Turning the Tide Recommendations
The 30 recommendations cover the whole environment in which we live and deliver a positive vision for the future, building on existing policy progress and identifying new routes for action, outlining next steps for government and other stakeholders.
Keep policies already in place or that are on the way to being implemented that support a healthy weight environment.
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1. We fully endorse plans to introduce a 9pm watershed on TV and a ban of paid-for advertising online for unhealthy food and drink, plus new restrictions on promotions on unhealthy food and drinks in retail outlets and online. These must be implemented in full and without delay.
We back plans to introduce calorie labelling in large outlets along with a comprehensive evaluation to understand the impact on different groups.
We encourage the UK Government to push ahead with plans announced in the 2019 Prevention Green Paper:
- Reinstatement of the National Infant Feeding Survey.
- New restrictions on sales of energy drinks to children under 16.
We fully support a continued focus on addressing the drivers of obesity across the life course, ensuring stronger arrangements to secure cross-government co-operation, action and accountability in healthy weight policy.
Intensify existing policies or approaches to increase impact.
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2. Ensure government communications and campaigns do not perpetuate weight stigma and policies and strategies relating to healthy weight actively refute stigma.
Responsibility: All government departments
3. Ensure nutrient information is displayed clearly on all food and drink products at point of sale, including online, to include:
- Mandatory front-of-pack nutrient labelling.
- Addition of free sugar content on front-of-pack labels and quantity of sweeteners on back-of-pack labels.
- Calorie information on all alcoholic product labels.
4. Make a specific, time-bound commitment to introduce regulation to mandate calorie limits on single-serve portions of HFSS products if 25% of the calorie reduction targets have not been achieved by the first report point (2022) in the ongoing calorie reduction programme.
5. Update food and buying standards to reflect dietary guidance and ensure they are robustly applied and monitored in multiple settings with monitoring and enforcement assigned to relevant statutory bodies or the FSA.
6. Mandate Ofsted to evaluate primary and secondary schools on their delivery and implementation of a whole school approach to building in opportunities for structured and unstructured physical activity across the day.
7. Introduce next-stage regulation to ensure all advertising and promotion in external settings is for healthier products by: extending the 9pm watershed on unhealthy food and drinks adverts to cinema and radio; removing outdoor advertising for unhealthy food and drinks and ending marketing and promotions related to unhealthy food and drinks in family attractions, childcare and educational establishments.
8. Extend all existing and new advertising restrictions to adverts for food and drink brands that are associated with predominantly unhealthy products.
Responsibility: DHSC, DCMS
9. Incentivise a shift to promotions and deals on healthier food and drinks in the out-ofhome sector (including online delivery platforms) by extending restrictions on multibuy promotions of unhealthy food and drink products.
10. Improve the nutritional content of infant food by strengthening the existing reformulation programme to fully align with WHO Europe recommendations for sugar and salt and commit to the introduction of a regulatory lever (such as fines or sanctions) if sufficient progress is not made by 2024.
11. Strengthen the policymaking process across the design, implementation and evaluation of policies on obesity and healthy weight, ensuring detailed policy plans are published along with economic, health, equity and environmental impact assessments.
Responsibility: All government departments
12. Identify opportunities to share the UK’s experience of successful and unsuccessful approaches to healthy weight policy internationally and work collaboratively with other countries to bring in aligned policies that incentivise global change across the food system.
Responsibility: DHSC, FCDO, DEFRA
13. Deliver a sustainable strategy for the NHS and local authorities to guarantee consistent and equitable access to all levels of effective weight management services, including
- Centrally mandating the provision of all levels of effective weight management services in every local health system, ensuring embedded psychological support plus a range of virtual and traditional services.
- Reviewing and updating NICE and NHS England guidance to improve the effectiveness of service delivery by simplifying commissioning and introducing more flexible patient pathways.
Responsibility: DHSC, NHSE, NICE, local authorities, local health systems
14. Use data to ensure that services are tailored to the needs of the population, including an analysis of the planned National Obesity Audit data to inform future service planning; quantitative evaluation of local service provision to identify areas for improvement in uptake, impact and development of validated patient reported outcome measures.
Responsibility: NHSE, local health systems
15. A well-resourced system is needed to provide the services and create the environments needed to facilitate healthy weight. These recommendations relate to funding.
Invest at least £1 billion more a year in the Public Health Grant, with future yearly increases aligned to the NHS budget increases. This will ensure local authorities are well placed to deliver the recommendations outlined in this strategy outlined below.
- Increase the mandated universal face-to-face contacts with a health visitor to eight, with enhanced tailored follow-up where needed to improve outcomes.
Responsibility: DHSC/local authorities
- Ensure universal breastfeeding support programmes are accessible to all families.
- Provide children’s centres or family hubs in areas of high deprivation.
- Provide and maintain local environments that promote physical activity.
Responsibility: Local authorities
Maintain at least £350m/year investment into PE, school sport and physical activity across all state schools and link to national targets for children’s physical activity to
Deliver greater sustainability in funding across the range of weight management services, both in central government funding and in local health system budgets. This should include a minimum term for all weight management funding.
Responsibility: Local health systems
16. A range of professionals have a stake in improving health and training; it is vital to ensure they have the right knowledge and skills.
Health and care professionals should receive comprehensive training in discussing weight and disordered eating with confidence, in a sensitive and non-stigmatising way.
All education and training curricula for all health and care professionals should include the complexities of obesity and the implications of weight stigma.
