Friday, 30 October 2020

The "whole systems approach" to obesity is anti-scientific garbage


Dolly Theis has written a three part article about what the government should do about obesity, as if it's any of their business. Dolly is a well meaning Conservative who has fallen in with a bad crowd as a result of doing a PhD in 'public health'. I was on a Spectator panel with her recently discussing the nanny state, along with Steve Brine and Joanna Williams (you can watch it here). 
Theis's thesis is that successive governments have failed to reduce obesity because of poor implementation and evaluation. She makes the improbable claim that 700 anti-obesity policies have been proposed in Britain in the last thirty years.

[The government] currently proposes obesity policies in a way that does not readily lead to implementation, which is likely to be why it does not then implement its own policies. Could you imagine the same happening in business? No, you couldn’t imagine that because it just wouldn’t happen.

There's a simple explanation for that. Businesses respond to what people want whereas the government responds to fanatical single-issue pressure groups and half-witted academics. The policies they propose are, by and large, unworkable, ineffective and go against what people want. Sometimes they encounter equally clueless politicians, such as the aforementioned Steve Brine, who embrace these bad policies because it makes them feel important. That's where the problems begin.
For example, banning 'junk food' advertising and forcing calorie counts in the out-of-home sector sound like great ideas to illiberal politicians until it is explained to them that there is no legal definition of 'junk food' and that many restaurants change their menus on a daily basis. 
When the costs and unintended consequences of such policies are laid out, politicians have no choice but to do a U-turn or water down them down. They should really think through the implications before they announce them, but they naively think that the likes of Action on Sugar are experts on policy. 

In some cases, policies are reproposed in a laughably short amount of time. For example, Chapter 2 of Childhood obesity: A plan for action was published in 2018 under Theresa May. It contained a number of policies, including a 9pm watershed on unhealthy food and drink advertising, and committed to legislating mandatory calorie labelling in the out of home sector.

Consultations were conducted. Individuals and organisations submitted their evidence, reflections and advice. Then poof! Two years later, instead of having implemented the policies, the Government, now under Boris Johnson, publishes another obesity strategy containing those exact same policies and another consultation process.

They say madness is doing the same thing over and over again and expecting different results. Well, hello…

The Childhood Obesity Strategy is a perfect case in point. David Cameron capitulated to the nanny state imbeciles on a range of tobacco-style regulations for food, but then resigned. Under Theresa May, Fiona Hill got rid of the worst of them, but she then lost her job and May reinstated them in a futile attempt to appease the 'public health' industry. May was then replaced by Johnson who rightly saw the nanny state as unconservative and kicked them into the long grass, but after 'long Covid' messed with his mind, he brought them back. As a result, Whitehall bureaucrats are once again saddled with their absurdities and are trying to limit the damage these daft policies will do. 

Yes, it's messy, but it's politics and the last few years have been unusually turbulent. With Brexit and COVID-19, the government would be quite entitled to bin the whole lot on the grounds that it has better things to do than ban supermarkets from placing sausages at the end of aisles.

Three cheers from anyone not keen on government regulation and legislation. But, hold on! Don’t get too carried away – because government proposes policies in such a way that does not readily lead to high compliance. The result is that sectors don’t do enough or don’t do anything at all, so government is pushed more and more into the regulation and legislation corner.
I assume this is principally a reference to the 'voluntary' food reformulation scheme, one of the most ridiculous projects any government has instigated in my lifetime. I put the speech marks around the word 'voluntary' because, as Dolly makes clear, it came with the threat of regulation if the companies didn't comply. 
The reformulation scheme is the perfect example of a hare-brained idea from gormless 'public health' activists. The government committed to it without giving any serious thought to how companies could take arbitrary quantities of fat, sugar, salt and calories out of food or what they could be replaced with. When it was explained to Public Health England that you simply cannot take sugar out of confectionery, for example, the goalposts were quietly moved to allow companies to shrink their products instead. That's not really 'reformulation'. As Josie Appleton has shown, PHE had no idea about such basic facts as jam having to have a contain amount of sugar to be legally sold as jam. 
The hilarious failure of the sugar reduction scheme, in particular, shows what happens when 'public health' ideologues are given free rein. The idea that it would work if the government explicitly introduced coercion is absurd. You can force companies to produce tasteless rubbish, but you can't make people buy it. You might as well pass a law telling water to run uphill.

[The government] should escalate to suggesting those actions to the responsible actor(s)/sector(s). Governments can name and shame, depending on progress, and state how they will move to more deterrence measures (e.g. taxation, laws, etc) if not enough progress is made.

As a last resort, an actor(s)/sector(s) could be fully incapacitated where action/inaction is deemed harmful.

Behold the progressive new Conservative Party! 

The problem of evaluation is addressed in achieving compliance, but I will make the point again here just in case. Policies should always be evaluated, ideally by an independent body.

I agree. Presumably, therefore, Dolly strongly objects to the sugar levy being evaluated by a bunch of academics who are staunch supporters of the tax, including several whose professional reputations depend on it being seen to be a success and one who believes that God literally told him to bring about a sugar tax in England. She must also object to the smoking ban being evaluated by an anti-smoking crusader (it had no impact on pubs, she reckons) and the salt reduction scheme being evaluated by the chairman of Action on Salt

This is quite obviously a racket. Could it be that if these policies were independently audited, they would be shown to be a waste of time and money?

Government must stop this. How is it supposed to know whether something worked if it is not evaluated properly? We also do not always have high-quality evidence about certain interventions and, in some cases, can only build this by introducing the intervention first.

I don't know about that. We don't licence medicines or perform surgery without evidence of efficacy. We have randomised controlled trials showing that food reformulation doesn't work, plenty of evidence that plain packaging doesn't work and masses of evidence that banning fast food shops near homes and schools doesn't work. The 'public health' industry still pushes ahead with such policies because it uses evidence like a drunk uses a lamppost. It is driven by hunches and dogma, not science. 

For example, to really know what the impact will be of a taxation policy such as the sugar tax, government must first introduce it, and then monitor the various impacts closely over time in order to build high-quality evidence.

Or you could use real world evidence from places that already have sugar taxes, but if you did that you'd have to concede that they don't work either.  

Government must therefore be bold in introducing interventions that have the potential to make it easier for us to live a healthier life, and then build the evidence through high quality evaluations.

The strategy of throwing any old policy into the mix in the hope that some of them will work is known euphemistically in 'public health' as the 'whole systems approach'. It is often illustrated with meaningless graphics and is anti-scientific, illiberal nonsense. Essentially, it gives activists a licence to do whatever they want regardless of the consequences. 
If anti-obesity policies are necessary at all - a question Dolly never really addresses - they should follow the same best practice we expect in other policy areas. Gather the evidence and evaluate the costs and benefits, including - crucially - the costs to wellbeing. The last thing we need is a million 'public health' monkeys bashing away on a million typewriters in the hope of finally coming up with something that works.

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