22
Examination of witnesses
Katharine Jenner, Anna Taylor and Fran Bernhardt.
Q1 The Chair: Good morning, everyone, and welcome to this public meeting of the House of Lords Committee on Food, Diet and Obesity. Today we are holding our first public evidence session of the committee’s inquiry. We are exploring the role of foods such as ultra-processed foods and foods high in fat, salt and sugar in a healthy diet and tackling obesity. The committee will take oral evidence over the next few weeks and months, and will also publish a call for written evidence later this month, which will also be on our website and sent out to the many stakeholders in this field.
Today we begin with three experts in the field to give us an overview of the issues relating to the topic that we have been asked to look at. We are joined by Katharine Jenner, who is director of Obesity Health Alliance; Anna Taylor, who is executive director of the Food Foundation; and Fran Bernhardt, commercial determinants of health co-ordinator at Sustain. I thank you all for taking the time to come and give us your evidence this morning. I shall ask you to give a very brief introduction before you answer the first question in turn.
Today’s meeting is being broadcast, and a verbatim transcript will be taken. It will be sent to you so that you can make any small changes of fact or detail that might be incorrect, for accuracy, before it is published. I refer to the list of Members’ interests published on the committee’s website. Members will have set out any interests that are relevant to this particular inquiry, and committee members will refer to them the first time that they speak. My own interests are as follows: I am a member of the All-Party Parliamentary Health Group, the All-Party Parliamentary Group for Children, the All-Party Parliamentary Group on Obesity and another one on food. I have no financial interests to declare.
As I said, I will ask our witnesses to introduce themselves briefly before answering the first question. I also remind our committee members to declare their interests the first time they speak. The first question is: what are the key barriers to eating a healthy diet?
Katharine Jenner: Good morning. I am the director of the Obesity Health Alliance. I am a registered nutritionist in public health and have been working in the field for 15 or so years. I set up a group called Action on Sugar, having led Action on Salt, and was the chief executive of Blood Pressure UK. I have no financial interests. The Obesity Health Alliance is an alliance of over 50 organisations working towards equitable population-based approaches to reducing obesity.[1]
What are the key barriers? First, the general English public have a fairly good understanding of what a healthy diet looks like. You would have had to have been living in a cave not to know that you need to have five a day, you need to have fibre and you need to have good-quality fruit, vegetables and other food, but unfortunately that is not really translating into practice and most people do not have a healthy diet at all.
You have to think of yourself as living in a “Sliding Doors” situation. From the moment you wake up, if you are a privileged person with a good income, you are offered completely different choices and options from those who are not well off. From the moment you wake up and listen to music, listening to an ad-free radio station is different from being served with lots of adverts for what breakfast you can have. Maybe you use your coffee machine as opposed to going to the coffee shop. You drive to the station as opposed to getting the bus, when you have to see lots of adverts and takeaways as you walk down the street. As you go through the day, you can see these two different situations playing out between those who are well off and get to eat well, and those who do not get to eat so well or eat what is left over.
That happens every single day for every single meal and every single opportunity. I have presented them as if they are choices but of course they are not; they are the result of what is offered to us—the choice architecture, if you like. A lot of people think obesity is a choice. It is not. It is not a lifestyle choice or something you would choose to happen; it is a result of the structural system around us, a very broken two-tiered system that serves some people better than others. I am sure other members of the panel have views on this too.
The Chair: Thank you very much. I should have said this in my introduction: where you can refer us to research, either research that you have done yourselves or research that you are aware of—in other words, evidence to back up what you are telling us—we would be grateful to be referred to that.
Katharine Jenner: I am happy to share information, particularly about the takeaway density in lower-income areas and how those on poorer incomes are served more unhealthy advertising. For example, if you bought your newspaper this morning you probably saw an advert for a healthy veg box or something, whereas I picked up the free Metro which, as you can see, contains a full-page advert for McDonald’s. There is some great evidence on that coming out of Liverpool University. We would be happy to send that on.
The Chair: Yes, please share that with us.
Anna Taylor: I am executive director of the Food Foundation, a charity trying to ensure that the food system enables everyone to eat healthily and sustainably, regardless of their background. We have a strict policy about not taking any funding from the food industry, to be clear on the conflict-of-interest point.[2]
On the key barriers to eating a healthy diet, I am going to build on what Kat has highlighted. The key point here is that it is an environmental problem. The environments in which we are making decisions about what to buy to eat are the biggest barrier to eating well.
You can look at those environments through three big lenses. First, what is actually available in the environment in which you are making the choice? Is there a healthy option there or not? Secondly, you can look at it in terms of price: how does that price relate to the money in my pocket, and how do those prices compare to each other for healthy versus unhealthier foods? Thirdly, there is what we call appeal or marketing: how attractive are these options in relation to one another? That might be in terms of taste but also down to what we have seen on telly, whether they have a cartoon on the packet, whether they are being promoted by a sports star or whatever.
Those are the factors that either hinder or enable us to eat in particular ways. There is growing evidence—I will refer you to our Broken Plate report, where we summarise a lot of it—that when you look at marketing, price and availability, you see that the odds are stacked against us, because for all those factors you see evidence in favour of unhealthier choices.
I want to draw an analogy with water. Food and water are, of course, essential to human life. We can imagine a situation where we discover that the water being piped into our homes has something in it that causes long-term health problems. In some parts of the country it is possible to pay to get good water into your home, but only a few people can afford to do that or have it in their area. Everyone else has to go to the middle of the town or village to get to a free pump of some sort and get water that will protect their long-term health. We have a very similar situation when it comes to food.
At the moment, the nanny state protagonists will basically argue, “It’s your responsibility. The water’s there. Take responsibility, look after your children properly and do the right thing”. We are saying that to people about food, but I would argue that when the nanny state protagonists make that argument it scapegoats parents, because we set parents up to fail in the endeavour of looking after their children.
