Diet, health and obesity

Thursday 6 May 2004

'Choosing health? Achieving a balance between diet and exercise' conference, QEII Centre, London.

Introduction
You don't have to be a statistician to know that obesity is on the rise – that children as well as adults are getting larger. And you don't have to be a doctor to know that weighing too much is bad for your long-term health.

Obesity costs people in terms of quality of life, and years of life. And it will cost the nation a great deal of money to treat if we don't do something to tackle it now.

What is the Food Standards Agency's role? Our remit includes nutrition. Nutrition and obesity are linked, though the two are not the same. For instance, eating too much salt, which on average we do, won't make you larger but it will raise your blood pressure.

Most people – mainly the better off – have no problem eating a healthy balanced diet. But too many people eat too much fat, sugar and salt – and one consequence of the wrong diet can be obesity.

In the next few minutes I want to talk about: Why? Who? and How? Why are people getting larger? Who is responsible for tackling the problem? And how are we going to it?

Why are people getting larger?
People's weight depends in part on the calories they eat and in part on the calories they spend. You read a lot of debate about which of the two is more important: is it sloth or greed? I get the feeling sometimes that the energy spent in this debate is enough to solve the obesity crisis on its own.

The key issue, however is balance. After I've been for a long run I'll eat like a horse. But if I've been lounging by the pool on holiday I only feel like something light. But for some reason, for some people, the body's normal system for balancing intake and expenditure seems to have broken down in recent years. There are plenty of possible explanations for this.

Could it be, for instance, that nowadays there is huge variety and availability of food, much of which is processed food with a high energy density? This combination might make it more difficult for our bodies to balance the equation.

And if you are going to lose weight or avoid gaining it, eating less is more effective than exercise alone, as a recent review by the Health Development Agency has shown. Doing both is the most effective combination.

Who is responsible?
Most people, quite rightly, see the Food Standards Agency as responsible for controlling 'traditional food risks' like food poisoning bacteria or chemicals contaminating food. But by far the biggest food risk for all of us is an unbalanced diet.

When it comes to diet and health, most say it's a matter of individual or parental responsibility. And of course, individual responsibility is the starting point. We all make choices about what food we eat and how much. But this does not mean that government, educators, NGOs, local groups, health professionals and others, and industry have no responsibility.

I see the FSA's role as helping, along with others, to create an environment in which individuals and families find it easier to choose to eat a healthy diet. For instance, our work on promotion and advertising of food to children is about creating the right environment for children

This environment involves three things: choice, information and influence.

Are the choices on offer to us ones that make it easier or harder to eat a balanced diet? In the old days when many meals were made up in the home from the basic ingredients – the traditional meat and two veg dinner, for example – it was generally accepted that there is no such thing as a good and bad foods, only good and bad diets.

But in the world of processed foods, snacks, ready meals, and eating out that we inhabit today, the choices about what goes into our diets are increasingly being made for us by others. The old distinction between foods and diets has become blurred.

So we cannot just say it's up to the individual to choose. The companies that make and serve our food have a responsibility to ensure that their offerings make it easy to go in a healthier direction. And this is certainly not always the situation at the moment.

Likewise, asking people to make choices means giving them information.

Yesterday I was looking at the labels on two snacks. One company chose to give me very clear information about what percentage of my daily target intake of salt, sugar and saturated fat was in the pack. The other just gave me a lot of data on sodium, fibre, fat and kilojoules – but no guide as to what it means for me, the consumer.

There is plenty of room to make the information on food labels easier for people to use. In time, the regulations are likely to change at a European level. In the meantime the FSA is exploring a range options for the food industry such as a simple traffic light system of the kind you already see on some restaurant menus, to give people the signposts to help them choose.

This is not about saying 'you should never eat such and such'. It's about recognising that some of the things that we call foods are in fact treats or extras to be eaten in modest amounts rather than as staples of our diet.

At the same time, our children need to be absorbing the basic messages at school to equip them to use the information.

Our latest consumer attitude survey shows that one third of consumers claim to have changed their eating habits in the last year towards a healthier diet and about half are concerned about fat, sugar and salt in food.

This suggests that the messages are beginning to get through, and that consumer demand is beginning to create new opportunities for food businesses. But let's see genuinely healthier options – not just healthier-sounding options – coming through to foster that demand.

Going beyond what is on offer and what is on the label, we are all influenced by the cacophony of advertising, promotion and marketing of food.

The review we commissioned from Gerard Hastings on the impact of promotion and advertising of food to children was comprehensive and impartial.

It has been more thoroughly scrutinised and reviewed by independent experts than any similar piece of work. It has withstood the criticisms, and in my view its conclusions hold.

They are that promotion and advertising of food to children not only affects brand loyalty (Kit Kat versus Mars) but also choices amongst categories (sweets versus fruits). It is not possible to put a number on the size of this effect, but peers and parents, who are subject to the same influences, amplify it.

Armed with this evidence, and after a considerable amount of public debate, the FSA has produced an action plan, which is out for consultation until July. The plan covers not just TV advertising, but all aspects of the food environment of children: schools, shops, restaurants, media and so on.

How do we tackle the problem?
Let me end by summarising what I see as the likely next steps in tackling obesity in particular and balance of the diet more generally.

Tempting though it is to be seduced by the single issue, there is not going to be a single quick fix. Some say, if only advertising were more regulated, if only labels on food were clearer, if only there were more cycle tracks, the problems of nutrition and obesity would be solved.

But don't forget that the USA has arguably the best nutrition labelling around, including a mandatory definition of portion size, and yet has an expanding waistline. Holland is a cyclist's paradise, but it still has an increasing concern about obesity.

So we should not be talking 'either/or', but about a range of measures, involving as many people as possible, to change the environment in which people choose, to make the healthier choice the easier choice.

And you are already involved. I just want to say a few words about what we are doing in the FSA.

One of our roles is working with the food industry.

The consumer's growing interest in healthy eating is setting the scene for changes in the food industry, which sees new opportunities.

But how will the industry respond? Some people tell us that the only answer is more regulation. But this isn't our experience.

Look at the work we have be doing on salt over the past 18 months. We have done three things:

• First we assembled the latest scientific evidence on which to set targets for adults and children.
• Second we gave consumers information about the hidden salt in their food. In part to show them how much is there and in part to show that equivalent products from different shops can vary hugely in the salt content. We will continue to do this as a means of helping to inform consumers and create demand.
• Third, we talked to the different players in the food industry and developed targets for salt reduction, recognising that it will be gradual and involve not just a few, but all the products we eat.

At first the pace of change was disappointingly slow, but momentum is now building and changes are beginning to come through that will really reduce risks to you and me. A key thing for us is that any changes are properly documented and checked. Our aim is to protect the health and interests of consumers, and to do this we will continue to hold the industry to account publicly.

It's a long road and at the moment we are just half way to the M25 if you think of it as a journey from London to Edinburgh. But at least we are travelling in the right direction. And we won't be taking our foot off the pedal.

Some changes will come through legislation, for instance the new European proposals on health claims related to food and the expected proposals on nutrition labelling.

In the FSA's work with the Department for Education and Skills we are identifying the steps towards changing the school food environment, in the classroom, the lunch queue, the tuck shop and the vending machine.

And when our 20-point Action Plan on promotion of food to children is finalised, we will be ready to recommend a whole range of changes for the better.

One thing is clear. The problem will not go away. We cannot turns our backs on it. Talking is fine, but doing is what counts in the end. And all of you have been working on nutrition and obesity for many years. Perhaps what has been missing so far is the focus and support from within government. But looking at the programme and speakers today, its clear that the focus is now there. This will help all of us to make a difference.