340.The previous chapter set out how factors within the ‘food environment’ can drive dietary choices. We have argued that there is a clear and compelling argument for controlling what many see as the ‘aggressive’ marketing and promotion of less healthy food, and for reshaping the food environment to support healthier choices.
341.The food environment can have a profound effect on consumer choice, but clearly, so can the types of product that are made available. Our attention was drawn repeatedly to the prevalence of products high in energy, unhealthy types of fat, salt or sugar, commonly associated with highly processed foods. It bears repeating that these types of foods are much more likely to be on promotion, making them appealing to those on a tight budget, and that a high proportion of both adults and children’s dietary energy comes from highly processed food. We also eat more processed products than other European countries. We are, as Anna Taylor suggested, “heavily dependent on those foods.”
342.The general consensus was that interventions which make minimal demands on individuals and are delivered to whole populations are considered to be more effective in driving public health improvements, than approaches that aim simply to encourage individuals to change their behaviours. As such, many witnesses highlighted that government-led reformulation programmes have the potential to be a powerful lever in enabling healthier diets and improving health outcomes. As levels of food insecurity and health inequalities were a central concern of this inquiry and given the potential that reformulation has for delivering equitable effects across the whole population, it was important for us to consider that merits of different approaches to encouraging industry to reformulate their products to make them healthier.
343.The Government certainly appears to have put a good deal of faith in the ability of reformulation programmes to drive improvements in public health, with voluntary sugar and calorie reduction forming key components of Chapter 2 of the Childhood Obesity Plan. Further commitments to salt, sugar and calorie reduction were outlined in its 2019 Green Paper on prevention, which stated that: “Central to our approach to improving diets is working with food and drink companies to make their products healthier.”
344.The evidence we received was broadly in agreement that government-led reformulation programmes can be effective in tackling excess levels of fat, sugars and salt in processed foods, and should play a key role in continuing efforts to improve dietary health. There were, however, serious concerns raised about the limitation of reformulation, both in how effectively reformulation programmes have been implemented and adhered to, and to what extent reformulation should be relied upon to deliver the public health improvements that are so urgently required. Witnesses emphasised that reformulation should not be relied on too heavily as part of effort to improve dietary health. Shirley Cramer from the Royal Society for Public Health, said on reformulation:
“We feel, with others, that it is part of the mix of the things we need to do to tackle obesity and promote healthy eating. It is for the researchers to look at how big a part it is, but we cannot see it as the main plank of what the UK needs to do to solve the obesity crisis.”
345.There was a further concern expressed by others that reformulation is a sticking plaster when a more widescale shift in the food environment is required. This view was articulated most clearly by Professor Jebb:
“If we are fundamentally to address the very big issues this Committee is focused on, we have to make bigger changes in the way people eat. We cannot do it just by fiddling around when changing the composition of the things that people currently eat. We have to eat fewer biscuits and cakes, less chocolate and confectionery, and more fruit and vegetables. You are not going to achieve that through reformulation.”
346.The representatives from food retail and manufacturing sectors that we heard from were keen to emphasise their willingness to help reduce the availability and appeal of less healthy food. While we acknowledge that there is some encouraging work underway by individual companies and organisations to reformulate their products, the Government’s assessments of industry progress against its reformulation targets show that significant improvement is required. The food industry is highly competitive and, although SMEs make up a significant proportion of food businesses, the industry as a whole is dominated by the major supermarkets and by large multi-national food manufacturers. The fact that industry progress against voluntary reformulation targets has been limited suggests that many manufacturers and retailers are not yet fully engaged in efforts to reduce harmful levels of less healthy ingredients. The industry needs to take more responsibility for the products it produces, manufactures, and sells to the consumer. Industry has the power and the capability to make positive changes to the dietary health of the nation but where it fails to do so, the Government must intervene.
347.Professor Susan Jebb suggested that the Government was placing too much faith in reformulation: “Unfortunately, the Government have decided that reformulation is the answer”. Requiring industry to make their products healthier is a key element of Public Health England’s strategy in relation to obesity. As such, it was important to consider if there are opportunities to strengthen existing reformulation programmes, and to learn from the (in some cases) not insignificant success of others.
348.Food reformulation is defined as the re-designing of an existing processed food product with the objective of making it healthier. A key benefit to this approach is that the nutritional composition of food and drink can gradually improve. This has the potential to impact on the whole population, including children and regardless of population subgroup. Crucially, it was argued, this type of intervention does not require any behaviour change in individuals.
349.The key reformulation measures introduced by the Government include:
• The Salt Reduction Programme. Salt targets were first introduced by the government in 2006, challenging the industry to reduce salt in everyday foods. In 2003, the Scientific Advisory Committee on Nutrition (SACN) recommended that salt intake should be reduced to no more than 6 grams per day for adults. Following this, the Food Standards Agency (FSA) set salt reduction targets for food and drinks to be met by 2010. In 2010, responsibility for nutrition transferred from the FSA to the Department of Health. According to Public Health England: “To date, four sets of targets have been published (2006, 2009, 2011 and 2014), covering up to 80 individual product types.”
