“There are four myths about tackling the problem that we have to dispel. One is that exercise or product substitution works, another is that education and encouraging a sense of personal responsibility will do the job. Third, we must remember it is not all down to one group of players and, lastly, there is no ‘silver bullet’ – no single action that will achieve everything.

“So we have to ask, have we been creative enough? Are retailers using their marketing skills to help? I think not.

“For example, many supermarkets have removed chocolate products from by their check-out tills, yet the same is not true if you go into a service station or a convenience store.

“And if we’re going to succeed, we must use the passion of people like Jamie Oliver so they work with us and not end up on the outside criticising.”