17
Examination of witnesses
Professor Tim Spector and Dr Keren Papier.
Q38 The Chair: Good morning, everyone, and welcome back to this public meeting of the House of Lords Committee on Food, Diet and Obesity. We continue our meeting with the fourth evidence session of the committee’s inquiry, 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.
We hear today from Professor Tim Spector, professor of genetic epidemiology at King’s College London and founder of ZOE, who is joining us remotely; and Dr Keren Papier, senior nutritional epidemiologist at University of Oxford, who is joining us in person. You are both very welcome. We very much look forward to the evidence from both our witnesses. I ask you to please introduce yourselves briefly the first time that you speak. I will be asking the first question in a moment.
Today’s meeting is broadcast, and a written transcript will be sent to you to check for accuracy before it is published subsequently. I refer to the list of Members’ interests, including my own, which are all on the committee’s website and were announced at the committee’s first evidence session on 8 February.
What is a healthy diet, and how does poor diet contribute to rates of obesity and ill health?
Dr Keren Papier: Thank you for the introduction. I am a Senior Nutritional Epidemiologist working in the Cancer Epidemiology Unit based in the Nuffield Department of Population Health at the University of Oxford. I work with very large cohort studies (including the Million Women Study, the UK Biobank study, and the European Prospective Investigation into Cancer and Nutrition (EPIC) study) and follow people over time through record linkage to see what and how diets and lifestyles associate with different disease risks. I have worked in different international settings, tracking how diet and lifestyle, which are very different across different countries and settings, relate to different disease rates. I am heavily involved in the collection and management of these different types of data.
Your question is a great one and why we are here. A healthy and balanced diet can mean many things. Depending on where you come from and where you are based, what that diet looks like will likely be quite different. Even within the UK, we have a lot of diversity; for instance we have people following vegetarian and vegan diets, and people consuming animal foods. We have various types of diet, but we are also very fortunate that we have years of good research, which guides the dietary guidelines, so that they are based not just on one or two studies but on decades of good research.
The dietary guidelines here in the UK are fantastic and very clear. In addition to having a plate that shows what different proportions of foods on a plate might look like or what you might be eating throughout the day, there are also specific guidelines on limiting our salt intake, added sugar intake, saturated fat intake and red and processed meat consumption, and on what foods we can be eating more of (for instance high fibre foods); it is not always just about having less, of course.
When we think about a healthy diet, we are thinking about various aspects, because health covers lots of different things. It also includes environmental health and sustainability. Our Eatwell Guide does quite well; there is room for improvement in terms of environmental impacts, but high adherence to the Eatwell Guide (compared with low adherence) has been found to be associated with lower greenhouse gas emissions.[1]
The Government has done a really good job on the dietary guidelines, based on robust research and taking into account what we have published over the years. As for how it relates to health, what is in the dietary guidelines is backed by epidemiological evidence, trial evidence and genetic evidence on diet and health High adherence to the Eatwell guide (compared with low adherence) has also been found to be associated with favourable health outcomes, including lower risk of mortality.[2]
We have long known about the impacts of sodium and salt on our blood pressure and cardiovascular disease risks. We know that saturated fats increase low-density lipoprotein and cardiovascular disease risk. We have consistent evidence that processed meat increases the risk of colorectal cancer. We also have trial evidence that shows that a higher percent of sugar in the diet increases energy intake in adults and higher sugary beverage intake increases weight gain in children and adolescents. The list goes on. The foods in the guidelines are there because they have been linked with various health outcomes, and eating more or less of them as part of a whole balanced diet will have an impact on human and environmental health.
Professor Tim Spector: I trained as a clinician and epidemiologist, and I set up a twin cohort 30 years ago that follows 15,000 twins, so I also know about larger cohort studies and their difficulties. For the last 12 years, I have focused on nutrition, gut health and the microbiome through my twin work. Seven years ago, I co-founded the company ZOE, which is involved in personalised nutrition and understanding how individuals can eat better and choose better, knowing that the food choices we make are probably the most important things we can do for our own health and for the planet. That is a really important point.[3]
With ZOE, we did a Covid symptoms study that allowed us to look at millions of people’s health throughout the pandemic. One of the big highlights for me was doing a survey of a million people and seeing who developed more severe Covid. It turned out that one of the biggest factors involved was not just obesity but, even after adjusting for obesity, the quality of the diet. People who were in the bottom quarter of the population for poor-quality diet had around 50%[4] greater risk of getting severe Covid. Even with crude measures like this, this brought home the importance of diet quality.
