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Editorials

Industry self-regulation fails to deliver healthier diets, again

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4762 (Published 06 January 2021) Cite this as: BMJ 2021;372:m4762
  1. Paraskevi Seferidi, research fellow,
  2. Christopher Millett, professor,
  3. Anthony A Laverty, lecturer
  1. Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
  1. Correspondence to: A A Laverty a.laverty{at}imperial.ac.uk

Public Health England’s replacement must take bolder action

In common with much of the rest of the world, the UK has inequity in access to healthy food. Feast day food is available every day, driving higher levels of overweight and obesity, while substantial numbers of people are hungry and undernourished. No single action will solve these problems, but governmental regulation to improve the nutritional content of foods should be an important part of any plan.

Industry self-regulation to improve diets has been in vogue worldwide for more than a decade, but evidence has steadily accrued on its deficits. The latest Public Health England (PHE) report on the voluntary sugar reduction strategy 2015-19 should finally put an end to the idea that industry self-regulation works.1 The strategy challenges the food industry to achieve a 20% reduction in the sugar content of foods that contribute most to children’s sugar intake, and suggests reformulation, changes to product size, or shifting consumers to low or no sugar options.

This strategy continues to make disappointing progress: between 2015 and 2019, total sugar per 100 g (sales weighted) fell by an average of just 3% in foods sold in retail stores, and by 0.3% in foods eaten outside the home. This is despite some successes, such as a 13% fall in the sugar content of yoghurts and breakfast cereals. Comparison with other measures is informative: the mandatory soft drink industry levy achieved a 35.4% reduction in total sugar sold in drinks subject to the levy during 2015-19, despite a 14.9% increase in sales.

In 2016, PHE’s chief nutritionist was clear that having an open and accountable system was important, and if the sugar reduction strategy had not delivered by 2020, legislation would be considered.2 The current report notes that further action is likely to be needed: but what form should it take?

Robust approach

Research clearly shows that a robust independent regulatory system is required, with targets set by government and progress publicly monitored. Previous analyses of reductions in salt intake in England found that the switch from a robust independent system to a looser public-private partnership halved the speed of progress in taking salt out of diets.3 When industry is allowed to decide and set targets, real change is often avoided and minimal progress made.4

Reformulation is no panacea, however, and can produce harm, especially when industry’s own targets are used to promote ultra-processed foods as healthier options. This is a risk, particularly in low and middle income countries, where consumption of ultra-processed foods is growing rapidly and reformulation can legitimise their introduction into local markets.5

Beyond mandatory regulation, we need bolder food policies to achieve meaningful change. Fiscal measures such as England’s soft drinks industry levy have been shown to be more effective than policies focused on consumer choice, for example.6 But the commercial food system is complex and adaptive, as shown by the fact that while the sugar levy reduced total sugar content, the food industry responded by increasing advertising to maintain customers and profits.7 This means that policies need to be continually monitored and adapted to respond to industry activity and to any unintended consequences or regressive effects. Further options include extending sugar taxes to a wider range of products and using the revenue raised to subsidise healthy foods.

The UK’s prime minister renewed a government commitment to reduce obesity after his brush with covid-19, but policy is still framed in the language of individual choice—based on an underlying assumption that with more information, consumers will make healthier dietary decisions.8 Proposals to ban all online adverts for unhealthy food are ambitious and welcome, although evidence from bans on television advertising indicates the effects will depend on how both advertising and food industries respond.9

Bolder approaches to food labelling should be considered. Front-of-pack warning labels on foods high in energy, sugar, salt, and saturated fats have been successful in some Latin American countries, including Chile and Peru, especially when combined with policies to restrict marketing.10 Finally, the steady accumulation of evidence on the human and environmental harms of ultra-processed foods suggests that these should be a target for further action.11

The planned abolition of Public Health England is a retrograde step, as it has been instrumental in guiding and evaluating dietary policy. Its successor must have the freedom to take a more robust approach with the food industry and must abandon the failed experiment of self-regulation. Without mandatory measures, the food industry will continue to prioritise profit over health and drive unsustainable increases in diet related diseases.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

References

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