The question I am asked most often when doing TV and radio interviews is “so what’s your solution to obesity?” The question invariably comes after I have been pooh-poohing a nanny state proposal designed to interfere with the food supply. Leaving aside medical interventions such as bariatric surgery and semaglutide, my solution to obesity is to eat less and move around more, but that is not what interviewers want to hear. They want to know what the government should do about obesity.
That is a different question. I am not convinced that the size and shape of the population is something politicians should try to control but, since I keep getting asked the question, I have given it a lot of thought. The only workable solutions would, I think, be politically unacceptable.
Firstly, the government could introduce an actual fat tax. Not a tax on saturated fat but on body weight. People would report their body mass index (BMI) in the same way as they report their income and would be taxed on a sliding scale depending on whether their BMI was below 30, over 30, over 35 and so on. If that doesn’t work, the state could introduce rationing to control calorie intake.
I would be leading the protests if the government ever suggested anything so draconian, but if the question is what would work, that is my answer. Nothing else has worked and I have yet to hear any proposals from the “public health” lobby that sound like they would work.
A four-year randomised control trial in Australia worked intensively with 3,000 children to encourage healthier lifestyles but by the end of it had failed to reduce obesity. If even this expensive, hands-on project didn’t produce the goods, what hope is there for broad brush policies aimed at tinkering with the food supply?
The likelihood that such policies will fail does not mean they won’t be introduced. “Public health” policies designed to make people eat, drink, smoke and (more recently) gamble less are held to a lower standard than other health policies and to a much lower standard than would be acceptable in medicine.
For a new drug or medical procedure to be approved, a strong body of evidence is required. If the patient dies after they are treated, the treatment would be considered unsuccessful at best. Those responsible may even be criminally negligent. If the treatment makes no difference whatsoever, aside from a few unpleasant side effects, it would not be licensed.
But when it comes to lifestyle regulation, things are rather different. A policy can be introduced on the basis of little more than a theoretical model produced by advocates of the policy, as happened with the UK’s sugar tax and minimum alcohol pricing in Scotland.
When the policies fail to produce the expected benefits – childhood obesity rose in the UK and alcohol-related deaths rose in Scotland – new models are created to show that the problem would have got even worse in the absence of the policies. Compare this with traditional public health interventions such as vaccinations, which produce a clear decline in the incidence of a disease and/or its mortality rate, and you can see that the lifestyle regulators are playing by a different set of rules.
Since most nanny state policies do not alleviate the problem they are set out to tackle, the “public health” lobby settles for looking at meaningless proxy measures. Sugar taxes have never reduced obesity anywhere in the world, but the UK sugar levy was portrayed as a success because it led to slightly less sugar being consumed in soft drinks.
Plain packaging for cigarettes made no difference to the smoking rate nor to the number of cigarettes sold, but was portrayed as a success because smokers said they found cigarette packs to be less attractive after it was introduced. The aforementioned Australian experiment was deemed a partial success because the kids were less likely to order takeaways by the end of it.
Properly understood, these indicators are not a sign of success. They are negative side effects. Since the sugar tax made no difference to obesity, all it achieved was to take away choice from people who preferred Lucozade when it had more sugar in it. This is a cost without a benefit. Making smokers enjoy their cigarettes slightly less without helping smokers who want to quit is also a cost without a benefit.
In recent months there have been calls for plain packaging for sugary breakfast cereal and health warnings on “ultra-processed food”. There are endless demands for advertising bans for booze, gambling and so-called junk food. The evidence that such policies will have any effect on a range of complex health issues and mental disorders is extremely weak. It often amounts to nothing more than a few chin-stroking social scientists reckoning that they will work.
Since very few countries have made much of an effort to control what people eat, most of the anti-obesity policies proposed by “public health” campaigners are completely untested. On the few occasions when they have been tested, they haven’t worked. Hungary has an extensive array of sin taxes on allegedly unhealthy food that doesn’t seem to have improved health outcomes (Hungary’s obesity rate is even higher than Britain’s).
