Obesity 

Can legislation can help the nation's eating habits? 

"Obesity can’t be dealt with in isolation, economic measures are necessary to combat the growing problem. Policy in this sector must give people time to cook and prepare meals"

Obesity

There was very little control from the EU in relation to obesity. We are the fattest country in the EU. We already have enough control to improve the situation. It must be part of any discussion about our future food and farming. In the book Bittersweet Brexit, it shows how we came to adopting the (US) Dietary Guidelines which demonised fat - that favoured processed corn products in the USA.
Brexit Diet could lead to death because even less fruit and Veg will be eaten. "By value, imports make up more than 90% of the fruit and vegetables consumed in the UK and half of the meat. Brexit is expected to increase trade costs and make food imports more expensive, something that could lead to changes in diets and dietary risk factors that influence health. "  Mind you there are those shouting for 'cheap imported food', which will make matters worse.

Class Issue

Obesity images
It is poverty, not individual choice, that is driving extraordinary obesity levels. "Obesity is not just a matter for nutritionists: rather, it is a product of social inequality and requires a collective social response."
RSA Commission  on Food & Farming halfway report says:"One of the intractable issues at the intersection of food, farming and the public’s health, is that the rapid increase in diet-related ill health is a result of over-consumption of calories, largely from food of poor nutritional quality. We live in an obesogenic environment: one which encourages us, through marketing and promotion, to buy and eat more than necessary. Many of these calories come from the sorts of food which sector specialists call ‘value added’. It may be time to ask the question: “value added for whom?” 
Check out Paul Heaton and Jacqui Abbott singing about in 'The Fat Man'.
Is 'fatphobia' a class issue? "Eating problems and social class are inextricably linked. Being healthy is a symbol of privilege... On the opposite side of the spectrum, fast food and obesity have come to be associated with those on a lower income." 
Jamie Oliver says "For families on the breadline, eating healthy food is secondary to eating at all.” 
SNAP incentives in US (like a coupon, token or debit card) simultaneously increase consumption of nutritious produce and stimulate local economies by unlocking demand for fruits and vegetables. Moreover, when linked to local agriculture, the benefits expand to support the foundation of local economies. See Preston Model for more
"Overeating could be the most rational response in a dysfunctional, uncaring, unequal, unnaturally commercialised society." Yasmin Alibhai-Brown 
We need to produce more calories to feed bigger people. No we don't

United Kingdom


The UK is one of the three most obese countries in Europe "With an obesity rate of 27.8%, the United Kingdom (UK) is the third fattest country in Europe, and the fattest in Western Europe. One in five pregnant women in the UK have a BMI greater than 30. The World Obesity Federation has predicted that if obesity in the UK is not effectively tackled, the cost of treating obesity-related health problems will reach a whopping $31 billion per year in 2025. "  Malta and Turkey bit fatter..
And that is before Covid.

Double Burden


A report in The Lancet (2019) says a third of poor countries now face the double burden of obesity and malnutrition. They say: "The problem is caused by global access to ultra-processed foods, and people exercising less." More .  Places where there are too many fat and too many are thin In South Africa, almost one in three boys are overweight or obese, while a further third are underweight. 
Charlie (site author) was a co-author for World Health Organisation's (WHO) Manual for Decision Makes on Food & Nutrition Policy Development  
15 years ago  he delivered WHO/FAO courses on food plans & policies in franco-and anglo-phone Africa. it was clear then that poorest countries face both obesity and malnutrition.  We called it the 'double burden' @  WHO.
When we asked participants from seven African countries what had changed over previous 30 years, most said 'we do not now sit down and eat together, but instead we eat on the move''.
Click image below to see / hear my introduction (in tres anglais francais)  for 'training the trainers' in francophone Africa - in Cotonou  Benin 15 years ago

