̽��ֱ�� of Cambridge - Martin White

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.

Sugar purchased in soft drinks fell 10% following introduction of industry levy

cjb250 — Wed, 10 Mar 2021 23:30:06 +0000

Following publication of this study, subsequent analysis by the research team identified that the analysis presented in the original paper contained an error. ̽��ֱ��authors alerted the BMJ, who have now retracted the original paper and published a corrected version in BMJOpen.

Overall, the estimate of change in purchasing of sugar from all soft drinks combined at one year post implementation of the levy reduces from a 30g (or 10%) fall per household per week to an 8g (or 3%) fall per household per week. Alongside, the estimate of change in volume of soft drinks purchases increases from no change to a 189g (or 3%) increase per household per week.

̽��ֱ��authors believe that the results still have important public health implications and indicate that the UK Soft Drinks Industry Levy may have had a public health benefit (by reducing household purchasing of sugar from soft drinks) without harming, and indeed potentially benefiting, industry (by increasing total volume of soft drinks purchased).

For further details, visit: https://www.bmj.com/content/372/bmj.n254

While the volume of soft drinks purchased did not change, the amount of sugar in those drinks was 30g lower per household per week, which the researchers say represents a ‘win-win’ for public health and industry.

Sugary drinks have been linked to a number of health issues, including dental caries, obesity, type 2 diabetes and heart disease. In April 2018, the UK introduced a Soft Drinks Industry Levy explicitly designed to incentivise manufacturers to reduce the sugar content of soft drinks. ̽��ֱ��levy was placed on manufacturers, importers and bottlers rather than on consumers. It included two levy tiers: 24p per litre for ‘high tier’ drinks containing more than or equal to 8g total sugar per 100ml; and 18p per litre for ‘low tier’ drinks containing more than or equal to 5g and less than 8g total sugar per 100ml.

A team led by researchers from Cambridge’s Centre for Diet and Activity Research (CEDAR) at the MRC Epidemiology Unit analysed data from the Kantar Worldpanel, in which participating households are asked to record all food and drink purchases brought into the home. This included approximately 31 million purchases of drinks, confectionery and toiletries from March 2014 to March 2019.

̽��ֱ��team divided soft drinks into three categories based on sugar content: high tier drinks, low tier drinks and no levy drinks (those with less than 5g total sugar per 100ml). As the Soft Drinks Industry Levy may have led households to substitute other drinks, they also examined purchasing of drinks exempt from the levy, including milk-based drinks, alcoholic drinks and no-added-sugar fruit juices.

̽��ֱ��researchers compared purchases in March 2019 against a ‘counterfactual’ estimate – that is, an estimate based on pre-existing trends of how the purchases would look had the levy not taken place at all. This is the first analysis of the impact of the UK Soft Drinks Industry Levy on drink purchases that takes pre-existing trends into account. ̽��ֱ��results of the study, funded by the NIHR, are published today in ̽��ֱ��BMJ.

Prior to the introduction of the levy, the volume of high-tier drinks and amount of sugar associated was on a downward trend. However, even taking this trend into consideration, by March 2019, the volume of high tier drinks purchased had fallen by 155ml (44%) per household per week compared to the counterfactual estimate. ̽��ֱ��amount of sugar purchased in these drinks reduced by 18.0g per household per week, a 46% decrease.

For low tier drinks, the volume of drinks purchased was 177ml (86%) lower per household per week in March 2019 compared with the counterfactual estimate. ̽��ֱ��amount of sugar fell by 12.5g (an 86% decrease).

Although the volume of no levy drinks purchased didn’t change, as these soft drinks are not sugar-free and some increased in their sugar content, this meant that the sugar purchased from these drinks increased by 15.3g, equivalent to a 166% increase.

Overall, compared to the counterfactual estimate, there was no change in the volume of all soft drinks purchased in March 2019. However, there was a reduction in sugar purchased in all soft drinks (including exempt drinks) combined of 29.5g per household per week, equivalent to a 10% decrease.