Diet quality is the essence of what I have talked and written about. I spent six years researching a book all about diet and going back to first principles. Most doctors are not taught anything about nutrition at medical school. So that is where I am. It is all about diet quality; it is not about the macronutrients or the calories per se. There is something in the very essence of the food that we are eating that is causing us this problem. That is why the UK is the sick man of Europe; it is because the highest percentage of our calories are eaten in this poor-quality food that makes us overeat.
A good diet is based on: whole foods; having virtually no ultra-processed food, although that is hard to achieve; having minimal amounts of fish and meat; plenty of fibre; plenty of diversity of plants. There is a whole range of things in there, such as having nuts, seeds and wholegrains, that are really important. We do not emphasise fibre enough when talking about a good diet. Around the world, what makes all the blue zones — which have the highest longevity — stand out is that they have a high percentage of whole foods rather than ultra-processed foods. Some of them eat fish or meat, and some do not, but most of their plate contains lots of diverse, high-fibre, healthy whole plants and not these industrially made food-like substances.
Q39 Baroness Browning: In the area of personalised medicine, genetics now play an important role in identifying the right medication and dose, et cetera. With personalised diets, which I think is the direction you have been describing, do genetics play a role? I ask, because there are vegans in my circle of friends. They eat a diet that I think you would find very acceptable, but within that family eating the same diet one succumbs to cancer but others do not. Do genetics play a part in this, and how do you identify that?
Professor Tim Spector: I spent 20 years convincing myself that genetics were important. We did a study[5] at ZOE of a thousand people, including 600 twins. When we gave them identical meals, even in identical twins we got very different responses in blood sugar levels and how the fats and inflammation levels changed after the meal. Genetics is only a small factor in responses to food. That was a big surprise to me when we published those results. Genes are not nearly as important in our response to food as they are in many other aspects of health. The big thing we found in identical twins that suggested why they would be different is that their gut microbes are very different. We will probably discuss that more, but the major reason why we respond to foods differently seems to be that we all have very individual gut microbes.
Dr Keren Papier: A lot of our work is based on assessing vegetarian and vegan diets, and these diets change all the time. A vegan diet can mean Coca-Cola and chips all day. You know what they (vegetarians and vegans) do not eat but not what they do eat. We do not know enough about what you are genetically predicted to eat. I do not know whether that is the way to guide this, but diets are changing and there is still a lot left to learn. Most of what we know comes from comparing groups of people rather than individuals.
Q40 Baroness Jenkin of Kennington: Some of us are old enough to remember the F-plan diet, which seems to be coming round again. What does the evidence tell us about the health impacts of UPF and HFSS consumption?
Dr Keren Papier: That is a big question. The key word there is evidence. A lot of what we know or what is available when thinking about how ultra-processed foods relate to different health outcomes comes down to how we ask that question. Defining ultra-processed foods is the first step, but there are various definitions guided by different things. The most widespread and popular definition by far is the Nova definition from Brazil, which has a four-category system which I am sure you have heard a lot about by now, ranging all the way from minimally processed to ultra-processed foods. It was designed in a setting where the consumption of ultra-processed foods was mostly of particular types of foods, compared to a setting like the UK.
A lot of the research into UPFs and health uses the Nova classification, and the evidence is mostly based on large cohort studies, the sort of study that I and Tim work on. People very kindly take part and fill in a questionnaire. The questionnaire could ask how frequently they ate meat, bread or rice over the last year or it might ask what they ate yesterday. They might give exact information: “I had half a cup of oatmeal with orange juice and raisins”.
Different types of dietary measurement tools can be used to collect dietary data (for instance food frequency questionnaire, 24 hour dietary recalls), and the tool you use to collect dietary data will give you very different information. To classify something as ultra-processed, you need to know what the brands are and whether there are additives and emulsifiers. The Nova definition is about industrially manufactured products. What does that mean? I am not sure whether it is about formulation, which is the same as a recipe—you could be making it at home—or processing. It could be both, in which case it is more about technology or introducing other processes. There are already different things within the same definition. A UPF tends to have a long list of ingredients, which can include high sugar and high saturated fat, but it might not.
