When I was younger, and at war with my own body, I was a sucker for diets. I tried The Rotation Diet (Lose Up to a Pound a Day and Never Gain it Back), The Beverly Hills Diet (a 35-day programme, but I never made it past the first three days) and numerous punitive low-fat regimes involving raw carrots and dry crispbread. None of them lasted long, but each time I broke a diet, I would soon be looking around for another, equally unrealistic, weight-loss plan. No matter how similar the new diet was to the last, it gave me a sense that I was doing something productive about what I saw as the problem of my body.
Personal weight-loss diets have a lot in common with obesity policies in England and beyond. For a start, the sheer quantity of these policies is astonishing. Earlier this year, two researchers based at the University of Cambridge – Dolly Theis and Martin White – published a paper showing that from 1992 to 2020, there were no fewer than 689 separate obesity policies put forward in England. Like failed diets, almost none of these initiatives have been realised in any meaningful way. Instead, their main effect has been to remind people with obesity that the government views the mere existence of their bodies as a “crisis”.
While England is not alone in failing to reduce the prevalence of obesity – the World Health Organization reports that it has more than tripled worldwide since 1975 – “obesity policy” in England has been strikingly ineffective. (I say England because since devolution, Scotland, Wales and Northern Ireland have their own separate health policies.) Between 1993 and 2015, obesity among England’s adult population rose from 14.9% to 26.9%. Twice as many adults in the UK are living with obesity as in Italy, Sweden or Switzerland. At the same time, levels of hunger in the UK are some of the highest in Europe. Nearly one in five 15-year-olds live in a household where the adults are “food insecure”, which is a fancy way of saying that they can’t reliably afford enough food.
Covid has brought to the surface some hard truths about the British food system, and what a poor job it does of feeding the population as a whole. As the first lockdown hit in March 2020, plenty of better-off British households were able to carry on eating much as before, while millions more were plunged into food poverty. According to data from the Food Foundation, during the first two weeks of lockdown in the spring of 2020, the proportion of households facing food insecurity doubled to more than 15%. Black and Asian people have been twice as likely to suffer hunger during the pandemic as their white counterparts. As Marcus Rashford said in a letter to parliament about food poverty in June 2020, “This is a system failure”. But it is a system failure that existed for decades before the pandemic at long last pushed it on to the national agenda.
British politicians, as a rule, have shown little interest in tackling the problem of poor-quality food and its relationship to health. These policy failures go back to the 19th century. Our early Industrial Revolution meant that a larger percentage of the population lost its connection with agriculture at an earlier stage than in any other country. When it comes to food policy, there has long been an attitude of “leave it to the market” (the shining exception being the two world wars, when the constraints of rationing forced governments to join the dots on food and health). Campaigners against the grossly adulterated food supply in Victorian times sometimes complained that the selling of food in London operated on “buyer beware” principles, which meant that grocers were free to sell poisonous pickles and fake coffee to an unsuspecting public without fear of retribution. Not much has changed, except that instead of poisonous pickles, we are sold a surfeit of ultra-processed food.
Recent English obesity policies have spoken endlessly of “action” to help people eat healthier diets, but what they deliver, often as not, is another raft of patronising diet information leaflets, such as the bright yellow Change4Life diet pamphlets handed out in schools and GP surgeries. (One uninspiring gem: “If you’re shopping for packaged snacks for your children, try sticking to 100 calorie snacks.”)
For three decades, Theis and White found, successive governments have repeatedly proposed “similar or identical policies” and then not done anything to see them through. What counts as an obesity policy could be anything from a plan of action to a statement of intent. Whichever party has been in charge, the most popular policies have been ones placing high demands on individuals to make personal changes (such as the 5 a day campaign) rather than meaningful reforms such as restricting the sale of unhealthy foods, or subsidising fruits and vegetables to make them more affordable. Most of the ideas for structural interventions – for example, that the food industry should reformulate its unhealthiest products – were voluntary. Unsurprisingly, compliance was not high. One of the few exceptions has been the Soft Drinks Industry Levy (AKA Sugar Tax) of 2018, which resulted in a 30g a week drop in household sugar consumption, but I suspect that this will turn out to be a pyrrhic victory given new evidence that consuming aspartame, the artificial sweetener used in many diet drinks, also causes weight gain as well as possibly altering the gut microbiome.
The almost 700 obesity policies fell under the banner of 14 separate obesity strategies. It is poignant to read the titles of these largely failed and forgotten strategies, which share an air of wishful purpose. Under John Major in 1992, there was Health of the Nation. Next, under Tony Blair in 1999, came Saving Lives. Also under Labour came Choosing Health (2004), Choosing a Better Diet (2005) and Choosing Activity (2004, 2005 and 2005) and Healthy Weight, Healthy Lives (2008). The Coalition government produced Healthy Lives, Healthy People and A call to action on obesity in England (2011). Most recently, under the Conservatives there have been three instalments of Childhood Obesity: A Plan for Action and then, in 2020, Tackling Obesity.
Notice how the words “choosing” and “action” keep reappearing in these strategies. Given that poorer UK households would have to spend nearly 40% of their income to buy food for a healthy diet, according to recent data from the Food Foundation, to frame healthy eating as simply a matter of “choosing” is dishonest. It’s not choice if you can’t afford it.
Decades of research show that obesity is determined to a large extent by environmental factors such as socioeconomic inequality, the rise of ultra-processed food and the way that cities are built to facilitate car use. But policymakers of England have stayed wedded to the idea that weight is all about personal responsibility: just eat less and move more.
The failures of obesity policy in England and the UK are part of a larger problem with food policy in general. As well as being a source of joy and nourishment, food is Britain’s biggest employer, accounting for 4.1m jobs (most of them low-paid). At the same time, poor diet is the country’s biggest cause of preventable disease and the food supply is also one of its biggest drivers of climate breakdown (10% of our greenhouse gas emissions come from agriculture).
And yet for decades, a food policy to address any of this has seemed to be missing in action. Fewer than a quarter of the policies analysed by Theis and White (24%) included any plan for monitoring their progress. Nearly a third (29%) of the policies did not include any timeframe, any evidence or any position on who or what is responsible for driving the rise in obesity. It isn’t just that food policies in England have long been ill-suited to improving our diets. It is that very few people, inside or outside government, seems to have the slightest idea what these policies actually are.
Earlier this year, the need for a radical rethink of food policy in the UK was set out in Henry Dimbleby’s National Food Strategy: The Plan, an independent review commissioned by the Department for Environment, Food and Rural Affairs (Defra). Dimbleby, one of the founders of the Leon chain of cafes, wrote the report after consultations with more than 300 organisations, as well as town hall meetings with members of the public. It took three years to produce.
Unlike all the earlier failed obesity policies, Dimbleby’s plan recognised that how a person eats is not just a question of personal choice, and that healthy food is a basic need for all of us, no matter how much we weigh. It called for a range of ambitious strategies themed around reducing diet inequalities, improving food education, making better use of land and, crucially, setting as a clear goal that the food system of the future must “make us well instead of sick”. It suggested that school inspections should pay as much attention to cookery and nutrition lessons as they do to English and maths, and that meat consumption should be cut by 30% over 10 years, with more investment going to growing vegetables and fruits.