̽��ֱ�� of Cambridge - Jean Adams

Are weight loss jabs the solution to the obesity crisis?

jg533 — Wed, 30 Oct 2024 10:50:43 +0000

Almost two thirds of UK adults are overweight or obese. Are weight loss drugs the solution? Cambridge experts share their opinions.

AI predicts healthiness of food menus

cjb250 — Fri, 08 Mar 2024 08:00:27 +0000

Cambridge researchers have used artificial intelligence to predict the healthiness of café, takeaway and restaurant menus at outlets across Britain and used this information to map which of its local authorities have the most and least healthy food environments.

Sugary drinks tax may have prevented over 5,000 cases of obesity a year in year six girls alone

cjb250 — Thu, 26 Jan 2023 19:00:11 +0000

̽��ֱ��study, published today in PLOS Medicine, looked at the impact of the levy on reception age children and those in year six, but found no significant association between the levy and obesity levels in year six boys or younger children from reception class.

̽��ֱ��research was supported by the National Institute of Health and Care Research (NIHR) and the Medical Research Council.

Obesity has become a global public health problem. In England, one in ten reception age children (four to five years old) is living with obesity and this figure doubles to one in five children in year six (10 to 11 years). Children who are obese are more likely to suffer from serious health problems including high blood pressure, type II diabetes and depression in childhood and in later life.

In the UK, young people consume significantly more added sugars than is recommended – by late adolescence, they typically consume 70g of added sugar per day, more than double the recommended amount (30g). A large source of this is sugar-sweetened drinks. Children from deprived households are more likely to be at risk of obesity and to be heavy consumers of sugar-sweetened drinks.

In April 2018, to protect children from excessive sugar consumption and tackle childhood obesity, the UK governments introduced a two-tier sugar tax on soft drinks – the soft drinks industry levy. ̽��ֱ��tax was targeted at manufacturers of the drinks to incentivise them to reduce the sugar content of soft drinks.

Researchers from the Medical Research Council (MRC) Epidemiology Unit at the ̽��ֱ�� of Cambridge tracked changes in the levels of obesity in children in England in reception year and year six between 2014 and 2020. Taking account of previous trends in obesity levels, they compared changes in levels of obesity 19 months after the sugar tax came into effect.

̽��ֱ��team found that the introduction of the sugar tax was associated with an 8% relative reduction* in obesity levels in year six girls, equivalent to preventing 5,234 cases of obesity per year in this group alone. Reductions were greatest in girls whose schools were in deprived areas, where children are known to consume the largest amount of sugary drinks – those living in the most deprived areas saw a 9% reduction.

However, the team found no associations between the sugar tax coming into effect and changes in obesity levels in children from reception class. In year 6 boys, there was no overall change in obesity prevalence.

Dr Nina Rogers from the MRC Epidemiology Unit at Cambridge, the study’s first author, said: “We urgently need to find ways to tackle the increasing numbers of children living with obesity, otherwise we risk our children growing up to face significant health problems. That was one reason why the UK’s soft drinks industry levy was introduced, and the evidence so far is promising. We’ve shown for the first time that it is likely to have helped prevent thousands of children each year becoming obese.

“It isn’t a straightforward picture, though, as it was mainly older girls who benefited. But the fact that we saw the biggest difference among girls from areas of high deprivation is important and is a step towards reducing the health inequalities they face.”

Although the researchers found an association rather than a causal link, this study adds to previous findings that the levy was associated with a substantial reduction in the amount of sugar in soft drinks.

Senior author Professor Jean Adams from the MRC Epidemiology Unit said: “We know that consuming too many sugary drinks contributes to obesity and that the UK soft drinks levy led to a drop in the amount of sugar in soft drinks available in the UK, so it makes sense that we also see a drop in cases of obesity, although we only found this in girls. Children from more deprived backgrounds tend to consume the largest amount of sugary drinks, and it was among girls in this group that we saw the biggest change.”

There are several reasons why the sugar tax did not lead to changes in levels of obesity among the younger children, they say. Very young children consume fewer sugar-sweetened drinks than older children, so the soft drinks levy would have had a smaller effect. Similarly, fruit juices are not included in the levy, but contribute similar amounts of sugar in young children’s diets as sugar-sweetened beverages.

