Conclusions and recommendations
A whole systems approach
1.The implementation of an effective childhood obesity plan demands a joined-up, ‘whole systems’, collaborative approach driven by effective leadership and ambitious targets. (Paragraph 16)
2.Local leadership will be essential in identifying areas of greatest need and in drawing up action plans which can start by drawing on existing good practice and focus on joining up existing services by identifying community, school, local government and neighbourhood-led projects that already exist, and ‘filling in the gaps’ where service provision is lacking. (Paragraph 17)
3.Alongside this, there needs to be a concerted effort at both national and local level to change the narrative around childhood obesity, to make it clear that reducing the personal cost and inequality is everyone’s business. (Paragraph 18)
4.The next round of the Government’s childhood obesity plan must include a dedicated discussion of the role and responsibility that local government has in reducing childhood obesity, and the specific ways in which the Government intends to support local government to achieve that aim. We heard that many local authorities feel that their influence can only go so far. National Government must give them the levers they need to be able to tackle the obesogenic environment and to provide an effective range of support services. We therefore urge national Government to listen to local authorities and give them greater powers to reduce health inequality at local level. (Paragraph 21)
5.The revised government Childhood Obesity Plan should be championed by the Prime Minister. A cross-department Cabinet-level committee should be set up which reviews and evaluates the implementation and effectiveness of the plan, with mandatory reporting across all departments on the implementation of the childhood obesity plan every six months. Tackling childhood obesity effectively will take time, and political leadership will be needed to bring decision-makers together with a shared mandate to create and sustain healthy food and activity environments for children. (Paragraph 25)
6.Whilst leadership at national level is important, it should also be reflected and driven at local level. We urge local authorities to identify named individuals to do so. (Paragraph 26)
7.The Government must ensure that future trade deals do not negatively impact on childhood obesity by worsening the obesogenic environment. (Paragraph 27)
8.We fully endorse the conclusion of our predecessor Committee in its 2017 report–Childhood Obesity: Follow Up - that “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 repeat its call for 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. (Paragraph 30)
Marketing and advertising
9.We fully endorse the calls for a 9pm watershed on high fat, sugar and salt (HFSS) food and drink advertising, and expect to see this measure included in the next round of the Government’s childhood obesity plan. Failure to implement this restriction would leave a worrying gap and call into question the commitment to serious action to tackle one of the key drivers of demand for high fat, sugar and salt food and drink. (Paragraph 41)
10.The next round of the Government’s childhood obesity plan should include a ban on brand generated characters or licensed TV and film characters from being used to promote high fat, sugar and salt products. The plan should also include a commitment to end sponsorship by brands overwhelmingly associated with high fat, sugar and salt products of sports clubs, venues, youth leagues and tournaments. (Paragraph 43)
11.We heard consistent evidence that current regulations around non-broadcast media marketing to children are ineffectual, and fail adequately to appreciate the dynamics of children’s non-broadcast media consumption. We urge the Government in its next childhood obesity plan to tighten regulations around non-broadcast media to bring them in line with broadcast media restrictions, and to ensure that sites such as Facebook and YouTube amongst others are taking responsibility for helping to reduce exposure of children to inappropriate advertising and marketing, including advergames. The regulator should play a pro-active role in investigating breaches and taking enforcement action. (Paragraph 46)
12.Furthermore, just as for broadcast media, the next round of the Government’s childhood obesity plan must include a ban on brand generated cartoon characters or licensed TV and film characters from being used to promote high fat, sugar and salt products in non-broadcast media. (Paragraph 47)
Price promotions
13.We endorse the findings of our predecessor Committee in calling for Government to regulate to restrict discounting and price promotions on high fat, sugar and salt food and drinks, and particularly those that drive increased consumption, such as multi- buy discounts and ‘extra free’ promotions. Regulation ‘levels the playing field’ so that those who are doing the right thing are not disadvantaged. (Paragraph 53)
14.We endorse the case made by our predecessor Committee, and by Public Health England, for removing confectionery and other unhealthy snacks from the ends of aisles and checkouts. We heard evidence that public opinion is in favour of Government action on product placement, and from retailers that they want a ‘level playing field’ on regulation. We also call on retailers to end the promotion of high calorie discounted products as impulse buys at the point of sales, particularly in the non-food retail environment. We understand that this cannot be achieved by voluntary action due to the fierce competition in the retail environment, and therefore we recommend that Government commit to regulation. (Paragraph 59)
Early years and schools
15.We recommend that the Government should put in place further measures around early years and the first 1000 days of life to combat childhood obesity. Such programmes should include:
- Promotion and support for breastfeeding for all infants in all areas (including improved provision for mothers to breastfeed in the community), and further support and advice on appropriate and responsive bottle feeding for those cases where breast feeding is not appropriate.
- A ban on advertising and promotion of follow on formula milk as this has long represented a ‘back door’ route to advertising of formula feeding. There needs to be better enforcement of the existing rules around the promotion of infant formula milk.
- Improved early years education to inform and promote appropriate introduction of solids to infants’ diets.
- The strategy needs to set ambitious targets for initiation and maintenance of breastfeeding.
- Training and equipping the early years workforce, in both the voluntary and statutory sector, to effectively support parents and families to promote healthy eating and activity in their children. Evidence-based training should be made available and the long-term effectiveness of current national online training should be independently evaluated.
