The government recently announced new measures to halve rates of childhood obesity by 2030 and significantly reduce the health inequalities that persist – closing the gap in obesity rates between children from the most and least deprived areas.

This proposal builds upon the first chapter of the Childhood Obesity Plan, which was widely criticised at the time as lacking the breadth and depth of initiatives needed to effectively tackle such a widespread and entrenched issue.

Steve Brine, Public Health Minister has stated: “One in three children are now overweight or obese by the time they leave primary school. Overconsumption, combined with reduced activity, is having a catastrophic effect on our children’s health. As both a parent and minister, I am committed to driving today’s pledge of halving obesity over the next 12 years with bold new action.”

“Our updated plan will put parents in charge, providing more information and support. Our aim is to help families make healthier choices, which will in turn provide a better chance at a longer, healthier life for our children.”

Obesity – A systems issue

The financial burden of obesity is too great to ignore: it’s estimated that the NHS in England spent £6.1 billion on overweight and obesity-related ill-health in 2017/18, which, to put into context is more than was spent on the police, fire service and judicial system combined. The wider costs to society of these conditions are around £27 billion a year, if not higher.

Ever since the Foresight report was published over a decade ago, it has been recognised that obesity is a systems issue and one that therefore requires reform at many points, to deliver change. This idea and the fact that no plan to date has sought to address childhood obesity in a multi-sector way, was reiterated in the recent inquiry by the parliamentary Health and Social Care Committee into childhood obesity. Childhood Obesity: Time for Action argued for a change in narrative, making clear that obesity is everyone’s business and “an effective childhood obesity plan demands a holistic, joined-up, ‘whole systems’ approach with clear and effective leadership”.

How does the Childhood Obesity Strategy measure up?

This update to the Childhood Obesity Strategy is a welcome step forward. It contains a raft of proposed measures that seek to tackle the issue using a co-ordinated range of policy levers. What is also good to see is that this new plan takes a firm but fair approach in how it will deliver change: using voluntary measures in the first instance but being clear that a harder tact with the likes of regulatory and fiscal measures will be considered where progress is deemed insufficient, or where a level playing field is required.

Here at Nutrilicious, we’ve taken a closer look at what’s in store and benchmarked the new childhood obesity plan against the World Cancer Research Fund’s NOURISHING framework, as well as the recommendations from the Health and Social Care Committee’s report mentioned earlier.

The NOURISHING framework

The NOURISHING Framework sets out that policies are needed within three core areas to improve diets: the food environment, food system and behaviour change communication.

N – Nutrition label standards and regulations on the use of claims and implied claims on food
O – Offer healthy food and set standards in public institutions and other specific settings
U – Use economic tools to address food affordability and purchase incentives
R – Restrict food advertising and other forms of commercial promotion
I – Improve nutritional quality of the whole food supply
S – Set incentives and rules to create a healthy retail and food service environment
H – Harness food supply chain and actions across sectors to ensure coherence with health
I – Inform people about food and nutrition through public awareness
N – Nutrition advice and counselling in health care settings
G – Give nutrition education and skills

Bearing in mind that some policies and actions targeting childhood obesity were in place prior to this strategy update, overlaying the new measures show how broad their impact alone intends to be:

New measures	N	O	U	R	I	S	H	I	N	G	Nutrilicious notes
Improved food labelling to display ‘world-leading, simple nutritional information’ as well as information on origin and welfare standards following Brexit	X
Strengthen School Food Standards to reduce sugar consumption		X					X				We would like to see these universally applied and close the loophole that exists for some academies
Strengthen Government Buying Standards for Food and Catering Services*		X					X
Ban price promotions such as buy one get one free, multibuys or unlimited refills of unhealthy foods and drinks in the retail and out of home sector*						X					It is good to see a mandatory approach applied here, as this is what is undoubtedly needed when policies will impact businesses’ bottom line.
Ban the sale of energy drinks to children*						X
Ban promotion of unhealthy food and drink by location e.g. positioning – checkouts, end of aisles and store entrances, in retail and out of home sector*						X
Introduce a 9pm watershed on unhealthy food and drink advertising and similar protection online*				X							We would like to see similar controls applied to sports advertising
Review governance arrangements for advertising rules (currently overseen by the Committee of Advertising Practice and Advertising Standards Authority)				X
Potentially bring ‘sugary milk drinks’ into the soft drinks levy if insufficient action on sugar reduction takes place			X		X
Introduce mandatory calorie labelling for out of home sector in England*	X					X
Sugar reduction plan for products aimed exclusively at babies and young children due in 2019*					X
Calorie reduction plan due mid-2019*					X
Develop trailblazer programme with local authority partners to highlight what can be done within existing powers						X					We would like to see greater powers for local authorities and health services
Develop plan to use Healthy Start vouchers to provide additional support to children from lower income families*			X
Ofsted will review school curriculum to understand how it can better support healthy behaviours, including food choices							X			X	We would like to see improved early years education for parents to support a healthy first 1000 days and compulsory home economics with healthy cooking skills at the core in both primary and secondary schools

*Proposal for further consultation

Is it enough?

While we applaud this latest round of the childhood obesity plan, we would also draw attention to the fact that there is still some way to go.

By mapping the proposed policy options against the NOURISHING framework, we can see that in this latest iteration of the plan much more focus has been given to shaping an environment that enables and supports healthier choices, which is great to see.

However, what is noticeably absent is the ‘I’ in terms of improving food and health literacy of the population. In a ‘post truth’ world where consumers are increasingly sceptical of messages coming from the scientific community, and when social media influencers are capturing the hearts and minds of the masses with questionable dietary advice, never has it been more important to provide clear, simple and authoritative information and advice. As such, we’d like to the see the government step-up their efforts on social marketing and educational campaigns.

What is more, a number of recommendations made in the Health and Social Care Committee are notably absent, including:

• Establishing a Cabinet-level committee to review the implementation of the plan, ensuring it gets the high-level traction it requires
• Proposing further measures around early years and the first 1,000 days of life, including targets to improve rates of breastfeeding
• Banning the advertising and promotion of follow-on formula milk
• Providing local authorities with further powers to limit unhealthy food and drink advertising near schools (the only powers available to local authorities extend to the positioning of the billboards themselves, not the content of the advertising)
• Introducing services for children living with obesity

Finally, while this plan is overtly focussed on limiting unhealthy foods and drinks and making processed, packaged foods a little better through reformulation (lower in salt etc), we would also like to see equal attention given to measures that work improve the quantity and quality of foods that we do want people to eat more of. Changing the dietary landscape will require strong efforts to provide families with the tools and knowledge to instil these healthier behaviours in a sustainable way.

The full plan for action can be viewed here:

https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action