Government announced yesterday and published this morning the Second Chapter of its Childhood Obesity Plan , which follows the First Chapter published in 2016 . The Government’s stated intention in this plan is to outline the actions it will take towards achieving its stated goal of halving childhood obesity and reducing the gap in obesity between children from the most and least deprived areas by 2030.
“We are setting a national ambition to halve childhood obesity and significantly reduce the gap in obesity between children from the most and least deprived areas by 2030.”
There is much in this plan that should be strongly welcomed. A lot will be dependent on consultation so we may be at the mercy of other political priorities overtaking these. So now is the time to work with Government and agencies on getting this done. That said, there are some really good things in here and we should warmly welcome them.
The cost of obesity in childhood spans not only health and care services but lifelong impact on physical and mental health. Children who are obese or overweight are increasingly developing type 2 diabetes and liver problems during childhood. They are more likely to experience bullying, low-esteem and a lower quality of life and they are highly likely to go on to become overweight adults at risk of cancer, heart and liver disease. They are also disproportionately from low-income households and black and minority ethnic families.
More than one in three children are obese or overweight by the time they leave primary school, with those in more deprived areas having higher rates of obesity than in affluent areas.
“In August 2016 we laid strong foundations for our fight against childhood obesity with our world-leading Childhood obesity: a plan for action. Based on the best evidence, and informed by expert opinion, the plan identified the central issue that must be tackled if we are to reduce obesity: the food and drink children consume needs to be healthier and, for many children, less calorific.”
The key commitments span across five areas of action. A lot of them are “may” and will require consultation so this is the setting out of intentions for some areas and firm commitment to legislate for others. It will be important to ensure we support achieving these areas if we are to achieve the impact the plan desires.
- Sugar reduction
- Calorie reduction
- Advertising and promotions
- Work with local authorities and local areas
The 2016 Chapter of the plan announced a range of measures, and while some were widely welcomed, there was also criticism that some of these measures were insufficient. In response government and officials briefed that this was “the start of a conversation” and the first chapter. Since then, reformulation of food to remove sugar and fat has made some progress and the sugar levvy has come into force. Government has, to its credit, listened to representations on other measures and has taken into account the advice of its advisors. A criticism was made of the 2016 chapter that there was insufficient “upstream” (i.e. population and preventive measures) made to achieve the step change we need to halt or reduce the rise in childhood obesity. The new chapter goes some way towards upstream measures, providing all the “may” and “consult” commitments turn into reality.
The measures in this plan will not please everyone. For some they go too far towards “nanny state”, to others they do not go far enough towards the kind of regulatory and population level action needed for step change. At the same time bodies like the Royal College of Paediatrics and Child Health have stated there is still not enough in the plan for children who are already overweight or obese. On balance this plan should be strongly welcomed, there are some very good upstream measures in here. The thorny issue will remain investment.
We should not underestimate the significance of the the fact that a government which is not naturally inclined to regulatory measures has agreed to take a number of them with the stated aim of improving our childrens’ health. Moreover, in an era when expert advice is often distrusted, has shown it has listened, at least in part, to that advice. We should see this, coupled with Government agreeing to bite the bullet on tax raises to fund the NHS, as an important sign that commitment is there to deliver this. I intend to take a glass half-full not half-empty approach.
Having said that, the elephant in the room remains the lack of investment in prevention at local level While the plan makes the point that the Government agrees a step change in measures is needed – the public health budgets continue to be cut, and we have a situation in England where measuring children is mandated but due to cuts, many local authorities cannot afford to do everything they would like to fund intervention. The Local Government Association and Association of Directors of Public Health have made the case for investment in prevention.
There is a balance in achieving healthy weight as a population between local and national action. Doing that while resource is being cut locally, however welcome the national action will be, is ever more difficult. The Public Health cuts have consequences.
The Soft Drinks Industry Levy (SDIL) came into force on 6th April 2018 and was introduced to incentivise industry to reduce the sugar content of soft drinks, though many will suggest it hasn’t had the results government claims. Industry reformulation is ongoing. Government points out that many manufacturers including Tesco and Asda have reformulated proprietary and own brand soft drinks to be below the Levy rates.
That said, overall the 5% goal of sugar reduction across industry has not been achieved.
Actions in this plan include:
- Treasury will consider the sugar reduction progress achieved in sugary milk drinks as part of its 2020 review of the milk drinks exemption from SDIL. There was widespread criticism that this was excluded last time.
- Government will consult before the end of 2018 on our intention to introduce legislation ending the sale of energy drinks to children.