For example, I might think, “Right, I’m going to give my kids paid-for school dinners because I know that’s more nutritious than a packed lunch”, but then I discover that 60% of school lunches are made up of ultra-processed foods, so I think, “That’s not such a great thing”. I go for the sugar-free drinks, then I find out that sweeteners might have harms attached to them in some way. I might look at baby foods and go, “Oh, right, this is sugar-free and this one’s organic, so that must be okay”, and then I discover that it is full of fruit juice. In parallel to that situation, companies are, frankly, spewing marketing into my children’s phones and devices at home, so they are building up this huge level of brand awareness from a very young age about what they want to be eating, and it becomes impossible to go shopping with them.
We are setting parents up to fail. The nanny state protagonists say that this is parents’ responsibility—“You go out there. It’s possible to eat a healthy diet, so take some responsibility and do it”—but we are setting our parents up to fail. That is very evident when we look at the dietary and health data, which we will no doubt come to look at in due course.
Fran Bernhardt: I am the commercial determinants co-ordinator for Sustain, the alliance for better food and farming. I specialise in supporting Governments to bring in advertising policies. Like my colleagues’ organisations, Sustain takes no funding from food companies or the food industry more generally.[3] Again, I will build on the comments that my colleagues have made.
We are flooded with unhealthy food and unhealthy messaging. This makes it incredibly difficult for all of us to eat healthy food, but there are particular inequalities. We know that the odds are stacked against people from low-income communities and backgrounds, and that they are, for example, much more exposed to unhealthy food advertising. They will see much more advertising on their journey to school and work. Some really interesting evidence found that, in some cases, this was because there was more unhealthy food advertising within those places, so we know that those low-income areas were particularly targeted. There was also a particular targeting of transport routes that low-income communities are more likely to live near. We see this throughout the system. There is lots of evidence to show that there is this disparity and that the odds are stacked against low-income people trying to access healthier food.
The Chair: Thank you very much indeed. It is very complex, is it not? We are hoping to get to grips with it.
Q2 Baroness Pitkeathley: I have no interests to declare. Thank you very much for coming. What are the most common diet-related health issues, and can you give us some idea of the extent to which they occur and their frequency? Perhaps you would like to start this time, Anna; I am sure that all your colleagues will want to contribute.
Anna Taylor: The main point to start with is that poor diets are now the biggest contributor to preventable ill health in the UK. There are pathways through which that occurs. Of the diseases that can manifest as a result of poor diets, there are the probably more obvious ones such as type 2 diabetes, which is linked to an unhealthy weight. Diet also contributes to a whole sphere of cardiovascular and coronary heart disease outcomes, to musculoskeletal problems, which debilitate people in later life, often for very long periods, to blood pressure and a whole raft of metabolic conditions, essentially, and to a growing number of cancers, with the links between diet and cancer increasingly being highlighted.
It is not just a problem of adults accruing these problems through their lives, which is happening on a very large scale. It is now affecting our children. Here is one stat that tells its own story: we used to call type 2 diabetes “late-onset diabetes”; it was never seen in children before the year 2000, when the first eight cases of paediatric type 2 diabetes were recorded. We now have about 900 cases. Some of those children have already become adults, of course, so the total number affected has been much greater. That tells you a story about how these problems attributable to diet have been accruing over time.
The other problem children face is tooth decay. A quarter of children now have tooth decay, and it is the number one reason for children going into hospital. This is in addition to unhealthy weight and obesity, which not only affect children’s long-term health and well-being but have a whole set of social impacts. It is often a stigmatising experience for people. It might affect their willingness to participate in sports, and a whole stack of things can affect their mental health, knocking on to educational attainment, relationships and how they develop as humans in the world. A whole accrual of diet-related disease is happening.
The other point to make is that the deterioration in our health over time has been speeding up. We are now really starting to see it. More alarm bells are being rung about what is happening to children. In particular, on Monday, the Academy of Medical Sciences produced a report specifically on children’s health.
Fran Bernhardt: We have seen this huge rise in obesity and food-related ill health over the past few decades. Despite a number of initiatives that the Government have spoken about, including their aim to halve obesity by 2030, we have not seen the progress that we need and we continue to see a rise in all those figures. In fact, the Local Government Association came out with some really startling evidence that analysed the data from the national child measurement programme, which looks at the weight of young people, and found that all local authorities will miss that deadline if we carry on along the current trajectory. We need to do something about it; we are not currently addressing it.
Katharine Jenner: When we think about nutrition and diet-related illnesses, people naturally jump to undernutrition, malnutrition, infectious diseases and nutritional deficiencies. Malnutrition has two sides to it: undernutrition and overnutrition. They are two sides of the same coin. Overnutrition is having the wrong sorts of nutrients, which are not beneficial for growth and really good development.
Anna talked about some of the conditions, but I want to talk about how broadly this affects people. This is obviously a global issue. If we think about obesity in particular, rates have tripled globally since 1975. In the UK, about two-thirds of adults now live with overweight or obesity, and two children in a class of five live with overweight. These are really huge numbers. Of course, you are twice as likely to have obesity if you are in an area of deprivation.
Those children are five times more likely to suffer obesity-related ill health as they grow older than a wealthier, healthy-weight child. Anna mentioned the consequences. There is cardiovascular disease. Type 2 diabetes has doubled in the last 15 years. There are 13 different types of cancers; obesity is the second-biggest preventable cause of cancer. There are respiratory disorders, gastrointestinal disorders, and liver disease. These are all quite costly issues, and they have a huge cost to the individual’s mental health; the stigma has already been alluded to. These are tough conditions to be in, for a child and for an adult. The biggest word—which we said quite quietly—is that they are preventable. We could have done something about this.
As well as consequences on our physical and mental health, this also has huge consequences for our society. I know it is not good to talk about money, but these are expensive conditions. There was a report out from the Tony Blair Institute and Frontier Economics saying that obesity is now costing nearly £100 billion a year to the NHS and wider society. The OECD said it was costing another £500 per person on tax. Importantly, it is keeping people out of work: 37 million sick days are taken due to weight-related ill health, costing another £4 billion in welfare. I know that these are big figures; we can send you all the reports and background information from the institutes that have done research, likewise from the major charities in our alliance, such as Cancer Research UK, Diabetes UK and the British Heart Foundation.
