'Fizzy drink tax' to stop UK being 'fat man of Europe'

The Academy of Medical Royal Colleges has published a report containing 10 recommendations designed to tackle the UK’s obesity epidemic – a story covered by most of the UK media.

The latest health survey data suggests the UK is the ‘fat man of Europe’, with a quarter of men and women, and one in five 10-11 year olds being obese.

In a compelling analogy, the report likens the current situation of obesity to that of smoking during the 1970s.

During the 1970s, most people working in the medical profession knew that smoking presented a significant risk to public health, but little was being done about it.

The report argues that a similar situation now exists regarding the health risks associated with obesity – which is estimated to cost the NHS £5.1 billion a year.

The views of thousands of practicing doctors in the UK were sought by the report's authors on how best to tackle the obesity crisis.

The report presents 10 key recommendations on new ways to address the growing public health problem of obesity, including:

  • banning junk food advertising before the 9pm watershed
  • reducing the proximity of fast food outlets to schools, colleges and other places were young people gather
  • a one-year trial of a 20% tax on sugary drinks, to see what effect this could have

As the chair of the Academy of Medical Royal Colleges says, ‘This report does not pretend to have all the answers. But it does say we need together to do more, starting right now, before the problem becomes worse and the NHS can no longer cope.’

Where did the report come from and why was it carried out?

The report, ‘Measuring Up: The medical profession’s prescription for the nation’s obesity crisis’, was written by the Academy of Medical Royal Colleges and published this month.

It reveals how data from the 2009-11 Health Survey for England suggests that the UK is the ‘fat man of Europe’.

The survey showed that one quarter of men and women in England are obese (defined as a body mass index [BMI] over 30) and that two thirds of adults are obese or overweight (BMI over 25).

Another worrying trend highlighted by the report is that the 2011-12 National Child Measurement Programme reported that one in five children aged 10-11 is obese and one in three is overweight or obese.

Over the last 20 years, the number of morbidly obese adults (BMI over 40) is said to have more than doubled and now stands at over 1 million UK citizens.

The report is said to represent the views of the vast majority of the UK’s 220,000 practicing doctors, who are ‘united in seeing the epidemic of obesity as the greatest public health crisis facing the UK’.

It is said to be ‘unprecedented’ for medical colleges and faculties to come together like this, but they have done so in recognition of the massive crisis that is happening and the fact that current strategies to reduce obesity are having an insufficient impact. 

The report says that both past and current governments have made stringent efforts to address the tide of obesity, and there has been progress, such as the ‘traffic light’ food labelling in supermarkets and the ‘5-a-day’ scheme. However, the UK still faces ‘a problem of epidemic proportions’.

The report does not claim to be a systematic review of all available strategies to tackle obesity, and the authors explicitly say that the recommendations they make have not been tested in randomised controlled trials.

Instead, the Academy embarked on a ‘call for evidence’, inviting individuals and organisations to ‘tell us what works’.

It wanted to hear from those who could recommend interventions and programmes that had helped to either prevent or treat overweight and obesity in the areas of individual responsibility, action by healthcare professionals, environmental factors, economic measures, and educational influences.

The Academy says it received hundreds of suggestions, and the discussions that followed helped it to further focus thoughts and ideas.

What were the main findings of the report?

The report has 10 key recommendations which include actions that would need to be taken by health professionals and ways to make healthier choices easier. The key recommendations are as follows:

  • *Education and training programmes for healthcare professionals:
    The report says that Royal Colleges, Faculties and other professional clinical bodies should promote targeted education and training programmes within the next two years. These should help to train healthcare professionals working in both general practice and hospital care to ensure that they ‘make every contact count’. This means sensitive recognition and appropriate referral and management for overweight and obese patients.
  • Weight management services:
    It is recommended that the departments of health in the four UK nations should together invest at least £100 million in each of the next three financial years to increase provision of weight management services across the country, to mirror the provision of smoking cessation services (£88.2 million was spent on smoking services in 2011/12). This is recommended to include both early intervention programmes and greater provision for management of severe obesity, including bariatric (weight loss) surgery. The report says that adjustments could then be made to the Quality and Outcomes Framework, providing incentives for GPs to refer patients to such services.
  • Nutritional standards for food in hospitals:
    Within the next 18 months food-based standards should be introduced in all UK hospitals in line with those put in place for schools in England in 2006. Commissioners should work with a delivery agent similar to the Children’s Food Trust to put these measures into place.
  • Increasing support for new parents:
    The health visitor service in England should be extended to include delivering basic food preparation skills to new mothers and fathers, and to guide appropriate food choices which will ensure nutritionally balanced meals, encourage breastfeeding and using existing guidance in the Personal Child Health Record as a tool to support this.
  • Nutritional standards in schools:
    The existing mandatory food- and nutrient-based standards in England should be applied to all schools including free schools and academies. From the 2014/15 academic year, this should be accompanied by a new requirement on all schools to provide food skills, including cooking and growing – alongside a sound theoretical understanding of the long-term effects of food on health and the environment.
  • *Fast food outlets near schools:
    In its first 18 months of operation, Public Health England should undertake an audit of local authority licensing and catering arrangements with the intention of developing formal recommendations on reducing the proximity of fast food outlets to schools, colleges, leisure centres and other places where children gather.
  • Junk food advertising:
    A ban on advertising of foods high in saturated fats, sugar and salt before the television watershed of 9pm, and an agreement from commercial broadcasters that they will not allow these foods to be advertised via internet ‘on-demand’ services, such as ‘catch-up’ internet streamed TV services.
  • Sugary drinks tax:
    A duty should be piloted on all sugary soft drinks, initially for one year, increasing the price by at least 20%. The authors say that estimates suggest a duty of just 20p per litre could generate revenue of approximately £1 billion per year, which could theoretically be used to provide weight management programmes across the country. It is suggested the tax would be an experimental measure for one year, looking at the effects and then seeing what impact it has upon consumption patterns and producer/retailer responses.
  • *Food labelling:
    In the next year, major food manufacturers and supermarkets should agree a unified system of traffic light food labelling (to be based on percentage of calories for men, women, children and adolescents) and visible calorie indicators for restaurants, especially fast food outlets.
  • Travel and green spaces:
    Public Health England should guide Directors of Public Health in working with Local Authorities to encourage active travel and protect or increase green spaces to make the healthy option the easy option. In all four nations, local authority planning decisions should be subject to a mandatory health impact assessment to evaluate their potential impact upon the populations’ health.

What happens next?

The report outlines what medical professionals believe to be ‘a wide-ranging set of recommendations that have the clear objective of reducing the prevalence of obesity across the UK population’. The authors looked at the obesity crisis from both the doctors’ and patient/public’s perspectives, and have made the responsibility of professionals clear, while being realistic about limitations. 

The Chair of the Academy of Medical Royal Colleges concludes, ‘This report does not pretend to have all the answers. But it does say we need together to do more, starting right now, before the problem becomes worse and the NHS can no longer cope.’

He continues: ‘We suggest 10 ideas that should be considered seriously. They need to be evaluated and, if they don't work, we need to explore other options. There is no single simple solution – if there was we wouldn't be in the position we are now. But this is no excuse for us to sit on our hands and do nothing.’ 

In response to the report, a spokesperson for the Department of Health quoted in The Guardian said that it was considering the report’s findings.

If the relevant authorities do decide to implement the recommendations contained in the report, due to their wide-ranging nature, it is unlikley that they will come into force during this Parliament.   

NHS Attribution