- Health and care providers should encourage all clinical staff to complete appropriate training on stigma and how to discuss weight and health appropriately.
Training for professionals working with expectant parents and families must include the skills needed to discuss infant and child healthy growth and healthy eating with compassion and sensitivity.
Training for early years practitioners should include skills to enable them to incorporate physically active play in their settings and confidently reach out and support play between parents and children in and around the home.
Training for planners and other built environment specialists should include modules on healthy place-making, providing an understanding of the role of the built environment as part of the wider determinants of health.
New proposals are recommended for evidence informed actions
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17. Ensure that healthcare environments are size-inclusive where feasible, with provision of suitable equipment for people with obesity.
Responsibility: NHS Trusts & other health providers
18. Provide greater clarity on the legal responsibility of employers to not discriminate against employees based on their weight. This should include consideration of policies that would specifically prohibit obesity discrimination in the workplace.
19. Introduce a fiscal lever on food and drink manufacturers to incentivise further reformulation of processed food, such as the sugar and salt reformulation tax proposed in the National Food Strategy.
Responsibility: HMT, DEFRA, DHSC
20. Set out a process to ensure that the UK Government, in its trade negotiations and agriculture policy development, protects the right to health and the right to adequate nutritious food and related rights for all, to include:
- participation of public health experts and relevant civil society organisations;
- the publication of mandatory health impact assessments;
- time for meaningful Parliamentary scrutiny and debate;
- the adoption and implementation of mechanisms intended to protect public interests from undue commercial interference.
Responsibility: DIT, DHSC
21. Introduce new regulations to limit the use of promotional techniques on unhealthy food and drink product packaging, including: restrictions on the use of cartoon, brand equity and licensed characters along with celebrities and sports stars; ending the use of on-pack promotional offers including giveaways and competition prizes and restrictions on nutritional and health claims.
22. Introduce a legal duty for large food businesses to provide annual data on their sales of HFSS products, to be collated and published by the Food Standards Agency.
Responsibility: DHSC, FSA
23. Update national planning and licensing policies to explicitly state that a primary purpose of the planning system is to create places in which people of all ages, abilities and financial means can live safe, active healthy lives, including objectives to reduce health inequalities and address public health priorities such as healthy weight.
Responsibility: MHCLG, DHSC
24. Ensure only healthier food and drink products can be associated with sports, with new restrictions on any kind of sports sponsorship of unhealthy products and brands.
Responsibility: DHSC, DCMS
25. Ensure that all infants and young children at risk of, or with overweight and obesity are identified and supported. This requires height and weight measurements to be taken at 2-2.5-year check with data nationally collated, and the development of a model pathway with guidance to identify infants and key principles for future management with targeted pathways for the highest risk communities (such as looked after children and those with special education needs).
26. Prevent the misleading marketing of food and drinks aimed at infants and young children with new regulations to ensure honest labelling that aligns with public health advice. Introduce further regulation – including extending the ban on advertising infant formula milk to follow-on formula – so marketing cannot be used to undermine breastfeeding or mislead parents.
27. Undertake initiatives across the entire healthcare system to increase the uptake of weight management services, particularly amongst socioeconomic groups that are most under-represented in these services.
Responsibility: DHSC, OHID, local health systems
28. Develop, collaboratively across the four UK governments, fair and ethical principles fair and ethical principles for interacting with the food industry, underpinned by the latest evidence on the commercial determinants of health.
Develop policies based on the results of new, promising areas for research and investment, identified throughout this strategy.
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29. The following areas require further policy development with a view to bringing in new policies in the next ten years.
- Policies that address disproportionate pricing structures on unhealthy products.
- Policies that facilitate purchase of healthier options on food delivery aggregator platforms.
- Policies that reduce the accessibility of unhealthy food and drink, particularly to older children, including licensing retailers or curbing the hours when products can be sold.
- Regular reviews to update the nutrient profiling model to reflect the latest dietary guidance.
- Assess the potential and utility of fiscal stimulus mechanisms to support food businesses to shift towards the production, manufacture, and sale of healthier food and drink products. Regular reviews to update the nutrient profiling model to reflect the latest dietary guidance.
Responsibility: DHSC, HMT, BEIS
30. Increased investment into obesity related research is required. SCHOPR should review the key evidence gaps in research and policy evaluation, review research investment in the area, and identify areas and mechanisms (including role of funders) for improving the evidence base for policy through increased research investment and the evaluation of policies as they are implemented.
In reviewing relevant literature to inform the strategy, a number of research gaps were identified. This is not an exhaustive list, but instead provides examples of topics where new or further research is needed to inform future policies and interventions.
- The relative effect of different elements of product packaging – such as use of colour, pictures, warnings and branding – on purchase and consumption.
- Further research into effective approaches to support physical activity in the workplace.
- Digital marketing innovation – emerging food marketing techniques.
- The impact of price reduction strategies on purchasing of unhealthy products.
- How to reduce obesity stigma in all settings.
- Effectiveness and take-up of weight management support and interventions for families.
- Impact of regular monitoring of weight in healthcare settings on motivation of patients and healthcare professionals.
- An assessment of the latest developments in treatment options and their role in weight management services.
- Effective approaches to maintain weight loss.
- Effectiveness of new commercial self-management services.
- To ensure conclusions from research offer the best opportunity to support progress in as broader range of the population as possible, while also guarding against unintended negative consequences, all future research (whether focused on treatment or prevention) should include the mental as well as physical health aspects of obesity and disordered eating.
Responsibility: SCHOPR with OSCHR and funders to review research landscape