Childhood Obesity

A study by University College London found that the children of single mothers working full-time were 25% more likely to be overweight compared to children with stay-at-home mothers. Increases were also related to working mothers who have partners, but found that children are fatter regardless of whether their mother works full- or part-time. "It found that the dramatic increase in the numbers of obese children and teenagers over the past four decades had been accompanied by a similarly sharp rise in the employment of mothers". 
In Bittersweet Brexit, Chapter 'All Change' I said: "In the 1990s, more women joined the workforce than ever before" reflecting what happened when the amount the male 'breadwinnner' bought home declined I went on to say "As a result, the manufacture of processed and packaged meals increased dramatically, providing a ready-made replacement to home-cooked food".
Leeds becomes first city to reduce childhood obesity "6,000 families in Leeds were given 8 weeks of  lessons, which costs councils £50 per family, with 625 children a year "saved" from obesity.The programme is aimed particularly at poorer areas.Rates of obesity in five-year-olds in Leeds dropped from 9.4% to 8.8% between 2013-14 and 2016-17, while remaining unchanged in England as a whole at around 9.4% over the same period."
Beware of International Life Science Institute is challenging the new US dietary guidelines, fearful of them being adopted elsewhere. They are a front for the likes of Coca Cola and Monsanto.
Government's version 'world-leading obesity plan' 1 Children's Food Campaign differs saying' It is shocking that the Department for Education has been allowed to disregard the commitments it made in the Childhood Obesity Plan. A search party may be needed to track down any signs of progress the Department has made.  The list of inaction includes ....2 The Healthy Ratings Scheme for primary schools is yet to be drawn up, despite the promise to bring it in from this September.3 The Secretary of State for Education was tasked with leading a campaign encouraging all academies and free schools to meet the School Food Standards, but this has not happened.4 The Standards themselves have not been revised to meet new nutritional guidance.5 The revised early years menus have not been released either, despite assurances they would be.
2 years on sugary snacks to be banned at checkouts and halve childhood obesity by 2030

Globesity


The Lancet asked (April 2018) "how is it that obesity has nearly tripled worldwide since 1975?". Obesity was first noted in late 1970s in USA. “It is implausible that each age, sex and ethnic group, with massive differences in life experience and attitudes, had a simultaneous decline in willpower related to healthy nutrition or exercise”, but rather that it is important to consider factors that have a mass exposure, are widely distributed, and act with short time-lags. The US farm bills in the 1970s appear as a strong candidate, which led to a rapid increase in food production and thus an increase in food portion sizes; accelerated marketing, availability, and affordability of energy dense foods; and widespread introduction of cheap and potent sweetening agents, such as high-fructose corn syrup, which infiltrated the food system and affected the whole population simultaneously. This observation might well extend to other countries, such as the UK and most European countries—as most populations have been exposed to similar substantial changes in food supplies, with consequences for dietary patterns." This echoes the chapter on obesity in my Bittersweet Brexit book!
WHO say marketing controls on unhealthy foods not good enough

Schoolchildren

Record number of severely obese (BMI = 40+) school children Levels of childhood obesity have remained fairly stable in recent years, but a new analysis, from Public Health England, shows that severe obesity has been on an upward trend over the last decade  - now one in 25 (over 20,000) on leaving primary school. With a national average of 4.1% children severely obese, there are 4.9% in Blackburn, Accrington 4.7% and Burnley 4.5%. Over the hill in posh Ribble valley it is 1.4%.
According to the Lancet no amount of 'education' is going to solve the issue of obesity among children  

'The Broken Plate' makes recommendations for how to reshape the food system so that healthy diets are affordable, appealing and convenient for all. "Calorie for calorie, unhealthy food is 3x cheaper than healthy food. 

Did fat people vote for Brexit?

Here is a curious finding. The top ten districts voting to 'Leave' in the Referendum are associated with high proportions of obese adults, while top ten ‘Remain’ districts are much leaner.  This result does not correspond with obesity and poor districts. One suggestion is that it may be driven by personality traits that characterise both ‘Leave’ voters and obese adults.  I’m not sure about that, as the top three ‘obese’ districts are in the fens with the plantations, and the bottom three in East London with no fields. But I’ll leave that to you to decide. 
Leave voters prefer 'well done steaks', Remain 'medium rare'. Surveyed in April 2017 about the environmental impact of eating meat, 24% of Leave voters said they were “very unwilling” to consider “eating less meat and fewer meat products in the future”. Only 9% of remain voters felt so strongly carnivorous. 
Theresa May seems startled with chips while Ed Miliband struggles with a bacon sandwich. Leave voters overwhelming declared that Ed Miliband eating a bacon sandwich was far worse than Theresa May’s chip-eating face: 76% said Ed looked worse; just 6% said Theresa. Remain voters were more evenly matched, with a quarter saying Theresa’s chip moment was worse, and half plumping for Ed.
The question that needs answering is: "Why do we consume more ultra processed foods in Britain than any where else?"
High fibre good for you. Trials over 40 years "suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least".
FCRN Report "What is ultra-processed food? And why do people disagree about its utility as a concept?"

