Obesity

I start by making several assumptions on behalf of us all here today: that we have a significant problem on our hands, and that we are not prepared to sit back and let life expectancy go down or ignore all the other consequences of the obesity timebomb. That we are looking for answers, and we recognise that there are no simple solutions.

Even if the problem can be reduced to a simple physical equation between energy in and energy out, how to deal with that apparently simple imbalance is not a straightforward matter.

What has changed in the last 20 years? Certainly not genetics. Possibly energy intake? And probably energy output. Eating habits have changed, and people are now eating more energy dense food – which probably work against the grain of the body's natural body mass regulatory mechanism.

When I leave Oxford in the mornings, I see the kids going to the local school eating their breakfast of two packets of crisps and a can of fizzy pop – a perfect example of energy dense, high fat, high sugar food being consumed at the start of the day.

The Health Development Agency recently produced an analysis of the efficacy of measures in the management of obesity and overweight, looking at what works and what doesn't. Basically, it makes the point that we need to be tackling intake and expenditure together. And that we need to get on with it, with concentrated focus and effort over a time period.

Just as an example of the difficulty of working off calories, I go to a local gym regularly, and I see people do 25 minutes or so on the treadmill and come off having really worked hard to burn off, say, around 200 calories. Then they go to the soft drinks machine and put the 200 calories straight back on with one quick drink. To me this illustrates why, if anything, dietary changes might be more effective than exercising – though both have to be worked on together – as part of the jigsaw of measures needed to tackle obesity.

The Food Standards Agency's responsibility within this very complex mix is to advise the Government and advise the public on food and the balance of the diet. Within that overall remit, one particular area I would like to talk about is the work we are doing on how food is labelled, how it's promoted, and how it is advertised.

About two weeks ago, we launched a paper in which we described a range of possible options for action in relation to promotion and advertising food to children. This followed a review in which we looked through every significant piece of research into the evidence of the effects on children of promotion and advertising of food.

The media coverage since that time has snowballed, and I think has contributed to a shift in public mood. Part of that shift is illustrated by the industry responses reported in the headlines from the last three weeks. Read the newspapers and you'll see reports that Cadbury are thinking of putting health warnings on chocolate bars; that Heinz are considering a voluntary ban on advertising to pre-school children; that Coca-Cola are also to ban advertising to children under 12; and that Walkers will be putting healthy eating messages on crisp packets as from next year.

As well as the shift in public mood, I sense, as compared to the situation four years ago when I joined the Food Standards Agency, that there's a shift in mood within the industry – which is to be welcomed. And I think people and asking what is going to be done, rather than if anything will happen, in relation to promotion and advertising to children.

But there are polarised views. On the one hand, there are the 'nanny state-ists' who favour the path of informing and educating the public and letting them choose.

On the other hand, there are the interventionists, who argue for bans and controls.

And then there are the 'in-betweenists', who are in favour of some combination of voluntary action and education, particularly with the most vulnerable groups in society – children and less well-off consumers – in mind who have less opportunity or means to make use of information.

To quote from a selection of opinion polls published recently, there was one by YouGov ten days or so ago, which showed 94% of respondents saying children's diets were the responsibility of parents. A few months earlier, an ICM poll in The Guardian, had 79% thinking food manufacturers are irresponsible. And a more recent MORI poll shows that 84% of parents think that food companies target children too much in their marketing.

So views may differ according to which questions you ask. A further illustration of this mix of opinions is illustrated by two articles from the Scottish newspapers published on the same day earlier this month. In The Herald, you have Hugo Rifkind saying, 'It's not the fault of McDonald's that fat people are fat,' while in The Scotsman Gillian Bowditch writes, 'Parents who try to counteract the fast-food culture on their own are fighting a losing battle.' Clearly views are polarised both in public surveys and in the media.

Let’s look very briefly for a moment at the role of education and information in schools. FSA’s Deputy Chair, Julia Unwin, gave a talk at this forum a couple a weeks ago in which she referred to a range of work we’re doing in the school environment. One particularly high profile piece of work that was formally launched last week by Melanie Johnson, the Minister of Public Health, is our school cooking bus. It’s called a bus, but is actually more of a pantechnicon which converts into a mobile kitchen classroom, and is a method of bringing practical cooking skills and knowledge of nutrition and food hygiene to children in schools where they don’t have facilities in-house.

Moving from education to choice, there is no point telling people about healthy choices unless they have signposts on the food on which they can base those choices. But the signposts aren’t always that clear. If you want to eat healthily, and look at a typical nutrition label, you’re told, for example, that a particular breakfast cereal contains 1,848 kilojoules per 100 grams, 65.3 grams of carbohydrates, and 16.6 grams of fat. Unless you’re a nutritionist, it’s very hard to tell what you are getting from that information. There is no signpost saying ‘good’ or ‘bad’ if you want to cut down on fat.

Another example is Philadelphia Light, which, looking at the nutritional panel, I see contains 16% fat – which according to FSA guidelines puts it in a high fat category – although many people might buy it thinking it’s a low fat product. So it's clear that some signposts are not always helpful, and if the push is to have information to enable educated choices, we clearly need easier to understand signposts. Labelling nutrients as ‘high, medium, or low’ would seem to be the easiest option, and one that has done well in our consumer surveys.