So the problem, when you are collecting data from people who tell you that they had bread and rice, is that a lot of the time you do not know enough about the food (for instance what the brand is). Even if I asked you what you ate yesterday and you said, “I had homemade pasta sauce”, is “homemade” buying a jar of sauce and popping it on the stovetop or chopping up tomatoes and onions and cooking from scratch? We currently cannot collect that information. If the important thing about the definition of ultra-processed food is the processing, the additives and the formulation, we are not currently capturing that information. I know that methods are being developed to try to capture this better and we are still developing in that field, but our current databases are also quite limited (for instance they don’t contain information about processing). The NOVA definition has been developed, but when measuring it practically in a cohort study by asking people what they eat you are not exactly capturing what the NOVA classification needs you to capture.
In addition, the four Nova categories are really big. At the moment, a fizzy drink is in the same category as wholemeal bread in the UK (since it has additives and emulsifiers). That is a bit of a problem when trying to interpret the effect of UPFs on health. Most ultra-processed foods tend to have high sugar and high saturated fats, so we have an overlap with discretionary foods in our dietary guidelines, which is great, but what happens for foods where they do not overlap, or what about something like soya milk, which a vegan might be consuming and which has added calcium and vitamins D and B12—really important nutrients that the vegans may not get otherwise? In the UK, about 25% of the ultra-processed foods we eat are breads and cereals, and we fortify white flour in this country with e.g. calcium and iron which provide important nutrients for the population.
Going back to your question about the evidence, there are multiple studies investigating the association between UPFs and health, although not all studies use the exact same categorisation. I am not a scientist in a lab who knows exactly how to interpret what additive was added to bread, but none the less that is not even reported. I can try my best to categorise this from the information we collect from our participants, and so can the researcher next to me, but we will probably not do it in the most consistent way. Overall, it makes sense that some of the foods coming up as ultra-processed foods overlap with foods that are high in saturated fat, sugar and salt, but other foods get clumped into the same definition (e.g. fizzy drinks and wholemeal bread), which makes it a messy picture. What we are measuring as UPFs is not clear, so it is very difficult to judge the evidence.
Professor Tim Spector: I am less negative. I am old enough to have lived through the passive smoking debates in epidemiology. The initial studies were not that clear, and a few of them showed different risk ratios. The tobacco industry pushed back and said that we did not really understand the exact dose that is harmful to children, et cetera and that we should not worry about it because it is all very confusing. That is very much what we are seeing here.
On the latest meta-analyses, a 2023 paper by Vitale[6] took 25 studies. Not all of them are great, but by taking many studies, you take out a lot of the noise that you get in any individual study, and you see a consistent picture: in the top quartile of those having the most ultra-processed food have an increase in diabetes, more obesity, higher blood pressure and altered lipid levels. If you add that sort of data, which to my mind is as good as we will probably get, to the randomised controlled trials, say from the Kevin Hall study[7]—a feeding study that shows they cause overeating by 500 calories a day—it is fairly clear that you have a health problem that is partly due to the fact that these foods are inducing you to eat more because they are hyperpalatable. We have not discussed the concept of hyperpalatability in food very much. I can come back to that.
These foods interact with our health not only through overeating but also through the chemicals affecting our gut microbes. Plenty of animal studies[8], but not so many on humans, show that the emulsifiers[9], glues, gums and artificial sweeteners[10] that are added to all these products have harmful effects on our gut microbes, which means that they produce abnormal chemicals in response. These seem to have adverse health outcomes, certainly in all the animal models so far, and make it quite likely that that is another mechanism by which these products cause harm.
If we divide ultra-processed foods into those that are designed by the industry to make us overeat—that is the definition of hyperpalatability—through the combination of fats, sugars and particularly salt in exactly that right combination and the fact that the industry is using these chemicals to extend shelf life and stick these food substances together, which is affecting our gut microbes, that explains the epidemiology and why, even when you adjust for fat, sugar and salt, you still have excess health problems. To me, it is consistent, given the evidence we have, and is very similar to where we were with passive smoking at that time.
Baroness Suttie: Thank you, Professor Spector. If I understood you correctly, the science is not necessarily there yet, but the precautionary principle comes into play. Is that what you are basically saying?
