20/02/18 – “Does food industry marketing undermine anti-obesity measures?”

Speakers: Katy Askew, Senior Editor of Food Navigator; Dan Parker, the Chief Executive of Living Loud; and Malcolm Clark, Policy Manager on Obesity at Cancer Research UK.

20th February 2018  – meeting notes

All-Party Parliamentary Group on a Fit and Healthy Childhood

‘Does food industry marketing undermine anti-obesity measures?’

Chair: Baroness (Floella) Benjamin

Chair’s Opening Remarks:

Good evening everybody and welcome to this, the 32nd meeting of the All-Party Parliamentary Group on a Fit and Healthy Childhood. Tonight we are addressing the question ‘Does food industry marketing undermine anti-obesity measures?’

We know that the food industry is responding to the obesity crisis and we have seen some significant progress in reducing the levels of fat, sugar and salt in many brands. Everybody wants to be seen as part of the solution, not part of the problem. And that is right, and that has been at the heart of the work we do here in this Group. We need everybody to get involved if we are to make a serious difference, because the problems are huge. We do need to appreciate that the food industry is highly competitive. If companies do not make a profit then they will collapse. So even as they reformulate their products or slim down their portion sizes, at the same time the constant work of marketing and advertising their products to us must go on.

The issue that has hit the headlines recently is ‘shrinkflation’, notably in chocolate bars. The size of many bars has been reduced whilst the price has remained the same. Meanwhile, advertising has switched focus to what we used to think of as ’family sized’ packs but now all too often, they look like an individual portion.

To our speakers tonight I say thank you very much for sparing some of your valuable time tonight. Firstly we will hear from Katy Askew. Katy is the senior editor of Food Navigator, a business to business publication which covers the European food industry. Katy will provide us with context to help us understand the realities of the food industry today.

Then we will hear from Dan Parker, the Chief Executive of Living Loud. Dan was previously a food marketing executive, now turned critic. His article about shrinkflation in chocolate bars hit the headlines.

Finally, we will hear from Malcolm Clark, the policy manager on obesity for Cancer Research UK. Many of us will know Malcom from his time at the Children’s Food Campaign.

I have asked them for about 7 minutes each before we go in to our usual Q&A session.

Katy Askew, Food Navigator

The question ‘Is Public Health policy fit for purpose?’ has been overlooked. The statistics of 1 in 3 children being overweight by 11, etc. are well known. The problem can be traced back to the 1950s and 1960s with the introduction of edible oil which made a huge difference to the way the globe eats. The modern food environment really clashes with our physiological needs, because our biology means that we want sweet and fatty flavours, which are now cheap and readily available. The issue goes way beyond fizzy drinks and fried food. Industrial-based animal husbandry means that we have shifted to much more animal-based proteins in our diets, away from legumes, whole grains and vegetables.

There have been various studies. Ghent University (in the Netherlands) did some research on the economic impact of animal-based protein consumption, and found that if just 10% of UK citizens increased their consumption of plant-based proteins, we would save £5.21 bn in healthcare costs and absenteeism.

Research from San Paolo (study of 19 EU countries) supported the correlation between availability of processed foods and obesity rates, with the UK having both the highest consumption and highest obesity levels.

Public Health England has switched the focus away from ‘just sugar’ towards overall calorie intake and improved education, but a fundamental shift in our attitude to food is required.

We are making some headway with reductions in portion sizes and reformulation, and there are some significant numbers, but progress is slow and not currently making much difference.

We need to understand the barriers to reformulation. Remember that the food industry does not use sugar merely for sweetness: it provides bulky texture as well. This means that reformulation is expensive and complicated as different ingredients are necessary – this takes time and extensive testing.

However, the public are indeed waking up to the health messages and the fastest-growing brands now are the ‘better for you’ brands. While this means that the food sector is responding with innovation, remember it’s coming from a very low base and the mainstream consumers (who are also the strongest revenue stream) are not the ones getting the message.

So, reformulation has to be the way forward, but it will take time to educate palates and the messages cannot simply be forced upon people. If they don’t like the taste, consumers will simply vote with their feet.

