In this article for The Conversation, CEDAR PhD student Dolly Theis discusses new insights into why successive government’s obesity policies in England over the past three decades have largely failed.
In England, 63% of men and women live with obesity or are overweight. Although the government has recognised obesity to be a significant health challenge that needs to be addressed, none of the obesity strategies they’ve published since 1992 have successfully reduced the prevalence and inequalities of obesity.
My team wanted to find out why this was the case. So we analysed England’s 14 obesity strategies and 689 obesity policies that have been proposed over the last 28 years by government. We found that during this period, English obesity policy has largely been unfit for purpose.
Many of the policies we analysed were poorly designed, or were proposed in ways that could not readily be put into action. Many failed to learn from previous policy successes and failures. This may explain why they’ve been poor at effectively reducing obesity.
We assessed the policies by looking at what behaviours were targeted (such as diet or physical activity), policy type (for example, if the policy proposed placing restrictions on unhealthy products), how easily the policy could be implemented, regulation approach, and whether the policy focused on requiring people to make changes, or if they focused on making population-level changes.
We found that the proposed policies were unlikely to be implemented for a number of basic reasons. Around 76% of all policies had no plan to monitor or evaluate whether they were actually working. A further 81% were published with no cited evidence (for example, on whether the policy was likely to be effective), while 91% included no cost or budget for implementing policies.
Many policies were also similar or exactly the same, recycling recommendations made in previous strategies, but failing to make it easy to implement them. Just 8% of the policies we looked at included all the necessary details about how the strategy could be readily implemented.
A total of 43% of the policies we looked at required people to make changes to their lifestyle (such as dieting or exercising) to tackle obesity. Yet research shows these types of policies aren’t effective. Just 19% of policies focused on making it easier for people to be healthier by shaping the choices available to them.
Even when strategies addressed other factors that can effect weight and weight change (such as requiring the food industry to supply healthier options), the interventions proposed were voluntary around 64% of the time. For example, the Public Health Responsibility Deal only asked members of the food and drinks industry to voluntarily pledge to reducing calories or sugar in their products – it wasn’t a requirement.
Research shows this approach tends not to work. This is because there’s often low compliance, or insufficient commitment to pledges.
What’s more, 13 of the 14 strategies explicitly recognised the need to reduce health inequality – but only a fifth of the proposed policies included ways to address this.
While it’s clear work still needs to be done, there are signs that the government may be learning from past faults, as shown by the design of more recent policies.
First, strategies published between 2016 and 2020 contained the highest proportion of population level, low-agency policies that aim to change environments. This will likely make these strategies more effective than previous policies.
For example, the most recent obesity strategy proposes a ban on advertisements of products high in fat, sugar and salt being shown on TV and online before 9pm. Evidence shows that such a measure could reduce the number of children living with obesity or excess weight. Other proposed measures include ending “buy one, get one free” deals on junk food, and creating more comprehensive calorie labelling on products and in restaurants.
Second, policies such as 2018’s Soft Drinks Industry Levy are more likely to see changes take place on a population-wide level in reducing obesity compared to individual-focused policies. The levy places a charge on sugar-sweetened beverages – which emerging evidence shows is likely to have positive health impacts. Strict enforcement and has successfully achieved high compliance.
Third, there have been steps to conduct long-term policy monitoring and evaluation, as seen with the sugar reduction programme. Monitoring the effect of these policy changes will allow the government to better see what works in reducing obesity, and what doesn’t.
Whether these latest strategies work has yet to be seen. But government is certainly moving in the right direction. Of course, any policy monitoring strategies will need to be creative in their evaluation and study their effects in real life settings.