Another thing that I think we need to be very aware is the notion of some foods that might be signposted as healthy in relation to one nutrient, whilst having quantities of another nutrient that would not qualify for a health claim. I caricature this as, for example, a chocolate bar with added vitamin C. We would not want to see this labelled as ‘a good source of vitamin C’.

Health claims is one of the labelling issues that we are involved with in Europe, and one market where Britain is unusual in Europe is in the area of healthy eating ranges of prepared foods. The European Commission in its proposal on health claims wants to include these healthy eating ranges as part of the proposed health claim legislation, and industry would like an exemption. But the fact is that, since the UK is the only country with a significant market in this area, it is going to be difficult for industry to persuade the Commission.

One critical issue here for the industry is defining what is meant by ‘healthy eating’ on these product ranges in relation to the nutrition profile. What is a ‘healthy eating’ version of a shepherd pie or chicken korma? If the industry could come forward with some draft definitions as part of a code of practice, that might be a basis for discussions in Europe.

Now, let me move then on from labelling, education, and choice and return to the subject of promotion and advertising – not just TV advertising, I’m talking about the whole range of promotion tools in use by the industry: super-sizing, two for the price of one offers, text messaging, use of media icons like the Teletubbies or David Beckham, vending machines in schools, sponsorship, exchanging confectionery wrappers for sports kits and so on.

As you will know, the FSA has commissioned a review of the literature of the impact of these forms of promotion and advertising on children’s food preferences. The review was carried out by a team led by Professor Gerard Hastings from the University of Strathclyde, and, without going through all the details of it, I’ll just say that the review started off with a list of 30,000 papers and reduced this down to about 100 that were considered to be robust enough to contribute to the analysis.

Looking at those one hundred studies, the review concluded that, not only is most of the promotion and advertising for foods that are high in salt, sugar and fat – as groups like the Food Commission have been telling us that for years – but it confirmed that the way the food is promoted and advertised doesn’t relate to its dietary consequences but focuses more on images of lifestyle, fun and associations with icons and celebrities.

But, most importantly, the Hastings study concluded that this promotion and advertising, in the broad sense, influences children’s preferences and dietary habits – just not just in relation to brands (chocolate bar A versus chocolate bar B) – but also in relation to categories: sweets versus fruit, for example.

The review wasn't able to quantify the degree of influence, because so many factors are inter-related: you can't say how much comes from promotion, from peers, or from parents; and where do the parents get their views from? But it did conclude there was some influence from food promotion.

At the same time, the Food Advertising Unit commissioned a study by Dr Brian Young from University of Exeter, which asserts that advertising has no impact on the dietary preferences of children – and that the major influences are peer pressure and parents, or the family background.

Both of these studies have been put in front of a neutral jury of distinguished academics, chaired by Professor Mackintosh FRS, former Head of the Psychology Department in Cambridge, and the jury heard the presentations from the two experts and questioned them. The jury's deliberations are published on our website today, and are that:

• the Hastings review is more systematic and robust, and
• that the group of academics on the jury supports the thrust of the Hasting's review.

I'm aware that the food industry has also commissioned experts to scrutinise the Hastings report and I was told last week by somebody from the food advertising industry that there is to be a report from their expert teams of academics that will conclude that the conclusions of the Hastings review are not justified.

Now, as was said by one major retailer I was in discussion with last week, we could get into an argument about whether our scientists are bigger than yours. But let's not get into that argument. The evidence is sufficiently robust, let's move on. Let's accept that the evidence is not perfect; that the perfect is the enemy of the good; and let's take a precautionary approach and see what needs to be done next.

The question is though, where do we go next?

As I mentioned earlier, the FSA has put out an options paper for discussion, and between now and early next year, we're trying to generate debate so that we can hear what the arguments are for all the different possibilities – and the options paper is not an inclusive document. We are in a stage of listening to the different points of view on our proposals.

I don’t want to go into too much depth here, other than to say that you don’t have to be a rocket scientist to be aware of the intricacies. If you want to ban something, what do you ban, where do you ban it, and how would you implement it? If you want to have a voluntary code – and we’ve already heard that the industry is considering voluntary action - what do you put in the voluntary code? So the devil will be in the details - and that is what we have to start to uncover in the next two to three months.

And I would also like to emphasise before I close, that we should look at the positives as well as the negatives – like offering healthier options in vending machines, or using advertising and promotion as a tool to encourage healthier eating. Maybe we should think of using icons like Johnny Wilkinson to promote fruit and vegetables – to adults as well as children?

I'll end by saying there is a need for a co-ordinated approach involving different parts of Government and many others – the Food Standards Agency being one piece of the jigsaw.

I also think there may never be a perfect solution – but none of us here should sit on our hands and say, 'because we haven't got the perfect solution, we should throw in the towel and do nothing'. In looking at the solutions, we must all consider what's tractable, what's desirable, and where the national balance of opinion lies.