When I was younger, and at war with my own body, I was a sucker for diets. I tried The Rotation Diet (Lose Up to a Pound a Day and Never Gain it Back), The Beverly Hills Diet (a 35-day programme, but I never made it past the first three days) and numerous punitive low-fat regimes involving raw carrots and dry crispbread. None of them lasted long, but each time I broke a diet, I would soon be looking around for another, equally unrealistic, weight-loss plan. No matter how similar the new diet was to the last, it gave me a sense that I was doing something productive about what I saw as the problem of my body.
Personal weight-loss diets have a lot in common with obesity policies in England and beyond. For a start, the sheer quantity of these policies is astonishing. Earlier this year, two researchers based at the University of Cambridge – Dolly Theis and Martin White – published a paper showing that from 1992 to 2020, there were no fewer than 689 separate obesity policies put forward in England. Like failed diets, almost none of these initiatives have been realised in any meaningful way. Instead, their main effect has been to remind people with obesity that the government views the mere existence of their bodies as a “crisis”.
While England is not alone in failing to reduce the prevalence of obesity – the World Health Organization reports that it has more than tripled worldwide since 1975 – “obesity policy” in England has been strikingly ineffective. (I say England because since devolution, Scotland, Wales and Northern Ireland have their own separate health policies.) Between 1993 and 2015, obesity among England’s adult population rose from 14.9% to 26.9%. Twice as many adults in the UK are living with obesity as in Italy, Sweden or Switzerland. At the same time, levels of hunger in the UK are some of the highest in Europe. Nearly one in five 15-year-olds live in a household where the adults are “food insecure”, which is a fancy way of saying that they can’t reliably afford enough food.
Covid has brought to the surface some hard truths about the British food system, and what a poor job it does of feeding the population as a whole. As the first lockdown hit in March 2020, plenty of better-off British households were able to carry on eating much as before, while millions more were plunged into food poverty. According to data from the Food Foundation, during the first two weeks of lockdown in the spring of 2020, the proportion of households facing food insecurity doubled to more than 15%. Black and Asian people have been twice as likely to suffer hunger during the pandemic as their white counterparts. As Marcus Rashford said in a letter to parliament about food poverty in June 2020, “This is a system failure”. But it is a system failure that existed for decades before the pandemic at long last pushed it on to the national agenda.
British politicians, as a rule, have shown little interest in tackling the problem of poor-quality food and its relationship to health. These policy failures go back to the 19th century. Our early Industrial Revolution meant that a larger percentage of the population lost its connection with agriculture at an earlier stage than in any other country. When it comes to food policy, there has long been an attitude of “leave it to the market” (the shining exception being the two world wars, when the constraints of rationing forced governments to join the dots on food and health). Campaigners against the grossly adulterated food supply in Victorian times sometimes complained that the selling of food in London operated on “buyer beware” principles, which meant that grocers were free to sell poisonous pickles and fake coffee to an unsuspecting public without fear of retribution. Not much has changed, except that instead of poisonous pickles, we are sold a surfeit of ultra-processed food.
Recent English obesity policies have spoken endlessly of “action” to help people eat healthier diets, but what they deliver, often as not, is another raft of patronising diet information leaflets, such as the bright yellow Change4Life diet pamphlets handed out in schools and GP surgeries. (One uninspiring gem: “If you’re shopping for packaged snacks for your children, try sticking to 100 calorie snacks.”)
For three decades, Theis and White found, successive governments have repeatedly proposed “similar or identical policies” and then not done anything to see them through. What counts as an obesity policy could be anything from a plan of action to a statement of intent. Whichever party has been in charge, the most popular policies have been ones placing high demands on individuals to make personal changes (such as the 5 a day campaign) rather than meaningful reforms such as restricting the sale of unhealthy foods, or subsidising fruits and vegetables to make them more affordable. Most of the ideas for structural interventions – for example, that the food industry should reformulate its unhealthiest products – were voluntary. Unsurprisingly, compliance was not high. One of the few exceptions has been the Soft Drinks Industry Levy (AKA Sugar Tax) of 2018, which resulted in a 30g a week drop in household sugar consumption, but I suspect that this will turn out to be a pyrrhic victory given new evidence that consuming aspartame, the artificial sweetener used in many diet drinks, also causes weight gain as well as possibly altering the gut microbiome.
