Obesity in the UK has been steadily rising for three decades – despite the introduction of at least a dozen separate policy initiatives to tackle the issue.
Back in 2008, for example, a wide-ranging report from Gordon Brown’s administration vowed to improve diets, increase exercise and make this the first major nation to reverse the trend. Yet today the figures are as damning as ever: the Government-commissioned National Food Strategy, out this month, reports that two-thirds of UK adults aged 45-74 are now classed as either overweight or obese. In England, 68 per cent of men and 60 per cent of women aged 16 and over fall into one of those categories.
The matter is urgent, because excess weight increases our risk of a range of life-threatening diseases, including type 2 diabetes, heart disease and cancer – and now causes more deaths per year than smoking. So what’s been going wrong, and how can we fix it?
At Nesta we believe the problem is one of emphasis.
Successive governments have placed far too much weight on providing people with dietary advice – when research tells us that obesity is not caused by lack of willpower.
Policymakers have relied on persuading people to make lifestyle changes to trim their weight, but the evidence suggests this is simplistic. All our good intentions are no match for the so-called ‘food environments’ around us. Everything from the products in our supermarkets to the deals in our pizza-shop windows is pushing us toward buying and eating fattening food, and while there are signs that policy is inching in the right direction – such as the forthcoming ban on TV junk food ads before 9pm – we need to act more strongly and swiftly. Just last year the Department of Health and Social Care promised to invest £100 million on weight management apps, coaches and clinical support: at Nesta we think that money would be better spent on a holistic approach, creating better food environments that make it easier for everyone to eat healthily.
Research tells us that obesity is caused not by a lack of self-discipline but by a complex web of factors, including genetics, responses to stress from childhood and (importantly) a lack of healthy food options. Worse still, interventions which urge behavioural change shift the blame onto people living with obesity, perpetuating false stereotypes that they are lazy or weak-willed. This not only has devastating effects on mental health, it can actually lead people to consume more calories and feel less in control of their eating. One study found that women who perceived themselves to be overweight consumed about 80 calories more after reading a news article that stigmatised obesity.
So what of efforts to encourage more physical activity? The science suggests that while excellent for your health in other ways, the time and effort it takes to achieve real weight loss from exercise is just not possible for most people – lowering consumption is really the answer.
All this goes to explain why Nesta is approaching its Healthy Life mission very differently. We firmly believe that by training our focus on food environments we can halve the prevalence of obesity among adults by 2030, which in turn would increase healthy life expectancy by an average of two years for around 10 million people nationwide. So what are food environments, and how can we fix them?
Our food environment can be defined as the physical features of our neighbourhood and how they interact with our personal circumstances – the money we can spend on food, for example, or the time we have to prepare it. Taken together they shape the availability, accessibility, affordability and advertising of food, and in the UK they are stacked heavily against us. They also help explain why obesity levels are 80 per cent higher in the most deprived areas – the prevailing food environments there simply make eating healthily much more difficult. Let’s break down these factors to illustrate their impact – and discuss some of Nesta’s ideas for improving them.
The problem: We stand no chance of eating healthy food if it’s absent from our shops and restaurants – and sadly the available options are too often high in sugar and offered in unhealthy portions (the average size of both a family bag of crisps and a chicken curry ready-meal have both grown by 50 per cent over recent decades). This is especially marked in convenience stores, where shoppers report that only 16 per cent offer a wide range of healthy meal options. Meanwhile, restaurants are little better. One in four UK eateries is now a fast-food outlet, exposure to which has been linked with increased obesity risk, and they tend to cluster in less affluent urban areas: Blackpool for example has more than twice as many per person than the national average. Such places can be referred to as ‘food swamps': plenty of food is available, but it’s overwhelmingly high in calories and low in nutrients.
Some solutions: Well-designed taxes like the Government’s Soft Drink Industry Levy, introduced in 2018, can help incentivise producers to adapt their recipes and so increase the availability of healthier food. The levy took 28 per cent of sugar out of the UK’s soft drinks market without impacting sales or satisfaction, and Nesta applauds the recommendation in the new National Food Strategy to extend the so-called ‘sugar tax’ to a much wider array of products in the wholesale sector. Despite concerns about ‘nanny state-ism’, one UK poll found that 63 per cent of people would like the levy to be applied to other sugary foods such as sweets and biscuits, while Nesta’s own new research with the Behavioural Insights Team reveals that 54 per cent of people now support taxing unhealthy food. So while more work is needed to build public consent, the Government should act now and extend the tax on sugar.
Nesta is also exploring how we can contribute directly to improving recipes through a Challenge Prize — a cash sum awarded (often with other support) to whoever first or best solves a defined problem. While the National Food Strategy suggests GPs should prescribe fruit and vegetables to support weight loss, we think it’s vital to make convenience foods healthier and more affordable, so our focus is on encouraging ready-meal producers to reformulate their products, or innovators to enter the market with new healthier options.
The problem: Just being on the shelves of stores is not enough: healthy food needs to be accessible to all. Many of us are time-poor, so food shopping has to piggyback on our daily routines, which often means using stores and takeaways close to our commute or the school run. Those who rely on public transport or who have mobility issues can find this especially challenging. It’s been suggested no one should have to walk more than 500 metres to a shop stocking healthy food, but research tells us that 25 per cent of urban areas and 20 per cent of rural ones fail on this measure – these are often termed ‘food deserts’.
The era of out-of-town superstores has exacerbated these issues – often they’re accessible only by car, and they’ve led the majority of local grocers and butchers to close. More than one in five people on the lowest incomes cite the lack of a car or an affordable nearby supermarket as a barrier to healthy eating. And while online shopping has increased access to healthy, convenient food for many, those in low income households and the elderly sometimes find their shortage of digital access, skills and confidence a challenge. It has been argued that the rise of online supermarkets could prompt more store closures, more food deserts.
