Improving the nation’s health through tackling obesity

It’s an uncomfortable truth: obesity is one of the biggest predictors for premature death in the UK today. It affects 35 million adults, and Nesta’s Healthy Life Mission aims to halve its prevalence by 2030.

To investigate the opportunities and challenges, Nesta chief executive Ravi Gurumurthy chaired a roundtable gathering of health experts from across the food industry, the NHS, academia and the third sector. It brought together different perspectives on the problem, exploring how Nesta can help find solutions. The discussion was held under the Chatham House rule, and here’s what we learned.

Understanding the issues around obesity

Nesta is approaching the obesity challenge primarily through the goal of improving food environments. That embraces physical factors like the availability of healthy, affordable options on our shelves and the influence of food advertising, but also people’s individual circumstances – like their income or their ability to travel to shop. Taken together these elements can stifle people’s freedom to make healthy choices, especially those living in areas of deprivation.

"We have to win public opinion on this issue. If you meet people where they are and tap into the existing motivations, you can engage people in the topic and take them on a journey."

To make sense of the challenge ahead, our panel first discussed the obstacles facing Nesta and our partners. We explored how the complex arguments that surround obesity are driving inertia. Our experts agreed there is a lack of understanding over the types of intervention that make the biggest difference – and an over-emphasis on changing individual behaviour and educating people to eat well. This can make it tough for individual players – retailers and manufacturers, political leaders and charities – to know how best to intervene. The panel felt that consistent messaging and practical support will be critical.

The fragmented food system is also an issue. Consumers buy from more than one source, so we need to examine the whole retail environment. Given that 96 per cent of retailers are small and medium-sized enterprises without the same knowledge and skill base as their larger competitors, our group felt a more nuanced, tailored approach is essential. First off, it’s important that everyone is moving in the same direction – and currently big players in the food industry are not in sync. Retailers and producers need to be convinced to work together, but competition laws currently bar them from doing so. It was noted, though, that those rules have been eased during the pandemic, and could feasibly be relaxed again. Conversely, the panel warned that good work already being done by larger retailers is in danger of being undermined by discount stores, which are price-driven and historically harder to engage.

"The point about scale is that trying to get one solution that will work nationally across the board won’t work for target communities, so a place-based focus is really important."

Participants felt we need to build on what has gone before, reframing and then scaling with the principles that have been tried and tested. Keeping the momentum going is key, and there’s a need to scale up the many successful smaller initiatives – one speaker felt that focusing on one or two proven interventions would make that more effective. It was noted, though, that local contexts are vital: while some ideas could be rolled out at a national level, others will need more flexible, place-based approaches.

Next, attention turned to the stigma around obesity. It was generally acknowledged that weight is intrinsically linked with body image and mental health, sometimes fostering a fatalistic mindset on the issue – and this creates a challenge for our messaging. We need to confront the idea that tackling obesity is mostly about willpower. Participants agreed that weight reduction campaigns should include messages about body positivity to generate greater engagement.

We asked our roundtable guests which factors might prevent us from halving the prevalence of obesity by 2030, and they ranked their choices like this:

  1. Public (mis)understanding of the causes of obesity
  2. The tension between tackling obesity and promoting positive body image/mental health
  3. The complexity of the issue
  4. The fragmented food system
  5. Insufficient data and evidence
  6. Undefined roles of stakeholders
  7. Maintaining momentum
  8. Lack of clarity on best practice from industry
  9. Balance of local/place-based vs national-scale interventions

It was agreed that public opinion needs to be won over, and that by meeting people where they live and tapping into their existing motivations, we can take them on a journey. But one speaker felt that it may prove difficult for individuals to translate our overarching messages into personal lifestyle changes.

Regulatory regimes often set minimum standards that give little incentive for organisations to exceed them. Our panel discussed the levers we might pull to help companies recognise good practice and encourage investors and consumers to demand more. There is some willingness in the industry to take further steps, but this is hampered by a lack of clarity from government on how businesses could adapt.

Speakers also agreed that it’s vital to consider deprivation and the related factors that influence individual food choices – factors like money, time and housing.

"None of these initiatives on their own are a silver bullet, it's going to need bringing them all together. You've got to lead on the things that the public is more prepared to run with."

Next steps for Nesta

Our group concluded that Nesta’s best opportunity lies in directing attention to food environments, and starting with a local focus that benefits the maximum number of people, especially those from low-income backgrounds. They agreed it will be hard to make initiatives stick unless they’re applied across all the food environments consumers interact with – that means looking beyond the major supermarkets to work with smaller retailers and fast-food outlets, baking in a bigger impact.

There was consensus, too, around capitalising on the momentum from recent policy measures, such as the sugar levy and the commitment to ban TV advertising of high fat, salt and sugar products before 9pm. Those changes demonstrate to the industry that more can and should be done. Nesta must interrogate the factors that will motivate businesses and investors to get on board, and encourage them to take action.

The panel also urged a reframing of the conversation. The issue of childhood obesity has won greater and more meaningful engagement by shifting the emphasis to focus on health, and a similar strategy could work for adults – perhaps by improving environments to support health rather than restricting personal choice.

Winning hearts and minds is vital, because at present there is a disconnect between the evidence and public attitudes to obesity. We need to explore ways to make people feel passionate about change in the food environment. Start with ideas they are more willing to sign up to, and we’re more likely to achieve results.

We'd like to thank the participants who contributed to this roundtable. This is just the beginning of Nesta's journey into tackling obesity, and we’ll continue to work with a range of experts and stakeholders as we proceed. So, please do get in touch if you are interested in talking to us.