Anna Taylor, Executive Director, Food Foundation
Feb 27, 2018
One in ten four year olds are obese. When you hear it enough times it stops having an impact. And yet that amounts to over 11,000 children who start school every year already disadvantaged before they’ve even learned to hold a pencil and spell their name.
We know too that many people in positions of power still think it is a result of retrograde behaviour among sections of society – mothers who no longer know how to cook for their children, children who don’t know where a carrot comes from and generally, a lack of discipline and common sense around eating.
So, what can be done? Are we at the mercy of the major food corporations and retailers, in the hope that some will exercise a higher level of accountability to the public good? After all, we’re eating from a global food basket, relying for 60% of our calories from highly processed food, manufactured by a few major global corporations.
There is undoubtedly a role for central government (indeed there’s also arguably a role for cooperation between governments at the global level). Following the publication of the Government’s rather flimsy childhood obesity plan, it’s fair to say that almost all of the government energy is going into the Sugar Levy and the Sugar Reformulation Plan. This work is critically important (and moreover, the UK is world leading in this), but it is missing a central vision of what good food is, and how delicious it could be with the right mix of policy and practice change.
That’s why we help to set up the Peas Please initiative, which is bringing together businesses working right along the supply chain, along with local authorities and central government to make it easier to eat veg. The central proposition is that we all know about 5-a-day but our veg consumption is in decline. And there are many good reasons for this – it doesn’t taste good, it’s too expensive, it’s hard to prepare, it’s not convenient etc. Peas Please is bringing people together to solve these problems and drive up consumption. We need leadership on healthy food environments from Government first, but also from businesses and the third sector if we are going to see the scale of impact needed.
There’s a job to protect those at greatest risk. If you live in a deprived area, your children have double the chances of ending up obese. Our Force-fed report showed that healthy foods are three times more expensive, calorie for calorie, than unhealthy foods. People on a low income often squeeze their food budget in order to pay for housing and utilities. If you don’t have much money, you go for cheap empty calories and these are the worst foods for your children. A representative survey conducted by Ipsos-MORI in London in 2013 showed that 8% of parents reported that at some point in the last year their children had had to skip meals because they could not afford to buy food. This situation is toxic for children. Data from Canada show children who experience two or more food insecure episodes during their early years are nearly five times more likely to report poor health aged 10-15 years. By the time they reach 16-21 years, they have a three times higher chance of having a chronic health condition.
All organisations concerned with health and well-being in pregnancy and the early years, and with public health, food policy and food poverty, should engage with and recognise their role in supporting Healthy Start. We need to make sure that all pregnant women and mothers of toddlers who are on a low income get access to Healthy Start vouchers (for fruit and vegetables) – a funded national programme which currently one in three of those eligible do not get.
Making connections across departments and work streams to help different elements of London’s local authorities understand the roll they can play in helping to take a whole systems approach to the problem of childhood obesity will be key in enabling the approach to succeed.
"If you don’t have much money, you go for cheap empty calories and these are the worst foods for your children."
We must also think very carefully about allocating resources to children already obese or living with other dietary risks. In a context where public health budgets are being cut back even further, tough choices between priorities like drug and alcohol abuse, sexual health and obesity will need to be made. But the evidence to date suggests that obese children are at the bottom of the shopping list.
For examples of what this targeted support might look like, we can look to recent innovation in the US, where fruit and vegetable incentive programmes – projects that enable cost savings for healthier foods at the point of purchase for low-income shoppers and those with diet-related health risks – are now found extensively.
One group of these, ’fruit and vegetable prescriptions’, use a range of medical triggers – including adult and childhood overweight/obesity, hypertension and childhood asthma – and household food insecurity, as criteria for eligibility. Generally, programme participants are identified by primary or secondary health services, after which they will receive a weekly ‘healthy food prescription’ funded by a variety of federal, state and city agencies for redemption with local retailers. ‘Fruit and veg prescription’ programmes have spread rapidly across the USA due to the fact that they simultaneously offer multiple benefits to multiple constituencies: programme participants, fresh produce growers and retailers and the local economies in which they operate.
Pooled data from 2012-2016 participants of Washington DC’s FVRx Program indicate that 50% of project participants achieve a reduction in BMI through the course of a prescription – dispensed over the course of a growing season for redemption at local farmers’ markets. There is already work planned to bring such initiatives to the UK through the work of the Alexandra Rose Charity but much more political and financial support is needed to take these ideas to scale.
Finally, we must start to measure food poverty. It was last done in the UK more than ten years ago. Without knowing how big the problem is and who is worst affected it is impossible to do anything about it. There are now globally standardised methods which could be used. We just need the political will to do it. Local authorities could do more to demand this data from national survey bodies.
There is no shortage of good ideas on what needs to be done. Leadership and, where necessary funding, are in much shorter supply.
Co-authored with Robin Hinks, Churchill Fellow
“There are many small changes that would have extraordinary impact.”Jamie Oliver's view
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