• The Soft Drinks Industry Levy (SDIL). Announced in March 2016, the SDIL is a tax on soft drinks that contain more than 5 g sugar per 100 millilitres, with a higher rate on drinks with more than 8 grams per 100 millilitres. Fruit juices and milk-based drinks were exempt from the levy. The stated aim of the SDIL was to encourage the soft drinks industry to improve the healthiness of the drinks they produce, by reducing sugar content or reducing portion sizes. The SDIL was implemented in April 2018.
• The Sugar Reduction programme. In August 2016 the Government’s Childhood Obesity: A plan for action included a commitment for Public Health England (PHE) to oversee a sugar reduction programme. This challenged all sectors of the food industry to reduce sugar in their products by 20% by 2020. Industry was also challenged to achieve a 5% reduction in the first year of the programme.
350.The Government is also developing measures for a wider calorie reformulation programme. It has consulted on measures relating to product ranges aimed at babies and young children, and has undertaken a programme of engagement with the eating out of home sector.
351.There was some discrepancy in the evidence about how targets on reformulation should be applied. The main argument centred around whether voluntary or mandatory interventions were more likely to deliver the necessary improvements in public health. There was some acknowledgment of the achievements voluntary reformulation programmes have been able to make, in particular for salt, but concern was expressed that mandatory reformulation measures may be required if significant progress is not made. There was considerable support expressed for the Soft Drinks Industry Levy, and the potential for fiscal measures to encourage industry more forcibly to reformulate their products, with some calling for this approach to be extended to cover other nutrients, food groups and products. The evidence did not, however, dismiss voluntary measures entirely, with some witnesses making suggestions on how voluntary measures might be improved to ensure greater levels of adherence to reduction targets.
352.Both the Salt Reduction Programme and the Sugar Reduction Programme set voluntary reformulation targets for certain processed foods. Voluntary salt reduction targets have been in place since 2006 and sugar targets were first set for industry in 2016.
353.The salt reduction programme was cited as an example of a successful reformulation programme. Professor Susan Jebb told us that: “Reformulation has been a huge success story, in which the UK has had real leadership. It started with the salt reduction programme, which continues today and has been extraordinarily effective.” Similarly, the Nuffield Council on Bioethics told the Committee that:
“There have been a number of voluntary initiatives directed at the food industry to create healthier products, primarily aimed at reducing sugar, salt, saturated fats, and/or trans-fats. Many of these voluntary initiatives have shown that much can be achieved through self-regulation. For example, seven-to-eight years after the introduction of the Food Standards Agency’s voluntary salt reduction programme, the salt content of many food products was reduced through reformulation, alongside the introduction of a number of low-salt versions of products to the market.”
354.Jenny Oldroyd from the Department of Health and Social Care told us that:
“The salt reduction programme has also made gains in reducing salt in foods. Between 2005 and 2011 we saw salt decrease in foods by 11%, from 8.8 grams to 8 grams per day on average. We saw really big gains in particular foods. Bread, for example: that programme resulted in 40% less salt on average in bread in this country.”
355.It was suggested that the initial success of the programme was due to effective monitoring by the Food Standards Agency, which allowed it to hold companies to account and to drive improvements in salt reduction. Mhairi Brown from Consensus Action on Salt, Sugar and Health, stated that the Food Standard Agency’s salt reduction programme was:
“ … robust and well monitored, and it became a model for salt reduction programmes around the world. We saw transparent and publicly published monitoring reports, which made it much easier to hold the food industry to account …”
“It was so successful that the salt content of many products decreased by about 40% and the public were not aware of that. They still continued to buy the same products. It had a huge impact on population blood pressure.”
356.The support expressed for the salt reduction programme was, however, frequently caveated by the assertion that initial progress made by the programme in the early 2000s was not subsequently sustained. Susan Lloyd, Executive Lead for Policy at the Faculty of Public Health, stated that:
“Our view at the faculty is that the salt and sugar levies have been effective. However, they have now stalled, primarily because they were voluntary agreements … The salt reduction process has stalled, certainly, when it comes to reductions in formulated salt in products.”
357.A number of witnesses expanded on this and identified the transfer of responsibility from the FSA to the Department of Health, (which placed salt reduction under the Public Health Responsibility Deal) and eventually to Public Health England, as a turning point when the momentum on salt reduction was lost. The Nuffield Council on Bioethics was amongst the organisations that noted this shift, stating that:
“… seven-to-eight years after the introduction of the Food Standards Agency’s voluntary salt reduction programme, the salt content of many food products was reduced through reformulation, alongside the introduction of a number of low-salt versions of products to the market. However, later figures published by Public Health England showed a more mixed picture for the food industry’s progress in meeting the Government’s salt reduction targets.”
