- Email: [email protected]
Nothing new in UK's strategy on childhood obesity
Comment
We declare no competing interests. 1
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Nordic Council of Ministers. Nordic nutrition recommendations 2012. Part 1: summary, principles and use. Copenhagen: Nordic Council of Ministers, 2014. http://www.norden.org/en/publications/publikationer/ nord-2013-009 (accessed Aug 2, 2016). US Department of Health and Human Services, US Department of Agriculture. Scientific report of the 2015 Dietary Guidelines Advisory Committee. Part D. Washington, DC: US Department of Health and Human Services, 2015. Cleland V, McNeilly B, Crawford D, Ball K. Obesity prevention programs and policies: practitioner and policy-maker perceptions of feasibility and effectiveness. Obesity 2013; 21: E448–55. Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2015; 6: CD011737. Guasch-Ferré M, Babio N, Martínez-González MA, et al. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr 2015; 102: 1563–73. de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 2015; 351: h3978. Michas G, Micha R, Zampelas A. Dietary fats and cardiovascular disease: Putting together the pieces of a complicated puzzle. Atherosclerosis 2014; 234: 320–28. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003; 77: 1146–55. Laatikainen T, Critchley J, Vartiainen E, Salomaa V, Ketonen M, Capewell S. Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997. Am J Epidemiol 2005; 162: 764–73. O’Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart 2013; 99: 159–62.
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Mortality Trends. Trends in national mortality rates. Mortality Trends. http://www.mortality-trends.org (accessed Oct 5, 2014). World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity and the prevention of cancer: a global perspective. Washington, DC: American Institute for Cancer Research, 2007. Joint Food and Agriculture Organization of the United Nations, WHO Expert Consultation. Fats and fatty acids in human nutrition. Geneva: Karger, 2008. WHO. Sugars intake for adults and children. Geneva: World Health Organization, 2015. http://www.who.int/nutrition/publications/ guidelines/sugars_intake/en/ (accessed Aug 2, 2016). Hession M, Rolland C, Kulkarni U, Wise A, Broom J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 2009; 10: 36–50. Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2015; 3: 968–79. Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD. Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ 2012; 345: e7666. Mann J, McLean, R, Skeaff M, Te Morenga L. Low carbohydrate diets: doing against the grain. Lancet 2014; 384: 1479–80. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014; 383: 1999–2007. Bloomfield HE, Koeller E, Greer N, MacDonald R, Kane R, Wilt TJ. Effects on health outcomes of a Mediterranean Diet with no restriction on fat intake: a systematic review and meta-analysis. Ann Intern Med 2016; published online 2016 July 19. DOI:10.7326/M16-0361.
Obesity is a worsening and far-reaching public health problem. The future costs of rising diabetes prevalence, as obesity rises in older age, are well understood. Tackling childhood obesity is an urgent task, and it is essential to do it well.1 Addressing childhood obesity was a manifesto commitment in the 2015 UK general election, and its delivery was expected to coincide with the Public Health England’s sugar-reduction strategy in October, 2015. It was delayed to December, then again to January, 2016, then to February, and then to non-specific summer, 2016. Now we have the strategy, has the wait been worthwhile? Or have the lobbyists had time to empty it of meaningful content? In the early days, there were rumours the strategy would include a sugar tax, then it wouldn’t, and then it would again—but in the end, the then Chancellor of the Exchequer, George Osborne, trumped the rumours with a soft drinks sugar levy due in 2018 with the money raised to help pay for sports in schools. This announcement was widely welcomed by health www.thelancet.com Vol 388 August 27, 2016
workers and parents at the time, but the levy may yet be abandoned as the food industry argues that it cannot cope with a levy while Brexit is underway.2 Other rumours suggested that the strategy might include the long-called-for 2100 h watershed for showing TV advertising for fatty and sugary foods, replacing the Ofcom rules banning advertisements during children’s programmes. This restriction is something that has been demanded by public health campaigners since it became clear that all the advertising that was once shown on children’s TV had migrated to so-called family TV, around 1900–2100 h, when even more children are exposed to the alluring messages.3 The UK Government itself had been encouraging Public Health England to develop sugar-reduction strategies, resulting in a series of well-researched evidence documents identifying both fiscal and market regulatory measures to achieve these ends. We approach the new childhood obesity strategy with a certain scepticism, and a fear of more voluntary measures by industry—which are all too easily