̽��ֱ��introduction of the Soft Drinks Industry Levy also coincided with significant decreases in purchasing of bottled water. However, the team say this reduction may be due to increases in concern about single-use plastic, which have been attributed, in the UK, to the broadcast of the BBC’s nature documentary series Blue Planet 2.

Dr David Pell from CEDAR, the study’s first author, said: “A 10% drop in the amount of sugar purchased from soft drinks might sound modest, but we know there’s an association between the amount of sugar drinks we consume and the risk of developing conditions such as obesity, type 2 diabetes and high blood pressure. Cutting out even a relatively small amount of sugar should have important impacts on the number of people with obesity and diabetes.”

Professor Martin White, also from the CEDAR, and the project lead, added: “ ̽��ֱ��Soft Drinks Industry Levy appears to have led to a reduction in the amount of sugar that people are purchasing in soft drinks without impacting on the overall volume of soft drinks sold. It’s likely that this is due to manufacturers reformulating their products and reducing the sugar concentration in their drinks, as well as to consumers switching to lower sugar alternatives.

“This represents a valuable win-win for public health and the food industry – potentially improving people’s health with no detrimental effect on the volume of soft drinks that companies are selling.”

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

Reference
Pell, D et al. Changes in British household purchases of soft drinks associated with implementation of the Soft Drinks Industry Levy: a controlled interrupted time series analysis. BMJ; 11 Mar 2021; DOI: 10.1136/bmj.n254

̽��ֱ��amount of sugar purchased by households through soft drinks fell by 10% in the year following the introduction of the UK Soft Drinks Industry Levy, say researchers at the ̽��ֱ�� of Cambridge. [RETRACTED]

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Successive governments’ approaches to obesity policies have destined them to fail, say researchers

cjb250 — Tue, 19 Jan 2021 08:52:28 +0000

This is the conclusion of new research by a team at the ̽��ֱ�� of Cambridge funded by the NIHR School for Public Health Research.

̽��ֱ��researchers say their findings may help to explain why, after nearly thirty years of government obesity policies, obesity prevalence in England has not fallen and substantial inequalities persist. According to a report by NHS Digital in May 2020, 67% of men and 60% of women live with overweight or obesity, including 26% of men and 29% of women who suffer clinical obesity. More than a quarter of children aged two to 15 years live with obesity or overweight and the gap between the least and most deprived children is growing.

Successive governments have tried to tackle the obesity problem: in research published today in ̽��ֱ��Milbank Quarterly, Dolly Theis and Martin White in the Centre for Diet and Activity Research (CEDAR) at the ̽��ֱ�� of Cambridge identified 14 government-led obesity strategies in England from 1992 to 2020. They analysed these strategies – which contained 689 wide-ranging policies – to determine whether they have been fit for purpose in terms of their strategic focus, content, basis in theory and evidence, and implementation viability.

Seven of the strategies were broad public health strategies containing obesity as well as non-obesity policies such as on tobacco smoking and food safety. ̽��ֱ��other seven contained only obesity-related policies, such as on diet and/or physical activity. Twelve of the fourteen strategies contained obesity reduction targets. However, only five of these were specific, numerical targets rather than statements such as ‘aim to reduce obesity’.

Theis said: “In almost 30 years, successive UK governments have proposed hundreds of wide-ranging policies to tackle obesity in England, but these are yet to have an impact on levels of obesity or reduce inequality. Many of these policies have largely been flawed from the outset and proposed in ways that make them difficult to implement. What’s more, there’s been a fairly consistent failure to learn from past mistakes. Governments appear more likely to publish another strategy containing the same, recycled policies than to implement policies already proposed.

“If we were to produce a report card, overall we might only give them 4 out of 10: could do much better.”

Theis and White identified seven criteria necessary for effective implementation, but found that only 8% of policies fulfilled all seven criteria, while the largest proportion of policies (29%) did not fulfil a single one of the criteria. Fewer than a quarter (24%) included a monitoring or evaluation plan, just 19% cited any supporting scientific evidence, and less than one in ten (9%) included details of likely costs or an allocated budget.

