My Lords, I support the regret Motions from the noble Lord, Lord Allan of Hallam, and the noble Baroness, Lady Merron. At the noble Lord’s invitation, I will kick a slightly different ball into the open goal.
I share the Government’s concerns about levels of obesity in the UK, but the failure to adequately explain or justify both the delay to and the rationale for these
regulations is further evidence that the Government’s strategy to tackle obesity is disjointed, partial and careless of unintended consequences, and that it falls far short of the integrated public health approach that will be required if we are to meet this major public health challenge.
Research in obesity and eating disorders has often followed separate paths, but it is increasingly recognised that eating and weight-related problems need to be seen on a spectrum that goes from diagnosable eating disorders, through to disordered eating behaviours such as fasting, vomiting or laxative use, to body dissatisfaction, binge eating, being overweight and obesity. Studies show that individuals often present with more than one problem concurrently or move between different problems at different times in their lives, so eating disorders and obesity cannot be seen as separate and distinct issues. There is a raft of risk factors common to both: poor body image and low self-esteem; weight-related teasing; the modelling of poor eating behaviours at home; the stigmatising attitudes of teachers or sports coaches; and the socio-cultural norms around body shape that underpin everyday life. Any of these can increase the risk of both eating disorders and obesity in adolescence and adult life.
The interactions between the two mean that any strategy to address them needs also to be integrated. This is especially important when it comes to messaging. Many campaigns position being overweight and obesity as issues of personal responsibility and choice, shaming and stigmatising people, rather than acknowledging and addressing societal and environmental factors, as well as the powerful impact of genetics, epigenetics, metabolism and biology.
In 2020, 100 obesity specialists from around the world signed a statement in which they explained:
“The assumption that body weight is entirely under volitional control, and that voluntarily eating less and/or exercising more can entirely prevent or reverse obesity is at odds with a definitive body of biological and clinical evidence developed over the last several decades.”
Yet that same year, just months later, the Government produced an obesity strategy underpinned by the assumption that everybody is able to make the choice to modify behaviour and change their weight status. Not only does this stigmatise those who cannot, it can have negative consequences for people for whom the message is not intended. It can cause or exacerbate incipient or established eating disorders, promoting unhealthy dieting or inducing body dissatisfaction.
Children and adolescents are especially vulnerable to this kind of messaging, particularly those who are prone to anxiety. The simplistic portrayal of foods as good and bad, healthy and unhealthy, is risky for children, because they may not yet be at the developmental stage needed to appreciate the nuances involved. Many pre-adolescents report healthy eating initiatives at school as the trigger for an eating disorder, internalising messages such as “fat is bad” in a literal way, impervious to the importance of fat in their neurological development—of course they would be impervious to that; they are children. Children have a degree of cognitive inflexibility, and it can lead them to adhere very strictly to rules. In susceptible children, this can
result in obsessive preoccupation with reducing calories, avoiding foods or increasing exercise to burn off what they have eaten.
The current obesity strategy, developed at speed as the links between Covid and obesity became clear, is far from the integrated approach that is needed to address these complexities. Its policies focus mainly on physical activity, diet and weight control and seem to have been designed in consultation with experts in obesity but with little or no input from specialists in eating disorders or body image. In my conversations with officials and Ministers about food labelling regulations, I was astonished at the levels of disconnect between eating disorder and obesity research, policy and clinical practice, and I found it hard to avoid the conclusion that concerns from an eating disorder perspective had been sacrificed to the perceived greater needs of the obesity crisis.
It is completely understandable that the Government have focused their attention on tackling obesity, given its increased prevalence, the long-term health consequences and the burden to both the NHS and the public purse. But it is regrettable that so many aspects of the strategy were not thought through: the complex interactions with other weight-related or eating-related issues; the particular risks to children; and, as the Secondary Legislation Scrutiny Committee has highlighted, the practicalities of implementation and the impact of this further delay on young people’s health.
Obesity is a major public health challenge, and it requires an integrated public health approach, one that balances risks and benefits and focuses on better education, healthcare and policies that modify the environment in ways that support healthier behaviours. The current patchwork of policies, with its partial focus and unexplained delays, is not going to be the answer.