Changing nutritional habits
70. Although, according to Jebb and Prentice, "it
is generally assumed that ready access to highly palatable foods
induces excess consumption and that obesity is caused by simple
gluttony", in their view the National Food Survey in fact
points to an overall drop in energy consumption since the 1970s.
Even after adjustments for meals eaten outside the home, and for
consumption of alcohol, soft drinks and confectionery, average
per capita energy intake seems to have declined by 20% since 1970.
The food industry has been quick to seize upon this evidence to
point the blame for spiralling rates of obesity firmly on reductions
in physical activity. However, this argument ignores many other
complex changes in people's nutrition patterns that have taken
place in recent years, and masks the important contribution that
nutrition makes to obesity. Andrew Prentice was himself displeased
by this use of his research by what he termed "rogue elements
of the food industry":
We have been less than pleased at the way that paper
has been wilfully misused by certain parts of the food industry,
saying, "It is nothing to do with our products, it is nothing
to do with food; it is all down to physical inactivity."
71. An important note of warning is that the data
used for the National Food Survey are self-reported, and, notoriously,
individuals are reluctant to report consumption of foods they
regard as being bad for them. As Tim Lobstein, for the Food Commission
the latest national diet survey says [adults] are
eating 82 grams of confectionery each week, self-reported. If
you look at industry sales figures, those are 250 grams per week
being sold to somebody. Clearly there is a huge gap between what
industry is selling and what people are reporting they are eating.
72. Given the profound significance of overweight
and obesity to the population we believe it is essential that
the Government has access to accurate data on the actual calories
the population is consuming, including figures for confectionery,
soft drinks, alcohol and meals taken outside of the home. Although
we acknowledge the difficulties of obtaining accurate data, given
the limitations of any self-reported survey, the current information
is very weak and clearly underestimates actual calorie consumption.
We recommend that work is urgently commissioned to establish a
Food Survey that accurately reflects the total calorie intake
of the population to supersede the flawed and partial analysis
currently available. The Food Standards Agency and Scientific
Advisory Committee on Nutrition should advise on this.
73. Even if overall calorie consumption has fallen,
there have been significant changes in the composition of people's
diets. Firstly, there has been an increase in the proportion of
fat in the British diet: in the 1940s, each kJ of carbohydrate
in the diet was associated with 0.6 kJ of fat but in the 1990s
with 0.9kJ of fat, an increase of 50%.
Although both carbohydrates and fats produce energy, exactly where
and how people take in their energy has a crucial role in obesity.
74. During the course of this inquiry, the food industry
has made constant use of the formulaic argument that 'there are
no such thing as unhealthy foods, only unhealthy diets', a phrase
we have also, perhaps surprisingly, heard from sports officials
and Government ministers. But it is patently apparent that certain
foods are hugely calorific in relation to their weight and/or
their nutritional value compared to others:
Weight and calorie content of snack foods
Bag of Walkers crisps 35g 183
Snickers bar 61g 280
Apple 112 g 53
75. Besides portion size, calorie content is determined
largely by fat, sugars and other refined carbohydrate content.
More important than the total amount of energy (or calories) a
food has is how much energy it contains in relation to its weight,
that is to say its energy density. Put simply, energy density
is a measure of a food's calories in relation to its total volume,
and relates to how satiating, or filling, a food is. For example,
a king size Snickers bar, which weighs 100g, has more calories
than a main meal of sirloin steak served with potatoes and broccoli,
which has a total weight of 400g.
Its high energy density means that the Snickers bar, although
it is highly calorific, is not correspondingly filling, and so
does not send the brain signals telling a person to stop eating
in the same way that a filling main meal would. Foods that are
high in energy density, and in particular high in fat, have only
very weak effects on satiety that is they do not fill you
up. A Snickers bar, although it is in fact as calorific as some
main meals, would typically be eaten as a snack between meals,
and a person in the habit of having a Snickers bar with their
mid-afternoon cup of tea could arguably be said to be having four
meals a day rather than three.
76. According to Professor Prentice, humans have
evolved to have an "asymmetry of appetite control",
often described as the 'thrifty genotype' theory:
We are very good at recognising hungerit is
an evolutionary obligatory fact that we should respond to hunger
very wellwe are very bad at recognising satiety. Indeed,
if you think it through, we are almost predesigned to lay down
77. While in times of uncertain food availability
this asymmetry could help people survive famines, in today's environment,
it is very conducive to weight gain. Professor Prentice explained
that while it does not necessarily pose problems for people who
are very physically active, who are generally able to control
their weight successfully on their hunger drive, the reverse is
true for people who are very physically inactive: "the environment
is pressing on you much more food than you need and your body,
physiology, is just not designed to stop it; in fact it is designed
to say, 'Thank you very much, I will lay that down as fat.'"
78. Professor Prentice went on to describe to us
how controlled experiments demonstrated this phenomenon:
You have experimental volunteers who you ask to eat
normally but you secretly change the content of their foodsthen,
as soon as you add fat in and increase the energy density they
overeat. It is extremely easy to replicate under any experiment:
they automatically overeat. The reason they do this is they continue
to eat the same bulk of food, the same amount of food, without
recognisingtheir bodies simply do not recognisethat
it has more calories, more energy in it.
79. While the energy density of soft drinks, which
are frequently highly calorific, needs to be considered differently
from that of solid foods, recent research has demonstrated that
consumption of soft drinks is likely to increase normal caloric
intakein other words, when people consume soft drinks,
they do not recognise that they have taken in extra energy and
compensate by reducing energy from elsewhere in their daily diet,
or by expending additional energy; they simply add it on.
A standard 330 ml can of Coca-Cola contains 139 calories. Thus
if a person were to consume a can of Coca-Cola with two meals
per day, over a week that would result in an energy surplus of
nearly 2,000 caloriesmore than a whole day's recommended
calorie intake for the average woman, and about three-quarters
of the recommended daily calorie intake for a man. Evidence from
the British Soft Drinks Association suggests that children drink
an average of 4.7 litres of soft drink per week, of which only
10% are fruit juice or water.
80. Recently, the thesis that unhealthy food may
have specific addictive properties has also been explored. John
Blundell, Professor of Psychobiology at the University of Leeds,
has argued that while there are fundamental differences between
the brain's response to food and to addictive drugs, the pleasure
and the positive reinforcement people obtain from eating food
could lead to the development of a compulsive element to food
to Susan Jebb, this is fostered not only by the taste of food
but by "the whole aura surrounding food, the marketing, the
lifestyle that you buy into."
81. The past 20 years have seen considerable changes
not simply to what people eat and how much, but also to the ways
in which they eat. Snacking, eating out, and reliance on convenience
food have all increased dramatically. These changing patterns
of consumption are in part a response to the far reaching social
changes of the last 50 years, including a greater number of women
working outside the home, longer working hours, and higher levels
of disposable income. However, while these changing eating patterns
may not of themselves be a problem, they can be conducive to obesity.
82. Readily available snack foods and drinks are
typically very energy-dense, and are usually consumed to supplement
rather than replace meals, despite their high calorie content.
Between 1993-98, sales of snacks to adults more than tripled in
the UK, from £173 million to £541 million.
As the Department pointed out in its memorandum, British people
now consume an increasing number of meals outside the home, with
25% of respondents to a consumer attitudes survey saying that
they regularly used some form of fast food or takeaway outlet.
83. There is also increasing consumer demand for
convenience food, and a growing trend towards snacking and eating
on the move. The average time spent preparing a meal in 1983 was
an hour, but today it has shrunk to 13 minutes.
In the period 1990-2000 alone, purchases of convenience foods
rose by 24%. According
to market analysts Mintel, between 1998-2002, demand for ready
meals in Britain grew by 44%, compared to 29% growth across Europe
as a whole, and figures suggest that Britain is now consuming
the highest number of ready meals in Europe, double the amount
consumed in France, and six times that in Spain.
84. Eating ready prepared snacks or meals, whether
pre-packed meals which are heated up at home, or food purchased
from a restaurant or fast food outlet, reduces a consumer's choice
and control over what they eat. When preparing a meal from scratch,
a consumer will have full control over how much fat, sugar and
other ingredients are put into the dish, control over what quantity
to make, and over the portion size that is served. Buying a snack
such as a bag of crisps, or a ready-prepared meal to heat up,
effectively removes those choices. People eating out in a restaurant
are even less likely to be aware of the fat or calorie levels
of the meal they have ordered.
85. Consumption of alcohol, particularly amongst
women and young people, has increased dramatically during the
past years. With
most alcoholic drinks being at least as calorific as a high-sugar
soft drink, such as Coca-Cola, it would seem intuitive that the
massive increase in their consumption has had some impact on the
nation's weight. Much attention has focused in recent months on
the growing culture of 'binge drinking', particularly amongst
young people. While the health risks associated with this are
well documented, what is less publicised is that drinking five
pints of lager over an evening adds an extra 1,135 calories, nearly
half a man's daily energy requirement, and five bottles of an
'alcopop' such as Bacardi Breezer contain 990 calories, nearly
half a woman's daily energy requirement.
86. During the course of our inquiry, we have been
continuously surprised by the lack of emphasis given to the impact
of alcohol consumption on obesity. While the Department, and most
experts who gave evidence to us were in no doubt that it must
have an impact, there seemed very little definitive evidence in
this area. We were also concerned to note that the Government's
recent Alcohol Strategy made no mention whatsoever of the potential
impact of alcohol consumption on weight gain, leading to a further
set of health problems in addition to those already linked directly
87. The relationship between alcohol consumption
and obesity is too little understood. We recommend that the Department
of Health commissions research into the correlation between trends
in alcohol consumption and trends in obesity.
Information and choice
88. What people consume is, at its simplest level,
determined by personal choice. However, changing lifestyles have
made the nutritional environment, spanning supermarkets selling
ready meals, restaurants, sandwich bars and fast food outlets,
increasingly complex, and this means that making healthy, informed
choices about nutrition is more complicated than ever. The nutritional
environment of the United States was described in stark terms
by Marion Nestle, from the Department of Nutrition, Food Studies
and Public Health, New York University, who argued that American
society had changed in ways that made it "much, much too
easy for people to over-eat":
Food is extremely cheap in our country, and there
are many, many driving forces keeping the cost of foods extremely
low. Low-cost food encourages people to eat more. Food is extremely
convenient; it is ubiquitous; it is available all day, 24 hours
a day, 7 days a week; and it is available in larger and larger
Every single one of those aspects encourages people
to eat more, and there is a considerable amount of research that
demonstrates that. We have created a societal environment in which
it is considered totally acceptable for people to eat anywhere,
to eat all day long and to eat in larger and larger quantities;
all of which encourages people to eat more and to gain more weight.
89. While the UK may be some way behind the US in
terms of its obesity epidemic, our evidence suggests that the
information and tools consumers require to negotiate a changed
nutritional environment have not kept pace with those rapid changes,
and that frequently external factors are directing consumers towards
unhealthy rather than healthy choices.
90. Information and education are clearly key to
making healthy choices about what and how much to eat. Yet although
the evidence-base about what constitutes a healthy diet has been
well developed for many years, it is clear that people are not
adhering to healthy eating recommendations. According to the Food
Standards Agency (FSA), British children eat fewer than half the
recommended portions of fruit and vegetables a day, and the vast
majority have intakes of saturated fat, sugar and salt which exceed
the maximum adult recommendations.
91. Why, then, are these messages not getting through?
Perhaps they are not being delivered loudly or consistently enough,
meaning people are simply unaware of how to balance foods to make
up a healthy diet that does not lead to weight gain. Alternatively,
people may be insufficiently aware of the devastating health consequences
associated with being overweight or obese. According to Tim Lobstein
of the Food Commission healthy eating messages are well known,
but external pressures prevent people from adhering to them:
When I go and give talks to even low-income families,
they are fairly well aware of the sorts of things they ought to
be eating more of, but they are not doing it and they are not
doing it for a variety of cultural and economic reasonsand
also for children there are fashionable reasons and so on. There
are a number of other pressures besides the health education message
that are encouraging them away from healthy eating.
92. We address these other pressures, including commercial
food promotion and food pricing later in this chapter.
93. In addition to a good theoretical understanding
of what constitutes a healthy diet, being able to prepare a healthy
meal is a cornerstone of healthy eating habits. Yet we have received
evidence suggesting that a growing number of British people lack
the basic skills and confidence to do this. The Nutrition Society
also argued that the "lack of ability to cook amongst the
school generation means that people are not as in control of their
food supply as they might be."
Focus on Food echoed these sentiments by stressing that dietary
behaviour could not be changed without teaching people relevant
skills such as cooking, which reduce the reliance on high-fat,
high-salt, processed foods.
The need for such skills to be taught is all the more marked,
given that, for the first time, the current generation of children
is being raised by parents whose main experience of cooking is
preparing convenience foods, thus removing a major source of food
education from children.
94. The national curriculum currently includes Food
Technology under the remit of Design and Technology, and this
covers learning about food preparation, food hygiene and the design
of food products. Food Technology is compulsory up until the age
of 11, but after that there is no compulsion for any practical
cooking skills or food education to be learnt. Moreover the Qualification
and Curriculum Authority states that the focus of Food Technology
should be on manufacturing and processing food rather than practical
95. The dire state of cookery provision has led to
a number of initiatives where mobile facilities for cookery teaching,
dubbed 'Cooking Buses', travel to schools providing lessons for
children and training for teachers. The existence of these schemes
has clearly tapped into an unmet need and enthusiasm for cookery
training at school, as many of these schemes have waiting lists
of over a year.
96. Even if people are well aware of what constitutes
a healthy diet, and have full information about the nutritional
value of what they are eating, their decision-making does not
take place in a vacuum. Any health information about nutrition
that consumers currently receive is heavily counterbalanced by
advertising and promotion campaigns undertaken by the food industry.
Table 5: Advertising
spend across the top ten advertised food brands in the UK (2002)