Sunday, 19 July 2020

The Observer's ignorant view of obesity

Some dog-bites-man news from Britain's least liberal Sunday newspaper, the Observer...
‘Junk food is the new tobacco’: experts call for restrictions to tackle obesity 
Ministers should regulate processed food as heavily as tobacco to tackle the “massive national challenge” of the UK’s obesity crisis, health experts have warned.

They have urged severe restrictions on supermarket promotions of processed foods, and bans on fast food outlets near schools, and TV adverts for pizzas, burgers and similar foods before 9pm. One campaign group even urged the government to consider plain packaging for processed food.
No slippery slope there then, eh?
The paper also carries an editorial calling for more heavy regulation from government.

The government is expected to set out a new strategy this week, aimed at reducing obesity levels both in the next few months – ahead of a possible second wave of infections – and the longer term.
Anyone who thinks a government strategy released next week is going to reduce obesity levels in three months is away with the fairies. 
There is robust evidence about what is needed to cut obesity and in recent years report after report, including from Public Health England and the former chief medical officer, have called for urgent action.
There is no credible evidence to support any of the proposals in the Childhood Obesity Strategy. The impact assessment is based on nothing but guesswork. The claims about the efficacy of banning so-called 'junk food' advertisements are based on extremely weak evidence. There is essentially no evidence for the idea of banning retailers from displaying certain food in certain parts of their shop. And the evidence on calorie labelling and restricting fast food outlets suggests that neither policy has any impact.
Yet these calls were ignored by Conservative ministers who have seemingly prioritised the food and drink industry’s financial interests over the health of the nation.
This is not only a false dichotomy, it is untrue. It was a Conservative government that gave us the sugar tax and a Conservative government that put forward all the proposals that the Observer supports. A public consultation on them was held last year, although a genuine public health crisis has understandably taken priority since then.

The continuing failure to act is consigning a generation of children to a lifetime of health problems. One in three leaves primary school overweight or obese, putting them at significantly greater risk of cardiovascular disease, cancer and type 2 diabetes later in life.

Poor diet has overtaken smoking and drinking to become the nation’s biggest premature killer...
The link provided by the Observer refers to the world, not the nation, and it is based on a basic misunderstanding of statistics.  
That is 3.6% of the NHS budget and you need to look at the net costs to overall spending, which are lower, rather than the gross costs. obesity-related hospital admissions continue to rise.
To 700,000 a year, according to the Observer's source. Which amounts to 3.4% of all admissions.

Increasing obesity levels are not the result of the nation becoming more wilfully irresponsible about its nutrition choices or parents deliberately choosing to load their children’s diets with unhealthy foods. They are primarily the result of an industry that stands to gain from packing processed foods with increasing amounts of cheap and addictive fat, sugar and salt, in a way that has reduced consumer choice by conditioning our palates to crave more over time.
This is an evidence-free assertion. Per capita consumption of sugar, fat and salt have all declined since the 1970s. None of them are addictive.
Its efforts are working: children are consuming, on average, more than twice the recommended amount of sugar each year and tooth decay is the most common reason for those aged five to nine to be admitted to hospital.

The one area where the government has taken proper action has been the introduction of a sugar levy on fizzy drinks, eventually brought in in 2018 after years of delay. This has been highly successful on its own terms – the amount of sugar in fizzy drinks has fallen by almost 30% without a corresponding fall in soft drink sales – but it is far too limited in scope to make a big enough difference on obesity. 
It hasn't made any difference to obesity, so it hasn't been a success, has it? 

Apart from this, the government has relied on asking for voluntary action from the food industry, which has completely failed to deliver. A more interventionist approach is required. 
Before 2010, the UK was a leader in nutrition policy and was the first country to successfully reduce population-level salt intakes by forcing manufacturers to gradually reduce salt levels in food, an approach that has been copied around the world with other countries applying it to sugar and fat as well as salt with great success.
This is incorrect. The salt reduction scheme was voluntary.
However, Conservative governments have ripped up this approach.
Quite the reverse. Via Public Health England, Conservative governments have presided over a massive expansion of the reformulation programme which now encompasses sugar, fat and calories. Why can't the Observer get these basic facts straight?

We need to see the compulsory reformulation of processed and convenience foods to reduce sugar and fat as well as salt levels...
 Really? I'd love to see how that legislation would be worded. 
...and, as the King’s Fund argues in today’s Observer, we need a comprehensive ban on junk food advertising, regulation to eliminate unhealthy food being sold as a loss leader by supermarkets and beefed-up powers to enable local authorities to maintain the area around schools as fast food-free zones.
The King's Fund is a pressure group whose main focus is on pressing the government to give the NHS more and more money. They have no expertise in this area. 'Unhealthy food' is not used as a 'loss leader' (on the contrary, it is quite profitable, as the Observer article seems to acknowledge a few sentences earlier). There is no legal definition of junk food and a ban on HFSS food advertising would hit advertisements for foods that Observer readers think are wholesome. A ban on fast food outlets near schools would not only be a de facto ban on fast food outlets nearly everywhere, but the evidence strongly suggests that it would have no impact on obesity.
So far, government briefings suggest that the new strategy, like the ones that went before, will be focused on weak measures such as public education campaigns and “nudges” such as the repositioning of unhealthy food in different parts of supermarket aisles.

A ban on positioning 'unhealthy food' at the entrance and exit of shops would not be a 'nudge' (bans are not nudges). 'Public health' campaigners have spent years screeching about the horrors of chocolate bars at the check out. They are the ones who have been demanding a ban.  

The real test for an overweight prime minister said to be shaken by his own experience of Covid is whether he is prepared to take on an industry seemingly determined to extract as much profit as it can, regardless of the cost in premature deaths.

Is the industry selling at a loss or extracting as much profit as it can? On this, as with so much else, the Observer seems confused. It doesn't even have a superficial understanding of the facts. It mentions industry no fewer than seven times, but never mentions physical activity. From a misdiagnosis of the problem, it comes up with the wrong prescription.

The Observer is always going to take a nanny state line on such issues. It is a paternalistic newspaper read by a small number of people who take a dim view of the public. The question for Boris Johnson is whether he is going to capitulate to the left-wing press, as Cameron and May did, or chart a different path.

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