It’s unclear why the sugar tax might affect obesity prevalence in girls and boys differently, however, especially since boys are higher consumers of sugar-sweetened beverages. One explanation the researchers put forward is the possible impact of advertising – numerous studies have found that boys are often exposed to more food advertising content than girls, both through higher levels of TV viewing and in how adverts are framed. Physical activity is often used to promote junk food and boys, compared to girls, have been shown to be more likely to believe that energy dense junk foods depicted in adverts will boost physical performance and so are more likely to choose energy-dense, nutrient-poor products following celebrity endorsements.

̽��ֱ��study was a collaboration involving researchers from the ̽��ֱ�� of Cambridge, London School of Hygiene and Tropical Medicine, ̽��ֱ�� of Oxford, Great Ormond Street Institute of Child Health and ̽��ֱ�� of Bath.

*A relative reduction is the difference between the expected incidence of obesity had the sugar tax not been introduced and the actual incidence.

Reference
Rogers, NT et al. Associations between trajectories of obesity prevalence in English primary school children and the UK soft drink industry levy: an interrupted time series analysis of surveillance data. PLOS Med; 26 Jan 2023; DOI: 10.1371/journal.pmed.1004160

̽��ֱ��introduction of the soft drinks industry levy – the ‘sugary drinks tax’ – in England was followed by a drop in the number of cases of obesity among older primary school children, according to Cambridge researchers. Taking into account current trends in obesity, their estimates suggest that around 5,000 cases of obesity per year may have been prevented in year six girls alone.

We urgently need to find ways to tackle the increasing numbers of children living with obesity, otherwise we risk our children growing up to face significant health problems. That was one reason why the UK’s soft drinks industry levy was introduced, and the evidence so far is promising

Nina Rogers

ti-ja (Getty Images)

Child's hands pouring a drink into a glass

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Beyond the pandemic: rethink the menu and how much it costs

lw355 — Thu, 24 Sep 2020 08:30:12 +0000

Boris Johnson has urged the country “to lose weight to beat coronavirus” through exercise and healthy eating. Dr Jean Adams suggests that food policies should be sensitive to the fact that healthier diets are beyond the budget of too many people in the UK.

Menu labelling linked to less fat and salt in food at major UK restaurant chains

cjb250 — Wed, 16 Oct 2019 18:00:23 +0000

̽��ֱ��researchers behind the study argue that if government policy made menu labelling mandatory, it could encourage restaurants to produce healthier options, leading to public health benefits.

Obesity levels worldwide have almost tripled since 1975, making it one of the most pressing public health challenges today. Poor diet is a leading contributor to obesity as well as to diseases including type 2 diabetes, heart disease and cancer.

Food from restaurants and fast food takeaways tends to be high in energy, fat, sugar and salt compared to food prepared at home. Some health campaigners have called for restaurants to improve the nutritional information available to customers. Mandatory menu labelling for large restaurant chains was introduced in the US in May 2018. In the UK, the government included voluntary menu labelling in its Public Health Responsibility Deal in 2011. A proposal for compulsory menu labelling was included in last year’s Childhood Obesity Plan and a public consultation closed last December, but no announcement on a final policy has been made so far.

̽��ֱ��assumption behind such measures is that providing customers with clearer information on the energy content of food served will allow them to make more informed, and hence ‘better’, choices. But it is also possible that menu labelling could change what outlets serve, as nutritionally-poor food could lead to bad publicity.

Researchers at the Centre for Diet and Activity Research (CEDAR), ̽��ֱ�� of Cambridge, set out to determine whether there were differences in the energy and nutritional content of menu items served by popular UK chain restaurants with ,versus without, voluntary menu labelling in their stores. Their results are published today in the open access journal PLOS ONE.

̽��ֱ��team first looked at energy and nutritional information on the websites of the most popular 100 UK restaurant chains during March and April 2018. Of these 100 restaurants, 42 provided some form of energy and nutritional information online, but only 14 provided menu labelling in stores.

Items from restaurants with in-store menu labelling had on average 45% less fat and 60% less salt than items from other restaurants.

“This is the first study to look at differences in nutritional content of food from restaurants with and without menu labelling in the UK,” said Dolly Theis from CEDAR and the MRC Epidemiology Unit at Cambridge. “It suggests that on the whole, restaurants that provide information on calories on menus also serve healthier food, in terms of fat and salt levels. As well as providing useful information for customers, mandatory menu labelling could also encourage restaurants to improve the nutritional quality of their menus.”