Ultra-Processed Foods


A study of 19 countries has found that the UK has the most ultra- processed food per household amounting to over 50% of dietary energy. "A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults..each percentage point increase in this availability resulted in an increase of 0·25 percentage points in obesity prevalence."   More The UK Dietary Guidelines are pre-occupied with reducing fat levels urging us to consume only around 10% of dietary energy as fat, and virtually 'ignores' ultra-processed foods. More in Bittersweet Brexit book.Study of over 100,000 people in mid forties found that with every 10% increase in proportion of diet coming from ultra-processed foods, this increases overall cancer rate by over 10%. Further work is suggested as whether these results are due to " nutritional composition, food additives, contact materials, and neoformed contaminants". The ultra-processed truth about 10 of our bestselling foods.
BMJ Could we agree to demonise processed food not saturated fat? "Clarification of the distinction between processed food and saturated fat could provide opportunity for agreement that processed food is unhealthy, while saturated fat is a natural part of most natural foods." 
Ultra-processed foods - those which have been through substantial industrial processing and often have long ingredient lists on the packet, including added preservatives, sweeteners or colour enhancers -  have been linked to early death and poor health. Researchers in France and Spain say the amount of such food being eaten has soared.
If a product contains more than five ingredients, it is probably ultra-processed, says Prof Maira Bes-Rastrollo, of the University of Navarra.

How to spot ultra-processed foods video

Over the past decade, large-scale studies from France, Brazil, the US and Spain have suggested that high consumption of UPFs is associated with higher rates of obesity.  

Ultra processed diets cause increased calorie intake and weight gain
"Ad libitum intake was ∼500 kcal/day more on the ultra-processed versus unprocessed diet"
Study Involved 20 standardised adults on 14 days of each diet.

"A growing number of recent studies have raised health concerns about a certain type of food that most Americans eat: ultra-processed foods. One such study, published in November 2022 in the American Journal of Preventive Medicine, concluded that these foods likely contributed to about 10% of deaths among people 30 to 69 years old in Brazil in 2019. Other studies—including one published in Neurology in July 2022 finding that a 10% increase in ultra-processed food consumption raises the risk of dementia—have linked the food category to severe health outcomes." 

Fats or Carbs?

in my book Bittersweet Brexit - in the science section -  I went into some detail looking at the history of how the dietary guidelines were produced and how the 'fat makes you fat' gained so much prominence over sugars being the main culprit for obesity.  
Since then I have found many examples of how the evidence has been 'rigged' by the sugar lobbyists. 50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat. shows "that an industry group called the Sugar Research Foundation wanted to "refute" concerns about sugar's possible role in heart disease. The SRF then sponsored research by Harvard scientists that did just that. The result was published in the New England Journal of Medicine in 1967, with no disclosure of the sugar industry funding. .Big new study of 135,000 people 'found no evidence that below 10 percent of energy by saturated fat is beneficial, and going below 7 percent may even be harmful.' Moderate amounts of fat (35%) when accompanied with lower carbohydrate intake (50-5%) provide best balance. PURE study in The Lancet. Science Daily summary
Low fat diet could kill you says Telegraph. Oxford Professor Susan Jebb, the government’s former obesity tsar, the findings supported UK guidance, “This is a thumbs-up for UK recommendations which advise up to 35 per cent of energy from fat and an average of 50 per cent of energy from carbohydrate - of which only 5 per cent should be sugar." I wish these were the recommendations, but Public Health England (PHE) clearly believe otherwise.. As, Dr Alison Tedstone, chief nutritionist at PHE said a high fat diet could lead to weight gain and increase the risk of heart disease. “We recommend a balanced diet based on starchy carbohydrates, while reducing total fat intake and swapping saturated fats for unsaturated fats.” That is the recipe of the dietary guidelines that has led to - not cured, obesity. 
Full fat milk could reduce strokes - by over 40%  The study of 3000 people over 22 years, using various biomarkers, found that  "dairy fat, contrary to popular belief, does not increase risk of heart disease or overall mortality in older adults. "In addition to not contributing to death, the results suggest that one fatty acid present in dairy may lower risk of death from cardiovascular disease, particularly from stroke." The researchers said that low-fat dairy foods such as chocolate milk and low-calorie yoghurt often include high amounts of added sugars which may lead to poor heart health. 
Vindication of cheese, butter and full fat  "The average American in the 1970s drank about 30 gallons of milk a year. That’s now down to 18 gallons"
Both low and high carb diets increase risk of early death. Medium carb diets (40-70% as recommended by most) not included in observational study. "what counts most is the type of fat, protein, and carbohydrate"