Research suggests that food cues (including branding and marketing) have much more sway than health messages when it comes to choosing food. Research from Amsterdam has found that when people encounter stimuli that they associate with certain foods, the health concerns are overshadowed. The pull factor is incredibly strong and in some cases the mere sight of a letter M or the shape of a Coca-Cola bottle can act as strong triggers. It’s not just about TV commercials or celebrity endorsement or toys: it’s much more pervasive than that.

So if health warnings are rendered ineffective by marketing, limiting exposure to marketing will help. The UK already has tough regulations on advertising on children’s TV, and the food industry has said that further regulation could limit product development and innovation.

There is a third way: food stimuli could be used to promote positive food choices and healthier options. Any such initiative would need to put education at its centre and clearly the UK Government has done some work to advance education in schools, but more can be done. There is strong evidence (e.g. from Germany) that free fruit in schools increased children’s consumption of fruit at home. We only have free fruit in the first three years of primary schools at the moment, and we don’t yet know whether the changed behaviour continues when the free fruit stops, so there is more investigative work to do on many levels.

In summary, our Public Health policy needs to go much further and needs to investigate the broader and more complex issues, and not just go for the ‘low-hanging fruit’ of marketing restrictions.

 Dan Parker, Chief Executive of Living Loud

 I worked in the marketing industry for 20 years before a type 2 diabetes diagnosis stopped me in my tracks and changed my life. I am now involved with a charitable organisation that promotes healthy living and I am fighting to reform the industry that I used to work for. I will use my extensive marketing experience to enlighten the group about marketing techniques.

Using Pringles as an example, the food industry spends an enormous amount of money employing extremely bright people to produce the most appealing and moreish flavours, crunch, speed of absorption, etc. Experts are dedicated to separate roles and purposes to ensure that products are designed to be delicious and addictive.

Then the product goes over to the Marketing Department, which employs top-grade psychologists to use a very wide range of tools and media to manipulate people to buy more. The best technology on the planet today is used to get people to buy more stuff.

Here is a case study involving crisps: to get people to eat crisps at other times of the day, prizes were awarded at five-minute intervals (people had to open a packet and text in a code to win a prize). Because the idea was to get the crisps out of the cupboard at all times of the day and not just lunchtime, the best prospect of winning was at 7.30 pm. In a similar campaign now, people can win a flight every hour with a Pringles pack.

The idea is that when the pack is opened to find the code for the competition, the contents of the pack will be eaten.

This is an example of a technique known as normalising: making it normal for people to eat crisps at any time of the day. Normalising can also be size-related, e.g. by showing much larger bags being consumed without sharing, e.g. Gary Lineker eating a 180g bag of crisps and refusing to give any to anyone else.

Providing ‘assurance’ messages is also common: this is where packaging displays positive messages such as ‘high in vitamin B’ on breakfast cereals or pictures of natural fruit or vegetables on ready meals.

In terms of the money spent, we consume 6 bn packets of crisps p.a. in the UK, which is 100 packets each. Pepsico (who make Walkers) has a turnover of $63 bn and profits of $6 bn. They spend $5 bn a year on marketing, split between media space and other forms of marketing. They give $1 m a year in campaign contributions (to all US political candidates) and $3 m a year to US lobbyists. In the UK they are one of the major contributors to the food and drink federation, whose sole purpose (on an income of £6½ m per year) is to protect the status quo for its members.

It is very important to note that these companies are not evil. Their role in our society is to maximise value for their shareholders within the framework of the law. It is the role of the Government to turn the will of the people into that law. What has happened now is that is the freedom that these companies have to maximise value is out of synch with what the moral code of our society wants.  We need the Government to step up to their responsibility and to put regulations in place that reflect what we as people, parents and consumers, want.

To allow the food industry to grow and prosper, we need to get the message through to the food companies about what we want, and then allow them to employ all their creative genius into reformulation and innovation.  They have very bright people working for them, and those people WILL be able to come up with the new, healthier, products that we need. 