The almost 700 obesity policies fell under the banner of 14 separate obesity strategies. It is poignant to read the titles of these largely failed and forgotten strategies, which share an air of wishful purpose. Under John Major in 1992, there was Health of the Nation. Next, under Tony Blair in 1999, came Saving Lives. Also under Labour came Choosing Health (2004), Choosing a Better Diet (2005) and Choosing Activity (2004, 2005 and 2005) and Healthy Weight, Healthy Lives (2008). The Coalition government produced Healthy Lives, Healthy People and A call to action on obesity in England (2011). Most recently, under the Conservatives there have been three instalments of Childhood Obesity: A Plan for Action and then, in 2020, Tackling Obesity.
Notice how the words “choosing” and “action” keep reappearing in these strategies. Given that poorer UK households would have to spend nearly 40% of their income to buy food for a healthy diet, according to recent data from the Food Foundation, to frame healthy eating as simply a matter of “choosing” is dishonest. It’s not choice if you can’t afford it.
Decades of research show that obesity is determined to a large extent by environmental factors such as socioeconomic inequality, the rise of ultra-processed food and the way that cities are built to facilitate car use. But policymakers of England have stayed wedded to the idea that weight is all about personal responsibility: just eat less and move more.
The failures of obesity policy in England and the UK are part of a larger problem with food policy in general. As well as being a source of joy and nourishment, food is Britain’s biggest employer, accounting for 4.1m jobs (most of them low-paid). At the same time, poor diet is the country’s biggest cause of preventable disease and the food supply is also one of its biggest drivers of climate breakdown (10% of our greenhouse gas emissions come from agriculture).
And yet for decades, a food policy to address any of this has seemed to be missing in action. Fewer than a quarter of the policies analysed by Theis and White (24%) included any plan for monitoring their progress. Nearly a third (29%) of the policies did not include any timeframe, any evidence or any position on who or what is responsible for driving the rise in obesity. It isn’t just that food policies in England have long been ill-suited to improving our diets. It is that very few people, inside or outside government, seems to have the slightest idea what these policies actually are.
Earlier this year, the need for a radical rethink of food policy in the UK was set out in Henry Dimbleby’s National Food Strategy: The Plan, an independent review commissioned by the Department for Environment, Food and Rural Affairs (Defra). Dimbleby, one of the founders of the Leon chain of cafes, wrote the report after consultations with more than 300 organisations, as well as town hall meetings with members of the public. It took three years to produce.
Unlike all the earlier failed obesity policies, Dimbleby’s plan recognised that how a person eats is not just a question of personal choice, and that healthy food is a basic need for all of us, no matter how much we weigh. It called for a range of ambitious strategies themed around reducing diet inequalities, improving food education, making better use of land and, crucially, setting as a clear goal that the food system of the future must “make us well instead of sick”. It suggested that school inspections should pay as much attention to cookery and nutrition lessons as they do to English and maths, and that meat consumption should be cut by 30% over 10 years, with more investment going to growing vegetables and fruits.
Almost everyone I have spoken to in food policy and nutrition circles has showered Dimbleby’s report with praise, relieved that someone close to government was finally recognising the scale of the problem and proposing real solutions. Some public health experts, such as Rob Percival at the Soil Association, have been disappointed that the report still talks about foods high in sugar, fat and salt as the problem, rather than addressing the harm done by ultra-processed products as a whole. But Percival has still praised the report as “important and progressive” in making the connections between farming and health.
No sooner had the National Food Strategy (NFS) plan appeared, however, than the government backed away from taking action. The first of the strategy’s recommendations was a “reformulation” tax of £3 a kilogramme on sugar and £6 on salt for use in food processing, catering and restaurants and food processing. But on 15 July, Boris Johnson announced that he would not support the plan’s call for higher taxes on foods high in salt and sugar. “I’m not attracted to the idea of extra taxes on hard working people,” said Johnson, before repeating his belief that weight loss could best be achieved through exercise. His language could have come from any one of the 14 failed obesity strategies.
This was a characteristic piece of political theatre from Johnson, who knows he will win points with some voters by positioning himself as a brave warrior against the nanny state. More significant than the fact that the prime minister ridiculed the first recommendation in the NFS plan is the fact that he remained silent on the other 13 proposals. Did this silence imply approval or disapproval (or simply that Johnson couldn’t be bothered to read the whole thing)? The real test will be the government white paper, which is due to be published in January 2022, setting out plans for legislation based on Dimbleby’s report. Will the libertarians in the Tory party ever lose their conviction that it is not government’s place to meddle in how people eat? If they don’t, it is unclear how Dimbleby’s radical policy suggestions can be put into action.