Professor Tim Spector: Yes. I am saying that we do not understand all the mechanisms, by a long way, but we have enough evidence that these are causing harm such that, if they are not essential for our life and we have other choices, we should start to warn people to avoid them in the same way we did with passive smoking. We knew that cigarettes themselves were harmful, but we did not quite know what those extra effects were, which are more in line with what we are talking about here. We are not talking about tenfold increases in cancer but about 20% to 50% increases[11]. Those are the orders of magnitude. It will take a long time before epidemiology gets it down to precise estimates and everyone agrees on definitions, et cetera, but at the moment, the precautionary principle should prevail, and consumers, particularly children, should be protected.
Q41 Lord Krebs: Tim, I have a couple of follow-up questions. First, you did not respond to what Dr Papier told us about the difficulty of retrofitting the UPF Nova scheme on to dietary records that were collected at the beginning of a cohort study, maybe 10, 15 or 20 years ago.
My second point relates to what you just said. Are you saying, in effect, that the Food Standards Agency is falling down on the job by not regulating the things that you say are dangerous, such as emulsifiers and stabilisers?
Professor Tim Spector: I think the FSA is falling down on the job. It is not keeping up to speed with other countries that have highlighted this. The WHO, for example, has recently highlighted some of the products that are commonly in our foods, particularly emulsifiers. We seem to have a very lax standard that is not precautionary at all. You have to prove without any doubt that some of these emulsifiers or artificial sweeteners definitely cause X disease or cancer before we even think about reducing it. It is the threshold that is at issue here, not necessarily the committee not taking the evidence. It is more at what point it should act as a precaution to say, “Let’s put a warning out while we do more research. Let’s try to move people away from these potentially carcinogenic or obesogenic chemicals”.
On retrofitting, it is the nature of epidemiology that we have always collected basic information and then worked on it years later to try to work out what is going on. There is nothing new about that. I should say that you get similar answers if you use other ways of looking at the data, such as what is called the Healthy Eating Index[12] and other more standardised questionnaires that look globally at things like fibre and rough amounts of fruits, vegetables and fresh products versus industrially made ones. I do not think that the exact definition of UPFs is the problem here. You get similar answers when you use other related indices. I do not think it is flawed in that way or necessarily biased because of it.
This new area of hyperpalatability might be an easier way to classify foods. I do not know whether the committee is aware of it, but a researcher in Kansas called Dr Fazzino[13] looked at a large number of studies in the US that dealt with hyperpalatability—this is about the industry studies—and from that used the US database to work out that the industry used three outstanding ratios to make its food hyperpalatable: 25% of calories from fat, plus 0.3% of sodium; 20% of calories from fat, plus 20% from sugars; and 40% from carbs and 0.2% of sodium. These are very precise measures that are quite easy to put out there. They make foods that are designed specifically so that people will overeat them.
The Chair: Could you refer us to that paper after the session?
Professor Tim Spector: Yes, I am happy to. I am just making the point that we have had this debate in which people argue about whether wholegrain bread is a UPF, but there are other ways of classifying it for different purposes. For the purpose of regulation, you might want to look at foods that are created by the industry specifically to make people overeat or overdrink them, so even if they did not have that many calories in them, your brain would be rewarded if you kept drinking or eating them, and over a week or a month you would ingest many more calories. That is a really interesting concept.
The Chair: You will be interested to know that we will do some taste testing on these issues, so thank you for raising that. Keren, do you want to add anything before we move on to the microbiome?
Dr Keren Papier: Just to remove the negative hat and put on a cautious hat, I am hopeful. In response to Tim’s comments, we have web-based approaches now so that we can collect data in real time. We can get better information on brands to get a better way of classifying some of these things and getting into the nitty-gritty of whether salt is added to preserve or as a flavour, because that makes a difference for the UPF definition but maybe not if we take in too much overall. There is room for improvement and work is already being done, so watch this space. The debate is not over yet, and there is room to improve the evidence.
Q42 Baroness Boycott: Tim, can you give the committee a sense of what the gut microbiome is? It has been there for ever, obviously, but it is a relatively new medical understanding. How important is it to our health? Given where it is, diet and what we feed it are crucial. Could you unpack that general statement so that we have it on the record?
