Tackling obesity – What the UK can learn from other countries

This week 2020health is producing its third report on obesity: Tackling obesity – What the UK can learn from other countries. The prevalence of overweight and obesity among adults and children has never been higher in the UK, so what the country has spent and implemented to date is clearly not enough.

What we know 

In our first report on obesity, Careless Eating Costs Lives (2014), we made 17 recommendations that required at least as many agencies, local and national government departments, national health and clinical institutions to be involved in the delivery of a cross-cutting strategy. Our second report Fat Chance? in 2016 looked at the evidence for who becomes, and is most likely to become, obese. One revelation in the socio-economic context was that both upwardly and downwardly mobile groups are correlated with higher rates of obesity than the stable rich or middle classes, while upwardly mobile groups have the same obesity rates as the stable poor; uncertainty seems to be a significant factor for weight gain.

Where we are

In 2017 we began a review of countries we had researched four years previously to discover where they had got to with their obesity programmes. We case-studied policies implemented at the country, region, city and town level to inform a discussion on potential insights and transferable learning for the UK.

Key findings in our latest report Tackling obesity – What the UK can learn from other countries include:

• National Interventions – Top level leadership needs to convey the importance of obesity prevention through stronger accountability structures, intelligent taxation, and mandatory school-based education on health and wellbeing
• Regional Interventions – Coordinated, cross-sector local programming is essential across multiple environments, with consideration of public-private partnerships
• City/town Interventions – A detailed understanding of the social determinants of obesity within the locality are vital to the implementation of relevant and targeted initiatives
• 0-12 years – Multi-stakeholder, community-based programmes for school-aged children (across multiple environments) are more effective than school-based programmes; interventions need to consider improving access to drinking water in schools, public (parent) health literacy and the built environment

Obstacles to progress included a lack of evaluation of obesity programmes, preventing shared learning and buy-in; the widening price gap between junk food and healthier options; and obesity prevention with a school-only focus, which often shows no effect in the long term, leading to stakeholder discouragement and possible disinclination to pursue further strategies.

What we can do next

Strong and mandated central policy, supporting bold, holistic local action, is needed to impact what is arguably the greatest health challenge of the 21^st century. The UK government has rightly placed principal focus on children, but a health-in-all-policies approach has yet to be realised.

In the light of our three reports we therefore urge the government:

• to help finance Local Authority pilots of EPODE (‘Ensemble Prévenons l’ObésitéDes Enfants’: EPODE, Together Let’s Prevent Childhood Obesity), or similar community-based programming, in a range of communities around the UK, supported by robust academic evaluation to enable learning and effective dissemination
• to support healthier food choices among the poorest families by extending the healthy start voucher scheme
• to introduce a compulsory Ofsted rating scheme of school policy and action on physical and mental health – in both primary and secondary schools
• to ‘obesity check’ all new policies to spot potential unintended consequences

While local, whole-systems approaches to obesity need to be explored (as being trialled in the London Borough of Lewisham), children require special focus. If the UK fails to implement joined-up, multi-sectoral obesity prevention strategies for children and their families across a range of local contexts, it has little hope in ever reversing the obesity epidemic among the wider population.