/ Food & Drink, Health

The government’s Responsibility Deal – is it good for our health?

Obesity costs the NHS around £5bn per year. The government’s ‘Responsibility Deal’ aims to tackle this national emergency. But is it working? One year on we examine whether it’s having an impact.

This week marks the first anniversary of the government’s Public Health Responsibility Deal. The idea is to encourage voluntary actions by the food industry to help people make healthier choices.

So far, companies have been asked to sign up to pledges to reduce salt in foods, remove trans fats and display information about calories in restaurants. A new pledge is also being launched to encourage companies to help people reduce their calorie intake.

How responsible are restaurants?

Which? has just done an assessment of what the Deal’s achieved so far. While work on salt reduction is good news, it’s quite limited as there are no plans to make further reductions beyond 2012.

It’s good that companies are taking trans fats out of foods, but a lot of this work had been done already and there’s no clear plan around targeting smaller food companies that might still be using them.

More progress has been made on providing calories in chain restaurants with companies such as McDonald’s, Subway and Starbucks displaying the information nationwide. But there’s still very limited commitment from the main restaurant and pub chains.

The cost of the obesity crisis

With over a quarter of people obese in the UK (we’re the worst in Europe) and an estimated cost to the NHS of over £5 billion a year, the government’s response is totally inadequate.

The food industry clearly has an important role to play – but isn’t it obvious that it’s going to have different and sometimes conflicting interests? While regulation isn’t always the answer, the government has to start showing leadership in this area if we are ever going to turn around rates of obesity and diet-related diseases.

When we discussed calorie counts in McDonalds, Wavechange was all for it:

‘Food chains should provide the same nutritional information as supermarkets. Fat, sugar and sodium content are particularly important.’

Bev Allen told us she wasn’t surprised that restaurants were reluctant:

‘They are fully aware of how high some items are and know that seeing it in black and white will definitely put some people off buying it.’

What do you think? Can food manufacturers and restaurants be relied upon to voluntarily add calorie counts and help tackle the nation’s obesity crisis? Or do we need a stronger plan from the government to help us cast off the calories?

Monika says:
15 March 2012

While I applaud this belated initiative by Which? I do wonder – Is calorie counting really the best way forward? I don’t think it’s done much good so far and fails to recognise some of the more important issues about the nutritional QUALITY of foods we’re consuming. All calories are not equal. Sorry to bring up the issue of Nutrition again, Which?, but these things are all connected. As suggested in the Nutrition conversation, Nutritional Therapists working alongside GPs in the NHS just might be of help in this matter….. *hunkers down to wait for NT-skeptic responses* 🙂

Monika says:
15 March 2012

Why calorie counting may not be the way forward.

I’d agree with the premise that calorie counting is not really the way forward in tackling obesity, but could be better resolved by education, food choices, and self-discipline.

There is a school of thought that believes that much overeating is caused by a lack of nutrients within the diet, as is the case with many processed foods, and which in turn keeps the body in a constant state of hunger to satiate this desire; eating nutrient dense but low calorie foods would satisfy the body nutritionally, and therefore curb appetite/hunger, preventing overeating and therefore obesity.

I recall a case not so long ago of a well known breakfast-cereal manufacturer who came up with the idea of adding something to their food-products which would bypass the appestat in the brain; this would encourage consumers (hopefully) to eat more of their food products and increase their profit margins; this was exposed by one of their food scientists who had worked on the project, and who was subsequently sacked.

Food corporations have much to answer for in my opinion.

I know a couple of people who ask for a child’s portion when they have a pub meal. Perhaps offering smaller portions might be better than calorie counts, especially if prices are lower.

Lex says:
23 March 2012

I completely agree! I am one of those people that will generally ask for a smaller or child size portion. I have come across some places that have age restrictions on the child’s portion sizes though (generally under 10 years). I can imagine this is so people spend more money! Can you imagine the food waste taken out at the end of the day if lots of people, like me, only eat small portions but are forced to order a large size!