358.It was argued that the transfer of responsibility resulted in a decline in pressure from the Government on the food industry. The key criticism to emerge was that, while the FSA publicly monitored industry progress on salt reduction, the bodies that have subsequently overseen salt reduction have not. The Public Health Responsibility Deal was criticised for lacking robust or independent target setting, monitoring and enforcement mechanisms as it made “the food industry responsible for making progress by itself without giving it the leadership and support to enable that.” Consensus Action on Salt, Sugar and Health claimed that:
“Salt reduction has stalled since the removal of strict monitoring by the Food Standards Agency to be replaced by little to no monitoring under the Public Health Responsibility Deal in 2011”
359.Jenny Oldroyd told the Committee that:
“The salt reduction programme has also made gains in reducing salt in foods. Between 2005 and 2011 we saw salt decrease in foods by 11%, from 8.8 grams to 8 grams per day on average. We saw really big gains in particular foods. Bread, for example: that programme resulted in 40% less salt on average in bread in this country.”
360.In March 2020, Public Health England published its 2018/19 urinary sodium survey, which looks at population salt intake, rather than the industry’s progress on meeting salt targets. The latest PHE report revealed that salt intakes had not significantly changed since they were last measured in 2014. The report found that the mean estimated salt intake for adults was 8.4 grams per day (40% higher than the Government recommended maximum of 6 grams a day).
361.PHE’s latest report does appear to support the assertion the progress on salt reduction has slowed, though we acknowledge the possibility that success is easier to achieve earlier on in a reformulation programme. What is more certain is that reporting against progress on population salt intake has been patchy. Until the 2019 urinary sodium survey, UK population salt intake had not been measured since 2014. If urinary sodium levels were cross-referenced against information on the salt content of products, it could be ascertained whether the apparent stalling in progress relates to reformulation or to consumer behaviour.
362.Public Health England stated that its first assessment of the food industry’s progress towards meeting the government’s salt reduction targets (published in December 2018) showed a “mixed picture overall”. In the in-home sector, PHE reported that:
• Just over half (52%) of all the average salt reduction targets set were met by 2017. Retailers made more progress than manufacturers towards achieving average targets, meeting 73% of these compared with manufacturers meeting 37%;
• All average salt targets were met in 9 food categories, including breakfast cereals and baked beans, however, meat products met none of these targets; and
• Overall (for retailers and manufacturers combined), where maximum targets were set, 81% of products had salt levels at or below their target (retailers 86%, manufacturers 72%).
363.The Government told us that it is revising its targets for the salt reduction programme. The Department of Health and Social Care acknowledged that: “While our consumption has decreased over the last decade, we are still having too much salt and there is a long way to go. To achieve this, we will publish revised salt reduction targets in 2020 for industry to achieve by mid-2023 and we will report on industry’s progress in 2024.”
364.The evidence on the progress of the sugar reduction programme was similarly pessimistic. The Government has set a target for the food industry to reduce the sugar in its products by 20% by 2020, with 5% in the first year of the programme (August 2016 to August 2017). Public Health England published its second-year report on the industry’s progress on meeting the government targets on sugar reduction in 2019. It stated that:
• Between 2015 and 2018 there has been an overall 2.9% reduction in total sugar content (sales weighted average in grams per 100 grams) among retail and manufacturer branded products (in-home sector).
• More progress has been achieved in specific food categories, particularly for breakfast cereals (8.5% reduction), and for yogurts and fromage frais (10.3% reduction);
• Overall the total tonnes of sugar sold in foods included in the reformulation programme from the in-home sector has increased by 2.6% between 2015 and 2018 (excluding cakes and morning goods), whereas the sugar sold in soft drinks subject to SDIL has decreased by 21.6%.
The Public Health Minister, Jo Churchill MP, referring to the sugar reduction programme said:
“Some categories are lagging behind. The most notable is that we have not seen much advance in confectionery at all.”
365.In fact, according to Public Health England’s progress report in the retailer own brand and manufacturer branded products there were small increases for some categories (puddings and ice cream, lollies and sorbets). In the out of home sector products there were some more significant increases, including a 21.9% increase reported for chocolate confectionery.
366.Speaking about the likelihood of the Government meeting its target of a 20% reduction by 2020, Professor Jebb stated that: “There is no way we are going to achieve that.”
367.Echoing criticisms levelled at the salt reduction programme, efforts to reduce levels of sugar in the population’s diet were criticised for lacking any mechanism to encourage adherence to the targets. Dr Hilda Mulrooney from the Obesity Group of the British Dietetic Association, stated that:
“With the voluntary sugar programme, all that was said was that, if sufficient progress had not been achieved by 2020, additional levers might be used. There is no clarity about what those levers are, so it is perhaps more difficult for industries to engage with it, or they do not see the need to engage with it. So far there is no stick. You either engage with it or you do not.”
