This interview carries two health warnings. The first is that the health of the British nation is not good. The second is to expect use of the F-word. Not that F-word – the other one. The one which has to be used with even more caution because it can grievously offend. The F-word is “fat”, because we are now officially a Fat Nation.
The United Kingdom has followed the United States in becoming increasingly overweight, increasingly obese, increasingly diabetic, increasingly sick – as a result of what we choose to shove into our mouths. We’re increasingly heavy, big-boned, chubby, extra-large, whatever your favourite euphemism is for being overweight, because fat is the new normal.
MPs, the government, doctors, scientists, nutritionists and people in the food business know all this, but beyond occasional handwringing there is no great impetus to do anything about it. We’ve had seven health secretaries in the past five years. One of them, Steve Barclay (Health Secretary twice in those five years, lucky fellow) suggested that the answer to Fat Britain is anti-fat drugs called semaglutides. Think about this for a moment. The politician in charge of the NHS tells us that paying pharmaceutical companies to treat the results of our British national eating disorder is easier than stopping us getting morbidly obese and sick in the first place.
The real problem is easy to diagnose yet tricky to fix. Britain is overweight because of the food we eat. The facts are clear: “The Health Survey for England 2021 estimates that 25.9 per cent of adults in England are obese and a further 37.9 per cent are overweight but not obese. Obesity is usually defined as having a body mass index (BMI) of 30 or above. BMI between 25 and 30 is classified as ‘overweight’.”
Two-thirds of us, therefore, have a weight problem. It’s killing us. It’s killing the NHS too. I’m reading these gloomy statistics in an excellent new book, Ravenous, while on my way to meet its author, Henry Dimbleby, at a book festival in Scotland. Henry’s father is the broadcaster David Dimbleby, while his mother is the prolific cookery writer Josceline Dimbleby. Henry is a successful businessman, co-founder of Leon fast-food restaurants, a cookery and food writer and – as he tells me when we meet – “accidentally” a campaigner for a better British diet.
Thanks to the failure of another of our public services in 2023 – the railways (seven transport secretaries since 2010) – instead of being in Scotland, I’m stuck at a railway station in the Midlands. I’m also hungry, you might even say ravenous, while reading Henry’s book. Its theme goes beyond an investigation into obesity to comparisons with countries which have successfully tackled the diet issue (Finland and Japan are good examples) to become healthier.
Britain is headed in the opposite direction because we are increasingly addicted to cheap, ultra-processed food. This makes enormous profits for the food processors but takes a terrible toll on the National Health Service. And on millions of us.
Inspired by the book I look around the station for healthy eating. There are the coffee chains with their cakes and biscuits and other sugary treats. And there are shops with chocolate and sweets, fizzy drinks, bottled water and some terminally depressed, almost suicidal, sandwiches. There is a doughnut place and a couple of other fast-food places, which smell of frying. I’m not a fussy eater and tofu always seems to me the culinary equivalent of marinated beermats, but the unhealthiness of the offerings around me at the station fits perfectly into Dimbleby’s definition of ultra-processed Fat Nation junk nutrition.
At the start of Ravenous he warns that “over 80 per cent [of ultra-processed food] is unhealthy”. I eventually choose cheese-and-pickle sandwiches and a yogurt, although the cheese is slimy. And when I read the food labels I realise I’m eating some of the 80 per cent unhealthy junk Dimbleby warns about.
When I finally get to meet him, Dimbleby turns out to be friendly, hugely well informed and fun. He’s also full of facts. Did you know that we eat five times more packets of crisps per person than we did 50 years ago? Or that our national sweet tooth means that “by 2035 the NHS will spend more on type 2 diabetes than on all cancers” put together today? Or that food is so class-based that it is “one of the clearest markers of inequality” between rich and poor? Poorer people are much more likely to be at risk from diet-related diseases. Food labels that say “free from” are more about marketing than diet information. Anything that says “low fat” probably means it’s high in sugar or starch or something else you don’t want in your body. And so on. Ad nauseam. Literally.
Henry tells me, with considerable pride, that his mother helped create his interest in food. She is “a fantastic cook. She sold more than two million cookbooks without ever doing telly, which is pretty rare. So I grew up with really great food.” Did he cook as a child? He laughs. “I was never allowed in the kitchen because she was always working. So she trained my palate but didn’t train me to be a cook.”