Sophie Gilbert says:
16 March 2012

I think it’s fine to ask food manufacturers and restaurants to voluntarily add calorie counts (Monika has a point re calories though; info re solely calories is insufficient) and help tackle the nation’s obesity crisis, but I don’t believe for a moment that they can generally be relied upon to do so.

I also think, however, that we must take responsibility for what we eat and use our own brains a little. Unless we are very ill and lying in bed somewhere fighting for our lives, nobody is forcefeeding us, especially not junk food in grotesque quantities.

Olga Miller says:
16 March 2012

I agree with sophie Gilbert that we must take responsibility for what we each. I’ve watched some of the TV shows depicting the fattest man in Britain – I have a question. To be able to eat as much as he does costs a small fortune. Who pays for the huge amount of food he consumes? I’m slim because I CAN’T afford to eat so much.

Sam says:
16 March 2012

Where is the evidence to support the national dietary guidelines that obese people should base their meals around starchy foods? Anyone know?

I do not believe that the advice for obese people differs from that for others. What is regarded as a balanced diet contains carbohydrates as the main component. The reference to starchy foods is a little misleading because starch is rapidly metabolised to produce glucose. The recommendation for starch foods is qualified by a recommendation for wholegrain foods, if possible. These are metabolised more slowly, so can help avoid produce a short-term peak in blood glucose. Thus it is better to eat porridge made from coarse oats rather than cornflakes made of refined cereal, and the extra benefit is that you are less likely to feel hungry an hour later.

Obese people are at greater risk of Type II diabetes and can reduce the risk by steering clear of added sugars and refined carbohydrates wherever possible.

Diets that restrict carbohydrates (e.g. the Atkins diet) are potentially harmful.

nutrihealth says:
16 March 2012

I think there’s a tendency to forget how non-starchy vegetables are also fantastic sources of carbohydrates. Take spinach, for example, if you look at the macronutrient breakdown (see nutrition data sheet here: http://bit.ly/yKaFPp) you’ll see how not only do they provide an excellent amount of carbohydrates, but also they’re loaded with other vitamins and minerals. Compare that with brown rice, a typical healthy wholegrain, which is 86% carbohydrate. 100g of brown rice would contribute with 370 (kilo)calories to your daily diet. You may think that’s OK, but most of those calories (318 out of the 370) come from carbohydrate… That’s a lot of carbohydrate, even if it takes longer to break down into sugar (see full nutrition data sheet here: http://bit.ly/y1Qvoo).

What I’m trying to get across is the fact that the government should be paying much more attention to increasing the recommendations for green vegetables as sources of “healthy carbohydrates”, as opposed getting everyone on the wholegrain bandwagon. Switching from refined to wholegrain is a fantastic step, but for someone who is already obese it won’t make much difference as they’re a source of starch at the end of the day, which is highly glycaemic, i.e. it will most likely end up being metabolised to triglycerides and deposited as “fat around the middle”…

So having a generous side of greens with your fish, meat or eggs will be a much better option in the long run than a side of whole grains, particularly if you’re tackling severe weight and blood sugar control issues…

I agree about the benefits of eating green vegetables. The current recommendation that we should eat at least five portions of fruit and vegetables is not as successful as it should be. I have seen adults and children drink enormous amounts of fruit juice, encouraged by the fact that it is fruit. They are taking in a lot of sugar, and it does not make any difference that it is natural sugar.

Any food that is surplus to the body’s requirements can be metabolised to produce fats, though I don’t think anyone is likely to eat enough green veg for that to be a problem.

It would be good for parents to encourage their children to eat green veg. My father’s home-grown cabbages sometimes contained caterpillars, so I have not eaten cabbage since I was a child. I eat all other green vegetables – and red cabbage.