- A programme to ensure the widespread take-up of best practice, cost-neutral early years schemes such as the NHS Champ project in Manchester, and continued support to those already in operation.
- Government funding for local authorities to make available effective interventions to support families with pre-school children most at risk of obesity. (Paragraph 63)
16.We recommend that the next childhood obesity plan include specific measures to ensure that data on child measurement are able to flow effectively between different parts of the health and social care system to the child’s general practitioner, who should take on primary responsibility for co-ordinating appropriate weight management advice and services, and to the child’s parent. We recommend that consideration is given to including a further measurement point within the Child Measurement Programme, in addition to better collation of opportunistically gathered measurements. Early identification and targeted support is necessary to reduce health inequalities. (Paragraph 65)
17.We urge the Government, and specifically the Department for Education, to review its performance in executing the measures contained in the Government’s first childhood obesity plan relating to schools. We urge a full and timely implementation of all of the measures contained in their first Childhood Obesity Action Plan, including updating the School Food Plan to account for the updated dietary recommendations for free sugars and fibre. School Food Standards should be mandatory for all schools including all academies, as should the Healthy Rating Scheme. (Paragraph 69)
18.We endorse the approach taken by the Amsterdam Jump In programme and in particular the culture change it drives around a healthy food and drink environment as well as the importance of wellbeing and physical activity. We look forward to the Government’s publication of its appraisal of the role of sleep quality in tackling obesity and improving wellbeing. The Government should act on its findings and recommendations. (Paragraph 70)
19.The greatest attention should be focused on schools with the greatest prevalence of obesity in order to reduce the unacceptable and widening health inequality of childhood obesity. Messages however should be positive and focus on health and wellbeing rather than stigmatise obesity. We also recommend that the Government commission research to find the messages that will be most effective within communities at greatest risk, for example on the need to reduce sugar to protect children’s teeth. (Paragraph 71)
Takeaways
20.We repeat the calls of our predecessor Health Committee, and argue that the next round of the Government’s childhood obesity plan must, as a matter of urgency, include provisions for changes to planning legislation to make it easier for local authorities to limit the proliferation of unhealthy food outlets in their areas. The Government must also provide further clarity for local authorities on the extent to which existing powers can be used and enforced as we heard that planning inspectors do not take a consistent approach to appeals. (Paragraph 78)
21.Local authorities need further powers to limit the prevalence of high fat, sugar and salt food and drink billboard adverting near schools. Currently, the only powers available to local authorities extend to the positioning of the billboards themselves, not the content of the advertising. Local authorities also need further powers to tackle the proliferation of existing takeaways. (Paragraph 79)
22.We strongly support recommendations, including those which we heard from Public Health England in our most recent evidence session, that health should be made a licensing objective for local authorities. (Paragraph 80)
Fiscal measures
23.We echo our predecessor Committee in welcoming the introduction of the soft drinks industry levy and urging the Government to extend it to milk-based drinks. (Paragraph 84)
24.The next Government’s next childhood obesity plan must set out further fiscal measures which are under consideration to cover food groups such as puddings and chocolate confectionary, which the PHE sugar reduction and wider reformulation programme review has shown are not making progress in sugar and calorie reduction. We recommend that these measures should be implemented if there is not substantially faster progress on reformulation for these groups in the coming year. (Paragraph 85)
25.The Government’s new childhood obesity plan must maintain the pressure on industry to reformulate through the promise of concrete further action if there is not faster progress on reformulation. (Paragraph 87)
26.We are extremely disappointed that the revenue being generated from the Soft Drinks Industry Levy has been diverted into core schools budgets. We reiterate our predecessor Committee’s argument that the proceeds of the soft drinks industry levy should be directed towards measures to improve children’s health, and specifically addressing health inequalities. (Paragraph 92)
27.We recommend that the Government undertake a consultation on the adjustment of VAT rates on food and drink after Brexit as a possible measure to tackle childhood obesity. (Paragraph 95)
Labelling
28.Efforts to increase awareness of healthy dietary behaviour must be supported in the next round of the Government’s childhood obesity plan by measures to ensure consistent and clear labelling information for consumers. We also support a ban on health claims on high fat, salt and sugar food and drinks, in line with oral evidence from Public Health England. Current progress on labelling in the UK is reliant on voluntary commitments and is therefore not universally applied. (Paragraph 98)
29.Calorie labelling at point of food choice for the out-of-home food sector would provide basic information to enable healthier choices. However, in light of evidence that current labelling tends to be less effective at changing choices in communities where obesity prevalence is greatest, we urge the Government to ensure that the effects are carefully monitored, in order to ensure that labelling is designed to make the healthy choice clear and straightforward. (Paragraph 99)
Support for children living with obesity
30.We heard that signposting to appropriate advice, and where necessary, timely referrals for treatment was inconsistent for children living with childhood obesity. The Government must ensure there are robust systems in place not only to identify children who are overweight or obese, but to ensure that these children are offered effective help through a multidisciplinary, family-centric approach. This should include children identified by the National Child Measurement Programme. Addressing health inequalities must include providing help for those children who are already obese. (Paragraph 103)
Published: 30 May 2018