Malcolm Clark, Cancer Research UK 

To set the context with some facts and figures, from the perspective of Cancer Research UK, obesity is now the 2nd biggest preventable cause of cancer after smoking, linked to 13 different types of cancer. What’s worse, children living in the most deprived areas are twice as likely to be obese.

We are all taxpayers, and obesity-related costs are £5.1 bn annually to the NHS and £7 bn to employers – huge numbers. We pay our taxes and we want value for money from the NHS but also businesses lose out when their staff suffer from these completely preventable illnesses.

Looking at the ‘Change4Life’ public health marketing campaign, the £5 m spent annually on promoting healthy messages is dwarfed by the £143 m spent by top crisp and drinks companies on advertising – nearly 28 times as much.  Of course, good dietary advice is extensively available (and not just from Change4Life), but it is the sense of scale that we are up against.

We have run focus groups with teenagers and young people and we get the message that there is not enough information from marketing messages.  Other children have spoken about seeing advertisements and then pestering their parents until they say yes. It is easy to blame the parents for this, but we are constantly surrounded by food and food-related stimuli and it is very difficult to combat. We may forget an advertisement once we’ve seen it, but when we encounter the brand elsewhere we have that trigger. Not all advertising is bad, but we know that most of the messages are trying to persuade people to buy things that make us consume more calories.

At a recent parliamentary round table Emma Boyland (University of Liverpool) commented on something that struck us all: we often get told that the we need  a gold standard of proof for Government that marketing affects choice and affects children, and we know that long-term trials are hard to do. Emma explained that there is an internationally-recognised widely-used standard for causality (the Bradford-Hill Causality Framework) which lists nine criteria for providing evidence of a causal relationship between a presumed cause and an observed effect. If we run through that list of criteria, we can tick every box, so there is compelling evidence that junk food and obesity are causally related.

For the past ten years, thanks partly to campaign and pressure groups, we do have marketing restrictions to children, but these restrictions don’t reflect what children’s viewing now is, e.g. family viewing (up to 60% of advertising is for junk food so children can see up to 9 adverts per hour). In 2008 Ofcom and the Government saw that there was enough evidence to take action, and in the last 10 years there is nothing to show that that evidence base has weakened, but the current rules no longer fit current viewing habits and need to be reframed.

Our challenge is to say to the Government and Ofcom that they made the right decision in 2008, but why they have allowed the rules to be weakened?  We need to ensure, for example, a 9 pm watershed on junk food advertising, and we have a window of opportunity now in the coming weeks and months while they think about the next stage of the child obesity plan.

Questions and Comments

Baroness Benjamin: Banning advertising leads to children’s programmes losing a lot of advertising revenue, so there needs to be a balance. The answer is not to ban advertising, but to ensure that whatever is advertised is of benefit to children. However, we can’t solve the problem without the food and drinks industry stepping up.

Dan Parker: It’s really not complicated to promote healthy food choices during children’s programmes: cereals with less than 10% sugar, for example.

Paul Wragg: The food industry was forced to change with the announcement of the sugar tax. The money was said to be for healthy eating but it will be used for other areas of education that are nothing to do with obesity.

Malcolm Clark: The original promise was that the money from the soft drinks industry levy would go to schools, and that is still right and still happening, but from the original estimates of £1 bn over two years, the figure has been revised downwards to around £500 m. This is because of the reformulation efforts that have been turbo-boosted as a result of the sugar tax announcement, so it’s a good news story because it’s boosted reformulation efforts.

Coco Pops Granola has less sugar which means it can be advertised to children. All these measures encourage the food industry to go further than they otherwise would. Even the industry itself admits that Government intervention helps them to move more quickly towards healthier products.

Katy Askew: In San Francisco they introduced a rule to say that toys could not be given away with fast food, and this had both a demonstrable impact on consumption but also forced McDonalds into action to provide healthier options. Without the rule that wouldn’t have happened.

Baroness Benjamin: There is a lot of good happening in Britain, e.g. the movement against plastic straws after David Attenborough alerted everyone. People are waking up to these issues. I was appalled at yesterday’s news of KFC’s chicken shortage, and the subsequent video of an overweight child expressing anger about it. KFC should be ashamed of themselves, putting this high-fat product into the bodies of children.

