Written Evidence Submitted by Mr Alex Boyle at The Health Foundation (FWM0083)

Evidence submission: Food and Weight Management Inquiry

Policies to reduce unhealthy food consumption and prevent obesity

August 2025

About the Health Foundation

The Health Foundation is one of the largest independent charitable foundations in the UK providing research, analysis and grant funding to improve health and health care.

We spend around £50m a year on our work to improve policy and enable systemic change in pursuit of our mission to build a healthier UK.

Summary

Our response explores current and previous government policies to address unhealthy food consumption and rates of overweight and obesity in England. We find that the majority of policies have focused on interventions that require high levels of agency from individuals, despite evidence suggesting that these interventions are generally less effective than low-agency, population-level interventions.

The Health Foundation believes that, to reduce unhealthy food consumption and obesity rates, the government must learn from previous successes in tobacco control, adopting a multi-pronged approach designed to address the complex system of influences that shape behaviours. This must include a decisive shift towards population-level, low-agency policies – such as advertising bans on unhealthy food, taxes on unhealthy food to subsidise healthier options, and further reformulation taxes similar to the Soft Drinks Industry Levy (SDIL) – supported by targeted interventions for those most at-risk of overweight and obesity. To implement such policies most effectively, the government must develop clear processes and frameworks to reduce the influence of the food industry in public health policymaking.

While these policy measures will be impactful in themselves, the government should complement them with wider structural interventions to improve the circumstances in which people live, as our behaviours are shaped by more than just the food environment. This will require cross-government action to shift a wide range of policies on the factors in our lives that support our health, like our jobs, homes and education. Such cross-government action could best be driven by a new Health Inequalities Strategy, embedding health improvement as a shared goal, underpinned by advice and accountability, prevention-led spending and appropriate targets.

The problem

Obesity is a large and growing problem in the UK. In 2023/24, 64.5% of adults in England were living with overweight or obesity, up from 61.2% in 2015/16, and from 52.9% in 1993. A similar trend can be seen in children, with 35.8% of children in Year 6 living with overweight or obesity in 2023/24, as compared to 34.2% in 2015/16.
Within these data there are also significant inequalities, particularly related to socioeconomic status. For example, in 2023/24, overweight or obesity affected 43.3% of Year 6 children living in the most deprived 10% of areas, as compared to only 25.2% of those living in the least deprived 10% of areas; for adults, these figures are 71.2% and 59.4%, respectively.
Overweight and obesity rates are also expected to increase further over the coming years, with forecasting for the Global Burden of Disease Study 2021 estimating that 72.6% of over 25s in the UK will be affected by overweight and obesity in 2050, up from 63.8% in 2021.
These soaring rates of overweight and obesity are extremely concerning because overweight and obesity increase the risk of a range of diseases. Common comorbidities such as type 2 diabetes mellitus and cardiovascular disease account for a significant burden of disease in the UK, and contribute to our stagnating life expectancy and healthy life expectancy – the extent of which has been significantly worse in the UK than other EU28 countries. As a result, recent estimates suggest that overweight and obesity cost the UK economy £126bn per year in reduced productivity, impaired quality of life, NHS and social care costs, and informal care costs.
Moreover, with rates of overweight and obesity projected to continue growing in coming years, our projections show that obesity will drive a significant portion of the projected increase in the burden of major illness in the UK population by 2040, further exacerbating its social and economic impacts.
One of the leading drivers of overweight and obesity is poor diet. Poor diets are those low in nutritious whole foods and high in ‘high fat, sugar and salt’ (HFSS) foods and ultra-processed foods (UPFs). The UK population consumes more processed products than any other European country, with recent analyses of the National Diet and Nutrition survey demonstrating that UPFs account for between 51 and 68% of total energy intake in the UK. By contrast, fruit and vegetable consumption in the UK has been consistently low over the past decade, and has further reduced in recent years, with only 31.3% of adults meeting the ‘5-a-day’ fruit and vegetable consumption recommendations in 2023/24. These comparatively poor diets are in large part driving the increase in overweight and obesity across society, and must be urgently addressed to stem the rising tide of these conditions.

Responses to call for evidence

Question 1: Why are existing policies relating to food and diet seemingly not succeeding in reducing rates of obesity, and what should the Government learn from this, or do differently, when designing and implementing policy in future?