Pam says:
16 March 2012

On a completely different tack, why is it the responsibility of the government to fight obesity. The problem does not lie in food labelling it lies in greed and laziness. As long as people are too lazy to cook for themselves and depend on junk food and takeways then there will be obesity. I am not sure what the answer is, education maybe, although that doesn’t seem to be working. Short of closing all takeaways and banning all ‘junk’ food there doesn’t seem to be much you can do. If these people wanted to lose weight they would, but most of them are too laz to even make the effort.

Sheila says:
16 March 2012

Surely one of the government’s roles is to legislate to prevent the food industry providing so much food which provides little or nutrition, does enormous harm, promoted by information and labelling which is misleading, all for the benefit of profit, whilst never once considering that that they are at the root of this massive rise in adult and childhood illness. Perhaps a large %age of their profits (and advertising budgets) should should be diverted to the NHS.

Sarah Crawford says:
10 April 2012

I believe it is the responsibility of the government as they are encouraging obesity by paying Disability Living Allowance – top grade to – to people with this condition and this only encourages them to eat and get fat not to get up off the couch and slim down!!

Doreen says:
10 June 2014

I agree, since when was obesity an illness or a disability?

KIM says:
16 March 2012

It’s really not about calories – the government, supermarkets, restaurants should be looking at quality of food and the nutritional impact that has. We are over fed and under nourished. End of.!!
Yes we all enjoy a cup of coffee from time to time but if people knew it has no nutritional value to our daily intake of food, would they drink as much?
People need to know what food does for our bodies – and if some food (if you can call it that) is not doing anything then why are we eating it??

For most people, drinking coffee is not a major problem and decaffeinated coffee is readily available. Most coffee drunk in the UK contains milk, and that certainly does have a nutritional value. We drink it because we enjoy it rather than for its nutritional value.

It would be good for us all to be better informed about nutrition, but much of the information available is very poor indeed. The information provided by the NHS is not perfect but I would rather people used that rather than read some of the nonsense on websites.

Kate says:
16 March 2012

People need to be taught that there is a link between what they consume and their health, I feel that they should also be made more accountable for and proactive about their health. The food manufacturers should also be made responsible for creating food that is full of chemicals, sugar and saturated fat – perhaps a tax on these things might make them think twice about loading it into the food that they are producing.

sue says:
17 March 2012

I think that calories should be added to menus along with saturated fat %.People have a right to know what they are eating. It might also be worth considering adding calories on alcohol menues too so that people realize the whole health issue. The government concentrate on units of alcohol but the calories are another major problem for gaining weight.
All that said, skinny people still have arteries that will clog and livers that will fail. just because it doesn’t show on the outside doesn’t mean you will get away with it 🙁
We all need to take responsibility for ourselves but the way the world is and the fast food that’s on offer is it any wonder why there’s an obesity problem, its about time the government showed us a bit more support !

nutritious says:
18 March 2012

I believe we have reached a point in time where “one-size-fits-all” weight loss programmes are simply not enough. We need to look at our individual need for nutrients, instead of just tampering with different ratios of the main food groups (carbohydrates, protein and fats). We need to go deeper than that. We’re at a crucial time where traditional dietetics need to be replaced by more systemic approaches that revolve around the individual and their individual needs.

Sam says:
19 March 2012

@wavechange. I understand that it is received wisdom, well for Dept Health at least, that obese people should base their diet around starch (wholegrain where possible) but it is somewhat counter-intuitive. Given that Dept Health advice is evidence-based then presumably it must be based on some science/evidence to support it. So where is it? Do you know?

I have no specialist knowledge but the recommendations will be based on scientific studies. There is a lot in the literature about diabetes and the influence of diet. Unfortunately, the general public does not have access to most scientific papers and reviews. The US and other governments make similar recommendations for a balanced diet, with carbohydrate as the main source of energy. I am not aware that dietary advice differs for obese people and others.

Dietary advice does change. As late as the 1980s, diabetics were advised to avoid carbohydrates and eat foods that are high in fat and protein. The risks associated with a diet high in saturated fats were known by then and many diabetics died an early death through heart disease rather than as a result of the complications of diabetes.