̽��ֱ��researchers say that it is possible that menu labelling encourages restaurants to change the content of their food and also that those chains with ‘healthier’ offerings are more likely to label their menus. Twelve of the 14 restaurants that provided voluntary menu labelling were in the top 50 restaurants by sales – larger chains may come under more scrutiny from governments, the media, campaign groups and the public to provide both menu labelling and healthier options.

Across all menu categories, at least three-quarters of individual menu items were below the daily maximum recommended intake for energy, fat, saturated fat, sugar and salt. However, some individual items contained more than twice the daily recommended amount for energy, fat, saturated fat, sugar or salt. In one case, an individual dish contained 5,961Kcal – almost three times the daily recommended maximum for an average adult woman.

Dr Jean Adams added: “We found some restaurant items that hugely exceeded the daily recommended intake for energy, fats, sugar and salt. More than a quarter of UK adults eat meals out at least once a week, so such large or nutritionally-imbalanced portions could contribute to poor dietary intake at a population level.”

̽��ֱ��research was funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, and Wellcome.

Reference
Theis, DRZ and Adams, J. Differences in energy and nutritional content of menu items served by popular UK chain restaurants with versus without voluntary menu labelling: a cross-sectional study. PLOS ONE; 16 Oct 2019; DOI: 10.1371/journal.pone.0222773

Food sold at restaurants whose menus display energy information is lower in fat and salt than that of their competitors, according to new research from the ̽��ֱ�� of Cambridge.

As well as providing useful information for customers, mandatory menu labelling could also encourage restaurants to improve the nutritional quality of their menus

Dolly Theis

Pexels

Chef preparing food

Researcher profile: Dolly Theis

Tackling the obesity epidemic – and particularly childhood obesity – is likely to require policy changes at a local and national level. But how can academics feed the findings of their research into this process?

̽��ֱ��answer may not be straightforward, as PhD candidate Dolly Theis from the MRC Epidemiology Unit explains.

“Policymaking is a complex business,” she says. “Even for those inside its very heart, the policymaking process can feel like an unnavigable maze.”

Dolly has experience of working closely with policymakers and has brought this knowledge with her to Cambridge. Prior to joining the MRC unit, she led research into childhood obesity and grassroots sport at the Centre for Social Justice think tank in Westminster. Between 2010-2013, she worked as a Parliamentary Researcher for Baroness Jenkin of Kennington, focused primarily on food waste, international development, obesity, poverty and women in politics.

At Cambridge – which Dolly describes as “an inspiring and pretty magical place” – she is studying how the UK government policymaking process works in relation to childhood obesity. In particular, she wants to understand how childhood obesity policies are conceived, framed and introduced by government; what and how evidence is understood and used; and who is most influential in the policymaking process.

“My research involves me doing what feels like investigative work!” she explains. “I try to identify as much quality evidence as I can that best explains the policymaking process in relation to childhood obesity; whether that is searching for relevant documents, speaking to people, trawling government and Parliament websites, or keeping up with the news.

“Hopefully by understanding how the policymaking process works in practice, academics and researchers can better influence it with the very best research.”

Outside of work, Dolly runs the Big Tent Ideas Festival, a non-partisan political ideas festival bringing together thousands of people from all backgrounds, beliefs, sectors and parties to discuss the major problems facing our society and to find consensus on solutions.

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Children from disadvantaged backgrounds and certain ethnic minorities do less vigorous physical activity

cjb250 — Tue, 28 May 2019 08:55:20 +0000

̽��ֱ��patterns mirror inequalities seen in levels of childhood obesity, suggesting a need for a greater focus on the promotion of vigorous physical activity, particularly for those children from more disadvantaged backgrounds.

Over the past four decades, the global prevalence of childhood obesity has increased tenfold. Obesity in childhood is associated with illness and early death in adulthood, so tackling childhood obesity is increasingly a public health priority for governments.

There are also widening inequalities in obesity prevalence. By age 11, UK children from disadvantaged families are three times as likely to be obese than more advantaged children. There are also stark ethnic and racial differences in levels of childhood obesity, with higher rates of obesity within certain ethnic minorities including children from Black African, Black Caribbean, Pakistani and Bangladeshi backgrounds.

Evidence suggests that more vigorous intensity activity – such as running or swimming – is more strongly linked with reduced waist circumference and body fat than moderate intensity activity. International guidelines say that children should engage in moderate-to-vigorous intensity activity for at least 60 minutes per day.