Henry graduated in physics and philosophy – not an obvious background for the food business – but the kitchen drew him in. He trained under the great French chef Bruno Loubet before deciding that he “wasn’t dexterous enough to be a professional chef. You have to be a bit like a ballet dancer.” But the business side, especially trying to provide fast but nourishing food, inspired him and his business partner, John Vincent, to set up Leon. Their mission was to offer the kind of fast food I couldn’t find on my train journey – good value, tasty, visually appealing, fresh and not ultra-processed.
Leon broke with the previous business model for fast food, which was to add plenty of sugar to the dish in question, salt it and then fry it. And rather than just staying focused on cash for calories, he “accidentally” became a campaigner. “I set up a thing called the Sustainable Restaurant Association with a couple of friends because it was so hard doing it on your own. We thought there needed to be a not-for-profit organisation that would help people do it. I was asked to do work on school food and then kind of gradually got drawn into the system.”
By 2013 this accidental campaigner, along with John Vincent, had produced the School Food Plan. It made seventeen recommendations to improve the quality of school meals and food education. By July 2020 Henry had published the National Food Strategy at the request of the Conservative government. It contained three key recommendations: introduce a salt and sugar tax; use some of the tax revenue to help get fresh fruit and vegetables to low-income families; and introduce mandatory reporting for large food companies.
The official reaction to his suggestions of higher taxes, help for the poorest among us and more regulation of the food business can be summed up as: “Well done, Henry. Excellent work. Don’t call us – we’ll call you.” A change in government policy? Fat chance, you might say. Ravenous can be seen as his attempt to campaign by other means: a literary act of quiet frustration.
The more Dimbleby researched, the more shocked he became. He tells me: “You can look at the number of aisles in a supermarket that sell crap versus the good stuff. The numbers shocked me. The fact that 57 per cent of calories [we eat in the UK] are from ultra-processed food; 85 per cent of those foods are deemed by the World Health Organisation to be too unhealthy to market to children. The fact that we spend £2.8 billion a year on fresh fruit and veg and £3.9 billion on sweets! That was what really shocked me.”
British officialdom knows all this. Experts and officials understand the need to do something – if only to prevent the NHS being bankrupted by food-related ailments – but the political will isn’t there. “I remember talking to [England’s chief medical officer] Chris Whitty during covid,” Dimbleby tells me. “He gave an online lecture on the damage that diet is doing to our health, [even] while he was running the pandemic response. And that’s because people who are really up against it in the health service see how much the food system is responsible for the weakness of our systems. In covid it was noticeable how many of those who were suffering had pre-conditions related to diet.”
I mention to Henry his statistic that by 2035 the NHS will spend more on type 2 diabetes than all cancer treatment we’re spending money on today.
“Yeah,” he sighs. “And there’s one statistic that isn’t in the book, which really shocked me. I learnt just the other day of the 2.5 million people who are out of work now from long-term sickness – more than have ever been out of work before – the Treasury thinks there are four conditions that are causing this. Musculoskeletal problems, hypertension, type 2 diabetes and mental health. Three of those conditions are directly caused by diet and the fourth is exacerbated by it.
“In Whitehall now the pressure to do something about this is coming as much from the Treasury [as the Health Department] because this is lack of productivity, lack of GDP receipts. It’s from health. If we don’t deal with it, it’s going to make us both sick and impoverished. It’s a nightmare.”
So why did he run up against a political brick wall? “On the environmental side,” he demurs a little, referring to farmers and agriculture, “the system is working. The big companies in agriculture can see a way of doing [better food] in a less destructive way and making money, whereas the big food companies can’t.”
“People are worried their children are bombarded with adverts for disgusting food that’s going to kill them”
The lack of political will to implement his findings, Dimbleby says, comes from politicians sensing they are on dangerous ground telling people what to eat and introducing regulations that may raise prices. “There is this idea of the nanny state, this deep sense among politicians that the public don’t want intervention. The free market ideology is very strong. The Labour Party are worried about the Red Wall. They’re worried that if they deal with this stuff, they’ll be characterised as nanny-staters.”
He smiles. “Funnily enough, there’s huge political opportunity here. When you talk to voters, they don’t present how they’re characterised by politicians. There’s a parallel with the recent polls in the London mayoral race. Everyone thought that Uxbridge was a turning point.” He means the predicted backlash against extending the Ultra Low Emission Zone (ULEZ) to outer London which may have ensured that Labour narrowly lost a winnable seat. A wider backlash simply did not happen.
“The way in which ULEZ was introduced was a bit cack-handed and enabled short-term pressure, but people are worried about climate change, people are worried about pollution and people are worried about the fact their children are bombarded with adverts for disgusting food that’s going to kill them.”