Dont ditch saturated fats


" People miss out on nutrients in eggs, chocolate, meat and cheese, scientists warn. Researchers have criticised World Health Organization policy on saturated fat. "Saturated fats are those found in milk, cheese, meat, butter and pastries, chocolate and cream. And although linked to increasing the risk of heart disease, many foods which contain them have health benefits as well."
Original BMJ article 'Time for new approach?' spells out 4 key messages:
* The 2018 WHO draft guidelines on dietary saturated fatty acids and trans fatty acids recommend reducing total intake of saturated fat and replacing it with polyunsaturated and mono-unsaturated fatty acids
* The recommendations fail to take into account considerable evidence that the health effects of saturated fat varies depending on the specific fatty acid and on the specific food source
* Maintaining general advice to reduce total saturated fatty acids will work against the intentions of the guidelines and weaken their effect on chronic disease incidence and mortality
* A food based translation of the recommendations for saturated fat intake would avoid unnecessary reduction or exclusion of foods that are key sources of important nutrients

Big Sugar

How to take on 'Big Sugar' and win says "“Parents are literally killing with kindness...In Britain, one in 10 children are already obese when they arrive at primary school at the age of five. That doubles to one in five when they leave primary school, aged 10 or 11. And the most vulnerable are the poor "Sugar Association paid in the 1960s the equivalent of $50,000 to three Harvard scientists to review existing research. The Sugar Research Foundation set the review’s objective, contributed articles for inclusion, and received drafts.  Published in The New England Journal of Medicine (in days before you had to declare any conflicting interests), it critiqued the evidence linking sucrose to coronary heart disease - helping policy makers off of that path. "The attention turned to fat and away from sugar". 
Global Energy Balance Network a non profit organisation, backed by Coca Cola to tune of $1.5 million last year, aims to promote a new “science-based” solution to the obesity crisis: To maintain a healthy weight, get more exercise and worry less about cutting calories. More on 'Energy Balance'
Eat to Run Dan Saladino meets the runners convinced low or no carbs is the way to peak performance based on Prof. Tim Noakes advice. He was found not guilty of misconduct bought by Association of Dietetics South Africa.
Take part in Sugar Smart September  Gather stories and case studies from individuals, get other organisations more active in your campaign and spread the word.
Making China safe for Coke  China is now Coke’s third largest market by volume.And with its vast population, huge growth potential remains, making it “critically important to the future growth of our business,” according to former Coke chief executive Muhtar Kent. 
Town in Mexico with little drinking water. Coca cola everywhere and so is surge in diabetes. If diabetes were an infectious disease the cola plant would be closed down.

