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Diet and food

Government responds to House of Lords Committee report on the obesity crisis in England

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In October 2024, the House of Lords (HOL) Food, Diet and Obesity Committee published a report; Recipe for health: a plan to fix our broken food system. The report highlights an obesity crisis across the country and points to a number of key factors driving the reality that 64% of adults in England are now living above a healthy weight.[1] As CancerWatch, we welcomed the publication of this report because of the clear and well-established link between obesity and 13 types of cancer, including cancers of the breast and bowel (two of the most common types of Cancer), pancreatic and oesophageal (two of the hardest types of Cancer to treat) and womb, kidney and liver.

The Government has now published their response, acknowledging the role that obesity plays in driving ill health, economic activity and premature mortality.[2] With a Government Mission focused on reforming the NHS which includes reducing the burden on frontline services and developing a more preventative approach to healthcare, we’ve taken a look at their response and drawn out three commitments they’ve made to tackle obesity and drive improved public health.

  1. The Government has agreed to produce an “ambitious food strategy” – one of the headline recommendations from the HOL report – which, alongside improving food security and environmental impact of food production, will seek to facilitate greater access and availability of healthier foods. While this strategy will be led by the Department for Environment, Food and Rural Affairs, it will be developed in close collaboration with the Department for Health and Social Care and the Department for Education and the Food Standards Agency.
  2. As part of its manifesto commitment to provide breakfast clubs to all primary school age children at state-funded schools, the Government is working with the FSA and local authorities to ensure a whole school approach to food to ensure quality and quantity standards for the food being provided to children in the school environment.
  3. The Government will review the effectiveness of front-of-pack nutrition labelling to ensure consumers are well-informed about the nutritional benefits and health drawbacks of foods. They have also committed to evaluating the impact of calorie labelling implemented by large businesses across England, with a review due to be published by 2027.

As CancerWatch, along with our partners and friends from across sectors, we will continue to call on Government to ensure that these commitments lead to tangible action and impact in enabling a sea-change in access and affordability of healthier choices and action on poor diet across the country.

[1] https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england

[2] https://www.gov.uk/government/publications/get-britain-working-white-paper

Planning for better health: new rules to limit fast-food outlets near schools

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There was some good news before Christmas for anti-obesity campaigners and all those who care about improving the diet of children and young people. The Government announced that it will from now on be harder to open new fast-food outlets, especially in close proximity to schools or places where young people gather.

Planning policy tightened

The newly revised version of the National Planning Policy Framework (NPPF) which came into use in December states that:

Local planning authorities should refuse applications for hot food takeaways and fast food outlets:

a) within walking distance of schools and other places where children and young people congregate, unless the location is within a designated town centre; or

b) in locations where there is evidence that a concentration of such uses is having an adverse impact on local health, pollution or anti-social-behaviour.

The NPPF is a key planning document which sets out the overarching principles of national planning policy. All local authorities are obliged to abide by these principles in developing their own local planning policies and deciding planning applications.

Fast food, obesity and cancer

We know that fast foods tend to be high in calories, saturated fats and salt, and higher consumption of them raises the risk of obesity. And we know that obesity is a major driver of cancer in the UK, being a causal factor in up to 13 different types of cancer, including cancers of the breast and bowel (two of the most common types of cancer), and pancreatic and oesophageal cancer (some of the hardest to treat).

As such, though the relationship between diet and cancer is complex, we could make very significant in-roads into reducing preventable cancer by improving our diet. To achieve this, CancerWatch believes that we need to seek structural changes in our economy and society which will make cancer-causing products and choices less prevalent and healthier choices much more prevalent.

Enabling and encouraging children and young people from all backgrounds to take on healthier dietary habits from a young age is central to our ability to do this. As campaigners have pointed out, fast food outlets are disproportionately clustered in the most deprived neighbourhoods and this concentration may have been growing in recent years.

This change in planning policy is exactly the kind of structural change we need to see to improve the nation’s diet and seriously cut back the number of preventable cancers.

Building on success

The new policy is also a real victory for food campaigners from a wider range of organisations, including Obesity Health Alliance, of which CancerWatch is a member, Sustain, and Food Active who have rightly celebrated this victory. Now we need to build on these successes and continue to campaign for a better food environment for children and young people. We could begin by reducing the proportion of ultra-processed foods in school meals, as set out in CancerWatch’s 2024 Cancer Prevention Manifesto.

State of play: diet and food

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Throughout this Cancer Prevention Action Week, we are reviewing the current state of public policy for the major risk factors in causing preventable cancers.