“When we look at overall physical activity we don’t see clear differences between children from different backgrounds despite clear inequalities in obesity,” says Rebecca Love, a Gates Cambridge Scholar at the Centre for Diet and Activity Research (CEDAR) in the MRC Epidemiology Unit at the, ̽��ֱ�� of Cambridge. “To investigate this further, we looked at whether overall physical activity was hiding inequalities in the intensity with which that activity is performed that might explain these patterns.”

̽��ֱ��researchers studied data from almost 5,200 children aged 7 years who were part of the Millennium Cohort Study, a longitudinal study of children born in the UK between September 2000 and January 2002. ̽��ֱ��children were given accelerometers and their activity measured for a minimum of ten hours for three days. ̽��ֱ��results are published today in the journal BMJ Open.

̽��ֱ��team found that the higher the level of education attained by the mother, the more minutes of vigorous intensity activity her child was likely to have, accounting for time spent in moderate physical activity. Children with mothers with high levels of education accumulated three minutes more vigorous activity per day then those with low levels of education. Similarly, the team found significantly more time spent in vigorous intensity activity incrementally with increasing household income.

Intensity differences were also apparent by ethnicity. White British children perform on average more than three minutes more daily vigorous physical activity in comparison to children from Pakistani and Bangladeshi backgrounds. Children from ‘other ethnic groups’ also accumulated 2.2 minutes fewer daily vigorous intensity activity overall.

It is suggested these differences are relevant on a population level and changes to reduce differences in vigorous physical activity could have population implications for inequalities in adiposity in UK children. ̽��ֱ��differences were consistent in both boys and girls.

“There are clear differences in the amount of vigorous physical activity a child does depending on their socioeconomic and ethnic background,” explains senior author Dr Esther van Sluijs. “Although individually, these differences are small, at a population level they are likely to make a difference. Changes to reduce existing gaps in vigorous intensity activity could help reduce existing inequalities in levels of obesity in children.”

̽��ֱ��team say that there are many factors that might explain the differences, including access to or the cost of participating in sports activities, and a parent working longer, inconsistent work hours within a low-income job. There may also be differences in home and family support for physical activity between ethnic groups.

“Children from different backgrounds can face a number of barriers preventing them from participating in sports or other types of vigorous physical activity,” adds Dr Jean Adams. “We need to find more ways to provide opportunities for all children to get involved in vigorous activity.”

̽��ֱ��research was funded by the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and Wellcome. Additional support was provided by Gates Cambridge.

Reference
Love, R et al. Socio-economic and ethnic differences in children’s vigorous intensity physical activity: a cross-sectional analysis of the UK Millennium Cohort Study. BMJ Open; 28 May 2019

Children from disadvantaged backgrounds and certain ethnic minority backgrounds, including from Pakistani and Bangladeshi backgrounds, have lower levels of vigorous physical activity, according to researchers at the ̽��ֱ�� of Cambridge.

Children from different backgrounds can face a number of barriers preventing them from participating in sports or other types of vigorous physical activity

Jean Adams

Margaret Weir

Children playing

Researcher profile: Rebecca Love

Rebecca Love, a PhD student at the Centre for Diet and Activity Research (CEDAR) researches the factors that drive obesity, particularly among children from different economic and social backgrounds.

It is perhaps ironic, then, that she has spent most of her PhD “sitting at a computer in the CEDAR offices at Addenbrooke’s [Hospital] – not quite the picturesque Cambridge working environment I had imagined”!

Rebecca grew up in Canada. As part of her undergraduate degree at Queen’s ̽��ֱ�� in Kingston, Ontario, she spent a year in Trinidad and Tobago working alongside the Caribbean Sport and Development Agency on a project to implement educational programming and change policy structures to protect the rights of children. It was through these experiences that she gained an interest in the evaluation of interventions and in understanding how to identify what works within a given context.

Rebecca is currently finishing her PhD, supported by Gates Cambridge. Her work has involved examining population cohort studies from a range of countries to understand whether differences in patterns of physical activity behaviour between children help to explain the rising and widening obesity disparities seen within many countries. She is now investigating whether school-based interventions are effective at improving physical activity behaviour – and if this effect is the same in children from advantaged and disadvantaged backgrounds and between girls and boys.

“I’m fascinated by the complexity of influences driving the worsening epidemic of obesity globally,” explains Rebecca. “If we’re going to find effective solutions, we’ll need an interdisciplinary approach involving collaboration from a wide range of stakeholders and institutions.”

