̽��ֱ�� of Cambridge - Dolly Theis

Successive governments’ approaches to obesity policies have destined them to fail, say researchers

cjb250 — Tue, 19 Jan 2021 08:52:28 +0000

This is the conclusion of new research by a team at the ̽��ֱ�� of Cambridge funded by the NIHR School for Public Health Research.

̽��ֱ��researchers say their findings may help to explain why, after nearly thirty years of government obesity policies, obesity prevalence in England has not fallen and substantial inequalities persist. According to a report by NHS Digital in May 2020, 67% of men and 60% of women live with overweight or obesity, including 26% of men and 29% of women who suffer clinical obesity. More than a quarter of children aged two to 15 years live with obesity or overweight and the gap between the least and most deprived children is growing.

Successive governments have tried to tackle the obesity problem: in research published today in ̽��ֱ��Milbank Quarterly, Dolly Theis and Martin White in the Centre for Diet and Activity Research (CEDAR) at the ̽��ֱ�� of Cambridge identified 14 government-led obesity strategies in England from 1992 to 2020. They analysed these strategies – which contained 689 wide-ranging policies – to determine whether they have been fit for purpose in terms of their strategic focus, content, basis in theory and evidence, and implementation viability.

Seven of the strategies were broad public health strategies containing obesity as well as non-obesity policies such as on tobacco smoking and food safety. ̽��ֱ��other seven contained only obesity-related policies, such as on diet and/or physical activity. Twelve of the fourteen strategies contained obesity reduction targets. However, only five of these were specific, numerical targets rather than statements such as ‘aim to reduce obesity’.

Theis said: “In almost 30 years, successive UK governments have proposed hundreds of wide-ranging policies to tackle obesity in England, but these are yet to have an impact on levels of obesity or reduce inequality. Many of these policies have largely been flawed from the outset and proposed in ways that make them difficult to implement. What’s more, there’s been a fairly consistent failure to learn from past mistakes. Governments appear more likely to publish another strategy containing the same, recycled policies than to implement policies already proposed.

“If we were to produce a report card, overall we might only give them 4 out of 10: could do much better.”

Theis and White identified seven criteria necessary for effective implementation, but found that only 8% of policies fulfilled all seven criteria, while the largest proportion of policies (29%) did not fulfil a single one of the criteria. Fewer than a quarter (24%) included a monitoring or evaluation plan, just 19% cited any supporting scientific evidence, and less than one in ten (9%) included details of likely costs or an allocated budget.

̽��ֱ��lack of such basic information as the cost of implementing policies was highlighted in a recent National Audit Office report on the UK Government’s approach to tackling childhood obesity in England, which found that the Department of Health and Social Care did not know how much central government spent tackling childhood obesity.

“No matter how well-intended and evidence-informed a policy, if it is nebulously proposed without a clear plan or targets it makes implementation difficult and it is unlikely the policy will be deemed successful,” added Theis. “One might legitimately ask, what is the purpose of proposing policies at all if they are unlikely to be implemented?”

Thirteen of the 14 strategies explicitly recognised the need to reduce health inequality, including one strategy that was fully focused on reducing inequality in health. Yet the researchers say that only 19% of policies proposed were likely to be effective in reducing inequalities because of the measures proposed.

UK governments have to date largely favoured a less interventionist approach to reducing obesity, regardless of political party, prioritising provision of information to the public in their obesity strategies, rather than more directly shaping the choices available to individuals in their living environments through regulation or taxes. ̽��ֱ��researchers say that governments may have avoided a more deterrence-based, interventionist approach for fear of being perceived as ‘nannying’ – or because they lacked knowledge about what more interventionist measures are likely to be effective.

There is, however, evidence to suggest that policymaking is changing. Even though the current UK government still favours a less interventionist approach, more recent strategies have contained some fiscal and regulatory policies, such as banning price promotions of unhealthy products, banning unhealthy food advertisements and the Soft Drinks Industry Levy. This may be because the government has come under increasing pressure and recognises that previous approaches have not been effective, that more interventionist approaches are increasingly acceptable to the public, and because evidence to support regulatory approaches is mounting.