Existing policies relating to food and diet in England are failing to reduce rates of obesity because, in general, they centre around interventions that require high levels of individual agency.
Public health interventions can be designed to target individuals or particular population groups, or can be designed to impact the whole population. They can also be designed to require significant personal agency to engage with – that is, requiring people to spend time, money and/or energy to reap the benefits of the intervention – or designed to shape behaviours passively. Research shows that interventions that impact the whole population and that require low levels of individual agency – termed population-level, low-agency interventions – are most effective in achieving behaviour change across the population in an equitable manner because they change the environment in which all people live and work, relying on non-conscious processes to influence behaviour by making the healthy option the easy option.
On the other hand, individual-level, high-agency interventions are generally less effective because engagement with them depends on an individual’s personal resources. For example, to engage with exercise classes, a person needs to recognise the benefits of attending the class, and needs the time, funds and energy to travel and engage with the class. As such, engaging with such interventions can be difficult for many people, whether that be due to low income, working multiple jobs, caring responsibilities, or a lack of education on the benefits of exercise, among other factors.
The efficacy of population-level, low-agency interventions in changing behaviour is demonstrated by the trajectory of smoking rates in response to policy changes over the last 50 years, as highlighted in the Health Foundation’s analysis of policies on the leading risk factors for ill-health. Since the 1970s, a range of tax and regulatory policies on tobacco have been implemented, including advertising bans, duty increases, smoke-free laws, and plain packaging, with the UK regarded as a global leader in tobacco control. While smoking rates have remained higher among those who are more disadvantaged, overall smoking rates in Great Britain have declined significantly since the government began to take action – from 45.6% in 1974 to 10.5% in 2023.
Tobacco control policies demonstrate that fiscal and regulatory interventions to change the food environment in the UK are likely to be most effective in changing dietary habits and subsequent obesity rates. In line with this, there are some examples of population-level, low-agency policies in place or promised in the UK, such as the SDIL, which was implemented in 2018 to incentivise manufacturers to reformulate their products, leading to a fall in soft drink sugar content (see response to question 2). More recently, the National Planning Policy Framework has been updated to set a presumption to refuse planning applications for hot food takeaways within walking distance of schools and other places that children and young people congregate, and in locations where there is evidence that a concentration of such uses is having an adverse impact on local health.
Aside from these examples, government action on obesity has largely focused on changing individual behaviour rather than changing the food environment, with most other current policies requiring high levels of individual agency. For example, adherence to the Eatwell Guide requires education and incurs significant costs (see response to question 3), while agency is required to elicit behaviour change based on calorie counts on packaging, with recent evidence suggesting that calorie information is unlikely to encourage people to eat healthier. Moreover, a number of the policies are voluntary, such as front-of-pack traffic light labelling and sugar, salt and calorie reformulation, allowing food companies to ignore guidelines without consequence.
Further population-level interventions have been significantly delayed, such as the 9pm watershed for less healthy food and drink advertising on TV and restrictions of online advertising of the same, while the ban on the sale of high-caffeine energy drinks to under 16s also remains without an implementation date, despite being announced in the 2019 Prevention Green Paper and again in the 2024 Labour Party manifesto. And while the 10 Year Health Plan for England pledges to ‘launch a moonshot to end the obesity epidemic’, it also outlines that a number of population-level interventions brought in by the previous government will be overturned, such as restrictions on the placement of HFSS foods in supermarkets and restrictions on volume price promotions, which seemingly contradicts this ambition.
This reluctance to implement population-level, low-agency policies for obesity prevention has broadly been the case over the last few decades, too. The Health Foundation’s analysis of government interventions between 2016 and 2021 demonstrated that many population-level policy measures that have been proposed by government have ultimately been abandoned, even where there is strong evidence of their effectiveness. This resulted in most policies focusing on providing information and interventions that require people to invest considerable personal resources, with a likely smaller impact on population health.
Population-level, low-agency policies have been abandoned for a range of reasons. One such reason is that they are often deemed to be less politically acceptable and therefore harder to implement than individual-level, high-agency policies, given that discourse around the leading risk factors for ill-health has been ‘dominated by notions of personal responsibility, individual choice and the primacy of free markets’.
However, contrary to this belief, public polling by the Health Foundation found that the public is broadly in support of more robust population-level measures to limit the impact of unhealthy foods – with Labour voters being even more supportive than the general population. We found particular support for introducing a tax on organisations that produce HFSS foods to subsidise healthier foods for low-income families (62% support), as well as banning advertising of unhealthy food on TV before 9pm and online (61% support).
Another key factor underlying the hesitancy around population-level policies is the influence of the food industry over policymaking. A recent Food Foundation report found that food industry representatives and their trade associations met with Defra ministers over 40 times more frequently than food NGOs between 2020 and 2023, despite potential conflicts of interest between policies that promote public health and the profits of food corporations. Interviews with former senior ministers also highlight this industry interference as a significant obstacle to implementing effective policies, reporting that previous attempts to legislate have been stymied by industry lobbying. Moreover, a recent analysis demonstrates that manufacturers of harmful food and drink are exhibiting similar strategies to the tobacco industry to undermine government action, representing a significant barrier to implementing evidence-based policies to improve health and equity. Despite this, the government has expressed that is has “no plans to exclude food businesses or industry representatives” from the decision-making process.
And it’s not just policies around the food system itself that are leading to the failure to move the dial on overweight and obesity. There are complex causal systems surrounding the pathogenesis of overweight and obesity, with people’s ability to adopt healthy eating habits shaped in part by factors outside of the food system, such as education, resources, and housing quality. For example, an individual’s ability to cook and eat healthy food will rely on the individual understanding what constitutes healthy food and how to cook it, having access to transport to get to and from shops, having the resources to purchase healthy food, and having the facilities at home to cook the food. As such, while it is of vital importance that the food environment is changed, it will also be vital to take cross-government action on the building blocks of health – the factors that sit outside of the health service that impact our health, such as our jobs, our homes, our education and our environment.
Accordingly, to improve people’s diets and reduce obesity rates, the government will need to deploy multiple policy approaches designed to address the complex system of influences that shape behaviours. Government needs to learn from previous successes in reducing tobacco use, switching its focus to population-level interventions that modify the food environment, rather than placing the burden on individuals to spend more and/or act differently to lose weight.
The biggest immediate gains in terms of reducing consumption of unhealthy food could be made from implementing price-based policies, such as imposing taxes to decrease the affordability of unhealthy food & drink and subsidise healthier options (see response to question 2). This should be backed up with targeted support for those most in need, such as deprived communities (see response to question 3).
Government must also work urgently to implement clear processes and frameworks to reduce the influence of the food industry in public health policymaking. Furthermore, policies that directly target the food environment must be underpinned by wider structural interventions designed to improve the circumstances in which people live, making it easier for people to adopt healthy behaviours. Given that these interventions will cross departmental boundaries, this will require a coordinated, cross-government strategy underpinned by advice and accountability, prevention-led spending and appropriate targets, with health improvement embedded as a shared goal across all government’s missions; further guidance on this approach can be found in our Health at the Heart of Government report.