In 2016, Chile introduced new food labels which amount to health warnings and banned cartoon characters on the packaging of “unhealthy” food. Although British “public health” activists are slavering to copy Chile, there is no evidence that these policies have reduced obesity either. Like Chile, Britain bans “unhealthy” food advertising on television during children’s programmes. The UK ban has been in place for fifteen years and seems to have had no effect.
Britain is now out on a limb trying policies that have never been tried before and for which even weak theoretical evidence is in short supply. Boris Johnson blamed his own obesity for his rough bout of COVID-19 that saw him briefly hospitalised in April 2020. Whether it was this or a more cynical desire to deflect from his government’s failures in the early days of the pandemic that led him to announce a crackdown on obesity is something historians will argue over. Whatever his motive, Johnson pulled an obesity strategy off the shelf where it had been lying since the David Cameron era.
Drawn up by Public Health England and various “public health” academics, it had been of little interest to Theresa May who was busy trying to negotiate Brexit. Under the supposedly libertarian Boris Johnson, it was assumed to be dead in the water, but his Damascene moment in a London hospital changed all that.
The strategy included a ban on shops putting HFSS food (high in fat, sugar and salt) in prominent places, such as the entrance, exit and end of aisles; calorie labelling on menus; a ban on HFSS advertising on television before 9pm; a total ban on HFSS advertising online; and a ban on volume price discounts such as buy-one-get-one-free (BOGOFs). With the exception of calorie labels on menus, which had been tried in other countries with mixed results, Britain is in uncharted territory.
Devised by ivory tower academics who have no skin in the game, the policies were not well thought out. It was plainly unfair to ban the local bakery from having a Facebook page. It was unreasonable to expect the local pub to carry out a scientific analysis of its soup of the day so it could specify the exact number of calories.
And although HFSS food is routinely described as “junk food” by campaigners, it is an incredibly broad category that includes raisins, sultanas, ham, hummus, walnuts, most tinned fruit, pesto, olive bread, paté, salami, cream crackers, tomato soup, Cornish pasties, dried fruit, butter, margarine, olive oil, most yoghurts and nearly all cheese. Banning adverts for such products would make the government look almost insane.
The civil service was left to clear up this mess and did so by exempting all but the largest companies from the rules and creating a new definition of “less healthy” food that contained fewer obvious absurdities. Johnson then left office leaving Liz Truss to kick back the BOGOF ban in her short-lived dash for growth. Rishi Sunak has since postponed both the advertising ban and the BOGOF ban until 2025.
Although campaigners ludicrously claim that volume price discounts cost consumers money, everybody else can see that banning them during a cost of living crisis is a terrible idea. Even Public Health England admitted (in 2015) that these deals are “a useful coping strategy” during periods of high inflation.
Apart from calorie labelling, which is fiercely opposed by eating disorder charities, the only part of the strategy to have been introduced is the ban on in-store promotions. A food reformulation scheme focused on reducing sugar in processed food crashed and burned spectacularly under Public Health England but continues under its successor Office for Health Improvement and Disparities.
Having encouraged food companies to take sugar out of their products, consumers reacted by buying less of the reformulated products and more of the sugary products. The net result, as Public Health England admitted in 2020, is that “there has been an increase from 723,103 tonnes of sugar sold at baseline to 741,966 tonnes”.
Herein lies the problem. You can lead a horse to water but you can’t make it drink. The “public health” lobby is constantly undermined by the public. Generally speaking, people know what they want and they are going to get it, even if they have to spend slightly more money or walk around a supermarket a bit more.
You might be able to suppress the sales of a new variety of Magnum by banning adverts for it, but you won’t suppress the demand for ice cream. You could, I suppose, tax “unhealthy” food at the level at which cigarettes are taxed. That would no doubt have an effect, but no party is going to propose it because the public would hate it.
Any reasonably affluent and free society is going to have a lot of fat people in it. The government can’t make people exercise more and the tools it has to intervene in the food supply are, in practice, too trivial to make any difference. It will take many years of failure and huge sums of wasted money before politicians admit that this is one problem they cannot do much about.
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Joe Warner, Editor-in-Chief, Unfiltered