Sugar Tax 


What you need to know. Introduced April 2018. 50% of manufacturers already reduced sugar content - so much so that the Treasury has reduced its estimates for tax revenues to below £1/4b. The tax is to help improve primary schools' sports. The trouble is that sugar may be replaced with sweeteners - which are as bad for obesity and diabetes.
Boris Johnson in his bid to be Tory leader says he would review sugar tax questioning "whether levying these types of taxes disproportionately affected the disadvantaged, and suggested that Brexit would allow the UK to examine its tax policy. Er..it has nothing to do with EU - we introduced it on our own.
Others fudge saying 'eat more fruit and vegetables and more fibre, forget the fat v sugar debate'.  But this ignores the obvious issue that most people think that fat is the problem - because that is what is shouted 
Overwhelming public support for reducing sugar and calories in everyday foods. PHE have challenged the food industry to reduce sugar and calories by 20% in everyday foods such as breakfast cereals, yoghurts and pizzas, as well as ready meals. at them all the time. 
US Big Sugar trying to stop cities putting their own sugary drinks tax

Cereal Killlers Kellogg's agree to put traffic lights on cereals, at last.

Guidelines

NICE guidelines

GPs must refer almost two million overweight people for NHS cooking and exercise classes at £435-a-head. Classes are a mix of one-to-one and group sessions where patients are taught healthy recipes and the importance of eating fruit and vegetables. I predict this wont be very effective. Because 1. Education part sounds well meaning, but if based on the Dietary Guidelines, it will not be effective, as has been shown in the past - they do not work - see Chap 8.  They do not address refined food reduction enough, and lump  ‘fats’ into equation, whereas consumption up to 30% energy intake is sensible. Let's see what happens after a year - the project needs to be evaluated. 
2.While working with of ‘Our Life’ 'Talking Food, Taking Action' we visited areas of deprivation to discuss with people why they didn't eat better. It wasn't because they didn't know they should eat more vegetables, but because of access. Sometimes they are not there (Cleator Moor) but also because there are ‘too many takeaways’ i.e. cheap already prepared readily available food. Not a matter of knowing, but being surrounded by obesogenic environment.

Eatwell Guide 

UK's official guide - produced by medical profession for public guidance. Could it 'actually be harming us?' BBC Food Programme.
New Eatwell Guide not much better. While recognising in heading 5 that sugary have drinks received a lot of attention "as well as good evidence to their negative effects on health",  high fat and sugars treated the same in terms of exclusion. Can PHE answer the question 'If fats reduced, where do people get their calories from?" Most will eat ultra-processed foods - the main problem!

Plates, Pyramids and Planet  

This FAO report "evaluates government-issued food guidelines from across the globe, looking in particular at whether they make links to environmental sustainability in addition to promoting good eating habits." They found only four countries who did. These included Sweden who emphasise more plant based foods. "Brazil’s guidelines stand out for emphasizing the social and economic aspects of sustainability,... and to avoid ultra-processed foods that are not only bad for health but are seen to undermine traditional food cultures."   New government gets rid of inspirational National Council for Food Security and Nutrition (Jan 19). 
Diabetes UK ask us to call on our MPs to implement clear labelling on menus in restaurants.

Salt

Over 3/4 of our intake of salt comes from processed foods. 

While soem slat is vital to health, to much too often, is not. Salt & health

FAO EU FIRST 

Partnership between FAO and the European Union (EU), whereby the EU invests €8 billion in over 60 countries 2014–2020 period to improve food and nutrition security and sustainable agriculture. The FAO supports an institutional environment in which investments have tangible impact.  (Check that they blame animal fats nearly as much as processed food - although they do recognise it's damage.) What is the UK going to do instead/as well?
Policies for healthy lives - a look beyond Brexit says "Promoting a health-in-all-policies approach to post-Brexit arrangements could put centre stage the protection and promotion of the public’s health. "

Cancer

3/4 million new cases of cancer world-wide attributable to diabetes and high BMI Lancet

Obesity now 'causes' more cases of four cancers  (bowel, kidney, ovarian and liver) in the UK than smoking, according to a Cancer Research UK 

Sweetners linked to obesity and diabetes and tumour growth


Why obesity increases the risk of certain cancer types, such as those of the kidney, remains unclear. New research suggests a simple explanation: people who are obese have larger organs and thus more cells. CT scans of organs in 750 people reveal that people with a BMI of around 50 have organs that are between 50 and 100 per cent larger than people with a healthy BMI. The size differences are mainly due to larger numbers of normal cells, and the increases in each organ correspond with the reported increase in cancer risk.