It would be useful to have the information you are looking for, in a form that can be understood by the public and backed up by good science. Unfortunately, there is a lot of questionable nutritional advice promoting rather eccentric diets or the sale of supplements.

Tatjana says:
19 March 2012

I agree with Sam. The compelling evidence is that starch is a major culprit when it comes to increasing your chances of gaining weight. But the Department of Health seems to be ignoring it?

Sam says:
19 March 2012

Perhaps we can inveigle the support of Which? to ask the nutrition people at the Department of Health what the evidence is to support their advice that obese people should base their meals around bread, potatoes, rice and pasta (wholegrain where possible). I am sure the Dept Health must have the evidence to hand.

We are fast heading for the obesity problems in the US and it is time for the government to invest more money in helping most of us to achieve and maintain a lower weight. If successful, that money could be recouped by lower costs in treating problems and diseases associated with overeating. It is particularly sad to see overweight and obese schoolchildren.

I liked the post by nutrihealth about the value of eating non-starchy vegetables. If children are encouraged to do this, then it may become a habit for life.

Sitting front of the TV and driving rather than walking or cycling are obvious contributors to our current problems.

Margaret Moss says:
19 March 2012

The British nutritionist, Dr. Yudkin, realised that sugars were the main problem for obesity and degenerative illness. Unfortunately this wise insight was derailed by American research. Keys chose to study seven countries that would give a straight line graph between fat consumption and heart disease death. Data was available from 22 countries, and he could as well have chosen countries that gave him the opposite result. This level of statistics would be unacceptable in a school project. However, the Americans seized upon this false research, and told everyone to cut down their fat consumption. The British meekly followed suit. The result is that, in order to give food taste, fat was replaced by sugar. Obesity and diabetes soared.

Sugars attach to protein, in a process called glycation. This produces harmful chemicals, including oxidised LDL, which is deposited in artery walls. The most avid dietary glycator is galactose in milk. So it is safer to eat hard cheese than to drink milk, as the sugar has been removed from the milk when making hard cheese. The next most avid glycator is fructose, fruit sugar, which is why it is better to eat vegetables than fruit. Glucose is a less avid glycator. Sucrose, or table sugar, is half glucose and half fructose. So it comes between fructose and glucose. Starch gradually breaks down to glucose, and so it is safer than table sugar or fruit juice. Fructose is also used by cancers to make DNA for new cells for tumour growth and spread. If we want a healthy population, we could start by labelling trans fats, galactose and fructose, rather than calories and total fat.

Read a book long ago by the professor of nutrition Yudkin
where he alluded also to the benefits of consuming honey
if I correctly recall.

Just a few thoughts on your comments, Margaret.

It is already a requirement in the UK to state the trans-fat content of foods. As far as I know, these are only a problem if there is a significant intake. Food manufacturers are doing fairly well at reducing or eliminating these fats.

Galactose is present in milk and some other dairy products as lactose (milk sugar). Perhaps we consume too much milk but it is worth noting that there is more lactose in breast milk than what we buy in the supermarket.

We have glucose in the bloodstream and this is an essential source of energy for the brain. In healthy individuals the glucose concentration is maintained constant, with surplus used to create glycogen in the liver and fat in tissues. It is best to avoid eating a lot of sugar and starch (which is rapidly degraded to produce glucose) because these temporarily increase the blood glucose concentration.

Fructose or sucrose is not necessary to produce tumours. Avoiding them completely will mean that glucose and other materials will allow cancers to grow.

Fruit and potatoes are important sources of vitamin C, though that does not mean we should be drinking large amounts of fruit juice or potatoes.

I was intrigued by your comment within your last post……………….
“Fructose is also used by cancers to make DNA for new cells for tumor growth and spread”.

I am curious as to where you received this information, as this was denied by many in the WHICH NT debate.
Many thanks.