̽��ֱ��researchers found little attempt to evaluate the strategies and build on their successes and failures. As a result, many policies proposed were similar or identical over multiple years, often with no reference to their presence in a previous strategy. Only one strategy (Saving Lives, published in 1999) commissioned a formal independent evaluation of the previous government’s strategy.

“Until recently, there seems to have been an aversion to conducting high quality, independent evaluations, perhaps because they risk demonstrating failure as well as success,” added White. “But this limits a government’s ability to learn lessons from past policies. This may be potentially compounded by the often relatively short timescales for putting together a strategy or implementing policies.

“Governments need to accompany policy proposals with information that ensures they can be successfully implemented, and with built-in evaluation plans and time frames. Important progress has been made with commissioning evaluations in the last three years. But, we also need to see policies framed in ways that make them readily implementable. We also need to see a continued move away from interventions that rely on individual’s changing their diet and activity, and towards policies that change the environments that encourage people to overeat and to be sedentary in the first place.”

Living with obesity or excess weight is associated with long-term physical, psychological and social problems. Related health problems, such as type-2 diabetes, cardiovascular disease and cancers, are estimated to cost NHS England at least £6.1 billion per year and the overall cost of obesity to wider society in England is estimated to be £27 billion per year. ̽��ֱ��COVID-19 pandemic has brought to light additional risks for people living with obesity, such as an increased risk of hospitalisation and more serious disease.

̽��ֱ��research was funded by the NIHR School for Public Health Research, with additional support by the British Heart Foundation, Cancer Research UK, Economic & Social Research Council, Medical Research Council, and Wellcome Trust.

Reference
Dolly R Z Theis, Martin White. Is obesity policy in England fit for purpose? Analysis of government strategies and policies, 1992-2020. Milbank Quarterly; 19 Jan 2021; DOI: https://doi.org/10.1111/1468-0009.12498

Government obesity policies in England over the past three decades have largely failed because of problems with implementation, lack of learning from past successes or failures, and a reliance on trying to persuade individuals to change their behaviour rather than tackling unhealthy environments.

In almost 30 years, successive UK governments have proposed hundreds of wide-ranging policies to tackle obesity in England, but these are yet to have an impact on levels of obesity or reduce inequality

Dolly Theis

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Silhouettes of three women running

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Menu labelling linked to less fat and salt in food at major UK restaurant chains

cjb250 — Wed, 16 Oct 2019 18:00:23 +0000

̽��ֱ��researchers behind the study argue that if government policy made menu labelling mandatory, it could encourage restaurants to produce healthier options, leading to public health benefits.

Obesity levels worldwide have almost tripled since 1975, making it one of the most pressing public health challenges today. Poor diet is a leading contributor to obesity as well as to diseases including type 2 diabetes, heart disease and cancer.

Food from restaurants and fast food takeaways tends to be high in energy, fat, sugar and salt compared to food prepared at home. Some health campaigners have called for restaurants to improve the nutritional information available to customers. Mandatory menu labelling for large restaurant chains was introduced in the US in May 2018. In the UK, the government included voluntary menu labelling in its Public Health Responsibility Deal in 2011. A proposal for compulsory menu labelling was included in last year’s Childhood Obesity Plan and a public consultation closed last December, but no announcement on a final policy has been made so far.

̽��ֱ��assumption behind such measures is that providing customers with clearer information on the energy content of food served will allow them to make more informed, and hence ‘better’, choices. But it is also possible that menu labelling could change what outlets serve, as nutritionally-poor food could lead to bad publicity.

Researchers at the Centre for Diet and Activity Research (CEDAR), ̽��ֱ�� of Cambridge, set out to determine whether there were differences in the energy and nutritional content of menu items served by popular UK chain restaurants with ,versus without, voluntary menu labelling in their stores. Their results are published today in the open access journal PLOS ONE.

