But ambition is one thing, a workable strategy and its competent implementation something entirely different.
All previous attempts to launch a comprehensive obesity strategy in the UK have fallen flat, derailed in large part by the lobbying of a handful multinational conglomerates responsible for the great bulk of sugary junk foods sold in Britain and around the world.
Politicians always start in the right place – demanding cross-government action on both the supply and demand sides of the equation – but end up with campaigns which place all the emphasis on consumer behaviour. Not surprisingly, they are then derided as “nannying”.
The appalling Change for Life campaign which kicked off in 2009 with an advertisement depicting non-sedentary cavemen living alongside dinosaurs was a classic of the genre.
Chadwick also faced a vociferous economic elite who regarded disease, not as a societal problem, but one of personal frailty. His genius was to show, empirically, that disease had more to do with urban squalor than individual failings.
The same point holds good today. Obesity, like good hygiene, is an environmental problem. Its primary determinants are high calorie intake and low levels of physical activity. Personal choice plays a role but not much of one when the world around us is designed to prompt constant grazing on sugary foods and a sedentary lifestyle.
The early noises from Downing Street are that the Prime Minister intends to tackle the UK’s “obesogenic environment” head-on. Already local authorities nationwide have been ordered to narrow roads and widen pavements in an urgent bid to encourage cycling and walking.
The new strategy is also expected to financially incentivise GP’s and NHS trusts to encourage those most at risk to have bariatric surgery and other proven interventions. This should force the NHS leadership to move beyond simply paying lip service to the issue.
But it “population-level interventions” on the supply side which have the most impact and without which any strategy is certain to fail.
Just as the ban on smoking in public buildings proved a game-changer in tobacco consumption and breathalyser tests, seatbelts and speed limits slashed road traffic deaths, it is legislation which cuts calorie consumption that will be the game changer for obesity.
The empirical evidence for this comes from Public Health England’s sugar reduction initiative – one part of which is voluntary, the other statutory. It aimed to reduce the average sugar content of all UK food products by 20% between 2015 and 2020.
Final results have yet to be published, but by 2018 the statutory Soft Drinks Industry Levy, which imposes a wholesale tax on the most sugary soft drinks, had cut sugar in the drinks it applies to by an impressive 28.8%. In contrast, the voluntary scheme, which covers all other products and relies on the goodwill of the food industry achieved only a 2.9% reduction.
If the Prime Minister is to become a modern-day Chadwick, he will need to follow the evidence. An obesity strategy which does not restrict sugar consumption will be about as much use as a sanitation policy without a sewage network.
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