̽��ֱ��lack of such basic information as the cost of implementing policies was highlighted in a recent National Audit Office report on the UK Government’s approach to tackling childhood obesity in England, which found that the Department of Health and Social Care did not know how much central government spent tackling childhood obesity.

“No matter how well-intended and evidence-informed a policy, if it is nebulously proposed without a clear plan or targets it makes implementation difficult and it is unlikely the policy will be deemed successful,” added Theis. “One might legitimately ask, what is the purpose of proposing policies at all if they are unlikely to be implemented?”

Thirteen of the 14 strategies explicitly recognised the need to reduce health inequality, including one strategy that was fully focused on reducing inequality in health. Yet the researchers say that only 19% of policies proposed were likely to be effective in reducing inequalities because of the measures proposed.

UK governments have to date largely favoured a less interventionist approach to reducing obesity, regardless of political party, prioritising provision of information to the public in their obesity strategies, rather than more directly shaping the choices available to individuals in their living environments through regulation or taxes. ̽��ֱ��researchers say that governments may have avoided a more deterrence-based, interventionist approach for fear of being perceived as ‘nannying’ – or because they lacked knowledge about what more interventionist measures are likely to be effective.

There is, however, evidence to suggest that policymaking is changing. Even though the current UK government still favours a less interventionist approach, more recent strategies have contained some fiscal and regulatory policies, such as banning price promotions of unhealthy products, banning unhealthy food advertisements and the Soft Drinks Industry Levy. This may be because the government has come under increasing pressure and recognises that previous approaches have not been effective, that more interventionist approaches are increasingly acceptable to the public, and because evidence to support regulatory approaches is mounting.

̽��ֱ��researchers found little attempt to evaluate the strategies and build on their successes and failures. As a result, many policies proposed were similar or identical over multiple years, often with no reference to their presence in a previous strategy. Only one strategy (Saving Lives, published in 1999) commissioned a formal independent evaluation of the previous government’s strategy.

“Until recently, there seems to have been an aversion to conducting high quality, independent evaluations, perhaps because they risk demonstrating failure as well as success,” added White. “But this limits a government’s ability to learn lessons from past policies. This may be potentially compounded by the often relatively short timescales for putting together a strategy or implementing policies.

“Governments need to accompany policy proposals with information that ensures they can be successfully implemented, and with built-in evaluation plans and time frames. Important progress has been made with commissioning evaluations in the last three years. But, we also need to see policies framed in ways that make them readily implementable. We also need to see a continued move away from interventions that rely on individual’s changing their diet and activity, and towards policies that change the environments that encourage people to overeat and to be sedentary in the first place.”

Living with obesity or excess weight is associated with long-term physical, psychological and social problems. Related health problems, such as type-2 diabetes, cardiovascular disease and cancers, are estimated to cost NHS England at least £6.1 billion per year and the overall cost of obesity to wider society in England is estimated to be £27 billion per year. ̽��ֱ��COVID-19 pandemic has brought to light additional risks for people living with obesity, such as an increased risk of hospitalisation and more serious disease.

̽��ֱ��research was funded by the NIHR School for Public Health Research, with additional support by the British Heart Foundation, Cancer Research UK, Economic & Social Research Council, Medical Research Council, and Wellcome Trust.

Reference
Dolly R Z Theis, Martin White. Is obesity policy in England fit for purpose? Analysis of government strategies and policies, 1992-2020. Milbank Quarterly; 19 Jan 2021; DOI: https://doi.org/10.1111/1468-0009.12498

Government obesity policies in England over the past three decades have largely failed because of problems with implementation, lack of learning from past successes or failures, and a reliance on trying to persuade individuals to change their behaviour rather than tackling unhealthy environments.

In almost 30 years, successive UK governments have proposed hundreds of wide-ranging policies to tackle obesity in England, but these are yet to have an impact on levels of obesity or reduce inequality

Dolly Theis

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