- Government “may also consider further use of the tax system to promote healthy food if the voluntary sugar reduction programme does not deliver sufficient progress. “
- In 2019, Government will “look at the level of progress towards a 20% sugar reduction in the foods most commonly eaten by children and will be able to assess if this challenge has been met in 2020.” They may take further action.
Assessment of this: Good if it all happens. We should welcome it.
In 2017 government started a voluntary calorie reduction programme, which challenges food and drink companies – manufacturers, retailers, restaurants and takeaways – to reduce the calories by 20% in a range of everyday foods consumed by children by 2024.
- Government commits to monitor progress against the target and and consider what additional steps could be taken if progress is not delivered.
- Government will Introduce legislation to mandate consistent calorie labelling for the out of home sector (e.g. restaurants, cafes and takeaways) in England, with a consultation before the end of 2018.
- Government will explore what additional opportunities leaving the European Union presents for food labelling in England that displays world-leading, simple nutritional information as well as information
Assessment of this: Government will say this voluntary commitment is working. Some critics would say it is not biting as much as it needs to. Food labelling is not a “magic bullet” but is important and part of both reducing calories and helping people make choices. This is necessary, but not sufficient.
Advertising and promotions
The 2016 plan committed to updating marketing restrictions to ensure they reflected the latest dietary advice. This work is underway. But as the plan states “despite strict restrictions around children’s TV we know their impact will be limited if they do not reflect their media habits across all the media platforms which they use. “
- Seek to make more progress to reduce the marketing and promotion of unhealthy food and drink (products that are high in fat, sugar and salt (HFSS) ) and will:
- Consult, before the end of 2018, on introducing a 9pm watershed on TV advertising of HFSS products and similar protection for children viewing adverts online, with the aim of limiting children’s exposure to HFSS advertising and driving further reformulation.
- Consider whether the current self-regulatory basis for online advertising is right,, or whether legislation is necessary. Act on where food is placed in shops and how it is promoted
- ban price promotions, such as buy one get one free and multi-buy offers or unlimited refills of unhealthy foods and drinks in the retail and out of home sector through legislation, consulting before the end of 2018.
- ban the promotion of unhealthy food and drink by location (at checkouts, the end of aisles and store entrances) in the retail and out of home sector through legislation, consulting before the end of 2018.
Assessment: This would be important and valuable to achieve. It will require consultations.
There is some recognition that place is important, such as the way towns and cities are designed to ensure greater active travel or safe physical activity, and how many fast food outlets can operate near schools.
“Each local authority already has a range of powers to find local solutions to their own level of childhood obesity but while some are already taking bold action, others are not. We want to make sure that all local authorities are empowered and confident in finding what works for them, whilst learning from local authorities both here and international examples such as Amsterdam that have tackled the problem.”
- Develop a trailblazer programme with local authority partners to show what can be achieved within existing powers and understand “what works” in different communities.
- Develop resources that support local authorities who want to use their powers. We will help set out the economic business case for a healthy food environment and provide up to date guidance and training for planning inspectors.
Assessment: This should be welcomed. It could glean important lessons. But it will not replace or negate the impact of cuts to the public health budgets nationally.
The plan recognises the importance of schools in reducing childhood obesity. Actions outlined in the 2016 plan will continue including promoting physical activity and using monies from the Soft Drinks Industry Levy. To “further support schools in their role” government will:
- update of the School Food Standards to reduce sugar consumption.
- The update will be coupled with detailed guidance to caterers and schools
- Consult, before the end of 2018, on strengthening the nutrition standards in the Government Buying Standards for Food and Catering Services, to bring them into line with the latest scientific dietary advice.
- Review how the least active children are being engaged in physical activity in and around the school day.
- Promote a national ambition for every primary school to adopt an active mile initiative, such as the Daily Mile.
- Invest £1.6million during 2018/19 to support cycling and walking to school.
- Consult before the end of 2018, on plans to use Healthy Start vouchers to provide additional support to children from lower income families.
- Ofsted is developing a new inspection framework for September 2019 which will consider how schools build knowledge across the whole curriculum and how they support pupils’ personal development more broadly, including in relation to healthy behaviours.
- Ofsted will undertake research into what a curriculum that supports good physical development in the early years looks like.
Assessment: These actions should all be welcomed. Some will call for the return of the Healthy Schools Standard. For some, however, a duty on schools to promote the health and wellbeing of students and explicitly co-operate with Directors of Public Health would have been an important gain. Perhaps a step too far at this stage