368.Mhairi Brown later emphasised that: “A voluntary programme is only effective if it is well monitored and there is buy-in across the sector.”
369.Overall, the potential for voluntary reformulation programmes to deliver improved health outcomes was not dismissed entirely in favour of mandatory approaches. It was, however, made clear that voluntary reformulation programmes can only be effective if they are supported by close monitoring and clear leadership from the Government. Given that the salt reduction programme was able to demonstrate significant success in the past, there is a reasonable case to be made that it could be revived, through introducing more transparent and regular monitoring and stronger accountability for industry to adhere to the targets set. Getting the food industry to commit to the voluntary programmes is also critical. The limited evidence on the success of the Government’s voluntary reformulation programmes on salt and sugar reduction show that, as a whole, the industry is a significant way off meeting the Government’s reduction targets. This suggests that some in the industry will not make the effort to participate in the programmes, or will even avoid participating in them entirely, unless they are made to. This point is further reinforced by the evidence on the success of the Soft Drinks Industry Levy in reducing the amount of sugar in drinks, versus the limited progress that has been made with other products that fall under the voluntary sugar reduction programme.
370.Many witnesses made the case that voluntary measures will always be limited as they cannot effectively incentivise all companies across the industry. Witnesses (including some industry representatives) expressed the need for a level playing field, which many argued could only be achieved through regulation. The Nuffield Council on Bioethics, for example, concluded that:
“Much can be achieved through self-regulation of the industry. However, where self-regulation fails to deliver, regulation can be necessary as an effective driver of change.”
371.A number of witnesses cited their support for the Soft Drinks Industry Levy (SDIL). Sustain were one of many to highlight the successes of the levy, stating that: “The key measure to be implemented has been the introduction of the Soft Drinks Industry Levy which has removed 90 million kg of sugar from drinks since 2017.”
372.Public Health England’s assessment of the SDIL found that there had been:
• A 28.8% reduction in total sugar content per 100ml between 2015 and 2018 for the drinks subject to be included in the SDIL among retailer own brand and manufacturer branded products;
• An increase in sales of drinks subject to the levy of 10.2%, but a reduction in the total sugar content in the drinks sold of 21.6%;
• A shift in the volume of sales towards low sugar products (below 5g per 100ml) with no levy attached;
• A decrease in total sugar purchased from drinks subject to the SDIL per household among all socio-economic groups.
373.Some witnesses also highlighted that the Government received far less revenue from the levy than had been anticipated, an indication that it had been successful in incentivising manufacturers to reformulate their products to avoid paying the fee.A study, supported by the National Institute for Health Research (NIHR), which analysed stock market returns of soft-drink companies listed on the London Stock Exchange, found that they have continued to experience positive growth in their share prices during the implementation of the SDIL. Dr Hilda Mulrooney stated that:
“The soft drinks industry levy has shown that, with the 28.8% reduction in sugar between 2015 and 2018, there has at the same time been an increase in the soft drinks that are being consumed. More of them are being consumed from the lower no-sugar category, so that suggests that it is possible to achieve meaningful gains while still protecting the right of industry to make a profit. It is an important market for the country. It is an important part of the economy of the country, so industry must be protected, but not at the expense of children.”
374.Many concurred with Mhairi Brown’s view that: “the scale of progress that has been made under the levy shows what kind of progress is possible if the Government are able to show leadership and state their priorities clearly.” There were consistent calls to extend the SDIL in line with the Government’s proposals to include a wider range of products, and for the Government to assess where fiscal measures might be applied elsewhere to help drive public health improvements. Cancer Research UK asked that:
“When the [Soft] Drinks Industry Levy (SDIL) is reviewed in 2020, the UK Government should commit to extending the levy to sugar-sweetened milk-based drinks and consider tightening current sugar thresholds to encourage further reformulation. The UK Government should also work with devolved administrations to continue to build the evidence on fiscal measures and explore how these policies can aid reformulation and change business and consumer behaviour.”
375.The Public Health Minister, Jo Churchill MP, informed the Committee that:
“The Government has also committed to consider the sugar reduction progress achieved in sugary milk-based drinks as part of its 2020 review of the milk drinks exemption from the SDIL. Sugary milk drinks may be included in the SDIL if insufficient progress on sugar reduction has been made.”
376.The evidence also included calls for the Government to reconsider the zero-rated VAT status of some food products. Professor Susan Jebb argued that:
“The obvious immediate place you could take action would be on VAT. There are ridiculous anomalies that do not help the health agenda. Why do cakes not have VAT on them? That seems to me very easy to fix. If the price of cakes went up by 20%, you would probably see something of the order of a 15% to 20% reduction in consumption.”