Tim Boyle/Staff/Getty
Nothing new in UK’s strategy on childhood obesity
See Editorial page 841
For Public Health England sugar-reduction strategies see https://www.gov.uk/ government/publications/sugarreduction-from-evidence-intoaction
853
Comment
For the Childhood Obesity: A Plan for Action see https:// www.gov.uk/government/ publications/childhood-obesitya-plan-for-action
854
rolled back—and more health education or social marketing campaigns, which emphasise individual choices and personal responsibility for failure. What we have received is even weaker. The first page is not encouraging: the document is not a strategy as such, but A Plan for Action. Moreover, at the end of the Introduction we are warned, “…the launch of this plan represents the start of a conversation, rather than the final word”. The new Plan does emphasise the sugar tax levy, already announced by Osborne, and states that the resulting income will be “invested in programmes to reduce obesity and encourage physical activity and balanced diets for school-age children”. The Treasury will consult on the levy, and there is a 2-year pause to give companies a chance to reformulate their products in order to reduce their levy payments. There are also proposals to challenge the food industry to reduce the sugar content of their products by 20% by 2020. Public Health England will set targets for the sugar content of product categories, and report on progress in 2018 and early 2020. The measures are voluntary, with the government deciding in 2020 if so-called other levers might be needed. The focus on physical activity rightly recognises the health benefits of increasing levels of activity. Schools will be asked to provide at least 30 min of activity per day, supported by “a new interactive online tool” to help schools plan their timetables. With a target of 1 h per day, the Plan suggests the remaining 30 min activity should be “supported by parents and carers outside of school time”. Throughout the document, the emphasis is on what is already happening; the sugar levy proposals, the labelling of foods with traffic lights, the role of voluntary organisations and health professionals in raising awareness, the government’s ongoing Cycling and Walking Investment Strategy, and the ongoing Healthy Start scheme. A proposal invites the Office for Standards in Education, Children’s Services and Skills to devise a “voluntary healthy rating scheme” for assessing
primary schools, and the government will “actively seek to involve parents in the rating process”, backed up by an “annual competition to recognise schools with the most innovative and impactful projects”. In the Report of the Commission on Ending Childhood Obesity from WHO,4 governments around the world were urged to accept their responsibilities to protect and promote the health of this and future generations, to take greater control of the food supply chain through agriculture and food policy measures, to restrict industry lobbying, and to give the health departments greater powers to protect and promote health without worrying unduly about red tape or the impact on a producer of unhealthy products. These proposals were matched in the UK in last year’s Health Select Committee’s call for “brave and bold action”5 which set out a range of measures that, sadly, have been largely ignored. What we read in the government’s Plan is nothing particularly new, nothing bold, and very little that can actually be measured to assess the Plan’s success. It is a document that is not only a disappointment to public health professionals, but also evidence of a government walking away from its moral duty to protect the health of children, and its fiscal duty to protect the NHS from the consequent costs. Tim Lobstein, *Klim McPherson World Obesity Federation, London, UK (TL); and Oxford University, Oxford OX1 3BN, UK (KMP) [email protected] We declare no competing interests. 1
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Butland B, Jebb S, Kopelman P, et al. Tackling obesities: future choices— project report. 2007. http://www.foresight.gov.uk/Obesity/Obesity_final/ Index.html (accessed Aug 19, 2016). Michail N. Put the sugar tax on hold until after Brexit, says FDF. Food Navigator, July 12, 2016. http://www.foodnavigator.com/Policy/ Put-the-sugar-tax-on-hold-after-Brexit-says-FDF (accessed Aug 19, 2016). Ofcom. HFSS advertising restrictions: final review. London: Ofcom, 2010. http://stakeholders.ofcom.org.uk/market-data-research/other/tvresearch/hfss-final-review/ (accessed Aug 19, 2016). WHO. Report of the commission on ending childhood obesity. Geneva: World Health Organization, 2016. House of Commons. Health Committee: childhood obesity—brave and bold action. First report of session 2015–16. HC465. London: Stationery Office, 2015.