Fortunately, Rebecca’s research does sometimes get her out ‘into the field’. In 2017, she visited the ̽��ֱ�� of the Witwatersrand in Johannesburg, South Africa to investigate physical activity and obesity within the Birth to Twenty Cohort. This is Africa’s largest and longest running cohort of adolescent health and development, which has followed a cohort of children born in 1990 in Soweto, South Africa.

“Two months of warmth in exchange for the UK winter and cold bike rides to Addenbrooke’s came at a welcome time in my PhD! There, I had the opportunity to visit childcare centres and schools in townships surrounding Johannesburg and Cape Town, across which rates of childhood overweight and obesity are rising. Listening and learning from the experiences and perspectives of individuals working across these settings was thought-provoking.”

Rebecca describes CEDAR as “an extremely supportive and welcoming community. ̽��ֱ��opportunity to constantly be exposed to innovative research and conversations has been really influential and a central part of my learning experience”.

She is currently a PhD student at King’s College. This, together with her Gates Cambridge scholarship, has allowed her to meet students and researchers from a wide range different backgrounds and disciplines, developing friendships and learning from perspective of peers from all corners of the world.

“Constant events, lectures and opportunities make Cambridge an exciting and stimulating place to be a graduate student. It can be quite distracting at times – but to me that is one of the best parts about being here!”

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Removing sweets and crisps from supermarket checkouts linked to dramatic fall in unhealthy snack purchases

cjb250 — Tue, 18 Dec 2018 19:00:52 +0000

̽��ֱ��study, published in the journal PLOS Medicine, found that 76% fewer purchases of sugary confectionery, chocolate and potato crisps were bought and eaten ‘on-the-go’ from supermarkets with checkout food policies compared to those without. In addition, 17% fewer small packages of these items were bought and taken home from supermarkets immediately after introducing a checkout food policy.

Large supermarket chains such as Tesco, Asda and Sainsbury’s have captured the majority of the grocery market and play a major role in shaping food preferences and purchasing behaviour. Retail practices such as product displays, positioning, promotions and pricing can all influence consumers’ choices in stores.

Supermarket checkouts provide a unique location for prompting purchases as all customers have to pass through them to pay and may spend considerable time in queues; however, the majority of food at supermarket checkouts could be considered unhealthy. Over the last decade, many UK supermarket groups have made voluntary commitments to remove or limit unhealthy foods at the tills or to provide healthier options.

“Many snacks picked up at the checkout may be unplanned, impulse buys – and the options tend to be confectionery, chocolate or crisps,” says Dr Jean Adams from the Centre for Diet and Activity Research at the ̽��ֱ�� of Cambridge. “Several supermarkets have now introduced policies to remove these items from their checkouts, and we wanted to know if this had any impact on people’s purchasing choices.”

To examine the effect that the introduction of checkout food policies in major supermarket chains has had on shoppers’ purchasing habits, Dr Adams led a team of researchers at the universities of Cambridge, Stirling and Newcastle who analysed data from the Kantar Worldpanel’s Consumer panel for food, beverages and household products. Six out of the nine major supermarkets introduced checkout food policies between 2013 and 2017. ( ̽��ֱ��researchers anonymised the information to avoid ‘naming and shaming’ companies.)

Firstly, the team looked at how purchases of less healthy common checkout foods brought home changed following the implementation of checkout policies. They used data from over 30,000 UK households from 12 months before to 12 months after implementation.

̽��ֱ��researchers found that implementation of a checkout food policy was associated with an immediate 17% reduction in purchases. After a year, shoppers were still purchasing over 15% fewer of the items compared to when no policy was in place.

Next, they looked at data from 7,500 shoppers who recorded food bought and eaten ‘on-the-go’ during 2016-17 from supermarkets with and without checkout food policies. On-the-go purchases are often impulsive and can be the result of children pestering their parents. ̽��ֱ��researchers found that shoppers made 76% fewer annual purchases of less healthy common checkout foods from supermarkets with checkout food policies compared to those without.

As the study was not a randomised control trial, it was not possible to say definitely that the changes in purchasing behaviour were due to the checkout food policies. Stores that chose to have checkout food policies may have been different from those that did not. Or shoppers may have changed to purchasing larger packages from the same stores, or similar products from stores that aren’t supermarkets.