Dr Hilda Mulrooney highlighted that extending taxation on certain foods could impact on consumer practices, stating that:
“If the product price is raised by about 20% due to taxation, it seems to effect behaviour change in consumers. That will generate less income from taxation because people stop buying products that are subject to the levy. As regards income for the Government it is not a great approach, but in consumer behaviour it seems to be.”
377.Following the UK’s exit from the European Union we consider that there is a clear opportunity for the Government to review VAT rates on food and drink to help to rebalance the cost of food and drink in favour of healthier products.
378.The Government should review the current zero-rated VAT arrangements on some food products which are known to be energy dense, and contain high levels of salt, sugar and unhealthy types of fat. It should commence this review before the end of the transition period in 2020.
379.There was broad agreement that that the food industry should be taking more responsibility for promoting healthy and sustainable diets. We consider this an entirely reasonable argument, given that it is the food processors and manufacturers that create and produce highly processed food products. However, with both voluntary and mandatory approaches to reformulation, it was clear that some level of industry buy-in is required. Industry representatives were able to highlight some of the difficulties and limitations of reformulation from their perspective.
380.Industry representatives and others highlighted that reformulation is different across different food products, with some products easier to change than others. Professor Susan Jebb highlighted, for example, that: “Sugary drinks are relatively easy. You can replace the sugar with artificial sweeteners or just make the drinks less sweet” but other products are not as easy to change. Dr Hilda Mulrooney explained that “sugar in other foods has structural properties as well.” Kate Halliwell from the Food and Drink Federation explained the success of the SDIL might not be able to be replicated in other products, stating that: “Trying to translate that to a cake, where sugar has a much more structural role, would be much more difficult.”
381.Industry representatives also suggested that two components of the government obesity proposals—reformulation targets and restrictions on the advertising of HFSS products—were, in some cases, working against each other. Nestlé UK&I highlighted that the Government’s restrictions on the advertising of products categorised as HFSS:
“… do not distinguish between those whose nutritional profile have been improved and those that have not, meaning producers are faced with the possibility of being unable to showcase the healthier alternatives.”
It was suggested that this deters companies from reformulating their products, posing a dilemma for companies when considering whether to invest in reformulation. Kate Halliwell from the Food and Drink Federation explained that:
“A company trying to decide now what to do, given how long it takes to reformulate, would not be able to promote or advertise 30% reduced confectionery. If you were trying to develop a product and invest a lot of money in it, it would raise a question as to whether you should or not. How do you successfully bring something to market?”
382.There were also concerns expressed over the lack of clarity over what measures will be introduced next, caused in part by the fact a number of government proposals on improving dietary health have been announced through the three Childhood Obesity chapters, but not yet implemented. Kate Halliwell highlighted that: “We have had three childhood obesity plans in two years. Inevitably, that means that civil servants are processing that work, and we are just catching up with the announcements all the time.”
383.Various witnesses referred to Scottish and Welsh efforts to support businesses (particularly SMEs) to reformulate their products in a healthier way. The Food and Drink Federation told us that:
“In Scotland, they fund a reformulation manager post to engage with those companies. In Wales, there are food centres that look across the piece more broadly. It is not just reformulation but sustainability issues, and packaging comes into it as well. They have specifically said that they are going to uplift the money to help companies on reformulation. In England, we do not have an equivalent for that.”
384.Given that the food industry is made up of a complex range of businesses, with a significant number of SMEs, the argument that the Government should invest in support for business to reformulate effectively, was compelling. David Morris, the Deputy Head of Food, Agriculture, Fisheries and Rural Strategy in the Welsh Government, explained the support it offers to help industry meet its targets on reformulation:
“We believe it is about providing the right support at the right time. To go back to our SME cohort, the largest part of the food manufacturing sector, a number of them—particularly the smaller SMEs and the micro businesses—do not have in-house resources for things such as reformulation. In our food centre network, under our Project Helix umbrella, we have a food centre in north Wales at Coleg Menai, in west Wales at Horeb and in south-east Wales at Cardiff Metropolitan. It is an outreach programme for all food manufacturers. It is heavily supported and costs them very little, if anything, and they have access to all the food technologists they need. They have the production facilities they need. They have tasting suites and access to virtual reality grocery retail experiences. There is a suite of support and programmes to aid their development. That makes concepts such as reformulation much easier for businesses.”
385.Although the industry representatives did highlight some of the barriers they felt existed for industry to reformulate certain products, there was some support expressed for mandatory reformulation measures. Andrew Opie, Director of Food and Sustainability at the British Retail Consortium, stressed that the food market is very competitive, and suggested:
“That bites on things such as reformulation at points where a retailer may go so far to reformulate a product, but eventually it may not have the quality or taste that a consumer might perceive to be what they want to buy. It is a competitive market, and not having some mandatory levels around things such as reformulation or labelling is a handicap and holds back further progress across the food industry.”