Professor Tim Spector: A healthy gut microbiome came to light only about 20 years ago and there has been popular awareness only in the last 10 years. The 40 trillion to 100 trillion microbes that live in our gut, mainly our lower intestine, work essentially as mini pharmacies. They are the source of many of our vitamins and neurochemicals, and they have hundreds of times more genes than we do. So in a way, they are an integral part of our body that, up to now, we did not know existed.
It is a bit like we have discovered that we have a new liver because it is how our body interacts with food. Essentially, these will interact with the food that we eat, and they control our immune system[14] in particular, which is key for allergies and for fighting cancer, ageing, infections and Covid. They are integral to many of our processes. They also send chemicals to the brain, which is increasingly known to be important in mental health diseases such depression and anxiety in particular and potentially some of the autism spectrum disorders. They break down our foods, release nutrients and have a key effect on how we might respond to medications and drugs. One in three do not respond to anti-depressants because they have a different type of microbe that might deactivate it. They are crucial in fighting[15] cancer[16], working with immunotherapy drugs; the state of your gut is the biggest predictor of whether you will survive[17] cancer therapy.
The other thing to bear in mind is that we have lost[18] about 50%[19] of our species in the last 100 years, compared with our ancestors[20] or those in developing countries[21] who have a much richer microbiome. We think that the richer your microbiome, the more chemicals you produce and the healthier you are. We now have lots of studies, and in particular a big database—the biggest in the world—from the ZOE company that I work with, which now has a key idea about what makes a healthy gut microbiome[22]. It is this combination of diversity of species plus having a good ratio of healthy microbes and relatively few unhealthy microbes. We know that diet can manipulate those in a big way. People who are on unhealthy diets—the diets that we are talking about here—have low diversity[23] and a high rate of microbes that like living in a stressful and high-inflammatory environment. We think they put out lots of chemicals that can affect your mental health, make you more likely to put on weight, reduce mood and energy, and alter your metabolism.
It is a crucial part of our body that we have ignored. The good news is that, unlike our genes, we can improve it with diet. Unfortunately, with a bad diet, we have probably made it much worse over the last 50 years.
Q43 Baroness Boycott: You have used the phrase “we think” quite often. How much of the evidence about the way the microbiome reacts to, say, Coca Cola or something we all agree is not a great food can now be used completely scientifically and robustly to drive policy?
Professor Tim Spector: That is a great question. Most of the work on specific foods and the gut microbiome is done in animal models. They sometimes do the big experiments in the animals and then might translate that into humans. They have done studies on artificial sweeteners[24] and emulsifiers[25], for example—this is one of the biggest areas that they have looked at. There are many rodent studies showing that it will disrupt the gut microbiome, and you will get less diversity and abnormal chemicals produced by those microbes. A few small-scale feeding studies[26] in humans have shown that the gut microbiome degrades.
We do not have long-term studies or randomised control trials, which would be virtually impossible to do, so we have to infer various gaps in our knowledge and say that we know what a healthy gut looks like and what effects junk foods have on the gut, both in humans and rodents, and we have the big epidemiological picture of what is happening to health and gut microbiomes. We then have to piece it together. I think we have enough to go on, using the precautionary principle, for regulation, but it is not the same as saying that we have scientific certainty about the methods, amounts and doses.
Baroness Boycott: Keren, do you find that the study of the microbiome comes into the work that you do?
Dr Keren Papier: Not yet.
Baroness Boycott: Why is that?
Dr Keren Papier: Honestly, it is a big part of what Tim was saying about what is available. Most people do not want to provide stool samples—it is not a comfortable thing to ask. A lot of the studies around are also quite small, because they are quite difficult to do. More measures are becoming available and there are different ways of measuring. You could do it through saliva, and we are getting different metabolites or measures in the blood that might indicate whether someone’s microbiome might have a certain density of bacteria. That is a big part of the problem, however. As Tim was saying—he does a lot of this work—a lot of the studies are on animals and in vitro, because it is difficult to conduct them and to do them well in humans.
There is some good evidence coming out from the available studies. With fibre, for instance, the bacteria munch away on it and we see that the more fibre or less fibre that we eat affects the gut microbiota density and that can affect certain health risks, including for example cancer risk. With a cautionary hat on, not a negative hat, small numbers are something to think about. You need a long time to look at several different health outcomes. It is not only diet that affects the microbiome; so do antibiotics and stress, and other things. We need to be able to take these things into account. If a study is done on 300 people, will you have enough smokers, non-smokers, those taking antibiotics or not taking antibiotics? Do you have that information at the same time they gave you the stool sample?
