The behaviour change strategies the UK is using to tackle the obesity crisis

According to the World Health Organization worldwide obesity has nearly tripled since 1975 and is more common than under-nutrition, with almost 40% of adults overweight and 13% obese (WHO 2020).

The crisis can be condensed down to the simple fact that we're consuming more energy than we burn, eating more energy-dense food high in fats and sugars and exercising less. But tackling obesity isn't so clear-cut. The drivers behind it are complex – it's not simply down to an abundance of bad foods and more sedentary lifestyles. The intricacies of our environments, genes and behaviours are all contributing factors. So responding to it requires a sophisticated, multi-layered approach.

Obesity in the UK

Almost two-thirds of adults in England are living with excess weight, over one in four have obesity. The rates are similar in other UK nations. But it's an issue in childhood too – in England obesity is reported to affect one in five children by the time they leave primary school (NHS Digital 2020). The consequences are far-reaching: being overweight is a risk factor for illnesses such as Type 2 diabetes, heart disease and certain types of cancer (WHO 2020) and increases the risk of being severely affected by coronavirus (Covid-19) (PHE 2020). In England alone, there were more than a million hospital admissions for obesity-related treatment from 2019 to 2020 (NHS Digital 2021).

Recognising the complexities of the issue, the UK government is trying to promote behaviour change using several approaches. Rather than assuming people make a conscious choice to overeat and not exercise, it acknowledges that many behaviours and choices are responses to our environment.

1. Public-facing campaigns

Big multi-channel campaigns to promote healthier behaviours have been the primary approach taken by the UK government to tackle obesity so far.

Most recently, these include Better Health and One You. The former first launched in 2020 to target obesity and capitalise on people's natural desire to improve their health during the Covid-19 pandemic, using tools and apps to help them make healthier choices. One You, which first launched in 2016, focuses on living healthily in midlife and the steps people can take to avoid preventable diseases in older age. It offers tools, information, and advice to encourage positive everyday behaviours, such as eating healthily and stopping smoking.

While it's too soon to assess the impact of Better Health and One You, we know that past campaigns have had promising results. In 2016, the Change4Life Sugar Smart campaign inspired more than 2 million downloads of a mobile app. And 96% of parents of children aged 5-11 said it had prompted them to cut their family sugar intake (Bradley et al. 2020).

2. Industry regulation

Changing or regulating our environment is just as important as asking people to change their behaviour.

So there have been several moves to target the food and drink industry. In 2017, ads that directly or indirectly promote High Fat, Salt and Sugar (HFSS) food and drink products were banned in children's media. And the government has lofty plans for the future, including a 9pm watershed on ads for HFSS products, online and on TV, by the end of 2022. It also plans to target our eating-out and shopping habits. It wants to restrict offers and promotions for unhealthy foods in supermarkets, prohibit free refills of sugary soft drinks, introduce calorie labelling on menus and force cafes, takeaways and restaurants to reduce the calorie content of their products.

3. Face-to-face interactions

Recognising that regular contacts between health professionals and the public are potentially life-changing, Making every contact count (MECC) has become standard practice with the NHS. It enables healthy lifestyle information to be consistently delivered and reinforces healthy behaviours.

Losing weight, quitting smoking, reducing alcohol intake, or helping to reduce social isolation are some key MECC focus areas. And health providers are required to develop and maintain organisational plans for making each and every everyday contact count.

4. Nudges and activations

Innovative behavioural insights and techniques to nudge people into making the right choices in a low-cost, unobtrusive way are developed by the Behavioural Insights team (BIT), popularly known as the Nudge Unit.

A recent example of its work is a behavioural science-informed letter to encourage more parents to access weight management services for their children. Studies show that feedback letters can have a positive response (Mooney et al. 2010) but often don't lead to tangible change, so the letter was modified to include behaviour change nudges such as:

  • A visual frame of reference so that parents could objectively compare their child's weight.

  • Reassuring social norms information explaining that most children are a healthy weight.

  • Booking forms for local facilities pre-populated with details to make the process easy.

This modified letter approximately doubled enrolment at weight management services (Sallis et al. 2019).

What next?

Behavioural interventions to spur changes in diet and physical activity seem to be effective in reducing weight and improving health at least in the short term (Drombowski et al. 2010). But much of the success lies in how sensitive they are to the context of people's lives. In other words, how well they understand the target audience, and their specific environment and culture.

But to achieve lasting change and build on the progress made so far, bold action is needed. Former Chief Medical Officer Dame Sally Davies stressed much stronger and more extensive action in her independent report on childhood obesity (Davies 2019). Meanwhile, the Faculty of Public Health advocates extending regulations to cover sponsorship of sports and family attractions and marketing communications in schools (FPH Policy Team 2018). And there's a clear need to explore the correlation between deprivation, inequality and obesity. In essence, we need to move beyond nudges and campaigns and go further upstream to address the root causes of obesity and the social factors that underpin them (Mahase 2020).

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References

Bradley J et al. (2010) Impact of a health marketing campaign on sugars intake by children aged 5–11 years and parental views on reducing children's consumption. BMC Public Health. 2020; 20: 331.  doi: 10.1186/s12889-020-8422-5

Davies S (2019). Time to Solve Childhood Obesity, Department of Health Social Care 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/837907/cmo-special-report-childhood-obesity-october-2019.pdf

Drombowski SU et al. (2010) Behavioural interventions for obese adults with additional risk factors for morbidity: systematic review of effects on behaviour, weight and disease risk factors. Obes Facts. 2010;3:377–396

Falconer CL et al. (2014) The benefits and harms of providing parents with weight feedback as part of the national child measurement programme: a prospective cohort study. BMC Public Health, 14 (1) (2014), p. 549

FPH Policy Team (2018) Behaviour-change campaigns on obesity have best chance if combined with regulation. https://betterhealthforall.org/2018/03/07/behaviour-change-campaigns-on-obesity-have-best-chance-if-combined-with-regulation/

Mahase E (2020). Covid-19: England's obesity strategy will fail without tackling social factors, warn doctors. BMJ;370:m2994

Mooney A et al. (2010). The National Child Measurement Programme: Early Experiences of Routine Feedback to Parents of Children's Height and Weight

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

NHS Digital (2021) Statistics on Obesity, Physical Activity and Diet, England, 2021

Park MH et al. (2014) Predictors of health-related behaviour change in parents of overweight children in England. Prev. Med., 62 (2014), pp. 20-24, 10.1016/j.ypmed.2014.02.002

Public Health England (PHE) (2020). Excess Weight and COVID-19: Insights from new evidence. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907966/PHE_insight_Excess_weight_and_COVID-19__FINAL.pdf

WHO (2020) Obesity and Overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

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