Christmas is the time for feasting. Indulgence is everywhere, from the ads adorned with sumptuous tables to the carousel of Christmas parties. December is the time of year where being greedy is not just OK, it’s celebrated. And for many people, it’s a welcome break from calorie counting and being careful. For others who struggle with their weight, though, it can be a time of dread.
Obesity is a global issue: its prevalence has increased in every country in the world in the last 40 years. But it has done so much more slowly in countries with healthier food cultures like Japan and Korea. The UK is at the other end of the scale: we have the third highest obesity rate in Europe, and the third highest in the G7, behind the US and Canada. Almost one in three British adults are obese, with terrible implications for public health: obesity is the third biggest cause of premature death, behind smoking and high blood pressure. One estimate puts the cost to the NHS each year at £6.5bn.
Reducing levels of obesity has therefore long been a priority for those governing us. The Institute for Government has highlighted that every government since 1992 has recognised it as a problem and that, since then, there have been 689 policies and fourteen strategies aimed at tackling the problem. Moreover, fourteen different institutions and agencies that have been created, then abolished, over the same period, all of which had reducing obesity as part of their remit.
Why so little progress? It is not for a lack of know-how. Yes, improving population health by shifting the behaviour of individuals is one of the more difficult challenges facing government. But there have been some incredible successes in the recent past. The ban on smoking in public places (implemented in 2006 in Scotland and 2007 across the rest of the UK) was associated with a fall in cigarette sales, significant reductions in the number of children getting admitted to hospital with asthma and a drop in the number of hospital heart attack admissions. Less well known is the fact the UK was the first country in the world to successfully reduce population-level salt intakes; in 2006, the Food Standards Agency set tough salt reduction targets for food manufacturers that reduced salt intakes by ten per cent in just two years, saving an estimated 6000 lives a year.
There are a number of policy options available to a government looking to reduce obesity. These include advertising bans for unhealthy food and adopting similar measures to the ones taken by the (now-disbanded) Food Standards Agency when acting on fat and sugar. This would mean obliging companies to reduce the levels of harmful ingredients in processed foods and widening access to evidence-based treatments that help the morbidly obese (with associated grave illnesses) to lose weight, such as bariatric surgery. The UK performs far fewer of these operations (including gastric bypasses, bands and duodenal switches) per head of population than other European countries with lower levels of obesity. There are also, of course, new weight-loss drugs like semaglutide.
Only active nanny state-ism will counteract calorific big food interests
The Conservative government has introduced one important, but limited, measure to try and curb obesity: the 2016 sugar tax on soft drinks. It has been very effective, reducing the sugar sold in soft drinks by 35 per cent between 2015 and 2019. But ministers have shied away from other interventions, including a more general wholesale tax on sugar or salt (as recommended by a review headed by restaurateur Henry Dimbleby), bans on junk food advertising and asking food manufacturers to reformulate products with less sugar and fat.
There’s a mix of reasons for this. The government has been keen to avoid charges of “nanny state-ism” and, in the face of determined lobbying from the food industry, has been philosophically reluctant to intervene in the free market. More widely, there is a social stigma to being very overweight that extends beyond ministers’ views on the matter. Some see obesity as evidence of gluttony and a lack of willpower; that if you want to lose weight, you should just eat less. Obese people are paid less on average, less likely to be hired in the first place, and are considered less qualified for leadership positions. This plays into the government’s leanings towards treating it as a matter of individual responsibility rather than something that requires significant government intervention to sort out.
This analysis is wrong on all counts. Obesity isn’t simply about a lack of willpower: studies suggest that between 40-65 per cent of the risk of obesity is explained by genetic factors. And there is so much about modern food that makes it hard to eat healthily. In particular, there is a race to the bottom in the food industry: loading processed foods with cheap fat, salt and sugar makes them tastier and moreish, meaning our collective palates adjust to expect further helpings. As levels increase over time, any manufacturer acting alone to make their foods healthier will lose out because they will either need to sacrifice taste or price. This is why compulsory reformulation – where manufacturers are obliged to reduce levels over time or face penalties – is the only effective way of readjusting our palates so we expect less fat and sugar.
Obesity – like smoking – is not an area where encouraging individuals to lose weight off their own back will begin to have the strong effect required. It requires some active nanny state-ism to counteract the profit-seeking, calorific behaviours of big food interests, which come at the expense of our collective worsening health.
Sonia Sodha is chief leader writer at the Observer and a Guardian/Observer columnist