What is really interesting is that we already have a shrinking workforce: we have apparently lost another 1% in the past year. That is going in the wrong direction, and it is ringing serious alarm bells, because it will have a huge and worrying effect on the economy. I understand that Jeremy Hunt told the Cabinet last week that there would not be any tax cuts due to the low productivity caused by ill health. So the consequences are individual but they are felt by society.
Baroness Pitkeathley: Is it inevitable that an obese parent will have an obese child?
Katharine Jenner: There is a correlation but that is not necessarily true. There are definitely genetic identifiers for increased weight, but one way of describing it is while the genetics loads the gun, it is the environment that pulls the trigger. It is not inevitable but at the moment it is more likely.
The Chair: Is it possible to be overweight and undernourished?
Katharine Jenner: Absolutely.
The Chair: Are there any figures for children who are overweight in childhood but grow up not to be overweight?
Katharine Jenner: You can grow up not to be overweight, but you have to get in very early with interventions. The childhood intervention programmes are not brilliant at the moment but I think they are working on them. So it is possible but, again, not inevitable.
We saw this a little during Covid. There is a national child measurement programme, and during Covid it looked as if the rates of obesity came down slightly—sorry, they went up during that year and then came back down again. We are not sure how much of an anomaly that was. Maybe it was due to policy changes, with children getting back into school so they had meals and not so many snacks, and got more exercise. That may have changed the trajectory, which gives us hope that it is changeable.
Q3 Baroness Ritchie of Downpatrick: You are all welcome. I declare my interest as a member of the board of Co-operation Ireland, which is all-encompassing and deals with lots of different issues. I shall start with Fran. What are ultra-processed foods? How widespread are they in diets in England? If you could give us some of the evidential base, that would be very useful. How useful is “ultra-processed foods” as a definition?
Fran Bernhardt: Ultra-processed foods are complementary to high fat, salt and sugar products in the system that we use. My colleagues will speak to this more than I will, but currently we know there is a lot of overlap between the high fat, salt and sugar products and ultra-processed foods. We have growing evidence—as you may have seen, lots of scientific evidence is coming out at the moment, but it is something that needs to be considered. We need to make sure that we look at robust evidence to build into future models and policies.
Katharine Jenner: I will give you a demonstration. I apologise on behalf of the nutrition profession that there are so many acronyms in nutrition, but ultra-processed foods are known as UPF.
I shall start with my daughter’s favourite, a Pink Lady apple. There is not much you can do with it; you can eat it and enjoy it or make a little pie if you like. That would be classed as an unprocessed, original, pure ingredient. The next level up might be apple cider vinegar: something that you can use as an ingredient but does not contain any other nasties and is made from a simple process.
The next level up is called NOVA classification 3. We can send you evidence on that, but think of it as normal processed food. It might be those apple slices that you can buy in Holland & Barrett; they have been dried and have not had much added to them apart from maybe a bit of sugar. That is a process.
Ultra-processed takes things to the next level. I took a little trip to my local convenience store this morning on the way to the station and have brought in what I found. The first example from the shelf is these apple pie cookies—a long-lasting and energy-dense product. They say they are 25% apple but, when you read closely, you see it is 25% apple filling that contains only 5% actual apple, while the other ingredients are things such as modified corn starch and stabilisers.
The next example is a nice apple sauce—again, just like mum used to make at home, except I do not think your mother made it with potassium sorbate, glucose-fructose syrup and modified corn starch. There is 25% sugar in that product too, although at least it contains some apples.
Next is a ‘great’ kids’ product: some fruit twists that you might put in your kid’s lunchbox. They are very much approved for kids; you can see all the child friendliness on the packaging. They contain some apple juice from concentrate—48%—but there is 40% sugar in there and they are made in a way that you could not do at home.
Then there are these apple-flavoured sweets. They are actually made with 3% apple juice, so are pretty much on a par with the cookies in terms of how much actual apple they contain. I do not think anyone would think they were a particularly healthy choice, but let us say they are using apple branding. My final example, one of my favourites, is infant food—a pouch containing puree that looks like a healthy choice for children. It looks as if it is full of strawberries but actually it is 80% pureed apple.
I am trying to show you that these are products that you could not make at home in the same way because you do not have the ingredients or the technology, or you do not have the packaging or the design skills. You cannot mass-market them and sell and advertise them to a million people in the supermarket. So you could make equivalents of these products at home but they would not be ultra-processed. That was to give you a bit of a flavour of what UPF is, but that is the last time I will talk about products containing ultra-processed food because it is not really about the products; it is about the system that has created the environment where these are acceptable, saleable products that we think would be a good part of a diet.
Baroness Ritchie of Downpatrick: Could you give us some percentages to show how prevalent it is?
Katharine Jenner: Adults and children in the UK have about 60% ultra-processed foods in their diets. It will be completely different depending on your circumstances—ethnicity, age and where you live—but the figure is about 60%, and possibly higher for children because of products such as the ones I have brought in. That has changed dramatically over the years but is the same over the population.
These products are not all equal in terms of health impacts. Some of them may have some nutritional benefits too, and there is good research showing gradients between different types of food. There were some meta-analyses that we can send you showing that they are not all equal, but they are all part of this broken food system that wants to promote and sell you value-added ingredients and products, and package them up as if they are food when they are barely food in some cases.
Anna Taylor: To build on that, I will look at some of the statistics. It is important to note that our dietary pattern—eating foods that include products like Kat’s, and relying on those products—is very widespread across the UK. This is not a minority situation; it is the majority. As Kat said, it is estimated that between 50% and 60% of our calories across the population come from ultra-processed foods. The figure for high fat, sugar and salt foods is somewhere between 40% and 50%, so it is not wildly different.
If you delve into different sections of the population, you do not see huge amounts of difference. No subgroup, whether older or younger, richer or poorer or living in the north or living in the south, has less than 50% of their calories from ultra-processed food, from the dietary data that we have. The exception is ethnicity which is associated with a slightly lower proportion, about 45%, but otherwise this is a majority experience. If you dive into the data and ask, “Who are the lowest consumers?”, academics who have looked at the spread of consumption and taken the lowest quarter who get about 35% of their calories from ultra-processed food, while the figure for the top quarter is about 75%. So this is a majority experience.
