The writer was head of the Downing Street Policy Unit and is author of ‘Extra Time: Ten Lessons For Living Longer Better’
As we emerge from lockdown, I’m startled to find that some friends have changed shape. The new world seems to divide into those who look leaner and those who have put on the coronakilos. The trouble is, this isn’t just an aesthetic issue. After age, obesity is the second biggest risk factor for hospitalisation from Covid-19.
Slimming their populations before a second wave should be an imperative for governments. It should also be a mission for social justice campaigners. Obesity and its associated diseases (type 2 diabetes, heart disease and some cancers) disproportionately affect lower socio-economic groups.
The inequality is stark as young as 11. In the UK, twice as many 11-year-old boys from the poorest fifth of the population are obese as in the richest fifth, and the gap is widening. Black and South Asian 11-year-olds are getting bigger at a faster rate than white children: a signal that should be flashing red given the extra vulnerability of ethnic minority groups to Covid-19.
You cannot “level up” the nation, as Boris Johnson wants to do, unless you close this health gap. The prime minister’s near-death experience in intensive care has converted him from libertarian to obesity warrior. Yet vested interests are trying to dilute his ambitions.
The government has floated ideas for banning some two-for-one price promotions in supermarkets and putting calorie counts on restaurant menus, policies that have been stuck in draft since I oversaw Number 10’s obesity strategy in 2015. But it is backing away from restricting television and online advertisements for unhealthy food. Officials at the Department for Digital, Culture, Media and Sport are siding with advertisers, just as they did in 2015. Mr Johnson is also going cold on sugar taxes, under pressure from Big Food.
The sugar tax on drinks was the only part of our 2016 strategy that survived, partly because the then leadership didn’t give the cabinet a chance to disagree. The levy has reduced the average sugar content in purchased drinks by 28.8 per cent, and showed that companies can reformulate rapidly. But at the time, many Conservative MPs were convinced the policy would be wildly unpopular. Under fire from the tabloids, they feared to be seen as “nannying”.
Today’s Conservative party has an even stronger libertarian wing and a fear that newly acquired voters in working-class seats are especially allergic to bossy public health messages. This prime minister, who likes a good time and has reminisced about late-night bingeing on chorizo and cheese, cannot be portrayed as a killjoy health fascist. But he will need to be bossier on this subject than he is naturally inclined.
Above all, Mr Johnson must confront the notion that government intervention is the enemy of freedom. I used to be libertarian about both diet and smoking, wary of government interference in personal lives. When I became a parent I found myself trapped by a market that is adept at unleashing pester power, which serves up what are only degrees of badness between different breakfast cereals, making “choice” an illusion. I also learned that sugar is as addictive as nicotine. It takes enormous willpower to avoid being saturated in junk, and willpower is in especially short supply if you work the night shift and get home exhausted after a long commute.
The problem is not a lack of information — we have been told to eat our vegetables for decades. It is that our brains are very susceptible to environmental cues: adverts that make us salivate, chocolates by the till. Everyone may be free to eat what they like, but when did you last see a two-for-one offer on carrots? Policies to educate have failed. When one management consultancy followed supermarket shoppers to test “traffic-light labelling”, which classes foods as red, yellow or green according to their nutritional value, they saw customers seeking out the red-labelled products because they taste better.
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It makes sense to target supermarkets, because they supply so much of what we eat. But the government needs to do far more. I would take the action to deprived areas where the problems are most acute and enlist local people in a national effort to stay healthy. Offer weight loss programmes and dance classes; turn food banks into sources of fresh food; upgrade the content of free school meals; issue exercise trackers with rewards; get all schoolchildren walking a mile a day. I would suggest using randomised control trials to find out what works. And why not enlist the 750,000 citizens who volunteered to help the NHS during the first wave of the coronavirus crisis? After all, obesity costs the NHS more than £5bn a year.
In addition to inspiration and exhortation, we need to remove temptation at source. We will still reach for the sweets; so we need them to contain less rubbish. Those who oppose extending the sugar tax to food portray it as a stealth tax that will raise prices for the poorest. But prices do not rise when companies reformulate to avoid such a levy. All that changes is the ingredients.
There is a big role for doctors here, who can be reluctant to mention a patient’s weight. Some tell me they are embarrassed; others think patients won’t achieve their goals. But studies show that, with support, they can. GPs who ask if you smoke but do not calculate your body mass index are failing in their duty.
There is no shortage of ideas but there has been, until now, a lack of political will. With the wind of fear at his back, a deadly virus at large and a personal story that resonates, Mr Johnson must stick to his guns and think very big.
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