Anew government-commissioned review has examined how the UK grows, delivers and consumes food, following the trail from farm to fork. Due to COVID-19, the first part of the report looks at the hunger and ill health brought to the fore by the pandemic. Part two focuses on the system overall, looking at harm to people's health and the health of the environment.
The independent report, National Food Strategy. The Plan (Dimbleby, 2021), highlights that less wealthy families are more likely to be vulnerable to the consumption of unhealthy food, which exposes the nutritional gap between rich and poor in the UK.
It is the first major review of the UK food system for 75 years, and was chaired by founder of fast-food chain Leon, which promotes healthier food. The report puts forward a number of interventions to prevent and alleviate the human and environmental harms, and sets out a strategy for the future.
In many respects the review was timely, in that it was commissioned before the full horrors of the pandemic became apparent. As events unfolded in early 2020, it was soon evident that COVID-19 particularly affected individuals who were obese, whose mortality rates far exceeded that of patients with a lower body mass index.
The first part of the review was published as an interim document in July 2020, with the full report published in July 2021. The government's full response to the report's findings and recommendations is expected within 6 months, and the ensuing White Paper will set targets for transforming the food system. Any proposed legislation will be subject to parliamentary approval and there are already media reports suggesting that not all of the Dimbleby recommendations will be implemented in full (Addy, 2021).
Background
The report seeks to radically change both the way we eat and what we eat. Although obesity is high on its agenda, this is not its only goal—it is wide reaching and references the government's Climate Change Committee, which has linked meat production to global warming. The committee has concluded that the UK needs to reduce meat consumption by 20–50% by 2050 in order to reduce CO2 levels to a level where climate change can be reversed. According to a Greenpeace report (Harvey, 2020), farm animals such as cows and pigs across Europe produce more greenhouse gases such as methane per year than the combined amount produced by all motor vehicles.
Dimbleby believes that our eating habits are destroying the environment, which in turn undermines food security. Climate change in the form of extreme weather events and catastrophic harvest failures are expected to become more prevalent. The report points out that agriculture currently produces 10% of the UK's greenhouse gas emissions, despite contributing less than 1% of the nation's gross domestic product. This is a timely warning, given that 2021 has seen extremes of hot weather, with 49.6°C reported in Canada and Greece and Turkey suffering heat waves of 44-47°C, with wildfires threatening populated areas.
Consequently, the National Food Strategy recommendations seek to address the major issues arising from, and facing, the food system, including climate change, biodiversity loss, land use, diet-related disease, health inequality, food security and trade. The Dimbleby report recommends that the government sets four specific objectives:
- Protect the NHS by helping people escape the so-called junk food cycle
- Reduce diet-related health inequalities
- Make optimum use of the land
- Create a long-term shift in the nation's food culture.
It is useful to consider when and where it all went wrong in society. In the 19th century, people who were fat were predominantly the wealthy, with the poor, particularly those in industrial areas, suffering from nutritional diseases such as rickets caused by a lack of vitamin D (a fat-soluble vitamin found in meat products). The availability of cheaper sugar products in the Victorian period, however, paved the way for more widespread obesity (Clayton and Rowbotham, 2009).
At the outbreak of the Second World War the wartime coalition government introduced rationing that lasted from 1940 until 1954, when meat finally came off rations. Davey (2004) highlighted that, during the years of rationing, the incidence of obesity was negligible in the UK. Since then, obesity has become more prevalent as cheaper, high-calorie foods have become ubiquitous. At the same time, portion sizes have become bigger—during a visit to Toronto about 30 years ago, I remember seeing for the first time a Subway submarine sandwich full of meat and cheese that was over a foot long!
Dimbleby argues that the origins of our attraction to high-calorie food harks back to the prehistoric period when food containing sufficient calories to support life was difficult to find and required hunter gatherers to work hard to acquire sufficient nutrition to survive. We, along with other mammals, are pre-programmed to devour any food high in calorific value. Dog owners of certain breeds will be aware of this phenomenon and can recount similar stories: one Christmas my wife made two dozen mince pies and placed them on the kitchen table. Just as she was about to put them in the oven, the phone rang. She returned to find our chocolate brown Labrador had wolfed down every single one. Humans are not that different: most of us will have eaten an entire family chocolate bar or a whole tub of ice-cream at some point.