We see that played out if we look at the data through a nutrition lens, which is another way to look at the issue of how we describe our diets. An estimated 1% of the population actually eats the diet that aligns with the suite of government recommendations for what we should be eating. When it comes to sugar, 95% of children eat too much of it. When it comes to fruit and veg, 9% of children meet the recommendations. So this is not a problem that is isolated within a few pockets of the population who need to be helped to eat better; it is a population-wide problem. Even if you look at income disparities, on the ultra-processed food side there is only a difference of nine percentage points between the poorest and the richest in the dietary data that we have, which is not actually that dramatic. It is probably significant in health terms but it is still not huge.
The key point to take away is that this has become how we eat. It is normal for people in Britain to eat in ways that are very dependent on these foods. If we are serious about tackling that then we have to think about it as a population-wide challenge and therefore, as Kat said, about the system that is creating those environments.
I also have one small prop—if you do not mind, I will pass it around—to try to describe this challenge. We have done a lot of data analysis on different categories of food. This graph displays the yoghurt data. We looked at the five big supermarkets and all their single-pot yoghurts. We are interested in yoghurts because kids eat a lot of yoghurts and it is a staple food; it should be a really nice, nutritious food for children. Out of the 372 products on the market, 13 are unsweetened yoghurts—basic, natural yoghurts. The average price of an unsweetened yoghurt is 83p per pot. The flavoured and sweetened yoghurts are considerably cheaper at about 65p.
The four products in this image are from Asda at today’s prices. We have been looking at the trade-off between price and the healthiness of product. The cheapest product on the left side is 7p per pot. If you look at the ingredients, which are highlighted, quite a few of them are ultra-processed ingredients, which are the ones being highlighted in some of the reports on ultra-processed food.
Next, with lower sugar but three times the price is the Petit Filous, at 21p per pot. That has half the amount of sugar of the cheapest one, so it is definitely good in terms of health, but you are paying three times more.
The unsweetened yoghurt on the right-hand side is 60p per pot. That is almost 10 times more expensive than the very cheapest one, although you may eat two of those little ones compared with one of the biggest ones. There is a slight size issue there.
Then look at the Müller one: this is a relatively cheap yoghurt (cheaper than the average price), but it is extremely high in sugar. It has four times the amount of sugar than a natural yoghurt, but is cheaper than it.
If you are a parent and you are thinking, “What am I going to put in my kids’ lunch box?” and you have a budget of perhaps £50 per week for your family shop, these pennies really matter—and they really matter now we have seen food insecurity rise rapidly during the cost-of-living crisis. You have a tough set of choices. This is not working in your favour as a parent. This goes back to the point about the environments that are not enabling parents to do the right thing for their children. Hence, we have dietary patterns which are quite catastrophic across the country.
The Chair: Thank you. Three members would like to ask some supplementary questions. We will start with Baroness Browning.
Q4 Baroness Browning: I should declare that, between 1994 and 1997, I was the Food Minister at the Ministry of Agriculture, Fisheries and Food.
I am particularly interested in the apple example. It is quite obvious that there are quite minute quantities of apple in a lot of these ultra-processed foods. What is your view on the process itself? The process must take out quite a lot of essential vitamins, minerals and amino acids—all the things we look at when looking at nutritious foods. Has any work been done to look at how much is taken out of the raw ingredients compared with how much that is unhealthy, such as sugar and fat, being put in? Do we really know, when there is only, say, 10% of apple in an individual product, whether that apple really constitutes a real apple’s nutritional value?
Katharine Jenner: As you process food, nutrition gets degraded. A lot of food needs to be held in certain levels of water or heat before it becomes quite poorly degraded. The biggest and most telling thing that you have mentioned that gets taken out, or at least processed to such an extent that it has no benefit, is the fibre. These products all score very poorly in terms of nutrition because they are very low in fibre, which is contrary to what you might expect from an apple. That is one of the key things I would notice.
I do not know particularly whether what is taken out has been looked at, but work is certainly going on to try to understand the underlying mechanisms of ultra processing, where a food is concentrated down to, for example, 3% apple and extra flavour is added to enhance it, and what that does above and beyond its nutritive ingredients. I think we are all watching that with great interest. We can certainly send you where we are at with the evidence thus far if that helps.
The Chair: Thank you. Would either of the other two witnesses like to add anything? No? I will move on to Lord Krebs.
Q5 Lord Krebs: Thank you for coming to give us evidence this morning. I declare my interests. I chair the World Cancer Research Fund’s global panel on diet, lifestyle and cancer risk. I am a scientific adviser for Marks & Spencer and a fellow of the Academy of Medical Sciences. Anna referred to the report the academy produced earlier this week. I am also a fellow of the Royal Society, which hosted a meeting on obesity two years ago.
My question is about the contents of ultra-processed food. Two of you mentioned cornflour as one of the unhealthy ingredients. Could you explain why cornflour is not healthy and why it makes food more dangerous?
Katharine Jenner: We do not know yet whether it specifically makes it more dangerous, but it is not something you would necessarily use at home in the form of modified corn starch. It still contains the calories but with little nutritional benefit, so for me it is more about what it does not have. I know there is some work to look at this further, but it does not have any nutritional benefit and contains calories that you might consider to be “empty”, compared with just straight apples, which obviously, it is not.
Lord Krebs: So in that regard, it might be like rice or pasta.
Katharine Jenner: Again, it is broken down and seems to be held in some kind of emulsification, so it is presented in a different way from how you might make it at home. When rice is really ground down it might be absorbed much more quickly in the system, so you would get the glucose from it much quicker.
I must say that this is all still new and emerging. The biggest evidence for me around UPF is the lack of fibre, which slows down digestion. There is also the fact that it may use less healthy ingredients to bulk the food out, therefore pushing out more nutrients from the food. It is very energy-dense and quite often dry. It is highly palatable, often because it has extra flavours and colouring that make you eat more. Those are the main mechanisms that really stand out at the moment.
Q6 Baroness Suttie: Thank you for the evidence this morning. I start by declaring my interests. I am a trustee on the board of the charity Campaigns in Global Health.
Has there been any research into public awareness of what is meant by UPF? In addition, has there been any research into public attitudes at present towards ultra-processed foods?
Anna Taylor: I have some here. It is certainly evident in the media narrative that the ultra-processed food description is quite relatable for people and resonates with their experiences. The media is demonstrating just how much that is the case by the amount of coverage that some of these stories are getting.
In terms of survey evidence, IGD has done a survey testing particular frames around ultra-processed foods. There is a full report that we can send to you, but the one I have pulled out tested what citizens thought about using the definition of ultra-processed foods to guide people in their decisions. In the survey, 82% of consumers said that they liked the idea of a label on food that classified them as ultra processed or not, and 74% of consumers liked the idea of including UPF as a concept in dietary guidelines.
The Food, Farming and Countryside Commission has done quite a lot of public dialogues, so this is more qualitative evidence than quantitative. I think it had quotas for representation, but it is not a big survey. Some 74% of citizens involved in the dialogues wanted a target set for reducing UPFs in shops and on the high street.
The polling data are indicative, but this is something for us to think quite hard about, because of the extent to which we are dependent on ultra-processed foods. Ultra processed, by definition, brings in a set of foods previously not thought to be linked to any harm—not the high in fat, sugar and salt foods, but things such as bread.
People are grasping that in the media. I have been invited on to radio shows to talk about this, and people have rung up and said, rightly, that this is absolutely impossible. There I am, saying that these ultra-processed foods are harmful—I was not saying that particularly, but that was the narrative of the conversation—and they say that it is completely impossible to eat a diet that is not like that if you are on a very low income. I am quite concerned that that will fuel a lot of anger.
Going back to my water analogy, you would be pretty upset if you had to get clean water from a central location. If we are excluding large sections of the population from being able to eat a diet that is fully nutritious then we are in a very dangerous situation. The fact that this is resonating so strongly with the population is potentially fuelling that anger and concern. As a result, getting clarity—a lot of this evidence will be important—and, more importantly, acting to make it easier for people to feed themselves well are flying up the agenda.
The Chair: Thank you. I am afraid that we have to move on now. I have an eye on the clock.
Q7 Baroness Goudie: Thank you very much indeed for coming. I have read quite a lot about all your organisations. I have no interests to declare on these issues. What are HFSS foods? How are they defined, and how widespread are they in diets in England?
Katharine Jenner: There you go: there is another acronym for you. Although they are known as high fat, salt and sugar foods, HFSS refers to a nutrient profile model. This is a nutrient-based approach, using a composite score of information from a product based on how many calories and how much saturated fat, salt and total sugars, including those added in any process, there are—these are the unhealthy ingredients, if you like. The other element of that score is the more healthful ingredients, such as how much fibre, protein and fruit, and how many vegetables and nuts there might be in a product. There is a score, an algorithm, that you can follow to work out how healthy that is overall.
This was developed by the Food Standards Agency in about 2003 or 2004 and adopted by the Department of Health as a way to decide whether adverts could be shown to children. It is used as quite a binary score—a product is non-HFSS, so it is healthier, or HFSS and less healthy, so you can or cannot advertise it to children—but it is based on a very big scale, and you can gain or lose points depending on whether it is a liquid and whether you have good things in it. So you can improve the nutrient profile score of your product if you make improvements to it.
You will not be surprised to see that this apple is a non-HFSS food, but I will illustrate an example to show you how the two systems—HFSS and UPF—are complementary and highlight different dimensions of what a less healthy diet looks like. This apple sauce is an HFSS product: it is low in fibre, does not contain enough fruit and vegetables, and contains too much added sugar. It would be UPF and HFSS. These sweets would obviously be HFSS: they are pure sugar. These biscuits would be HFSS and UPF products as well. These children’s snacks were actually the worst that I tested of all: they came up with the lowest score. They are HFSS and UPF. You cannot test products for infants because the nutrient profile model is not appropriate for them, but there is a brilliant one called the NPPM, which we can send to you and should be adopted post-haste so that we can measure the healthfulness of children’s food and improve the composition of their products. That is a really big gap in policy.
You can see how there is so much overlap. There are areas that are not included in it, but what is different about the HFSS approach is this gradient effect. Whereas UPF is quite binary, with HFSS you could make slight improvements to these products and increase their scores. You could take some sugar out of the apple sauce or add some extra apple. To be honest, there is not that much you could do with the cookies—you could add a bit of fibre.
We have been trying to do this as part of the reformulation programme. Unfortunately, there has been a very voluntary and fairly light-touch approach to trying to improve the foods. However, in many cases they have been able to reduce the salt or sugar in food to get a better nutrient profile model score. They are still UPF but are better on salt, fat and sugar, and there is good evidence to show that those particular nutrients are harmful: there is SACN evidence on each of those, big reports that we can follow up with, to say why those are nutrients of concern. They are not the only ones, but you can see that HFSS is designed as part of a package to look at the overall healthfulness of food, separately but complementarily to UPF, which measures the level of processing and other factors. It is quite complicated.
Anna Taylor: To reiterate my point, if you look at HFSS consumption across the population, between 40% and 50% of our calories come from those foods. It is not wildly different from UPF; it is probably about 10 percentage points higher. Again, these foods are a pillar of our diets, whether we like it or not. That is the reality, particularly for children, whose consumption is a little higher than that of adults.
Fran Bernhardt: It is really important to remember, when we look at these policies and models, that we need to have an objective line. We need to be able to say, “These products comply with the policy and these products don’t”. The nutrient profiling model was created by experts, as Kat has detailed, to define that and create a model where we have products that are less healthy and therefore not compliant with a policy. Such as for advertising—you cannot have an advert that is half-up; it is either up or down.
We have this really good precedent, developed by experts, which has been in use nationally across the UK since 2007. It has been used in multiple policies, including the proposed TV and online advertising policies, as well as the current policies we have and local government policies. It has also inspired international models: we have seen lots of different countries develop their own models, based on Britain’s nutrient profiling model, because they have seen the success of ours.
In 2022, Kellogg’s took the Government to court—you may be familiar with this—in a claim that sought to question the nutrient profiling model’s applicability to its breakfast cereals. The claim was defeated because of the solid evidence and the precedent that the nutrient profiling model has.