386.There was some agreement that regulation on content would represent a fair method of encouraging the industry to reformulate products to make them healthier without putting them at a competitive disadvantage. Andrew Opie went on to suggest that mandatory regulation:
“sets a level playing field in many areas. With issues such as salt reduction, for example, it is a bit of a mystery why retailers have managed to remove so much salt and other manufacturers have not. I just put that as a question. That is a choice issue because it is a voluntary area.”
“There are other things that would underpin that. We need education for consumers so that they know when to make the right choices and build the right diet. That is a more complex thing than just choosing the right individual product. I am not sure that we see as much of that as we could.”
“Similarly, to help SMEs to participate in this, particularly in some of the food-to-go sector, there probably needs to be help from local authorities, which have responsibility for public health, so that some of those smaller businesses can make changes that they probably could make without costing them business. There are lots of other areas that underpin it.”
387.We listened to the concerns from industry and we acknowledge calls for clear direction from the Government on the issue of reformulation. We were concerned, however, that the evidence we received from the retail and manufacturing industries did, at times, direct responsibility for reducing the availability and accessibility of less healthy food elsewhere, either to Government, local authorities, schools or to the consumer. During the oral evidence session with retailers, the Committee asked witnesses to respond to its concerns that blame for the population’s poor dietary health is often shifted onto others by the food industry. Andrew Opie responded by stating that:
“The point we are making is that we are not here to blame anybody else. I am here to accept the responsibility for retail, but if we want to make a real difference, we have to see everybody in the food industry taking a more progressive approach to the issue”.
Mr Opie went on to state that:
“It will be a comprehensive answer if we really want to make a difference. I am certainly not here to say, “It’s them, it’s them, it’s them”. What I am here to say is, “This is what is possible”. We have shown what is possible in labelling, reformulation, removal of trans fats and healthier promotions. All of those things are absolutely possible. We just need universal application of those and support from government.”
388.Another area where it was argued that Government regulation could be effective in encouraging healthier choices was in mandating responsible portion sizes. Both Nestlé and Sainsbury’s supported this as an approach. Judith Batchelar, Director of Sainsbury’s Brand, told us:
“We have done all this work on reformulation but it hasn’t really worked. If you think we have been reformulating products for 20 years, we still have a massive problem in terms of nutrition, health, wellbeing and at the extreme, obesity and that’s because we have been unable to create an equivalence on portion size. If you look over the same period of time, portion size has grown and one of things we have been lobbying for ….is portion size guidance, which years ago we used to have.”
389.The Centre for Diet and Activity Research raised the issue of portion size and highlighted that: “An extensive body of research illustrates the contribution of increasing portion sizes to the prevalence of obesity and overweight.” City Harvest suggested that: “Portion sizing also has a huge impact on the average consumer leading to obesity and excess waste. Around 70% of all food waste happens in the home and most of this is down to portion size and date labels.”
390.Mark Laurie from the Nationwide Caterers Association highlighted that large portion sizes were an issue in the catering sector. He told us that
“A lot of people buy based on size. I guess that size is relative to value in people’s minds, especially if they do not have very much money. A massive portion of chips will probably seem like great value, whereas, in the nutrition they are getting from it, it is terrible value.”
“I had a chat with someone from the fish friers’ association. I said, “Why do you guys always sell massive portions of chips?” Whenever we buy fish and chips, we get a massive portion that would feed a whole family. I said, “Why do you do it? No one eats them; they just throw them all in the bin. It is a waste of food and money”. He said, “It is a race to give the biggest portions because that is what people want”.
391.The Government’s sugar reduction programme states that businesses are able to take action to reduce the levels of sugar in their products through reformulation, reducing portion size or shifting consumers purchasing patterns towards lower/no added sugar products. Similarly, the Government’s calorie reduction programme states that industry has the option to reduce the portion size of its products to meet the Government’s target to reduce calories. The Government has not yet indicated that it will consider measure to mandate portion sizes in the published chapters of its childhood obesity plan or through any other current public health proposals.
392.As part of any future measures the Government sets out to tackle obesity and poor dietary health, it should develop and publish a consultation with industry on the issue of mandating maximum calories per portion. This consultation process must involve active engagement with SMEs and the catering sector.
393.It was suggested that reformulation has limits as an approach. Overall, witnesses were sceptical of the Government’s apparent dependency on reformulation measures to deliver public health improvements.
394.There have, however, been signs that both voluntary and mandatory measures can deliver results. Consistently throughout the evidence, programmes that aim to encourage, or mandate, manufacturers to reformulate their products to make them healthier, were cited as an important component of the solution to deliver better health outcomes.