“Our findings suggest that by removing sweets and crisps from the checkout, supermarkets can have a positive influence on the types of purchases their shoppers make,” says Dr Katrine Ejlerskov, the study’s first author. “This would be a relatively simple intervention with the potential to encourage healthier eating. Many of these purchases may have been impulse buys, so if the shopper doesn’t pick up a chocolate bar at the till, it may be one less chocolate bar that they consume.”

“It may seem obvious that removing unhealthy food options from the checkout would reduce the amount that people buy, but it is evidence such as this that helps build the case for government interventions to improve unhealthy behaviours,” adds Dr Adams.

“One such intervention might be to introduce nutritional standards for checkout food as suggested in the Government’s recent Childhood Obesity Plan. Such a government-led policy might prove attractive to supermarkets as it would provide a level playing field across the sector.”

̽��ֱ��work was undertaken by the authors as part of the Public Health Research Consortium. ̽��ֱ��Public Health Research Consortium is funded by the Department of Health and Social Care Policy Research Programme.

Reference
Ejlerskov, KT et al. Supermarket policies on less healthy food at checkouts: natural experimental evaluation using interrupted time series analyses of purchases. PLOS Medicine; 18 Dec 2018; DOI: 10.1371/journal.pmed.1002712

Policies aimed at removing sweets and crisps from checkouts could lead to a dramatic reduction in the amount of unhealthy food purchased to eat ‘on-the-go’ and a significant reduction in that purchased to take home, suggests new research led by the ̽��ֱ�� of Cambridge.

It is evidence such as this that helps build the case for government interventions to improve unhealthy behaviours

Jean Adams

paulbr75 (Pixabay)

Shopping carts

Researcher Profile: Dr Jean Adams

“Most people have a vague idea about what eating better involves – more fruit and veg, less fat and sugar – and they also often have an aspiration to eat better,” says Dr Jean Adams. “But they don’t always manage to put this aspiration into practice.”

Jean’s research group in the Centre for Diet and Activity Research (CEDAR) asks why this is the case – and what can be done about it. “We’re particularly interested in how we can provide environments that make it easier for everyone to eat better. This might involve making healthier foods more available, cheaper, attractive, or easier to prepare.”

Jean began her career studying medicine at Newcastle ̽��ֱ��, but admits she “never really enjoyed it”. But between her second and third year at medical school, she did a research year and realised this was where her passion lay. She went on to study for a PhD in public health and since then her career has involved public health research, rather than clinical medicine.

“I do a lot of talking and listening to people working in local and national government to understand what sorts of opportunities they feel are coming up and what research they would find helpful. In Cambridge we then try and focus on what the most rigorous and useful research we could do would be.”

Jean hopes that her research will lead to more people finding it easier to eat better. “Poor diet accounts for as much death and disease in the UK as tobacco smoking, so we are trying to address a major problem,” she says.

While she finds her work interesting and rewarding, she says research can be more prosaic than it is sometimes painted. “I have never had a Eureka moment and no-one’s ever slapped a sheaf of papers on my desk that explains everything! In my experience, research is more about grinding things out with a lot of refining and polishing leading to incremental accumulation of knowledge.”

Nor is it particularly glamorous: “ ̽��ֱ��CEDAR offices are in a slightly dingy corner deep in the heart of Addenbrooke’s Hospital. We have a small meeting room with a big white board. Sometimes I think that whiteboard has been the key vehicle for almost all of the great research CEDAR has produced!”

But fortunately, it can be both enjoyable and exhilarating. “My favourite meetings are the ones where we talk about ideas and share our brain power to arrive at new insights. I particularly enjoy when someone makes me see an old problem in a new way, or helps me crystallise some vague ideas that have been bubbling in my head for a while.

“We also try not to take ourselves too seriously and have a lot of fun along the way.”

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It’s time to change the way we think about changing what people eat

cjb250 — Mon, 11 Apr 2016 16:31:18 +0000

̽��ֱ��UK has a diet problem. We eat too much processed food high in sugar, fat and salt and not enough fruit, vegetables and whole grains. ̽��ֱ��result is an epidemic of obesity and other diseases.

There are two different approaches to improving what people eat. Either you can provide information, support and encouragement – telling people about healthy diets and how to eat them. Or you can change how easy it is to eat a healthy diet. ̽��ֱ��Chancellor took almost everybody by surprise with his announcement of a tax on sugary drinks in his budget last month. This is a great step in the right direction. As UK Government finalises its long-awaited Childhood Obesity Strategy, we hope they will focus even more on changing how easy it is for people to eat well.

