Intended for healthcare professionals

Rapid response to:

Observations From the Heart

It’s time to ban junk food on hospital premises

BMJ 2013; 346 doi: (Published 26 June 2013) Cite this as: BMJ 2013;346:f3932

Rapid Response:

Re: It’s time to ban junk food on hospital premises

We fully agree with Dr Malhotra that often decisions about food and other health choices are automatic and made without full awareness. That is why we think a more holistic approach is needed for this epidemic of obesity. Instead of mainly focusing on individuals we need to also change our obesogenic environments into health promoting ones; and that includes hospitals.

An approach to health education which only focuses on individuals rather than the external forces that influence an individual person may result in victim-blaming and be ineffective.(1) That is why diverse but complementary approaches were recommended in a seminal document of the new public health.(2,3) The approaches included: developing personal skills; creating supportive environments; and reorienting health services so that they move increasingly in a health promotion direction. Examples of some of these measures were recently included in “Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis”.(4)

For those who are against environmental approaches it is important to note that many of the great public health successes in the past have been the result of environmental changes and some of these have had quick results. Injury prevention and smoking are just two areas where lessons can be learned.(5,6)

The Olympics were a missed opportunity for public health. It seemed bizarre that McDonalds and Coca Cola were being promoted to the world whilst more healthy options were not being linked to this great sporting event. Perhaps we should now have some of the UK heroes of this spectacular event providing high profile leadership to a multifaceted healthy eating and exercise campaign.(7)

However, we are not suggesting they act alone, as health promotion expertise will be needed. Action is needed in many settings including: schools; workplaces; media; and hospitals. The government should play key roles in coordinating the activities of its different departments. But most importantly a dramatic increase in activity is needed to tackle this public health crisis: stronger and more comprehensive government action is needed.


1) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001
2) World Health Organization, Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.
3) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
4) Academy of Medical Royal Colleges. Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis. London: Academy of Medical Royal Colleges 2013
5) Hemenway D, While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.
6) Callinan JE, Clarke A, Doherty K, et al. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2010;(Issue 4).
7) Public Health England. Our priorities for 2013/14. London: Public Health England, 2013.

Competing interests: No competing interests

01 July 2013
Michael C. Watson
Associate Professor in Public Health,
Dr John Lloyd (President Institute of Health Promotion and Education)
University of Nottingham
Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA