Childhood obesity: follow-up Contents


1.We conducted a brief inquiry into childhood obesity in September and October 2015. Our report, Childhood obesity—brave and bold action, was published in November 2015.1 We began as follows:

The scale and consequences of childhood obesity demand bold and urgent action. We believe that if the Government fails to act, the problem will become far worse. We urge the Prime Minister to make a positive and lasting difference to children’s health and life chances through his childhood obesity strategy.2

2.Our report went on to make recommendations in a number of areas:

Our recommendations endorsed and built on the action proposed in Public Health England’s review Sugar Reduction–the evidence for action.3

3.The title of our report reflected the evidence which we heard about the necessity of bold action to tackle a significant problem:

24. We believe that a full package of bold measures is required, and share Jamie Oliver’s view that:

“This opportunity is very important. Being gentle and polite is not the way to have a progressive obesity strategy. We need to be big, bold and brave.”

25. [ … ]

“We have to wake up to the scale of the challenge. It is huge. We have to have a proportionate response. That means far bigger, bolder steps… Frankly, I do not think we have the luxury of being able to pick and choose and say “Well, we prefer not to do something on that. I don’t think we will look at it now”. Wake up. We have to focus on all of these and we have to take action across a whole breadth of areas. It is far too casual to think we can just park this on the sidelines as something we are not going to look at right now.” [Professor Susan Jebb OBE, a nutrition scientist, Professor of Diet and Population Health at the University of Oxford and since 2010 the independent Chair of the Public Health Responsibility Deal Food Network4]

[ … ]

27. In our view, the evidence is sufficiently strong to justify introducing all the policies we recommend. Rather than wait for further evidence to follow from international experience, we urge the Government to be bold in implementing policy, with the assurance of rigorous evaluation and sunset clauses if found to be ineffective.

4.The Government’s childhood obesity plan, which had originally been expected in autumn 2015, was eventually published on 16 August 2016.5 Campaigners on childhood obesity were largely underwhelmed by its contents. The following quotes are taken from written submissions sent to us following the announcement of our intention to follow up our earlier work with a further evidence session examining the content of the published plan:

The plan is a good start; however urgent, stronger and more decisive action is needed from government to tackle the obesity epidemic. (Association of Directors of Public Health)

While there are measures in the government obesity action plan which the BMA is strongly supportive of we are also extremely disappointed with the scope of the strategy, in particular the absence of measures to curb marketing and promotional activities. (BMA)

While individual measures and programmes like the soft drinks industry levy and the sugar reduction programme are important steps, the Government’s Plan falls short of a comprehensive strategy. In particular the absence of measures to reduce children’s exposure to junk food marketing is a missed opportunity. Without such measures achieving a significant reduction in childhood obesity has been made more difficult. (Cancer Research UK)

The RCPCH was disappointed to see the Childhood Obesity Plan predominately focus on personal responsibility. Reliance on personal responsibility is not enough as infants and children do not have freedom of choice, and are vulnerable to the actions of adults. The most striking benefits to public wellbeing have come from public health, not medical interventions. We would therefore like to see the Plan built upon to include additional interventions in a number of areas. (Royal College of Paediatrics and Child Health)

The Trust welcomed ‘first steps’ in the government’s plan for action, but we were disappointed that it didn’t go even further. Being overweight is not a choice a child makes. The way children eat is the product of what they learn at home, in childcare, at school and in what they see in the wider world around them. As such, we anticipated from government the promised ‘game-changing’ strategy which would bring together efforts across all government departments, local authorities, communities, healthcare, industry, schools, nurseries and parents to get children eating better–because the costs of failing to act, for children’s health and our NHS, are simply too great. (Children’s Food Trust)

I’m really pleased that the Health Select Committee will be holding a follow-up session on childhood obesity. It’s badly needed, after the government ripped out so much meaningful substance from the much-anticipated strategy document that I was involved in last year. Given the epidemic of diet-related diseases in the UK and the vulnerability of children in the poorest communities, I was deeply depressed by the watered-down strategy. It offends me as a parent, taxpayer and public servant that–even though Theresa May had all the statistics on child ill health–this vital strategy was published to receive as little attention from the press as possible. It is shocking that this incredibly important piece of work was released at midnight, in August, with no minister to communicate and represent it–or even answer any criticism. (Jamie Oliver)6

5.Even the retailers’ representative and the manufacturer from whom we heard oral evidence were similarly underwhelmed:

[ … ] when the obesity strategy came out I was surprised to discover that the only concrete measure was the soft drinks industry levy, which I do not think in itself is going to have any meaningful impact on obesity rates for either children or adults.7 (Jon Woods, General Manager of Coca-Cola Great Britain and Ireland)

[ … ] we were a little disappointed that that level of regulation was not expanded to areas of product improvement as we had been calling for. We are a little concerned that the plan does not specify how we are to achieve the level playing field that we believe is so important.8 (Andrea Martinez-Inchausti, deputy director for food and sustainability at the British Retail Consortium)

6.The respected commentator David Buck, Senior Fellow in Public Health and Inequalities at the King’s Fund, published the following analysis of the Government’s response to our recommendations:

Health Select Committee recommendation

Childhood obesity plan

RAG rating

Strong controls on price promotions of unhealthy food and drinks

No mention of price promotions

Tougher controls on marketing and advertising of unhealthy food and drink

No mention of marketing and advertising

A centrally led reformulation programme to reduce sugar in food and drink

Targets in nine categories of food contributing most to children’s sugar intake, but action is voluntary until 2020 and no mention of penalties or sanctions

A sugary drinks tax on full sugar soft drinks, with all proceeds targeted to help those children at greatest risk of obesity

Benefit of the doubt but devil is in the detail - proceeds to go to school sports and unclear whether targeted on those at greatest risk

Labelling of single portions of products with added sugar to show sugar content in teaspoons

Labelling mentioned, in context of Brexit and greater flexibility, but no details or commitments

Improved education and information about diet

No mention of education and information about diet

Strongest powers for local authorities to tackle the environment leading to obesity

No mention of stronger powers for local authorities

Early intervention to offer help to families affected by obesity

‘Recommitting’ to Healthy Start voucher scheme; income from sugar levy to schools including an incentive premium

7.David Buck commented as follows:

The childhood obesity plan (no longer a strategy) [ … ] dutifully sets out the scale of the challenge, including the cost of obesity to the NHS (£5.1 billion every year) and recognises inequalities in obesity. But it essentially stops there, failing to mention its estimated cost to the economy of £27 billion, due, for example, to its effect on productivity, earnings and welfare payments. This is a telling omission, and indicative of the extreme narrowness with which those in the upper tiers of government appear to understand obesity, its causes, effects and therefore its solutions. It is also particularly ironic given that the impact on the food and drink industry–and therefore on jobs and the economy–was reportedly one of the reasons we have ended up so far from a game-changing strategy.9

8.That comment alludes to a point also referenced by a number of written submissions to our follow-up inquiry: the difference between the final plan and an earlier draft version of the plan which was leaked. Channel 4’s Dispatches programme undertook a comparison between the draft and final versions of the plan, reporting:

9.The Government’s response to our report said

The causes of obesity are complex, caused by a number of dietary, lifestyle, environmental and genetic factors, and tackling it will require a comprehensive and broad approach involving many Government Departments. As such, the Government considered a wide range of options for tackling childhood obesity, and the contribution that we, alongside industry, families and communities can make.

Childhood Obesity: A Plan for Action presents a bold package of policy proposals, informed by the available evidence.11

10.Giving evidence to us on 7 February 2017, the Minister for Public Health, Nicola Blackwood, defended the Government’s plan, describing it as “world-leading”:

No country elsewhere has introduced a reformulation plan as we have; no other country has introduced a producer-led tax like we have. That is why Ireland and Portugal have copied us. No other country took the innovative step to link reformulation to a sugar drinks industry levy and physical activity and work in schools as we have. This is genuinely a world-leading programme [ … ]12

11.Nevertheless, she accepted that the plan did not go as far as the original recommendations:

[ … ] my understanding was that four key measures were prioritised by Public Health England for impacting obesity in young people in particular. One was reformulation; one was the sugar drinks industry levy; one was advertising; and one was promotions. Two out of four is not bad.13

12.Duncan Selbie, Chief Executive of the Government’s main public health advisers Public Health England, took a similar view:

The evidence remains as it was, but we have the plan we have; we took the deal we could get, and we are getting on with it. The most important line in that plan is that it is not the end of the argument. [ … ]

There was a whole lot of other things we wanted, but there are four rules in public health: you never quite get what you hope for; it always takes longer than you ever expected; it is harder to do than you ever imagined; and it only gets tougher. You take the deal you can get and you keep having the argument. I am not here to renegotiate the child obesity plan; right now I want to implement it.14

13.Mr Selbie’s reference to “the most important line in the plan” echoed earlier comments from the Minister:

[ … ] we put in the plan that this is the beginning of a conversation; it is not the end of the steps we will take. We also put in the plan that, if we do not achieve the impact we want with the measures and steps, we will look to further levers. [ … ] We have been perfectly clear that this is not the end of the story.15

14.We welcome the measures the Government has included in the childhood obesity plan, but are extremely disappointed that several key areas for action that could have made the strategy more effective were removed. Vague statements about looking “to further levers” if the current plan does not work are not adequate to the seriousness and urgency of this major public health challenge. We call on the Government to set clear goals for reducing overall levels of childhood obesity as well as goals for reducing the unacceptable and widening levels of inequality.

15.In the remainder of this report, we comment on areas of the obesity plan where we particularly welcome the action that has been promised, as well as areas where we urge the Government to strengthen the plan with further action.

1 First Report of 2015–16, Childhood obesity—brave and bold action, HC 465.

2 HC (2015–16) 465, para 1.

3 Public Health England, Sugar Reduction – the evidence for action, October 2015.

5 HM Government, Childhood Obesity: A Plan for Action, August 2016.

7 Q2

8 Q2

9 David Buck, “The childhood obesity plan – brave and bold action?”, King’s Fund, 26 August 2016 [accessed 21 March 2017]

10 Channel 4, The Secret Plan to Save Fat Britain: Channel 4 Dispatches”, 31 October 2016 [accessed 21 March 2017]

12 Q74

13 Q75

14 Q78

15 Qq 74, 75

23 March 2017