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Covid-19: England’s obesity strategy will fail without tackling social factors, warn doctors

BMJ 2020; 370 doi: (Published 27 July 2020) Cite this as: BMJ 2020;370:m2994

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Healthy eating strategy: needs to be bigger, positive and adequately funded.

Dear Editor
The Institute of Health Promotion and Education has welcomed publication of the Government’s new obesity strategy, Tackling obesity: empowering adults and children to live healthier lives, but we still don’t believe it is sufficient and a more radical approach is needed.(1,2)

In 2002 the Chief Medical Officer for England, Sir Liam Donaldson in his annual report discussed “Obesity – defusing the ticking time bomb” recommending clear multifaceted actions.(3) Since then there have been further authoritative reports describing the comprehensive strategies that are needed to tackle obesity.(4-10) However, the new strategy promotes a simplistic view of a complex topic and tends to focus on individuals rather than tackling some of the underlying causes of ill health.

A focus on tackling poverty is needed. People with little money often buy food that is filling, cheap, and high in salt, sugar and fat. Additionally, many lack cooking skills. Although foodbanks and free school meals are necessary for supporting some families, the new strategy needs a long-term plan so that this type of initiative would become redundant. Fiscal measures could be introduced to address this, an example being: to use tax on less healthy foods to subsidise fruit and vegetables.

We are pleased that the new strategy is covering different age groups rather than just children and that physical activity is now being promoted alongside the strategy.(11) Walking and cycling have the potential to greatly improve health but we would also like to see a wider range of activities promoted including swimming and dancing. There are inequalities in relation to physical activity including those linked to age, race, disability and gender. Women's sport for example is often overlooked and underfunded. The barriers that prevent individuals being active need to be removed so that the healthier option will be the easier option.(12)

Parents can play a proactive role in preventing obesity from a very young age. A noteworthy element that is missing from the strategy is the promotion of breastfeeding. This we think is critical in infant healthy weight development as well as supporting mothers regain their pre-pregnancy weight.(6,13)

It is positive that products high in fat, sugar and salt (HFSS) will now not be able to be advertised on TV and online before 9pm. However, we would like to see these restrictions extended to other settings where children are targeted, for example on public transport.

Healthy eating was one of the criteria for achieving the Healthy Schools Standard and school canteens were part of that. This ought to be an opportunity for the government to revisit the Healthy Schools initiative and an opportunity to link the development of healthy eating as an outcome for PSHE in schools too. High quality PSHE for all pupils was an essential criterion for achieving the Healthy Schools Standard.

A comprehensive approach to tackling obesity will have action across many sectors including schools, hospitals and the local communities. Hospitals should be exemplars to other organisations.(7) Staff in different settings will need to be trained and activities will need to be stimulated and coordinated. These are key roles for public health specialists. However to do this, local authority public health departments will need sufficient resources and long term national commitment.(14-18) It is crucial that funds are allocated.

A major issue we have with the new strategy is that overall, it has the wrong approach, a positive one would be far more likely to create healthy individuals. In the UK tackling the covid-19 pandemic has increased fear and anxiety, and this is likely to be higher for people identified as at higher risk of severe illness and death. The new obesity strategy has been launched with a focus on the negative and this may add more fear for some people and may lead to many unintended consequences. The goal should not be anti-obesity and using shock tactics, but one that promotes a healthy relationship towards food and bodies.

We are pleased that the strategy ends by stating that “further measures will be needed” as there are still a considerable number of elements that are required before this could be considered a comprehensive strategy that is fit for purpose. We hope that the government will demonstrate a sustained commitment to this area and tackle the root causes of deprivation which are inextricably linked to obesity and lack of physical activity.

The scale of the obesity epidemic should not be underestimated and real improvements in positive health will take time to achieve. We urge the government to build on this initial work, and significantly increase activity to produce a multifaceted long-term positive healthy eating strategy.

1) Mahase E. Covid-19: England’s obesity strategy will fail without tackling social factors, warn doctors. BMJ 2020;370:m2994

2) Department of Health and Social Care. Tackling obesity: empowering adults and children to live healthier lives. Published 27th July 2020.
[Accessed: 27/07/20]

3) Donaldson L. CMO Annual Report 2002. London: Department of Health.

4) Foresight. Tackling Obesities: Future Choices – Project Report. Government Office for Science: London 2007.

5) World Health Organization. Prioritizing areas for action in the field of population-based prevention of childhood obesity. A set of tools for Member states to determine and identify priority areas for action. Geneva: World Health Organization 2012.

6) Academy of Medical Royal Colleges. Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis. London: Academy of Medical Royal Colleges 2013.

7) BMA Food for thought: promoting healthy diets among children and young people. London: BMA 2015.

8)House of Commons Health Committee. Childhood obesity: follow-up. 27 Mar 2017.

9) World Health Organization. Taking Action on Childhood Obesity. Geneva: World Health Organization, 2018.

10) Davies S. Time to Solve Childhood Obesity. London: Department of Health Social Care 2019.

11) Department for Transport. Gear Change. A bold vision for cycling and walking. London: Department for Transport, 2020.

12) Watson M C and Lloyd J. (2015) Seismic shift in policy needed to increase physical activity. BMJ 2015;350:h3486.

13) Watson M C. IHPE Position statement: Breastfeeding. Welwyn: IHPE, 2017.

14) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761.

15) BMA. Funding for ill-health prevention and public health in the UK. May 2017.

16) House of Commons Health Committee. Public health post-2013: second report of session 2016-17. House of Commons Paper No 140, 2016-17.

17) Watson M C and Thompson S. Government must get serious about prevention. BMJ 2018;360:k1279.

18) Scally G, Jacobson B and Abbasi K. The UK’s public health response to covid-19. BMJ 2020;369:m1932

Competing interests: No competing interests

29 July 2020
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK.