In England, you can expect to live nearly 20 more years in good health if you live in the wealthiest areas compared to the most deprived. Across the UK, this gap has been growing since 2010. The lowest-income groups are up to four times more likely to live with multiple conditions, developing chronic illnesses 10-15 years earlier than their better-off peers.

Narrowing this inequality at a population level will require us to confront one of its primary drivers: obesity. Obesity plays a disproportionate role in increasing ill health in the UK and widening health inequalities, accounting for 57% of premature deaths with prevalence much higher in the most deprived communities (36%) compared to the least deprived (22%). Children in those poorer communities are twice as likely to live with obesity.

This cycle can be self-reinforcing: chronic ill health leads to more people leaving the workforce and becoming economically inactive in disadvantaged regions, which in turn worsens local poverty. Economic analysis indicates obesity costs the UK economy £31 billion annually in lost output (roughly 1% of UK GDP), and productivity losses are 22% higher in the most deprived communities.

Obesity drives a higher prevalence of preventable conditions, from Type 2 diabetes to cardiovascular disease and musculoskeletal problems. This places substantial, avoidable pressure on NHS GP practices and acute care. For instance, diabetes care accounts for 15% of total prescription spending.

Obesity rates also create substantial demand for acute hospital services. In 2022/23, obesity was a primary or secondary diagnosis in over 1.2 million hospital admissions in England, with higher admission rates linked to greater deprivation. The impact is also felt in social care; the cost of council-funded social care for an individual with severe obesity is nearly double the cost for someone living at a healthy weight.

There has been a massive upsurge in GLP-1 prescribing across the UK, but when you look at where obesity rates are highest (which correlates with areas of higher deprivation), rate of access is lower compared to affluent areas, and at a higher BMI point. Although we need to see the roll out of NHS provision to those most in need, this comes with a cost - extending these medications to all people living with obesity would cost the government £42 billion over five years.

Obesity rates have doubled over the last two decades, despite the announcement of almost 700 obesity policies. So why haven’t they worked?

The answer is two-fold. First, in the past 30 years, the food environment in the UK has changed, making it increasingly difficult for everyone to make healthier choices: the way food is priced, advertised and made available is stacked against us. In the most deprived areas, fast food outlets account for 33% of food outlets, and junk food advertising is far more prevalent.

Second, the policy response has been insufficient. Most policies have overly focused on behaviour change interventions, such as lifestyle advice and public communication campaigns, which fail to narrow, and can even widen, health inequalities. These approaches rely on personal time, cognitive bandwidth, and financial resources. The rise in obesity has not been due to a failure of personal willpower - evidence shows these approaches are less effective. Conversely, legislative and structural reforms - that are mandatory and not voluntary - are far more likely to lead to population-wide improvements without widening the health divide.

In his first speech as Prime Minister, Andy Burnham committed the government to ‘building a more preventative state’. The responsibility to deliver this can’t fall solely on the NHS - it will require population-level preventative health policy, and must include tackling obesity. The evidence shows that if we are serious about reducing obesity and inequality, we must reshape the food environment. The good news is that the public wants the government to act and supports them tackling businesses to deliver healthier lives. Tackling obesity is possible - you only need to achieve a reduction of roughly 200 daily calories per person living with excess weight to halve obesity rates in the UK in three years, equivalent to a bottle of Coke.

One policy highlighted in the government’s 10 Year Health Plan offers genuine hope: the healthy food standard (HFS). This policy consists of mandatory health reporting and targets for large food businesses which would incentivise them to improve the healthiness of what they sell by making small, incremental changes, e.g. via reformulation or tweaks to promotions without placing extra financial burdens on households. Regardless of income, deprivation level, region, or rurality, over 90% of calories consumed at home in Great Britain are purchased from the top 11 largest supermarket chains. Focusing the policy here could reduce national adult obesity by 20% and childhood obesity rates by 23% - that’s around 3 million adults and 400,000 children less living with obesity.

Nesta analysis also showed that, if implemented in line with Nesta’s recommendations, supermarkets could not meet targets by simply overcompensating in wealthy areas; they could not leave those most in need behind.

Clinical innovations like GLP-1 weight-loss medications offer real therapeutic value. However, slow NHS rollouts and uncertain long-term costs present clear challenges. Although they are significantly impactful for individuals, they are not an equitable approach and do not prevent people from falling into obesity in the first place. Relying solely on clinical interventions will worsen government spending pressures and risks compounding inequalities.

Obesity, as a key driver of health inequalities, demands urgent and decisive action. We know from decades of evidence what high-impact policies look like, and the government needs to act now. At the heart of this must be the healthy food standard; an evidence-based policy already sitting in the government’s 10 Year Health Plan. It’s now time for bold action that actually delivers it. No single intervention will solve obesity, but mandating health targets across major supermarkets will lift national health, narrow the health divide and do so at minimal cost to the public purse. The public remains strongly in favour of greater government intervention on food and health, and if Andy Burnham is serious about building a preventative state, there is no rationale for waiting.