There is an exciting space developing. There is definitely some nice evidence coming out of it, but we need more and bigger studies with longer follow-up to really know what is going on for several different health outcomes.
Q44 Lord Krebs: Tim, I will read a sentence last year from a review published last year by Matthew Dalby from the Quadram Institute. The final sentence is: “In conclusion, high-profile research indicating links between the gut microbiota and excess body weight were not based on robust and repeatable results and have not been supported by later research”. Do you agree with Matthew?
Professor Tim Spector: I agree that some of those earlier studies exaggerated the effects in rodents, but the large-scale epidemiological studies are still consistent that there are links.
What has failed to appear is something unsavoury called faecal transplants—poo transplants—from thin people into obese people, which we thought would work. That has been clearly shown not to work. The direct relationship between microbes and obesity is not as clear-cut as we thought it was, but they have a much bigger role to play in the immune system and general health than just making us thin or fat.
Q45 The Chair: What are the ways in which an individual could improve their gut microbiome? What are the components that could have a positive effect rather than a negative effect?
Professor Tim Spector: Much more is known about that. There have been lots of small clinical trials, and it is clear that fibre is important. That is why we have done studies with our US colleagues to show that if you can get a large variety of plants in your diet—some 30 plants a week[27] is optimum to get the best gut diversity and gut health—it does not matter whether you are vegan or whether you eat some meat. The key is to get that bigger variety of plants on your plate. That can mean nuts, seeds, herbs and spices as well, so it is not just kale.
Another thing we have known for a while is that eating the rainbow[28] is sensible. We now know that by eating the rainbow, you are eating lots of colourful chemicals, which are defence chemicals in foods called polyphenols[29]. We know that these are in all kinds of healthy foods. They act as fuel for your gut microbes as well, which then go on to produce other healthy substances.
The third thing that we now know is important is to eat fermented foods regularly[30]. A number of really good, detailed clinical trials recently have shown that if you eat fermented foods every day, in just a few weeks, you can improve your immune system, reduce your inflammation[31], et cetera. These are essentially probiotics in real food. They are live microbes in things such as yoghurt, cheese, kefir, kimchi, and kombucha.
The fourth thing is leaving a gap so that you are not eating or snacking all the time, and your gut has a chance to rest. We have done some big studies[32] in ZOE of over 30,000 people, showing that gut health improves in people who leave at least a 12-hour gap overnight.
Finally, there is a clear correlation[33] between ingestion[34] of ultra-processed food and your gut health. Again, mechanisms are unclear, but the data is pretty clear on that.
They are the five general principles if you want to improve anyone’s health in a trial or in a programme of changing diets.
Q46 Lord Brooke of Alverthorpe: How influential is the food industry in driving poor health outcomes and in the wider policy-making process? Which specific elements of the industry are most influential, in your view?
Dr Keren Papier: What is the food industry? Is it the supermarket or the café downstairs? Most of us do not grow our own food; we eat only what is available to us. It is essential; that is what we rely on. That is how we eat our food, so if what is available is not great and is high in sugar, saturated fat and sodium, we are in trouble.
Also, the food industry, the food system and supermarkets sell wholemeal bread and fruits and vegetables, so what we have there can promote health as well. There are two sides to the coin. There is also adding things such as iron and calcium to our flour. Because of the food industry we have avoided a lot of nutritional deficiency since the Second World War. It has an important role in both sides of our health.
I believe the second part of the question was about responsibility.
Lord Brooke of Alverthorpe: Could you say which elements of the industry you think have the most influence?
Dr Keren Papier: Retailers are very important. There is also marketing and the actual products: what is available in the products and who is formulating them.
Lord Brooke of Alverthorpe: If we are to effect change, who should we tackle?
Dr Keren Papier: I think you need to work in collaboration with anyone responsible for deciding what is going into the product (for example the companies). We have seen what the sugary drinks levy has done to sugary beverages by decreasing the amount of sugar sold in those beverages. That was through working together with people responsible for making the products and putting something in place to do that.
The Chair: Let us leave responsibility for the moment.