̽��ֱ��team first looked at energy and nutritional information on the websites of the most popular 100 UK restaurant chains during March and April 2018. Of these 100 restaurants, 42 provided some form of energy and nutritional information online, but only 14 provided menu labelling in stores.

Items from restaurants with in-store menu labelling had on average 45% less fat and 60% less salt than items from other restaurants.

“This is the first study to look at differences in nutritional content of food from restaurants with and without menu labelling in the UK,” said Dolly Theis from CEDAR and the MRC Epidemiology Unit at Cambridge. “It suggests that on the whole, restaurants that provide information on calories on menus also serve healthier food, in terms of fat and salt levels. As well as providing useful information for customers, mandatory menu labelling could also encourage restaurants to improve the nutritional quality of their menus.”

̽��ֱ��researchers say that it is possible that menu labelling encourages restaurants to change the content of their food and also that those chains with ‘healthier’ offerings are more likely to label their menus. Twelve of the 14 restaurants that provided voluntary menu labelling were in the top 50 restaurants by sales – larger chains may come under more scrutiny from governments, the media, campaign groups and the public to provide both menu labelling and healthier options.

Across all menu categories, at least three-quarters of individual menu items were below the daily maximum recommended intake for energy, fat, saturated fat, sugar and salt. However, some individual items contained more than twice the daily recommended amount for energy, fat, saturated fat, sugar or salt. In one case, an individual dish contained 5,961Kcal – almost three times the daily recommended maximum for an average adult woman.

Dr Jean Adams added: “We found some restaurant items that hugely exceeded the daily recommended intake for energy, fats, sugar and salt. More than a quarter of UK adults eat meals out at least once a week, so such large or nutritionally-imbalanced portions could contribute to poor dietary intake at a population level.”

̽��ֱ��research was funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, and Wellcome.

Reference
Theis, DRZ and Adams, J. Differences in energy and nutritional content of menu items served by popular UK chain restaurants with versus without voluntary menu labelling: a cross-sectional study. PLOS ONE; 16 Oct 2019; DOI: 10.1371/journal.pone.0222773

Food sold at restaurants whose menus display energy information is lower in fat and salt than that of their competitors, according to new research from the ̽��ֱ�� of Cambridge.

As well as providing useful information for customers, mandatory menu labelling could also encourage restaurants to improve the nutritional quality of their menus

Dolly Theis

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Chef preparing food

Researcher profile: Dolly Theis

Tackling the obesity epidemic – and particularly childhood obesity – is likely to require policy changes at a local and national level. But how can academics feed the findings of their research into this process?

̽��ֱ��answer may not be straightforward, as PhD candidate Dolly Theis from the MRC Epidemiology Unit explains.

“Policymaking is a complex business,” she says. “Even for those inside its very heart, the policymaking process can feel like an unnavigable maze.”

Dolly has experience of working closely with policymakers and has brought this knowledge with her to Cambridge. Prior to joining the MRC unit, she led research into childhood obesity and grassroots sport at the Centre for Social Justice think tank in Westminster. Between 2010-2013, she worked as a Parliamentary Researcher for Baroness Jenkin of Kennington, focused primarily on food waste, international development, obesity, poverty and women in politics.

At Cambridge – which Dolly describes as “an inspiring and pretty magical place” – she is studying how the UK government policymaking process works in relation to childhood obesity. In particular, she wants to understand how childhood obesity policies are conceived, framed and introduced by government; what and how evidence is understood and used; and who is most influential in the policymaking process.

“My research involves me doing what feels like investigative work!” she explains. “I try to identify as much quality evidence as I can that best explains the policymaking process in relation to childhood obesity; whether that is searching for relevant documents, speaking to people, trawling government and Parliament websites, or keeping up with the news.

“Hopefully by understanding how the policymaking process works in practice, academics and researchers can better influence it with the very best research.”

Outside of work, Dolly runs the Big Tent Ideas Festival, a non-partisan political ideas festival bringing together thousands of people from all backgrounds, beliefs, sectors and parties to discuss the major problems facing our society and to find consensus on solutions.

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