Question 2: Which public health interventions have been the most effective, either domestically or internationally, at reducing obesity or consumption of less healthy foods? What should the Government learn from them?

As discussed above, population-level, low-agency interventions have been the most effective in reducing the consumption of unhealthy food and drink. For example, the SDIL resulted in a 47.4% reduction in the sales-weighted average sugar content of drinks purchases, and 42.4% reduction in the sales-weighted average calories per portion between 2015 and 2024, without a detrimental impact on the industry.
Similarly, the Transport for London (TfL) advertising ban – which banned advertising of HFSS foods and drinks across the TfL estate from 2019 – resulted in reductions in energy purchased from HFSS foods of 6.7% within one year of implementation, including a 19.4% reduction in chocolate and confectionery purchases, accompanied by an increase in advertising revenue. A more recent economic modelling study also estimated that the policy resulted in almost 95,000 fewer individuals with obesity in London within 3 years, and that it will produce over 16,000 additional quality-adjusted life years and save £218mn in NHS and social care costs over the lifetime of the current population, with greater gains in more socioeconomically deprived groups. Analysis by Nesta therefore indicates that expanding such advertising bans across public transport networks in England – alongside policies to ban advertising online and before the watershed – could result in a 16% relative reduction in obesity prevalence and a cost-benefit of £10bn per year.
On the other hand, a number of previous government policies have been proven to be ineffective, particularly when they are positioned as voluntary rather than mandatory. One example is the Public Health Responsibility Deal (PHRD), implemented in 2011. This was a voluntary agreement for industry to commit to pledges for the benefit of public health. However, many businesses chose not to reduce sugar, fat and salt content significantly due to the risk of losing customers, and minimal progress was made on reducing advertising and promotions as this was seen as ‘too commercially sensitive’. Accordingly, the PHRD has been proven to have been ineffective, in large part because the production and uptake of pledges was driven by the interests of industry, enabling the wider system to resist change.
Another voluntary initiative was the sugar reduction programme, which challenged industry to reduce 20% of sugar from food categories contributing most to children’s diets by 2020, that only achieved a 2% reduction in the first year and a 3.5% reduction by 2020. Similarly, only 18 out of 52 targets within the voluntary salt reduction programme were met by manufacturers by 2018 despite the targets being in place for four years, and calorie content actually increased in the majority of tracked products within the voluntary calorie reduction programme up to 2021. These examples demonstrate that such voluntary initiatives are not effective enough to make real change in rates of overweight and obesity; this view is supported by the Food Diet and Obesity Committee, which has called for ‘a decisive shift away from voluntary measures to a system of mandatory regulation of the food industry’, based on evidence of greater effectiveness.
From these examples, government should learn that population-level, mandatory policies are most effective. On the basis of this, government should not only commit to further population-level interventions – such as giving local authorities the power to limit advertising of HFSS food and drink on non-council owned premises, as recommended in our recent report – but should also increase the impact of current voluntary policies by making them mandatory, such as the salt, sugar and calorie reformulation programmes. The government should also reconsider their plan to repeal policies on volume price promotions and HFSS product placement.