Professor Tim Spector: The big food companies, not the supermarkets or retailers, are largely responsible for the obesity crisis in this country. Supermarkets just sell what people want and respond to customer demand. They obviously make margins on some foods more than others, but essentially it is the food companies, which are driven to make profit, that are making all this industrially made food. They have brilliant food chemists. They recruit the best people in the business. Their job is to make food as ultra-palatable as possible by tweaking the amount of fat, sugar and salt in exactly the right proportions that make people overeat them. Those companies’ sole aim is to make profit. That is like any company. I do not think that should be held against them. If they made their foods less hyperpalatable so that people were not eating as much of them, their competitors would run them out of business.
In my view, it is fairly clear where that responsibility lies. The food companies have been allowed a free rein, as you also heard in the last session. They have infiltrated every part of nutrition in the UK through organisations such as the British Nutrition Foundation[35], which newspapers think is completely independent. The food companies fund a lot of nutrition research in this country and give universities nice new labs. They have huge budgets to influence Parliament and parliamentarians through lobbying. Their aim is to keep us eating more of this food because it is much more profitable to make it than anything else, or trying to get farmers to make real food. It is all made in industrial complexes that are automated and getting cheaper all the time. It is fairly clear-cut, in my view. There is a clear relationship[36] between obesity levels across Europe and the amount of ultra-processed food we are eating. That is why the UK is top of both.
Q47 Baroness Suttie: You have both tackled this a little already, but what should be the role and responsibility of the food industry in tackling obesity—indeed, if it should have any role in that?
Dr Keren Papier: The industry has to be involved. We have to be able to collaborate with it, because, as Tim has nicely covered, if it is making these products, we need to be involved in understanding what can be done. Can we reformulate the products? Should we change which products are on which shelves? We need to be involved in how things are designed and sold. We cannot do that without the industry, unfortunately, because it is making the products that people are eating. We need to be able to involve researchers in part of this.
Lord Brooke of Alverthorpe: Can there be reformulation?
Dr Keren Papier: I hope so. We have seen it with the sugary drinks levy. The companies did not want to have to pay and dropped the amount of sugar in the drinks. That is a winning story and an example of a good collaboration. You could also do it for salt. As recommended by salt action: you could use potassium-based salt to reduce some of the sodium. So yes, there is absolutely room for reformulation.
Baroness Suttie: Tim, do you think the food industry can have a role in reducing obesity?
Professor Tim Spector: Yes, if it is forced to do it, but not if there is a voluntary component. That would be daft from a commercial view. No one wants people to eat less of their product. We have to make a level playing field.
I have spoken to a number of people in the industry, the bread industry in particular, and they would love to see some guidelines to help them to say, “Okay, let’s make our food at this level”. For everything else, you pay double the tax, or whatever it is, to disincentivise it. At the moment, they are not being incentivised to make any healthy products. It is about getting more palatable foods that people like to eat, and they will dress it up accordingly.
I think the industry is ready for strict mandates from government that say: “We know what you’re doing. You’re making food so that people overeat it. We’re going to control that and reduce those things that make it hyperpalatable so that it’s below that threshold”. That is how it should respond. At the moment, we have hyperpalatable foods that contain all these chemicals, emulsifiers and other things that are bad for your gut microbes, and they do not have health warnings on them. In fact, they have what we call health halos, saying “low calorie”, “low fat” or “high in vitamins”, so parents buying their children something from the dairy counter are being totally misled into thinking that they are buying healthy foods. That is an even worse scenario than the one we are depicting here. People are being misled by retailers into buying the wrong foods. We should do something about that immediately.
Q48 The Earl of Caithness: I ought to declare my interest as having been a member of ZOE for over a year now, with good effect I might say. Can you tell us more about the effectiveness of government policies? It is pretty clear that they have not been a success, but I would be grateful for a bit more detail, including on the current dietary guidelines of the nutrient profiling model. People have said that it is a good model but it is not used properly. Should it be changed to include fibre and calories?
Professor Tim Spector: I do not even think it is a good model. It is probably about 14 years since it was devised. Like most of the current guidelines, it is hopelessly out of date. Those guidelines still propose that people have low-fat spreads instead of whole foods or cheese or whatever. They are very behind the times. There is nothing in them about eating whole foods rather than heavily processed foods. In general, the guidelines are wrong. Even things like the NHS guidelines are very out of date; they state that you should never miss a meal. They focus on low-fat foods, which all the recent evidence[37] and virtually every nutrition colleague I speak to does not believe in.