Some solutions: Mapping food environments across neighbourhoods can help local policymakers identify food swamps and food deserts, then devise strategies to improve them — such as using planning regulations to create ‘healthy food zones’. Nesta is interested in how data science and collective intelligence tools can enhance the available information on this, and our People Powered Results team has been assisting Liverpool Council with its Good Food Strategy, creating an interactive map of the city’s food outlets and how they intersect with areas of high deprivation and obesity. While our prototype focused on food security, a similar approach could be extended to consider the healthiness of different outlets.
The problem: Calorie for calorie, eating healthily is more expensive: recent research by the Health Foundation shows 1,000 calories of healthy foods cost on average £7.68, compared with £2.48 for less healthy options. Worryingly, this price gap seems to be rising, and it is making healthy food unaffordable for many. After deducting their housing costs, one in five of the least affluent households with children would need to spend 42 per cent of their income on food to meet NHS healthy-eating guidelines. This means many families must constantly juggle tough decisions between buying healthy food and other essentials like clothes. A recent survey revealed 34 per cent of low-income households opt for cheaper, less healthy options in response to high food prices.
Some have made the counter-argument by comparing the weight-for-weight cost of ready-meals, pizzas and burgers with fresh fruit and vegetables, but that fails to account for convenience. Ready-meals can be on the table in minutes with very little preparation, whereas a kilo of veg must be combined with several other ingredients. Many people juggle paid work with childcare responsibilities – in one survey 22 per cent said they have insufficient time to prepare meals from scratch. So if we want people to eat healthily, we need more affordable and convenient healthy food options in our shops.
Some solutions: From April next year the Government will introduce new rules to restrict in-store promotions for unhealthy foods, including buy-one-get-one-free offers. A definite step in the right direction, making unhealthy foods less appealing on cost. But it will not increase the affordability of healthy options, which Nesta believes is long overdue. Retailers could help drive this change by instead using promotions to actively nudge consumers toward healthier choices, and there is potential for the Government to further close the gap by using income from taxes like the Soft Drinks Levy to subsidise healthy foods.
The problem: As we walk to work or school, billboards and bus stops bombard us with adverts for takeaways, chocolate bars and other unhealthy foods. These brands spend over £143 million on advertising each year, urging us to buy and consume more calories. A study in Newcastle found that almost half of outdoor food advertising was devoted to items ‘high in fat and/or sugar’ – with the strongest concentrations in the least affluent areas. This matters because research from the US has shown that the higher the percentage of ads promoting unhealthy foods, the greater the likelihood of obesity in the area.
Stores, too, nudge us to make unhealthy choices using in-store promotions and attention-grabbing positioning. Research has shown that popular deals like 'buy one get one free’ are heavily skewed toward less healthy products, and that 43 per cent of food and drink placed prominently in stores is sugary in nature.
We can’t escape this advertising in our homes either, whether on television or online. A Government study found that almost half of all TV food ads are for unhealthy products, while young people are exposed to 15 billion junk-food ads a year online. These adverts are often aimed at children, using bright colours and licensed characters or celebrities. Research indicates they may be causing young people to eat more calories — and by Year 6 more than a third of UK children are overweight or obese.
Some solutions: The Government has already committed to a ban on junk food adverts before the 9pm TV watershed, and a total ban on paid online advertising for unhealthy products by the end of next year. However, its focus on “paid-for adverts for products” leaves loopholes for companies to advertise on their own websites or social media pages, and for ads focusing on brands rather than specific lines, which would limit the potential impact of the new rules. One factor stifling more effective regulation is the paucity of information on the types of unpaid-for digital food marketing that are being targeted at young people. Nesta is exploring how collective intelligence tools could gather better evidence on this, to discover how it impacts the perceptions of young people and their consumption of unhealthy food.
As with price promotions, the retail industry could also nudge consumers through attention-grabbing positioning in-store and healthier suggested swaps online. Nesta is working with the Behavioural Insights Team to explore how behavioural science can help us design such nudges to maximum effect, and how we can test those ideas through experimental trials in real-world settings. We are keen to partner with supermarkets, convenience stores, restaurants and food delivery platforms ready to help us test changes and evaluate impact in a range of settings.
This blog has outlined just some of many possible interventions that could radically improve UK food environments and advance Nesta’s goal to halve the incidence of obesity in the UK by 2030. We know that the hearts and minds of policymakers and the public still need to be won – our recent research with BIT found that 82 per cent of people believe ‘maintaining a healthy weight is a person’s own individual responsibility’. But the fact this contention is widely held does not make it true – obesity is largely caused not by a lack of willpower, but by the UK’s polluting food environments. Put bluntly, we need to stop blaming individuals and take a more holistic approach.
Nesta will continue to work hard to change the narrative, and we take inspiration from the environmental movement, which has gathered widespread public disapproval for the ways industry normalises a society hooked on over-consumption of goods of all kinds. Policies once seen as the epitome of the ‘nanny state’, such as using the tax system to make environmentally damaging behaviours more expensive, are now widely supported by the public.
In the field of public health, it is producers and retailers who are promoting the over-consumption of unhealthy foods. As Nesta’s chief executive Ravi Gurumurthy put it when responding to the new National Food Strategy: “Obesity is where carbon and climate change were 20 years ago. Over that time, we’ve forced companies to pay carbon taxes, disclose their carbon footprint and be accountable to investors for their environmental performance.
“In the next decade we need the same degree of radicalism in how we deal with food, or we’ll see millions of people suffer from avoidable disease and premature death, particularly those on low incomes.”