It is really important that we do not take our current model for granted. There will always be new and emerging evidence that we need to build into our models and policies, but we have this really robust framework, so we need to make sure that we build on what there is already and use it well. The Government have watered down and adjusted the nutrient profiling model’s application in some policies. We need to make sure that we really make the most use of it; it is a very robust model that we should be using for our policies.
Q8 Baroness Boycott: Thank you all for coming. My interests are that I was chair of the London Food Board from 2008 to 2018, and I am currently trustee of the Food Foundation and of Veg Power, patron of Sustain, vice-chair of Peers for the Planet, and chair of Feeding Britain. Veg Power works with Channel 4 and ITV, and some of our adverts are paid for by supermarkets. Feeding Britain accepts donations of unwanted food from supermarkets—indeed, from any sources.
These are my questions to you all. I do not know whether you want to take them together or split them. The initial question is this: what is the role and responsibility of the food industry in diet-related poor health outcomes, such as obesity in England? Fran, could we get the details on that last point you made on what happened in that Kellogg’s case? It is a really interesting example for the committee to know about.
Fran Bernhardt: Yes, we can send that through. The role of industry is to respond creatively to the challenges of delivering healthy food to everyone across the UK, from manufacturing, marketing and sales. We need it to step up to make sure that all the current barriers of availability, affordability, accessibility and appeal that we have been talking about are brought into line with what we need to see for everyone to champion our health.
We know the industry can do it: we have seen how incredibly it can provide and mass-market products to everyone. There are some brilliant examples, including challenger brands that have reformulated and made much healthier products. Veg Power’s Eat Them to Defeat Them campaign really championed vegetables for children and saw a massive uptick in children eating vegetables.
We have also seen industry respond really well to local government policies on advertising restrictions. Within weeks of these policies being announced, industry swapped out unhealthy food for healthier food within its advertising. Now we have these celebrations of fruit, veg and nuts in advertising where those restrictions are in place. So we know industry can do it.
However, we also know that, right now, industry is spending considerable resource on undermining health policies. Industry lobbying is a serious threat, even to incredibly well-established and well-evidenced policies. We have seen multiple examples of this. We also know that this is a classic tactic, which has been borrowed from tobacco. We are seeing legalistic tactics from the tobacco playbook, which are used to dispute, delay and dilute policies. There are many examples we know of, and many others; obviously, industry lobbying is hard to keep track of and we cannot see it all, but we know that it is extensive.
For example, we have seen industry lobbying that successfully delayed the TV and online advertising restrictions in national government’s policies. We had a recent investigation in the Times, which revealed extensive lobbying against the obesity policy, with lots of papers coming from industry. Another Times article towards the end of last year revealed that KFC challenged 43 English local governments’ planning policies, and overturned over half of them—that is just since 2017. Those are just the ones we know about.
We have also seen this on an international scale. The Mexican, Uruguayan and Colombian Governments face legal challenges from the food industry. Again, it is using the tobacco playbook. We have seen parallels—for example, Philip Morris v Uruguay, a recent case. This is pervasive and a real barrier to bringing in strong policies, because we also know that all the difficulties other Governments are going through to bring these policies in really undermine other progress. Other local governments or national governments considering bringing in a policy will think, “I’m not sure I want to get into a court case”. There are a lot of barriers they will have to work through. Industry is using this as a way to undermine the progress we are seeing now, but also in the future.
Baroness Boycott: Anna, can you also answer that question? When a food company sues the Government, presumably saying, “You’re restricting our trade”, is there not a comeback: “But what you’re selling is not healthy”?
Anna Taylor: Let me start with the first bit, and then I will come to that. I would take a slightly different emphasis from Fran on the role and responsibility of the food industry. Businesses have a legal responsibility to their shareholders—and they are doing a very good job at that, right? Their job is to produce quarterly returns and comply with the rules around the ways that businesses operate. In some ways, although I would love to level at the food industry, and say, “You should be doing, this, that and the other, and sorting this out”, the incentives built into the system now are such that it is extremely difficult for companies to do otherwise.
We are seeing evidence of this. A small number of companies—big companies—are going, “Right, we see this problem. We see this diet crisis happening on our watch, and we want to try to do something about it”. They are trying and failing. They are talking more openly about the fact that they are failing and the reasons why they are failing: they are worried that if they do certain things they will definitely lose market share or footfall. If I can make a suggestion, it is really important that you as a committee try to identify those business leaders and hear their views from the perspective of trying to take those steps and the barriers built into the system that are acting against them. That is where the policy process becomes so vital.
On your point about the healthiness of products, I think we are back to legal definitions and the fact that we do not have a bottom bar, if you like, on nutrient profile—that below this level it would not qualify as food. Obviously, we have the codex and all the food safety stuff. I am not a lawyer; I do not know the full answer to your question, but that would be my guess.
We need to insulate the policy process from the food industry more effectively. Over the last five to six years we have repeatedly seen policy processes that have gone all the way through this House and the House of Commons, and which have still been delayed because of food industry pressure. There is a huge level of influence, and we are not seeing, in parallel, the public’s voice being heard by policymakers. Policymakers are hearing, “Nanny state, nanny state, nanny state”, but they are not actually talking to people. If you talk to the citizens, that is not their view at all. It is completely different; they want the situation to improve for them.
Baroness Boycott: I have one follow-up question before coming to Kat. The other day, we were discussing attempts by some people to relabel certain things, and we were told that the amount of money the food industry spends on supermarkets and marketing means that their hands are tied too.
Anna Taylor: That is right. Supermarkets are often in an easier position because they sell such a range of products: if one product becomes problematic then it is okay because they have a big portfolio. But you are right that the relationship between the manufacturers and supermarkets is complicated, and a lot of supermarkets depend heavily on, essentially, funding from manufacturers, which goes alongside them listing their products and might require them to describe the products in particular ways or position them in certain places, et cetera. It is not an easy-to-disentangle relationship.
The Chair: Thank you. Time is beginning to run away with us. Katharine, could you be as brief you can, please?
