The Prime Minister is known for his opposition to a “nanny state”, which meant opposition to policies aimed at reducing the determinants of ill health, such as obesity.
However, in 2020 Boris Johnson was admitted to hospital with Covid, and obesity probably contributed to the severity of his infection. His government subsequently put forward a new obesity strategy, which promised the end of deals like ‘buy one get one free’ on unhealthy foods. More recently, though, Boris Johnson has done a second U-turn with the announcement that the proposed bans on advertising junk food (before 9 pm) and on promoting it via “buy one get one free” deals will be delayed and possibly never implemented.
Obesity has become an epidemic, and the UK is one of the worst affected nations in Europe in relation to adults.
Obesity increases risk of ill health
Obesity is associated with musculoskeletal complications, diabetes, and cardiovascular diseases. Moreover, obesity also increases the risk of mental health problems, dementia, liver diseases and the risks of least 13 different types of cancer. Obesity is likely to surpass smoking as the biggest preventable cause of cancer.
Boris Johnson, back in 2004, had argued that it is your fault if you are fat. In his view, obesity was a choice and “the more the state tries to take responsibility for the problem, the less soluble the problem will become”. Academics and medical practitioners with an interest in obesity know that this is false.
Professor Ahima in his book, ‘Can the obesity crisis be reversed?’, explains why obesity cannot be easily reversed by simply deciding to eat less and exercise more, as many people cannot control the factors that make them gain weight.
Genetic predisposition may explain why some individuals are at greater risk but does not explain why obesity has increased. The obesity epidemic is better explained by the emergence of what is called an “obesogenic environment”.
Junk food industry
Ready-to-eat and calorie-dense foods have become increasingly available from both supermarkets and fast-food retailers. Junk foods are heavily marketed whilst the time, ability or inclination to cook and eat healthy foods has decreased. Junk food advertising is particularly detrimental on children.
The food industry has created the demand for sugar-sweetened beverages. Sugar does not just add extra calories. Sweetened foods cause a spike in insulin secretion by our body, which increases our hunger and makes us eat more. Processed foods are designed to stimulate our appetite, not to satiate us. A key strategy in reducing body weight is an increase in the consumption of less energy-dense foods, like fruit and vegetables, that will make us feel full despite a lower calorie intake.
It is not just what we eat, but how we eat, that has changed. Cooking and family meals are less common. Grazing in front of the TV and eating out has increased; in these settings, portion sizes and calory-density have increased.
Less opportunity for activity
Work, school, and the built environment are also part of the obesogenic environment that has made us less physically active than in the past. Increasingly, we have sedentary jobs, drive to work and use lifts. Poorer neighbourhoods offer even less opportunity for physical activity or healthy eating.
We need to reverse the decline in physical activity: this requires
having the appropriate infrastructure including safe bike lanes.
Losing weight requires a change in what and how we eat, rather than calory counts, as most of us are not able to eat less if we still feel hungry. Physical activity is beneficial not just because we burn calories: increasing the muscle mass results into increased calorie consumption even when we rest. Weight-control strategies for children include making sure children have family meals, adequate sleep and limited screen time.
Professor Ahima puts emphasis on the fact that even modest weight reductions can be quite beneficial and health, not ideal weight, is the main goal. A key component in the battle against obesity is health literacy: we need a wider awareness of what dietary and lifestyle changes can help to achieve a sustainable weight loss and better health. When appropriate, there are obesity medications and the option of bariatric surgery.
We cannot end the obesity epidemic without population-level interventions. Policy changes recommended by WHO include limits on portion/package size, subsidies for fruit and vegetables possibly matched by taxation of unhealthy foods, increasing the availability of healthy foods, facilitating walking and cycling and the promotion of physical activity.
Real political leadership is required.