Can public policy tackle obesity?

Drugs aren’t the answer to everything obesity-related though; arguably, changes in lifestyle, diets and activity levels have played a massive role in creating the obesity pandemic in the first place, which means that effective policies around exercise, public health, and what we eat are crucial if we’re to halt the trend. Dolly van Tuelleken is from Cambridge University's MRC Epidemiology Unit. She told me why, compared with yester-year, waistlines are bulging more than any other time in human history…

Dolly - The vast majority of our diets would've been made up of essentially whole and minimally processed foods, foods that you would recognise as having maybe grown in the ground or come from an animal, et cetera, et cetera. Maybe processed a bit, so we would have foods such as milks and cheeses. These days though, we have seen the huge ultra processing of foods to almost an unrecognisable state. So you can look at ingredients, lists of packets of food in the supermarket today, and there might be not even anything in the ingredients list that you would recognise or just a handful of many of the ingredients that we've recognised. So we've had this huge ultra processing industrialisation of our food system, and that has basically led to an enormous rate of diet related disease and food related ill health in that time. And that's for all sorts of reasons. That's because these highly industrialised foods often contain ingredients and additives that we are slowly starting to find out have very harmful effects on our health. They are designed purposefully in a way to be hyper palatable. That delicious, almost addictive quality. They are also designed to be over-consumed. And that's not just the food itself in the way that it's designed, it's also the way that the marketing is designed and the fact that you can have 'buy one get one free's on unhealthy foods, which we know isn't about giving people, out of kindness, more food or food for free. It is about making sure that people consume more and more of those products and have that familiarity with those products, those products built up over time. So there are lots of techniques and strategies that the largest food companies in the UK use to make sure that people consume as many of their products as possible. And unfortunately, the majority of those products that they sell are unhealthy.

Chris - Do you not feel a bit uncomfortable, then, that we're in a position where we're having to invoke drugs, jabs, injections, pills in order to combat what is effectively a marketing success? We've basically made food over-addictive, over-calorie rich, and people are overeating it as a result, and now we're having to compensate by giving people injections.

Dolly - Yeah, I mean it's a very bleak way to put it. I was having a conversation recently and the idea of a kind of corporate solution by big pharma to a corporate problem made by big food was discussed. And that is another pretty bleak way to look at it. Essentially you've got huge industries that are making, um, a lot of money from treating a problem that another group of people in companies are making a lot of money from. So it is sad, but it's really important to provide treatment to people that need it. We are where we are in terms of the system that we have, the food system that we have, and the health consequences of that. So it's really important that no individual is penalised for being part of that system. And if their health has been affected, then they should absolutely get access to the treatment needed. But in order to tackle this issue, I don't see treating our way out of it as the solution. We cannot treat them and send them back to the conditions that made them sick in the first place. We have to see essentially a transformation of our food system so that it enables good health for everyone.

Chris - That effectively means policy, doesn't it? It means we need healthy food, and healthy eating policy, and something has got to change. So what is the nub of that? Where do we go in order to exact that? Because governments have been told for decades that the population are becoming overweight. This is becoming a huge drain on resources. It's very unhealthy for them. They know that. Why have they not been able to do anything? It can't be an easy nut to crack.

Dolly - The UK government has been trying to tackle obesity and food related ill health for decades. It published its first obesity reduction targets in the early 1990s, and you won't be surprised to know that they never reached the targets. But since then, we've basically had government, after government publishing strategies containing literally hundreds of policies. We've had 689 policies published by the government to tackle obesity and food related ill health since the early nineties. So a huge number of ideas were proposed. And, and behind that, I would absolutely say that politicians and governments have wanted to tackle this. It's not that there's necessarily a lack of will to do that in government. There has been a tension on this, but it is a very difficult problem to solve. Part of it is because policies are so rarely fully implemented, and there are lots of reasons why that is, but there are lots of good ideas out there. It's just that the nature of government and the politics of it means that ideas don't get seen fully through and we'll either have the same ideas proposed again and again, delayed, scrapped, introduced but weakened. That happens time and time again. And we're seeing that at the moment. So implementation is one of the biggest problems. The second is that the government has tended to try and focus on getting people, individuals, to change their own behaviour without making that easy by shaping the environment around them. And we know that that doesn't work because essentially you are telling people to change their behaviour in a situation that makes it incredibly difficult, and in some cases almost impossible, for people to do that. But I would say on a positive note, we've had more governments in recent years proposing more policies that seek to shape the environment, to make it easy for everyone to live a healthy life.