01/12/15 – Public Health England’s recommendations to the Obesity Strategy

Speaker: Dr. Alison Tedstone, National Lead, Diet and Obesity and Chief Nutritionist, for Public Health England

1st December 2015 – meeting notes

All-Party Parliamentary Group on a Fit and Healthy Childhood

Chair: Diana Johnson MP

Public Health England was commissioned to provide a report on sugar which would feed into the Government’s Childhood Obesity strategy. The report considered the science, including the relationship between all carbohydrates (including sugar) and health as reported by SACN. They looked at the evidence in a quality controlled way. They saw evidence to advise caution on the amount of sugar being consumed. They identified consumption levels in the UK associated with particular health risks.

High levels of consumer consumption are linked to consuming too much energy. When you have a high sugar diet you are less likely to modulate the food intake to match your energy expenditure.

The evidence base on sugary drinks led then to its cautionary advice to government about how much sugary drinks should be consumed.

Their recommendation is for the maximum sugar consumption to be halved from 10% to 5% of energy. It also advised that sugary drink consumption be minimised. That is now the official advice of Public Health England, presented to government in July. It is now official public health advice, which is being integrated into public health messaging.

The next thing PHE had to do was to look at the levers for reducing sugar consumption.

The majority of sugar is in the food that we buy, so telling people to add less sugar is not a solution, the solution is on food consumption. Sugar is linked to obesity; this is a problem across society. In addition, 30% of children arrive in primary school with tooth decay. This is costing the NHS £5 billion + a year. An obese child is less likely to be attending school, their life chances are damaged, and are more susceptible to bullying and other social challenges.

Public Health England looked at the drivers of consumption, looking at price promotions. Foods in the UK are more highly promoted on price than in the rest of Europe, with 40% of food bought on promotion.

The industry would argue that this just results in an opportunity to swap products (one pack of biscuits for another) and value for money. However, PHE found that there was a 20% increase: so people are buying more biscuits, the frequency of shopping is not changing, people really are buying more.

The research (PHE narrowed it down from 500 to 45 studies, where there was evidence that marketing and adverts do affect the choices and preferences) found this across all platforms.

Whilst there is a small amount of data on sponsorship of sporting events, it does show that sponsorship does affect food choices and preferences. There is a similar situation with branding, there also needs to be a bigger evidence base on that area. However, what we have so far suggests that controls on marketing and adverts would be an effective lever.

The case for taxes is based on limited evidence so far. In the countries which have levied taxes there have been few evaluations (in only 5 countries) of relatively low quality, but the results are consistent. It is difficult to separate the price effect from the halo effect of introducing the tax.

As there is not a great evidence base to support it, subsidies are not necessary to create improvements in diet. Controlling promotions and advertising and reformulation are above taxation in order of priority. In the UK there is the example of the lowering of salt in food, which has been an incredibly successful policy; we have lowered our salt consumption by 40%. As with this, a different approach is needed. Whilst things like the responsibility deal have been useful, there needs to be a far more structured and managed programme.  We need to talk about portion size, it needs to be tackled. For examples, crisp packet sizes have increased. Another key recommendation is the scope for work to be done in public food procurement; it could be better in areas such as leisure facilities (with their vending machines) whilst the NHS is generally not a healthy food environment.

Based on the evidence, PHE has made some broad structured recommendations

The food environment drives choices, whilst education is important, it will not solve the problem. You need an iron will to resist the nudges in society.

Comments and questions

The theme of yesterday’s parliamentary debate (on a sugar tax) seemed to be a call for interventions that will affect changes in people’s habits. The answer seems to be a whole society approach. How does PHE see its role in “nudging” all these changes? Is sugar the nudge?

Dr. Alison Tedstone The job of PHE is to describe the evidence and describe the risks of certain things. Obesity solutions at the moment are about individual changes, I agree, we do need a whole society approach.

Diana Johnson MP: What were the results of the Mexican policy of taxing sugary drinks?

Dr. Alison Tedstone: There was a 6% reduction in consumption, there has been a smaller impact than there would be from reforming price promotions and reformulation of foods would have. Many obese people don’t drink sugary drinks and a sugar tax is only on drinks.

Has PHE researched new approaches and products that allow foods to be changed without affecting their taste? There is a trend towards healthier foods and processes to make foods healthier.

Dr. Alison Tedstone: Innovative and novel processes are interesting and do have a role but there is large scope for sugar reduction before getting to those new processes.

The market for health marketed foods has expanded, but it is only appealing to a small segment of society.

If schools no longer cook and playtimes are reduced can we just concentrate on foods? Meanwhile people who rely on food banks don’t get a choice of what they eat.

Dr. Alison Tedstone: PACT is part of the previous agenda, schools have a role, but are not always the solution.

The notion is that healthy food is more expensive, but it does not have to be. The issues around food banks are complex and not necessarily a food supply issue.

We are all eating too much, all ages, all parts of society and all levels of education.

Recommendations for portions for the under 5’s cannot include fruit juice, with the Eat Well plate under review, where does fruit juice (which is just empty calories) sit?

Dr. Alison Tedstone: There is as much sugar in fruit juice as in a glass of cola, the advice is not to consume more than 150mls a day. Most things that contain lots of sugar (like pineapple juice) are not heavily marketed. Soft drinks are more of a problem than fruit juice. A glass of fruit juice is all the sugar for a day.

Are there plans for PHE to extend the national child measurement programme and are there any plans to enhance the training for professionals?

Dr. Alison Tedstone: There is a commitment to enhance the national child measurement programme, 94% of 5-11 year olds are measured. We need to maximise the opportunities around the programme, for example the letters that are sent by Local Authorities, some of these need to be worked on. The programme is expensive; we would need to look at what the impact would be of extending it.

There is investment in teacher training resources. Those who procure our food need better training, competency issues have been identified in this area.

Calorific intake in the 1950’s was higher than now, but the difference now is about exercise and activity levels. One way to deal with this, for the benefit of children, is to designate certain areas as car free.

Dr. Alison Tedstone: The planning agenda is important to the obesity agenda.

What is your view on the retail environment presently companies with the deeper pockets also produce the more unhealthy products; the current system supports “big sugar”. Could a polluter pays strategy, targeting the soft drink industry, get to the root cause of the problem?

Dr. Alison Tedstone: The British retail scene is a highly competitive one. It is notable that end of aisle placement results in a 50% increase in sugary drink purchase, we probably have the cheapest food in Europe and it is also the most heavily promoted. Policies around retail are not in the remit of PHE.

How do we tap into the energy, anger and emotions people have about sugar?

Dr. Alison Tedstone: Advocacy and lobbying are powerful. In my own experience I now choose not to attend meetings which do not serve healthy food, I have a “no biscuits” rule for meetings.

We need to know how much is a “portion size” and how much of that is sugar? So much food consumed is not from raw ingredients; rather, it is packaged up.

Dr. Alison Tedstone: Sometimes it is unhelpful to say the problem is sugar or fat, it is too much of everything. Telling everyone to cook from scratch is not a solution. Processed food is fine but can be improved at lot.

How do we ensure that controls on promotions and adverts cut across all the platforms?

Dr. Alison Tedstone: There is large scope for controlling UK produced platforms. Children’s TV controls do work, for example. We believe that there could be broader controls across the internet. TV is still where most children see adverts.

Companies would say that they are not “advertising to” children, contrast that to the effects of celebrity endorsement of crisps, for example.

The Chair thanked the speaker and brought the meeting to a close.