www.thelancet.com Vol 388 August 27, 2016
We declare no competing interests. 1
2
3
4
5
6
7
8
9
10
Nordic Council of Ministers. Nordic nutrition recommendations 2012. Part 1: summary, principles and use. Copenhagen: Nordic Council of Ministers, 2014. http://www.norden.org/en/publications/publikationer/ nord-2013-009 (accessed Aug 2, 2016). US Department of Health and Human Services, US Department of Agriculture. Scientific report of the 2015 Dietary Guidelines Advisory Committee. Part D. Washington, DC: US Department of Health and Human Services, 2015. Cleland V, McNeilly B, Crawford D, Ball K. Obesity prevention programs and policies: practitioner and policy-maker perceptions of feasibility and effectiveness. Obesity 2013; 21: E448–55. Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2015; 6: CD011737. Guasch-Ferré M, Babio N, Martínez-González MA, et al. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr 2015; 102: 1563–73. de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 2015; 351: h3978. Michas G, Micha R, Zampelas A. Dietary fats and cardiovascular disease: Putting together the pieces of a complicated puzzle. Atherosclerosis 2014; 234: 320–28. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003; 77: 1146–55. Laatikainen T, Critchley J, Vartiainen E, Salomaa V, Ketonen M, Capewell S. Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997. Am J Epidemiol 2005; 162: 764–73. O’Flaherty M, Buchan I, Capewell S. Contributions of treatment and lifestyle to declining CVD mortality: why have CVD mortality rates declined so much since the 1960s? Heart 2013; 99: 159–62.
11 12
13
14
15
16
17
18 19
20
Mortality Trends. Trends in national mortality rates. Mortality Trends. http://www.mortality-trends.org (accessed Oct 5, 2014). World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity and the prevention of cancer: a global perspective. Washington, DC: American Institute for Cancer Research, 2007. Joint Food and Agriculture Organization of the United Nations, WHO Expert Consultation. Fats and fatty acids in human nutrition. Geneva: Karger, 2008. WHO. Sugars intake for adults and children. Geneva: World Health Organization, 2015. http://www.who.int/nutrition/publications/ guidelines/sugars_intake/en/ (accessed Aug 2, 2016). Hession M, Rolland C, Kulkarni U, Wise A, Broom J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 2009; 10: 36–50. Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2015; 3: 968–79. Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD. Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ 2012; 345: e7666. Mann J, McLean, R, Skeaff M, Te Morenga L. Low carbohydrate diets: doing against the grain. Lancet 2014; 384: 1479–80. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014; 383: 1999–2007. Bloomfield HE, Koeller E, Greer N, MacDonald R, Kane R, Wilt TJ. Effects on health outcomes of a Mediterranean Diet with no restriction on fat intake: a systematic review and meta-analysis. Ann Intern Med 2016; published online 2016 July 19. DOI:10.7326/M16-0361.
Obesity is a worsening and far-reaching public health problem. The future costs of rising diabetes prevalence, as obesity rises in older age, are well understood. Tackling childhood obesity is an urgent task, and it is essential to do it well.1 Addressing childhood obesity was a manifesto commitment in the 2015 UK general election, and its delivery was expected to coincide with the Public Health England’s sugar-reduction strategy in October, 2015. It was delayed to December, then again to January, 2016, then to February, and then to non-specific summer, 2016. Now we have the strategy, has the wait been worthwhile? Or have the lobbyists had time to empty it of meaningful content? In the early days, there were rumours the strategy would include a sugar tax, then it wouldn’t, and then it would again—but in the end, the then Chancellor of the Exchequer, George Osborne, trumped the rumours with a soft drinks sugar levy due in 2018 with the money raised to help pay for sports in schools. This announcement was widely welcomed by health www.thelancet.com Vol 388 August 27, 2016
workers and parents at the time, but the levy may yet be abandoned as the food industry argues that it cannot cope with a levy while Brexit is underway.2 Other rumours suggested that the strategy might include the long-called-for 2100 h watershed for showing TV advertising for fatty and sugary foods, replacing the Ofcom rules banning advertisements during children’s programmes. This restriction is something that has been demanded by public health campaigners since it became clear that all the advertising that was once shown on children’s TV had migrated to so-called family TV, around 1900–2100 h, when even more children are exposed to the alluring messages.3 The UK Government itself had been encouraging Public Health England to develop sugar-reduction strategies, resulting in a series of well-researched evidence documents identifying both fiscal and market regulatory measures to achieve these ends. We approach the new childhood obesity strategy with a certain scepticism, and a fear of more voluntary measures by industry—which are all too easily