Dimbleby highlights a dilemma for some parts of the food industry, where the large market for unhealthy foods motivates companies to keep investing more in their production to enhance profits. The report highlights that processed foods high in salt, fat and sugar are on average three times cheaper per calorie than healthy foods, and perhaps one of the reasons why consumption of junk food is more common among those with the least income.
However, this does not explain why other sectors of society are prone to obesity. Nurses, for example, are increasingly becoming obese, despite a reasonable level of income. According to Kyle et al (2017), one in four nurses are obese. The Healthy Weight Initiative for Nurses is a collaboration between different agencies, including the Royal College of Nursing, which has worked with registered nurses who are obese to launch a series of programmes to help nurses achieve and maintain a healthy weight.
The findings of a systematic review of obesity among nurses found that a number of factors affected attempts to tackle the issue, including shift patterns (Kelly and Wills, 2018). Night shifts, in particular, are associated with a greater tendency to obesity: this is because staff are not only less likely to engage in off-duty physical exercise, but more likely to snack on foods low in fibre and high in carbohydrates, animal fats and proteins. The prevalence of obesity among the unregistered nursing workforce is even greater at almost 33%. In Scotland, incidence across the entire nursing workforce is almost 40%, 10% higher than in the general population (Neville, 2017).
The consequences of poor diet and its link to ill health are now clear, and the UK is rated as the third most obese country of the G7 members, with almost three in ten of the adult population being clinically obese.
With regard to avoidable illness, four out of the top five risk factors are related to diet. The Dimbleby report makes for depressing reading; it shows, for example, that the combined weight of animals bred for food is now ten times the combined weight of all wild mammals and birds taken together. Furthermore, the intensity of animal farming is fuelling the global overuse of antibiotics, which are part of routine animal feeding regimens and help animals gain weight. The report regards the practice as being responsible for the development of antibiotic-resistant organisms, posing a further threat to global health.
The Dimbleby report is not solely concerned with obesity. Since 1998 there has been a 338% increase in children's emergency admissions caused by food allergies, and 2 million people in the UK now have a food allergy. Food allergies are becoming a global problem, especially among children in whom an increase in allergy susceptibility is thought to be driven partly by environmental factors. The Hygiene Hypothesis, for example, suggests that, because the environment has become less dirty, especially in western societies, some children's immune systems can overreact to new food proteins, launching allergic responses instead (FAACT, 2021)
Conclusion
The Dimbleby report has 14 recommendations to tackle the food crisis in this country, ranging from new taxes for foods containing excess sugar and salt, expanding the Healthy Start scheme and extending eligibility for free school meals to helping farmers transition to more sustainable land use. This is an ambitious report and over the next few months the government will consider its findings. Perhaps not all of the Dimbleby recommendations will make it to the statute book, but this notwithstanding the report is unequivocal in highlighting that diet-related disease is putting an intolerable strain on the nation's health and finances.
In the Biblical book of Genesis, the Pharaoh tells Joseph to bring his brothers to Egypt where they can escape poverty and ‘eat the fat of the land’ (Genesis 45:18). In contemporary times, at least in many Western countries, the population has overly eaten of the fat of the land and has literally become the ‘fat of the land’. It is to be hoped that this report will make a real and radical difference to diet-related disease.
KEY POINTS
- A new independent report on a national food strategy seeks to provide answers on how the UK food system operates, examining the damage it is doing to people's health and the environment, and suggesting a range of interventions to help prevent and alleviate these harms
- When rationing was enforced during the Second World War the prevalence of obesity was negligible in the UK, which could be attributable to the consumption of less meat and lower calorie foods
- The incidence of obesity among the entire nursing workforce in Scotland is currently running at almost 40%, 10% higher than that found in the general population
- The Dimbleby report is an ambitious report. Although not all of its recommendations will make it to the statute book, it has highlighted the strain that diet-related disease is having on population health and the country's economy