Central to government attempts to improve our diets since 2009 has been the Change4Life campaign. Under three successive governments, bold colours and cartoon characters have been telling us to “eat well, move more and live longer”.

Change4Life tries hard to be fun and to avoid nannying. But the problem with giving people information, encouragement and support on eating well is that it will only work for the people who are ready and able to listen, engage and respond. Calorie labelling on food packages and menus is one, much discussed, way of giving consumers information. For calorie labelling to make a difference to what people eat, they have to notice it, read it, understand it, care about it, and be able to find an alternative that is tasty and convenient and still affordable. All this takes time, motivation and energy. To keep doing it each and every time you’re faced with a food decision requires the obsession and dedication you might only find in health fanatics (and dietary researchers).

Which is the other problem with telling people what to eat: it probably works best in those people who need help the least. There are substantial social inequalities in both diet and obesity in the UK. Poorer people are more likely to be overweight, obese and to eat unhealthy diets. Researchers have found little effect of calorie labelling on menus on overall choices. But they do find an effect in more educated people. Information-based interventions may do little to alleviate social inequalities, and may even exacerbate them.

One obvious reason why poorer people find it harder to engage with information is that they have less money and fewer of the resources that more affluent people take for granted. Finding healthier alternatives that are tasty, convenient and affordable is not always straightforward. Typically, it is easier and cheaper to fill up on less healthy foods than it is to buy and prepare lots of vegetables and whole grains. Poorer people may also struggle to prioritise healthy eating. With lots of other, more pressing, concerns about holding together family, jobs and self, the goal of eating well may be overlooked. Mothers of all social grades want to feed their children well. But there is some evidence that the stress of living in poverty makes people less able to focus their decisions on achieving long-term goals (like health and eating well), rather than short-term problems (like feeling full).

̽��ֱ��UK Government claims it is interested in promoting health at the same time as reducing inequalities in health. To do this, they need to concentrate on making it easier for everyone to eat well. This means making good food easier to find, more heavily marketed, and cheaper to buy; at the same time as making bad food harder to come by, advertised less, and more expensive to buy.

̽��ֱ��Chancellor’s recent announcement that the UK will introduce a tax on sugary drinks in 2018 is a great example of this approach. ̽��ֱ��NHS in Scotland has also recently announced restrictions on how food is displayed and marketed in hospital shops. There will be no more upselling of chocolate at the till, no multi-buy offers on sweets and crisps, and sugary drinks will make up a maximum of 30% of drinks displayed. These are both useful steps in the right direction, but more needs to be done. Scottish hospital shops make up only a tiny proportion of all shops in the country.

Alongside a tax on sugary drinks, extending restrictions on display and promotion of less healthy foods to all shops, and restricting advertising of junk foods on TV and elsewhere would all be expected to help more people eat better more often. Changing what goes in to processed foods may also help. Great progress has been made on reducing salt in processed food in the UK. Food manufacturers should be pushed harder to make further efforts like these. We also know that people eat more food when more is available to them – as either larger portions on their plate, or more opportunities to buy fast-food in their neighbourhood. Some local authorities are trying to stop new fast food outlets opening, but they face legal challenges which they don’t always have the resources to fight.

There is no simple solution to the diet and obesity ‘problem’ and we will need to use lot of different approaches simultaneously to make big changes. Hoping that everyone will be able do the right thing with enough information and encouragement is naïve. We need interventions that focus on changing the quality of food and that make good food obvious and easy for people to buy and eat. These are the changes that are most likely to achieve the improvements in diet, reductions in obesity, and narrowing of social inequalities so urgently needed.

Reference
Adams J, Mytton O, White M, Monsivais P (2016) Why Are Some Population Interventions for Diet and Obesity More Equitable and Effective Than Others? ̽��ֱ��Role of Individual Agency. PLoS Med 13(4): e1001990. doi:10.1371/journal.pmed.1001990

̽��ֱ��Chancellor's recent announcement about a tax on sugary drinks is a step in the right direction towards fighting obesity, but we will need to use lot of different approaches simultaneously to make big changes, writes Dr Jean Adams from the Centre for Diet & Activity Research, Medical Research Council Epidemiology Unit.

Christian Kadluba

Max burger (cropped)

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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