Tim Boyle/Staff/Getty
Nothing new in UK’s strategy on childhood obesity
See Editorial page 841
For Public Health England sugar-reduction strategies see https://www.gov.uk/ government/publications/sugarreduction-from-evidence-intoaction
853
Comment
For the Childhood Obesity: A Plan for Action see https:// www.gov.uk/government/ publications/childhood-obesitya-plan-for-action
854
rolled back—and more health education or social marketing campaigns, which emphasise individual choices and personal responsibility for failure. What we have received is even weaker. The first page is not encouraging: the document is not a strategy as such, but A Plan for Action. Moreover, at the end of the Introduction we are warned, “…the launch of this plan represents the start of a conversation, rather than the final word”. The new Plan does emphasise the sugar tax levy, already announced by Osborne, and states that the resulting income will be “invested in programmes to reduce obesity and encourage physical activity and balanced diets for school-age children”. The Treasury will consult on the levy, and there is a 2-year pause to give companies a chance to reformulate their products in order to reduce their levy payments. There are also proposals to challenge the food industry to reduce the sugar content of their products by 20% by 2020. Public Health England will set targets for the sugar content of product categories, and report on progress in 2018 and early 2020. The measures are voluntary, with the government deciding in 2020 if so-called other levers might be needed. The focus on physical activity rightly recognises the health benefits of increasing levels of activity. Schools will be asked to provide at least 30 min of activity per day, supported by “a new interactive online tool” to help schools plan their timetables. With a target of 1 h per day, the Plan suggests the remaining 30 min activity should be “supported by parents and carers outside of school time”. Throughout the document, the emphasis is on what is already happening; the sugar levy proposals, the labelling of foods with traffic lights, the role of voluntary organisations and health professionals in raising awareness, the government’s ongoing Cycling and Walking Investment Strategy, and the ongoing Healthy Start scheme. A proposal invites the Office for Standards in Education, Children’s Services and Skills to devise a “voluntary healthy rating scheme” for assessing
primary schools, and the government will “actively seek to involve parents in the rating process”, backed up by an “annual competition to recognise schools with the most innovative and impactful projects”. In the Report of the Commission on Ending Childhood Obesity from WHO,4 governments around the world were urged to accept their responsibilities to protect and promote the health of this and future generations, to take greater control of the food supply chain through agriculture and food policy measures, to restrict industry lobbying, and to give the health departments greater powers to protect and promote health without worrying unduly about red tape or the impact on a producer of unhealthy products. These proposals were matched in the UK in last year’s Health Select Committee’s call for “brave and bold action”5 which set out a range of measures that, sadly, have been largely ignored. What we read in the government’s Plan is nothing particularly new, nothing bold, and very little that can actually be measured to assess the Plan’s success. It is a document that is not only a disappointment to public health professionals, but also evidence of a government walking away from its moral duty to protect the health of children, and its fiscal duty to protect the NHS from the consequent costs. Tim Lobstein, *Klim McPherson World Obesity Federation, London, UK (TL); and Oxford University, Oxford OX1 3BN, UK (KMP) [email protected] We declare no competing interests. 1
2
3
4 5
Butland B, Jebb S, Kopelman P, et al. Tackling obesities: future choices— project report. 2007. http://www.foresight.gov.uk/Obesity/Obesity_final/ Index.html (accessed Aug 19, 2016). Michail N. Put the sugar tax on hold until after Brexit, says FDF. Food Navigator, July 12, 2016. http://www.foodnavigator.com/Policy/ Put-the-sugar-tax-on-hold-after-Brexit-says-FDF (accessed Aug 19, 2016). Ofcom. HFSS advertising restrictions: final review. London: Ofcom, 2010. http://stakeholders.ofcom.org.uk/market-data-research/other/tvresearch/hfss-final-review/ (accessed Aug 19, 2016). WHO. Report of the commission on ending childhood obesity. Geneva: World Health Organization, 2016. House of Commons. Health Committee: childhood obesity—brave and bold action. First report of session 2015–16. HC465. London: Stationery Office, 2015.
www.thelancet.com Vol 388 August 27, 2016