Katharine Jenner: I will, thank you. Industry’s role is not a lot of things: it is not to try to educate our children and be in schools; it is not to advertise unhealthy products to them, although they do, but there is law in place that has not been enacted; it is not to fund research that might be influenced in its outcomes or might be able to influence policy.
The junk food marketing restrictions that have been mentioned have had huge delays and have been watered down at every single stage of the journey. Lord Krebs may remember spending some of his valuable time in the House of Lords having to stand up against this particular product, a Grenade bar: taking up primary legislation time to debate whether there should be an exception for such a product that has more salt in it than a packet of crisps and more saturated fat than a sausage. That is an unacceptable way of doing policy. To your point, how are we in a world where the Nestlé KitKat cereal can go straight to market? I cannot remember what the percentage of sugar is, but there are no controls on that kind of thing. The public probably think that there is some kind of checking process: that something for children would be approved for children, and that products meet certain healthful criteria. That is not the case, and I am pleased to say that it is something we can do something about.
The food industry absolutely does have a role in making our food healthier: it can put healthier products on the shelves, advertise them more fairly, and make our high streets look healthier and be inviting places to have food. I really hope that it will do so. As Anna says, some companies are doing really well. When we talk about regulation to level the playing field, do not think about it as a race to the bottom, as has been going on. The rising tide lifts all ships; let us get everyone back to the top.
The Chair: Baroness Suttie, has your supplementary been answered? Yes? Thank you. I am pleased to be able to move on, because time is running away with us. Lord Krebs?
Lord Krebs: In a way you have hinted at the answer to my question, but maybe you could be very brief, because we are running out of time. How effective has government policy been in tackling diet-related obesity? I think we are talking about Westminster Government.
Katharine Jenner: Certainly. You may have heard some research from our colleague Dr Dolly Van Tulleken, who is in the audience, showing that there has now been over 30 years of failed government policies, with nearly 700 policies proposed. The main reason we have not had any success in government policy is because government has not done a lot about it; it has either not enacted the policies, or the policies have focused largely on trying to change individual behaviour and not been weighted towards the health inequalities to try to make people in worse situations do better. Even if they had been enacted, a lot of them would not have done exactly what we wanted.
Other people have stepped in to fill the void left by the Government. The food industry has jumped in with a whole new diet world—things that did not exist, and did not need to—to try to solve the problem of obesity. There are pharmaceutical interventions, surgical interventions and weight management things that you have to pay for, as well as all the food on the shelves.
There is a great historical success in nutrition: the Food Standards Agency salt reduction programme got off to a flying start many years ago. All it did was reduce by a bit the amount of salt in our food across the field, but it had an impact in reducing our blood pressure. However, while good work was done on front-of-pack labelling, it was never made mandatory. That could have happened years ago but it did not—and I should say that an awful lot of lobbying went on at EU and UK level. Then there was the public health responsibility deal. Again, voluntary measures, asking people to do what they thought was best, did not work, while the reformulation programme, which is voluntary with very little resource to implement it, has had minimal success.
However, they have done another good thing: the soft drinks industry levy. If you are not familiar with that, it is the tax on drinks whereby you get taxed a certain amount based on how much sugar is in your drink. That has led to huge amounts of reformulation. We have a lot of work showing the benefits of reducing sugar in drinks, by nearly 50%; that sugar in people’s diets from soft drinks has come down; that rates of obesity in older girls have come down slightly; and that dental decay in young children in particular seems to have come down. It has also raised money towards things such as the national school breakfast programme. That is brilliant because it is the only policy I can think of that has had an effect on those on lower incomes as well as those on higher incomes. It is a really good model. It is now five years old, and why we have not extended it to other drink and food categories is beyond me.
The Chair: I am pretty sure I am correct in saying that the money is no longer going to those things. It did at first.
Katharine Jenner: It is not, but it started off by going to them and it has raised about £1.5 billion to go into the pot.
Anna Taylor: I want to highlight the slowness of the process, which in my view is unforgivably slow. I shall give you two examples. First, in 2018 the nutrient profile model that people have referred to, which classified high fat, sugar and salt foods, was out to consultation because it was going to capture the new diet recommendations around sugar. Six years after that consultation, nothing has happened. Secondly, the advertising restrictions were first committed to in 2018. They have gone all the way through Parliament and on to the statute book, but the current estimate is that they will not be implemented until October 2025.
That demonstrates the point about slowness. That is seven years of a child’s life. Time is not on our side with this problem. We have children accruing these problems with their health, which is creating a lag—a huge wave that is now crashing into the NHS. We have to find a way to do policy more efficiently and to have the leadership and, frankly, care for our children to really drive some of these policies through. That is what we desperately need, and it would transform the process.
Fran Bernhardt: I agree with everything that has been said. Where we have seen fantastic leadership is in local government, where there are fantastic leaders championing health. National government should learn from what are essentially pilots across the country, which are successful and showing fantastic impacts. I will speak more about that on the next question.
The Chair: I am pleased to say that we have just over 10 minutes for our final question, which is from Baroness Jenkin.
Q9 Baroness Jenkin of Kennington: Thank you for coming. I declare my interest as a shareholder in Lord Rayleigh’s Farms. From your experience, what do you believe are the most effective strategies and approaches to tackle diet-related obesity? Do you know of any other countries that have done anything innovative and better?
Katharine Jenner: I slightly take issue with the idea of ‘tackling’ obesity, as it sounds a bit as if you are trying to go against the person. We have to remember that there are people who are living with obesity at the moment who need to get treatment, and access to the right kinds of treatment, fairly and equitably, but that is not happening. That may be a topic for a different discussion.
What we are really talking about is prevention, which should be the easy bit of it—stopping people going on the treadmill towards less healthy outcomes. People want that to happen. There is so much support for intervention and prevention. People feel the Government are not doing enough, they do not want the industry’s interference in their policy-making, and they want the Government to make big decisions about how to make life healthier. Sure, that is not reflected in the press, but it is absolutely what comes out in polling, and we are happy to share that.
