In the first part of this piece we took a look at the real extent of the obesity crisis and its worrying implications on the healthcare system. Even as I sat discussing this in my favourite Shoreditch eatery tonight it boggled my brain at the complexity and difficulty in finding a starting point for dealing with it. If nothing else you should hopefully have realised that the expanding waistlines of the UK population are not going to be fixed by any facile advice, no matter how well intended, to ‘eat less’ or ‘take more exercise’. You should also have realised that the standard (they might not like you to think they are standard, but they really are) mantras of the fitness industry probably aren’t going to do a whole lot of good either, again despite their generally good intentions. If you had the time or the inclination to read the Foresight report you’ll also now have an appreciation of how this topic is at best vastly oversimplified, or at its worst how aspects of it are ignored. So many factors (Foresight identified 108 of them) can contribute to obesity in any given population and can often be entirely different across nations. One of the paradoxes that we can see globally with obesity is its relationship to income. In developed countries like the UK and the US, obesity still remains highest in the lower socioeconomic groups. However, in developing countries such as Brazil obesity is seen to rise as people can start to afford to increase food consumption, particularly of sugary, fatty, processed foods. This is particularly prevalent in kids as shown below, but it isn’t exclusive to them. As Brazil’s GDP increased the poorest women went from being the thinnest to the fattest in just 20 years. The speed of that transition is frightening.  This has definite implications for strategies to try and prevent the increase of obesity, which I’ll expand on later. 

Even the researching of these issues across populations is difficult. Meaningful numbers requires the use of large self-reporting surveys and it is widely acknowledged that people have a habit of overstating things like activity habits while understating nutritional ones. However, in one European country it does seem they are having some success in at least slowing the seemingly inevitable increase in obesity. If you read my first piece thoroughly then you may have noticed that while every country started moving inexorably upwards in the early 90‘s, Finland didn’t and their success with the North Karelia Project, which was actually aimed at reducing heart disease, shows that there is some hope. So, the question now is how we actually go about dealing with it. 

What can we do about junk food? 

McDonalds largest restaurant in the world was recently built on the site of the 2012 Olympics, right here in London and the signature golden arches of this global food giant have become a common feature on every high street in the UK. The spread of McDonalds into developing markets may well signal the beginning of a shift in those countries own obesity levels as the convenience, speed, and marketing of fast food becomes within economic reach of the poorer parts of the population. 

There is even a ‘Big Mac’ index that can correlate the amount of labour hours required to be able to buy a Big Mac with the levels of obesity in that country. The less work required, the fatter the population. It is an indictment on the brand that only a few years ago attempted to introduce ‘healthier’ options onto its menu and whose latest ‘healthy’ addition is somehow classified as one of your ‘five a day’, despite the fact that a 500ml cup contains almost 50g of sugar. Needless to say, as the convenience food becomes even cheaper and even more convenient, less and less people are eating at home. The concept of a family meal now all too often revolves around a trip to the nearest fast food outlet. 

Of course, it isn’t just McDonalds who are producing low-cost, high-margin, energy dense, nutrient poor, food for the population. As global demand for food has grown and consumer competition increased, the giant corporates behind food production and retail have striven to increase margins on their foodstuffs, robbing them of nutrients, driving intensive and non-sustainable agriculture practices, and indulging in all manor of nefarious practices.  From loss-leading on known-products to blocking food labeling, the interests of these organisations currently sits at odds with the nations health. The brilliant journalist Felicity Lawrence has written about this in her excellent book Not On The Label; I’d urge you to read it. 

The question is though, what can we actually do about it? Well, various options have been raised from increasing taxation on ‘junk’ food to restricting marketing and advertising. The latter is a major challenge, given that the food industry spends a voluminous amount on the marketing and brand positioning of their product. The recent Olympic games was a great example with some even suggesting that the games couldn’t run without the support of Mcdonalds and Coca Cola (both who contributed around £64m), Cadbury (good for £20m) and Heineken (another £10m) to name but a few. Compared to the government budget on public food education, who in 2004 spent a grand sum of £7m, it is no wonder that the message of the fast food providers is taking precedent. However, this marketing is insidious and in places many of you may not even know exist. Take for example this website http://www.happymeal.com/en_US/index.html#/Games a blatant advertising site (you can tell by the trite warning to ‘kids’ in the top left corner) that is capturing children at an early age to identify with the fast food brand. This site for the nutritional powerhouse that is Reeses Puffs http://reesespuffs.com is even worse. Hit Mixer and get audibly assaulted with an incessant rap of ‘Reeses puffs, Reeses puffs..’ all set to a hip hop beat....catchy isn’t it? One area the government could target is junk food marketing aimed at children, yet they remain reluctant to do so. 

The government did step up in 2009 launching the Change4Life campaign with a budget of £75 (still only 10% of what the food industry spent in 2004 marketing their products) only to pull the plug on it just a year later, rejecting the notion that children needed education and that instead it was the over-40’s men that was a better target. Originally slated to run through to the 2012 Olympics, the Change4Life campaign only made it a year. It is clear that the politicians prefer to see obesity as a social problem and not a government one that can be solved through legislation or regulation. Even the use of a watershed time for junk food advertising is an unpopular strategy with Ofcom highlighting the lost revenues to the broadcaster from imposing such restrictions. 

There is little doubt though that the marketing and advertising of these junk food products to kids is at the heart of our obesity problem. Alvin F. Poussaint, MD of Harvard Medical School gives us a stark warning: 

Egregious advertising to children using toys to lure them to McDonald’s for low-nutrient, high-calorie Happy Meals is damaging to the well-being of children and their families. No doubt, it is one major contributing factor in the current obesity epidemic in the United States.

Introducing taxes and regulations is one of the first arguments from the health and fitness industry but it is a solution fraught with problems and fundamentally it sits uneasily with me. San Francisco tried it, introducing a city-wide ban on giving away toys with Happy Meals. It attracted criticism from the libertarians who dislike this type of ‘nanny-state’ legislation (even the Mayor declared his desire to vetoe it) and McDonalds sidestepped it easily anyway, charging a token 10 cents for the toy in the price, an amount they then gave to charity. Clever. 
Legislating how we buy our food is though a thorny area and I feel that top-down population wide legislative measures are likely to be as unpopular amongst the public as they would be with the food companies themselves. Handing over responsibility for choice in how we eat seems a radical and rather fascist solution and not one I am comfortable with. That said, some regulation over how such nutritionally poor food is marketed and advertised would seem a good step, still allowing free choice, but with limits on how it can be advertised, to children in particular. Obesity is ingrained into our culture, as are the fast food shops on every high street in the UK. If we are to truly reverse the current growing trend of obesity then we need to work out how we can encourage people to make better choices themselves, starting with our educational system. Organisations like the School Food Trust www.schoolfoodtrust.org are trying to make inroads and in pockets of the UK there is certainly some green shoots, but against the might of the food industry it will be a tough task without some stronger support from the government. 

Junk food will not disappear from the UK high street anytime soon, it will likely always be popular and some will always exercise their right to eat there. We have to tackle it from the bottom up, increasing customer awareness of the true ‘health value’ of something with clear disclosure on nutrient and calorie levels, improving food education so that young people can see what goes into these foods and learn how to cook properly, and we must work on offering alternatives that are as easily accessible and affordable, as the low-cost availability of junk food is one of it’s most alluring features. Consumers do have the power to change it, simply by not eating there, however without the compelling desire not to, combined with the marketing efforts of these major corporations it is a big ask. More money needs to be spent countering the powerful marketing methods these companies use both through popular media avenues as well as frontline healthcare practices.