395.In her report, Time to Solve Childhood Obesity, Professor Dame Sally Davies called on the Government to: “Rebalance the food and drinks sold to favour healthy options, through regulation” and stated that:
“Ministers are in a unique position of influence to shape the environment. They can set the scene for nudging positive outcomes or they can continue to allow the flow of unhealthy options to dominate a child’s upbringing. Political apathy will mean that negative health consequences for children continue—limiting their life chances whilst restricting economic productivity and the viability of the NHS.”
396.The success of the SDIL demonstrates that regulatory action on reformulation can deliver results, without impacting on economic viability in the sector. This is a clear indication to us that that the Government should do more to explore further mandatory and fiscal measures to compel the food industry to act. The Public Health Minister, Jo Churchill MP told us that:
“I would like to see reformulation go on at pace. We have been incredibly clear that where progress isn’t being made, we will consider what further action can be taken. I think that the SDIL lays down a very strong marker to the industry that the Government is willing to take regulatory action. We need to send a strong message that this isn’t about reducing sales it is about reducing sugar and ultimately about helping people make healthier choices.”
397.Reformulation is an important part of overall efforts to drive healthier diets. The Government must maintain the pressure on food manufacturers to reformulate their products. The Government must recognise that the fact that Government-led reformulation programmes are required at all, points to wider and more serious failings in the food system as a whole.
398.For voluntary programmes to be successful it is imperative that targets are transparently monitored and regularly reported on. Voluntary approaches may be successful if the Government sets out the right support to ensure industry stays engaged.
399.We recommend that all reformulation programmes, both voluntary and mandatory, should be subject to transparent and regular monitoring. Progress reports need to be carried out on a regular basis by the responsible body and should include details of the companies that have successfully made reductions in the levels of salt and sugar in their products, to aid industry-wide reformulation.
400.We recommend that where voluntary approaches are adopted, the Government should make clear that if the industry does not respond comprehensively and swiftly then regulatory action will follow. Both the sugar and salt reduction programmes are unlikely to meet their stated targets. To ensure that necessary and significant public health improvements are actually achieved, the Government needs to face the reality of the situation and start to plan now for how further progress on reformulation might be delivered. The Government should set out now what mandatory action would look like, if sufficient progress is not made on the existing reformation programmes in the near future. Industry can then prepare. We ask that the Government does this by the end of 2020.
401.Mandatory (fiscal) approaches can be highly successful, as evidenced by the Soft Drinks Industry Levy. As there is a proven mechanism for delivering successful reductions in harmful ingredients, in a way which has not had a significant detrimental impact on the industry, the Government must not delay in exploring the application of fiscal measures (such as further levies or changes to VAT) to other product categories where reformulation is not in line with Government guidance or targets.
402.We recommend that the Government stands by its commitment to review the Soft Drinks Industry Levy in 2020, and commits to extending the levy to other drinks containing added sugar, including sugary milk-based drinks. It should also conduct work to explore the impact of lowering the current sugar thresholds to encourage further reformulation. It should rapidly determine which other food products high in sugar could be subjected to a similar levy.
469 Written evidence from the Food Foundation, London School of Hygiene and Tropical Medicine and Sustainable and Healthy Food Systems (SHEFS) ()
471 Written evidence from the University of Southampton and the MRC Life Course Epidemiology Unit Southampton General Hospital ()
472 (Anna Taylor)
473 Department of Health and Social Care, Advancing our health: prevention in the 2020s:consultation document, CP 110 (July 2019): [accessed 30 June 2020]
474 (Shirley Cramer)
475 (Professor Susan Jebb)
477 Scientific Advisory Committee on Nutrition, Salt and Health (April 2003), p ii: [accessed 30 June 2020]
478 Public Health England, Salt Reduction Programme PHE’s first assessment of the food industry’s progress towards meeting the government’s salt reduction targets (December 19 2018): [accessed 30 June 2020)
479 HM Revenue and Customs, Soft Drinks Industry Levy (December 2016): [accessed 30 June 2020]
480 Public Health England, Sugar reduction and wider reformulation, (20 September 2019): [accessed 30 June 2020]