They need to be dramatically overhauled. It is really bad that we do not update our guidelines more often. Also, it is always the same committee marking its own homework, which never wants to criticise the last lot because they were generally their mates. We are stuck in a situation where we have really poor guidelines. This nutrient score has never been put into practice, but it comes back to the old idea that the importance of food can be brought down to whether it has the right nutrient profile and vitamins. That goes back to the Second World War. We are past that now. Nobody is running around with scurvy, calcium deficiency or anything like that. We have to start looking not at nutrients but at the quality and structure of the food—the fact that it is not all created from extracts of other food in some massive industrial complex. Going back to whole foods with real structure and fibre is much more important than these individual nutrients. We need a holistic approach.
Dr Keren Papier: I think it is helpful to inform consumers. It is still good for them to have something to pick up, but I agree with Tim that it needs to be updated. For instance, the profiling has not even been updated to incorporate SACN’s implementation of limiting free sugars, just because of the time when it happened. However, it would be nice if it could be used to incentivise the companies to reformulate, rather than just putting the onus on the person to buy or choose something that fits them best. It would be nice to push it back to the people making the foods. Of course there is a place for the guidelines. They are still informative and still inform our healthcare in terms of the foods being provided to patients. There is still a place for them, but I agree that there is room for updating them.
Q49 The Earl of Caithness: Tim, to follow up quickly and change the subject, we will be discussing poverty and child obesity in the near future. There seems to be a perception from people I have talked to that fresh vegetables are better than tinned or frozen ones. I think you said on a podcast that there is no difference. What do you think, as that might help us in the next stage of our discussion?
Professor Tim Spector: It is a misconception. Many cheap products are just as nutritionally healthy. Most frozen[38] vegetables, such as peas or spinach, have as many or sometimes more[39] nutrients than what you would get from a greengrocer. A can of tomatoes may have more polyphenols[40] and lycopene than fresh tomatoes, and things like beans and legumes in cans are extremely nutritious and very cheap. They just do not get promoted. Families on real budgets should be eating these things rather than lots of white bread and ready meals. They are available; we are just not doing enough to publicise that.
Lord Krebs: Given that we are very close to running out of time, perhaps I will phrase my question in the following way. If you had to propose strategies for tackling obesity and diet-related disease, and their adverse health consequences, what would be your top three?
Dr Keren Papier: As has come up in the discussion, voluntary labelling is not good enough.[41] As Tim highlighted, if businesses are trying to make money, why would they be interested in doing that? Mandated labelling would be really helpful, whether it is of calories or the traffic light. There are so many things to choose from.
I am a believer in the sugary drinks levy for sugary beverages. It has been such a good experience and there is room to roll that out for other products (e.g. milky drinks); the seller is still selling products, but they are better for the population. If we could look at other things being sold, that would be ideal. Working to reformulate is important.
Finally, there is emerging evidence that marketing appears to make a difference, but we need to think about who we are marketing to.[42] Are people who are at a disadvantage or in low-resource settings seeing more marketing for different sorts of high in saturated fat, high-sugar foods compared to people living in areas that may be less disadvantaged? If possible, we should get the marketing a bit more across the board. Those are some of the things. Of course, there is no silver bullet, so the more we can attack upstream and downstream, the better.
Professor Tim Spector: If I wanted a quick fix, I would agree about warning labels. That is a very easy thing to do. When you have a black sticker on something, you obviously cannot make a health claim at the same time. I would extend the sugar levy to dairy products and beyond. They were restricted because of lobbying by the food industry to a very narrow range, but we should go as broad as we can on that. Thirdly, I would make sure that all taxpayer-funded institutions, such as schools and hospitals, have a policy of having less than 10% ultra-processed food in their diets. It is particularly important that schoolchildren get some real food. Number four on my list would be to force companies to reformulate, but I think that will take longer.
The Chair: Thank you. You have both given us a great deal of food for thought, if I may put it that way. I remind you that you will be sent a copy of the transcript so that you can correct anything that is incorrect before it is published. Thank you both for a very interesting session.