The ambitions of the NFS report raise a question: can this new holistic vision of food policy actually be delivered? The final recommendation is the introduction of a Good Food bill, which would commit the government to five-year action plans, and to coming up with a “healthy and sustainable reference diet”: an agreed vision of what healthy eating actually means, to create a consistent approach to food across the whole system, from schools to farms. So far, so good. The problem is that the report handed responsibility for monitoring progress to the Food Standards Agency, a non-ministerial department whose remit is mainly food safety and things such as use-by dates.
“Delivery ain’t gonna come from the FSA, no way!”’ said Tim Lang, emeritus professor of food policy at City, University of London, when I spoke to him on the phone recently. Lang, who is most famous for coining the term “food miles”, has long been recognised as one of the leading experts on food policy in Britain. The week after the NFS plan was published, he wrote an opinion piece in the Spectator praising much of the content of the report but suggesting that the FSA was unfit to deliver it. The FSA is, he wrote, a “long-weakened body … a kind of genial facilitator” whose role is purely advisory. Since it is not a government ministry, Lang argued, the FSA lacked the power to get anything meaningful done.
“Nothing happens unless you get laws and regulations that get translated into daily cultural values,” Lang told me. Since the war, he argues that the closest that the UK has come to having a systematic food policy was in 2008, under Gordon Brown, when the Food Matters review of food policy was set up (under which the Healthy Weight, Healthy Lives strategy fell). “They integrated environment and nutrition and hospitality all in one document,” Lang said. But when the coalition government came to power in 2010, the review was “shut down by the Tories overnight”. Now, he wonders whether the government really wants a unified food policy, or whether they would prefer “no policy at all”, to keep their friends in industry happy.
For years, Lang has decried what he calls the lack of “food democracy”. In the UK, 94.4% of food is supplied by one of the nine leading retailers. Along with his colleagues Erik Millstone and Terry Marsden, earlier this year Lang wrote a paper setting out nine “tests” for food policy in the UK. “How will people be fed and to what standards, from where, produced how, and with which consequences?” the paper asked.
Lang feels that Whitehall brushes these questions aside because there is a “naive optimism” that other countries will always come along to feed us. After Brexit, this post-imperial complacency looks dangerously misplaced. As recently as October there were tonnes of broccoli and cauliflower rotting in the fields without workers to pick them, tens of thousands of pigs faced being culled because of a post-Brexit shortage of butchers and empty shelves in the supermarkets because of the shortfall of lorry drivers.
In the midst of this chaos, who will actually step in to protect the food supply? Successive governments have been largely happy to leave it to the market – which in practice means leaving it to the supermarkets and the ultra-processed food industry. Dimbleby says that one of the core aims of his report is to break what he calls “the junk food cycle”, in which retailers oversupply us with low-nutrient sugary foods and we in turn demand more of them. At the same time, the report was informed by conversations with many of the biggest food companies including Coca-Cola, Greggs, Tesco and Asda (as well as smaller organic companies such as Yeo Valley).
To regulate industry, Dimbleby proposes forcing all food companies with more than 250 employees to publish an annual report. As well as admitting how much food they waste, they would be forced to declare how many healthy foods such as vegetables they sell each year – for some companies, the answer would presumably be “none” – as well as how many unhealthy sugary foods. The hope is that this process of public accounting would enable government to track whether businesses are moving in the right direction. The problem is that it’s currently unclear who would oversee this, or what the sanctions would be for companies that continue to sell us the same old junk.
It is hardly surprising that English food policy to date has seemed muddled, given that responsibility for it is spread across no fewer than 16 separate government departments. As well as the obvious candidates such as the Department of Health, the Department of Education and Defra, there are more surprising departments such as the Department of Justice (prison food) and Digital Culture, Media and Sport (food sponsorship and advertising).
In 2020, Kelly Parsons, a food policy researcher at the University of Hertfordshire, produced a report identifying which government departments are responsible for which aspects of food policy in England. The meticulous research process confirmed Parsons’s hunch that “there is no single place to go to find out about food-related policy, either for those inside or outside government”. Parsons told me that after she published her map of the different groups and departments a number of people in Whitehall told her how useful it was, because they had been just as much in the dark about food policy as the rest of us.
