What should we do?

#5 Rethink the menu
and how much it costs

The pandemic is forcing us to change direction, to rethink what we do
and how we do it.

We ask our experts:
where should we go from here?

Rethink the menu and
how much it costs

by Dr Jean Adams

Boris Johnson has urged the country “to lose weight to beat coronavirus” through exercise and healthy eating. Dr Jean Adams suggests that food policies should be sensitive to the fact that healthier diets are beyond the budget of too many people in the UK.

We do not eat well. Less than a third of adults in England reach the ‘5-a-day’ recommended portions of fruit and vegetables target, and poor diet quality is one important reason why almost two-thirds of adults are now living with overweight or obesity.

While the negative health impacts of unhealthy diets and excess body weight are widely understood, there is often political reluctance to embrace strong preventive policies. But now that the Prime Minister himself has realised the importance of a healthy body weight following his own experience of COVID-19, will things finally start to change?

On 27 July 2020, Boris Johnson launched a new obesity strategy, urging the country to “lose weight to beat coronavirus and protect the NHS”. Alongside support and encouragement for weight loss, the strategy focuses on healthier eating with proposals around ‘traffic light’ labelling of food in supermarkets; calorie labelling of food in restaurants, cafes and takeaways; restrictions on TV and internet advertising of less healthy foods; and bans on supermarkets promoting less healthy food.

“Our group at Cambridge’s Centre for Diet and Activity Research has conducted research on many of the measures included in the Prime Minister’s recent obesity strategy.”
Dr Jean Adams

As the pandemic has progressed, evidence has emerged that obesity may be associated with poorer outcomes of SARS-CoV-2 infection. There’s no evidence that people living with obesity are at higher risk of being infected but, once infected, there is evidence that they may experience worse outcomes. However, as with most things related to COVID-19, very much still remains to be known including whether this correlation is robust and, if so, whether it represents causation.

Given the high proportion of people living with overweight and obesity around the world, excess body weight has also been described as a pandemic. That the obesity and COVID-19 pandemics may be exacerbating each other as they intersect highlights how vulnerable we are to new health threats if existing preventable causes of death and illness like obesity and unhealthy diets languish unchecked.

The Prime Minister has suggested that COVID-19 is a wake-up call on diet and obesity. I am still hoping that COVID-19 will be reasonably transient. But there are many reasons that will endure beyond the pandemic as to why we need to address the obesity pandemic and build a society that supports citizens to achieve and maintain healthier diets and weights.

COVID has put a spotlight on UK food poverty

In April this year, a four-fold increase in food poverty was reported in the UK in the first weeks of lockdown. There seems little doubt that the economic stressors imposed by the COVID-19 pandemic are likely to have increased food poverty – at least in the short term. Our work shows that food poverty was a major problem in the UK even before the latest pandemic hit. Nearly one in four (24%) UK adults reported food insecurity at some point in 2017.

Somewhat paradoxically in high income countries such as the UK, food poverty is associated with higher, rather than lower, body weight. In the UK, healthier foods and diets cost more than less healthier alternatives. So, when budgets are pressed, people turn to cheaper, less-healthy food, skimping on healthier fruits and vegetables and filling up on energy-dense processed foods. Low incomes are, therefore, a major cause of unhealthy eating and excess body weight in the UK.

Food poverty will not just go away when we finally get to grips with COVID-19. It too could now be considered ‘endemic’ in the UK. Without specific attention to household incomes and the price of healthier foods, many households will continue to struggle to afford enough of the foods they need to keep their families healthy.

Rethinking the menu post-COVID

Over recent years, our group at Cambridge’s Centre for Diet and Activity Research has conducted research on many of the measures included in the Prime Minister’s recent obesity strategy.

We have documented that TV advertising for less-healthy foods is pervasive, that the current restrictions focusing only on children’s shows did not change children’s exposure to these ads, and that the proposed total ban on less healthy TV food ads before 9pm will likely have a small but important impact on the number of children living with excess weight.

In work looking at junk food at supermarket checkouts, we found that shoppers are exposed to an average of eight foods that are less healthy every time they traverse a supermarket checkout, but that supermarkets are willing and able to remove this food from their checkouts and doing so reduced sales of the unhealthy food by 16%.

When we compared the food served by chain restaurants that already provide calorie labelling with those that don’t, we found that labelling was associated with serving dishes that contained substantially less fat and salt. While calorie labelling is often proposed as a method of educating consumers, it seems it might also be a way of educating manufacturers about what they are serving and encouraging them to develop healthier alternatives.

Advertising restrictions on less healthy foods, changing where less healthy foods are displayed and how they are promoted, and incentives for manufacturers to design healthier recipes and menus all change the ‘food environment’ rather than ask people to make healthier ‘choices’.

Our daily lives are saturated with temptations and encouragement to make food choices that are less healthy – from fast food adverts on the tube, to two-for-one offers on crisps at petrol stations. Irrespective of how much education, encouragement and motivation we give to people to eat better, it is very hard to make healthier choices in a context constantly sending the opposite message.

Where should we go from here?

Stop just telling people to eat better and lose weight. Most people in the UK understand what healthier eating means and that carrying too much weight increases their risk of illness. Making healthier ‘choices’ is extremely difficult when the food environment is stacked against you.

Reshape fiscal, social, and physical environments to make healthier eating easier. In addition to the proposals in the current obesity strategy mentioned above, other examples includes planning restrictions on hot food takeaway outlets, taxes on less-healthy foods, and subsidies on healthier foods.

Strengthen welfare and employment policies, including higher minimum wages, working hour mandates, and universal basic income. Healthier food and diets are beyond the budget of too many people in the UK.

What’s next?

Our work suggests that changing the environment that individuals make food choices in should lead to larger changes in diet and obesity than simply asking individuals to change their choices.

It’s encouraging to see so many environmental approaches in the Prime Minister’s new obesity strategy but it’s important not to let the lessons learned from food poverty get lost. One important way to be more supportive of healthier eating and body weights is by ensuring that everyone has the financial resources they need to be able to eat well.

There has been UK policy concern about the health impacts of poor-quality diets for more than 100 years. This has led to many, many diet and obesity strategies to tackle the problem, and the situation today  might well have been even worse without these efforts.

But much more remains to be done. Without concerted effort to make it not just easier, but also possible, to eat well and maintain a healthy body weight, many people in the UK will remain at unnecessary increased risk of many preventable causes of illness and death.

Dr Jean Adams co-leads the Population Health Interventions programme at the Centre for Diet and Activity Research (CEDAR) and the Medical Research Council Epidemiology Unit in Cambridge. She is involved in a range of work exploring issues around dietary public health and food policy – particularly focusing on food marketing, food retailing, cooking and how these factors interact with socio-economic position.

Artwork: Balvir Friers
Series Editor: Louise Walsh

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