How Public Health England plans to win the obesity war

• Soft drinks reformulation​ ​
• Cornerstone of the obesity battle​​
• Not at war with manufacturers​​

One-in-five UK children arrive at primary school obese or overweight. One-in-three UK children leave primary school obese or overweight. Three-in-10 primary school children have recognisable signs of tooth decay. One-in-10 children aged five to 19 are obese.

The figures may make depressing reading, but Dr Alison Tedstone manages to retain a curious air of positivity.

“I do think that I’m lucky to be in this position at this stage in my career – because everything has changed in the past couple of years. Let’s just say, this feels like a moment.”​

Given Public Health England’s (PHE’s) current level of involvement in tacking the nation’s obesity problem, it perhaps isn’t surprising that Tedstone – who leads the government agency’s policy-making strategy across all areas of nutrition – is in an expectant mood.

A year on from launching the childhood obesity plan, which set sugar reduction targets in a number of food categories and confirmed the imminent levy on sugary soft drinks, PHE upped the ante in September with the announcement that it is to target a reduction in overall calories.

The impact on food and drink manufacturers isn’t yet certain, but Tedstone believes it’s a justified move in what she deems the ongoing “war”​ against obesity. And it’s evident that she’s up for the battle.

For Tedstone, whose academic and working career has been devoted to improving people’s nutritional needs (see box), the negative impact of an obese population on wider society is beyond doubt.

“It’s a major driver of costs in the NHS, and it’s affecting us all as tax payers. There’s an economic imperative to get to grips with obesity with children, and when children move into adulthood,”​ she says.

In last year’s childhood obesity plan, PHE set a 20% sugar reduction target across nine key food groups by 2020, and a 5% reduction target by August 2017.

With the first deadline now passed, PHE will be publishing its first set of relevant data next March. Tedstone is cautiously optimistic about the outcome.

“Behind the scenes, companies are telling us they have made progress. And I know from our experience with salt reduction that some companies will be reformulating, but not telling us about it – so we wait and see what translates through into the data.”​

She concedes it is still “early days”,​ and expresses some empathy for manufacturers, considering the time it can take to test and market new products before they hit the shelves.

“The product needs to come off the factory line, get stocked on shelves and then consumed. That’s quite a lot to happen to 12 months.”​

Soft drinks reformulation​ (back to top)​​

Clear reformulation progress has also been made ahead of next April’s Soft Drinks Industry Levy, which will add 18p per litre (ppl) to drinks with 5–8g of sugar per 100ml, and a higher rate of 24ppl for drinks with more than 8g per 100ml.

The British Soft Drinks Association says its members have led the way with calorie reduction, helping consumers to cut their sugar intake from soft drinks by 17% since 2013.

However, the BSDA claims the levy will cost the UK economy 4,000 jobs and £132M in lost revenue. It adds that a soft drinks tax in Mexico has resulted in only six fewer calories per person, per day.

“The tax in Mexico was targeted at the consumer – the UK one is on the manufacturer,”​ says Tedstone.

“We know that a high proportion of sugar children consume comes from sugar, and we know that the levy is a major reason why drinks manufacturers are taking sugar out of their products – so we predict it is going to have quite a big effect on children’s sugar consumption.”​

Cornerstone of the obesity battle (back to top)​​​

While sugar has been the cornerstone of the obesity battle, Tedstone says the issue can only be truly addressed by tackling the 75% of calories consumed in the UK that are not sugar-related.

According to Tedstone, the move to an overall calorie approach is another step in “trying to put the pieces of the jigsaw together”​ – and she is particularly concerned about the growing proportion of calories eaten out of the home.

The next stage of the obesity plan will be set up to include the products not covered by the sugar reduction programme. Pizzas, ready meals and burgers are expected to be high on the list.

“In January, we will publish an evidence piece that will describe the scope and shape of the programme. And then, towards the end of 2018, we’ll produce detailed targets for product categories,”​ Tedstone says.

“We haven’t started talking to the food industry about it yet, but we will before the end of the year. We are trying to be as open and as transparent as we can. Everything has been put out in the public domain, and that will continue.”​

While food and drink manufacturers have long been used to reformulation targets, Tedstone says government has moved on from the days of the Public Health Responsibility Deal.

“This isn’t about industry telling us what they plan to do, and then doing it. This is about setting targets for industry, and then closely monitoring whether they have been met, or not. And if they haven’t, we’ll advise government accordingly,”​ she explains.

“As the childhood obesity plan says, this is the start of a journey. It doesn’t talk about this being the end of a journey. More than 60% of UK adults are obese or overweight – that is a shameful statistic, and one that needs addressing.”​

Not at war with manufacturers (back to top)​​

While understandably passionate about reversing the problem, Tedstone is also keen to stress that PHE is not at war with manufacturers. The prevailing spirit for her is collaboration.

“We know that British manufacturers will step on-board, because we learned that with salt reduction. The industry is a spectrum of people. But we have lots of honest collaborative conversations, and I don’t see that changing.”​

The reformulation drive will continue to be supported by PHE’s Change4Life programme and the Eatwell Guide, both of which Tedstone says help with the “campaigning” ​aspect of obesity reduction. However, one area in which she doesn’t believe a greater focus is necessary is more food education in schools.

“Education is important, and is always going to be part of the mix – but it’s not going to solve the obesity problem,”​ she explains.

“Most children broadly know what they should be eating, but they walk out of school and go and buy a bag of chips for £1. And then they stand at the bus stop, where advertising hoardings push more food and drink at them.”​

To Tedstone, it’s the food environment that’s the crux of the problem – and it’s not going to get solved any time soon.

“Tackling the nation’s obesity problem is a long-haul thing. It’s taken 30 years for our waistlines to expand, and it’s going to take just as long to shrink them again.”​