Question 3: What action could be the most effective in reducing ethnic and social disparities relating to rates of obesity, and how could any barriers to implementation be addressed?

Reducing socioeconomic health inequalities is a key priority for the government, with the 10 Year Health Plan stating that the government aims to “halve the gap in healthy life expectancy between the richest and poorest regions”. We welcome this aim, as the gap in healthy life expectancy in England is currently large, with a girl born in the 10% most deprived areas expected to live 20.2 fewer years in good health than a girl born in the 10% least deprived areas; for boys, the figure is 19.1 years.
Overweight and obesity is a significant contributor to inequalities in healthy life expectancy. This is because, as outlined above, socioeconomic disparities exist in overweight and obesity prevalence, with those living in the most deprived areas being significantly more likely to be affected by overweight and obesity.
The underlying causes of these disparities are complex but broadly relate to the socioeconomic patterning of factors promoting unhealthy diets. For example, there are significantly more fast-food outlets in more deprived areas than in less deprived areas, with the 10% most deprived areas having 148 outlets per 100,000 population on average compared to 81 outlets per 100,000 people in the 10% least deprived areas. In addition, the number of adverts for HFSS foods is significantly greater in more deprived areas, with 44% of all HFSS adverts found in the most deprived quintile as compared to only 4% found in the least deprived quintile.
This means that those living in deprived areas are much more exposed to unhealthy food outlets – high densities of which are associated with increased unhealthy food consumption and increased risk of obesity – and also to unhealthy food advertising – known to directly affect what people consume and shape long-term food preferences, particularly in children and adolescents. This makes choosing a healthy diet much more challenging for those living in deprived areas relative to those in more affluent areas, but means that universal policies addressing advertising and licensing of unhealthy food will have the greatest impact where deprivation is highest.
Choosing a healthy diet is even more difficult for the 7.5 million people experiencing food insecurity in the UK. This is because food insecure households often rely on food banks to access food, but research has shown that food parcels from food banks tend not to meet nutritional requirements. Moreover, even if not using a food bank, food insecure households are unlikely to be able to afford healthy food because healthy food is, on average, over twice as expensive per calorie than less healthy food, and the poorest 5th of the UK would need to spend 50% of their disposable income to meet the government’s Eatwell Guide. As such, a range of research has shown that food insecurity is associated with unhealthy dietary patterns, with people experiencing food insecurity being 1.5 times more likely to be affected by obesity. Moreover, the Food Foundation has found that food insecure families are cutting back even further on healthy food to make ends meet, with 60% of food insecure households reporting cutting back on fruit and 44% reporting cutting back on vegetables, suggesting that health outcomes might be further worsened for this group in future.
In addition to differences in the food environment between more and less deprived areas, there are wider issues that may further drive weight gain in communities experiencing socioeconomic deprivation. For example, low-income households may lack the funds to invest in cooking equipment, cookery books, and spices, and may lack appropriate cooking facilities in the home (particularly if living in temporary accommodation). They may also lack the time to cook due to working multiple jobs or having caring responsibilities, among other things. In addition, deprived communities are often at yet further disadvantage due to having lower access to green spaces and infrastructure for physical activity than more affluent communities, reducing the opportunities to be physically active, which plays a role in maintaining a healthy weight.
Overweight and obesity rates in deprived areas are also likely to be further exacerbated by long-term underfunding of local government. Local government provides a wide range of services that support the health and wellbeing of local residents, including education, social care, leisure centres, youth centres, libraries and parks. However, local government funding has been cut considerably since 2010/11, being 24% lower in real-terms in 2019/20 than in 2010/11 and, despite year-on-year increases in funding since, remaining 9% lower in 2025/26.