He shares a key discovery he learned from a conversation with an Australian doctor just before our interview. “They’ve been doing a study that started in the Eighties with 40,000 people. Those who had a bad diet were overweight when they were children. Unsurprisingly, they have six times the chance of having a stroke or heart attack before they’re 55. But surprisingly, which is news, even if they improve their lifestyle after childhood, about 30 per cent of the damage is done. It’s doing long-term harm to their underlying infrastructure, their organs. I think that’s really interesting in terms of how you help children become more healthy when they’re [still] children. If you know they can’t undo it, that puts even more of an obligation on the state to try and help them at least to get to nineteen without having permanently damaged their organs.”
But what, I ask, of Steve Barclay’s suggestion that the answer is fat-busting wonder drug, semaglutide? Dimbleby shows qualified optimism: “These drugs work. It’s the first of a whole bunch that are coming down the line. For people who are severely obese and have struggled all their life, it’s a good thing. I wouldn’t want to put people off doing it. But as a solution, it is almost certainly stirring up huge problems down the line. I can see a future where 30 per cent of people are permanently on these drugs. So yes, I think it’s possible that’s the future we go down.
“Walmart recently announced that they had spotted in areas with high semaglutide use that their food sales were going down. And so it’s literally direct profit transfer from big food to big pharma. I hope that in 30 years’ time we look back and think: ‘Wow, that was a time when we ate that stuff.’ And I don’t think that’s impossible. I was talking to a group of schoolchildren the other day and was trying to explain to them that when I was young we could smoke on the bus and on the plane. They were like: ‘What?! So I think cultural change is possible. But if I were a betting man, I would probably bet on the drugs being what solves the problem.”
“About 30 per cent of the damage is done in childhood”
Part of Dimbleby’s argument is that without government intervention to set standards and impose regulations, the big food companies are so competitive they will not act individually for fear of losing market share. Despite this, some have begun to ask publicly for government intervention. “The president of Danone has come out and said: ‘We need more regulation, we can’t do it on our own.’ Sainsbury’s and Asda have both said: ‘We can only solve this with government regulation.’ This is quite big because they are now admitting publicly that if they move independently, it will hurt their bottom line and they’ll be fired by their board, basically. So it’s good that they’re increasingly admitting it publicly.”
What more should be done? Henry ticks off his main recommendations:
“You have to have a restriction on marketing and advertising. Advertising works. You have to have taxation on sugar and salt. And, given that society is so unequal, you have to have support in the form of fruit and veg vouchers for people who are in the least affluent ten per cent. On top of that, you have to try to build the culture from the bottom up. You have to improve education, you have to improve food served in state institutions and so forth. You have to do all of those things.”
Dimbleby’s two key foreign examples from the book stand out. In Finland after World War II the government recognised that a terrible diet was killing Finns years earlier than in comparable northern European nations. State intervention changed the diet, offered recipes and healthy living tips, and Finns now live longer and healthier lives.
But Japan is the most intriguing, despite the UK’s clear cultural differences with a society on the other side of the world. “Maybe we’re not so different from the Japanese,” he tells me. “In the book, we give the example of the Metabo Law, which is that everyone is weighed and has a health check, and if they are at the office and overweight, they are given a weight management course. And everyone [in the UK] laughs about it. They go: ‘Ha, ha, ha, isn’t that funny? That could never happen here.’ But I was thinking that if businesses in this country were obliged to give a health check to all of their employees – the employees don’t need to take it but [employers] are obliged to give it – my guess is that most people would take it and would see that as a great bonus. And then if there were health interventions that were recommended, a lot of people would take them, because getting to the GP is a very, very difficult thing to do. So I thought: are we maybe just slightly closing off the art of the possible? As [the UK diet and sickness rate] gets worse and worse it’s going to be impossible not to try to do something. It’s just going to become so obvious.”
Obvious, yes. But, in an election year, a chronic healthcare crisis is likely to take a back seat to the immediate cost of living crisis. Oh, and for a sign of government action on the subject, you may like to know that the most recent of our seven health secretaries since 2018 is Victoria Atkins. BMA council chair Professor Philip Banfield said that as the new health secretary she “must make solving the NHS workforce crisis her top priority”. She is married to the boss of British Sugar – one of the world’s biggest sugar companies. Could you pass the semaglutides? And I’ll have fries with that.
Gavin Esler is a writer and broadcaster and his latest book is “Britain Is Better Than This” (Head of Zeus)