David Cameron convened another COBRA meeting last week. Normally associated with terrorist threats and natural disasters, this time it was for a crisis in health. We’ve known about it for years, we’ve seen the catastrophic effects on individuals, we have had a plethora of advice on prevention and we have some frightening numbers of the cost to the economy. Were they discussing the greatest threat to the nation’s health and possibly economic security, ie obesity? No. Obesity, which has been blubbering for attention from politicians for a couple of decades, was elbowed aside by the far more fashionable ebola.
Obesity is not a future theoretical threat, it is a present catastrophe. In the past 20 years, the proportion of adults that are obese has risen from 13.2 per cent to 24.4 per cent among men and from 16.4 per cent to 25.1 per cent among women. Including being overweight, the numbers are far worse: 57.6 per cent to 66.6 per cent among men and from 48.6 per cent to 57.2 per cent among women. Most people have heard of the repercussions of being obese: diabetes, heart disease, joint problems, though less known tends to be the rising association with cancer. In 2007 the cost to the UK economy of overweight and obesity was estimated at £15.8bn per year, including £4.2bn in costs to the NHS. 2007 was also the year that the Labour government brought out its seminal Foresight Report on “Tackling Obesities” which set out to answer the question “How can we deliver a sustainable response to obesity over the next 40 years?” The project assembled evidence and expertise from diverse academic disciplines as well as interested organisations within and beyond government.
Eight years on, one fifth of the way through the report’s timeline, and it’s safe to say the situation has not improved. We’re still getting fatter and we still have fat-sugar-responsibility-blame demonising headlines on a loop. The Foresight Report rightly asked for a system-wide approach and a portfolio of policies to be put in place. Politicians can point to things that have since been done, but they are self-evidently inadequate. The approach has remained to piecemeal, to voluntary, to weak, to uncoordinated and to blaming.
In “Careless eating costs lives” we have responded to the obesity crisis by putting together a portfolio of policies, acknowledging both that only a cross-cutting, robust approach will suffice and that there are more avenues to explore. Where previous activity has been limited, we are calling for extended application; where schemes have been half-baked, we are setting out a considered whole-sector approach; where good things have begun, we ask for them to be embedded in law as the new foundations of progress. For instance, the coalition government’s much debated voluntary “Responsibility Deal” has actually seen 713 different organisations and manufacturers sign up to one or more “pledge” to improve labelling, content, nutrition or workplace health. They have shown it can be done, so why not now phase in this deal as mandatory for all manufacturers, just as the Disability Discrimination Act was phased in over a period of years, allowing a reasonable amount of time for companies to adjust? Likewise, the ban on advertising unhealthy foods on TV aimed at children, needs to be now extended across daytime TV, not just during the early-afternoon. Having calories detailed on some menus now needs to become the norm, from KFC to Starbucks to Pizza Hut.
Above all, the severity of this crisis – the drain on individuals, economies and the NHS – means we need an overarching “obesity test”. All government departments need to consider the impact of proposed policy on eating behaviours and public health, to ensure it does not compound the crisis. This is essential because the causes are so complex and multifaceted. Health, education, business, treasury, transport, trade, farming and local government all have their part to play, but if the “obesity” question is not being asked, the unintended consequences of policy could be a more obesogenic environment than we have already.
If a new policy or initiative makes it easier to supply fast food, harder to walk to the shops, more difficult for schools to serve balanced meals, cheaper to buy junk grub then it should be rejected. Those are obvious. But due consideration should also be given to prevention: mental illness and counselling services, early years support and cooking classes are all vital to ensuring problem symptoms are tackled before they turn into the signs of excessive weight gain. One friend remarked to me that everyone in the over-eaters anonymous groups that she had ever attended had reported a history of abuse.
No, obesity isn’t as captivating as ebola. And as ever, those with the least resources, the lowest resilience, and often the easiest to ignore are the hardest hit. But with a tidal wave of calories surrounding us, we can’t go on ignoring obesity – because it will sink all of us if we do.
Julia Manning is Chief Executive of 2020health