481 Public Health England, Reduction and reformulation programme: Spring 2019 update (10 May 2019): [accessed 30 June 2020]
482 Public Health England, Salt Reduction Programme, PHE’s first assessment of the food industry’s progress towards meeting the government’s salt reduction targets (December 2018): [accessed 30 June 2020]
483 (Professor Susan Jebb)
484 Written evidence from Nuffield Council on Bioethics ()
485 (Jenny Oldroyd)
486 (Mhairi Brown)
487 (Susan Lloyd)
488 Written evidence from the Nuffield Council on Bioethics ()
489 (Mhairi Brown)
490 Written evidence from Consensus Action on Salt, Sugar and Health ()
491 (Jenny Oldroyd)
492 Public Health England, National Diet and Nutrition Survey, Assessment of salt intake from urinary sodium in adults (aged 19 to 64 years) in England, 2018–2019 (March 2020), p 6: [accessed 30 June 2020]
493 Action on Salt, ‘Action on Salt Position: UK Salt Reduction Strategy’: [accessed 30 June 2020]
494 Public Health England, Salt target 2017: Progress report, A report on the food industry’s progress towards meeting the 2017 salt targets (December 2018), pp 4–5: [accessed 30 June 2020]
495 Written evidence from HM Government ()
496 Public Health England, Sugar Reduction Programme, Progress made by industry in the first year (22 May 2018): [accessed 30 June 2020]
497 Public Health England, Sugar Reduction: Report on progress between 2015 and 2018 (September 2019) p 6: [accessed 30 June 2020]
498 (Jo Churchill MP)
499 Public Health England, Sugar Reduction: Report on progress between 2015 and 2018 (September 2019) p 8: [accessed 30 June 2020]
500 (Professor Susan Jebb)
501 (Dr Hilda Mulrooney)
502 (Mhairi Brown)
503 Written evidence from Nuffield Council on Bioethics ()
504 Written evidence from Sustain ()
505 Public Health England, Sugar Reduction: Report on progress between 2015 and 2018 (September 2019) p 9: [accessed 30 June 2020]
506 HM Treasury, Soft Drinks Industry Levy comes into effect, (5 April 2018): [accessed 30 June 2020]
507 National Institute for Health Research, Sugar tax had no lasting negative impacts on the UK soft drinks industry, (25 February 2020): [accessed 30 June 2020]
508 (Dr Hilda Mulrooney)
509 (Mhairi Brown)
510 Written evidence from Cancer Research UK ()
511 Supplementary written evidence from DHSC ()
512 (Professor Susan Jebb)
513 (Dr Hilda Mulrooney)
514 (Professor Susan Jebb)
515 (Dr Hilda Mulrooney)
516 (Kate Halliwell)
517 Written evidence from Nestlé ()
518 (Kate Halliwell)
519 (Kate Halliwell)
520 (Kate Halliwell)
521 (David Morris)
522 (Andrew Opie)
523 (Andrew Opie)
525 (Andrew Opie)
526 (Judith Batchelar)
527 Written evidence from the Centre for Diet and Activity Research ()
528 Written evidence from City Harvest ()
529 (Mark Laurie)
530 Public Health England, Sugar Reduction: Report on progress between 2015 and 2018 (September 2019) p 12: [accessed 30 June 2020]
531 Public Health England, Plans to cut excess calories consumption unveiled (6 March 2018): [accessed 30 June 2020]
532 Professor Dame Sally Davies, Time to Solve Childhood Obesity. An Independent Report by the Chief Medical Officer (2019), p 2: [accessed 30 June 2020]
533 (Jo Churchill MP)
534 (Professor Andrew Balmford)
535 Department for Environment, Food and Rural Affairs, The future Farming and Environment Evidence Compendium (February 2018): [accessed 29 June 2020]
536 Department for Environment Food and Rural Affairs, National Statistics: Food Statistics in your pocket 2017: Global and UK supply, (9 October 2018): [accessed 29 June 2020]
537 Department for Environment Food and Rural Affairs, National Statistics: Food Statistics in your pocket: Global and UK supply’, (30 March 2020): [accessed 29 June 2020]. Production to supply ratio is calculated as the farm-gate value of raw food production (including for export) divided by the value of raw food for human consumption.
538 Department for Environment, Food and Rural Affairs, The future farming and environment Evidence compendium (February 2018): [accessed 29 June 2020]
539 Department for Environment, Food and Rural Affairs, Agriculture in the United Kingdom (2018) p 10: [accessed 29 June 2020]
540 (Professor Tim Lang)
541 (Professor Andrew Balmford)
542 Professor Walter Willet MD, et al, ‘Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems’, The Lancet, vol 393, (2019), pp 447–492:
543 (Professor Tim Benton)
544 Written evidence from the Sustainable Food Trust ()
545 Written evidence from Martin Lovegrove ()
546 (Philip Hambling)
547 (Philip Hambling)
548 (Rob Percival)
549 Written evidence from Martin Yarnit ()
550 Department for Environment, Food and Rural Affairs, Agriculture in the United Kingdom (2018) p 10: [accessed 29 June 2020]. This figure encompasses those farms which failed to make a positive Farm Business Income.
552 National Audit Office, Early Review of the new farming programme (5 June 2019) p 8: [accessed 29 June 2020]
553 Department for Environment, Food and Rural Affairs, ‘Agriculture bill to boost environment and food production’ (16 January 2020): [accessed 29 June 2020]