If an epidemic suddenly began to cause thousands of deaths in Britain, you would expect a swift ministerial response. Between April 2019 and March 2020, more than a million hospital admissions in England were linked to obesity. Because this crisis has crept up slowly, the reaction from government has been weak. Since 1992, ministers have produced 14 strategies on obesity, containing 689 policies. All have failed to reduce the prevalence of this condition: 26% of adults and 34% of secondary school children in England are now overweight or obese.
The current government seems more interested in magic-bullet treatments than prevention. The health secretary, Steve Barclay, recently announced funding for “cutting-edge” obesity treatments and technologies, while ministers have since praised new obesity jabs approved by the National Institute for Health and Care Excellence for those with a body mass index (BMI) over 35. Pharmaceutical companies have been betting on the UK’s increasingly unhealthy population: a recent investigation found that Novo Nordisk, the firm that manufactures the Wegovy slimming jab that will soon be rolled out over pharmacy counters in England, had spent millions on a PR campaign before its jab was approved. It is now funding the expansion of NHS weight-loss services in England.
Medical innovations that allow people to live healthier lives are welcome. But focusing solely on treatments, which are helpful only to those who already have a high BMI, indicates a poverty of imagination. The government has been reluctant to address the causes of obesity, lest such interventions be perceived as the work of a “nanny state”. As a result, an emphasis on personal responsibility has trumped prevention. Most policies from the government’s 2020 obesity strategy have been delayed or shelved, while public health spending has been cynically stripped back, culminating in the scrapping of Public Health England in 2020. Details of this year’s public health grant were announced at the last minute, giving councils little time to plan services. Since 2015, the grant has been cut by 26% per person.
This is self-defeating. Preventing disease is more cost-effective than treating it, and obesity policies that put the burden on individuals are proven to fail. The causes of obesity are complex and overlapping, but it is clear that poor-quality food is one of them. Food companies have become locked into what Henry Dimbleby – who quit as the government’s food tsar last month, criticising its “ultra-free-market ideology” – calls a “junk food spiral”. Companies aggressively promote cheap, calorie-dense products. One solution would be building on the soft drinks levy and introducing a reformulation tax on processed snacks, encouraging companies to make products healthier. Revenue from this could be spent on subsidies for fresh food, which are proven to work.
It is widely known that obesity is correlated to poverty. Subsidising fresh food would be a step forward, but poverty isn’t just about money; it’s also about time. Low and insecure pay, long working hours and stress are all reasons that people reach for processed foods. One paper on obesity in the US found that low-income families were far more likely to live in “food deserts”, where they had to travel further in search of fresh food. The same applies in Britain. It’s difficult to eat well if your high street only has a corner shop, if you don’t own a car, and the bus to the supermarket is expensive and irregular. So long as these problems persist, obesity won’t be prevented – it will just be medicated.
• This article was amended on 5 April 2023. An earlier version said that “34% of secondary school children in England are now obese”; that figure relates to those who are overweight or obese.
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