Professor Susan Jebb on what’s changed since Foresight published their report on Obesity 10 years ago, and what we can still learn from it.
It’s been ten years since I contributed to Foresight’s Tackling Obesities: Future Choices report. The report developed scenarios of the future to explore how the UK could respond to rising levels of obesity. The precise scenarios we described in the report may not exactly fit the social and political changes we see in Britain today, but their purpose was to help develop a framework for action which would be robust in the face of changes in external circumstances. Looking back through the report, while the world has changed, there is a lot that remains relevant to policymakers today.
A more considered approach
Most striking is that the rate of increase in obesity has noticeably slowed and our original projections are mercifully wrong. Estimates of the prevalence of obesity in 2030 are almost 10 percentage points lower than we feared, while the rate of increase among primary school aged children has arguably plateaued (though this conceals a worrying increase in the disparities between the most affluent and the most deprived areas).
It would be foolish to claim these modest improvements are down to our report, but it certainly heralded a more considered approach to tackling obesity in the UK. The launch was quickly followed by the first ever obesity strategy in England ‘Healthy Weight, Healthy Lives’, overtly grounded in the strategic approach set out by Foresight. In 2011, its successor, ‘Healthy People, Healthy Lives,’ again used the Foresight report as a touchpoint to the scientific evidence.
The role of the environment and individuals
The obesity system map, while sometimes derided for its complexity, has been instrumental in creating a far more balanced perspective about the roles of the individual and the environment. More specifically, the independent contributions of a poor diet and physical inactivity as drivers of excess weight gain, an awareness that some individuals are biologically more susceptible to weight gain, a recognition of the impact of the environment on personal ‘choices’, and hence much greater acknowledgement of the interactions between the environment and the individual.
The map also helped to visualise the concept of a ‘whole systems approach,’ though scientists and policymakers still tend to focus on single initiatives, and more could be done to incorporate ‘systems thinking’ into tackling obesity.
Using economic modelling
Perhaps the most tangible impact of the project is the economic model which has been used extensively. Thanks to ongoing work by the UK Health Forum, the original model has been refined and deployed in support of work on obesity by Public Health England, the National Institute for Health and Care Excellence (NICE), and a range of academic partners. This analysis has shed light on the impact of obesity on a broader range of health outcomes and, increasingly, on the cost-effectiveness of interventions.
Re-reading the report now, there is much to celebrate. The Foresight report is recognised internationally as a landmark publication, achieving degree of scientific consensus in a hotly debated area and bridging the gap between science and policy to tackle obesity.
We have seen a government-led social marketing campaign, Change4Life, running for nearly a decade, new government standards for the procurement of food in the public sector and food provision in schools, modest restrictions on the marketing of food to children on TV, investment in cycling infrastructure and, most recently, the introduction of a strong fiscal intervention in the form of the soft drink industry levy.
But the report should also be seen as a reminder of the cost of failure – the impact on individuals and the cost of obesity related ill-health. Despite good progress, 10 years on, now feels a timely moment to dust off the Foresight obesity report and reconsider what we could achieve in the next decade to improve public health.