What we need, and what our alliance agrees we need, is actions to make healthier food more appealing, available, accessible and affordable in order to make the healthier choice the easier choice. We look into three areas of that. The first is about putting heathier products on the shelves—what we can actually buy and eat—and there is a lot that comes under that, including reformulation, warning labels and front-of-pack labelling. There are examples from other countries that have tried different approaches to labelling. I do not feel we have gone far enough with our traffic-light labelling, to be honest. It is a well-recognised and understood programme of work. If we used the new nutrient profile model and said “added sugars” rather than “sugars”, and perhaps used a warning about sweeteners, it could be vastly improved. There is a lot that we could do to make healthier products, and the soft drinks industry levy should be our beacon of hope about what could be done there.
Secondly, we need healthier high streets. We know that leaders up and down the country want to make their places healthier but they struggle to do so because they do not have the right powers to restrict advertising and stop hot-food takeaways opening. Yes, there is stuff that companies can do, but a lot could be done centrally to try to improve that, although it needs leadership from the top. A child, wherever they live, should be entitled to the same life choices.
Thirdly, we all know—well, maybe not all of us—that advertising is a big driver of consumption. Why else would you advertise your products? Marketing in all its different forms is something that can be addressed. We have a good programme going through at the moment, which we hope will come into force next October, looking at not advertising unhealthy food to children before 9 pm and online, but there are many opportunities to reach your audience and specifically target where you can reach them. But that is just part of the picture.
Those top-level regulatory measures have not been explored sufficiently but they could be done with enough support to get them through, and I would be happy to send the committee evidence packs on each of them. It certainly needs coherence across government and across different parties. A lot of the decisions about health are not made in the Department of Health. I do not know whether you have seen the news today that the Office for Health Improvement and Disparities has been greatly diminished. There are brilliant people in that organisation. There should be health across our government, with everyone being held accountable in order to drive change. Coherence is needed across all the modifiable risk factors, such as tobacco, alcohol, unhealthy food and drink, gambling, and more.
Anna Taylor: I will add a few stats on the reduction in obesity that we have seen from some of the interventions so far. We have heard about the soft drinks industry levy, which is estimated to have reduced obesity among 10 and 11 year-old girls by about 8%. The Transport for London ad ban is estimated to have reduced obesity by about 5% in adults and children. Universal free school meals are estimated to reduce the prevalence of obesity by between 5% and 9%, depending on the age of the child. That gives you orders of magnitude.
An area that has been really overlooked—we produced a report this week about it—is infant feeding and the role that breastfeeding can play in reducing the risk of obesity. It is really significant; there is a 25% risk reduction for children who are exclusively breastfed. Many mums—44% of those who start breastfeeding and stop—say that they would like to have continued for longer. For various reasons, many of them to do with the support that they receive and the fact that maternity pay is appallingly low, they stop breastfeeding earlier than they might have wanted to. We have to think seriously about how we can support those mums, because breastfeeding has such an important protective effect.
More generally, an important point to make is on the policy development process. The policies that have finally come through have been focused on some of those bad foods: the ones that are the least healthy. However, we have a very undeveloped policy process on how we improve access to nutritious foods. We have a little programme called Healthy Start, which provides vouchers for very low-income mums, and free school meals for some disadvantaged children, but we should be thinking really seriously about how we enable businesses that are selling great fruit and veg in our communities at a reasonable price to thrive, perhaps by linking to local production where possible.
Those kinds of things and that policy thinking is very undeveloped. If you talk to people in Defra, which is in charge of food, about those issues, they say that they are not interested in consumption and diet; they are interested in production and food companies. There is a complete disconnect. We need to put a lot more policy energy into thinking about access to nutritious foods, particularly if you have little money, alongside the kinds of things that we have been talking about here around how you can control the excesses of the least healthy foods.
Fran Bernhardt: We have seen some fantastic precedents at local level, particularly on healthy food advertising policies, with the Transport for London policy and the 12 local authorities that have brought this policy in as well. Evidence has shown that the Transport for London policy will lead to 100,000 fewer obesity cases, 3,000 fewer diabetes cases, 2,000 fewer heart disease cases and a £218 million saving for the NHS in London alone. That is just from the Transport for London policy. As local authorities bring in their own policies we expect that to be in addition to that finding.
There has now been a five-year precedent from that policy. The other really exciting thing about it is that it has maintained advertising revenues. We know it is often a balance of health versus the economy, but we are actually managing to do both with this policy. We strongly recommend that the Government learn from it and bring in an unhealthy food advertising restriction in full across all media, including on streets and transport, as well as radio, online and TV.
We have also seen some fantastic findings from planning restrictions. As I spoke about, local authorities have brought in planning restrictions around hot-food takeaways. Gateshead is a fantastic example of that: it took an approach that restricted all hot-food takeaways across Gateshead. Hot-food takeaways reduced by 14%, so we know that this is effective. We just need to look at how we can bring these policies in.
As was alluded to before, more than 80% of children are not getting their five a day. We know that there are inequalities built into that. We need to look at measures to make sure this is addressed. Healthy Start is a really useful intervention and we are keen to see an increased Healthy Start allowance. On school food, we would like to see an end to free school meal means testing, because both of these measures increase children’s access to fruit and vegetables. There is also the school fruit and veg scheme. We would like to see that expand to all 4.7 million state-funded primary school children. There is lots of potential; we just need the Government to run with it.
The Chair: Thank you very much. What a positive way to end. That was very helpful.
Baroness Jenkin of Kennington: Just briefly, I appreciate that I did not give you any warning that I would ask about other countries, but are you aware of anything that you can tell us about that? Is everybody on the same trajectory?
Anna Taylor: It is interesting that we are not all on the same trajectory. No country has effectively brought down obesity rates, but some have prevented them going up. Japan is a very good example: it has levels of overweight and obesity that are close to very low-income countries, such as Chad, Nepal and Bangladesh.
Some countries have stopped the huge acceleration. Obviously, there are a slew of countries in Latin America where the situation has got extremely serious. They are now acting at considerable pace.
The Chair: Thank you Anna, but I am going to have to stop you there.
Thank you all very much for your passion and knowledge, and for all the additional evidence that you are going to send us, especially if you have mentioned it this morning. We really look forward to receiving that. I remind you that you will receive a transcript of what has been said this and you have the opportunity to correct it if necessary.
