The focus on personal responsibility rather than official action in the government’s national food strategy is unlikely to tackle the UK’s obesity crisis, a leading authority on public health has said.
Sir Michael Marmot, who has led pioneering research into health disparities, said the approach was not supported by evidence, and that he was disappointed the strategy had dropped many of the recommendations of Henry Dimbleby, the government’s lead adviser on food.
While obesity was “terribly challenging”, Dimbleby’s ideas including an expansion of free school meals and new taxes on salt and sugar were welcome, said Marmot, who is professor of epidemiology at University College London.
“How to deal with that is complicated, but I think Henry Dimbleby made a good fist of it,” he said.
While other elements of Dimbleby’s proposals have made it into the final strategy, almost everything connected to health intervention was removed, to be addressed in a separate health disparities white paper due later this year, potentially before the summer recess.
In his report, Dimbleby argued the state has “the moral authority to intervene in people’s lives to help them eat better”. However, the food strategy refers to the “important role for individual responsibility and choice”, a popular mantra among ministers.
In a newspaper interview [paywall] on Saturday the health secretary, Sajid Javid, said people would “decide rightly for themselves whether they’re going to smoke and drink, they’re going to want to eat fatty foods”.
There was a danger, Marmot said, of creating an artificial ideological divide: “We’re agreed the government has an important role in health. There is an important debate as to where it starts and stops, and people will put the dividing line between government action and individual responsibility in different places.
“None of us wants the government telling us what we have for breakfast, lunch and dinner, but we’re all pretty pleased that we can check into a hotel room or send our children to a school and know there is no asbestos. We want the government to do that. We’re pretty pleased when we turn on the tap and the water is drinkable. We don’t want to have to contact a helpline first.
“But if we are all making individual choices, how come obesity rates are rising? Is each of us making the individual choice to be overweight or obese?
“When you see a societal trend like that and say the government shouldn’t get in the way because people are making their individual choices, my guess is that if you asked people, would you like to get diabetes, or heart disease, to increase your risk of cancer by a third, they would say, no, of course not. People aren’t putting on weight because they want to.”
All this was, he added, closely tied to the marketing of unhealthy foods, particularly the discounting of increased portions: “The cost per calorie is half for the extra amount. It’s saying: ‘Come on, have more than you need. It’s cheap.’ The people who say let’s leave it to the individual know that the laws of economics apply – you lower the price, you increase consumption.
“And then when you come to people with no purchasing power, it’s just cheaper to give your kids bread and jam, or biscuits, than it is to give them fruit or fresh vegetables.”
Inaction would have an impact on inequality and the government’s mission to level up the country, Marmot argued: “What’s happened is that the rise in childhood obesity in kids from more advantaged backgrounds has slowed and stopped. But it is continuing to rise in kids from more disadvantaged backgrounds.
“So the inequalities have increased, and children who are obese are at least three times more likely to become adults who are obese. It’s not good for the children and it’s certainly not good for their prospects through their life.”
Dimbleby has also criticised the government’s plan, saying it is “not a strategy” and warning it could mean more children will go hungry.
Dimbleby’s proposal for new taxes on sugar and salt was “not a total game-changer, but it’s a step in the right direction”, Marmot said, saying the recommendation that revenue from the taxes be used to fund fresh food for poorer households was “a brilliant idea”.