Dan Parker: Necessity if the mother of invention. The food industry employs extraordinarily clever people with vast resources, so if we make demands on them they will come up with solutions. There is so much to be invented  – ‘hollow’ sugar, for example. We can give them a choice by saying they can continue making unhealthy products with limitations on what they can do, or they can accept the challenge and put their money, their labs and their best brains onto the problem. They absolutely will solve it.

Katy Askew: Part of the problem is that things like that take time, and also the industry doesn’t have the platforms to collaborate on their reformulation efforts. Some of the innovative ingredients are a lot more expensive, so that raises questions about who picks up the cost.

Baroness Benjamin: It’s a balance between the consumer, the manufacturer and the money-people. We need more people who have a moral conscience about what we are doing to our children. We need board-level people to be prepared to make lower profits in exchange for doing the right thing.

Jack Winkler: It is possible to sell healthy food without marketing and advertising. The reformulation of salt was successfully done (15% reduction in 6 years) without the products making any mention of the change in salt content, and it was done gradually.

When Walkers introduced their baked crisps with lower fat there were hardly any on the shelves but nowadays there are five different brands using up 12% of the shelf space. Of the five brands, two mention the lower fat and three do not. In the panel’s opinion, which way is the best way?

Katy Askew: ‘Health through stealth’ has been around for a while, e.g. soft drinks companies tried to launch some healthier formulations onto an unsuspecting public some years ago, but there was a hostile reaction to the taste.

Consumers have moved on since those days and are more open to ideas now. Health doesn’t need to be the primary message, but people are more interested nowadays in healthy eating. We should be trying to make people want healthier choices but how do we facilitate that?  Technology plays a part: there are mobile apps for finding calorie content and for tracking intake. People tend to underestimate their calorie intake so they have to change their behaviour to help them make mindful decisions, and all food outlets have to join in to provide this information. This is starting to happen now, but I don’t think you can introduce new healthier products without talking about them.

Malcolm Clark: I think we need to address the change in snacking habits that has arisen in recent years. All snacking foods add calories, sugar and salt to our diets, and we should try to address this by asking what levers we can use to discourage the sheer scale of snacking that is now the norm.

Secondly, from the macro level, we can look at what the Government does in terms of subsidies and encouragement to support less processed food. We would like to work more with retailers: for example, an opportunity was missed with the introduction of small package sizes as one of the reasons for this move could have been framed as ‘health benefits’.

It’s interesting that some companies in the soft drinks industry are proposing that, in the name of transparency, the sugar tax should be reflected on the shelf price: sugary drinks should be more expensive than less-sugary ones. In general this should be the case – healthier food should be cheaper.

Baroness Benjamin: We would like to know the thinking of Aldi and Lidl. Perhaps the cheaper end could take on the obesity challenge?

Dan Parker:  95% of food decisions we make don’t involve the brain, and the idea that education and increasing people’s knowledge is going to solve this is a path to failure. There may be an alternative universe where everyone is happily at home cooking, but unfortunately that is not going to happen in the real world. The only question is, what’s in the packet?

The only solution is to let the food industry press ahead with reformulation to produce healthier products. They have the money, the clever staff and the technology to produce the products we want. The food industry needs to step up.

Jillian Pitt: Why does the panel think Governments have been so reluctant to regulate?

Dan Parker:  The answer is threefold.

  1. The food industry is the most valuable industry bar none. Pressure from industry may be subtle but it is relentless.
  2. Like cigarettes, unhealthy food is worth a lot in VAT – around £23 bn. It’s profitable.
  3. In general, people do not want things taken away from them. It’s similar to cigarettes and alcohol in that people are happy to accept harm to themselves from products that they enjoy. Until people start saying ‘this is not ok’, nothing will happen.

Katy Askew: I’m not sure of the answer. I was appalled to find that my daughter now gets access to the school tuck shop where she can buy flavoured milk and sugary snacks. And school dinners include dessert every day, so often children will decide whether they want a school dinner or not based on what dessert is on offer. It seems like a lot more support could be given to schools.

