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Obesity policy

Obesity expert slams government, food industry

Food industry "organises policy" for health minister
Obesity advisory group disbanded following critical assessment of government policy
Food standards agency stripped of responsibilities in move described as "the biggest setback to public health" by World Health Organisation

Professor Philip James, President of the International Association for the Study of Obesity, has delivered a scathing judgement on the UK government’s response to the obesity epidemic. Speaking at the 2012 British Obesity & Metabolic Surgery Society meeting in Bristol, James laid out what he saw as the British government’s public health policy failings, concentrating on British Health Secretary Andrew Lansley’s relationship with the food industry and a governmental belief that obesity is a matter of personal, rather than societal, responsibility.

Responsibility deal

Lansley, James said, has violated the World Health Organisation’s principle that conflicts of interest should play no role in policy making, by involving senior industry figures in his UK Responsibility Deal advisory group. Lansley created the Responsibility Deal as an initiative to involve the food and drink industry in reducing obesity through voluntary pledges to create healthier products.

Representatives from companies such as Unilever, Tesco, Mars, and Diego, as well as interest groups like the Wine and Spirits Federation, the British Retail Consortium, the Food and Drink Federation, and the Advertising Association, says James, are “organising policy” to deal with obesity through their presence on the advisory group.

The promotion of industry to advisory roles, he said, minimised the chance of the government adopting initiatives like taxes on fatty foods and tighter regulations on advertising, which could have a dramatic effect on levels of obesity in the UK, but would be likely to harm the profits of food companies.

“British Retail Consortium have, on a personal basis, attacked every proposal we’ve produced for 20 years,” said James. “Tesco is the only company that refused to meet me as I tried to compose the Food Standards Agency. Wine and Spirits Federation are a splendid pro-health organisation. Food and Drink Federation lambasted me for four hours with 14 chief executives when I said 10 years ago we should look at whether marketing has any effect on children’s behaviour. I had a ding-dong battle with the Advertising Association in a cabinet minister’s discussion as to what should happen during the last government.”

"Weakening the FSA is the biggest setback to public health - itwas a clarion call for governments throughout the world."Philip James

The new group replaces the old Obesity Advisory Group, which Lansley disbanded in November 2011. At the time, Oxford epidemiologist Klim McPherson, who was a member of the group, told the Guardian “too many of us were giving critical voice to the responsibility deal and its effectiveness. They ignored us, then rather than ignoring us, they disbanded us.”

“Businesses can make an enormous contribution,” said James. “They are said to be the cause; they could be part of the solution. The question is whether they should be involved in the actual policy.”

Food Standards Agency

James also expressed concern for Lansley reducing the powers of the Food Standards Agency (FSA), which was created based on James’ guidelines to remove food safety from direct political oversight.

The FSA developed the “traffic light” food labelling system, which James described as “the most dramatic, brilliant system – in all evaluations it comes out best”. Under Lansley, however, responsibility for nutrition, including food nutrition labelling, was moved to the Department for Health, placing it back under direct ministerial control.

“The World Health Organisation have said unofficially that this is the biggest setback to public health,” said James, “because [the FSA] was a clarion call for governments throughout the world.”

“We’ve been talking to the Government for about 20 years about the fact that public health should not be in the Department of Health,” he said. “It should be in the Cabinet Office, looking at all aspects of government.”

Failure of practitioners

What James saw as the medical profession’s failure to come to grips with the epidemic also drew fire.

“We as doctors have never put it on the map,” he said. “It’s also become a problem because in medical terms, people are defeatist, apart from [when it comes to] bariatric surgery. [Obesity drugs] Rimonabant and Sibrutamine have been withdrawn.”

“For decades, doctors and epidemiologists have actually been assigning no significance to obesity. If you take blood pressure and cholesterol into account then what does obesity do that is extra and special to cardiovascular disease?”

GPs, James said, feel “completely inadequate” in facing the epidemic, believing themselves unable to cope. James saw these factors as directly affecting government policy. “You’ve got to remember that when you talk to politicians, they think like ordinary citizens. And so they think that, as the PM said before the election, it’s personal responsibility.”

NHS shakeup

James had gloomy forecasts for controversial proposed changes to the organisation of the NHS.

“What I’m predicting is chaos in the Health Service with battles, reorganisation,” he said. “If you need coherent thinking, it’s not going to come in my view for quite a long time.”

The changes were announced in a white paper, “Equity and Excellence: Liberating the NHS”, released in July 2010. In that document, noted James, obesity was not mentioned once.

“It’s not on the agenda,” said James, “because it’s an extraordinarily difficult societal question. In the economic crisis, they think it’s more important to back industry, and say to you: stay thin.“

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