The Maynard Doctrine: Tackling obesity - know your enemy!

Professor Alan Maynard looks at the growing health problems created by obesity, and wonders when Government will start to get serious about addressing it.

Companies make money out of making people fat and unhealthy. International organisations such as McDonalds, Nestles, Kraft, Walkers Crisps (owned by Pepsi) and Coca-Cola feed our desire for sugar, fat, salt and indolence, inducing over-feeding.

Thus we, the people, are getting steadily fatter.

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Companies such as these pay lip service to the need for consumers to have an energy balance and eat healthily, whilst grinding out profits for shareholders. Many of these shareholders are pension companies, who, by not pressing the food companies to ensure healthier eating habits, are disabling and killing the folk who fuel their coffers!

'Celebrities' such as the ex-footballer, now TV pundit Gary Linekar have earned nice incomes from partaking in industry adverts which cheer adults and their children, and induce excess consumption of obesity-inducing products.

A spreading problem
In China, the UK or the US, there is a rising tide of illness-inducing obesity. In the UK, the Foresight report (2007) described the magnitude of the growing problem of obesity, and recommended action.

The US Institute of Medicine has set out the need for a better evidence base (2010), and made policy recommendations based on the UK Foresight report.

In September, there is to be a High-Level Meeting of the UN General Assembly, which will address the issue of non-communicable diseases. Member states have poor basic data despite international discussion of obesity for a decade of its effects on citizens and their health care systems e.g. only a third of EU countries have good data on children’s weight and height. The need for system wide investment to protect citizen’s health is as obvious as it is neglected

More analysis is needed to improve information about the cost effectiveness of interventions competing for funding. NICE now provides some relevant analysis of cost-effectiveness through its public health programme. However, the characteristics of many public health interventions are weak analysis of effectiveness and an absence of cost data

These problems are nicely discussed in a collection of articles in a recent edition of The Lancet` (August 2011, 378). An article by Gortmaker and others in this volume of The Lancet presents Australian (the PAC study) estimates of the relative cost-effectiveness of a range of obesity interventions.

What works
The two “best” are an unhealthy food and beverage tax of 10% and front-of-pack ‘traffic light’ nutritional labelling. Next in line of efficiency come reductions in advertising of junk food and beverages to children and school based education programmes to reduce TV. viewing (and take more exercise).

Whilst Sainsbury have introduced traffic lights to their food packs, the other supermarkets seem reluctant to reduce the damage to consumers of unwise food consumption. The producers of sweet beverages, crisps (which are one of the most efficient ways of ruining dental health!) , sweets and chocolate fear for their profits and exhibit similar tardiness.

And the Government is doing ... ?
The Government of course is into ‘voluntary’ codes, best known as fiddling whilst Rome burns. This sounds so familiar, and can be seen in their policies about other mortality and morbidity-inducing products such as alcohol (where minimum pricing is needed, such as the Scots / SNP have sought to implement) and tobacco. Can’t they see that such codes generally fail, and have to be replaced by efficient regulation?

There is an urgent need for better analysis of public health interventions to increase exercise and improve eating habits. In the meantime, despite the Coalition’s preference to let folk kill and disable themselves from obesity induced diabetes, renal failure and heart problems, the pressure for unhealthy food and beverage taxes and traffic-light packaging will increase.

As ever (with smoking, for example), the English will probably see the wise Scots at Holyrood seeking change more rapidly than sleepy folk in Downing Street and Westminster! After all, making enemies of the Cokes, Pepsis and Nestles can damage the flow of non-executive directorships and votes in the English shires.