This means that councils have had to make increasingly difficult decisions on which services to cut to balance the books, resulting in wide-ranging cuts to services that support the health and wellbeing of residents. This has an impact on health outcomes, with cuts to children’s centres being associated with increased childhood obesity, and reduced access to leisure facilities being associated with higher BMI. These service cuts not only exacerbate inequalities on an individual level – given that people facing socioeconomic deprivation tend to rely on public services more than more affluent people – but also at an area level, as the most deprived fifth of areas received, on average, 9% less funding than their share of needs, as compared to the least deprived fifth of areas that received 15% more funding than their needs in 2022/23.
Councils have also had to substantially increase council tax receipts to plug financial holes, putting yet more financial pressure on low-income households and further reducing their ability to afford healthy food, particularly given the reducing value of many council tax support schemes across England. Moreover, despite a boost to funding in the most recent allocations, the public health grant remains 26% lower per person in real-terms than in 2015/16 – with greater cuts made to grants in deprived areas over the last decade – resulting in reductions to vital public health services that act to reduce health inequalities.
Effective interventions to reduce socioeconomic disparities in overweight and obesity must therefore focus not only on changing the food environment in deprived areas, but also on improving the building blocks of health for the communities living there. Interventions to change the food environment should be population-level and require low levels of individual agency, making the healthy choice the easy choice. This could include using planning legislation to reduce the density of fast-food outlets and the visibility of advertising.
Population-level interventions should be complemented by targeted support for disadvantaged communities. A number of these targeted interventions have been outlined in the 10 Year Health Plan for England, such as expanding free school meals (FSM) to all children with a parent in receipt of Universal Credit. However, the government could go further by reconsidering eligibility for FSM, given the strong evidence of impact on both obesity rates and overall child health of universal FSM, with cost-benefit analysis suggesting that universal FSM could generate £1.71 in savings from every £1 invested through improvements in educational attainment and overall health.
The 10 Year Health Plan also included a pledge to restore the value of Healthy Start, another scheme providing targeted nutrition support for families experiencing socioeconomic deprivation. This is welcome given evidence that the Healthy Start scheme increases consumption of fruits and vegetables and influences longer-term dietary choices. However, there are a number of issues with the scheme, such as the ‘cliff edge’ of eligibility in terms of household income that results in many children in low-income households falling through the net. This is exacerbated by the fact that only families with children under four years of age are eligible, resulting in a significant gap between Healthy Start eligibility and FSM eligibility. Moreover, over a third of eligible households didn’t receive this benefit in April 2024, suggesting that implementation of the scheme is suboptimal. And many argue that the value of the scheme is insufficient, having been frozen at £4.25 per week since April 2021 despite extreme rates of inflation in the intervening period. As such, while it is welcome that government intends to restore the value of Healthy Start, the scheme must also be reviewed to maximise effectiveness, making changes to eligibility, value and implementation as necessary to make the most of the benefits this scheme could offer.
In addition to these policies, comprehensive support for people experiencing socioeconomic deprivation across all aspects of life will be required to achieve significant reductions in inequalities. Investment in local government will be a good first step, ensuring that all local authorities have sufficient funds to provide the services their communities rely on, with funding matched to local needs and muti-year settlements provided to ensure sustainability. Reviving effective initiatives like Sure Start would also support this aim, as Sure Start has been shown to have a particularly positive impact on the health and social outcomes of children in the most deprived areas.
However, what is sorely needed is long-term cross-government action to ensure that all households have access to the resources needed to live a healthy life, through investment in good-quality work and education, affordable housing, and a welfare system that truly meets the needs of claimants. This could be achieved through a cross-cutting Health Inequalities Strategy; the government must urgently consider developing such a strategy to have the best chance of achieving their aim to halve the healthy life expectancy gap, including reducing disparities in overweight and obesity.