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Ministers’ fear of nanny statism is constraining effective government action on obesity

Political squeamishness and incoherent policymaking are preventing progress against the government’s obesity targets, argues Sophie Metcalfe.

A close up of a medical expert taking notes. On the desk is a plate with green vegetables, a blood pressure machine and a laptop.
Government has mostly tried to nudge individual behaviour change through education, information campaigns or nutrition labelling.

Some policy problems seem to be too big, too complicated, or just too political for governments to fix. Ministers make grand statements of intent. New initiatives are launched to much fanfare. Strategies and targets appear on a regular basis. But still the problem remains. This should not, however, mean that no solution – or route to progress – can be found.

One such problem is obesity and our new report, Tackling Obesity: improving policy making on food and health, is the first in a series of Institute reports on chronic policy problems, looking at why they have persisted and how government can tackle them more effectively.

Past governments haven’t effectively tackled rising obesity’s root causes

Every government since 1992 has recognised the challenge. There have been 14 government strategies, hundreds of policies, and key institutions and bodies – most recently Public Health England – have been repeatedly established and abolished. There have been multiple targets, all of which have been missed. Obesity has kept on rising.

Why have these approaches failed? Government has mostly tried to nudge individual behaviour change through education, information campaigns or nutrition labelling. Empowering people to make healthier choices is laudable, but the evidence suggests these policies have little impact set against the tide of huge changes in our food systems over the last 50 years, which have left us increasingly surrounded by food that is ultra-processed and high in fat, salt and sugar. Few people have the time to stop and read small print in the supermarket.

This policy failure has real life consequences. Put bluntly, the UK’s health is in decline. Improvements in average life expectancy have stalled, our hospitals and GP surgeries are struggling to keep up with demand, and diabetes has hit record level with more than five million cases in the UK.

One of the biggest drivers is excess weight and obesity. We have the third highest adult obesity in Europe, nearly doubled since 1990, behind only Malta and Turkey, and much higher than Germany, France and Italy. This increases serious health risks – heart disease, cancer and diabetes – and deepens inequalities because obesity is heavily concentrated in the poorest areas. It costs the NHS around £6.5 billion every year, and the wider economy an estimated 1-2% of GDP (including in reduced productivity). Failure to deal with the UK’s obesity problem means being locked into a future of higher spending, lower growth and increased regional inequality.

Political squeamishness and cross-department policy making incoherence have got in the way of more ambitious measures

So what can politicians, both Conservative and Labour, do differently? To start, they need to get over their squeamishness about the perception of “nanny-statism”. People react badly to politicians telling them what to eat, yet polling shows the public are highly concerned about rising obesity, particularly in children, and support government action, including interventionist measures like the sugar tax or advertising bans – which simply try to level the playing field between healthy and unhealthy food. In the 2000s politicians were concerned that a smoking ban would make them seem “agents of the nanny state”, but it has since proved incredibly popular.

There are also problems in Whitehall, where policy responsibilities are spread across departments and the relationship between food and health works badly. Tackling obesity hasn’t been a serious priority within Number 10 or any government department – not even the health department, which is more accurately a department for the NHS. There have also been 16 public health ministers since 1997, so it’s not surprising they have failed to come up with a more coherent approach.

Government needs a robust long-term strategy, and a cross-government unit to deliver it

If the government is serious about tackling obesity, it needs to develop a robust long-term strategy backed up by clear targets and evidence-based policies – as it has for net zero. Implementing changes will require more expertise and stronger coordination, and we recommend creating a new cross-government food and health unit. With support from the centre, this unit could better manage trade-offs and steward changes in the food industry. Stronger external scrutiny, via an independent annual assessment, would also help.

But to successfully tackle the UK’s high obesity, the government needs to start by understanding why its approach over the last three decades has not worked. In the coming months, the IfG will continue this series examining why chronic policy problems have persisted and how government can find a route forwards.

Health NHS
Political party
Conservative Labour
Institute for Government

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