There is a clear link between obesity and numerous cancers – 13, according to Cancer Research UK. This link is both statistically clear, and increasingly well understood in biomedical terms: fat cells do not simply sit in the body, but interact with its processes, particularly influencing growth and sex hormones and causing inflammation, all of which increases rates of cell division and therefore the risk of a cancer developing.

However, tackling obesity is a complex and sensitive topic. As we discussed in a previous article, the temptation to blame individuals for making poor choices is strong, but wrong-headed. The rise in obesity levels over recent decades has been overwhelmingly caused by changes in diet. The prevalence of obesity doubled from 1990 to 2020, following major structural changes to the food we buy and how we buy it. From the 1970s onwards, ready-made, “ultra-processed” foods high in salt, fat and sugar became more common in our diets: the UK has the highest consumption of these foods in Europe.

At the same time, supermarkets came to dominate food retail, spurred on by changes to planning laws that made large out-of-town shops feasible. Supermarkets achieved a dominance that enabled them to drive down prices for consumers, but also exert enormous influence over what is available for us to buy, and how attractive different products can seem.

Takeaway food options have also expanded enormously over recent decades, most commonly offer tasty but unhealthy meals, and are more common in economically deprived neighbourhoods.

The need for changes to diet and food supply

It is CancerWatch’s view that major structural changes are needed in order to reduce levels of preventable cancer. This must mean making changes to our food chain and distribution: while changing individual behaviours has its place in the mix, this sort of change is always easiest for people who are already relatively well-off and relatively advantaged. But that is not where change is most needed: the problems with our food supply are a key factor in health inequalities. Sir Michael Marmot’s second review of health inequalities identified the characteristics of an unhealthy high street: they include higher density of payday loan, alcohol, gambling and fast food outlets. And over a million people in the UK live in “food deserts”, meaning they lack access to cheap and nutritious food (in practice, this usually means access to a supermarket).

We therefore argue that this issue should be approached and framed in terms of food and diet, rather than obesity. There are several advantages to taking this approach. One is that it encompasses other food-related factors in causing cancer, such as processed and red meat, which are clearly established factors in causing bowel cancer, and heavily implicated in stomach and pancreatic cancer as well.

Even more importantly, discussion of healthy eating is more acceptable to public opinion. Obesity is still widely understood (or misunderstood) as a personal failing arising from individual choices, and many people are inclined to reject messaging suggesting that individual choice is not the main problem. However, people are generally more receptive to messages about healthy eating, or diet as a factor in improving their overall health, rather than focusing just on wider causes of obesity. Messages pointing out the role of health inequalities also tend to be better received when they relate to access to food, rather than to levels of obesity. This is therefore the route to achieving public buy-in for structural change (although entirely discounting the role of personal responsibility is understandably greeted with scepticism: people expect to continue to see it as part of the policy mix).

Cancer Research UK’s much-publicised advertising campaign in 2019, drawing attention to the link between obesity and cancer, therefore somewhat fell into the obvious trap. CRUK’s policy positioning on what is needed to reduce the incidence of preventable cancers by reducing obesity is entirely right, and it is true that the link between obesity and cancer is not as widely known as it needs to be. But their posters might have done better to call for a specific policy change to improve diets: without that, their messages were directed at an audience of individuals, which carried the implication (whether intentional or not) that it was for those individuals to do something about it, and nobody else.

Policy options, and action to date

So, what action could be taken, and how much is already on course to happen? The good news is that action can be taken on many fronts: there is no shortage of possibilities. Planning reforms could be deployed to address unhealthy high streets, for example, and food deserts could be targeted through a collaborative approach between supermarkets and government both locally and centrally. The power of supermarkets more broadly could be leveraged to good effect: they are being prohibited from heavily promoting unhealthy foods from October this year (albeit this measure is much delayed), but could potentially use their dominant market position to promote healthy choices more heavily.

Measures to prompt the reformulation of food and drink to be more healthy could also be developed. The Soft Drinks Industry Levy (better known as the sugar tax) led many manufacturers to reformulate their products, and has enjoyed widespread public support. More measures of this sort are surely viable.

Public Health England undertook much valuable policy development work in this area, prior to its abolition (for example this paper on calorie reduction and this on a whole system approach to obesity). Unfortunately the Government Food Strategy published last year falls well short of taking the bold structural action needed, including failing to adopt many of the recommendations of the independent National Food Strategy that it had previously commissioned. Until much stronger action is taken, the costs of our current food supply and dietary problems will continue to be passed on to the NHS, and many people will continue to develop preventable cancers.

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Image by Call Me Hangry on Unsplash.