It is well established that children growing up in the UK are much more likely to be overweight or obese than those in other European countries. As a result they are much more likely to grow up suffering a catalogue of health problems linked to being overweight. Many of the next generations will be vulnerable to conditions like type II diabetes, heart disease and high blood pressure, along with associated implications such as poor sleep quality, painful knees and backs, and higher infertility rates.
If we are to change these trends we must ensure that interventions for tackling the obesity crisis are concentrated in those areas where they are most needed, making healthy choices – whether through nutrition or exercise – easy.
Specifictaxation on foods high in salt, sugar and fat is one way to help fight the obesity epidemic.
The latest statistics from the Health and Social Care Information Centre showed that children in the UK are continuing to get fatter, with one-fifth of children aged between four and five and one-third of children aged between 10 and 11 now overweight or obese.
Furthermore, children from lower income families were identified as being most at risk. A quarter of all children aged 10 or 11 in the most deprived areas of England are overweight compared with one in eight in the wealthiest parts of the country. London’s rates of obesity were particularly high. For children aged between four and five years, the range went from 5.5% in the Royal Borough of Windsor and Maidenhead to 14.4% in the London borough of Hackney. In year six it ranged from 11.1% in the affluent borough of Richmond upon Thames to a startling 26.7% in the economically deprived borough of Southwark.
Cheap as chips
Although some grocery prices have recently gone down in the UK, healthy, fresh food is often more expensive to buy than fast food. For example, 2kg of potatoes are priced at £2 compared with 82p for stored-brand chips at one supermarket chain. A pack of two fresh chicken breasts at the same supermarket costs approximately £3 before the cost of spices or sauces used to cook with it, compared with a pre-prepared and ready-to-heat curry at just 95p. Many 2-for-1 offers and multi-buy options in supermarkets are for unhealthy products such as cakes, sweets, crisps and fizzy drinks, so for low-income families, healthy food is a difficult option. This dilemma has been clearly demonstrated by the Institute for Fiscal Studies, an independent microeconomic research institute, whose analysis showed families reducing their expenditure on food purchase cheaper and less nutritious alternatives.
So why, in a country where obesity is estimated to cost the NHS £5bn a year, does most junk food remain cheaper than healthier alternatives?
For too long the UK’s coalition government has been gently “nudging” people to make healthier choices through traditional campaigns such as Change4Life and “5-a-day”, but reviews of these approaches indicate a consistent problem relating to the funds available to families to spend on food.
Hard-line measures required
If we are to get to grips with the obesity crisis, policy initiatives are required to make the healthy choice a more affordable choice. One such measure is to tax foods high in salt, sugar and fat.
Some countries including Hungary, for example, already do this. The strategy is not always popular and some research suggests it isn’t immediately effective. But there is considerable evidence that fiscal measures such as taxation not only lower the consumption of unhealthy foods, but are also cost-effective over the longer term. An Australian study
calculated a saving of 559,000 disability-adjusted life-years (DALYs) on a 10% tax, with AU$18m investment. The report “
Food taxes and their impact on competitiveness in the agri-food sector
, produced last year by the European Commission, also confirmed that specific taxes on sugar, salt or fat do cause reductions in consumption in European countries.
For many people, such a food tax is seen as hitting those least able to afford it, but there are a number of ways this kind of tax could be implemented, rather than just a VAT-type tax on individual ingredients. One method incentivises manufacturers to adjust their prices to promote healthier alternatives and smaller portion sizes. To do this, government would need to excise a ‘SASS’ (salt, alcohol, sugar, saturated
fat) tax on each gram of saturated fat, salt and sugar.
To illustrate, taxes on tobacco have certainly had an impact on behaviour. According to campaigning charity Action on Smoking and Health the price of tobacco has increased by 80.2% between 2003-2013, making it 22.1% less affordable.
The proportion of household expenditure on tobacco has decreased from 3.6% 1980 to 1.8% in 2013.
The UK Government could also look to New York, Mexico, Hungary and France, where authorities have introduced a tax on high-sugar carbonated soft drinks to much acclaim.
Soft drinks, causing obesity and tooth decay, are the biggest source of sugar for children. The latest NHS figures show that about 25,800 children aged between five and nine are admitted to hospital with tooth decay each year. This has rocketed by 14% in just three years. It is therefore logical to tax this food ingredient first – a move backed by the UK’s Chief Medical Officer, the London Food Board, the British Dental Association and the London Health Commission. Many figures in the voluntary sector such as the Children’s Food Campaign and Citizens UK are also campaigning for this move.
There is a grave risk that if we do not commit to bold national strategies like these, we will not make inroads to addressing the UK’s high obesity rates.
Of course, fiscal measures alone are unlikely to prevent obesity. Collective action is required from many groups, including healthcare professionals, the government, parents, food manufacturers, supermarkets and advertisers.
If we want to get it right, data suggest
we need to begin early in a child’s life. We must educate children on what constitutes a healthy meal and teach them how and what to cook at a much younger age. We also need to ensure all school meals, regardless of whether they are served in an academy, free school or state school, meet strict nutritional standards. It is encouraging that this policy is now in place for newly established free schools and academies, but we must make sure that those existing schools that have not yet made the transition to a healthier school menu catch up quickly.
Outside the classroom, we need to look at other factors that affect children’s food choices.
Advertising has a powerful influence on children’s food choices, parents’ purchase behaviour and, ultimately, consumption. This effect means we need a ban on fast-food advertising before the 9pm watershed in addition to a restriction on new fast-food outlets being established within short distances of schools and colleges. Local authorities must consider the impact on health and well-being when they are planning new developments so that children have safe places to play and exercise.
A concerted and collaborative effort is needed if we are to reduce the UK’s obesity rates. Interventions must target greatest need; healthy choices must become easier choices facilitated by policies such as fat and sugar taxes. There must be an expansion of work with young children to teach them the importance of healthy eating and physical activity. Only by taking all these actions will we be able to slow the UK’s obesity rate.
By Colin Michie, chairman of the Royal College of Paediatrics and Child Health’s Nutrition Committee
 Food taxes and their impact on competitiveness in the agri-food sector: interim report. 20 March 2014.
 van Jaarsveld CH, Gulliford MC. Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study. Arch Dis Child. 2015 Jan 29 [Epub ahead of print].
 Lloyd J, Wyatt K. The healthy lifestyles programme (HeLP) - an overview of and recommendations arising from the conceptualisation and development of an innovative approach to promoting healthy lifestyles for children and their families. Int J Environ Res Public Health 2015;12:1003–19.