Given the poor state of the average British diet – the Food Foundation found in 2021 that almost a third of British children aged between five and 10 eat fewer than one portion of vegetables a day – it would be easy to assume that Britain must have a poor nutrition policy. But the problem is actually deeper and more nebulous than this. Britain doesn’t actually have a single nutrition policy at all, just a series of different policies on food, often contradictory ones, emerging from different departments at different times. Not only do these departments fail to coordinate their actions on food, but they may have directly opposing agendas. Current agricultural policy in the UK subsidises sugar and red meat, even though dietary advice from the Department of Health recommends eating less of them.
Earlier this year, Parsons set out to identify some of the key disconnects in food policy in England, based on interviews with senior officials in key departments in Westminster. One of the biggest contradictions was that different departments have different “client groups” to please. Health officials may wish to restrict junk food being marketed to children, but their counterparts in the Department for Digital, Culture, Media and Sport are more interested in protecting the profits of the advertising industry. “When you have [an agriculture] minister who says, ‘I’m going to be judged on whether I keep the farmers happy’, and a minister of health who has a completely different set of interests, it’s difficult to see how they would work together,” said one of Parsons’s interviewees.
The client who tends to get forgotten in all this is the ordinary person simply trying to feed themselves and their family as well as they can on a stretched budget. Another of the disconnects Parsons identified was between nutrition, obesity and income. Through the Department of Health, the government hands out advice on what to eat (through the much-criticised Eatwell guide), but there is no attempt to cross-reference this with policy on welfare and on food access – “specifically, people’s ability to afford the food being recommended for healthy weight”.
This clash of departments partly explains why so many obesity policies focus on physical activity as the solution, rather than reforming the food supply. As Tim Spector outlined in his recent book Spoon-Fed, evidence suggests that exercise – while beneficial, especially for mental health – does not reliably cause weight loss. But obesity policies that propose more sport, rather than changes to diet, have always been popular in government because they pose no threat to the junk food industry.
We shouldn’t be talking about obesity policy (let alone an “obesity crisis”) at all, but about food quality laws or junk food control. After all, the government does not produce tobacco strategies with titles such as “childhood smokers: a plan for action” or “tackling smokers’ lungs”. Chris van Tulleken, an infectious diseases doctor at University College London hospital, told me that, as with tobacco, the focus should be “on regulating the marketing, not blaming the consumer”. He argues that ultra-processed foods should come with a warning label and that these products should not be marketed to children. But there is still a reluctance within the UK government even to identify ultra-processed food as a problem. As Gyorgy Scrinis, an Australian professor of food policy, has shown, the big food companies have successfully lobbied governments around the world to ensure that official nutrition advice stays focused on individual nutrients in packaged foods rather than on ultra-processed food in general.
What would it take for England to have a food policy fit for the task? One obvious solution would be to create a designated minister of food to coordinate food policy, as there was during the war and up until 1955, when the Ministry of Food became subsumed by Agriculture and Fisheries.
Another solution would be to say that food is so relevant to every aspect of life that there should be food in every policy. This is the approach favoured by the NFS report, which ruled out the idea of a single food minister, noting that food is not unique in being split across multiple departments. Since the second world war, Dimbleby argued, the purpose of the food system in England has been to maximise the production of cheap food, regardless of quality. This urgently needs to change, but to pivot to a new system that produces nourishing, sustainable food would require radical adjustments all the way through the food chain. There is a need, as Dimbleby notes, for every cog in the wheel of the food system to be designed to “make us well instead of sick”, to be “resilient” and to help “halt climate change”.
But where will this shared sense of purpose come from? Having interviewed 23 of the most senior civil servants and politicians in Westminster, Kelly Parsons told me that she realised that at the highest levels of government in England, food was endlessly pushed down the agenda. It simply wasn’t seen as important.
The absence of adequate food policy in England reflects a wider culture in which most of the population has been disconnected from food production for a very long time. There is a maddeningly persistent view in the UK that caring about healthy food is snobbish or “middle-class”. (Witness the rage that greeted Jamie Oliver when he dared to try to improve the quality of school meals in 2005.)
