Government must proceed with landmark anti-obesity regulations in EnglandBMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2358 (Published 30 September 2022) Cite this as: BMJ 2022;378:o2358
- Sarah Muir, research fellow,
- Preeti Dhuria, registered public health nutritionist and senior research assistant,
- Christina Vogel, registered public health nutritionist and associate professor
Saturday 1 October 2022 was meant to be a landmark date in food policy, with the implementation in England of world leading legislation to restrict the placement, promotion, and marketing of high fat, sugar, and salt (HFSS) products in shops and online.1 Yet in May 2022 the government announced that the planned ban on volume based (multibuy) promotions of HFSS products—a core part of this novel legislation—was to be postponed for a year. The government blamed the delay on the cost of living crisis,2 despite objections from the public health community and concrete evidence that such promotions increase spending on, and consumption of, these unhealthy food products.34
In September 2022, this legislation was dealt a further blow, as it was reported that Liz Truss’s government would be carrying out a review that could see these regulations scrapped in their entirety.5 This would have also put an end to restrictions on the placement of pre-packed HFSS products in prominent locations, such as store entrances, aisle ends, checkouts, and website homepages, which were still scheduled for 1 October 2022.5 We, like other health advocates, are delighted that this legislation is for now still going ahead, but whether the government will change course on its obesity strategy in the longer term remains unclear.
A chance to tackle the junk food cycle
This legislation provides a solid start for the UK government’s efforts to tackle the nation’s upward trend of poor diet and obesity. Delaying or even revoking these laws will severely undermine progress towards this goal. The independent National Food Strategy made it clear that many businesses and families are trapped in a “junk food cycle.” This is a direct result of ultra-processed and HFSS foods being cheaper to manufacture, more profitable to market, and consequently more appealing to and affordable for customers.6 By contrast, healthy food is three times more expensive per calorie than HFSS foods, and less than 1% of foods promoted in prominent locations are fruit and vegetables.78
Ever increasing inequalities in the UK population’s diet and prevalence of obesity9 clearly show that interventions that rely on individuals’ actions are unjust and ineffective. They require high levels of financial, social, and psychological resources, which are more abundant among those who are more affluent.1011 Evidence from our work and that of other researchers shows that changing retail shopping environments to reduce the availability and visibility of HFSS products, and replacing them with healthier foods, leads to people making healthier choices in what they buy and eat across different socioeconomic groups.12131415 We also know that voluntary measures to curb the promotion of HFSS products have had limited success because there are no incentives for companies to comply. If anything, food businesses perceive participation as a commercial disadvantage against competitors who are not taking part.16 The “nanny state” argument against regulating food businesses simply does not stack up.
Wide stakeholder consensus
We’ve interviewed stakeholders affected by this anti-obesity legislation, including consumers, manufacturers, retailers, and environmental health and trading standards officers, as well as academic and non-government organisation health advocates. In partnership with the Consumer Goods Forum and Chartered Trading Standards Institute our team hosted a conference on the successful implementation of these restrictions, which attracted over 450 businesses, enforcers, and policy makers.17
Across stakeholder groups there is widespread acceptance of the need for this legislation and a shared hope that it will lead to healthier shopping baskets and improved diets. Businesses have put a lot of effort into understanding the details of this legislation. For some companies, it has accelerated new product developments and reformulations, or prompted them to rethink the products they promote in prominent locations.
The government should be doing more to ensure this legislation is implemented and enforced consistently. Firstly, a free central HFSS calculator would help all retailers and enforcement officers to determine what products are in and out of scope. Additional support (financial and strategic) for smaller businesses would increase awareness and understanding of the legislation and facilitate compliance equitably across store types. Finally, ringfenced resources for overstretched local authorities would enable them to prioritise enforcement of these novel and complex regulations. We should be collectively pressuring the government to continue with this legislation and take these additional steps to enable its effective implementation.
An opportunity to gather evidence
With the still looming threat of the revoking of anti-obesity measures, health professionals, academics, and research funders also need to ensure we carry out thorough, independent assessments of its implementation. Even if these rules are in place only for a short period of time, we still need to measure their effect on behavioural and health outcomes. Accumulating evidence of the positive effects of removing HFSS from prominent locations could further increase acceptance of this policy among all stakeholders18 and confirm if it is the right approach to take.
Evaluations of this legislation will also help us to identify and assess any unintended consequences resulting from industry exploitation of loopholes. Will we, for example, see increased promotion of unpacked HFSS products or alternative products with a high profit margin, like alcohol? Will businesses make increased use of in-aisle promotional displays or product or business exemptions, such as increased sales of HFSS products in exempt stores? Researchers will need to unpick a range of possible outcomes and developing trends and examine shopping patterns across different demographic groups and regions. This kind of careful independent evaluation will help us to refine anti-obesity legislation, optimising its public health benefit.
Improving the UK population’s diet would change our current trajectory of rising levels of diet related illnesses and deaths, boost population health and workforce productivity, save the NHS millions of pounds, and help lower greenhouse gas emissions.6192021 The possibility of realising these benefits highlights the urgency of pursuing anti-obesity regulations and creating a long term unifying food and health strategy that will drive sustainable, equitable change in population diet and health.3222324
Competing interests: CV and PD have a non-financial research collaboration with a UK supermarket chain; the authors have no other interests to declare.
Provenance and peer review: not commissioned; not externally peer reviewed.
Correction: This article was updated on 30 September 2022 to reflect announcements from the UK government.