Malcolm Clark: We do have some sense of popular desire for policy change as we conduct polls to find out. Even individual MPs will support change, but it stops short of action. When the sugar tax was first mooted, Coca Cola were against it but then changed their minds when they started looking at it. In the F&D industry there are a number of key individuals who have a very blinkered, short-term, aggressive view of how to defend their patch, but there are others who are more progressive, forward-thinking and willing to take action. We need more of the latter in positions of power.

Katy Askew: Healthy ageing is an interesting area, as we’re all living a lot longer and everyone wants to live well. Another area that could be exploited to promote health messages is technology, which is proving really disruptive to the F&D industry now. There is a lot being developed around good nutrition and we need to think how to leverage that.

Paul Aargaard: In 2004 the Department of Health launched free fruit in schools, and a lot of schools didn’t want to take it up because they saw logistical barriers and problems with managing and delivering it. The success criteria of the scheme was around circles of eating, where children would enjoy eating and talking together. What is happening now is that it is  common for children to be given the fruit at break times, so they are running around with it, not thinking about what they’re eating. We want to promote the idea of eating together mindfully and a lot of my work is around creating eating environments where children want to be there rather than just being a corridor to play. There are a lot of very cheap wins here: if you make healthy food accessible, affordable and attractive children will eat it. Children will eat crudities on tables when offered.

Katy Askew: There was a German study looking at free fruit which found that the best way to deliver value was around finding the optimum number of times that you gave away the free fruit and how it impacted on overall consumption. Where budgets are stretched it makes sense to look at the best value – it’s not just about getting the fruit into the children’s bodies but also about changing their minds. It’s important to ask questions about the impact, for example to establish when the optimum age is. Our children don’t get free fruit after year 3 but is 4-7 the optimal point for establishing the habit? If we withdraw free fruit at that point, do children continue with their increased overall consumption? We need more research.

Estelle McKay: For 30 years in terms of food policy nothing has happened, so these are exciting days to start the dialogue. Or are we starting the dialogue? Because just this week a new F&D sector council has been set up to work with the Government, but we are not mixing enough with academics. Academics are doing excellent research but it’s not translating into the ground. There are horrific visible differences between children in the classrooms of London and children in some other parts of the country. I do feel that the UK could lead the way by combining (in education and in academia) what’s happening politically with what’s happening in charities. This APGG group is one of the rare platforms where we can all turn up and give our views.

Dan Parker: Sadiq Khan, the mayor of London, has just announced a 12-person group to tackle obesity in London. They are all unpaid so this is hardly adequate. Can’t he find £50,000 to fund it properly?

Estelle McKay: Parents get very angry when they see their children eating rubbish.

Dan Parker: I hope that the horrible pain that people suffer through health-related obesity problems will ultimately turn to anger and this anger will be directed against the Government and against companies like Coca Cola.

Katy Askew: I found our recently that GP training in nutrition amounts to one week.

Dan Parker: Or a 90-minute online CPD course.  Doctors are scientists, trained to make a diagnosis and then prescribe. With obesity it’s very, very different, and doctors with fact sheets don’t work.

Paul Wragg: Personal and Social Health Education (PSHE) in schools lacks proper training, with co-ordinators often having no training at all. It’s very important that PSHE is done properly.

Another point I’d like to make is that obesity is the ‘new’ smoking. A lot of the smoking prevention messages were delivered through nudging, and getting all health professionals to ask people ‘do you smoke? can I get you help?’.

Baroness Benjamin: I am putting a question in the Lords on Monday. What single message would you (the panellists) like me to keep in mind?

Malcolm Clark: They removed a lot from the Obesity Strategy last time, so ask them to put all the measures in the draft back in, along with marketing and promotion restrictions..

Dan Parker: Return choice to parents – take away ‘pester power’ and stop the food industry dictating what children eat. They shouldn’t be brainwashed.

Katy Askew: There is not enough being done to acknowledge, investigate and tackle the link between poverty and obesity. It is not so bad for educated people, but what about time-poor people?

Dan Parker: and look at whether you can have a healthy diet on state benefits – is it financially doable?

The meeting ended at 1930.