How public health england is hoping to reduce obesity with the better health campaign

How’s your health? Are you feeling better yet? Maybe dropped a few pounds or honed a few muscles?

It’s been six months since Public Health England (PHE) launched the Better Health campaign, using a new public health emergency – Covid-19 – to tackle a much older one: the obesity crisis in the UK. It was, according to Public Health England, a “reset moment…a unique moment in time to help kick start our health – to eat better and get active”.

And it all felt quite inspiring at the time. Summer had arrived. We were emerging from the first wave of the coronavirus pandemic. Daily deaths had plummeted, national lockdown was ending, we were getting back to work and restrictions on our everyday lives were finally being lifted. With its energetic “Let’s do this” slogan, the Better Health campaign seemed to strike the right tone. We’ve all had a wake-up call they told us. Now it’s time to get our health back on track.

So have we? The truth is, it’s far too soon to tell.

The first adult public health obesity campaign?

By the Government’s own admission, tackling obesity is one of the greatest long-term health challenges this country faces. Around two-thirds of adults are above a healthy weight. Of those, half are living with obesity (1). And the consequences of this epidemic are bleak.

Obesity is a risk factor for a wide range of chronic diseases, including cardiovascular disease, type 2 diabetes and at least 12 kinds of cancer. It is also associated with reduced life expectancy (2). Not surprisingly, it can also have a negative impact on mental health (3).

The cost of all this is eyewatering. It’s estimated that the NHS spends £6.1 billion each year treating conditions related to obesity (4). Given all of this, it seems extraordinary that weight loss hasn’t been the focus of a public health campaign before.

Sheila Mitchell, outgoing Marketing Director and Public Health England alluded to some of the reasons for this when the Better Health at the launch of the Better Health campaign. Speaking to Campaign magazine, she outlined the risks the campaign faced. “If we got the tone on this one wrong, it would be really quite damaging,” she said. “We had to make sure it wasn’t scaremongering, it wasn’t nanny-state-ism”.

Ah, the nanny state. The accusation levelled at governments who are seen to be overprotective or interfering in people’s personal lives. Not so long ago, Boris Johnson himself was a leading crusader against the nanny state. But coronavirus changed all that.

How Covid-19 turned the UK’s obesity crisis into a catastrophe

On 11 March 2020, the World Health Organization declared Covid-19 a pandemic. Reports from China and Italy, where the disease first took hold, identified a number of factors that increased the risk of being severely affected by the virus, including old age, high blood pressure and heart disease. But then the pandemic hit New York and another risk factor emerged – obesity.

As numbers of infections rocketed, researchers rapidly confirmed the link. People living with obesity are twice as likely to be hospitalised with Covid-19, may be more likely to be admitted to intensive care and are at greater risk of dying.

Suddenly the need to talk about obesity gained a new urgency. As the only modifiable risk factor associated with Covid-19, the Government felt it was incumbent on them to address the issue. Plus, the pandemic had shown that behaviour change at population level could happen, and happen fast. Almost overnight the social norms by which we live changed dramatically. If we could be persuaded to stay home, keep our distance, wear a mask and wash our hands until our skin cried for mercy, what else could we achieve? Led by the Prime Minister, who blamed the seriousness of his own brush with coronavirus on his being “way overweight”, the Better Health campaign was launched.

How the Better Health campaign aims to change behaviour

Behind the bouncy marketing campaign for Better Health, Public Health England launched a weight loss app plus a series of offers from partner organisations offering weight loss or activity programmes. They also promised to support primary care networks to train staff to become healthy weight coaches.

At the same time, the Government launched its policy paper, Tackling obesity – Government strategy, outlining a raft of measures including:

  • A ban on adverts for food high in fat, sugar or salt (HFSS) on TV and online before the watershed. (The Government have since gone further and are now consulting on a total ban on advertising HFSS foods online.)
  • A ban on buy one get one free (BOGOF) promotions on HFSS foods
  • Calorie labelling on menus in large restaurant chains

Their aim is to make it easier for people to make healthy choices by supplying better information and removing incentives to buy unhealthy options.

Criticism of the Better Health campaign

There was plenty. The implication that as a nation we have a moral imperative to “lose weight and protect the NHS” was described in The Lancet Diabetes & Endocrinology journal as, “One of the most glaring examples of health promotion strategies that draws on guilt and shame”. They pointed out that “past public health history has shown that such campaigns are ineffective and even detrimental.”

British Association for Nutrition and Lifestyle Medicine (BANT) is supportive of the focus on better nutrition but pointed out the Better Health app’s reliance on calorie counting “takes little to no account of the nutritional values of different foods and their relation to health and is problematic for those at risk of eating disorders.”

Others pointed to the likelihood that the bans on HFSS food promotion will further health inequalities by driving up prices of foods that many families rely on. As one mum put it in an article on Vice: “You could spend the five quid on veg to make soup or a stew, but at least I know kids will eat the frozen meal and it will fill them up. If kids don’t like the healthy option, many mams won’t have the time or the money to make them a new meal.”

What’s next for the Better Health campaign?

We’re likely to see those ads back on our television sets in January, taking advantage of that annual “reset moment” when we make our New Year’s resolutions. Not that these have great track record. It’s estimated that 88% of New Year’s resolutions fail (5) for reasons ranging from unrealistic goals to simply forgetting.

Obesity is a highly complex issue, underpinned by many biological, social and psychological factors. Unlike some of the other behaviours we have all adopted in the face of the coronavirus pandemic, a change to healthy eating is going to require more than a single moment.

References

NHS Digital (2020) Statistics on Obesity, Physical Activity and Diet, England, 2020

Guh et al. (2009) The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis, BMC Public Health.

Luppino FS et al. (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 2010;67(3):220-9

GOV.UK. (2020) Tackling obesity: empowering adults and children to live healthier lives. Policy paper.

Wiseman R (2007) New Year’s Resolution Project. http://www.richardwiseman.com/quirkology/new/USA/Experiment_resolution.shtml

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