England is far from the only country where responsibility for food policy is spread across multiple departments. In South Africa, for example, food policy is splintered across 15 different departments. But one of the big differences is that South Africa also has a Department of Cooperative Governance, whose role is to coordinate food polices across all the departments at a local and national level. In 2019, South Africa was ranked as the most effective government in the world for its commitment to tackling hunger and undernutrition by the Hunger and Nutrition Commitment Index. Under South African policy, ensuring adequate food for the population is seen as such an urgent priority that nutrition has its own separate budget line.
Compare and contrast this with the UK, where hunger is still not generally recognised as an issue. In England, there is not a single department assigned lead responsibility for hunger, despite the fact that, in 2018, the Food and Agriculture Organisation found that there were more than 2.2 million people in the UK in a state of food insecurity. (The 2021 figures are undoubtedly higher). Last winter, for the first time in 70 years, Unicef stepped in to feed hungry children in the UK. Yet Parsons reported that the government continues to see hunger as an “overseas issue”.
If England has fragmented food policies, it is partly because this is a country that does not recognise how much food matters. In modern western societies with an apparently abundant food supply, treating food as trivial is a common mindset, as historian Paul Freedman shows in his short new polemic Why Food Matters. Effective food policies have a better chance of taking root in countries with long-established cultures of cooking, where it is normal for families to gather around a table every day. One example is Brazil, where school canteens are obliged to source 30% of their ingredients from local family farms. In 2014, Brazil totally rewrote the script on nutrition policy when the department of health issued new food-based nutrition guidelines urging Brazilians to avoid ultra-processed food and to eat more freshly produced food. At the time, these guidelines were unlike any other nutrition policy in the world, although similar policies have since been adopted by other countries including Ecuador, Peru and Canada.
When I asked Geoffrey Cannon, a British researcher who helped design the Brazilian nutrition guidelines, why Brazilian food policy is so much more ambitious than that in England, he pointed to the prevailing food culture. “In the Catholic tradition, Brazil is still largely family-based and therefore family meals are normal.” Even when people move away from home to the cities, they can still buy cheap home-style food at “per quilo” restaurants selling unpretentious food priced by weight. Cannon felt that people in Brazil still had a sense that homemade food was something normal and delicious – much more so than in the UK with its highly processed diet and long working hours.
But it’s also worth remembering that food cultures are not static, and just sometimes food policy can succeed in changing cultural attitudes for the better. In the 1970s, the region of North Karelia in Finland had some of the worst rates of fatal heart disease in the world. A visionary young public health official called Pekka Puska implemented a whole range of measures to address cardiovascular health, all at once. Puska worked with women’s groups to encourage people to cook new versions of traditional dishes, with more vegetables and less meat. He supported dairy farmers in diverting some of their land from butter to berries. He persuaded local sausage producers to take out some of the fat and replace it with mushrooms. And he recruited an army of local people to act as advocates for the new diet to their friends and neighbours. Puska also instigated smoke-free workplaces. By 2012, cardiovascular mortality among men in the region had dropped by 80%. Policy experts still debate which of Puska’s various measures made the greatest difference, but in a sense it doesn’t matter. This was food policy as doing, not talking, and it worked.
A good food policy is one that actually makes it beyond the announcement and gets carried out, with adjustments along the way for anything that doesn’t work. The example Dolly Theis likes to give is of the city of Amsterdam, which from 2012 to 2015 brought down rates of child obesity thanks to a series of measures that included increased support for parents, a ban on junk food marketing at sporting events, and a rule that the only drink in schools should be water. “Can you imagine that here?” Theis asks.
The hope held out by Dimbleby’s NFS report is that if enough measures can be put in place at once, as in Amsterdam, something fundamental will shift and we will collectively reach a point where we no longer tolerate a system so stacked against healthy eating. Our forgiving attitude to an ultra-processed food supply today might be a bit like attitudes to tobacco 50 years ago, when smoking on trains was normal.
There are signs that the pandemic has finally jolted us into new ways of thinking about food. Marcus Rashford’s passionate advocacy has made far more people recognise how unacceptable it is to live in a country where mothers like his struggle to buy “a good evening meal” on minimum-wage jobs. Our great-grandchildren may laugh when we tell them that English schools routinely used to sell sugary drinks for profit, that hospital food courts provided burgers and chips to people who had just undergone heart surgery, and that farmers were paid to produce the very foods that caused the most damage to health and the environment. “That was what it was like,” we will say, “living in a country where the politicians didn’t know that food mattered.”