Which? is calling for the government to demand that all food companies use traffic light nutrition labelling.

Bread and other bakery products are not usually labelled, nor are items purchased from the deli counter of supermarkets are not labelled. I should be possible to print this information on price labels.

Sam says:
19 March 2012

My great-grandmother tells me that in the days before dieticians and nutritionists if you wanted to lose weight the advice was to ‘cut out bread and potatoes’. So I now have a bee in my bonnet and seriously want to see Dept of Health evidence that obese people should base their meals around starchy foods (wholegrain or not). And presumbably if it turns out that advice to obese people, if not normal weight, is best to avoid starch – then each loaf of bread might need two traffic lights: green if you are normal weight and red if you are obese (or even a skull and crossbones?).

Eating less is good advice for anyone who wants to lose weight, but whether your great-grandmothers advice was wise depends on what else is in the diet. Potatoes used to be an important source of vitamin C for those who ate little fruit. Wholemeal bread helps to prevent diverticulitis and other bowel problems in later life. Of course there are non-starch vegetables that can make a valuable contribution to diet, as nutrihealth has pointed out.

Lex says:
23 March 2012

I think people’s lifestyle is a great factor in today’s health advice. With all due respect to your great-grandmother Sam (who I’m sure may have been right at the time) may have lived in a generation where people were far more active and had less access to high fat and high sugar foods which are now readily available and often cheaper to buy than ‘healthier foods’. If bread and potatoes were eaten in large quantities or even as a luxury item on top of their main ‘meat and two veg’ meals they would have course lost weight when they cut them out due to the extra calories being taken out of their diet.

Plus, as I mentioned in my reply on the NT discussion, it is often the things you put onto bread and potatoes like butter and cheese that contributes greatly to weight gain due to the high calorie content.

I do not want to disregard your great-grandmothers advice in any way, but simply point out that food choice, availability and physical activity levels may have been very different when she was young and so the advice may not now apply.

nutritihealth says:
20 March 2012

@wavechange potatoes, more than an important source of vitamin C, were cheap and available and “filled you up”, so you had to spend less money on other more expensive foods… pretty much the same applied to bread… if one cuts the starch down, weight just comes off… plenty of evidence out there for this approach, nothing new…

I am old enough to remember this, at least until the early 70s.

I believe that the obesity problem is more to do with portion sizes and eating between meals. Eating out is much more common than it used to be and often involves large portions. Even if we eat modest portions at home, it is very easy to snack between meals and the chances are that we will not just grab a carrot or an apple.

celcat says:
23 March 2012

It is cheaper to eat ‘unhealthily’ than it is healthy. Compare the cost of a loaf of own supermarket white loaf to that of a seeded/nutted/healthier brown; price of white basic rice to brown, basic pasta to wholemeal and just how cheap are pizzas?! The same is for eating ‘out’ – fast food is cheap.
Also, as has been said, bread and potatoes WERE once upon a time healthy. If you look at our ancestors who only ate what was available to them there was no obesity…. cutting carbohydrates down is what many need to do but those on low incomes can’t as it’s what fills them up. The government also need to look at the pricing of healthy foods and I don’t mean the so called low fat (higher in sugar) choices.

Home-made soup can be cheaper than what comes from the supermarket and if you make it yourself it does not have to have as much salt as commercial products.

Our predecessors probably had a much more active lifestyle.

There are many that would dispute that eating unhealthily is cheaper than eating healthily…………………..

so I think that cost is a pretty lame excuse against eating a healthy diet, rather than an unhealthy alternative.
Education and awareness is probably the way forward against obesity, along with limiting the influence of the major food companies that manufacture many unhealthy foods.

Lex says:
23 March 2012

I should have read to the bottom of this conversation before replying to Sam’s comment further up as I’ve just realised that I have simply repeated what some of you have already said! Apologies for that!

This is a very interesting topic in general and I’ll look forward to seeing more comments with people’s thoughts and opinions.