Reflections on the National Food Strategy - will it optimise the UK’s food system for nutrition and equity?
The past year has reiterated the need for urgent action to transform the way that the world produces, consumes, and thinks about food to achieve the Sustainable Development Goals (SDGs) by 2030. Across the world, 2.4 billion people face food insecurity, the cost of eating a healthy diet has increased and is now considered unaffordable for 3 billion people.
For this reason, In September 2021, the United Nations is convening its first Food Systems Summit. The ‘'people’s summit” has been preceded with a series of dialogues aimed to raise awareness and deepen understanding globally of the radical shift needed in the way we produce, process and consume food to improve human and planetary health without leaving anyone behind.
‘While 2020 was an immense challenge for the world, it is a warning of unwelcome events to come if more resolute actions to transform our food systems are not taken. We must not delay if we are to end hunger and malnutrition in all its forms’ - Nancy Aburto, Deputy Director, Food and Nutrition Division, Food and Agriculture Organization of the United Nations
This is also the rationale behind a series of national initiatives, including the government-commissioned 2021 United Kingdom (UK) National Food Strategy, led by restaurateur Henry Dimbleby. The report is a call to action for the government to address a rising tide of obesity and its associated co-morbidities in the UK. It investigates the current food system and makes 14 recommendations to escape the ‘junk food cycle’ and protect the National Health Service (NHS), reduce diet-related inequalities, make the best use of land, and create a long-term shift in food culture. The report highlights common demands and aligns with government commitments in its Obesity Strategy, published a year ago in response to COVID-19.
In the UK, 67% of men and 60% of women are living with overweight or obesity. Almost 1 in 4 children leaving primary school are considered, from a clinical perspective, to be living with obesity. Obesity increases the risk of chronic diseases, including cardiovascular disease, type 2 diabetes, at least 12 kinds of cancer, liver, and respiratory disease. The ongoing COVID-19 pandemic has also put obesity in the spotlight. On one hand, it became clear early on that when coupled with COVID-19, obesity can create a more significant risk of complications and death. On the other hand, lockdowns, and other measures to curb the growth of the pandemic have led to reduced opportunities to be physically active, shifts in dietary patterns, more frequent exposure to opportunistic marketing of ultra-processed foods (UPFs), and repercussions on mental health. While we have yet to see the full extent of the repercussions of the pandemic, its impact already appears to be felt hardest by people living in the most deprived areas, where the prevalence of obesity is already 50% higher than its counterparts.
Foresight’s obesity report and systems map has already illustrated how the social, physical, and economic environments influence the risk of overweight and obesity. Similarly, the National Food Strategy reiterates the importance of focusing on upstream drivers of obesity, taking a ‘systems approach’ in all efforts to change the UK’s obesity trajectory. Without substantially modifying the environment we work and live in; behaviour change won’t be successful. Systems thinking helps us identify triple-duty actions that simultaneously address the Global Syndemic of Obesity, Undernutrition, and Climate Change, presenting us with ‘win-win-wins’ and opportunities to protect human health, the environment, and our planet.
The recommendations outlined in the National Food Strategy call for a holistic approach to environmental sustainability and diets and include some long-standing successful policy examples. The first recommendation calls for the introduction of a sugar and salt reformulation tax, and to earmark some of the revenue to help get fresh fruit and vegetables to low-income families.
We learned from the tax implementation experience in Mexico that such a regulatory approach encourages manufacturers to reformulate their products to keep costs down, or conversely make these high sugar and salt (HSS) products less appealing to consumers. While one of the concerns when implementing taxes is the risk to widen socio-economic disparities, the current strategy is encouraging given its suggestion to earmark the revenue and use it to support low-income families. However, as demonstrated with the 2018 UK Soft Drinks Industry Levy, taxes need to be supplemented by additional measures to promote the establishment of healthy living environments. Sugar-Sweetened Beverage (SSB) manufacturers proactively acted on these new rules to reformulate their products to meet target sugar thresholds, and the sale of SSB that are not subject to the levy paradoxically increased. A similar response was seen in Barbados and the UK should not dismiss the likelihood of industry interference.
The report supports the facilitation of a “Community Eat Well” Programme, which would give GPs the option to prescribe fruit and vegetables – along with food-related education and social support – to patients suffering the effects of poor diet or food insecurity. However, it needs to be acknowledged that overweight/obesity shouldn’t solely focus on the “eat less move more” narrative and requires a life-course, cross-sectoral focus. Treatment options, including surgery and pharmacological approaches, may be necessary, and healthcare providers must act with caution to avoid preparing internalised weight bias and stigma if patients fail to control their weight by trialling this programme. The roots of obesity run deep and can be genetic, psychological, sociocultural, economic, and environmental.“Responsible consumption” has been a core message in the lead-up to the Food Systems Summit. However, the challenge is more complex and requires the government to commit to restructuring and legislating environments to reverse the balance and ensure healthy foods are affordable to everyone, while HFSS products become costlier.
A further recommendation of the new strategy is linked to the provision of nutrition education in schools and increased eligibility for free school meals. Children spend most of their time in schools, making them an ideal intervention setting. Nevertheless, what we have learnt from successful childhood obesity treatment and prevention programmes, for instance, the government-led Elige Vivir Sano programme, is the need to simultaneously launch initiatives that promote healthy behaviours during school holidays. Today, 38% of individuals familiar with Elige Vivir Sano claim to have changed their behaviours as a response to it.
The National Food Strategy presents a bold vision for the future and sends a strong message of the food system challenges we are facing in the UK and the rest of the world considering COVID-19 and beyond. The government is expected to react within 6 months. We remain optimistic that, if they give the report the recognition, and more importantly, the response it deserves we can optimise the UK’s food system for nutrition and equity, and address obesity. The UN Food Systems Summit is equally an opportunity to identify concrete actions and coordinated global responses for greater resilience and to halt the rise of malnutrition in all its forms.
Claudia Selin Batz, Policy and Projects Coordinator, World Obesity Federation
Jane Gordon, Data and Evidence Assistant, World Obesity Federation
Maria Bryant, Association for the Study of Obesity Chair of the Board of Trustees