For years, Alice Ingman’s favourite foods were takeaway curries, pizza, fried chicken, kebabs, and fish and chips. The 59-year-old gained weight steadily until one day she could not even fit into a size 20. She was 115kg and mortified.
“At the beginning I thought, ‘Oh, it’s because it’s a pencil skirt,’” says Ingman, from Cambridgeshire, calling it one of many excuses she had relied on to make herself feel better. “But there’s no getting away from it when a size 20 doesn’t fit.”
This was a wake-up call for her to change her diet. She joined a weight-loss group and started cooking meals from scratch for the first time in her life. She says she has maintained a weight of 60kg for five years since.
Ingman’s back-to-basics approach worked for her. But the arrival of the weight-loss jab Wegovy to the NHS last month has been heralded as a game-changer in the fight against obesity by using a hormone to suppress appetite.
While health experts and charities welcome the development of new drugs, they argue that a broader conversation is needed about the UK’s approach to food, and want industry and the government to take more definitive action.
Obesity, defined as having a body mass index equal to or greater than 30, is one of the most serious public health crises around the world. The UK, where 27.8 per cent of population is obese, has one of the highest rates in Europe.
An increased reliance on cheap, ultra-processed food, which accounts for 57 per cent of what Britons eat according to a 2019 study conducted by researchers at the University of São Paulo, suggests that the health crisis is unlikely to change anytime soon without intervention, argue campaigners.
“There is a very strange imbalance [in] that the foods that are most appealing, affordable and available just happen to be those that are the least healthy,” says Katharine Jenner, nutritionist and director of the Obesity Health Alliance, a coalition of more than 50 health organisations.
“The food system in this country is broken,” she adds. “It’s not serving society nor our health system, and certainly not individuals.”
The poverty health tax
The effects of obesity are widespread.
It causes severe health conditions including heart disease, diabetes and cancer, costing about £6.5bn in the UK every year, according to the NHS. Globally, the World Health Organization says at least 2.8mn people die each year as a result of being overweight or obese.
Many health professionals point to the severe dietary changes over the past 50 years. Data of family eating habits shows that more of us are consuming less healthy food, usually high in fat, sugar or salt. The average consumption of takeaway chicken has increased by 613 per cent from 1974, ready meals and convenience meat products by 549 per cent and crisps and potato snacks by 226 per cent.
Meanwhile, households buy less non-processed food. Consumption of beef and veal has decreased by 55 per cent, fresh cabbages by 67 per cent and fresh apples by 44 per cent.
Health experts say the affordability of processed foods is a significant driver of these dietary patterns. Fruits and vegetables are the most expensive category in the government’s recommended Eatwell Guide, costing on average £11.79 per 1,000kcal, compared with food and drink high in fat and sugar costing just £5.82 per 1,000kcal, according to the Food Foundation, a UK charity.
This is partly because fruits and vegetables have a lower energy density, fewer calories per gramme, than processed foods. But this price disparity explains why obesity is more prominent among the most vulnerable households.
The King’s Fund, through its analysis of the Office for Health Improvement and Disparities data, last year found that inequalities in obesity prevalence between the least and most deprived areas widened to nearly 18 points in 2020.
“Poverty is a driver of poor eating behaviours, because choice is not there,” says Paul Gately, professor of exercise and obesity at Leeds Beckett University. “Food retailers and the food industry would be able to fight against obesity by making healthy products more affordable.”
There are other changes that could be beneficial. Unhealthy food is often heavily advertised. A third of food and soft drink advertising spend in the UK goes towards confectionery, snacks, desserts and soft drinks, compared with only 1 per cent for fruit and vegetables, the Food Foundation has found.
“Many people think that obesity levels are very much about individual responsibility,” says Shona Goudie, the charity’s policy and advocacy manager. “But what we can see from [the research] is actually that the system is not set up to help us eat well.”
Decades of policy
The UK government set its first strategy focused on reducing obesity in 1992 and other efforts have followed with mixed success.
One of its key policies was a soft drinks levy introduced in 2018 to push manufacturers to add less sugar to their products. This step may have prevented more than 5,000 cases of obesity every year among girls in their final year of primary school, according to an analysis from the University of Cambridge.
Last October, the government barred large stores from placing items high in fat, sugar or salt in prominent positions, but health campaigners say too many of its obesity policies lack urgency. “I think it’s very clear that the government hasn’t gone far enough to tackle obesity,” says Goudie.
Henry Dimbleby, co-founder of fast-food restaurant chain Leon who quit his role as a UK government adviser in March, wrote in his book Ravenous, published this year, that the government’s strategy was “far too scant, fragmented, and cautious to meet the scale of the problem”. He recommended taxing salt and sugar to encourage manufacturers to produce healthier foods, a proposal rejected by ministers.
There have been other setbacks. The government announced in June that rules banning multi-buy deals on food and drinks high in salt and sugar, such as “buy one, get one free”, will be delayed until October 2025. The decision, taken amid a cost of living crisis, came after the policy had already been delayed once before. The government has also pushed back proposed restrictions on unhealthy food adverts.
Companies producing healthier alternatives of sweets and snacks, especially small businesses, had been counting on receiving more funding from investors off the back of the legislation.
“The more [the implementation] got delayed, the less interested investors became. By the time [the restrictions on product placement] happened, the spark had gone and lots of those small businesses hadn’t been able to raise money and died,” says Louis Bedwell, managing director at venture capital firm Mission Ventures.
The government is also scaling back public health grants to support services such as weight management. Data compiled by the Health Foundation shows that public-health spending on adult obesity by local authorities this year is estimated at £132mn, down 27 per cent from 2015. Although the government in March 2021 announced £100mn of new funding — a large part of which was invested in weight-management services through the NHS and local authorities — it was scrapped the year after.
Carolyn Pallister, the head of nutrition, research and health at Slimming World — which helped Ingman lose weight — says choosing healthy food is not just about how and where products are placed or advertised. “What we see from members is that people need support to be able to [make better choices],” she says, adding that there’s a “real kind of postcode lottery” based on where you live.
The Department of Health and Social Care says the government continues to take “action to help more people make healthier choices and tackle obesity”.
“The launch of Wegovy in the UK has also paved the future of weight management in England,” it adds.
Ingman, who jokes that she is now half the person she was, credits the first cookbook she bought from her slimming club with teaching her “what a healthy balanced plate should look like”. That was a big change, she explains, for someone who previously thought it was “quite acceptable to pick up something that you pop in the microwave”.
She is confident that she has the skills she needs to maintain a healthier weight: “It’s definitely a way of life for me now.”
