Nesta’s health mission is to halve the prevalence of obesity in the UK by 2030, in order to increase healthy life expectancy. We have identified reducing obesity as the best way to do this for several reasons. It is one of the biggest drivers of ill health, contributing to type 2 diabetes, cardiovascular disease, some cancers, and impacts on well-being. Obesity is also a leading cause of preventable death. 

We take a population-level approach to tackling obesity, meaning we look at measures that will impact everyone, rather than just targeting certain groups, because we think this is the most effective approach. But we want to do this in an equitable way, and we think our approach is the best way to do this.

In this blog, we’ll explore existing health inequalities in relation to obesity; outline our population-level approach to tackling obesity; and explain why we think that approach, if successful, will both halve obesity and narrow health inequalities.

We know that tackling obesity is necessary for creating a healthy society with a strong economy. But we also know that good health is distributed unevenly among the population. Health inequalities in the UK are stark. Between England’s regions, there’s almost seven years’ difference in how long people live in good health, and between local authorities, the gap is 18 years. People living in the most deprived areas of England are almost four times more likely to die prematurely from cardiovascular disease than those in the least deprived areas. These inequalities are evident across a range of health outcomes and are often linked to socioeconomic status, geography, and demographic factors. 

Obesity, which is a significant driver of ill health in the UK, has a social gradient: meaning it affects different groups differently. Broadly speaking, for adults, the higher the rate of deprivation in the area you live in, the more likely you are to be overweight or living with obesity. 

For children, the link between deprivation and obesity is even more clear cut. Children living in areas with high rates of deprivation are much more likely to be overweight or living with obesity.

It's important not to conflate deprived areas with people's income levels. You can be a high earner living in a deprived area, and vice versa. The patterns for household income aren't as clear-cut as the neighbourhood deprivation level. Income does matter for obesity risk, but the relationship is more nuanced and less pronounced than for areas of deprivation.

We know that to meet our ambitious goal of halving obesity by 2030, we need to reach the population as a whole to achieve the widest impact. We want to ensure that obesity levels are reduced across the population. That means we don’t work specifically on tackling poverty or food insecurity. While those issues are important, they are not Nesta’s focus. 

Targeting the whole population with ambitious goals means we can positively impact the lives of everyone living in the UK. Most importantly, it creates the largest real-world improvements in deprived areas that face the highest obesity rates.

And while there is a social gradient to obesity, inequalities are not the only driver of obesity. Obesity rates are high across all income groups.  

Our strategy for halving obesity is to focus on changing the food environment: the food that is marketed, promoted, affordable and accessible to us. Over the last 30 years, our food environment has changed significantly. Over the same timeframe, obesity rates have almost doubled from 15% to 29% in England. People want to live healthier lives, but our environment makes it so much harder. 

While we primarily focus on the food environment because of the potential for impact at scale, we also know that people’s food environments can look very different depending on their circumstances.

In more deprived areas, it’s likely that the food environment makes it even harder to live a healthy life. Factors like the availability of healthy food, how affordable it is and how it is marketed can disproportionately affect individuals in lower socioeconomic groups. Healthy food can cost more than less healthy options, making it harder for those on lower incomes to access a nutritious diet. And junk food advertising is more prevalent in deprived areas.

People with more resources like time and money also have more ability to access healthy options within their food environment. These choices might include driving to a larger supermarket with more affordable healthy options, or having the option of buying more expensive, healthy foods rather than whatever is on offer in order to stick to a budget. 

People with limited resources face greater constraints that can make healthy choices more difficult to access due to cost and time factors. When resources are tight, prioritising immediate needs is understandable and practical - this context can influence food decisions toward options that are affordable and filling, even when other choices might be preferable.

The powerful influence of our food environment is one of the reasons why so many previous obesity policies that have relied on ‘personal responsibility’ have failed. Past government policies overly relied on individuals making different choices and often failed to address the environmental drivers of unhealthy behaviours. 

The policy solutions that Nesta works on, such as health targets for supermarkets, advertising restriction and our blueprint for halving obesity, are designed to reach everyone. Because of this, we believe they have a better chance of narrowing health inequalities than previous approaches. Policies that don’t require individuals to change their behaviour are much more likely to have a widespread impact.

We are careful to ensure that our solutions will not create barriers, such as increasing the price of food, or exacerbate existing inequalities. We factor this into the policies we design, the trials we run and our recommendations on how to scale impact.

As well as having more potential for impact, population-level interventions are also more cost-effective, freeing up resources for treatment for those who need it most. Our recent analysis estimated the annual social cost of obesity and excess weight in the UK at £126 billion, including NHS costs, lost productivity, and social care. NHS and social care costs per thousand inhabitants are highest in the most deprived populations (£199,497 in the most deprived decile vs. £113,217 in the least deprived). Population-level approaches that aim to prevent obesity are much more cost-effective than treating it down the line.

At Nesta, we focus on solutions that reach across the population because we believe they will have the greatest impact on our mission goal to halve obesity by 2030. We are focussed on reducing obesity first and foremost, and want to do that in a way that is equitable. However health inequalities are not our sole focus. We believe our approach is one that is more equitable than other approaches to reducing obesity, and that it is more likely to reduce health inequalities than previous obesity reduction strategies that focus on personal responsibility.