Policy paper

Childhood obesity plan: PHE’s role in implementation

Published 29 September 2016

Introduction

Obesity is a leading cause of ill health and premature death in England. Being overweight and obese is associated with increases in the risk of:

  • heart disease
  • type 2 diabetes
  • stroke
  • some cancers

Approximately one-fifth of 4 to 5 year olds and a third of 11 year olds are overweight or obese, as well as two-thirds of adults. Children who are overweight or obese are more likely to experience bullying, stigmatisation and low self-esteem and are also more likely to be overweight or obese adults. Carrying excess weight increases the risk of associated health problems later in life.

Overweight and obesity cost the NHS over £6 billion per year.

Public Health England’s (PHE) priorities are to:

  • increase the proportion of children leaving primary school with a healthy weight
  • reduce levels of excess weight in adults

On 18 August 2016, the government published its childhood obesity plan Childhood Obesity: A Plan for Action.

PHE will work with the Department of Health (DH), other government departments and a wide range of stakeholders to achieve the aim of significantly reducing England’s rate of childhood obesity within the next 10 years by implementing the individual commitments in the plan. Two of PHE’s important contributions will be through implementing a sugar reduction programme (and calorie reduction from 2017) and reviewing the nutrient profile model which categorises food according to its nutrient value.

Why we need the childhood obesity plan

In July 2015, the the Scientific Advisory Committee on Nutrition (SACN) published its Carbohydrates and Health Report. SACN recommended free sugars intake should not exceed 5% of total dietary energy for all ages from 2 years upwards. Free sugars are defined as all sugars added to foods plus those naturally present in fruit juices, syrups and honey. It does not include the sugars naturally present in intact fruit and vegetables or milk and dairy products.

In October 2015, PHE published its sugar reduction evidence package in which it suggested 8 possible actions to reduce population sugar consumption. The report suggested that a structured and universal programme of reformulation to reduce levels of sugar in food and drink would significantly lower sugar intakes, particularly if accompanied by reductions in portion size.

It also stated that a clear definition for high sugar foods should be set to help significantly reduce opportunities to market and advertise high sugar food and drink products to children and adults. The only regulatory framework for doing this is via the FSA and Ofcom nutrient profiling model (NPM) which would benefit from being reviewed and strengthened.

Sugar reduction

A UK-wide programme to reduce salt consumption began after the publication of SACN’s Salt and Health report in 2003. Targets were set in 2006 to guide industry on the levels and types of reductions needed in a wide range of food and drink categories. These targets were revised in 2009, 2011 and 2014 to encourage further action. The programme has so far led to salt levels being reduced by up to 50% in some products. Data from March 2016 estimated daily salt intakes had fallen by 0.9g per day to 8.0g.

The success of the salt reduction programme led to PHE’s view that a similar, structured and universal programme, focusing on common foods that contribute most of the sugar we eat, would lower sugar intakes.

PHE determined where to focus efforts on sugar reduction by the food industry by identifying the main foods and drinks that contribute to children’s’ consumption of sugar, and the biggest businesses that make them, using National Diet and Nutrition Survey (NDNS) data and market share analysis. This data demonstrated that the 9 product categories that contribute most of the sugar that children eat are:

  • breakfast cereals
  • confectionary
  • ice-cream
  • yoghurt and fromage frais
  • morning goods
  • spreads
  • biscuits
  • cakes
  • puddings

Following final decisions on the scope of the sugar levy, drinks not included in it will be brought into the sugar reduction programme.

PHE will engage with food manufacturers and retailers who manufacture products that come under these categories over the coming months. The purpose of these meetings will be to discuss sugar reduction in these products and targets for each category. PHE will also be engaging with the ‘eating out of home’ sector – those that provide food that we both buy and consume out of the home. These types of outlets include:

  • restaurants
  • pubs
  • takeaways and fast food restaurants
  • cinemas
  • cafes
  • sandwich and coffee shops

From 2017, we will work towards setting targets to reduce total calories in a wider range of product categories and across all sectors, including the eating out of home sector. Work on saturated fat will be further reviewed in light of SACN recommendations due in 2017.

Nutrient profiling model (NPM)

The NPM was originally developed by the Food Standards Agency (FSA) in 2004 to 2005 to provide Ofcom, the broadcast regulator, with a tool to differentiate between foods and drinks on the basis of their nutritional composition. The model applies to television advertising of foods and drinks during programmes aimed at children.

The NPM uses a scoring system to assess a food or drink based on nutrients to limit and those to encourage.

The nutrients to limit are:

  • sugar
  • sodium
  • saturated fat
  • energy

The nutrients to encourage are:

  • fibre and protein as a marker of calcium, iron and omega 3 fatty acids
  • fruit, vegetable and nuts content

The product is given an overall score to determine whether it can be advertised during children’s viewing times.

The current NPM is over 10 years old and does not reflect recent scientific advice such as the 2015 SACN Carbohydrates and Health Report that concluded the recommended average population maximum intake of sugar should be halved and fibre intake should be increased.

PHE has been tasked by DH to review the existing NPM and develop and test options for a new robust model, which will aim to protect children from advertising. PHE is working with academics, regulators, industry, and health NGOs to ensure that its work is comprehensive and transparent. The review is due to be completed in around 18 months.

In order to oversee approaches and support progress, a NPM Reference Group and a NPM Expert Group has been established for this programme of work.

Plans

In autumn 2016, PHE will begin working towards setting sector specific targets in relation to the overall ambitions mentioned in the childhood obesity plan, initially for the 9 categories that contribute most to children’s sugar consumption.

PHE will also start a full programme of engagement with the ‘eating out of home’ sector. This is particularly important because this sector now accounts for a large proportion of the food we eat:

  • around 18% of meals were eaten out of the home during the year ending March 2015, a 5% increase on the previous year
  • 75% of people reported eating out or buying takeaway food in 2014 (compared to 68% in 2010)

PHE will review the existing NPM and develop and test options for a new robust model working with academics, regulators, industry, and health NGO’s to ensure that its work is comprehensive and transparent. The review will take around 18 months.

From 2017, we will work towards setting targets to reduce total calories in a wide range of product categories and across all sectors, including the out of home sector. Work on saturated fat will be further reviewed in light of SACN recommendations due in 2017.

Calendar of meetings with industry on product categories

  1. Yoghurts: Tuesday 1 November 2016.
  2. Breakfast cereals: Friday 4 November 2016.
  3. Biscuits: Tuesday 8 November 2016.
  4. Cakes and morning goods: Friday 11 November 2016.
  5. Puddings: Wednesday 16 November 2016.
  6. Ice-cream: Friday 18 November 2016.
  7. Sweet spreads: Monday 28 November 2016.
  8. Chocolate confectionery: Tuesday 29 November 2016.
  9. Sweet confectionery: Thursday 1 December 2016.